Frederic Sicre
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| A health worker attends to a patient at an outreach health program by Hindustan Aeronautics Limited and Trinity Care Foundation in Bagepalli Taluk, Karnataka, India. Photo by: Trinity Care Foundation / CC BY-NC-ND |
We all appreciate that the role of business in our societies is going through a far-reaching transformation. It’s not social empathy that is driving this change. To put it plainly, if businesses wish to stay relevant to their shareholders, they must also serve their stakeholders.
This is one of the key drivers of forward-looking companies that engage with governments and the United Nations to define and deliver the 17 Sustainable Development Goals we will live with for the next 14 years. The levels of innovation and collaboration between businesses, governments and nongovernmental organizations will distinguish the winning companies and countries from the losers, moving forward.
Why? Because long-term solutions to global challenges will need to blend private sector aptitudes to manage resources efficiently with NGOs’ understanding of delivery systems on the ground.
And if governments are going to nurture their social infrastructure and well-being of their citizens they will need to make these collaborative schemes scale massively, and quickly. But how?
As we celebrate the first anniversary of the SDGs we should remember two things:
First, we have only 14 years left to meet the Goals and this means rapidly scaling innovative solutions that are sustainable. Secondly, innovation is not the panacea in and of itself — it’s not the latest app that is going to save lives, it is the human capital and processes placed behind the steering wheel of innovation that is going to drive change.
There are many additional areas where philanthropy has an important part to play in conjunction with the private sector. Take these examples where innovative partnerships can play a role in building stronger health systems:
1. Innovation in training.
When physicians take on the Hippocratic oath they also make a promise to teach to those that want to learn “the art of healing.” Education and upskilling are major levers to scale health care delivery systems to those in need. Here again the private sector can lead in creating “clinical corridors” across countries and continents to upskill doctors and other dedicated staff and implement best practices. Innovative partnerships between centers of excellence involving training and exchange programs can truly have a catalytic effect on delivering specialized services across wide geographical areas and fill a much needed vacuum.
In CARE’s case, for example, senior doctors are constantly dedicated to capacity building in their teams. They train junior doctors according to well defined protocols thus building delivery capabilities whilst driving costs down; by training junior doctors in six months the cost of a dialysis session has gone down to $25 instead of $200 in the West.
2. Improve access.
The ultimate objective in rural populations is to achieve quick wins in minimizing the occurrence of acute health care problems. Seventy percent of spending on primary health care in growth markets are due to travel costs and lost wages. As such, screening communities and delivering health services through large scale community health care worker programs can create profound impact.
The costs associated with large screening programs is minimal and the ROI both socially and financially largely offsets the costs of these programs. Building outposts in small villages, for example, to screen for NCDs and building awareness programs around them is not expensive; the Aman Foundation in Pakistan demonstrated this by bringing the cost down to $0.25 per patient.
3. Build data banks.
Business, philanthropists and NGOs can create high-impact programs of this kind through mobile connectivity and technology, with the direct result of creating large data banks (which do not exist today) on health care needs in underserved areas. Armed with this data the private sector can help government funded schemes to achieve greater impact by focusing on prevention and affordable treatments related to the needs of specific communities whether they be hypertension, high blood sugar levels or require mother and child care.
Reality check
SDG 3 calls for bringing affordable, quality and accessible health care to all. Nearly 6 billion people, 80 percent of the world’s population, live in emerging markets, most of whom belong to low- or middle-income households and are severely underserved from a health care perspective. The World Health Organization estimates that by 2030, 52 million deaths are expected from noncommunicable diseases, over 80 percent of which will occur in LMICs.
Are we ready to meet that reality? In Nigeria, the average number of hospital beds is five per 10,000 people compared to a global average of 27 hospital beds per 10,000 people. Similarly, there are only two doctors per 10,000 people in Kenya, compared to 28 doctors for the same number of people in the United Kingdom. Nigeria needs to produce 700,000 doctors to match OECD equivalents: this will take 300 years at current rates of training.
You or I may take seeing a doctor as a totally mundane occurrence in our lives, but for many of our fellow humans the closest trained specialist lives 500 miles from their home and a simple blood test is something some people have never heard of, or had access to. Take that to the next level and imagine you develop cancer — what are your options?
Partnerships in practice
I recently saw this in evidence at CARE Hospitals in India, which was founded in 1997 by a team of leading Indian cardiologists. Today CARE operates 17 hospitals in nine cities with over 2,000 operational beds and is India’s fifth largest health care player. The doctors who founded CARE pride themselves in having created an innovation-oriented organization. However, the real innovation that has allowed CARE to treat 6 million outpatients and over 1 million inpatients in low-income segments of the population are common sense efficiencies.
CARE has re-engineered clinical delivery, identifying areas where process improvement, upskilling and task shifting work hand-in-hand to ensure better quality outcomes.
By putting an emphasis on redesigning operational and clinical processes to minimize costs, in turns allows for higher volumes whilst improving clinical effectiveness — the more you do something, the better you get at it! These clinical processes are supplanted by management and quality protocols on a monthly basis to ensure that consistency in quality treatment is maintained.
Make progress through partnerships
The public sector has traditionally been seen as the natural provider of health care in most of these markets but has struggled to deliver results. Hence governments should engage the private sector fully to change this situation.
Three strategic objectives should be targeted. First, an alignment between all actors on a broad health strategy; secondly, a focus on the priority needs of the underserved population segments; and thirdly achieving major enhancements to the capacity, capability, and quality of health systems.
The third objective is not about technology, it is about maximizing efficiencies, upholding best standards, understanding your cost base, driving it down whilst upholding top quality delivery and measuring outcomes — these things the private sector can do well, and private equity investors in particular.
Of course, technology plays — and will play — an important role in democratizing access to health care. Screening devices, remote mobile systems and big data collection will all lead to cheaper and more effective health care delivery. However, none of this will happen if efficient systems are not put in place first involving processes that are upheld by trained and committed physicians, health care workers, medical aids and nurses.
Human capital is at the core of the solution, not technology. That’s the quick win we must first tackle — 14 years to go, the clock is ticking.
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