Efficiency Expert

If you’re a doctor doing battle with Africa’s AIDS epidemic, you can’t be a snob about where you get your next good idea. Ernest Darkoh got one of his best ideas from Wal-Mart.

Darkoh, 35, has always had an appreciation for the hardheaded logic of business and has always felt that there is a place for it in the gentler field of healing. The son of Ghanaian academics, he was born in Wisconsin, reared in Tanzania and Kenya, and earned degrees in medicine and public health at Harvard and an M.B.A. at Oxford. After graduating, he followed his business bent and took a job at McKinsey & Co., the big New York City management-consulting firm. But that didn’t mean he left the medical world behind. The field of medicine, after all, is really about product distribution–that product being good health–and from what he could see, the distribution channels were too often clogged, particularly in Africa.

Four years ago, Darkoh got his chance to do things better. The Botswana government hired McKinsey to help design an AIDS-treatment program–a critical need in a country where 300,000 people out of a population of 1.6 million are infected with HIV. Darkoh volunteered to draw up the program and presented it to the Botswana leadership. With funding from Merck and the Gates Foundation, the government brought him to the capital, Gaborone, where he set up shop. What Darkoh found when he arrived was a population not only ravaged by AIDS but also seemingly numb to its horrors. “Someone would come into work and say his brother died,” Darkoh says, “and then continue to tell me the photocopier was out of toner.”

To overcome such complacency, Darkoh realized, HIV care had to reach beyond hospitals and clinics and involve everyone from local church groups to tribal chiefs–an approach that would get the treatments where they needed to go, raise awareness and, very important, break the stigma of the disease. He recruited local leaders, hired outside distribution experts and lobbied to introduce universal HIV testing so that people visiting clinics would have to ask not to be tested rather than the reverse.

His ideas sounded good, but no sooner had he got them going than the whole system began to buckle under the sheer crush of patients–particularly extremely ill ones, who required so much care that they left doctors unable to help healthier people. To fix that, Darkoh turned to checkout-line models that Wal-Mart helped pioneer, instituting what amounted to an express lane for people in need of just testing or medication and a slow lane for the gravely ill.

Those innovations have paid off. Roughly 38,000 people–more than 10% of the infected population–have access to free antiretroviral medications, and the number is growing. More significant, an untold number of HIV-negative people remain uninfected.

Other countries watching these changes have approached Darkoh, asking him to take on their cases too, and he has responded by recruiting two partners and founding BroadReach Healthcare, a private company that is setting up HIV programs in South Africa, Ethiopia, Haiti and Vietnam. In those places too, Darkoh makes liberal use of churches and existing AIDS advocacy groups to get treatment to the largest number of people possible. In South Africa, he added an online medical database that can monitor remotely the health of rural patients and assist hands-on providers in the field.

“It’s got scarily good potential,” Darkoh says. Actually, potential is something he and his company have already demonstrated. What they are getting now is results.