Access to care

Rethinking care for non-communicable diseases

Strengthening health systems through partnerships in low- and middle-income countries

Niels Anner
Published on April 24, 2023

To strengthen health systems in low- and middle-income countries, partnerships at multiple levels – international, local, public and private – are key. The World Economic Forum and City Cancer Challenge Foundation support and organize new solutions that are piloted around the world, particularly in the area of non-communicable diseases (NCDs). Siemens Healthineers partners with them to support access to care for everyone.

For three years, health systems were burdened with the Covid-19 pandemic. Today, they are still struggling – with treatment queues, delays in immunizations for children, and shortages of health workers. The pandemic has exposed and exacerbated the health gap in low- and middle-income countries, particularly for diseases that were not in the focus for these years – the NCDs such as cancer, cardiovascular diseases, diabetes, and stroke. 77 percent of all deaths from NCDs occur in these countries.[1]
<p>This, says Kelly McCain, formerly Head of Health and Healthcare Initiatives at the World Economic Forum (WEF), is "incredibly disruptive" to economic and social development. "It's going to be really important for these countries to start rethinking how they deliver and invest in care.”&nbsp;<br><br>McCain and her team have analyzed health trends, with a particular focus on low-resource countries, as the WEF is one of many organizations that have taken up the fight against NCDs. While access to quality and affordable health care is a fundamental human right, more than half of the world's population lacks access to basic health services. The task now is to learn from the experience, because even during the pandemic, there were "a lot of bright spots, a lot of innovation, a lot of partnerships," says McCain.</p>
<p>Collaboration and strong, relevant partnerships, both international and local, are critical to this effort. Governments, the private sector and communities must work together, says McCain, to ensure that individuals have better access to care and to make the health system more sustainable and resilient. <br><br>Siemens Healthineers is committed to play a leading role to improve access to care and enable more effective management. The company aims to achieve this goal by increasing the number of patient touchpoints with its technology in underserved countries. Since the start of the sustainability program in 2020, these touchpoints have increased by 44% or 65 million (+38 million in 2022). Today, approximately 212 million people worldwide have access to the technologies. It is also with this goal in mind that the Health and Healthcare Initiatives at the WEF are supported.</p>
<p>Good examples for collaboration and involving communities in NCD care have emerged around the world in recent years, and these can become role models for others. Countries such as Mexico, Brazil and Egypt have cancer-screening programs that cover at least 70 percent of the population, McCain explains. This has been achieved through robust public awareness programs and improved access using mobile services or taking screening equipment to community care centers.&nbsp;<br><br>During the pandemic, one important development in low- and middle-income countries was the emergence of alternatives to the hospital-based healthcare model, McCain explains. Both primary care and NCD care were increasingly moved into the community, into the home. This was safer during the pandemic, more cost-effective, and helped reduce the burden on the core health system significantly.</p>
<p>A key development has been the shift to digital tools for consultations, screenings, and for connecting patients with the best specialists or providers along the pathway. “It has been fascinating to see how virtual care has really further solidified its spot,“ McCain says. It has given patients greater access to care – and medical professionals new ways to deliver care. According to McCain, some of the most interesting and even potentially scalable solutions have emerged in countries with lower connectivity.&nbsp;<br><br>One example for this is in Rwanda, where there is only an average of one doctor for every 60,000 people. Together with private sector partners, a digital health consultation infrastructure has been built, used by over 30 percent of the population. The system even offers <a href="AI-supported">AI-supported</a> triage and a symptom review platform. Someone worried about a headache can potentially be reassured by using these tools without having to see a doctor.</p>
AI-supported products are fed with data and information. They are smart enough to classify these data to create accurate predictions and suggestions. Since 2020 Siemens Healthineers increased the number of AI-supported products and solutions in their portfolio by 21 to now 84.
Facts & Figures of non-communicable diseases
When it comes to AI, McCain says the technology can be "revolutionary" in its ability to help diagnose and catch conditions early. AI makes a difference in imaging, from X-rays to ultrasound, regardless of location, she explains. In sub-Saharan Africa, for example, someone can get a chest CT and with today's technology, that scan can then be reviewed by someone in another part of the world. “You are outsourcing some of the expertise that may not be available in the country,” McCain says.
<p>Collaboration is also a key in the eyes of Isabel Mestres. She is the CEO of the City Cancer Challenge Foundation (C/Can), an organization that helps cities in low- and middle-income countries improve access to equitable and quality cancer care. Currently, 13 cities are participating in the program, including Leon, Mexico; Nairobi, Kenya; and Phnom Penh, Cambodia.<br><br>When a city is selected for the program, C/Can engages "a huge ecosystem of stakeholders," as Mestres describes it: all levels of government, healthcare providers, research institutions and patient organizations. After a thorough assessment of data on all clinical services, financial and human quality aspects, such as guidelines and protocols, and bringing in the patient’s perspective, C/Can supports the city to identify gaps, prioritize and design, develop and implement projects to enhance cancer care. With continuous documentation and monitoring, the lessons learned can benefit other cities and countries.&nbsp;<br><br>Siemens Healthineers is one of the implementation partners for C/Can. Varian has been supporting C/Can’s efforts to find digital health solutions for cancer care since years. This includes remote education and training efforts to increase the number of local cancer healthcare professionals who can treat patients.&nbsp;<br><br>The collaborative approach, says Mestres, ensures that all stakeholders across disciplines and sectors are connected and bring their expertise together to ensure cost-effectiveness and maximum impact across the interventions. In Kigali, Rwanda, for example a digital solution has connected five cancer centers across the city and beyond to optimize the flow of breast and cervical cancer patients, reducing the time from diagnosis to treatment.</p>
<p>International partnerships are also vital to improve health financing and increase access to health technologies. For example, C/Can works with the International Finance Corporation (IFC), part of the World Bank, to increase access to imaging diagnostics in Ghana. "That's something we're very interested in, and we're looking forward to working with Siemens Healthineers as well," says Mestres.&nbsp;<br><br>Another form of collaboration helps build capacity by transferring knowledge. Developing the technical skills of health workers, but also their soft skills, is a high priority, says Mestres: "We are working with over 70 international partners to support cities in capacity building.” For example, one of the priorities identified in all cities is the need to improve early diagnostics. “In partnership with the Catalan Institute of Oncology in Barcelona, Spain, and a task force of international experts, C/Can developed e-learning training on early signs and symptoms for all primary health care professionals in the city. This course has been transferred to the local university for the development of future professionals,” Mestres adds.&nbsp;<br><br>To drive sustainable change, a local focus is crucial, both Isabel Mestres and Kelly McCain emphasize. A bottom-up approach allows the community to lead change based on real-world data and improves the chances of long-term health system transformation, says Mestres: "We're trying to take all these solutions identified and developed by local stakeholders and bring in the right partners and expertise to support the local people, to take them forward and scale them up to national level and beyond". This creates locally anchored approaches and communication that are meaningful to the community – sustainable solutions.</p>

Healthcare: A global challenge
Healthcare: A global challenge
Learn about burden of non-communicable diseases like cancer and heart disease in low- and middle-income countries. Hear about new ways to improve access to care in these countries and learn how the World Economic Forum and the City Cancer Challenge Foundation push for meaningful change.

By Niels Anner
Niels Anner is an independent journalist based in Copenhagen. He writes about science, health, technology, business and society in Northern Europe.