Sunday, April 20, 2014
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Health in Hard Places

BASEL – When it comes to health care, all stakeholders – patients, service providers, pharmaceutical companies, and governments – know that something needs to change. For decades, health-care spending has increased faster than economic growth by an average of two percentage points in OECD countries. And, as the population ages and the incidence of chronic disease rises, the problem will only get worse if it is not addressed. We need new and better models – and effective strategies to adopt them.

This is especially true in developing countries’ health-care systems, which often confront tighter resource constraints than health care in developed countries. Today, the world’s largest socioeconomic group, often referred to as the “bottom of the pyramid,” comprises three billion people who live on less than $2.50 per day. Yet their demand for health care is significant.

In low-income countries, nine million people, mostly children, die each year from infectious diseases, including malaria, diarrhea, and AIDS. This is unacceptable, especially given the availability of treatments for these diseases. I believe, however, that traditional corporate-responsibility efforts, such as donating medicines to patients who cannot afford health care, are no longer enough. They do not address the root cause of the problem, which is much deeper than a pricing issue.

In order to have a lasting impact on health care and quality of life in the developing world, we need to focus on addressing the larger societal challenges that affect the overall healthcare ecosystem. Most important among these challenges are health education, infrastructure, and distribution networks.

In order to ensure sustainable health systems, we need to help communities to build capabilities in these areas. And we need to do this in a way that does not seek simply to implement “one-size-fits-all” models. We need to tailor our approach in each market to fit local customs and health priorities.

For example, in India, 830 million people live in rural areas, presenting immense challenges in terms of distribution of medicines. As a result, an estimated 65% of the total population does not have access to adequate health care.

Novartis has had some success in addressing this issue through our Arogya Parivar, or “Healthy Family,” program. Arogya Parivar is centered on recruiting and training residents of remote villages to become “health educators,” who, along with qualified doctors, organize “health camps” – mobile clinics that provide access to health screenings and a robust portfolio of treatment options. This includes select over-the-counter products, which we sell in smaller, more affordable packages, helping to keep patients’ weekly out-of-pocket costs low. Since the beginning of Arogya Parivar, we have improved access to medicine for 42 million patients in 33,000 villages.

Similarly, in China, despite rapid urbanization, millions of people still live in nomadic communities, making it difficult to educate patients on critical health issues, particularly disease prevention. Novartis sought the most effective channel to reach these patients, and ultimately found that teaching children about health and hygiene in schools works best. We have been making progress in China’s remote Xinjiang province through our Jian Kang Kuai Che, or “Health Express” initiative, which gives local health-care professionals access to training at urban hospitals through remote education sessions and consultations.

Finally, in Africa, there are still countries like Zambia, where more than three-fifths of the population lives in rural areas, and many must walk or drive long distances for health care. Moreover, the quality of medicines available at health facilities varies greatly, and supplies are not reliable. That is why we have forged a partnership with the Zambian government to scale up a countrywide system of pharmacies in order to bring basic medicines to remote villages, and to build the country’s health-care infrastructure.

We can also expect that mobile health care will be able to make a positive impact on supply-chain management, education, and compliance in places like Africa. Through the SMS for Life program, an innovative public-private partnership led by Novartis, we use everyday technology, including mobile phones, text messages, and electronic-mapping technology to track weekly stock levels of malaria medicines at public-health facilities. This has helped us to maintain adequate stocks, broaden access to essential medicines, and, we hope, reduce the number of malaria deaths in developing countries’ rural areas.

Each of these programs, or, as we call them, “social ventures,” provides societal benefits beyond improving access to health care or simply donating medicines. They strengthen local infrastructure, improve education, create jobs, and drive economic growth.

This is the kind of change that we need in order to make a lasting impact on health-care systems worldwide. We need to think about more than drug pricing and donations, and consider how we can help communities to maintain a high quality of life after aid goes away. This implies a major shift in mindset – one that I believe we need to undergo for the sake of our world’s long-term health.

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