FT Health: The drive for universal health coverage

When Tedros Adhanom Ghebreyesus was elected director-general of the World Health Organization last month, he did so thanks to one dominant campaign pledge: to push for universal health coverage.

Progress will not be easy given the growing demand for healthcare in a world of limited resources and disagreements about the best ways to respond.

Access to medicines and other medical commodities including vaccines and diagnostics is one barrier, sparking questions about intellectual property but also about donations and differential pricing for poorer patients. 

But there are many broader issues around investment in health systems and innovation in how services are delivered — let alone the need for a far greater focus on prevention. 

Our Access to Healthcare report covers handouts of free medicines for Americans, South Africa’s reliance on charities to plug gaps in public services and profiles of innovative social enterprises.

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Three questions

Kees Van Lede, chief executive of Carepay, operator of mTiba - a ‘health wallet’ - one of the winners of the 2017 FT/IFC transformational business awards .

What is mTiba?

It’s a way to save, send, receive and spend money ringfenced for healthcare in Kenya by mobile phone. It gives full transparency on the patient, what they are treated for, the price and a quality check. mTiba turns the whole development debate upside down. It allows donors, insurers or others to give money straight to the end-user. It cuts overheads and gives power to the individual who decides how to spend it within limits. It turns beggars into choosers.

What is its impact?

So far we have signed up 450 hospitals and clinics, 900,000 people and processed payments totalling $1.4m for 100,000 visits. The growth suggests we are on to something really big. These are outputs and now we’re launching a project to get a sense of outcomes. But we’ve already had visitors from the US and Europe drooling. We are leapfrogging western healthcare practices. We can turn real-time data into really valuable tools to help doctors treat their patients better and help patients manage their own health better.

What help do you need?

We want to add more partners, products and services so we can reach millions of Kenyans, then go into other markets in East and west Africa. We need clever people who are experts in patient-doctor interactions. The biggest risk as a start-up is not to focus. We think there is a business model, not to charge the patients or the provider (or very little) but the third party payers [such as insurers]. We do not look at this as a donor project but a solution that should be able to pay for itself.

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Chart watch

Anger in India Dissatisfaction with healthcare in India has led to a spate of attacks on doctors. The country spends just 1.4 per cent of GDP on health — well below the 6 per cent world average and the 3.1 per cent of China, its more affluent rival. India has just one physician for every 1,800 people, well below the WHO recommendation of one per 1,000. (FT) 

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News round-up

Drugs list The WHO published its biennial list of essential drugs to help countries prioritise spending. Antibiotics are ranked for the first time alongside new treatments for hepatitis C, HIV, TB and cancer, bringing the total of recommended medicines to 433. The list first appeared in the late 1970s and can be controversial. (WHO, Stat) 

Mental health A report for the United Nations hit out at “biomedical gatekeepers” who perpetuate stigmas around mental health and called for reform of a “crisis-hit system built on outdated attitudes”. (UN News Centre).  

Cholera 'cover up' Sudanese authorities have been accused of downplaying an outbreak of cholera, after finally confirming 256 deaths and more than 16,000 cases of "acute watery diarrhoea" (BBC)

Obesity in China The urban poor are now most likely to be among the country's 320m overweight adults and feature heavily in a game show where contestants compete to slim the fastest. The problem has fuelled an explosion in obesity-related diseases such as diabetes. (FT)

Babatunde Osotimehin The head of the UN Population Fund and advocate for women's health died aged 68. After training to become a doctor in his native Nigeria, Dr Osotimehin became minister of health before moving to the UN. His agency lost US funding earlier this year to the dismay of activists. (NYT, FT)

Vaccination policies German kindergartens must now inform authorities if parents do not submit proof of vaccinations for their children. Immunisation policies elsewhere range from the strict school policies of the US to 'no jab, no pay' in Australia. A study looks at the example of influenza vaccination in Chicago. (CNN, PLoS)

Cancer update News from Asco, the big US cancer meeting, included a knock-back for Roche's breast cancer combination therapy, better trial news for AstraZeneca's Lynparza drug, and research that showed sufferers using an app to report their symptoms extended their survival rate for several months. (FT)

Healthcare in space The challenges for untrained astronauts handling emergency care and with little equipment are difficult enough, but performing procedures such as CPR in a weightless environment add another layer of problems. New techniques are being developed such as this handstand method (video). (Medical Xpress)

History lessons What do rickets, osteoarthritis, intestinal parasites and now smallpox have in common? Our understanding has been increased by studying traces in mummified bodies including 17th century specimens in Lithuania with flesh on bones and organs still intact. (NYT)

The pill at 60 The story of how a treatment originally for menstrual problems transformed society and drove increases in education and wages for women across the west and a contraceptive-drug market now worth more than $6bn. (Nature)

Pets as probiotics The modern obsession with eradicating bacteria from our homes also hits those germs that may actually be good for us. Enter the pet dog with its range of microbes that could lower the risks of autoimmune illnesses such as asthma and allergies. (NYT)

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Best of the journals

Humanitarian crises A series assessing health interventions in crisis-hit countries calls for greater protection of humanitarian workers, closer ties with development programmes and stronger leadership and co-ordination. (The Lancet)

Diabetes in India A cross-country study shows diabetes spreading to poorer sections of society and the need for urgent preventive measures. (The Lancet)

Alcohol warning Even moderate drinking can damage the brain and lead to conditions such as memory loss. "We all use rationalisations to justify persistence with behaviours not in our long term interest. With publication of this paper, justification of 'moderate' drinking . . . becomes a little harder". (BMJ study and editorial)

Cannabis debate Teenagers who smoke cannabis are more likely to take other illegal drugs but Nick Clegg, former UK Liberal Democrat leader, argues a legal, regulated market would boost public health.   (BMJ)

Hack attack The recent WannaCry cyber attack on Britain's NHS could be a turning point for modern medicine. Although much has been written about the potential breach of confidential records, healthcare providers must also guard against the risk of physical harm to patients. (NEJM)

LGBT health In the light of rising attacks against the lesbian, gay, bisexual and transgender community in some countries, the Lancet calls for a new emphasis on human rights, health data and good leadership — particularly in Africa. New York issued an LGBT healthcare Bill of Rights (The Lancet, NYC health department). 

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Book review

Rigor Mortis by Richard Harris An investigation of the dysfunctional $30bn biomedical research industry or how "sloppy science creates worthless cures, crushes hope and wastes billions." If the goal of research is to deepen knowledge, then it is structured in exactly the wrong way, argues the NPR science writer, from the non-reproducibility of experiments to the "publish or perish" race to appear in scientific journals. (FT)

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Podcast of the week 

Why has urban health received relatively little attention compared with the problems of rural populations? (Health Policy and Planning, 9m)

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In case you missed it

FT Health last issue: Funding the fight against disease

Latest news at www.ft.com/health and on Twitter at FT_Health

Read previous editions and discuss the issues on our Facebook page.

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Final thought

Healthcare’s final frontier Experiments carried out in the skies are not just for the benefit of astronauts. Here are ten examples of healthcare technologies that have come from the space race. (The Conversation)