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Integrating social entrepreneurs into the “health for all”
William Drayton,a Charlie Brown,b & Karin Hillhouse b

This month’s theme “Knowledge trans-                    Initiative designed a global sourcing                 change on a scale that develops its own
lation in global health” offers an oppor-               methodology — a mapping tool called                   momentum and staying power. Accord-
tunity to highlight the overlooked but                  a “mosaic” — that provides a scan of a                ing to David Bornstein, “What business
dramatic impact of social entrepreneurs                 particular field: a snapshot of its action            entrepreneurs are to the economy, social
in the health sector and to detail ways                 principles likely to ensure success, its              entrepreneurs are to social change. They
in which their knowledge, innovations                   principal barriers to change, and a                   are the driven, creative individuals who
and enterprise can add strength and util-               selection of mini-profiles of innovative              question the status quo, exploit new
ity to systems ripe for change.                         practitioners.4 The mosaic for health                 opportunities, refuse to give up — and
      The global health sector and its                  was the conceptual centrepiece of an                  remake the world for the better.” 9
corporate, academic, governmental                       online collaborative competition at                        The archetypal social entrepreneur
and philanthropic partners are fully                    Changemakers.5 An open engagement                     in health was Florence Nightingale: she
engaged in efforts to improve basic and                 with contestants brought together in-                 changed hospital practices completely
applied research, deliver networks and                  vestors, policy experts, academics and                and established the framework and prac-
resources for more timely and better                    citizen activists in a global process.                tices of professional nursing through
care, and design more effective mecha-                       “Cross-pollination” between sectors              her uncommon determination and
nisms to bridge the gaps between                        is desirable if sustained progress towards            meticulous attention to detail, even
knowledge and practice.                                 health for all is to be a reality, and                in the face of fierce opposition from
      This is an ambitious agenda of                    cross-sectoral success stems from the                 experts and authorities.9 Such drive is
growing urgency, with daunting chal-                    ownership that develops when various                  typical of social entrepreneurs around
lenges. Kwok-Cho Tang et al. provided                   stakeholders participate in develop-                  the world 10 working in myriad fields
the context,1 noting that since the 1986                ing action and policy.6 Changemakers                  within or alongside the health sector,
Ottawa Charter for Health Promotion                     follows this model of collaboration and               such as ageing, disability, HIV/AIDS,
new patterns of consumption and                         ownership by engaging health competi-                 reproductive rights, and mental health,
communication, urbanization, envi-                      tion finalists and other key participants             technology, post-trauma care, rehabili-
ronmental changes and public health                     in policy and investment deliberations.               tation and prevention.
emergencies — along with accelerating                        The competition attracted 139                         Elsewhere in the Bulletin, Molyneux
social and demographic changes to                       entries from 40 countries — a mix of                  et al.11 and Haines et al.12 have ex-
work, learning, family and community                    organization size, growth stage, profit               pressed the need for simple, low-cost
life — have become critical factors                     motivation and complexity. Ideas and                  solutions to improve health care and to
influencing health.                                     products were arrayed uniformly in                    heal the fragmentation between policy-
      Over the same period, Ashoka:                     an online forum for peer review. The                  makers and ground-level solutions.
Innovators for the Public began a global                most striking common factor in the                    This fragmentation has been a long-
search for individuals with ideas for                   competition entries is the presence of                standing barrier to the implementation
changing systems to make them capable                   a strong individual with a new idea                   of new solutions and suggests there is
of bringing about vastly improved                       — what Claire Bahamon et al. deem                     the potential for social entrepreneurial
outcomes in education, human rights,                    all-important to changing service                     strategies to bridge the gap between
environment, economic development,                      delivery practices in health: “a dedi-                action and policy. The limited time,
civic engagement and health.2 Ashoka                    cated internal change agent … taking                  money, programmes and personnel
recognized these people as “social                      responsibility for change”.7 The change               available to cope with health concerns
entrepreneurs” and led a change in the                  agent in question is social entrepreneur              further point towards — and recom-
ways that foundations and other inves-                  Fazle Abed,8 founder of BRAC (for-                    mend — the opportunity to bridge the
tors analyse opportunity and measure                    merly Bangladesh Rural Advancement                    “know–do gap” with the innovative
impact, that business schools prepare                   Committee), the world’s largest citizen               solutions that social entrepreneurs are
students for careers in the fast-growing                sector organization, whose contribu-                  pioneering and via online platforms
citizen sector, and that corporate and                  tions to improving health for under-                  such as O
community leaders create opportuni-                     served populations is legendary.
ties for meeting their goals.3                               Challenging the health sector in                 References
      Drawing on Ashoka’s 25 years of                   their inventive, opportunistic way, social            Web version only, available at: http://www.
experience with 1700 social innovators                  entrepreneurs are particularly good at      
in 70 countries, including some 400                     identifying and engaging the entire
in the health sector, its Changemakers                  cast of characters necessary to effect

 Ashoka: Innovators for the Public, Arlington, VA, USA.
 Ashoka’s Changemakers Initiative, 1700 North Moore Street, Suite 2000 (20th floor), Arlington, VA 22209, USA. Correspondence to Karin Hillhouse
Ref. No. 06-033928

Bulletin of the World Health Organization | August 2006, 84 (8)                                                                                            591

 1. Tang KC, Beaglehole R, O’Byrne D. Policy and
    partnership for health promotion — addressing
    the determinants of health. Bull World Health
    Organ 2005;83:884-5.
 2. Drayton W. Everyone a changemaker: social
    entrepreneurship’s ultimate goal Innovations:
    Technology, Governance, Globalization
    2006;1:80-96. Available from: http://www.
 3. Changemakers Initiative. Arlington (VA): Ashoka:
    Innovators for the Public. See: http://www. and
 4. Mosaic of principles, barriers and innovative
    solutions in health. Arlington (VA): Ashoka:
    Innovators for the Public; 2006. Available from:
 5. Changemakers’ Health for All competition,
    March–June 2006. Arlington (VA): Ashoka:
    Innovators for the Public; 2006. Competition
    entries available from: http://www.
 6. Bertollini R, Gee VT. Working across sectors for
    public health. Bull World Health Organ 2004;
 7. Bahamon C, Dwyer J, Buxbaum A. Leading
    a change process to improve health
    service delivery. Bull World Health Organ
 8. Hartnell C. Social entrepreneurship – its promise
    and its challenges. Interview with Fazle Hasan
    Abed. Alliance 2005;10:14-7. Available from:
 9. Bornstein D. How to change the world – social
    entrepreneurs and the power of new ideas.
    New York: Oxford University Press; 2004.
10. Leading social entrepreneurs. Arlington (VA):
    Ashoka: Innovators for the Public; 2004.
11. Molyneux E, Ahmad S, Robertson A. Improved
    triage and emergency care for children reduces
    inpatient mortality in a resource-constrained
    setting. Bull World Health Organ 2006;
12. Haines A, Kuruvilla S, Borchert M. Bridging
    the implementation gap between knowledge
    and action for health. Bull World Health Organ

Bulletin of the World Health Organization | August 2006, 84 (8)                

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