Leveraging at scale to tackle chronic illness

Michelle Akande

by Michelle Akande

Vice President, Health Markets

Significant progress has been made against infectious diseases over the past two decades. In 2004, an estimated 1.7 million people died of AIDS-related illness but by 2018, that figured had dropped to 770,000. Equally impressive strides have been made in the fight against malaria, with deaths decreasing by 180,000 between 2010 and 2018.

Whilst the progress against infectious diseases has been nothing short of remarkable, the burden of non-communicable diseases (NCDs) like cancer, cardiovascular disease and diabetes has increased, claiming an estimated 41 million lives in 2018.

The World Health Organization (WHO) estimates 15 million people aged between 30 and 69 die prematurely of an NCD, with more than 85% of these deaths occurring in low- and middle-income countries. The message is clear: while we have got better at preventing deaths from infectious diseases, we must increase our focus on NCDs to ensure people everywhere live full, healthy lives.

We can draw encouragement from our experiences tackling infectious diseases. The past two decades has seen the launch of initiatives such as “3 by 5” by the WHO and UNAIDS to get treatment to three million people by 2005. We have seen product development partnerships and innovative financing tools reduce the time it takes new, effective treatments to reach people in under-served markets. And millions of people have benefitted from the Affordable Medicines Facility providing malaria medication to public and private patients to shift the market away from less effective treatments. Patients, governments, the global health community, patient advocacy organisations, manufacturers and other critical stakeholders have demonstrated the power of partnership by responding to many of the biggest health challenges of our time.

Transformation through partnership

As we consider the way forward in responding to NCDs, we are excited about the transformative potential of partnerships in this space. Recently, my colleague, Hafeez Ladha, and I joined colleagues from government, global health and industry to discuss options for scaling up access to diagnostic tools, treatment and care for NCDs.

The discussion, led by the UN Interagency Taskforce on the Prevention and Control of NCDs and PATH, as the secretariat for the Coalition of Access for NCD Medicines and Products, was timely. Global concern around NCDs is increasing, and has been raised at the UN General Assembly, the Economic and Social Council of the United Nations and the World Health Assembly.

It is crystal clear that without focus and collaboration on NCDs, the world will miss targets 3.4 and 3.8 of the Sustainable Development Goals. This will result in significant loss of life, widespread poor health, personal financial hardship, and productivity loss bringing substantial economic implications.

In the coming months, Hafeez and I will look at three areas where existing and emerging solutions could have a major impact on the burden of NCDs. We have provided a brief overview below:

1. Market Shaping Interventions

As we have seen in other areas, demand aggregation helps to secure lower prices by promising manufacturers greater predictability and efficiencies through higher demand. Successful examples of this approach for infectious diseases include Gavi, the Vaccine Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Managed entry agreements and innovative access models are increasingly being used in lower middle-income countries and manufacturers are also exploring direct-to-patient models that remove additional costs that occur in the value chain between production and end user.

2. Positive approaches to financing NCD diagnosis and treatment

Countries are stepping up efforts to ring-fence money specifically for NCDs. For example, Kenya has dedicated part of its relatively modest health budget specifically for the reimbursement of treatment for NCDs. This gives all those in the health system, including patients, greater clarity on what will be reimbursed and what their expected contribution will be. In turn, this spurs greater innovation in responding to the financing gap.

We are also seeing greater advocacy at country level for increased domestic focus on NCDs. In Nigeria, coalitions including patient advocacy organisations, key opinion leaders (such doctors specialising in NCDs), manufacturers and NCD coordinators in the Ministry of Health are influencing critical funding decisions and budget allocations towards greater support for NCDs.

From domestic funding to multi-partner coalition advocacy and interventions that lessen the impact of out of pocket payments to developments in global financing, there are positive advances that can be modelled and amplified for NCDs.

3. Innovative approaches to service provision for NCD diagnosis, treatment and care

New partnerships are emerging to provide support for patients throughout the care journey. In many cases, they connect services offered by government or fill gaps where services do not exist and provide long-term continuity of care, often making use of mobile technology.

Some social health organisations are also shifting the focus from treatment to prevention. For example, many of the risk factors for diabetes and cardiovascular disease can be addressed earlier and the negative impact either lessened or avoided altogether. Where prevention is not possible, social health providers are supporting patients to better manage their conditions, helping them to adhere to treatment and providing advice to avoid symptoms of deterioration.

Working with partners, countries are also at the forefront of strengthening the regulatory systems that play a key role in ensuring patients have access to quality, safe care that is efficacious and patient centred. Tanzania, for example, has now reached level 3 regulator maturity, joining only 30 countries globally.  Countries like Egypt are bolstering their capacity by introducing Health Technology Assessments to ensure the most appropriate products are made available.

Next steps

Reducing premature death and preventable illness due to NCDs will be an enormous task, but we can take heart from the successes we have seen tackling infectious diseases, and the contextually appropriate solutions emerging in the chronic care space. Although many of the countries that bear the largest burden have nascent health systems and the most constrained resources, we know that effective partnerships can bridge financial and structural gaps to ensure people have access to effective diagnosis, treatment and care. Through our work at MedAccess, we will continue to play an active role in the discussions and look for opportunities for our social finance solutions to accelerate progress on NCDs.

Stay tuned for more.