Questions Improve Healthcare

As Minister of Health of Peru, I faced two cases that best illustrate what I learned about health innovation.

Case 1: Buy More Refrigerators!

With breaking news of a child dead because of the unavailability of a timely supply of snake-bite antidote in a remote rural area, the press was asking why we could not cope with something as simple as the logistics of antidotes. I called my staff and asked the same question. The answer was: You need a refrigerator to keep the antidote, and health posts in rural areas do not have them, although they had been in budget requests for the past 10 years. So I asked: Is it possible to dry the antidote for distribution and instruct the posts to reconstitute it with distilled water that we can also distribute separately? After a two-minute silence, the director of the National Health Institute, a bright young woman said, “Yes, it can be done.” Three months later, the antidote was distributed to rural posts throughout the country in a package. In addition, the dried antidote was developed for the adventure tourism travelers market, generating a source of income.

Case 2: The Human Papilloma Virus (Hpv) Vaccine Is Too Expensive!

At an annual meeting of the Andean Community Health Ministers, which come from six countries, we were discussing Peru’s successful inverse-bidding process—here all Peruvian public hospitals participate in a single annual auction in which the provision of drugs is granted to those suppliers that offer the least cost, given certain quality standards. I proposed the joint acquisition of HPV vaccines. Although Peru has a cervical cancer incidence of 48 out of 100,000 women, HPV vaccine is not a priority, at $300–400 per dose. Still, I insisted that the question is not how much the labs want us to pay, but at what cost it makes sense for us to buy, and I calculated that to be $20 per dose. So the question became: How many doses must we buy to get that price? Although I did not get a clear mandate to ask the labs, I called the two producer labs. Surprisingly, one of them was ready to sell at a slightly higher price under a special program.

As these two cases show, innovation is much more the result of finding the right questions to ask, rather than simply providing well-studied answers. In many situations, fresh and curious minds generate new questions and innovative solutions emerge. As Peru’s Minister of Health, I learned the importance of exploring a range of questions. And sometimes, a new approach outstrips even hundreds of refrigerators.