Business model innovation at the bottom of the pyramid

BMI for NGO’s in Southeast Asia

I recently visited Myanmar to support a group of NGO’s and corporates in healthcare to innovate at the bottom of the pyramid. We are all very enthusiastic about the result and the journey we’ve gone through so I would love to share this experience with you.

The context 

I’ve collaborated with Pepal, an NGO that bridges the gap between the corporates and NGOs. A very nice initiative if you ask me. The goal of this program is to help a variety of  local NGO’s in Myanmar to become financially sustainable. The NGO’s, in this case, are Alliance Myanmar, Ratana Metta and Phoenix. Their key activities are generally prevention and treatment of patients infected with HIV with a focus on the key population (KP) in Myanmar. The KP includes sex workers (SW) and intravenous drug users (IDU). Since 43% of Intravenous drug users and 32% of sex workers in Myanmar are most likely to be infected with HIV.  A team of very engaged managers from a leading multinational healthcare organisation, joined the NGO’s in the challenge to support this high-risk population.

Why business model innovation for NGO’s? 

It is important to know that most NGO’s in Myanmar rely on one source of income, generally donor funding. However, the misinterpretation of GDP calculations has switched the country’s position from low to low-to-medium income, which could result in organisations losing their donor funding. Our Challenge was to find new sources of income to allow them to keep on providing their services.

How we ran the program 

I’ll give you a quick overview of the work we’ve done. Executives and managers from both the corporate (large pharma company) and the NGO’s (Myanmar) were brought together to create alignment on the vision and sustainability of each of the NGO’s. By using a variety of ideation methods we were able to collectively discover new business opportunities. At the start of the week, we did a variety of eye-opening field observations in community centres and clinics. At the end of the week, the new business ideas were presented to the executive committee of the NGO’s in order to get funding or approval for execution. You could compare it with a shark tank setting.

Some results 

The result was amazing. We were able to create buy-in from most executives on several projects. Here is a summary of some of the results:

A local executive approved the potential launch of a new lab on site for one of the local clinics, hereby we could reduce the cost for both the patient and the NGO substantially.

We identified new revenue possibilities for the NGO’s, by reducing the travel cost for non-HIV patients and thereby being able to charge a small fee for the additional logistic services we delivered.

One project investigated a potential franchising model, whereby high-quality training and branding could be given to GP’s in order to improve their service towards patients, allowing them to do more and better treatments in return for a small monthly fee.


My personal experience with the collaboration with NGO’s in Myanmar

In addition to this great result, I would also like to share some personal findings of this journey.

1. The entrepreneurial spirit of local NGO’s in Myanmar is admirable

The willingness and energy of the local people at the NGO’s to find new sources of income is really amazing.  Most participants were very entrepreneurial and willing to change. Additionally, probably influenced by the years long dictatorship in Myanmar, the participants were very eager to decentralise all activities what automatically leads to a DIY mentality. One of the challenges I faced was mainly to create a business understanding since up until now most of their revenue is created by donors, their business insight is limited. By using simple business model tools, all stakeholders could align on every aspect of a ‘regular’ business, including the importance of diversifying revenue streams and optimisation of cost structures.

The picture above is taken in front of a local clinic in the suburbs of Yangon. The clinic run by a very entrepreneurial General Practitioner that cares a lot about the health of patients with HIV.

2. If you want buy in, you need early stage executive involvement 

Originally we wanted to pitch the results to the local executives at the end of the program but, through iterative discussions, we decided to get the executives involved at the start of the program so they can collectively build ideas. This eliminates the ‘we-against-them’ mindset. This allows the participants to understand the personal objectives of the executives and creates a pre-pitch buy in. It was very emotional to see that one of the  participants ( a doctor in one of the HIV clinics)was very emotional at the end of the program since they were able to convince his executive to invest in lab facilities, which would generate new income and make the patients life much more convenient.

The picture above is taken in the suburbs of Yangon. Through field visits and in-depth interviews with the Key Population, we were able to gain a lot of insights on what could bring value to the actual end users.

3. Field observations are eye opening 

We invested almost 50% of our time in observations and interviews.  We visited caregivers and GP’s in clinics and key populations. The field observation was a great help in the understanding of the local situation. Patients with HIV suffer a lot of discrimination. The population is extremely poor and most of the KPs are providing forced labour. The current healthcare infrastructure is outdated or inaccessible. Finally, the government is still unstable since it is strongly influenced by the previous army dictatorship. This made it essential to constantly balance between future ideas and concepts that can be implemented from next week.

4. Visual communication connects people, languages and cultures 

Clarity and alignment are essential, especially since we collaborated with 5 different NGO’s and a team of Corporates. We’ve used a variety of visual creativity tools to break the ice and stimulate cross-cultural sharing. Using visuals as both a communication and ideation tool really helped to overcome language barriers. We’ve used both flip-charts and our business model kit to explain business concepts to each of the stakeholders.

5. I love my job 

It was an amazing experience, that I hope to continue. I will take these insights with me for my entire life. Since you are reading this post, you might also be interested in the topic ‘bottom of the pyramid innovation’. I hope you also learned something new out of this post. I am currently writing a new post in the coming months about all my experiences in the area of business innovation at the bottom of the pyramid in Africa, and South East Asia. Feel free to comment if you have any feedback or additions to this post so we can all get better at what we do.


I’m Vincent Pirenne, Innovation Strategist @ Board of Innovation. Spreading innovation culture is in our DNA – if you liked the read, contribute to our mission by sharing this article.

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