http://www.ssireview.org/articles/ Strategies, Tools, and Ideas for Nonprofits, Foundations, and Socially Responsible Businesses en nicholas_jenna@gsb.stanford.edu Copyright 2010 2010-02-24T07:00:54+00:00 http://www.ssireview.org/articles/entry/research_medicare_saves_lives/ http://www.ssireview.org/articles/entry/research_medicare_saves_lives/ For decades, Americans have squabbled over whether the government should expand Medicare, maintain its current scope, or cut it altogether. But their debates have suffered for lack of an answer to one vital question: Does Medicare make a difference? A new study shows that Medicare indeed makes a difference for seriously ill patients—and that difference is the one between life and death. Following the fates of more than 400,000 people admitted to California hospitals through their emergency departments, a team of economists finds that patients who are just over 65 years old—and thus eligible for Medicare—are 20 percent less likely to die within a week of admission than are their slightly younger counterparts who do not yet qualify for the government insurance. “Until this paper, no one thought that health insurance of any kind affected something as straightforward as death rates,” says David Card, a professor of economics at the University of California, Berkeley, and the study’s lead author. “Fact is, if you show up at the hospital without insurance, they’ll take you in and give you fairly decent treatment.” But the Medicare-eligible set seems to get somewhat better treatment, Card and his colleagues find. Their study reveals that patients… Healthcare 2009-08-20T18:43:00+00:00 http://www.ssireview.org/articles/entry/the_answer_is_on_the_ground/ http://www.ssireview.org/articles/entry/the_answer_is_on_the_ground/ David Hares is a popular guy on the sixth floor of the Albert Einstein Medical Center in Philadelphia. Nurses, housekeepers, and hospital administrators smile and greet him as he walks down the corridor, some reaching out with an affectionate squeeze. At the end of a hall, Hares tries to exit though a locked door, and a nurse tsk-tsks him as he playfully jiggles the handle. “You gotta wait till I buzz you!” she says, and grins as she waves him through. However light the mood at Einstein today, Hares has a serious job. As the hospital’s quality manager, he is responsible for making good medical practices cost-efficient. In this era of drastic budget cuts and bleak fiscal forecasts, this is no easy task. Yet Hares and his colleagues have experienced extraordinary success combating one of the most intractable problems facing modern health care: the Methicillin-resistant Staphylococcus aureus (MRSA), an antibiotic-resistant “superbug.” MRSA clings to anything it touches—hands, gloves, doorknobs, pens, dining ware, shoes, and so on. To make matters worse, the bacteria can lie inert on surfaces for weeks without a human host. And then an innocent sweep of a mop can send the pathogen along its infectious journey. In… Healthcare, Nonprofit Management 2009-08-18T23:00:55+00:00 http://www.ssireview.org/articles/entry/mobilizing_against_fake_drugs/ http://www.ssireview.org/articles/entry/mobilizing_against_fake_drugs/ Your child is feverish and hacking, so you rush to the pharmacy to buy some cough syrup. If you’re living in the United States or Germany, you trust that the bottle contains exactly what the label describes. But in the developing world, there’s a one-in-three chance the medicine you purchase will be fake. Counterfeit drugs are a big and cruel business across much of Africa. They not only waste consumers’ money but put public health at risk. Western tools for authenticating pharmaceuticals— such as chemical testing, nanotechnologies, radio frequency identification, or holograms— rely on labs and technologies that aren’t always available in the developing world, where even electricity is unreliable. And even if government regulatory agencies are in place, they lack the resources to match well-funded counterfeiters. “All these options have failed us,” says Ashifi Gogo, a young, Dartmouth College-trained engineer who is a native of Ghana. “They don’t work in developing nations.” Gogo is the cofounder of mPedigree, a start-up that has devised a method for using mobile phones—ubiquitous in the developing world—to put drug authentication into the hands of consumers. Here’s how the drug authentication system works: At the point of sale, a buyer scratches off a label… Healthcare 2009-05-21T06:01:00+00:00 http://www.ssireview.org/articles/entry/clear_blood/ http://www.ssireview.org/articles/entry/clear_blood/ In December 1984, 53-year-old Kenneth Pittman underwent coronary bypass surgery in Toronto. During the operation, he received an infusion of cryoprecipitate, a fluffy white protein that helps clot blood. Pittman survived his heart disease and the surgery, but not the infusion: In March 1990, he learned that he had contracted HIV from the cryoprecipitate. He died a few days later. His wife, Rochelle Pittman, did not learn about the diagnosis until three weeks after her husband’s funeral. By June 1995, she too had succumbed to HIV infection, recounts André Picard in The Gift of Death, a chronicle of Canada’s tainted blood scandal. Starting in the 1970s, HIV and hepatitis C found their way into Canada’s blood supply. By 1990, more than 1,200 Canadians had contracted HIV from blood and blood products. Three-quarters of these people have since died. A much larger number—up to 20,000 people— were infected with the hepatitis C virus (HCV), which damages the liver. Although the exact number of Canadians who have died from liver disease caused by tainted blood is not known, the Canadian Hemophilia Society puts the estimate in the thousands. To investigate this public health disaster, the Canadian government convened the Commission of Inquiry… Healthcare 2009-05-13T20:17:00+00:00 http://www.ssireview.org/articles/entry/texting_it_in/ http://www.ssireview.org/articles/entry/texting_it_in/ Many developing countries don’t have enough data to accurately track such scourges as child malnutrition, HIV/AIDS, and malaria. To help address this problem, Washington, D.C.- based DataDyne has introduced wireless EpiSurveyor, a free, open-source software package that allows health care workers to create their own data collection forms, download them onto cell phones, and text data back to a central database. An earlier version of the software that runs on handheld PDAs is already used by regional health officers in every country of sub-Saharan Africa and is supported by the United Nations Foundation-Vodafone FoundationTechnology Partnership, the World Health Organization, and many ministries of health. The new version of EpiSurveyor for cell phones is expected to be even more popular. Indeed, in a field test last August in Nakuru, Kenya, ministry of health workers reported back that they preferred collecting data on a cell phone rather than a PDA because they would need to carry only one device and wouldn’t have to use a stylus (which they can easily lose). And as the costs of cell phones and cell phone service go down, their availability and usage will go up. DataDyne co-founder Joel Selanikio, a physician and epidemiologist, says that the… Healthcare 2009-03-05T06:01:01+00:00 http://www.ssireview.org/articles/entry/whats_next_the_new_frontier/ http://www.ssireview.org/articles/entry/whats_next_the_new_frontier/ As managing director of Ashoka, Andrew Kuper witnessed the tragedy of poor people starting businesses with microloans, only to be wiped out by a fire, a family member’s death, or even a short illness. But one day in a coffee house, staring down at a blank piece of paper, he devised a way for poor people to sustain and even grow their businesses: He would start a private equity firm, LeapFrog Investments, that would invest in microinsurance companies and thereby help bring insurance to more of the world’s poor. LeapFrog launched in October, but only after Kuper and co-founder Staph Bakali, an entrepreneur specializing in emerging markets, had assembled a senior management team plucked from the nascent microinsurance industry, and an advisory board comprising such global finance heavyweights as Felipe Medina, regional director for Latin America Private Wealth Management at Goldman Sachs, and Futhi Mtoba, chair of Deloitte South Africa. “LeapFrog is a big, bold, and new idea—so we wanted to have a huge amount of substance behind us,” Kuper says. Only about 2 percent of low income people in the world’s poorest 100 countries are currently insured, according to a study conducted by microinsurance expert and LeapFrog partner Jim… Healthcare, Social Entrepreneurship 2009-03-05T06:01:00+00:00 http://www.ssireview.org/articles/entry/paying_for_safe_sex/ http://www.ssireview.org/articles/entry/paying_for_safe_sex/ Will paying people to avoid unsafe sex stop the spread of AIDS in Africa? The World Bank thinks it’s worth a try: It will cofund a three-year experiment, whose start date has yet to be disclosed, wherein some 3,000 Tanzanian men and women 15 to 30 years old will be periodically tested for sexually transmitted diseases (STDs). Participants won’t be tested for HIV, however. Such tests are costly, and researchers can reasonably assume that if participants avoid contracting STDs during the experiment, they will also avoid contracting HIV if they engage in the same modifi ed behavior. An unpaid control group, meanwhile, will also be asked to avoid unsafe sex. Test subjects who test negative will receive $45 each month; most earn an annual salary of about $180. Joining the World Bank to fund the $1.8 million study are the William and Flora Hewlett Foundation, the Population Reference Bureau, and the Spanish Trust Fund for Impact Evaluation. Eric Brown, communications director for the Hewlett Foundation, says that this is just another case of Hewlett “funding a novel approach because the traditional approach hasn’t yielded results.” Indeed, the Joint United Nations Programme on HIV/ AIDS estimated that last year 2.5 million… Healthcare 2008-11-27T06:34:01+00:00 http://www.ssireview.org/articles/entry/whats_next_livinggoods_calling/ http://www.ssireview.org/articles/entry/whats_next_livinggoods_calling/ Chuck Slaughter, founder of clothing company TravelSmith, has a secret he doesn’t often share: He’s an Avon lady. But he only enlisted to better research the cosmetics giant, he explains, having had a “eureka” moment. If children in developing countries are dying because their parents can’t find or afford the requisite drugs, then why not deliver low-priced drugs to their doorsteps using an Avon-style direct sales technique? In 2004 Slaughter had been hired to turn around the struggling Child and Family Wellness Shops—microfinanced franchises in Kenya that distribute affordable medical products and services to remote communities—and he only succeeded, he says, once he had “gotten the clerks off their tails” and into schools and churches to sell their wares. “And later I thought maybe we don’t need the store at all. Maybe it’s not McDonald’s we want to imitate, but Avon.” (See “Micro-Franchise Against Malaria,” Stanford Social Innovation Review, fall 2007.) Slaughter now helms LivingGoods, a nonprofit he founded last year that sends its version of Avon ladies—white-uniformed “health promoters”—knocking on neighbors’ doors in 200 Ugandan communities. (That number will rise to 680 over the next few months.) From fat shoulder bags they sell… Healthcare, Social Entrepreneurship 2008-11-16T06:00:01+00:00 http://www.ssireview.org/articles/entry/opening_the_asylum_doors/ http://www.ssireview.org/articles/entry/opening_the_asylum_doors/ Social reforms that occur too quickly or promise radical change often fail. Retrenchment and blaming of the reforms’ beneficiaries typically follow. Indeed, prolific author and psychiatrist E. Fuller Torrey outlines in his new book, The Insanity Offense, two quixotic reforms of the 1960s and 1970s that followed just this pattern: the adoption of cost-cutting deinstitutionalization policies that whittled down American public mental hospital patients from more than 550,000 in 1955 to fewer than 40,000 at present (despite the nation’s population having doubled); and the extension of civil rights to those with mental illness that make it nearly impossible to commit someone to a mental facility involuntarily. (A half century ago, all it took to commit a patient was a psychiatric recommendation and a judicial order.) These reforms, which emanated from a curious combination of conservative, libertarian, and liberal forces, have allowed people who are sometimes dangerous and who often lack insight into their deteriorated mental states to languish in decrepit community facilities or even on city streets, without any means of getting the treatment they so urgently need. The results sometimes make headlines: People with paranoia and psychotic thought processes have committed brutal acts. But more often, the reforms have… Human Rights, Healthcare, Book Reviews 2008-09-02T18:00:00+00:00 http://www.ssireview.org/articles/entry/tackling_hiv/ http://www.ssireview.org/articles/entry/tackling_hiv/ “My uncle abused me sexually,” a female soccer coach tells a group of adolescent boys and girls in Port Elizabeth, South Africa, a city with one of the highest HIV rates in the country. “I never told anybody because I was scared and didn’t understand what was happening. … I have been living with HIV for 10 years now.” Thus begins another series of Grassroot Soccer workshops, which tap into soccer’s phenomenal popularity in sub- Saharan Africa to educate kids about HIV. After telling their personal stories about how HIV has affected them, Grassroot Soccer coaches lead their students through 20 hours of educational and trust-building activities. The whole program takes place around a soccer ball. “We’re having fun dealing with a very sad thing,” says Tommy Clark, the organization’s co-founder. A retired professional soccer player, he is also a pediatrician and former research fellow in HIV prevention at the University of California, San Francisco. “The popularity of soccer in Africa is like football, basketball, baseball, and video games [in America] rolled into one,” explains Clark. But not any soccer star can teach the program. Clark finds that kids in the organization’s flagship programs in Zimbabwe, Zambia, Botswana, and South… Education, Healthcare, Nonprofit Management 2008-08-05T14:00:01+00:00