A new wave of pioneer innovative healthcare models is evolving globally to address the rising burden of non-communicable diseases (NCDs) in low- and middle-income countries. The global healthcare eco-system is pivoting from the traditional emphasis on communicable/infectious diseases in low- and middle-income countries to focus on chronic/NCDs, according to a recently published IQVIA Institute report, Scaling-up Inclusive Healthcare Initiatives in Low- and Middle-Income Countries: Assessing the landscape of innovative approaches, produced in conjunction with Hystra – a consultancy specialized in inclusive business solutions. The report reviews the landscape of global inclusive initiatives and the identification of innovations that can strengthen the impact of businesses. These findings are intended to feed a later phase of research whose ultimate intent is to scale-up effective inclusive healthcare initiatives. Among 244 health initiatives identified and profiled, 41% of these are based in Sub-Saharan Africa, 29% in South Asia, and the remainder in Latin America and Southeast Asia.

Led by pioneers, promising inclusive initiatives are emerging to address, in a holistic way, the rising chronic disease burden and improve diagnosis, treatment, and care for those in low- and middle-income countries. However, the speed at which these models are being developed remains slow, and only few have reached their ambition for economic sustainability and scale. Therefore, finding ways to scaling up and sustaining these initiatives should be a major priority for global healthcare systems.

The IQVIA Institute for Human Data and Science and Hystra invited experts to discuss the findings of the report and to provide their perspectives on what will be required to further scale up these initiatives and strengthen the landscape of inclusive initiatives and business models.

Key highlights from the webinar discussion:

• Clustering of relevant business models: The panel reviewed findings from a global scan of 244 inclusive healthcare initiatives, which can be categorized into different segments. Using a framework for typology, the initiatives differ in the level of care they provide -– preventive care, primary care, and secondary care; in their setting– villages, towns, and cities; and can be categorized based on their approach to improving health into one of four business models– risk-prevention, community-based, pharmacy-based, inclusive clinics, and hospitals.
• Access barriers and costs of healthcare: With the rising burden of chronic/NCDs, the panel agreed that continued and repeat care is a necessity to maintain and achieve health outcomes; however, this also raises the issue around inclusive access to care, since there are challenges ensuring economic viability of these care models. In the area of risk-prevention – for example, the prevention of hypertension and diabetes – there are issues around health insurance and motivating people to pay for events that may happen in the future. Specifically, the high costs of healthcare remain a major barrier when ensuring affordability of access for people in low- and middle-income countries. According to estimates from the World Health Organization, high healthcare costs push 100 million people worldwide into poverty every year.
• Commercially viable healthcare models: Most commercially viable models for dealing with NCDs appear to be emerging primarily among healthcare providers; for example, in the development of networks of providers. The observation was made that in some countries, these networks focus on delivering a combination of care and insurance. In other countries, the emphasis is on creating leaner staffing and cost-effective workflows where new categories of healthcare workers are engaged to ensure that doctors and nurses can focus on delivering care to patients, rather than managing too many administrative tasks. In other countries, companies partner with foundations and governments to build viable models.
• Assessing and monetizing health outcomes: While access and efficiencies of care are important, improving outcomes of healthcare is the ultimate goal. Therefore, the panel agreed more efforts should be made to assess whether desired health outcomes of inclusive healthcare models are being delivered. Several organizations are performing randomized clinical studies to assess health outcomes from different programs, and some have been able to demonstrate significantly improved outcomes. An emerging emphasis is being placed on determining whether improved health outcomes can be achieved through innovative, results-based financing; in other words monetizing outcomes. One interesting area also mentioned is the rise in social loans.
• Partnering to further scale up inclusive healthcare: The panelists discussed various pathways to further scale up inclusive, innovative healthcare models. Getting the public sector involved is often a barrier and engaging governments appears to be a promising way to ensure viability and sustainability of initiatives. There is a positive trend, as governments today seem to be more inclined to get involved as partners in the novel healthcare models compared to previous years.  Application of technology, especially through partnership with technology companies, is also a way to build stronger support for cost-effective, sustainable programs. Furthermore, multi-sectorial partnerships seem to be the best way to scale up business models – for example, through broad partnerships among pharmaceutical companies, technology companies, companies in the supply chain, public sector organizations, and NGOs.
• Typology for assessment of healthcare models: The suggestion was made to develop a structured typology for assessment of inclusive, innovative healthcare models. Such a standardized typology could look at understanding intended and unintended consequences of implementing these business models at scale, validating evidence-based methodologies and data for how to assess these business models, including health outcomes, acknowledging the knowledge gaps and how to overcome them, and ensuring continuity and sustainability of services and models.

The panelists in the webinar were:

• Dr. Francois Bonnici - Director, Schwab Foundation for Social Entrepreneurship and Head of Social Innovation, World Economic Forum (WEF)
• Alexis Geaneotes - Operations Officer and Inclusive Business Lead, International Finance Corporation (IFC)
• Veronika Wirtz - Professor of Global Health at Boston University School of Public Health and Director of World Health Organization Collaborating Center in Pharmaceutical Policy

A link to the recording of the webinar may be accessed here.