How tech can help low-income countries manage noncommunicable diseases

Last November, the world reached the milestone of 8 billion people, highlighting major improvements in public health that have lowered the mortality rate and increased life expectancy. However, as populations live longer, health systems need to prepare for the increased burden of noncommunicable diseases, or NCDs, such as diabetes, cancers, and cardiovascular diseases.

While well-resourced health care systems have developed screening programs to detect NCDs early on, many low- and middle-income countries lack the infrastructure and capacity for early detection and management. Some 77% of all NCD deaths occur in LMICs, and out-of-pocket expenses can quickly drain household resources as treatment is often lengthy and expensive, according to the World Health Organization.

This means health care systems in many LMICs have to add detection, treatment, and management of NCDs to the list of health services they need to finance — often on small budgets. But technology and digital health innovations have the potential to significantly improve both the delivery and sustainability of health services and to make the management and treatment of NCDs more widely available and cost-effective.

Devex spoke to Elisabeth Staudinger, a managing board member at Siemens Healthineers, about the potential of technology to strengthen health care systems in LMICs for their shift toward more prevention, diagnostics and management of NCDs.

The conversation has been edited for length and clarity.

What are the current gaps when it comes to the detection, screening, and treatment of NCDs in LMICs?

If you look at the global population, we reached 8 billion last year and we know the population will continue to grow. People are living longer lives, and one of the reasons for this is better public health.

But at the same time, this aging population means you have more people aged 60 and above. And the estimations are that by 2030, about 1 in 6 people on this planet will be over 60. This drives a shift to more cases of noncommunicable diseases since these diseases — the ones that are not spread through infection or other people — are something you typically develop over time, for example, cardiovascular diseases, cancers, and diabetes.

This particularly affects low- and middle-income countries because, according to data, their populations are aging up to three times faster than in high-income countries, so there's less time to prepare for this shift. And there is a second factor, which is that disease is usually caught much later in lower-income countries, resulting in the unfortunate situation where about 77% of all people who die due to noncommunicable diseases are in such countries, and 86% of these are premature deaths. If you now envision that you're able to find ways of detecting disease much earlier — just when it starts to develop — you have a much wider range of treatment options and ways of managing the disease. And it's also less expensive to make sure the disease doesn't progress as quickly as it would have done without treatment.

How is Siemens Healthineers working with health care providers in LMICs to provide end-to-end solutions that help improve the management of NCDs?

When you are aiming to build a resilient health care system with the ability to detect disease early, you need a few different components. You need the basic infrastructure, you need the staff, and you need certain funding. It’s also important to raise disease awareness among the population so that they are aware of symptoms, can get tested, and are diagnosed as soon as possible.

If you look at these four components, it’s clear that one company or government can’t do this alone. Therefore, it's extremely important to look for multistakeholder approaches where both governments and companies are part of the equation. As you look at how to scale the availability of care in a country, the government is an extremely important stakeholder. But you also need to leverage international organizations to help close some of the gaps. For example, we are working with UNICEF to use data analysis to determine the gaps in the laboratory infrastructure of sub-Saharan Africa. This will enable us to identify and strengthen key elements of the health care system, especially within the diagnostics network. It’s only by bringing together the capabilities of different players that we can make an impact.

The concept of precision medicine is increasingly gaining ground. How could it help health providers in LMICs respond to the growing burden of NCDs?

When you look at the concept of precision medicine, it’s about ensuring that you get the most meaningful treatment that will help you as an individual. It’s not just following a predetermined protocol when somebody presents with certain symptoms but it’s making sure the treatment is individualized and targeted. Some people think this type of treatment must be incredibly expensive and start questioning how it can be translated to environments where you have fewer resources available and where you might not be able to pay for high-end treatments.

But I believe it's very important that we look at the opportunity of precision medicine in a different way. If you think about finding a way of catching disease early and then applying a very targeted treatment, then it becomes cost-efficient and an effective way of taking care of a patient. It also becomes very relevant in low-income settings, and we see an opportunity here where technology can really help open doors and support health care.

There’s even the potential for these countries to leapfrog older protocols by deploying digital and artificial intelligence-powered tools to move to a stage where they can provide precise and very targeted individualized therapy at a much lower cost and much faster than we think. It's definitely worthwhile to explore how to do this, but you also need certain skills and the ability to distribute these skills geographically — and that’s where digitalization can help.  

What’s the role of more and better data in strengthening health systems in LMICs for their shift toward more prevention, diagnostics and management of NCDs?

Data and digitalization can help scale medicine in different ways, for example through remote treatments. You can have a radiologist or a person who is highly trained at a certain procedure in an urban area, and by digitally connecting to a remote place, you can make health care more accessible — so long as there’s some basic infrastructure in place. This means you could catch diseases much earlier and make the expertise available in a decentralized setting. The benefit is that the patient doesn’t have to travel to the metropolitan area, which is often expensive and time-consuming, and they would only then likely do so if their condition was very serious. When we make knowledge available where it is needed, and by bringing it to the patient and not the other way around, we contribute to the democratization of health care.

And then, of course, you can capture the data of your population and make it available to help you really understand where or how disease patterns emerge in order to build a suitable system to address the most threatening diseases in a particular country and environment.

What’s your call to action when it comes to leveraging innovation and data for better management of NCDs in LMICs?

One key element to really making a difference is to look for a multistakeholder approach. Building a resilient and powerful health care system requires many different pieces, and if we can bring together these different stakeholders and team up to build a comprehensive solution, we can really make an impact.

To give a concrete example of what we are doing in this context, we are working in Vietnam with the University of Hanoi and the NGO Radiology Across Borders to jointly design a digital approach to improve the effectiveness of breast cancer screening. In Vietnam, it's very common for breast cancer to be detected very late and this is why we decided to focus on this kind of approach in a country where it would really make a difference.

Another example is in Colombia, where we’re partnering with City Cancer Challenge on breast cancer screening programs. We bring in our expertise and involve local stakeholders to look for new guidelines and ways to run breast cancer screening programs to capture as many potential patients as possible.

By bringing together different stakeholders, we as a community can create sustainable models that are also supported by digital technologies to improve the effectiveness and availability of breast cancer screening. You need more than just technological innovation to make a difference.

Learn more about Siemens Healthineers' work to support LMICs toward more prevention and management of NCDs at https://www.siemens-healthineers.com/perspectives/rethinking-ncd