Closing the Health Care Gap: Why Innovation Matters
The commitment to leave no one behind is enshrined in the 2030 Agenda for Sustainable Development but over the past two years, COVID-19 has set back our mission of levelling up health outcomes in countries around the world. To get back on track, we need to harness the intensity of innovation displayed in our response to the pandemic. To find out more about innovative ways of delivering health care services in markets where others don’t reach, Gemma Kyle—Senior Associate Director at APCO Worldwide and member of APCO’s strategic partnerships and global engagement team—sat down with Edward Booty, founder and CEO at reach52.
You founded reach52 in 2016 as a tech startup to deliver affordable and accessible health care solutions to rural communities. Your work undoubtedly took on heightened importance during COVID-19. Could you describe your work and the biggest changes resulting from the pandemic?
Of course, and thanks for having me share what we do!
Our mission is to reach the 52% of the world that lack access to health care. We train a network of “Agents,” often community health workers, in rural areas to collect data on health care needs and run more targeted health engagements (such as awareness, screening, disease-specific support and more). This is all managed through our tech platform.
We currently operate in five countries (Philippines, Cambodia, Indonesia, India and Kenya) where we’ve trained over 8,500 Agents and serve about 2,500 communities. We work closely with governments, and also private sector companies and foundations who often fund our campaigns and make affordable products available to emerging markets.
We’re not a charity; we work with lower-middle income people who have some ability to pay but struggle to access services. Through our platform, we’re able to empower people already in the community to extend traditional health care to remote areas.
The pandemic was tough. We were completely grounded for a while. But we worked hard to reach people through a ‘full digital’ service (chatbots, remote support via the phone…) and also by engaging community partners on the ground (such as NGOs and small businesses) to recruit and train Agents. This has worked so well that it’s become our primary growth model. Much of our recent focus has been on COVID-19 awareness and vaccine access but we’ve also done a lot of work in diabetes, hypertension, vaccines, maternal health, nutrition and even insurance.
The name reach52 refers to a 2018 World Bank and World Health Organization statistic which showed that 52% of the world’s population lack access to essential health care. Are we making progress in closing this gap? What trends are you seeing?
That’s a tough question. Are we making progress? Yes, in some areas. Are new issues arising? Yes, most definitely. It is a sad fact that, as a result of COVID-19, even fewer people today are able to access health care.
On the progress front, many more pharmaceutical companies are creating new business units, pricing strategies, roles and teams, partnership models and “access strategies” to enable affordable access to drugs. While governments have been making steady investments in improving the quality and reach of public health care systems. We also have more social innovators, impact investors and a society that is sensitised to health inequities. Together, they are helping to push the agenda forward.
Compared to 10 or 20 years ago, we have a lot to be proud of. But challenges remain.
Pharmaceutical companies are becoming more specialised and jettisoning their primary care or genericised assets – arguably making them less relevant to mass-market global health needs. Demographic shifts (aging populations) and unhealthy lifestyles (diet, sedentary behaviour, pollution) are putting increasing pressure on fragile health systems.
As we turn a corner in the pandemic, what I hope to see is health care being placed at the centre of economic policymaking and a greater focus on prevention and wellbeing alongside reactive care. There is huge economic benefit to having a healthy, productive population.
The pandemic is jeopardising hard-won health and development gains. What should be the priority for health systems in low resource settings in the year ahead?
Perhaps as an unintuitive start to this answer, I’d like to take a step back from health care. Digital maturity, in terms of reliable internet, inclusive access and digital payment systems, is the bedrock of any socially-minded innovation. At reach52, we sometimes work offline, with cash and with health centres who lack internet. This makes everything harder.
Once we solve for this, it’s important to think about design. Lifting and shifting often-broken urban or developed country models of care just won’t work. New care pathways, tech and systems are needed for a completely different environment. And to ensure success, we need to focus on the benefits to end users—both patients and policymakers.
Next, I would consider operations. Here, it is critical to get the basics right—simple tech, collecting data, registering patients with an ID. Then get the referral systems between health professionals working. Make it a simple experience for frontline workers and patients.
Lastly, focus on the biggest challenges first. This will bring about greater returns in terms of impact on people and it makes solving subsequent challenges easier. For example, getting diabetes or vaccines sorted (high volume, high impact) makes it comparatively easier to tackle less prevalent (but often more complex) diseases, such as migraines, cancer, or more specialised vaccines, thereafter. Starting with mass-market basics provide the foundation for more complex referral and patient support systems over time.
To recover lost ground from COVID-19, we also need to accelerate innovation. This means pushing organisations to break down barriers and rethink the way they collaborate across sectors, with “improving health for all” as a common and unifying goal.
Innovation is critical to accelerate progress towards achieving SDG 3 “Good Health and Wellbeing” by 2030. What advice do you have for private sector actors looking to get involved?
I’m certainly of the belief that innovation has to come from the private sector, across all of the SDGs. We’ve been fortunate to have worked with over 15 major forward-thinking business partners, including Johnson and Johnson, Bayer, Pfizer, Sanofi and more.
I’d summarise my advice into three points:
Firstly, consider the business model. What is the private sector entity really trying to drive? All too often the rhetoric of access to health care is not matched with an appropriate business model or financial expectation.
Secondly, the time frame. Working in emerging markets is hard and takes time, especially when forging new partnerships and integrating your services with government. Initiatives like these don’t reap returns within an annual P&L cycle. Business leaders have to commit, stay the course and play the long game. I’d liken it to developing a new drug—it’s a 10-year strategy, not an annual sales and marketing plan.
Lastly, alignment. At times, the admirable ambitions of private players don’t translate into country level key performance indicators and goals. It’s critical to understand national needs and priorities and this takes time. There may be mistrust at first but it’s a team building exercise—clear and shared goals, transparent intentions and genuine partnership can drive multi-sector success. For any solution, this is key to ensuring long-term sustainability and delivering change at scale.