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Can it really not be done?

↓

In 2000, a year of antiretroviral therapy cost about $10,000 per patient.

Health ministries across Africa built treatment plans underneath that number and reached the same conclusion: treating everyone was unaffordable.

That was a reasonable conclusion.

Then in February 2001, the Indian generics manufacturer Cipla offered governments and NGOs a three-drug combination for $350 a year. Nine months later, the Doha Declaration confirmed that the generic price could be acted on. Over the next six years, the median price of first-line therapy across developing countries fell to about $90.

The medicine hadn't changed. The price had. And the price turned out to depend on who was arguing, how hard, and for how long. $10,000 had been treated as a hard fact about the medicine, when it was actually incredibly elastic.

Every plan has a sentence like that in it.

The ministry can't afford it.

The board won't go for it.

Procurement takes nine months.

Eleven people have to agree, and you only have influence over two.

These premises set the ceiling of a plan before anyone has said a word about strategy because they sound like arithmetic rather than opinion.

Worse than unchallenged premises are unstated ones. Because once a premise goes unnamed, nobody even has to defend it!

Look, many premises survive contact. Procurement really might take nine months. Your board really might say no.

But sometimes, these premises are wrong. And that's when the magic happens.

Try this

Write down the three things your current plan treats as fixed.

Next to each one, write the last time anyone actually tested it.

If you can't remember, that's useful information ;)

Sometimes the strategy is not finding a better way around the constraint. It is discovering the constraint was never quite as fixed as it seemed.

🌿 Test, don't tell.

Can't be done" is usually just the memory of the last time somebody tried.
Send me the three premises from the exercise above. I'll tell you which one I'd test first and how↓

Tell me what’s stuck.

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