Health and Healthcare Systems

Access to healthcare is not enough – high quality care has to be the target

A patient collects medicine at the Kogelo Dispensary in the U.S. President Barack Obama's ancestral village of Nyang'oma Kogelo, west of Kenya's capital Nairobi, July 16, 2015. Obama visits Kenya and Ethiopia in July, his third major trip to Sub-Saharan Africa after travelling to Ghana in 2009 and to Tanzania, Senegal and South Africa in 2011. He has also visited Egypt, in North Africa, and South Africa for Nelson Mandela's funeral. Obama will be welcomed by a continent that had expected closer attention from a man they claim as their son, a sentiment felt acutely in the Kenyan village where the 44th U.S. president's father is buried. Picture taken July 16, 2015. REUTERS/Thomas Mukoya - GF10000168099

Delivery of healthcare in low-income countries is as much about quality of care as availability of treatment. Image: REUTERS/Thomas Mukoya

Harald Nusser
Head of Novartis Social Business, Novartis
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Universal health coverage (UHC) in lower-income countries has been embraced by global organizations such as the World Health Organization (WHO) and the World Bank. Developing UHC – a system of basic health care for all – is seen as a key route to attaining Sustainable Development Goal 3, which aims to ensure healthy lives and promote wellbeing.

Much of the argument focuses on improving access to care – a World Bank/WHO report published a year ago estimated that at least half of the world’s population cannot obtain essential health services, and that out-of-pocket expenses on health force 100 million people annually into extreme poverty.

But a paper published in The Lancet by Margaret Kruk and colleagues in September last year makes a different point, which is that poor quality care in low and middle-income countries (LMICs) is probably killing more people than having no access to care at all. The paper estimates that there are 8.6 million excess deaths in LMICs every year which could have been prevented by treatment. Of these 8.6 million deaths, the paper estimated that 5 million were due to poor-quality care and 3.6 million due to non-utilization of care.

Image: Kruk ME et al; The Lancet

In some disease areas – such as cardiovascular disease – the authors estimated that poor care was killing nearly five times as many people as not having access to care. But in other areas, like cancer and chronic respiratory disease, many more deaths were due to not being able to access care at all.

So what does this mean for pharmaceutical companies such as Novartis? Along with others, we are trying to make a positive social impact at scale in lower-income countries, using sustainable social business models that are able to deliver affordable treatments to people who need them.

But it is clear from the Lancet study that just measuring the number of pills delivered is not enough. Delivery of healthcare in low-resource settings, particularly in chronic disease, is as much about quality of care as availability of treatment.

That is why we are working closely with Boston University to have our Novartis Access programme on treatment for non-communicable diseases (NCDs) fully evaluated in Kenya. For us, this means tracking whether access to NCD diagnosis and care for communities in the programme has verifiably improved, rather than whether a certain number of courses of treatment has been distributed. We are publicly sharing the methodology and all the data Boston University have collected in Kenya online, so others can benefit from its insights.

We are also now applying this framework to steer our interventions in other countries. For instance, in Ethiopia, as part of our partnership with the Tropical Health and Education Trust (THET) to help decentralize NCD care in the country, we will implement the framework and measure our objectives against a set of output, outcome and impact indicators.

Such frameworks should also be adopted by other non-governmental organizations, philanthropic organizations and governments working to improve healthcare, to allow funders and impact investors to make meaningful comparisons between different approaches.

For Novartis, such data are needed, as much for our shareholders as for the many partners with whom we work and which do so much to contribute to our joint success.

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