India can demonstrate its leadership in primary health care: Smita Jacob, AVPN, Singapore

Shahid Akhter, editor, ETHealthworld , spoke to?Smita Jacob, Director, Policy, at Asian Venture Philanthropy Network, Singapore, to figure out India's G20 Presidency priorities by way of health care leadership in primary health care, supply chain management and PPP models using blended finance.

G 20: Health imperatives

It is??a momentous year, not just for India but also globally – because if we look at the history of G20 itself, it’s for the first time that the Global South is going to consecutively be hosting the G20. It started with Indonesia, its moving to India, going over to Brazil and then South Africa.?If we try and understand the geopolitics of this what it means is that the Global South itself is leading the entire conversation now on what impact priorities are, and what are the socio-economic priorities for the entire world.

The other important piece is that it’s also for the first time that two Asian countries are hosting this consecutively. So really, this is the decade for Asia to lead. In that context, when India is now coming into the picture, for leading G20 this year, what is critical is to really look at what is it going to try to do for SDG-3 which is focused on healthcare, and what are the key aspects that can be focused on.?Our understanding is that one of the key aspects to focus on is going to be infrastructure for primary healthcare. That is something that can really?demonstrate doing well and it can be taken forward to the entire world to demonstrate what that can look like.?No other country will be able to demonstrate the scale that India will be able to. And if that can be a successful case study, I'm sure India can come out to be the leader in this space because??primary healthcare and the infrastructure related to it is the crux of a lot of the health-related issues?there are.

We continue to focus a lot more on infrastructure in urban areas, tertiary healthcare as well, but primary healthcare, especially in rural areas?is critical.??India can play the role of being the leader in this?and there is a lot of focus as well on it.???We are hopeful that at the end of this G20, India will be able to pave a roadmap ahead to take it forward, to show the world how this, the entire primary healthcare infrastructure can be focused upon.

G 20: Lessons learnt & Asian Solutions

?It’s very important to look at what G20 Indonesia was able to do.??Indonesia was able to really set forth the entire Asian context, find Asian solutions to the global problems that there are.?I think it’s critical that we now take forward the G20 Presidency. When India is taking it forward, we look at what Indonesia was able to do, and what many other Southeast Asian countries have also been able to do.

ASEAN is a great platform, similarly, where a lot of good practices are shared from across Southeast Asian nations,??I think that's a good space for India to start looking at best practices which can be adopted. For example, there is a lot more focus now in G20 on how developed countries do rely much more on developing countries for establishing global healthcare supply chains. And that's a very critical aspect which can be taken up.??India plays a very important role in the healthcare supply chain globally itself. So, the idea that we want to look at while we are solving for healthcare overall, is to also look at Asian solutions to these problems, rather than trying to only adopt solutions that are being deployed elsewhere, say in Western countries which may or may not completely fit to the kind of problems that especially developing countries in Asia face.

Need to showcase ASHA workers

?When we are looking at what have been the lessons that we have learnt so far, it’s very important to look at what Indonesia has been able to do, and similarly many Southeast Asian Countries across, so even ASEAN is a very important platform for India to learn from. One of the key points that were mentioned in the Leaders' Declaration this year at the G20 was strengthening of the global healthcare supply chains, especially in developing countries, and how developed countries can support developing countries in this space.

In the same breath I want to say that the G7 is also therefore continually relying much more on the G20 countries to really come back with solutions to global problems. In this context, I think what's most important to look at is what are Asian solutions to these global problems? For example, how can community healthcare be really strengthened? What is the role of community in prevention? That is a very critical piece because preventive healthcare now completely relies on individual behaviour. Individual behaviour is guided a lot by communities. For this, to look at solutions, it’s important to look at countries which are much more similar.??I think Asian countries have had some fantastic examples of how universal health coverage has worked, how primary healthcare has worked, how community programs come together. In India itself, one of the best examples is really looking at?ASHA workers.

Healthcare: Financing gaps & investments

?What is critical then to close the entire financing gap that is there and the financing gap especially for SDG 3 in healthcare is become even wider in the last two years, post the pandemic, because a lot of funding has been diverted post covid towards post-COVID recovery itself.??What is critical in that space then is the role of catalytic capital, which is how do we look at who is investing in the first mile delivery.

I think the first aspect around that is the role of blended finance itself. In blended finance, we look at two different kinds of investments. The first round of investment should come in ideally from the public sector, or even a philanthropic organization, who can take the first loss. Also, minimize the risk of the entire portfolio, and build a good proof of concept, showcase the model, following which that itself signals then to private sector impact investors overall or any kind of investors to come forward and then start investing in those areas.

To go back to the example of primary healthcare itself, that is critical how the government or philanthropic organizations can play that role. In India, there have been some fantastic examples including CMC in Vellore for example, where the government or a philanthropy?have come?together, created a fantastic healthcare model in a rural area and showcased it, leading to then much more private investments coming up in the same area. What private sector needs is that first round of signals that's coming. Because they cannot be expected to close that.

The overall SDG financing gap today is 4.2 trillion dollars, which means it’s about 170 billion dollars per year, for just developing countries. This cannot be closed alone today only by looking towards governments or only by looking towards charitable organizations or philanthropists. We need all sorts of capital flow coming together to be able to close this gap. And that's why it’s critical to look at models such as blended finance which explores public-private partnerships at scale and begins to close the SDG financing gap in a much more strategic way.

Need for PPP & Financial Alliances

?G20, 2022 was a very interesting year because Indonesia launched a legacy program which is called the Global Blended Finance Alliance. This is a?key building block towards strengthening public-private partnerships across the entire social impact space and closing the entire SDG financing gap. We, AVPN, were a founding member of the Global Blended Finance Alliance, and what we are hoping to do is take this across the next many G20 Presidencies that's coming up, to really strengthen the entire policy framework.

Today, what is missing in closing the SDG financing gap is very strong policy frameworks, for private investors, for impact investors to come forward and really invest in closing the gap that is required for achieving the SDGs at the earliest possible.??For that we require strong frameworks like the Global Blended Finance Alliance, and taking that forward, India will be able to build that, strengthen that. We have a lot of interesting examples. We are the first, one of the first countries to really mandate CSR spending on social impact. We have also got the recent social stock exchange that's come up. So, there have been a lot of interesting regulatory frameworks that's come up in India. What is now important is how do you strengthen that and look at aspects such as healthcare and look at PPP models using blended finance as a tool to close that gap.

AVPN: Bridging the gaps

AVPN's entire focus is how to move capital more strategically towards impact. And the key idea is to close the SDG financing gap itself. Now, with respect to SDG-3, which is focused on healthcare, one of the aspects that we, one of the key interventions that we had is the pooled funds, that's what we call it, which is a model for blended finance to come forward, for capital to come forward more strategically.

We've been able to bring together some key funders such as Johnson & Johnson, BMGF, Sequoia, Macquarie, to come together and invest in strengthening healthcare systems across Philippines, Indonesia, Vietnam, Thailand. And that's the key focus area that we are looking at.??We are trying to really look at how these pooled funds can be taken forward.??What's?important today is not just that capital itself moves towards impact, it’s important that capital moves more strategically.?So, for that we require that anybody and everybody who has the capital, to come together and strategically start investing rather than doing many different piecemeal approaches.?