Opinion: Universal health coverage and the power of partnerships

Telemedicine services in Ghana are being scaled up nationwide to expand access to quality care for populations in remote rural areas to reduce transportation times and costs for patients and to avoid unnecessary referrals. Photo by: Nana Kofi Acquah / Novartis Foundation

Every year, 100 million people are pushed below the poverty line due to out-of-pocket expenditure on health services. This is an untenable situation, both in terms of human suffering and for the long-term stability of economies around the world. Access to adequate health care should be universal, no matter where you live or what your income.

We must recognize that disease and health are not discrete episodes in our lives, but part of a bigger picture.”

— Dr. Ann Aerts, head of the Novartis Foundation

In recent years, universal health coverage has become a pressing priority in the global community. The World Health Organization recently emphasized that “all roads should lead to universal health coverage.” Similarly, the United Nations has set a target of achieving UHC by 2030, placing the aim at the heart of their Sustainable Development Goals for health. While studies generally suggest that UHC is financially feasible, it will be impossible to deliver without multisector collaboration and political commitment.

So, how do we achieve a more inclusive global health system? We must reassess our ideas of health care delivery and look at the issue holistically. We must recognize that disease and health are not discrete episodes in our lives, but part of a bigger picture. We need agile health services to respond to this, with more networks and better quality of care.

The role of technology

Digital health, with the potential to leapfrog low- and middle-income countries toward greater social equity, economic growth and environmental sustainability, can play a key role in transforming the way we deliver health care. In 2017, I co-chaired the Broadband Commission Working Group on Digital Health with information technology and consumer electronics company Nokia. We found that leadership from local government in partnership with other organizations was crucial in driving digital innovation forward, promoting well-being for all ages, ensuring healthy lives and fostering UHC.

Translating the learning into policy

How does this work on the ground?

At its inception in 2010, the Ghana telemedicine program was one of our first initiatives at the Novartis Foundation to incorporate digital health. Patients in Ghana’s remote areas faced geographical barriers to health services, including poor transport networks, limited access to health care providers and inadequately resourced health facilities. As a result, patients were being referred to hospitals for conditions that could be managed in the community, such as maternal and child health issues or hypertension.

The Ghana telemedicine program allows remote and rural communities to access specialist advice through a 24-hour teleconsultation center. Centralizing health expertise in a teleconsultation center and coaching community health workers by phone through their patient cases not only empowers them, but also improves quality of care with a direct impact on patient health outcomes. This then reduces the number of unnecessary referrals, allowing for immediate support in the event of medical emergencies.

It is vital to pioneer models that are sustainable at scale, giving the greatest chance of improving health outcomes for those most neglected by health systems. For example, the ambition of all of our initiatives at the Novartis Foundation is for learnings to eventually translate into policy that will help address global health challenges. This year, Ghana Health Services began integrating the telemedicine model into its national services. The health authorities have already started this rollout nationwide and telemedicine services currently cover 25 districts across five regions.

More recently, we have begun working on a new urban health initiative that seeks to operate at scale from the outset by taking a multidisciplinary, multisector approach. Better Hearts Better Cities aims to tackle hypertension by building a network of partners reaching beyond the health sector. These can include health care providers, as well as digital and telecommunications organizations, food suppliers, employers, insurance funds, social enterprises and civil society organizations.

This initiative will initially focus on tackling hypertension in three cities across three continents, but we ultimately want to create a roadmap for chronic disease prevention and management in low- and middle-income countries that, when translated to global policy, can improve the health of people around the world.

Partnerships as a player

Wired for Impact

Innovations in digital health technology have the potential to address growing health care needs in low- and middle-income countries, which face the rising tide of noncommunicable diseases, such as hypertension, while still dealing with infectious disease and maternal and child issues.

The Wired for Impact content series explores how to integrate digital health into global development in ways that are scalable and sustainable, and can improve the overall quality of health care delivery to build essential connections between patients, health facilities, health providers and policymakers.

Digital technology is a key enabler for the initiative. From empowering patients to manage their own health conditions to screening, diagnosing and monitoring hypertension, it is increasing access to vital services. Through partnerships with companies such as Intel Corporation, such initiatives can work to ensure barriers to the uptake of new digital tools are addressed from the outset. Again, active participation and buy-in from local government is vital in order to provide leadership and ensure long-term impact.

The success of initiatives such as the telemedicine program is evidence that the development of innovative, scalable and sustainable solutions can support and advance UHC. All stakeholders must work together to continue to implement programs that offer solutions to some of the world’s most pressing health issues: eliminating leprosy, tackling chronic and infectious diseases, and ensuring the health of our urban populations. However, we have learned that it is only when governments share in this endeavor and integrate solutions — digital or otherwise — into national services and policy that we can make UHC a reality.

For more information on the work the Novartis Foundation is doing to pave the way for UHC, click here.

How do we ensure that people worldwide get the care they need without the risk of being pushed further into poverty? Devex explores the path to universal health coverage. Join us as we ask what it will take to achieve UHC for all by visiting our Healthy Horizons site and tagging #HealthyHorizons, #Health4All and @Devex.

The views in this opinion piece do not necessarily reflect Devex's editorial views.

About the author

  • Ann Aerts

    Dr. Ann Aerts has been head of the Novartis Foundation since January 2013. The foundation is an organization committed to having a transformational impact on the health of low-income populations. Ann holds a degree in medicine and a master's in public health from the University of Leuven, Belgium, and a degree in tropical medicine from the Institute of Tropical Medicine in Antwerp, Belgium. In 2014, Ann was nominated by PharmaVOICE as one of the 100 Most Inspiring People in the life science industry.