Increasing Access to Care and Efficiency in Healthcare Delivery in Low- and Middle-Income Countries
Ramzi Dagher
Pfizer
Diego Guarin
Merck
Allon Jacobs
Roche
Matthew Lungren
Microsoft
Maia Thrift-Perry
BeiGene USA
Katherine Van Loon
University of California, San Francisco
J. Michael Wrigglesworth
The Max Foundation
Rebecca Vermeulen
DIA Fellow
Rachel Zhang
DIA Board Member
Courtney Granville
DIA Staff
Anna McDermott-Vitak
DIA Staff
S

ocioeconomic inequalities in medical care access and affordability, large out-of-pocket expenses, and vulnerabilities against catastrophic household expenditures continue to be significant barriers to improving health outcomes in low- and middle-income countries (LMICs). Based on 2020 World Bank Data, close to 85% of the world’s population (7.753 billion) resides in LMICs (6.52 billion), and nearly 40% do not have access to essential medicines.

This is particularly problematic when you look at the significant global health burden of noncommunicable diseases (NCDs): 77% of all deaths associated with NCDs are in LMICs. In addition, poverty is closely linked with NCDs, and the rapid rise of NCDs is predicted to impede poverty-reduction initiatives in low-income countries, particularly by increasing household costs associated with healthcare. These challenges have existed for some time, but the COVID-19 pandemic exacerbated them and brought them into further focus.

Our Opportunity

These inequities exist despite significant investments by many stakeholders attempting to improve or even create access. The need to act and unify appropriate stakeholders on a shared strategy to improve access to health screenings and early detection, medicines, and other health technologies is critical if we are to improve or create access. Some opportunities a collaborative approach might include are:

  • Co-create solutions locally to customize and ensure adaptability, feasibility, reliability, and scalability.
  • Generate tailored, affordable solutions that can be developed and adopted for different patient populations.
  • Create new/revised decision frameworks with policy makers to drive establishing predictable, inclusive health systems that prioritize early screening and detection programs alongside prevention and treatment.
  • Enable integrating digital tools and technologies into healthcare systems to make medical care (e.g., specialist consultations, disease tracking, symptom recognition, health education, referrals) more readily available to underserved populations.
  • Leverage cloud technology and cloud-based solutions to build scalable, affordable, and secure systems to collect, store, retrieve, share, and analyze health data to enable efficient, timely, and coordinated delivery of care.

Challenges and Barriers

Establishing access to care in LMICs will require overcoming several barriers related to diagnosis, funding, infrastructure, patient journey, regulatory consistency, and supply chain. Although the following list of challenges and barriers is not exhaustive, it prioritizes considerations that serve as a starting point for achieving successful pathways in these countries.

Patient Journey

  • Disease awareness and searching for information
  • Education to support patients with the disease to (overcome stigma and) manage it
  • Trust in the healthcare system, its established delivery methods, and its ability to improve outcomes
  • Access to routine care, follow-up, and management (see infrastructure)
  • Complexity of treatment algorithms make sustainable treatments in many markets untenable, requiring modification and innovation in treatment.

Diagnosis

  • Availability of reliable diagnostic methods to identify appropriate patients
    • Capacity questions:
      • New technology (self-sustaining)
      • Machines + people + other supplies
    • Quality and potential of artificial intelligence-assisted reads, partnerships for second reads, technology-coupled GeneXpert, etc.
  • Patient awareness
  • Healthcare professional awareness and ability to recognize potential differential diagnosis.

Funding

  • Sustainability of funding to ensure access over time
  • Transparency in crowd funding and other novel mechanisms such as risk sharing or pooled funding, and other innovative payment models in collaboration with third-party administrators.

Supply Chain

  • “Last mile” delivery infrastructure to get medicine into country
  • Taxation expectations
  • Clinical ability to receive and administer medicine or other technologies.

Infrastructure

  • System capacity to treat after diagnosis is often lacking
  • Availability of technology, tools, and other resources that can be shared for use, versus duplication and waste
  • Lack of operational expertise/capability.

Regulatory

  • Limitations of existing regulatory capacity overall
  • Suboptimal leveraging of collaboration models including reliance and harmonization
  • Lack of strong regulatory systems that use flexible approaches to enable approval and access.

Success is Possible

Despite these challenges, it is possible to treat patients across different disease states in LMICs. Solutions must be hyperlocalized, even where principles are common, in deployment (such as bringing the diagnostic or treatment to the patient or using cloud-based systems and other technology).

A multistakeholder approach to issues this complicated is the only way for their potential answers to have any hope of success.

To accelerate access to care and efficiency in healthcare delivery in LMICs, DIA has convened a multistakeholder consortium whose goal will be to define the sustainable “playbook” for tailoring strategies and tactics by specific markets and disease states. This playbook will define challenges/barriers and opportunities, including approaches that may be common from a practical perspective but will require localized solutions that incorporate cultural norms. This playbook will not specify any single “best” way of doing things but will instead demonstrate application of the playbook’s approaches through success stories.

Creating the Playbook

To this end, DIA has formally established a multistakeholder think tank consortium that will work together to solve a series of challenges and achieve specific goals. This consortium will create and share awareness and knowledge, ultimately improving the relationships required to move new initiatives forward. Stakeholders in the consortium currently represent:

  • Technology/cloud sector
  • Academic medical centers and professional societies
  • Patient advocacy
  • Foundations/coalitions
  • Pharmaceutical organizations
  • Regulatory representatives
  • Other subject matter experts

A pilot program will demonstrate a mechanism for creating these solutions, while an open application process will solicit ongoing challenges for this mechanism to address. This open process will create awareness of the problems faced by those working on the frontlines of bringing therapies to patients. It will also create a process for identifying challenges that local partnerships and regional customization can solve.

This collaborative consortium will build a library of profiles, best practices, and successful partnership models. The consortium will then drive projects to solve specific challenges and utilize these successes (and other experiences) to develop A Playbook for Sustainable and Repeatable Creation of Access to Care in Low- and Middle-Income Countries.

This playbook is envisioned as a resource to guide meaningful patient outcomes and increase healthcare access in LMICs.

To learn more about this DIA think tank consortium, or to learn how to contribute and help, please contact science@DIAglobal.org.

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