Design for emerging markets

The growth and importance of emerging, or high potential, markets are expected to play an increasingly important role in the growth of the global healthcare industry over the next five years. As the medical device industry increasingly turns to these markets for growth and profitability, it is necessary to ensure products are appropriately designed for these populations and that old generation solutions aren’t deployed solely for cost reasons.

There are numerous definitions of which countries are officially ‘emerging’, for example the well established BRICS (Brazil, Russia, India, China and South Africa) countries and other examples such as MINT (Mexico, Indonesia, Nigeria and Turkey), or CIVETS (Colombia, Indonesia, Vietnam, Egypt, Turkey and South Africa). These markets are typically ones that exhibit the following characteristics:

• They offer high growth potential (existing market penetration is often low)
• Population growth (i.e. more potential customers)
• Increasing standards of living (i.e. greater income for ‘non-essential’ items)
• Improving access to healthcare and prescription medications

Unlike the USA and Europe, with well-established economies, distribution networks, healthcare schemes and political frameworks, these emerging markets present some interesting challenges.

Countries in these emerging markets tend to have very differing economic and political conditions. The vast size and population of some of the single countries and their differing geographic and climatic environments can drive huge variations between regions and population segments. This means that it can be more appropriate to subdivide these markets. This is in contrast to grouping together many different countries which, for example, can be appropriate for those that exist in the European single market. The regulatory frameworks in these emerging markets have wide-ranging variations – from those who have adopted what are effectively direct translations of FDA guidance (e.g. Mexico), to markets where the framework is less well developed. These challenges are all further complicated by the unique and varying mechanisms for healthcare provision and purchasing.

There are many design, strategy and human factors tools that can be used in providing useful insights for design development work. Depending on the nature of the project/product, we link tools together in a considered manner and triangulate the findings to create the confidence that the insights gained are accurate. It’s particularly important in emerging markets to understand the stakeholders and the level of influence they have on the commercial success of the final product proposition.

In the world of consumer products, the user is generally regarded as ‘king’. If you can meet their needs and desires better than your competitors, you are likely to succeed. The marketplace for the healthcare industry is more complex. Long before a patient receives a diagnosis, treatment or medication, a long list of stakeholders will have had influence as to whether a patient even gets to see/use a particular product (for example regulators, distributors, prescribers etc.). For success, it is essential that this journey is understood, together with the motivations and frustrations that the key players can have along the route.

Stakeholder mapping evaluates the key stages in the product’s life cycle and seeks to use this as a mechanism to identify who the primary and secondary stakeholders might be. This could be from pre-market approval through manufacture, purchasing, ‘use’, and disposal. By mapping the stakeholders like this you can get an idea of the relative influence they have. Once the relevant stakeholders have been identified the project team can begin to plan and perform research activities and start working towards generating valuable insights.

Gaining insight directly from the field is paramount in generating high-fidelity data. An important method is to observe individual users conducting tasks in his or her own environment - a technique known as contextual inquiry. By way of an example, during a visit to a number of pharmacies in Africa, an insight came from George, a self-employed pharmacist who works on the outskirts of Nairobi, Kenya. George personally chooses what to stock, so to a certain extent if he doesn’t think it meets his needs or the needs of his customers, then he won’t offer it. Obviously, he will be influenced by the feedback he gets from his customers but it’s inevitable that he puts his own bias on his stock selections.

George would often cut up blister packs to respond to patient demand or to make the cost of access to a medication more ‘affordable’. From George’s perspective, the packaging of medication in a manner that easily facilitates unit dosing would be very helpful. Most packaging is not designed for this type of use and there are many implications such as the long-term impact on storage shelf life after secondary moisture seals are broken and/or the lack of instructions for each individual user.

Once the stakeholder interview process is complete, the data can be synthesised to develop a set of stakeholder ‘personas’. Personas are essentially a set of fictional characters created to represent the different user types that might use/interact with a product or device. They are typically captured in a short description that includes behaviour patterns, goals, skills, attitudes, and the environment, with a few fictional personal details to humanize the persona. If the product is to be marketed in multiple regions, persona sets for each of your markets may need to be created to account for the diversity between target markets. In some countries where there can be vastly different socio-economic populations within a single country, a segmentation model also needs to take this sub-division into account. Personas can then be used as a reference point to help guide strategy and allow the design team to ‘stress test’ concepts/hypotheses.

It is a common model to introduce existing products into an emerging market; products that have already been developed and are now second or third-generation in their markets of origin. One example is the automotive industry. Back in the 60’s and 70’s companies like Ford and VW set up manufacturing facilities in a number of emerging markets seeking to cater for the local markets. Typically these were based on producing already superseded models and using older technology and manufacturing equipment. With low cost being a primary driver, a number of these initiatives were reasonably successful – such as the VW beetle in Mexico. However, the world is changing and consumers in emerging markets are now demanding cars with comparable safety features and performance to those exhibited by current western models.

This “traditional” approach in itself is not wrong in all cases, but the recommendation is that the solution should be informed, holistic and not just driven by manufacturing cost alone. While cost is a key issue for emerging markets, this shouldn’t be the main factor driving the development of healthcare solutions for these markets.

Adopting a more considered, holistic and collaborative approach, to understand the full and varied characteristics of emerging markets, as suggested in this article, will build on a good foundation of insight and evidence, and is surely the best way to ensure success in these new markets.

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