3 Ways To Make Digital Health Services Work For Everyone” new piece in ICT works from reach52’s Rich Bryson…

Much fanfare about the acceleration of digital health services during the pandemic, but most don’t work for billions living in low-connectivity regions. We need to also accelerate digital health services that work for everyone on the planet!

 

The acceleration of digital health services during the pandemic has been accompanied by growing concerns about the ‘digital divide’ in global healthcare. The growth in virtual care has been predominantly in more affluent, urban populations.

Rural communities across low- and middle-income countries have found themselves even more isolated from health support during lockdowns. Vaccine drives have also been hindered by digital barriers, such as in India where poor rural communities lack information on how to register and the internet access to book through the online system.

3.7 billion people live in regions in the world without internet connectivity, and so many digital health services just don’t work for these populations. This is a huge barrier to achieving Universal Health Coverage for all and missed opportunity for healthcare businesses unable to reach emerging markets for their services and products. These are three priorities for building digital health services that work for everyone on the planet.

reach52 recently participated in the PMAC 2020 event in Bangkok focused on accelerating universal healthcare progress. The event featured presentations and panels with many organisations involved in global health, including WHO, the World Bank, Unicef and Amref. reach52’s CEO, Ed was a speaker at the “From commitment to action: private sector engagement for UHC” session run by the World Economic Forum.

Based on all the sessions at the event, we’ve summarised 5 key actions to accelerate UHC. Its impact not just ideas that ultimately matters.

 

Written by Edward Booty for the World Economic Forum – May 2020

The global spread of COVID-19 came at a moment when momentum for universal health coverage (UHC) was increasing. On the heels of the high-level UN declaration in late 2019, many low and middle-income countries (LMICs) had been working to translate the warm intentions of world leaders into tangible actions. With the response to COVID-19 currently consuming all the political oxygen and pushing already overburdened systems past their breaking points, progress towards achieving UHC is at a standstill.

 

In response, here are the big challenges we encounter every day and must overcome to expedite healthcare for all. We have a 10-year deadline to deliver the SDG commitments and unless we address these systemic challenges, I cannot see the vision becoming reality.

 

To read the full article for the World Economic Forum, click here.

New World Economic Forum article from reach52’s Rich Bryson on Accelerating Covid-19 Vaccine Rollouts to reach everyone across LMICs… providing practical solutions based on our current experience on the ground. 

Current Covid19 vaccine rollouts aren’t working quickly or efficiently enough in many regions we’re focused on across low- and middle-income countries, but through more effective use of digital systems, community health workers and data we can address this…

 

Read full article.

Whether we suffer from high blood pressure or mental health issues, or know someone who has faced a cancer diagnosis or undergoing treatment for diabetes – NCDs (Non-communicable diseases) impact all of us… 

Yet global commitment and action to address the burden of NCDs is not on par with their impact on our everyday lives. 

reach52 is proud to contribute and be featured as a case study in this report that outlines four interconnected fronts that guide the innovative pharmaceutical industry’s action on NCDs: 

💉 Innovation: Investing in the discovery of new medicines and vaccines to prevent and fight disease 

🗣 Availability: Promoting policies that drive expanded access to care 

🙋🏽‍♀️: Empowerment of people living with NCDs: Ensuring the design and implementation of policy solutions are co-created with people living with NCDs 

🏥: Capacity building: Working with health systems and their funders to build capacity that can effectively prevent, diagnose, treat and manage life-long conditions. 

Read this important report and check out case studies of other organisations working tirelessly to build capacity, ensure access to care, and empower those living with NCDs. 

Public health experts have long warned of the likelihood of a high-impact acute respiratory pandemic. Even as China experienced a major crisis related to COVID-19 beginning in January 2020, other countries failed to use the time to adequately prepare.  Now, with 225,237 cases and 9,276 deaths (as of March 19th), it is an emergency that will affect every single person on our planet.

 

As a health service provider in rural, remote areas of low- and middle-income countries  (LMICs) in Asia, we have many reasons for concern, but also optimism. The robust containment measures taken by many governments across an entire country do appear to be having an effect.  As draconian as some find it, I certainly support these firm and decisive measures to protect the health of millions.  This is also the view of the WHO, who have praised China for their unparalleled containment strategy.

 

Health providers in high-income countries will struggle to cope with the onslaught of demand for care, but the major impact will be felt in low-income regions. We spoke with a major medical devices company yesterday – the wait list to get a respirator is now two years or more.  Stock was allocated on a first come basis – there wasn’t a coordinated intergovernmental system to allocate resources equitably, and every country scrambled to protect their citizens. This will of course leave poorer countries behind. I don’t like to think that the profit maximisation incentive will prevail here, however the speed at which capital can be deployed means that that richer countries will get more essential devices and supplies.

 

Health systems in rural areas of poorer countries are not prepared for this. In the same way they are not prepared for many other killer diseases (ranging from diabetes, to hepatitis, to other respiratory diseases like COPD or asthma). Primary health infrastructure lacked funding long before COVID-19, struggling to treat the leading causes of morbidity and mortality. A new pandemic, albeit alarming, is no exception. While concerned by this crisis, I am equally concerned that when it inevitably subsides, people will still be dying from entirely preventable causes that the health systems are unable to support. The economic impact of those on day-wage labour will also be hit much harder than those living in the biggest economies in the world, with some form of social protection and deep government pockets to solve this crisis.

 

As I said though, there are a couple reasons that this crisis gives me optimism.  I’m impressed with the unprecedented attention, coordination and resources that governments, agencies and the private sector are dedicating to efforts to contain and respond to COVID-19.  It’s an indication that we have the collective willpower to address major health challenges head-on.  Perhaps I’m being overly optimistic, but there will be an opportunity when COVID-19 recedes to refocus these awesome efforts on the continuing epidemic of diseases which cause millions of premature deaths in LMICs every year.  The opportunity to accelerate systematic changes for future outbreaks by helping LMICs strengthen their primary health care systems, which is essential to disease surveillance and early warning systems, as well as the prevention and timely treatment of all health conditions. We must seize the opportunity.

 

I’m also incredibly encouraged by the current and potential role of digital solutions in responding to COVID-19.  It’s essential that we adapt and act quickly through digital programs and services that protect these communities both from COVID-19 itself and the barriers it is creating to other essential health services.  At reach52, this work includes rolling out COVID-19 focused chatbots and other digital services, helping ease the flow of non-critical cases away from busy health facilities and supporting isolated communities through the pandemic and beyond.

 

In the US, the federal government has responded with moves to spur a massive increase in telehealth access. In the Philippines, e-prescriptions are now temporarily allowed (e-mail, Messenger, Viber) for the most vulnerable during the current enhanced quarantine. Large multi-stakeholder initiatives, like COVIDcheck are also working to launch digital interventions to impact this issue from several different angles.  I believe that many of these solutions and innovations will be here to stay, and long after the global community eradicates this virus.

 

At reach52, we’re accelerating our solutions to deliver both short term and longer-term goals, so we can ensure every community not only survives but thrives. If you’re interested in partnering to support the regions where we live and work during this seismic public health crisis, reach out to us.  In the meantime, stay healthy and keep working hard to do your part.

 

Thank you for reading.

Ed

CEO, reach52

 

 

 

We are delighted to announce that from November 2019, we are changing our name from Allied World Healthcare to reach52. The new name and identity are the start of a dynamic, next phase of global growth, driven by our purpose to make healthcare go further, so every community can thrive.

Over the past 3 years, we have partnered with governments, NGOs, and the private sector to deliver accessible, affordable healthcare in low- and middle-income communities where previously there was no healthcare at all. Our work has been powered by award-winning apps and platforms, innovative public-private partnerships, and equipping community members to run services for their communities. We are proud of the impact that has been achieved, connecting over fifty communities to primary healthcare services they couldn’t access before, delivering health outreach programmes and a range of other support. And these are not stop-gap solutions. Through working with the communities, governments and NGOs, as well as innovative businesses such as Novartis, Gilead, IQVIA, and Facebook, we are establishing fully sustainable health system models that benefit everyone.

But we also believe progress towards UHC and access to healthcare for all is too slow. Affordable health services still don’t reach 52% of people on the planet… that’s over 3 billion people. Lost lives and lost potential for communities, governments, business and the world. Digital health isn’t being adopted quickly enough. Costs are increasing. Simply enhancing existing healthcare systems doesn’t go far enough for the communities without essential healthcare services. As reach52, we’ll continue to pursue new and better ways to deliver affordable healthcare for the 52%. Inventing and implementing new digital health solutions for low- and middle-income countries, harnessing data to drive precision public health, and forging new partnerships to provide access to affordable medicines, diagnostics and health insurance that communities need.

‘Words can’t describe how far we have come in the past two years, more than I ever thought possible, and I am so proud of our team and partners for making this happen. However, we are just getting started. reach52 represents what we have become, and our ambition to build solutions that can connect 52% of the world to healthcare support. Systemic change is needed to achieve this, and that’s what we’re going to deliver’ says Ed Booty, reach52’s CEO and Founder.

Going forward, reach52 will be organised into reach52 and reach52 for business. reach52 empowers community members as Access Managers who use offline-first apps to provide health support and connect residents to the treatment they need. Through our data-driven insights into the needs of communities, we also work with governments and NGOs to shape targeted, effective healthcare strategies and programmes.

reach52 for Business is our social business arm, which works with private sector organisations (Pharmaeutical, MedTech, and Insurance companies) to deliver heath products and services at affordable prices to previously inaccessible communities. This is powered by our mobile-enabled marketplace and logistics network, and teams of community-based agents on the ground.

We joined over +18,000 innovators for the #BuildforCOVID19 global online hackathon organised by the World Health Organization (WHO) and tech giants such as Facebook and Microsoft.

We’re grateful that reach52’s COVID-19 solutions were amongst the top projects highlighted by the panel (based on their viability and scalability), supporting our work to scale these solutions rapidly for communities with urgent COVID-19 needs.

Find out more about reach52’s solutions and other highlighted projects here.

You can also read more about our COVID-19 response for low- and middle-income countries here.

Access to health services remains a key problem in rural areas and lower and middle-income countries (LMICs), where skilled health workers and digital health options are often in short supply. Focusing on the “three Cs” of health delivery — community-led, connectivity and collaborations — can help to build more flexible health systems for hard-to-reach populations.

 

The views expressed are those of the author and do not necessarily reflect the position of FORESIGHT Global Health.


 

Over half the world’s population still lacks access to essential health services. Many live in rural regions in low- and middle-income countries (LMICs) where traditional health systems don’t reach and there are chronic shortages of skilled health workers. Typical digital health services also don’t work in these low-connectivity areas – we need to remember 3.7 billion people are not connected to the internet.

Clearly this presents a significant challenge to combatting the global NCD epidemic, with four out of five people with an NCD living in LMICs. As we work through the Covid-19 recovery, we must build health systems that work for everyone on earth. Health systems that are designed around the needs of the people and communities are more effective and cost efficient. We must recognise the reality of the patient experience in many parts of the world and work to alleviate inequal access to health systems by focusing on the 3Cs: community-led, connectivity and collaborations.

 

BUILDING FROM THE GROUND UP

Where patients live long distances from healthcare providers and funding is limited, health systems must be community-led to create a more level playing field. Residents living in rural regions where we work typically have to travel over an hour to expensive private clinics for basic tests for glucose, HbA1C and cholesterol. A comprehensive diabetes test panel costs approximately $50 in a private hospital or outpatient diagnostic centre, 10 times more than the average daily earning of a resident.

Community-led health systems in which the communities themselves are empowered to take control of their health services are the means to provide more accessible, quality care. There must be a rapid scale up of Community Health Workers (CHWs), given the predicted shortage of 18 million health workers by 2030. But it’s not just about the numbers – it’s about providing proper recognition, pay and capability building through a shift away from traditional classroom training and manuals. What our CHWs across South & Southeast Asia most want is mobile-based learning, checklists and diagnostic tools to support them in doing their job and dealing with problems on the front line.

Informal healthcare providers (IHPs) can be trained to overcome the workforce gaps in hard-to-reach regions. Examples include the Novartis Foundation’s ComHIP model in Ghana, which enabled local businesses to provide blood pressure screening, and a key part of our own model at reach52 is equipping community members to provide a marketplace of health products in their communities. Equipping a ‘lay person’ to manage last-mile health services is not without its challenges, it’s getting the right mix of recruitment (entrepreneurial community members), upskilling (don’t underestimate the level of hands-on coaching involved) and rewards (fair and achievable incentives) to motivate performance.

But investment in both groups is worth it, not only to address the workforce shortages and support ‘decent work and economic growth’, but also to build trust in the health services. In less accessible regions where there is misinformation and unhealthy practices, patients often trust the advice of fellow community members more than outsiders; this can help to drive the health-seeking behaviours needed for NCD prevention and management.

 

BRIDGING CONNECTIVITY GAPS

The pandemic has accelerated the adoption of technologies across global health, and digital health is essential to building health systems that work everywhere. But the reality is many digital health solutions are of little use to patients in regions with low to no internet connectivity. There’s been a lot of fanfare about telehealth over the past 12 months, but if you’ve tried doing a basic video call or even phone call with people in rural regions in some LMICs, you’ll understand the limitations.

First and foremost, health tech services must be designed to be ‘offline-first’; in other words, they can function with or without the internet. This enables roaming health workforces to use mobile applications and devices to provide patient services for NCDs in offline areas, and then sync the data when back online at specific locations. Patients can also be connected directly to health services through offline-first mobile applications, so long as they’re designed with a simpler user experience and work on basic versions of mobile operating systems. It’s not just about the tech; we must also invest more in digital literacy programmes to equip patients to use the tech. Digital health literacy needs more focus as a social determinant of health, ensuring everyone benefits from digital health. For example, the Bangladesh Government in partnership with Huawei and Robi Axiata jointly launched the Digital Training Bus project to bring digital skills to women in the heart of rural Bangladesh.

Collecting and sharing data between providers is the foundation for strong, connected health systems. Application of this data is essential to more preventative healthcare. Yet efforts in this space in primary health centres in rural areas are often flawed – doctors describe to us how they get provided a computer, but no budget, no internet and no support, so have to pay for the internet themselves and end up continuing to use paper-based systems. We should view these efforts as an opportunity to avoid the interoperability problems of health systems in higher income countries, and see them not just as a cost, but as an investment in building more efficient, data-driven health systems from the start. Getting basics in place would at least lay the foundation for making access to health systems more equal by establishing common data standards, more user-friendly platforms, staff training, and alternative power sources to run it. Government regulation can be catalytic, such as India’s Universal Service Obligation Fund (USOF), used to build fibre cables across rural and remote areas, into which telecom service providers pay 5% of their adjusted gross revenue.

 

ENABLING NEW PARTNERSHIPS BETWEEN MULTIPLE STAKEHOLDERS

Collaborations between different health actors (including patients, healthcare providers (HCPs), government, civil society and private businesses) are essential for any effective health system. But new types of collaborations are needed to establish health systems that reach everyone on the planet. The constraints in resources, funding and capacity can be used to fuel innovation between new partners in new ways.

The World Health Organisation has already advocated the need for a comprehensive approach across all sectors (health, finance, transport, education, agriculture, planning and others) to lessen the impact of NCDs on individuals and society, and the inequalities that they create. We need to reframe the challenge away from filling the system gaps to shaping preventative systems. This means collaborations with financial services businesses to expand affordable insurance, because the fear of health expenses is often bigger than the fear of an NCD, putting people off seeking treatment until it’s too late.

This involves collaborations with schools to promote healthy diets to reduce treatment costs for diabetes and cardiovascular conditions. It also requires collaborations with tech companies to harness social media for positive health promotion and leverage AI capabilities, such as Google’s AI for Good projects, to predict risks for expectant mothers in India. As WHO Director General Tedros Adhanom Ghebreyesus, advocates “Reach beyond the health sector to tackle the social, economic and commercial determinants of health”.

There needs to be greater collaboration between traditional competitors. There have been unprecedented partnerships on COVID-19 vaccine development (such as Sanofi and GSK), but such collaborations don’t happen enough in expanding health services for all and there is too much re-inventing the wheel. The problem is too big for one organization to solve – working together to pool resources and share capabilities to develop health systems will benefit everyone.

Increasing collaboration with the patient themselves in health systems is central to all of it. This means empowering people by bringing health services closer to where they live, involving them through shared-decision making about their care, and putting health information at their fingertips through a mobile device already in their hands.

New mindsets are needed to drive new collaborations. In particular, we need to reframe  ‘health for all’ as investment in GDP and growth, not just a cost to be managed. We need to shift from siloed programmes to scalable, sustainable models of care. And we must emphasise faster action to support policy statements. By doing so, together we can build the health systems everywhere that work for everyone, protecting lives from NCDs and driving inclusive growth for all. •

 

TEXT – Rich Bryson is the Chief Strategy and Marketing Officer at reach52, a tech social enterprise delivering health services in markets others don’t reach across the world.

The Gen.T List is made up of trailblazing entrepreneurs, creatives and young leaders who are creating a positive impact in the region.

We’re so proud of our Founder and CEO Edward Booty for being selected as one of the 300 leaders of tomorrow who will shape Asia’s future in Tatler Asia Group’s annual Gen.T List.

He has been recognised for his contribution towards using technology to extend access to health services.


Check out Ed’s profile here.