BARCELONA — Last month, the World Health Organization’s Independent High-level Commission on NCDs released a new report, Time to Deliver. Designed to advise WHO Director-General Tedros Adhanom Ghebreyesus on how to push for noncommunicable disease progress, the report outlines key recommendations and cites the barriers to success so far.
With September’s high-level meeting on the prevention and control of NCDs at the United Nations General Assembly just a few months away, many are viewing the report as a primer for the discussion to come and already considering how they can build their involvement in the recommended actions and fight against the set of chronic diseases.
“I think it’s a very good basis for the discussion at the high-level meeting because it nicely pulls together all the inputs and effects that have been discussed before in several different subgroups for quite a while,” said Harald Nusser, global head of Novartis Social Business.
“Now they are more independently endorsed by being brought together in this report.”
How can these recommendations — which include enhancing political leadership and responsibility; prioritization and scaling; the reorientation of health systems to include NCDs; increased collaboration and regulation; the development of a new economic paradigm for funding action; and strengthening of accountability — be taken forward?
“The global call for action is independent of which sector you’re coming from: Let's really tear down the walls between the silos, let’s get together and co-create.”— Harald Nusser, global head, Novartis Social Business
Speaking to Devex, Nusser explains how players in the pharmaceutical industry can help accelerate progress, what it will take to foment a joined-up approach, and how progress can be adequately measured.
This conversation has been edited for length and clarity.
The report mentions several reasons for a lack of progress in tackling NCDs. How do you think this can be turned around and what will be the role of the pharmaceutical sector in doing so?
In providing a solution, no one can do anything meaningful alone. The important thing is that each contributor, regardless of sector, is willing to leave its own comfort zone, step proactively into unchartered territory and make proposals that go beyond the usual responsibilities.
The report’s seven reasons for a lack of progress in tackling NCDs:
1. Lack of political will, commitment, capacity, and action.
2. Lack of policies and plans for NCDs.
3. Difficulty in priority-setting.
4. Impact of economic, commercial, and market factors.
5. Insufficient technical and operational capacity.
6. Insufficient (domestic and international) financing to scale up national NCD responses.
7. Lack of accountability.
In the case of the pharmaceutical sector, this could mean appreciating that it’s not only a disease or drug manufacturing and supply industry, but we oftentimes see ourselves as being members of the health care industry.
If we take this seriously, then it’s about caring for the health of people, which automatically means contributing to care for public health and public health topics that explicitly include speaking about prevention and co-advocating the WHO best buys — and maybe even becoming part of the WHO best buy campaign in one way or the other.
You mentioned that no one can do anything meaningful alone. How key are public-private partnerships to progressing the NCDs agenda?
They are very important. No one can bring about the significant change that we need on their own, so it's critical that partnerships take place, and more and more so, that partnerships go beyond the usual partnership paradigm — which would be, for example, service provision based on a grant or on a service contract where certain activities are being performed and based on a report which everyone feels good about, or [going] beyond the usual procurement public-private contract where commodities are being supplied for a fee.
From my perspective, it’s about finding new levels of collaboration that go beyond these multilateral partnerships or multilateral contractual relationships that we’re used to.
The report talks about a “health-in-all-policies, whole-of-government, whole-of society, and cross-sectoral” approach to action against NCDs. How realistic is a joined-up, inclusive approach?
This relates very well to our vision, so from our perspective this is paramount to our success. How realistic is this? Let me answer by asking a question: How realistic is it to really speak about getting closer to the development goals and objectives by not doing so?
I don't see any other option than really leaving the traditional ways of partnering and building more complex partnerships. They may take a little longer, but they also offer big opportunities for additional financing from the capital markets through social impact or development impact bonds — two innovative financing mechanisms that only happen and work sustainably if more than just one or two parties come together and co-create something very important.
The report calls for established benchmarks for countries to assess their own progress, and to compare themselves with others. How can companies do the same?
It’s an absolute must. If I’m being critical to my own industry, peers and competitors in former times, sometimes even today: Reports are being made and press releases are being announced simply saying, “Hey, we have a new grant from this NGO and we aim, together with the help of the NGO, to improve X, Y, and Z.” Many people applaud this but from my perspective, this is absolutely not efficient enough.
Case study: The Novartis Social Business approach
“It is with some pride I have to say that Novartis Social Business has pioneered this approach for the pharmaceutical industry by engaging Boston University and asking them to develop a framework, knowing this could be tough for ourselves and for industry. We have not shied away from it. What they’ve done, [for] the Novartis Access Intervention in Kenya, is developed a methodology questionnaire and logic model and framework for monitoring and independently evaluating the impact that we have. All of those activities are being made public on the webpage of Boston University, including the questionnaire and data, because we truly believe it's not just on [our] behalf that we should know better where we can improve intervention — we truly believe if we’re engaging in the public sector then this needs to be made available to all so that all can benefit from the insights.”
— Harald Nusser, global head, Novartis Social Business.
It’s important to establish and define clearly what the goals of the given intervention are and then get the right logic model in order to monitor progress and to evaluate the impact being generated and discussed, and then made public. This should go beyond pure output accounting — for example how many boxes have been shipped, how many health checks have been conducted.
The outcome would then be: “Have we generated a higher level of insights or awareness at the community level?” It could mean: “Have we actually achieved that households pay less because we've given favorable terms to a government or to a faith-based organization procuring the medicine?” Eventually those outcomes would ideally lead to impact on society. This is the framework we need to engage with and need to be measured on.
What is your call to action for the global health community around NCDs?
The global call for action is independent of which sector you’re coming from: Let's really tear down the walls between the silos, let’s get together and co-create. There’s no bad thing per se in the private sector, whereas there’s no universal good about the public sector. We all have our complications, difficulties, and challenges — and different incentive mechanisms — but in the end we are all human beings, so we need to take responsibility, sit together, and find a mutual action item and intervention.
For more coverage of NCDs, visit the Taking the Pulse series here.