Improving global health is a large, but necessary, goal if the world is to combat the wealth divide, social inequality and increase productivity and innovation. So far, interventions have focused on treatments, professionals and clinics being ‘helicoptered in’ from developed nations. However, a more sustainable and scalable approach is in empowering developing nations to build their own health infrastructure and reduce their reliance on external providers. Plus, by relying on developed countries and private companies to intervene, some of the world’s poorest are denied care because of stock limitations and affordability.

Drug affordability impacting care

Take, for example, the treatment of multiple drug resistant TB. One in 20 HIV-positive patients globally have this strain of tuberculosis. There are 32,000 people in Africa alone who suffer from the disease. But accessing regularly available, affordable drugs is problematic. New treatments are often exorbitantly expensive, so, if a patient becomes resistant to a certain drug regime, they may have to wait months for an alternative. Similarly, some third-line antiretroviral therapies for HIV remain out-of-reach to most patients as they are still under patent.

1.6 million Africans died of malaria, TB and HIV-related complications in 2015 - diseases that could have been treated or prevented with timely access to the right drugs. But less than 2% of drugs used in Africa are produced on the continent so many patients don’t have access to local drugs that are often more affordable. Some medicine may only be available in clinics that are hours away from a patient’s home.

Because of this, in some parts of Zimbabwe, nurses often give out painkillers to patients as a ‘treat-all’ drug. Most medicines are unavailable due to supply chain issues or pricing, so the nurses feel that they have little choice. A lack of storage facilities and poor transportation infrastructure worsens this.

Generic drugs as a solution

One solution being considered by global health bodies, including the World Health Organisation, is to empower developing countries to create generic versions of in-demand drugs. This, however, has been met with some resistance by the pharmaceutical industry. Not least because expensive patent-protected drugs are how pharma giants cover the cost of researching and developing new drugs (R&D). However, there has been some progress. GlaxoSmithKline is waiving its patent protection for new drugs in the world’s poorest nations including Afghanistan, Rwanda and Cambodia.

In any case, if the pharma industry does allow for generic drug production in the developing world, it will remain a long road to actualisation. Africa’s capacity for pharma R&D has a long way to go with only 37 out of 54 African states having some level of drug production. Plus, most African countries must rely on imported ingredients.

However, India is spearheading local generic drug production, alongside Egypt, Morocco, South Africa and Tunisia. Ghana, Kenya, Nigeria and Tanzania are currently developing production capacity. Early results are promising - with local production helping to bring down the cost of medicine in Cameroon.

Empowering with knowledge

Meanwhile, efforts are underway to equip and empower frontline workers in poor regions with the right knowledge to care for patients. They are also working to improve community healthcare education, particularly amongst mothers, and provide support in preventative medicine.

CommCare, for example, is a platform that helps non-specialist users to develop their own healthcare-based mobile apps. This is helping healthcare workers provide information to expectant mothers, or support for HIV patients. Crucially, the platform is designed to work “under the mango tree”, with workers able to iterate on their designs and expand interventions at their own pace.

Preventing poverty blindness

Similarly, the toll-free ‘Call Netra’ hotline was set up by the Tej Kohli Cornea Institute to inform patients on their eye care. Helping people to spot the signs of corneal degeneration before complications worsen and they lose their sight completely. At the same time, the Tej Kohli Cornea Institute also launched an education app that helped frontline workers assess a patient’s cornea health more accurately and on-the-field. Call Netra has, so far, reached over 280,000 patients in India.

The Tej Kohli Cornea Institute itself was set-up to tackle the issues around affordability and to prevent poverty blindness. Since its launch in December 2015, the organisation has taken care of 223,404 outpatients, completed 43,255 surgical procedures, collected 38,225 donor corneas into its eye bank and trained 152 clinicians. At no cost to patients.

Improving healthcare systems

Of course, specific projects can give healthcare workers the right drugs and knowledge to improve their area’s health. But more widespread intervention is also needed. The Agence Française de Développement (AFD), a bilateral development agency, works with governments and health ministries to help build their health infrastructure and capacity. It aims to improve healthcare systems as a whole, instead of targeting specific diseases.

Broadly, the organisation works to support countries in adapting and building their healthcare systems to new health threats. Some developing countries, for instance, are at the early stages of an obesity epidemic due to poor diet. Diseases like diabetes, cardiovascular diseases and Alzheimer's disease are on the rise due to ageing populations and lifestyle changes. The AFD also helps with epidemic detection and encourages neighbouring countries to share resources and healthcare information.

In the Comoros, it has helped to build a healthcare support program that saw local hospitals and clinics renovated and upskilling of nurses and midwives in the area.

Becoming independent

For the world’s health to improve, more must be done to support developing countries. Not just in terms of emergency provisions or air-dropping resources, but also in helping countries build their own capabilities. To be effective, this needs to take a multifaceted approach that considers the broader healthcare system in place and improvements to be made there, as well as individual projects to improve community and worker education, access to drugs and early intervention.

By working on global health from many different angles, and with multiple organisations and countries collaborating on the most pressing issues, we may finally build sustainable solutions to our global health inequality.

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