Case Study: Expanding Availability of Healthcare Services

Base of the Pyramid Innovation Project, Novo Nordisk


In 2010, Novo Nordisk established a corporate innovation project to identify solutions that could lead to an integrated approach to diagnosis, treatment and diabetes control for the working poor at the base of the pyramid (BOP). The ultimate aim is to develop sustainable solutions that will create new value for both the community and our company.

Novo Nordisk has initiatied pilots in Kenya, India and Nigeria as part of the project.

Lessons Learned

The overall objective with the BOP Innovation project is three-fold:

  1. Establish an effective supply chain to get the products to the patients
  2. Reduce the need for travel to acquire treatment and medicine
  3. Build capacity to treat diabetes

In Kenya, Novo Nordisk is working with distributors to limit price markups and to ultimately control the price that the patient has to pay at the pharmacy. Novo Nordisk signed individual MoUs with every link in the distribution chain, and the price of a vial of insulin has been stamped on the package (500 KSH), making it difficult for distributors and actors in the value chain to exceed the agreed price. Novo Nordisk is building capacity across the Faith Based Organisations network of rural healthcare facilities.

In India, the pilot is based on social entrepreneurship which will enable the creation of a network of health workers bringing diabetes care, testing and medicines to patients’ doorsteps.

In Nigeria, the pilot is a one-stop-shop diabetes kiosk. Novo Nordisk partners with public health institutions in urban settings where patients will find all the individual care they need to treat their diabetes in one dedicated location at the hospital.

Results to Date

Creating a successful business model targeting the Base of the Economic Pyramid takes time and a significant long-term investment and can only be found through testing and learning.

Outcome of the three pilots:


After a 6-months conclusive pilot in 2 counties, the initiative in Kenya was scaled up to 14 counties and have currently achieved:

  • 714 HCPS trained in diabetes care in 186 rural health centres
  • Establishment of 45 new dedicated diabetes clinics
  • Insulin available in 86 new rural facilities (22 new after training of the HCPs)
  • 73 clinics compliant to reduced insulin price of 500KHS (compared to 15 before training of HCPs)
  • 1489 patients attend the diabetes clinics

Our initiative is based on a Public Private Partnership with the GHI (General hospital Ikorodu), Lagos State, the largest secondary care hospital in Lagos which covers a population of 1 million people. In the diabetes care center established in March 2013, we have achieved:

  • Comprehensive diabetes training to 57 HCP
  • Diabetes Care centre open daily and manned by hospital nurse and pharmacist
  • After 2 months of operation: 205 patients attended diabetes care classes; 15 patients started insulin; 530 patients were screened; 39 individuals with high BG were referred to the center

The diabetes care centre in Ikorodu is seen as a model in the State of Lagos and generated requests from the Health authorities and other public hospitals for replication. We are now planning the establishment by end 2013 of 2 more diabetes clinics in Lagos.


The pilot takes place in a semi-rural community outside Patna (Bihar) and we observe a steady increase of activities since starting operations in March 2013.

  • 32 ASHA (Accredited Social Health Activist) workers, 5 doctors and 2 pharmacists enrolled in the pilot and fully trained on diabetes
  • BG test services provided by ASHA workers to 86 patients at their doorstep (129 BG tests performed), generating supplementary income
  • 11 community education programmes organised across 22 villages and attended by 550 people
  • 14 screening camps, 1889 people screened for diabetes

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