Doing more with less: health care inspiration from the developing world

I had the opportunity to attend the World Economic Forum in Davos, Switzerland. It’s always an amazing experience to learn about new ideas in health and other societal matters from around the world. As a strong believer in the importance of lifelong learning, Davos is a place where there is always something new to learn.

This year what struck me the most was how innovators in underdeveloped countries are overcoming economic challenges and lack of infrastructure to meaningfully advance health care delivery.  Despite limited resources, these people are providing ingenious solutions to health care issues, some of which have actually put their countries further along than the U.S. in scaling digital health solutions. 

Here’s a quick recap of three meetings I had with individuals who are advancing health care delivery through innovative approaches that leverage a wide variety of care access points, mobile technologies, and less-specialized clinicians. These solutions transcend economic and infrastructure challenges.

Integrated training and technology, distributed access points, and unconventional providers can be brought together to improve access to care. At the top of this blog, you’ll see a photo of Dr. Dixon Chibanda and me. Dr. Chibanda is the founder of The Friendship Bench and a psychiatrist from Zimbabwe, and he is one of just 12 psychiatrists practicing in Zimbabwe, a country of over 16 million. He’s an amazing individual whose Friendship Bench provides a relaxed and natural setting where people can speak comfortably about what’s bothering them.

Dr. Chibanda shared that he uses grandmothers as providers, using mobile apps to teach them to provide basic mental health services. He said grandmothers bring a level of empathy to the process that has been instrumental in getting people to open up about their problems. This successful program is not just in Zimbabwe; it’s been launched in the United Kingdom and New York City.

Mobile apps and transportation are changing health care in Venezuela. We’re all sadly familiar with the crisis in Venezuela. But despite the challenges they face, Venezuelans are innovating around access to care.

I sat down with Dr. Andres Gonzalez, Director of Venemergencia, which provides telehealth and a unique form of house calls to enhance care. For example, Venemergencia’s doctors and nurses, with their diagnostic equipment, use mopeds to see their patients. Combined with a mobile app, patients can schedule appointments, and doctors are able to access patients’ medical records to provide personalized care. It’s a great example of boldly delivering care locally without the constraints of brick-and-mortar clinics. 

Telehealth is transforming care delivery in challenging rural markets. Sangita Reddy, Managing Director of Apollo Hospitals, is using technology to help people who live in rural parts of India and struggle to access care.

In 2018, she and her company facilitated 2.4 million telehealth visits in India and nine other countries in which Apollo operates. During my conversation with Sangita, she spoke to the benefits of telehealth as a means for specialists in metropolitan areas to connect with their patients living with complex diseases. Primary care physicians and nurses benefit as well, because the work advances their training.

As I reflected on these learnings, it reminded me of underdeveloped countries going directly to cellular telephone technology, skipping landline technology. I experienced this firsthand, as my father’s career began with AT&T, installing landline switches in those brown cement buildings located in every U.S. city. In the later stage of his career, he was installing cellular technology in underdeveloped countries that had no telecommunication, bypassing the less-agile and building-dependent landlines.  Fast forward 20 years, and mobile has become the preferred technology. 

Could this foreshadow the evolution of the traditional health care system, which is more institutional and expert-dependent, making it more difficult to access and more costly? The future system -- with expanded access points through less-trained individuals aided by technology -- will come, but it requires the current system to actively invest in the technology infrastructure, governments to change public policy, and companies to transition to new business models. I hope we will embrace the transition more quickly than we embraced the conversion from landlines to cellular service.

Access to care is a global issue, but solving it happens on a local level. A report from Oxfam found that “every day, 10,000 people die because they lack access to affordable healthcare.”  Solving for this is a global imperative and especially hits home for those of us in the health care industry. It requires bold and innovative approaches that meet people where they are, ever mindful of the non-health challenges that impact their access to care.

I’d be interested in your thoughts. What assumptions about health care do we need to challenge? In your community, how are innovators helping to improve access to care?