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Universal Health Coverage One Trained Professional at a Time

Despite all the recent advances in technology, the delivery of high-quality health care still remains a human-centered activity. Biopharmaceutical company Takeda is supporting NGO Seed Global Health to use the power of people to tackle the health challenges of sub-Saharan Africa.

Like many other young people, Dr. Vanessa Kerry spent her gap year between high school and college traveling. Unlike most of them, however, her ambition to become a doctor meant that she did not shy away from places where she would encounter poverty and inequity in its starkest form. Once in medical school, she continued her world travels, first in her capacity as a medical student and then as a trainee doctor. Upon the completion of her clinical studies in 2012, she co-founded Seed Global Health, an NGO that trains health care professionals in sub-Saharan Africa, in a bid to redress some of the health care imbalances she had seen first-hand. “There should not be two standards of care in the world today,” Kerry says. “Every country deserves a robust health care workforce to provide for its population’s health needs. We need to close the health care gap.”

She is not alone in this belief. On 23 September this year, world leaders in New York adopted a high-level United Nations Political Declaration that committed to the realisation of universal health coverage, or UHC, by 2030, as part of achieving the United Nations’ Sustainable Development Goals. (UHC is defined as access to quality health services for all without suffering financial hardship.) 

One prerequisite for delivering universal health coverage is to train up more health care workers: 24 million by 2030, to be precise. If that sounds like a challenge, that’s because it is. In fact, the World Health Organization is predicting a shortfall of 18 million health care workers, particularly in low- and lower-middle-income countries, by 2030.

Power of the people

That is where the partnership between Takeda, a global biopharmaceutical company headquartered in Japan, and Seed comes in. Kerry’s experience of working in less-resourced countries means that she has important insights into which health care solutions work and which don’t. The fly-in, fly-out model of care delivery is not effective over the long-term because it fails to build local capacity. Work must be done at the local level to be sustainable and people must be placed front and centre. Over the last few decades, investment has come in a series of waves, focusing on themes like infrastructure, access to medicines, community health workers, or digital technology. But none of these elements are effective without a qualified health workforce, a relatively neglected and underinvested component of the overall health care equation. Yes, community health workers can identify and manage basic diseases—but with any life-threatening condition, such as sepsis, they need to refer the patient on to well-trained professionals. Likewise, for all their cutting-edge properties, digital technologies still require experts to interpret and act on the data they generate.  “Ultimately, health care is a human-centred intervention,” says Kerry. “It’s people who can recognise human suffering and give dignity to patients. It’s people who can recognise problems in the system and think about how to fix them.”

Highly trained frontline health care workers are thus crucial to closing the health care gap. In just the last seven years, Seed has trained more than 16,000 physicians, nurses and midwives with a focus on sub-Saharan Africa. Why there? Because with 25 percent of the world’s burden of disease, sub-Saharan Africa has just 3 percent of the world’s health care workforce and a mere 1 percent of the world’s health care expenditure. In other words, it is a crucial arena for closing the health care gap.

In July 2018, Seed received a US$4.5 million (JP¥500 million) contribution from Takeda. Spread over a five-year period, the funding will support the training of 5,000 health care professionals. “The size and multi-year commitment of Takeda’s award is game-changing,” Kerry says. “We’re training people who can not only provide care themselves but can also train their own successors, meaning that this investment with Takeda actually lasts over generations. The impact will be profound.”

Mr. Haruhiko Hirate, the Takeda executive in charge of corporate social responsibility (CSR) programmes, also sees the training aspect of the Seed programme as the differentiating factor that makes it genuinely local, sustainable and effective. “Even after Takeda’s support comes to an end, the trainers will remain in the country and keep training health workers into the future,” he says. “Its impact will be enduring.”

Since 2016, including the partnership with Seed, Takeda has launched a total of 14 partnerships focused on disease prevention in developing and emerging countries. “Our multi-year programmes increase patients’ access to quality diagnosis and treatment, including immunisations, in disease-endemic countries,” Hirate says. “They also help train health workers and strengthen health systems worldwide.”

Our multi-year programmes help train health workers and strengthen health systems worldwide.

Mr. Haruhiko Hirate,
Takeda Pharmaceutical, corporate communications and public affairs officer

On the training and education side, Takeda’s partners include well-known names like World Vision and Save the Children; on the system side they include the United Nations Foundation (global measles vaccinations for children in 40 developing countries) and UNICEF (strengthening health systems in sub-Saharan Africa).

For all Hirate’s enthusiasm for these partnership programmes, he does not have the final say on the decision to provide them with financial backing. Since 2016, Takeda has entrusted the job of selecting CSR programmes to its approximately 50,000 employees worldwide. Hirate’s role is akin to an election manager. He and his department draw up a shortlist of candidate organisations including NGOs, intergovernmental organisations and foundations, provide summaries of the programmes the organisations plan to initiate with Takeda funding, and even hold explanatory townhall meetings with employees in multiple countries. After all this canvassing, an online vote is held. Voting rates—which have increased from the mid-20 percent level in 2016 to around 40 percent now—suggest that Hirate is succeeding in boosting engagement and fostering a sense of company-wide participation and pride.

The Global CSR Programme has a halo effect that reaches an external audience as well. Hirate can point to cases where Takeda’s CSR activities proved the decisive factor in luring top-grade research talent to the company, while millennials as a cohort are increasingly likely to select employers based on values. A robust CSR programme also reinforces Takeda’s ESG (environmental, social and governance) credentials. “Takeda is very strong in the environmental and governance parts of ESG,” Hirate says. “It’s important to all of us to be creative about growing our social contributions as well.” 

Among the United Nation’s SDGs, Hirate sees “good health and wellbeing” (No. 3) and “partnership for the goals” (No. 17) as the most relevant. While Takeda’s mission is to “strive towards Better Health and a Brighter Future for people worldwide through leading innovation in medicine,” that is not always feasible through normal commercial channels. In such cases, the company can extend its reach by partnering with international organisations including NGOs or governments, whether to support immunisation programmes or (as with Seed) to train qualified health workers. The company’s long-standing commitment to serving developing and emerging countries found concrete expression in 2016, when Takeda opened an office in Nairobi, Kenya, to support health in sub-Saharan Africa through partnerships and collaboration.

Programmes in Malawi and Uganda

What will the actual outcomes of the Takeda-Seed partnership be? Let’s start with Malawi. The shortage of health care professionals can be particularly acute in rural areas—and 84 percent of Malawi’s population is rural. Seed is currently training two family medicine physicians for each of the country’s 28 districts. Data suggests that doctors who train in rural settings are more likely to stay and help raise the long-term quality of rural health care.

Seed is also building a model midwifery ward for midwife students at Malawi’s Kamuzu College of Nursing. “One woman dies almost every hour from complications of pregnancy or childbirth in Malawi. The vast majority in the 48 hours around labour and delivery,” Kerry explains. Through the model ward, Seed aims to provide clinical mentorship which will better equip the midwives to identify problems and apply their classroom knowledge to clinical practice.

Seed is also putting Takeda’s support to work in Uganda. According to the World Bank, half of all deaths in Uganda are caused by poor triage and emergency services. Seed has embedded a specialist technical advisor in the Ministry of Health who is helping to map out a 10-year health worker human resource plan specifically targeting emergency services. “If we can scale up emergency services from the community to tertiary care hospitals, we can have a meaningful impact on the number of deaths in the country,” says Kerry.

Health Care Means Economic Growth

Higher quality health care can also have a meaningful impact on economies. At the most basic level, a healthy population is more productive than an unhealthy one simply because people show up to work. The presence of a cadre of well-trained professionals able to identify and treat diseases at an early stage helps keeps national health care costs in check. 

Meanwhile, on the industry level, health care is a win-win, because as a sector it both promotes good health and creates the new jobs that drive economic growth. And with the population of Africa expected to nearly double to 2.5 billion between now and 2050, young people certainly need employment. “There’s a nine-to-one return on investment for investments in health,” Kerry says.

Perhaps surprisingly, the positive impact that Seed’s work has on the quality of health care is not restricted to Africa. When Seed’s volunteers return to the United States, their experience of working in low-resource settings makes them better historians (i.e., more sensitive to individual patient’s histories), better clinicians, and more sensitive to the social determinants of disease. As a result, they become better physicians, nurses and midwives—and often better educators—in their home country.

Putting Patients First

Kerry imbibed the idea of the importance of being a responsible global citizen from her parents, both of whom were in public service. Takeda, likewise, has been committed to the idea of acting as a responsible corporate citizen throughout its 238-year history. “Integrity is at the core of everything we do,” Hirate says. “We are a values-based company. Other companies may say similar things, but not that many really put those values into practice. We have been putting patients at the centre of all we do for two centuries now.”

Aligning its CSR efforts with the United Nations’ SDGs and the drive for universal health coverage dovetails nicely with Takeda’s values not just of integrity, but also of fairness, honesty and perseverance (a quartet known internally as “Takeda-ism”). An honest commitment to Better Health and a Brighter Future for people worldwide also represents the best way for Takeda to guarantee it continues to flourish in the years ahead. “Contributing to making society sustainable has the effect of making Takeda itself into a sustainable company,” Hirate explains. “We ask ourselves every day, ‘What can we do for society?’”

With its recent acquisition of Shire, Takeda nearly doubled in size. The financial resources the company commits to CSR have also expanded exponentially—by fourfold since 2018. “Traditionally Japanese companies don’t talk much about their philanthropic giving, but if you’re doing something worthwhile, why not let people know?” Hirate says. “Publicising our CSR efforts can shine a necessary light on health care challenges and bring attention to NGOs, which in turn attracts more partners, more donors, and better outcomes for people in Africa and other regions".

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