NCD: Tech adop­tion to im­prove over­all health con­di­tions

BioSpectrum (Asia) - - Content - Priyanka Ba­j­pai priyanka.ba­j­pai@mmac­tiv.com

Many coun­tries have re­alised the im­por­tance and ben­e­fits of con­nected care and en­folded tech­nol­ogy in or­der to meet health­care chal­lenges preva­lent in their re­gion. Tech­nol­ogy is a big part of any so­lu­tion at­tempt­ing to ad­dress the is­sue, play­ing a key en­abling role across all stages of health­care ser­vice and de­liv­ery – from pre­ven­tion, to di­ag­no­sis, to treat­ment and also care at home. How­ever, pri­vacy, cost and bu­reau­cracy con­cerns still chal­lenge greater adop­tion of con­nected care. This could be achieved by new or­gan­i­sa­tional struc­tures, gov­er­nance, plat­forms and change in mind-set.

In­ci­dence of non-com­mu­ni­ca­ble dis­eases (NCDs) is on the rise, glob­ally as well as in Asia Pa­cific re­gion. Im­pli­ca­tions are far reach­ing too – while on one hand, it re­sults in a loss of pro­duc­tiv­ity due to in­creased sick days or even per­ma­nent re­duc­tion in workforce, costs as­so­ci­ated with gov­ern­ment sub­si­dized in­sur­ance and health­care in­fra­struc­ture can also be quite stag­ger­ing on the pub­lic ex­che­quer. Im­pact is there­fore not only to an in­di­vid­ual or a fam­ily unit, but is also in­creas­ingly a bane for pol­icy mak­ers at a macro level. The fig­ures are just as alarm­ing: it is es­ti­mated that NCDs glob­ally claim over 40 mil­lion lives an­nu­ally, of which around 17 mil­lion are un­der 70 years old. About half of these are in Asia Pa­cific re­gion alone. While NCDs pose a global chal­lenge, it is im­per­a­tive to high­light that devel­op­ing coun­tries – whose health­care sys­tems are al­ready un­der stress be­cause of equally oner­ous is­sues such as fight­ing in­fec­tious dis­eases and pro­vid­ing greater ac­cess to ma­ter­nity care – are strug­gling the most.

Ma­jor NCDs, which also have the high­est cases in the Asia Pa­cific re­gion, are car­dio-vas­cu­lar dis­eases, can­cer, di­a­betes and chronic re­s­pi­ra­tory dis­or­ders. In­creas­ing ur­ban­iza­tion and globalization, a seden­tary life­style, obe­sity and hy­per­ten­sion have all been ma­jor con­trib­u­tors that are lead­ing up to these dis­eases – with ma­jor be­havioural risk fac­tors iden­ti­fied as a com­bi­na­tion of one or more habits such as in­creased tobacco use and al­co­hol con­sump­tion, in­ad­e­quate phys­i­cal ac­tiv­ity and un­healthy diet.

As a re­sult, the Sus­tain­able Devel­op­ment Goals of United Na­tions (that have re­placed the ear­lier Mil­len­nium Devel­op­ment Goals), pub­lished in 2016, have a cen­tral theme around good health and well-be­ing. The goal by 2030, specif­i­cally re­lated to NCDs, is to: Re­duce by one third, the pre­ma­ture mor­tal­ity from NCDs, through pre­ven­tion and treat­ment and pro­mote men­tal health and well-be­ing,

Strengthen pre­ven­tion and treat­ment of sub­stance abuse, in­clud­ing nar­cotic drug abuse and harm­ful use of al­co­hol,

Sup­port re­search and devel­op­ment of vac­cines and medicines for the com­mu­ni­ca­ble and NCDs that pri­mar­ily af­fect devel­op­ing coun­tries,

Pro­vide ac­cess to af­ford­able essen­tial medicines and vac­cines,

Strengthen the ca­pac­ity of all coun­tries, in par­tic­u­lar devel­op­ing coun­tries, for early warn­ing, risk re­duc­tion and man­age­ment of na­tional and global health risks.

All of this raises many in­ter­est­ing and rel­e­vant ques­tions around ap­pro­pri­ate frame­works and de­liv­ery ve­hi­cles to be adopted for ad­dress­ing this uni­ver­sal is­sue, as well as the roles and re­spon­si­bil­i­ties of var­i­ous par­tic­i­pants for en­sur­ing ef­fec­tive and qual­ity so­lu­tions to the chal­lenge at hand. While a ‘one-size-fits-all’ ap­proach will likely not be ap­pro­pri­ate, fol­low­ing con­sid­er­a­tions will be fun­da­men­tal for any­one grap­pling with the prob­lem: a) Adopt­ing new and in­no­va­tive tech­nol­ogy; for

build­ing scal­able so­lu­tions b) In­creas­ing aware­ness, for driv­ing be­havioural life­style changes for the pop­u­la­tion at risk c) Strength­en­ing pub­lic & pri­vate sec­tor part­ner­ships, for ef­fec­tive and cost-ef­fi­cient de­liv­ery

Tech­nol­ogy in­no­va­tion in health­care de­liv­ery

Tech­nol­ogy is a big part of any so­lu­tion at­tempt­ing to ad­dress the is­sue, play­ing a key en­abling role across all stages of health­care ser­vice and de­liv­ery – from pre­ven­tion, to di­ag­no­sis, to treat­ment and also care at home.

Growth in adop­tion of smart­phones as well as wear­able de­vices has been un­prece­dented in re­cent years, and is only go­ing to keep on ris­ing in Asia over the next decade. This pre­sents a unique op­por­tu­nity for both pub­lic and pri­vate play­ers – to be able to mon­i­tor and po­ten­tially treat pa­tients on a much more per­son­al­ized ba­sis than pre­vi­ously pos­si­ble. Pro­lif­er­a­tion of big data is an equally big op­por­tu­nity, which can aide in build­ing more rel­e­vant and em­pir­i­cally driven mod­els for early di­ag­no­sis on one hand, and devel­op­ing a more holis­tic view of pa­tients’ clin­i­cal needs on the other.

An in­ter­est­ing case is that of IBM’s Wat­son, which is al­ready be­ing used by some in­dus­try play­ers to de­velop ma­chine en­abled in­tel­li­gent learn­ing for build­ing cog­ni­tive health so­lu­tions. A key el­e­ment will how­ever have to be a ro­bust and scal­able tech­nol­ogy in­fra­struc­ture that can sup­port such am­bi­tions de­signs.

An­other huge ben­e­fit of tech­no­log­i­cal ad­vances is the abil­ity to re­move phys­i­cal and ge­o­graph­i­cal con­straints around de­liv­er­ing cer­tain health­care ser­vices only through hos­pi­tal­iza­tion. Wher­ever this can be made pos­si­ble – shift­ing care from hos­pi­tals to homes through con­nected care and re­mote mon­i­tor­ing, pub­lic health­care in­fra­struc­ture is greatly re­lieved of the bur­den of al­lo­cat­ing pre­cious med­i­cal re­sources and is thereby able to pri­or­i­tize these for those who need them most crit­i­cally.

Ac­cord­ing to var­i­ous es­ti­mates, it is also ex­pected that al­most 60% of the world’s pop­u­la­tion aged 65 and above will re­side in Asia by 2050. With the de­mo­graphic shift­ing towards older peo­ple, such con­nected care also pro­vides a much-needed so­lu­tion in cop­ing with the grow­ing bur­den of el­derly care.

Tran­scend­ing ge­o­graph­i­cal bound­aries in ser­vice de­liv­ery, con­nected care also en­ables the pro­vi­sion of health­care in re­mote com­mu­ni­ties and ur­ban cities alike – in some cases for the first time. In­dia has at­tempted many such pi­lots to de­liver ru­ral health­care through telemedicine, and with in­creas­ing suc­cess as con­nec­tiv­ity im­proves. Even in much ur­ban­ized so­ci­eties like Sin­ga­pore, there are ex­am­ples worth em­u­lat­ing. In 2016, Philips part­nered with NTUC In­come, the largest in­sur­ance provider in Sin­ga­pore, to sup­port re­cov­ery and over­all health im­prove­ment of pol­i­cy­hold­ers who were re­cently hos­pi­tal­ized be­cause of a heart con­di­tion. Pa­tients were re­motely put un­der ob­ser­va­tion - from Con­tin­u­ous Care mon­i­tor­ing room in the Philips APAC Cen­tre by a team of tele nurses and doc­tors.

Fur­ther, such ini­tia­tives can also help im­prove treat­ment com­pli­ance and over­all health con­di­tions through re­mote but con­tin­u­ous health mon­i­tor­ing, care, aware­ness and re­in­forc­ing be­havioural changes for the bet­ter. Pa­tients feel more cared for as well, and there­fore con­fi­dent in man­ag­ing their con­di­tion from within the con­fines of their homes. This can have a very pos­i­tive im­pact on their over­all qual­ity of life, not only im­prov­ing their phys­i­cal health but also their psy­cho­log­i­cal well­be­ing – as they do not feel that they are be­ing overly de­pen­dent on fam­ily time and re­sources.

Aware­ness and adop­tion

By em­pow­er­ing pa­tients to play a greater role in their own health­care, and by shift­ing care from in­sti­tu­tions to pa­tients’ homes, coun­tries stand to re­duce costs and ease the pres­sure on health sys­tems al­ready strained from care­giver short­ages and other ca­pac­ity or in­fra­struc­ture con­straints. How­ever, even if con­nected care can be in­stru­men­tal in tack­ling health­care is­sues re­sult­ing from NCDs and other health is­sues, a big chal­lenge for pol­icy-mak­ers and health­care in­sti­tu­tions is to retro­fit these new tech­nolo­gies and ap­proaches into their ex­ist­ing in­fra­struc­ture and equally im­por­tantly, to up­skill pop­u­la­tions – par­tic­u­larly the el­derly and those in ru­ral ar­eas – for them to be able to use them.

A sus­tain­able so­lu­tion will re­quire in­di­vid­u­als to take re­spon­si­bil­ity for their own health­care – but this of­ten re­quires gov­ern­ments to ed­u­cate and em­power their cit­i­zens to do this. There­fore, pub­lic aware­ness pro­grammes and gen­eral ed­u­ca­tion lev­els of the pop­u­la­tion play a crit­i­cal role in suc­cess­ful adop­tion of any in­no­va­tion tech­nol­ogy or de­liv­ery ve­hi­cle. The fo­cus of such aware­ness pro­grammes needs to be two-fold: Pre­ven­tive strate­gies – to en­cour­age health­ier habits, with the ob­jec­tive of re­duc­ing fu­ture costs and im­pli­ca­tions as re­gard­ing health­care. Up­skilling – not just health­care pro­fes­sion­als but the pop­u­la­tion at large – on how to best lever­age new tech­nolo­gies at their dis­posal.

This can­not be a one-time fix how­ever, and re­quires a sus­tained ef­fort, so as to en­sure that peo­ple can keep pace with the rapidly ad­vanc­ing tech­no­log­i­cal land­scape. It is there­fore a fun­da­men­tal shift in the way health­care pol­icy is for­mu­lated and adopted.

Pub­lic pri­vate part­ner­ships in health­care

It is in­creas­ingly ob­vi­ous that health­care de­liv­ery in gen­eral, and NCD man­age­ment in par­tic­u­lar, will

have to ex­tend be­yond the con­fines of a hos­pi­tal, and that the path to con­trol­ling and pre­vent­ing in­ci­dence of NCDs is go­ing to be a dif­fi­cult and oner­ous one. Pace of tech­no­log­i­cal in­no­va­tion, pro­lif­er­a­tion of big data and devel­op­ment of new busi­ness mod­els are all im­por­tant, but an ef­fec­tive and long-term change can only be re­al­ized if all stake­hold­ers – pub­lic, pri­vate and in­di­vid­ual – work in tan­dem.

Fur­ther, to be able to ef­fec­tively nav­i­gate through such a com­plex web of pos­si­bil­i­ties when it comes to so­lu­tion de­sign and de­liv­ery, gov­ern­ments need to in­creas­ingly lean in on the ex­per­tise of pri­vate en­ter­prise.

The theme of long-term pub­lic-pri­vate part­ner­ships (PPP) there­fore be­comes cen­tral to health­care de­liv­ery as well. Gen­er­ally speak­ing, this can be de­scribed as an im­ple­men­ta­tion ap­proach where-in a gov­ern­ment pro­grammes are pro­vi­sioned through part­ner­ships be­tween pub­lic and pri­vate sec­tor. They lever­age project ex­e­cu­tion and fi­nanc­ing ca­pa­bil­i­ties of the pri­vate sec­tor, with­out com­pro­mis­ing gov­ern­ment pre­scribed wel­fare ob­jec­tives pre­scribed. There­fore, em­pha­sis is on re­defin­ing state’s role from that of de­liv­er­ing ser­vices; to that of ser­vice man­age­ment and co­or­di­na­tion. Com­mu­nity par­tic­i­pa­tion and in­volve­ment of non-profit ser­vice agen­cies may also be favoured and en­cour­aged.

Fund­ing and op­er­a­tion can also be on a part­ner­ship ba­sis, with gov­ern­ments of­ten sub­si­diz­ing these through one or more of var­i­ous avail­able ap­proaches, such as - in­fus­ing cap­i­tal on easy terms, pro­vid­ing tax shields, in­clud­ing ex­clu­siv­ity clauses, or un­der­writ­ing guar­an­teed re­turns. Closer pub­lic-pri­vate part­ner­ship is also a po­ten­tial so­lu­tion to share such fi­nan­cial bur­den that gov­ern­ments, par­tic­u­larly those in devel­op­ing coun­tries, are strug­gling with. Stake­hold­ers here will need to re-imag­ine ways of fi­nanc­ing health­care care projects, and may have to con­sider a fun­da­men­tal shift in pric­ing prod­ucts and ser­vices on an out­come-based model, in­stead of on the num­ber of pa­tients or such older ap­proaches.

There are 4 key im­ple­men­ta­tion stages in such large-scale projects: Build, Own, Op­er­ate, Trans­fer (or BOOT in short). While pri­vate sec­tor su­pe­ri­or­ity in in­fra­struc­ture build-out ca­pa­bil­i­ties is un­ques­tion­able in most cases, de­ci­sion on the du­ra­tion of own­er­ship and op­er­a­tional re­spon­si­bil­i­ties, as also the tim­ing of the trans­fer, if rel­e­vant to the project – are de­ter­mined by a num­ber of fac­tors such as fi­nan­cial vi­a­bil­ity, scale of the project, gov­ern­ment pol­icy and long-term goals of di­vest­ing gov­ern­ment stake, etc.

This ap­proach to im­ple­men­ta­tion can be taken for tech­nol­ogy adop­tion in NCD man­age­ment, as well as for devel­op­ing and de­liv­er­ing con­tent aimed at in­creas­ing aware­ness. Fur­ther, any pro­vi­sion of tech­nol­ogy and in­fra­struc­ture to help NCD pa­tients bet­ter man­age their con­di­tions needs to go hand-in-hand with in­cen­tiviz­ing health­ier life­styles in the first place. Sin­ga­pore Heart Foun­da­tion has pro­grammes that help raise aware­ness around sud­den car­diac ar­rests, need for more in­di­vid­u­als to be trained in CPR and the use of au­to­mated ex­ter­nal de­fib­ril­la­tors to in­crease sur­vival. Na­tional Heart In­sti­tute of Malaysia pro­motes heart-healthy di­ets, en­cour­ag­ing healthy eat­ing among peo­ple. On this front too, a range of pri­vate sec­tor com­pa­nies – from wear­able man­u­fac­tur­ers to in­sur­ers – have a key role to play, and this mar­ket has al­ready opened up con­sid­er­ably and is grow­ing at a very fast pace.

There are nu­mer­ous ex­am­ples wherein ac­tive col­lab­o­ra­tion across the ecosys­tem – in­clud­ing in­no­va­tion part­ners, gov­ern­ments, uni­ver­si­ties and cus­tomers – help cre­ate the best so­lu­tions, while adding value for all stake­hold­ers.

ARE WE READY?

Ac­cord­ing to Fu­ture Health In­dex (FHI) 2016, many coun­tries like Sin­ga­pore, China and Aus­tralia have re­alised the im­por­tance and ben­e­fits of con­nected care and en­folded tech­nol­ogy in or­der to meet health­care chal­lenges preva­lent in the re­gion.

How­ever, pri­vacy, cost and bu­reau­cracy con­cerns still chal­lenge greater adop­tion of con­nected care. This could be achieved by new or­gan­i­sa­tional struc­tures, gov­er­nance, plat­forms and change in mind-set.

Re­cently with the launch of new NCD progress mon­i­tor 2017, WHO has launched a new mo­bile ap­pli­ca­tion – the WHO NCD Data Finder, for use on all mo­bile de­vices such as smart phones and mo­bile tablets. The NCD Data Finder pre­sents in­for­ma­tion on the NCD sit­u­a­tion in each coun­try – in­clud­ing data on deaths, risk fac­tors and coun­try sys­tems re­sponse.

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