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在中低收入国家扩大包容性医疗保健计划(英)-2022.pdf
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在中低收入国家扩大包容性医疗保健计划(英)-2022.pdf
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©2022 IQVIA and its aliates. All reproduction rights, quotations, broadcasting, publications reserved. No part of this publication may be reproduced or
transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without
express written consent of IQVIA and the IQVIA Institute.
Introduction
While a major part of public and philanthropic resources are allocated to communicable
diseases in low- and middle-income countries (LMICs), non-communicable diseases
(NCDs) are on the rise, creating a double burden for vulnerable populations. To reverse
this trend will require not only further resources, but also new business models for
LMICs that can improve drug aordability, availability and accessibility and deal with
a lack of infrastructure, scarcity of medical sta, unaordable healthcare services and
limited patient awareness of risk prevention and preventative care. Promisingly, over
the past decade, a new wave of inclusive healthcare initiatives has been emerging that
aim to improve the quality of chronic care and access to care for vulnerable populations
in LMICs, with innovative and economically sustainable business models.
This report presents the rst part of an analysis that
looks to pioneers that are implementing inclusive
business models in the healthcare space and explores the
innovations behind their success, while examining their
possible limitations in scalability and sustainability.
By examining the global landscape of inclusive
healthcare initiatives, this study attempts to draw
lessons from the various market-based approaches.
Grouping them into relevant business models, it reviews
the relevance of each model to specic segments of
patients, examines the innovations that are shared
across each model, or are distinct to specic initiatives,
and further questions the ability of each model to deliver
impact and scale.
In the second phase of the analysis — which will be
presented in a future report in this series — an in-depth
analysis will be conducted of selected initiatives deemed
to be promising, to understand the reason for their
success, challenges of scalability, as well as concrete
solutions to solve these issues. The ultimate intent will
be to build on these lessons to share with partners
high-potential localized blueprints oering concrete
opportunities to target non-communicable disease.
This report was produced by the IQVIA Institute for
Human Data Science based on research and analysis
undertaken by a partnership between Hystra and IQVIA
West Africa, with funding from Sano Global Health Unit.
MURRAY AITKEN
Executive Director, IQVIA Institute for Human Data Science
OLIVIER KAYSER
Executive Director, Founding Partner, Hystra
Scaling-Up Inclusive Healthcare Initiatives in Low- And Middle-Income Countries: Assessing the Landscape of Innovative Approaches
Find Out More • If you wish to receive future reports from the IQVIA Institute for Human Data Science or join our
mailing list, visit iqviainstitute.org.
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Table of Contents
Addressing the health burden of NCDs through inclusive initiatives 2
Identication of initiatives and their business models 6
Challenges that continue along the patient journey 8
Inclusive clinics and hospitals 10
Pharmacy-based models 12
Community-based models 13
Risk-prevention models 14
A framework for assessing innovation 15
Innovations tackling unmet needs 16
Future steps to scale up NCD-focused initiatives 18
About the authors 23
About Hystra 27
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2 | Scaling-Up Inclusive Healthcare Initiatives in Low- and Middle-Income Countries: Assessing the Landscape of Innovative Approaches
Addressing the health burden of NCDs through inclusive initiatives
+
going toward NCDs in middle-income countries
+ Though low- and middle-income countries
are experiencing a rising prevalence of non-
communicable diseases like diabetes, cancer, and
of development assistance for health to these
+ If interventions that target NCDs are progressively
+ Many initiatives have not been successful because
they addressed only one part of the problem in
countries where health systems are often weak and
+ Inclusive businesses provide goods, services,
and livelihoods to people living at the base of the
pyramid through commercially viable and scalable
enterprises and bring poor and underserved
individuals into their value chain as suppliers,
+ Inclusive healthcare models are emerging, led by
startups, social enterprises, corporate ventures,
disease burden and improve the diagnosis,
Global health spending has been rising faster than the
pace of the global economy and accounted for 10% of
the global gross domestic product in 2017.
1
In low- and
middle-countries (LMICs), health spending is growing on
average even faster than in high-income countries
(6% vs. 4%),
2
and yet access to quality healthcare remains
insucient and largely inadequate for the 6.5 billion
people living there.
3
Despite over $41 billion spent in 2019
on healthcare in LMICs,
2
health challenges include a lack
of public health coverage/insurance, shortage of qualied
medical sta, late diagnosis, improper healthcare
infrastructure, quality product value chain and delivery
issues, and absence of health knowledge and awareness.
This is especially true for non-communicable diseases
(NCDs) where the weaknesses of prevention, diagnosis
and care are persistent. Despite 13% of health spending
going toward NCDs in low-income countries and 30%
in middle-income countries,
1, 4-6
these countries are
experiencing a rise in diseases like diabetes, cancer,
and heart and lung diseases (see Exhibit 1). In Africa,
while some headway has been made on communicable
conditions like tuberculosis and malaria — in part, due
to funding from governmental agencies, NGO’s and
bilateral private-public partnerships — and deaths
from communicable, maternal, perinatal and nutritional
conditions have declined from 5.7 to 5 million (from
61.4% to 56.0% of total deaths) 2010-2016, NCDs have
been a lesser focus of funding and have risen as a share
of deaths from 29.4% to 34% over the same period.
7
Indeed, across LMICs, NCDs now account for 46% of all
disease prevalence,
8
and LMICs now account for 57% of
NCD deaths globally, however only 1% of development
assistance for health (DAH) in 2018 was allocated to
NCDs in LMICs (see Exhibit 1).
For individual households with family members
aected by NCDs, the nancial burden is high, with
those in LMICs spending 12% of their eective income
on health — more than twice the percentage (5%) of
![](https://csdnimg.cn/release/download_crawler_static/85752569/bg5.jpg)
iqviainstitute.org | 3
their counterparts in high-income countries suering
from NCDs, and twice the percentage of those in LMICs
unaected by NCDs (6%).
9
This burden also more directly
hits families in LMICs who pay a 40% share of total health
spending out-of-pocket,
1
adding to the burden patients
face and increasing the urgency of nding solutions that
can improve health while mitigating costs.
Increasing the focus of funding on NCDs and
implementing initiatives in an eective way could begin
to address both the health and cost burdens.
If interventions targeting non-communicable diseases
are progressively implemented between 2020-2030 in
low- and lower-middle-income countries, it is estimated
that more than 4.6 million lives of the world’s poorest
could be saved and 20.5 million years of life with
disability could be averted, including those of 1.3 million
who would otherwise die before the age of 40.
10
There have been many attempts to address the health
burden; however, many initiatives have not been
successful in part, because they sought to address
only one part of the problem
11
in countries where
health systems are often quite weak. The lack of health
resources available in LMICs has also acted as a barrier.
The result has been that an estimated fth of total health
spending is wasted
12,42
for reasons that include provision
of unnecessary or low-value care, poorly optimized use
of resources, care provided in settings that are not cost-
eective, or loss to fraud, corruption and administrative
Comparison of the growing NCD burden versus resources allocated to NCDs by the international community
Source: Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results; Institute for Health Metrics and Evaluation
(IHME), 2020. Available from http://ghdx.healthdata.org/gbd-results-tool.; Right chart: Institute for Health Metrics and Evaluation (IHME). Development
Assistance for Health Database 1990-2020. Seattle, United States of America: Institute for Health Metrics and Evaluation (IHME), 2021.
Notes: Left chart includes data on Low, Low-Middle income countries. Prevalence for specic diseases are overlapping and therefore do not sum to total NCDs
in a year. Middle chart: Developed by GBD researchers and used to help produce these estimates, the Socio-demographic Index (SDI) is a composite indicator
of development status strongly correlated with health outcomes. It is the geometric mean of 0 to 1 indices of total fertility rate under the age of 25 (TFU25),
mean education for those ages 15 and older (EDU15+), and lag distributed income (LDI) per capita. As a composite, a location with an SDI of 0 would have a
theoretical minimum level of development relevant to health, while a location with an SDI of 1 would have a theoretical maximum level. This dataset provides
tables with SDI values for all estimated GBD 2019 locations for 1950–2019, as well as reference SDI quintile values. Right chart: Includes DAH for Latin America
and Caribbean, South Asia, Southeast Asia, Sub-Saharan Africa, Global (i.e., funding focused on multiple regions). “SWAp and HSS” refers to “Health systems
strengthening and sector-wide approaches.”
45%
46%
0
1
2
3
4
5
6
7
2010 2019
Prevalence of NCDs in LMICs
with disease breakout, Bn
2010 2019
HIV/AIDS
26%
Newborn and
child health
19%
Reproductive
and maternal
health 14%
Other
12%
SWAp
and
HSS 9%
Malaria
8%
TB 6%
Other infectious
disease 5%
NCDs 1%
Development assistance
for health (DAH) by disease
in LMICs, 2018
56.9%
2019
LMIC percentage
of NCD deaths globally
by socio-demographic
index band
N=42Mn
Sense organ diseases
Neoplasms
Chronic respiratory diseases
Diabetes and kidney diseases
Mental disorders
Musculoskeletal disorders
Substance use disorders
Non-communicable diseases
High-middle & high
Low, low-middle, middle
Digestive diseases
Neurological disorders
Other non-communicable diseases
Other causes
Communicable, maternal,
neonatal and nutritional diseases
Skin and subcutaneous diseases
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