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Community health workers and disruptive innovations in government

Future of Government Case Study - Disruptive Innovation - Community Health Workers


  • Community health workers are a disruptive innovation: they require far less training than other health professionals, use more widely available skills, and cost (often much) less.
  • Due to a host of interests, incentives, beliefs, and the nature of government financing, government’s existing ways of working are often harder to ‘disrupt’ and displace than in the private sector.
  • This means innovations spread more slowly, which means less access to effective, affordable healthcare.

Governments and NGOs for the past century have introduced community health worker (CHW) healthcare teams. Community healthcare is a technique to select a shortlist of straightforward and mass-demand tasks for a cadre of less expensive health workers. These people require far less formal education to do their jobs (a nurse takes around seven years to train, while CHWs in Uganda can take about ten days)

CHWs are a market-creating innovation in the sense that their services can be accessed by people – and governments—who cannot obtain a more sophisticated medical service. Also, CHWs are a “disruptive” innovation in the sense that they are low-skilled relative to 'standard' healthcare industry workers, they are cheaper, and adequately meet the needs of the "low demand for performance" of previously unserved users suffering from common illnesses.

Future of Government Case Study - Disruption - Bus Rapid Transit
Other disruptive technologies with fairly low adoption rates include Bus Rapid Transit schemes.

Although starting from much lower levels of performance, they can take a path of improvement in order to meet the demands of more and more users. CHWs have been adopted globally to some extent, but few governments have gone ‘all in’ to really disrupt the existing model. Much government money and attention in low- and lower middle-income healthcare remains upstream in prestigious, doctor-provided care, rather than building out better coverage by deploying and rewarding CHWs to achieve their full potential. 

Because of a host of interests, incentives, beliefs, and tax financing, government’s existing activities are harder to ‘disrupt’ and displace.  But there are other ‘disruptive’ health innovations along the same lines of unbundling the family doctor or general hospital.  Single-condition hospitals do thousands of eye surgeries per day in India and clinics provide cut-price diabetes-only care in Mexico. While most users would prefer a general facility nearby, single-condition clinics get economies of scale which result in a better overall service. 

Much of this case study is drawn from The Prosperity Paradox.


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