Saving lives

  • A surge in the number of hospitals, medical schools and medical graduates has done little to help patients in rural Nepal
- Dr Manoj Bhattarai, Kathmandu

May 31, 2016-

Countries all over the world allocate a significant portion of their national budget to healthcare. In 2013 for instance, the US spent 17.2 percent of its Gross Domestic Product (GDP) in healthcare, thereby increasing its life expectancy to 79. On the other hand, Nepal, where the fee-for-service model is predominant, had a life expectancy of 68 after spending a paltry six percent of its GDP in healthcare over the same period. Consequently, Nepal ranked 125th on the world’s life expectancy list. Hong Kong achieved a life expectancy of 83 after spending six percent of its GDP on healthcare. 

Evidently, these country-specific figures point out that the allocation of funds does not necessarily translate into better healthcare.  Why do higher healthcare costs translate into low quality care at times? Essentially, an effective healthcare model helps reduce costs, streamlines service delivery and eliminates fragmentation. Health systems in emerging economies can learn from the pitfalls of their developed counterparts. The advent of new technologies such as mobile-based solutions and telemedicine can help channel much-needed information to help developing nations enhance their healthcare systems. However, such nations should be cognisant of the fact that previous attempts to implement carbon-copy systems borrowed from the West have fallen flat over the years. Lack of feasibility, absence of innovation and increased costs are some of the factors that have curtailed their efforts. 

Things to consider

In order for healthcare systems in developing nations to gain traction, certain ideals and practices need to take centre stage. States should consider collaborating with non-governmental organisations (I/NGO). This approach can help curb the top killers in the country, which include lung and cardiovascular diseases, road traffic accidents, and low birth weight and so on. Tweaking the current healthcare set-up can help alleviate these health-related ills affecting the masses. Collaborative efforts are the lifeblood of effective healthcare systems as they facilitate the planning, development, implementation and review of policies and programmes. The (I)NGOs can have a major impact on capacity building, technical assistance, mentoring, field coordination and monitoring of programmes. Such concerted efforts are worth their weight in gold as they foster efficiency at local and national levels. For this, a robust structure is required so that it can function properly and deliver full value. 

Creating a strong primary healthcare system is crucial. It appears that the upsurge in the number of hospitals, medical schools and medical graduates has done little to provide a respite to patients in Nepal. In fact, people in remote areas continue to suffer and die of common and treatable maladies. The migratory patterns of physicians to cities or abroad has further compounded the situation in the country.

Quality care hinges on a solid primary healthcare system. Such a system helps implement evidence-based programmes to safeguard patients’ health. The Nepal government’s attempt to place an MBBS doctor in every primary care centre is definitely a step in the right direction. Similarly, offering bonuses and free training to physicians serving in underserved government hospitals have been a major plus. Health systems in resource-constrained rural settings can be strengthened by an elective rotation of medical students, residents and specialists at regular intervals. 

The implementation of distance training models to empower lower cadre staff and technicians through group work and discussions can fill the resultant void. These professionals play a pivotal role in health maintenance, offering age-appropriate immunisations, cancer screening, and detection of common life-threatening diseases at early stage. The government can rely on them to create public awareness on various issues by offering lifestyle counselling so that individuals can take proactive steps to enhance their health. Efforts taken to educate patients can have a profound effect by reducing total spending on curative treatment. 

Innovation and technology

Adopting technology in healthcare delivery can also be very beneficial. Healthcare information technology enhances accuracy and efficiency of care, lowers healthcare costs and allows easy access to patient data for analysis. While the setup costs may appear prohibitive, the long-term benefits far outweigh the initial outlay. A unified medical record system that is accessible to patients and clinicians lowers healthcare costs drastically. In contrast, multiple record systems impair service delivery and increase costs. The use of technology bridges that gap by creating an integrated system. Such a connected system links hospitals, diagnostic services, pharmacies, research institutions, health insurance agents, and the government. The system, dubbed ‘Connected Health’ in Singapore has modelled and provided a benchmark for quality, cost reduction and access. In the same vein, telemedicine can transform rural communities by leveraging the expertise of physicians in far-flung cities and abroad. Similarly, smart phones can facilitate the delivery of personalised care by tracking therapeutic procedures and providing remote support. 

Championing innovation and entrepreneurship should also be a concern. Healthcare systems should be in step with the emergent trends in healthcare products, service delivery and the evolving patient needs and expectations. However, a major downside has been the government’s failure to spearhead innovative efforts to improve service delivery. Corruption, limited resources and sluggish administration have been pervasive, thereby averting possible gains. 

Tailored and innovative solutions result from multi-stakeholder collaboration. The ‘Health Wallet’ in Kenya exemplifies such participation. Kenya’s predicament in the healthcare and technology sector resembles Nepal’s. Citizens barely have access to basic healthcare whereas mobile use has seen an exponential growth. Entrepreneurs tapped this opportunity and developed Health Wallet, allowing people to save, borrow, and share money for healthcare at very low costs using their mobile phones. At present, donors and insurers use this technology to provide health products and funds to specific segments of the population, which in turn fosters transparency. Likewise, clinical decision support software empowers health care workers to provide quality care. Entrepreneurship and innovation foster competition and quality, eventually lowering the healthcare costs. Nepal can adopt the ‘Leapfrogging’ technique, supported by the World Health Organisation, which is a reasonable approach emphasising three criteria--innovation must accelerate a health system’s development, it must be cost-effective and it must be scalable.

But in the end, sound governance is the key. The government should play a leading role in fostering transparency and minimising the barriers to success for the models discussed to be effective. A checklist to evaluate success and the factors required for sustainability can provide an impetus for innovative models with a focus on quality. Similarly, helping customers make informed choices through efforts such as promoting food labelling can translate into worthwhile results. Overall, creating an inclusive healthcare system that is affordable and sustainable involves a consideration of the best mix of resources that can deliver quality outcomes. 

 Bhattarai is a nephrologist and geriatrics fellow at Brown University, US

Published: 31-05-2016 08:23

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