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Innovation - harnessing the power of communities

Charles Leadbeater is the co-founder of Participle, which innovates new approaches to public services.

The Dandora slum next to Nairobi’s main rubbish dump is an unlikely place to find a social innovation that could help Britain tackle its most pressing health challenges. Yet in Dandora’s run down health centre a small revolution is underway: three brave mothers with HIV are mentoring pregnant women newly diagnosed with HIV to make sure they take the drugs that will prevent their babies getting the virus.

Mothers2Mothers has changed mass behaviour at scale through a programme of peer-to-peer support

The mentor mothers have been trained by a remarkable organisation, Mothers2Mothers, created by Mitch Besser, an Aids doctor in Cape Town. Besser knew mother to child transmission of HIV could be prevented. Yet in Africa a third of children born to mothers with HIV also have the virus. The stigma of having HIV means mothers often do not admit to having the virus and so do not take the drugs they need. Besser worked out that if mothers already living with HIV were trained to support newly diagnosed mothers they would be far more likely to cope with the shock and so carry on taking the drugs they needed.

The effect has been dramatic: Dandora doctors used to see 20 HIV-positive babies a week; now there are two or three. To spread the Mothers 2Mothers model Besser teamed up with Gene Falk, whose background was in staging rock concerts: eight years after the first self-help group got started Mothers2Mothers operates at more than 600 sites, in seven African countries, employing 1,500 mentor mothers and dealing with 200,000 mothers per month. Mothers2Mothers is an organisation but it’s also a social movement, a self-help network and a campaign rolled into one.

Why should this model, devised in such extreme circumstances, be of any relevance to the UK?

It’s simple: Mothers2Mothers has changed mass behaviour at scale through a programme of peer-to-peer support in the community. That is also our biggest challenge. Our health system, designed for professionals to diagnose and cure people in hospitals and surgeries, is an ineffective and costly way to treat long term conditions, such as diabetes, which affect more than 15m people and account for 55% of GP appointments, 68% of visits to A&E departments and 70% of NHS spending. To respond more effectively we need a health system that supports people to prevent and self-manage long term conditions such as diabetes. This is what such a system might look like.

Good health is not mainly delivered by drugs and doctors, it is created by people in the way they live. Successful health systems should dispense motivation more often than drugs: the motivation to live healthily. As Mothers 2Mothers shows the motivation to change behaviour often comes from trusted peers.

So the key to behaviour change will be to enable much more mutual self-help. Professional services - doctor-to-patient - do a better job when they work with supportive peer-to-peer relationships for people to draw on and so to do without the need for professionals. Hospital based innovation focuses on better processes and pathways. Mothers2Mothers delivers a service - dispensing drugs - through a set of relationships among mothers: that is why it works.

Hospitals focus on conditions that can be cured. The doctors in Dandora did not get anywhere with mothers with HIV because they did not address the social and emotional issues they face. Mothers2Mothers engaged with those social and emotional issues because without confronting the stigma they had no hope of getting the drugs to people. The lesson: work with the people, not just the conditions.

Hospitals see patients in need of professional help. Mothers2Mothers sees people with HIV who have skills and knowledge to contribute. A distributed health service on the Mothers2Mothers model thus has a very different workforce: it would employ nurses and health visitors, but there would be lots of lay health workers, fitness coaches, dieticians and masses of peer-to-peer support.

Mothers2Mothers has spread fast and at low cost because it does not have any of its own buildings. A distributed health service would piggyback on shops, gyms, community centres, schools and pharmacies, which would provide a wide range of health advice not just drugs. Homes would bristle with health technologies. Remote monitoring and self-testing would become the norm.

We need radical and transformative social innovation to create a distributed health system based on a combination of professional knowledge, para-professional support, lay knowledge and mass, mutual self-help. We will not find that in pharmaceutical R&D labs. Radical innovation rarely starts in the mainstream. It usually starts in the margins. That is why, unlikely as it may seem, we need to learn from extreme places like Dandora.

Innovation showcase

Sticksafe

This is a simple, environmentally friendly, low cost device that prevents needlestick injuries from syringes and could generate savings to the NHS of £160m.

To find out more about Sticksafe visit www.showcase.nic.nhs.uk

Tim Tubes for Dysphagia

Avoidable dysphagia related incident costs are up to £70m each year. TIM tubes are a quick and easy way for carers to check viscosity and prevent difficulty with swallowing.

Lymph Node Biopsy Device

This unique dual blade biopsy system allows clinicians to sample the suspect lymph node in a simple outpatients procedure. If fully implemented across the NHS it could yield a cost saving of more than £10m. To find out more about TIM Tubes and Lymph Biopsy Device visit www.hee.org.uk

These examples are not exhaustive of innovative ideas in any given field but are simply examples that may deliver benefits to both patients and the NHS. If you have ideas you would like to share in showcase please send to innovation@dh.gsi.gov.uk. The Department of Health cannot guarantee the efficacy of these innovations

Charles Leadbeater will be taking part in a webchat about his article 11am on 26 March. Register here

Readers' comments (1)

  • The biggest factor in translating distributed power or social change into an organisational context is the power:distance struggle.

    The most senior people have to give explicit permission to act and then stand back.
    It's a scary notion for people in the middle of hierarchies, who's perpetual action plans don't put mortgage payments at risk.

    But when the leap of faith is taken from the roof, the people on the floor will do something amazing.

    Unsuitable or offensive?

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