“The challenge is no longer only to gain political support, but one of investment and implementation. It is no longer arguing for greater priority, but one of being accountable for delivery on agreed outputs and outcomes. It is no longer about proving the benefits of action, but about reaping the benefits of evidence-based solutions”
–WHO Independent High-Level Commission on NCDs
Medtronic LABS proposes a cross-sector partnership driven by private sector commitments and focused on achieving measurable Non-communicable Disease (NCD) outcomes through the design, implementation and scale of healthcare delivery models.
THE IMPENDING NCD CRISIS
For the first time in human history, non-communicable diseases (NCDs) kill more people than communicable diseases. Today, NCDs are responsible for 72.3% of all deaths worldwide. Despite the misconception of NCDs as “lifestyle diseases” of the affluent, low-and-middle-income countries (LMICs) are disproportionately impacted, with LMICs accounting for 78% of all NCD deaths and 85% of all premature adult deaths worldwide. Furthermore, the links between NCD burden and economic losses are well established. According to the World Economic Forum and Harvard School of Public Health, LMICs lose $500 billion USD per year in economic output due to the cumulative effects of NCDs. The burden of NCDs is projected to rise at a faster rate in LMICs than in high income countries, compounding global inequality. Yet despite longstanding evidence of the impending NCD crisis, financing remains woefully inadequate. Only 1-2% of total global health spending goes towards NCD care.
Meanwhile, political commitment to NCDs has been building. Decades of global resolutions, agreements, reports and campaigns have garnered political momentum leading up to the 2018 High Level Meeting on NCDs at the United Nations General Assembly where world leaders reaffirmed commitment.
EXISTING INITIATIVES AND PARTNERSHIPS
Building on the political commitments, notable multi-stakeholder initiatives focused on NCDs have emerged, including the NCD Alliance, the UN Interagency Task Force on Prevention and Control of NCDs, the Defeat NCDs Partnership, and UHC 2030. Each of these alliances include private sector constituents as donors and participants, but the efforts remain grounded in advocacy, knowledge sharing, capacity building and policy rather than concrete financing and implementation.
ALIGNMENT ON METRICS
In addition to common political commitments and multi-stakeholder initiatives, the global health community has also aligned on targets, anchored to Sustainable Development Goal (SDG) 3 on health and wellbeing and associated sub-metrics on NCDs. SDG 3.4 aims to “reduce by one third premature mortality from NCDs through prevention and treatment and promote mental health and wellbeing” by 2030. The associated metrics are SDG 3.4.1, the mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic kidney disease and SDG 3.4.2, the suicide mortality rate.
CONSENSUS ON APPROACH
There is growing consensus on the right ingredients and approach required to achieve SDG 3.4. The five major NCDs (cardiovascular diseases, diabetes, cancers, chronic respiratory illnesses and mental health) are comorbid and share common underlying risk factors (tobacco use, harmful alcohol use, unhealthy diets, physical inactivity and air pollution). The WHO recommends 88 “Best Buys”or cost-effective interventions for tackling NCDs grounded in two key objectives:
- “reduce modifiable risk factors for NCDs and underlying social determinants through creation of health promoting environments.”
- “strengthen and orient systems to address the prevention and control of non-communicable diseases and the underlying social determinants through people centered primary care and universal health coverage.”
On the face of it, the interventions are simple, but the financing, design and implementation of the healthcare delivery models required to achieve these objectives at the ground level are not.
THE TIME FOR PRIVATE SECTOR LEADERSHIP IS NOW
Political momentum, global partnerships and alignment on metrics and approach are critical steps to improving NCD outcomes for patients. Yet, commitment and consensus are not sufficient. According to the WHO, we are not on track to achieve SDG 3.4. The failure to reach SDG 3.4 will have far reaching effects. Because NCDs are so closely linked to economic and social development, the impact of our failure to achieve SDG 3.4 extends to other SDGs including those related to poverty, hunger, education, gender, equality, economic growth.
With inadequate financing and no major global funding mechanisms for NCDs in place, it’s time for the private sector to step-up. To date, coordinated private sector financial commitment, innovation, thought leadership, and most importantly, concerted action has been largely absent.
THE “NCD DELIVERY COLLABORATIVE” PARTNERSHIP
Given this backdrop, Medtronic Labs is calling on private sector leaders to join us in our fight against NCDs. We propose a new initiative, the “NCD Delivery Collaborative”, as private-sector led, cross-sector partnership focused on achieving measurable outcomes for NCDs through the design, implementation and scale of healthcare delivery models.
The Collaborative focuses on healthcare delivery and implementation to fill critical gaps in our global efforts to tackle NCDs. We believe that the private sector —with constituents from the medical technology industry, the pharmaceutical industry, digital health innovators are more —has the potential to bring together key pieces of the healthcare delivery system to shift NCD care delivery towards the aspirational objectives outlined by the WHO, while simultaneously aligning with Ministries of health and strengthening the local public health system.
Our goals support the objectives of the NCD Alliance, and align to metrics outlined in the WHO Global NCD Action Plan 2013-2020 and the 2030 Agenda for Sustainable development:
- By 2030, reduce by 33% overall premature mortality from NCDs and promote mental health and wellbeing
- By 2025, reduce by 25% overall premature death from NCDs
In the medium term, the Collaborative aims to:
- Measurably improve NCD outcomes for over 10 million patients
- Leverage adequate global financing to ensure long-term sustainability
- Innovate public-private-community partnership approaches
To achieve our goals, we propose that the work of the Collaborative rest of 5 strategic pillars that will define our design, implementation and scale of healthcare delivery models:
- Essential Medicines & Medical Technology:
- Ensure access to essential medication and technology for target diseases in both public and private delivery systems
- Patient-Centered Care Delivery:
- Design primary care delivery models around the patient, including incorporating social and behavioral determinants at the root of poor health
- Digital Health:
- Leverage digital technology to enable scale and efficiency as well as new insights through data science
- Outcomes Based Financing:
- Drive health system transforming towards paying for outcomes rather than inputs by through innovative financing models including, social impact bonds, outcomes-based financing and/or value-based healthcare models
- Cross-sector partnership
- Work alongside Ministries of Health as well as global and local stakeholders to ensure alignment and long-term sustainability of the models created
While the Collaborative aims to bring private sector capacity, capabilities and resources to bear, we must ensure cross-sector governance and participation. We will seek potential collaborators including, WHO, WEF, Ministries of Health, Academic institutions, Foundations, Civil Society Organizations, Local Communities, Local Patient Advocacy Groups, amongst others.
OUR TRACK RECORD
At Medtronic LABS, our mission is to expand access to healthcare for underserved patients, families and communities across the world. We do this by designing, building and scaling technology enabled service models that address critical barriers to care across the care continuum. We have already expanded access for over half a million patients and treated over fifty thousand patients in South Asia and Africa.
Earlier this year, Novartis Social Business, Medtronic LABS, the Ministry of Health of Kenya, county governments and Management Sciences for Health launched Afya Dumu, a cross-sector partnership to address the growing burden of diabetes and hypertension in Kenya and reduce health system costs. The “NCD Delivery Collaborative” will build on our initial signs of success and aim to amplify our impact across the world, continuing to innovate more efficient and effective ways to reach outcomes for NCD patients.
We envision a world where all people have access to quality, affordable healthcare. Today, as donor funding contracts, as disease burdens rise and as demographics shift, private sector participation in the global health community is more important than ever. To achieve this, we believe that we need a fundamentally new approach to healthcare delivery. Our work is just beginning.
By Anne Stake