Innovation - harnessing the power of communities

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.