We’ve often written blogs about the adoption of innovation and how innovation and technology is helping to support healthcare providers to work differently but it can often feel a little remote to our everyday experiences. This week I’m delighted to share with you a blog written by one of our Monitor Deloitte colleagues who took a sabbatical in late 2015 from her role as a Strategy Consultant in order to support the development of micro-enterprises in rural Nicaragua.

My sabbatical late last year was part of a DFID-sponsored programme called ICS Entrepreneur, which connects volunteers from the UK with local volunteers from developing countries to support young rural entrepreneurs and encourage economic growth. During this time, I worked with two sisters who wanted to develop a pharmacy to improve their community's access to medicines and, eventually, health care services.

Sustainable development and healthcare access are particularly important in Nicaragua, a country where:

• 76 per cent of the population have an income of less than $2 a dayⁱ
• 31 per cent of the country's population work in agricultureⁱⁱ, an occupation which has become increasingly unstable: Nicaragua was identified as being the fourth most affected country in the world by climate changeⁱⁱⁱ
• 33 per cent of the rural population live more than two hours walking distance from the nearest basic health services and even further from hospitals that offer specialised care
• individuals living in households engaged in agriculture have below-average access to health care services and preventive care^iv
• the lack of insurance and social security mean the population spends, out of pocket, a significant share of their income on health care with medicines the main expenditure item for all quintiles of the population, however poor households spend relatively more on them (80 per cent in the bottom quintiles vs. 41 percent in the highest quintile).^v

During our project we recruited 'entrepreneurs' across two rural communities: anyone who wanted an opportunity to make a change in their community or to have a new way of developing income. We worked around their schedules, developing practical ways to teach core business skills and coaching entrepreneurs to think around their ideas using the Business Model Canvas.

Ivania and Delila, two sisters studying nursing, joined the group of entrepreneurs in order to start a pharmacy. There were no doctors or health facilities in the community, and access to drugs was constrained to a limited set of over-the-counter items available in small, local all-purpose stores which sold everything from bottles of Pepsi to clothes washing soap. Anything else required paying for the 30 minute bus to the nearby towns of Ocotal or Somoto.

The sisters had a clear vision and mission for their pharmacy. It would provide a wider variety of medicines than the pulperias (small grocery stores) so that community members would not spend excessive time and money of purchasing medicines in a nearby town. In the future, they hoped to expand their services, including giving injections and providing basic nursing services. Additionally, with the presence of a pharmacist, they could also provide prescription-only products and expand to other locations. In what we might term a minimum viable product, they had already cleared a small stall near their home and advertised a list of medicines to sell in order to test demand.

To develop the idea further, the girls surveyed community members to understand how much they were willing to spend, demand for a wider selection of medicines, and any desired additional services. The responses of their friends and family members revealed two opportunities to innovate:

• out of hours - community members highlighted the fact that they sometimes needed to access medicines at different hours, and could not rely on buses or the pulperias at this time. The sisters decided that their unique selling proposition would be extended opening hours, including an out-of-hours text service that they could take shifts to fulfil
• delivery - for members outside the community, or those unable to get to the pharmacy, meaning a delivery service would be essential. The sisters agreed that they could receive orders by text, and operate a free daily delivery route. Customers who needed urgent deliveries would be charged a delivery fee.

With a clear idea of the medicines they should sell, the next step was to develop supplier partnerships and understand the economics of their future business. Armed with a pen and paper, we visited pharmacies in nearby towns to understand their pricing and gathered opinions on the benefits of procuring directly from laboratories in the capital city of Managua. During the process, we found a number of mentors who agreed to support the sisters with the administrative elements of setting up a pharmacy.

This month, the entrepreneurs we have worked with pitching for seed capital. Whilst Ivania and Delila were not able to join the pitches, they can be tremendously proud of the fact that they have successfully balanced family duties, their university education and working on their business plan. If successful, they will create the first community pharmacy in their local area. We wish them the best of luck, and hope to be able to report back on the entrepreneurs’ progress at a later date.

 Ushma Soneji - Consultant, Monitor Deloitte

 Ushma is a Consultant at Monitor Deloitte focused on healthcare and life sciences and has worked with clients across the private and public sectors. She has also  worked with a number of charities and social enterprises on a pro bono basis through the Deloitte Charity Partners and Super Pioneers programmes.

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ⁱ https://www.wfp.org/countries/nicaragua
ⁱⁱ http://www.nationmaster.com/country-info/profiles/Nicaragua/Labor
ⁱⁱⁱ https://germanwatch.org/en/download/10333.pdf
^iv http://www.amoshealth.org/needs-we-address/
^v http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/281627-1095698140167/CortezNicaraguaHealth.pdf