Increasing access to health products and services in developing countries is critical to the attainment of health-focused Millennium Development Goals. Spurred by high-profile successes in commercial microfranchising,1 the widespread distribution capabilities of independent mobile airtime agents,2 and—most important—an interest in delivering socially beneficial products to the rural and underserved poor, donors, social enterprises, and nongovernmental organizations are experimenting with direct sales agent networks. In doing so, they aim to overcome access barriers in the health sector.
There is considerable excitement about the potential of direct sales agent models in health, as they (1) offer the prospect of better coverage for the rural poor and hard-to-reach customers who are important targets of development efforts, (2) put in place a responsible and trusted intermediary who can deal with sensitive health subjects such as family planning, and (3) offer direct customer interaction, awareness-building, and product education opportunities that are critical for goods and services that require demand building and behavior change.
In 2010, USAID, through the Strengthening Health Outcomes through the Private Sector (SHOPS) project, co-funded a 16-month study to identify successful business models that enable enterprises to engage with baseof-the-pyramid (BoP) populations in Africa in ways that deliver social benefits, with a primary focus on five countries: Ghana, Kenya, Senegal, South Africa, and Tanzania (Kubzansky et al., 2011). The study mapped almost 440 of these inclusive businesses (see Terminology box on page 3) and analyzed five such business models in detail. These in-depth analyses included a study of informal distribution and sales channels covering improved informal shops and direct sales agent models. Three detailed field-based case studies were completed to understand the benefits, limitations, and applicability of direct sales agent models (see Figure 1).