Dear Ed... 52% of the world can't access healthcare

It’s a big problem, a social injustice. We need to talk about it – and turn it into a sector of opportunity for all.

‘There is enough knowledge, assets, technology and goodwill in the world to create health access for all; we just have to apply what we have and know differently’

My original mantra and strapline for reach52.

If you take anything away from what I write today, it would be to just take a step back and think about this and let it sink in. 52% of the world can’t access essential healthcare. That’s 3.7 billion people. This number is rising due to COVID-19, and disproportionate population growth in lower-income countries without comprehensive health infrastructure. ?This is a huge issue, and needs to become a sector of opportunity for all.

What does ‘no healthcare access’ even mean? Well… going to the doctor; getting basic medicine; having sanitary pads for a young girl’s period; treating or managing cancer; managing a genetic birth defect; getting a baby vaccinated; or providing care needs in older age. And a whole load more.

To solve the vast majority of this challenge, we don’t need new inventions. ?Access to basic medicines that cost as much as your morning coffee could transform the lives of billions, along with better human health resources and facilities, and a health-seeking population.

I’ve long been frustrated, depressed and aghast at this. I’ll lie awake at night and think about it to this day, imagining the unlucky people born in a country where healthcare sucks. All I did to get healthcare access was be born in the UK. To many, it’s ‘the other’, based ‘over there’ in poorer countries; and not directly affecting day-to-day life for those with the means to drive innovation and financing to solve the problem.

Why is it so hard, and are we doing at reach52 to try and build a company to tackle this? Candid rant ahead… (get me over a beer to hear the angry, swearing-filled version ??).

I’ll explore three topics:

1. The original plan
2. My present views
3. Hopes for the future

The original plan? Crowdsource a health service.

Get freebies or low-cost goods from different companies and glue it all together. For example – tech from Microsoft, training materials from a big health company, and meds from a pharma company. Joining different companies’ agendas to form a cohesive, more impactful service. ?Create some form of platform and revenue model based from that.

Why didn’t this work? ?There were just too many issues: aligning stakeholders was like herding cats; corporate impact strategies are on long (often 5-10+ year) cycles and too hard to stick together; legal implications; different countries of focus for partners; the complexity of getting a fully-functioning health service just through donations… ?Perhaps a stupid idea with hindsight. We also found that South East Asia gets less corporate social impact focus compared to other regions, like Sub-Saharan Africa. Even when we did get support, very little of the resources we received were easily portable across markets, and/or suitable for lower-resource settings (particularly tech).

More fundamentally, for all the lofty goals at global level involving social business or access to health, little of this sentiment filters down to local teams. At the country level, the operations typically function as sales offices, disconnected from their teams’ targets at HQ. So the reach52 pitch could align to the overall company, but often not many people’s actual goals within it. You need to find the right team that is willing to get their hands dirty, which is often a smaller offshoot group of the core business that cares about what you do.

My present views – We have made some progress, but the challenges ahead are steep.

So we evolved – building our own tech for low-resource settings; setting up an agent network; running campaigns and selling/distributing products. We generated revenue from businesses to run the campaigns, and from sales of affordable products. We had free tech resources from a number of partners, so build an app to use as a kiosk or shared platform, that could be used in a local shop of community facility, turning them into a health access point. Makes sense, right…?

…then the real problems started. ?Tech with no internet on old phones is hard. Big, listed companies typically have more of a social conscience than local private sector partners who are less mature in their ‘social business’ thinking and aspirations - and thus creating a health access platform is really hard. For example, some local firms will look to fix prices high and often not pass on discounts from our global manufacturing partners, refusing to support their fellow countrymen who can’t pay enough. ?You can find ways around this, but it costs time and money to set up complex and secure supply chains; especially as often the big global brands are often exclusive with these local chains, so you’re stuck.

Shared tech had a myriad of challenges – people aren’t naturally health seeking, were too scared to use the device in case they broke it, or just weren’t a ‘digital’ consumer of health services – like many of us, going to a doctor is the norm, even if the doctors are scarce. Regulation that made digital health services hard also hampered us at every step.

You need to work with governments, who are distrustful of the private sector.

There isn’t enough funding, from any party, so you can’t do a ‘quality’ service on a shoestring.?

One of my biggest shocks is, even when we got this all working, people say they want healthcare, but still don’t adhere to treatment and care plans – even when made incredibly affordable, or even free. This is a problem the world over.

These are the reasons why people can’t access health: lack of basic tech/payments infrastructure to innovate; partners don’t work together well enough; and there’s not enough money in the pot, which means businesses and innovators don’t have incentive to chase the prize and bring their services to market. New innovative solutions are often hampered by regulation, which in many cases is perfectly reasonable (e.g. a doctor should prescribe a medicine), but what do you do when there is 1 doctor where there should be 1,000 for the same population? Or when there is no pharmacist to work in a pharmacy? ?And above all, health seeking is low. If you’ve never really accessed a doctor-within-reach, why would you think to access a doctor via an app?

In short, I’d argue healthcare is one of the hardest, messiest and most complex sectors on the planet. Change doesn’t happen overnight, there is a lot of stakeholder misalignment, a big lack of human and physical resources, the legitimate need for regulation that often can’t work when the regulatory-necessary resources aren’t there, and the needs of populations are going up but funding isn’t!

The future: Big change is needed.

Bluntly, I’m less than optimistic about delivering the Sustainable Development Goals (SDGs – the global goals for inclusive development) call for ‘Universal Health Coverage’ by 2030. That’s 8 years to go; 52% of the world can’t access healthcare; and, Ill repeat, the figure is increasing!

I often hear a do-good rhetoric from companies that lacks action and substance. Even if corporate goals are successful, wider change across governments and multilateral agents are needed – there will still be a gap. Health access commitments are often marketing tools to appease wealthier customers and citizens – ‘greenwashing’ exists in health access too. Commercial imperatives will always (rightly so, in a commercial business) prevail… and, unfortunately, poorer people aren’t a market many want to build new products for…

Big change is needed, and not all can come from reach52. So what…?

My analogy would be ‘its very hard to buy a $100 phone, if you only want to spend $30’. To solve this, there needs to be more funds and a supportive innovation ecosystem (led by government) and ‘frugal innovation’ led by business (new product lines, or special prices for higher volumes in emerging markets, innovative low-tech solutions).

I still believe we have the tools to enact the change we need, and that the real issue is equitable distribution under current geopolitical and market systems. Better regulation and standards are also needed, to ensure future integration of partners and not recreating data-silos and fragmentation that has plagued many multisectoral health systems. A leapfrog is essential.

The real innovation must come from structural and institutional strategy, partnership incentives and action. I don’t believe current systems will deliver change, we’re sleepwalking in a dreamland of all-talk and low-action - too many conflicting, fragmented stakeholders passing the buck while people die of incredibly basic and easy-to-treat illnesses.

I’d love to explore a ‘human tax’ (creating a new pool of funds to rebalance global wealth for social goods), or tax incentives for big companies to generate ‘real’ models to improve access in lower-income communities, or multilateral pressure to get governments to spend more... Or in reverse, tax breaks and cheaper capital for those that actually do good.

There is no single solution, and ultimately each country’s politicians have to prioritise health as part of their pledges, and just put enough cash in the bank to catalyse the sector and make it happen. If there was enough money to train health professionals, build facilities, and stock them properly… reach52 would go out of business, and I’d be darn happy about that too! ?Albeit when we think about the leapfrog, it will also be essential to consider public health, prevention and wellbeing – versus another reactive health system that continually creaks under rising pressures. Social determinants of health, and the root cause of health issues also cant be ignored as low- and middle-incomes grow – unhealthy diets and sedentary lifestyles create the burden health systems have to deal with.

Governments need to lead the charge, and people need to elect them with that mandate. And, of course, money talks – so the big funders of the world have a role to reward the companies they invest in for having responsible, sustainable business models. Much private capital, especially in Asia, doesn’t do this and purely seeks to maximise returns.

Thus, the solution is relatively clear (yet, not simple):

1. Governments need to invest more, and lead the charge – including progressive regulation
2. Businesses, probably via financial incentives, need to adjust their business models to serve ‘the other half’ of the planet – in a sustainable way. This must also include wider industry players (telcos, tech and mobile devices, logistics etc are all essential)\
3. Innovative new leapfrog approaches are essential – driving public health and awareness, through to helping people get the care they need; whilst really addressing the environmental and societal challenges that spur many of the diseases people develop

I’ve often wonder if my frustration is normal or simply a common trait for startup founders who ultimately share the compulsion of seeing a problem want wanting to fix it. I share these hard truths, not to caste blame, but in an attempt to shake us from our slumber. There’s much to be done and too much at stake to continue sleep-walking in do-good rhetoric, without truly moving the needle.

I have never been more confident of a huge opportunity for impact and commercial success in our segment. I just hope more people look to develop solutions to capture, and create, this opportunity for all.

So eyes wide open, thinking cap on, and let’s push for real change. Healthcare sure needs it.