There’s something unique about building and creating in a humanitarian field. Your goal, on one hand, is to work yourself out of a job: you want your inventions to be so contextually appropriate that they remain feasible, so culturally apt that they are used correctly, and so accurate that the results are akin to those in a New York hospital. Your achieve success when you eliminate the health problem you were attempting to stem.
On the other hand, when you design for lower-resource settings you are designing for emerging markets. You hope that the health benefits of your invention will contribute to a cycle of productivity: of lower disease incidence, of more school days for children that would otherwise be ill, and ultimately of economic growth and increased earnings. You are building your work into the fundamentals of a nascent health system, with the hope that your design will flourish within this new system and remain relevant. Stemming a health problem is not the end-all; it is a stepping stone on the way to sustaining access to continued care.
I’m working at a foundation right now, and the purpose of IP protection for nonprofits and social ventures comes up for debate on what I would hazard is a weekly basis. While both sides propose that such organizations should want their efforts to result in the maximum amount of social good, one argues that the best way to achieve this is to share productive innovations openly – that overriding the egotistical human desire for ownership would result in greater total implementation, and a greater total number of lives saved.
In other words: if you truly want to help people, how dare you attempt to make a career for yourself in this field rather than voluntarily giving away your efforts. I find the degree of guilt-tripping that this mindset perpetuates very short-sighted. “Don’t you want your efforts to go to saving babies/reducing disease rates/increasing crop yields?” Well, yes, of course we do – if we didn’t, we would be working at for-profit engineering firms. But social ventures cannot perpetuate their ability to do good*, and to create new solutions, without receiving living wages and a financial safety net with which to invest in further research and design.
My stance is that this method of operation drives high-talent individuals away from the social sector and forces said ventures to remain beholden to donors. Being beholden to shareholders (by licensing bottom-of-the-pyramid designs to for-profit companies) is equally limiting: it delays the urgent business of providing such technologies to the locations most in need, rather than middle-income markets.
I maintain that the best way to maintain creators within this space is to provide them with a sense of ownership, and that maintaining high-quality creators is critical to building relationships with end users and clinical partners. In order to accomplish these things, creators need to out-perform other organizations when competing for donor funds or applying for grants. And in order to do this, they need to be able to protect their intellectual capital.
So, where do we go from here?
Peter Haas of the Appropriate Infrastructure Development Group mirrors my thoughts exactly:
“Sorry to break it to you, but this field is one largely of boutique players and very insular boutique operations in large companies. There aren’t many jobs out there to be had, and you need to look hard to find the ones that come up every once and a while. Most people in this field make their own jobs as entrepreneurs and consultants.”
Aside from the opportunities pointed out by Mr. Haas, it’s worth noting that a (relatively) tremendous amount of funding for global health research is channeled through universities. Interest in the field is growing for students of all disciplines, and it’s also worth noting that many low-cost health technologies are prototyped equally cheaply by students.
Stanford provides a particularly successful model for developing new opportunities, in part by honing their openness to student entrepreneurship in the for-profit tech sector. D-Rev, Embrace, and Medic Mobile all have roots here. That is not a coincidence. Stanford’s willingness to allow students to pursue their own inventions, which are unlikely to turn a profit if licensed, has resulted in a transformational impact: the products are life-saving, yes, but more substantial are the hardware and software engineers, the business students and fellows, the executive directors who are now freely and actively working to create more life-saving interventions.
But few seem to have followed suit. Diagnostics for All came out of Harvard, which kindly licensed patterned paper diagnostics from the Whitesides Group to the nonprofit (and I would hazard that Whitesides’ influence played no small role in this decision). But licensing fees are often out of reach of burgeoning nonprofits, and even if that were not the case, I understand that universities would be hesitant to relinquish potential profits. It makes more financial sense for these institutions to keep BoP technologies in-house, where they can be used to bring in grants (see Jhpiego at Johns Hopkins) and where tenured professors can pursue this type of engineering-for-change without worrying about financial security or market viability.
This model is not useless, and it does lead to the continued production of low-cost health technologies, often at the prototype scale. But it is also not transformational. For broader impact, universities need to leave the door open for students to pursue their inventions to market. New product-centric social ventures focused on health design for low-resource settings will broaden the scope of new health interventions, even the financial playing field for these organizations with higher-than-standard overhead, and provide an outlet for students to pursue this field instead of other potentially lucrative options. To summarize that mouthful of a sentence: this combination is what we should aspire to if we want to sustain this field beyond its boutique origins.
*For more thoughts on the application of this line of thinking to the broader nonprofit sector, see Dan Pallotta’s wonderful TED talk from this year.