Global Health - Sub-Saharan Africa - Innovation & Acceleration -IIE

Healing More Than Patients: Inclusive Innovation for a Fragmented Global Health System

- October 30, 2020

Key insights from our discussion with Ruchika Singhal, Vice President of Global Health and Medtronic Labs at Medtronic. Watch the full recorded webinar here.

 

Non-communicable diseases (NCDs)—such as diabetes, hypertension, and cancer—are the world’s leading cause of death. Yet in low and middle-income countries, Medtronic Labs points out that only 1% of health spending goes toward NCD care. These funds are spread across governments, NGOs and implementers, and private health systems in uncoordinated efforts, leading to inefficiencies and poor patient outcomes.

“In the global NCD space, it’s often just little pilots in small places. It’s incredibly fragmented,” said Medtronic Lab’s VP of Global Health, Ruchika Singhal. “Even with the private sector, there is very little collaboration. Most organizations are doing their own thing. How do we solve that with financing and sustainable models?”

Resonance’s Jay Chikobe and Marissa Gilman sat down with Singhal for our inaugural episode of the Inclusive Innovation Exchange to examine challenges in healthcare delivery systems and supply chains in emerging markets. Singhal shared the example of Medtronic Lab’s innovative partnership with Novartis Social Business to treating diabetes patients in Kenya to illustrate three ways that global health stakeholders can use inclusive innovation tools to address a fragmented healthcare delivery landscape and improve outcomes for patients worldwide.

Share Early, Partner Widely

Medtronic Labs is a social business backed by Medtronic that aims to expand access to healthcare in underserved communities worldwide. In Kenya, Singhal’s team wanted to test an end-to-end healthcare model to help diabetes patients in three counties receive better care. She knew that Novartis Social Business was aligned with Medtronic Lab’s mission and had a strong track record of aiding Kenyans living with hypertension and diabetes. She hoped the companies could leverage each other’s strengths and experience to provide better care.

Novartis “has been working for years to access low-cost medicine,” said Singhal. “We have the operations teams, do the training on a daily basis, the tracking, and have telecounselors following up about how we did in those processes.”

The two companies began their partnership journey by aligning on a shared vision and purpose. “The collaboration grew from there,” Singhal said. But they didn’t go it alone: They brainstormed and shared ideas with other partners, including the Kenya Diabetes Association, the Kenya Cardiac Society, the country’s Ministries of Health, and several others. The goal was to develop an approach that is rooted in and draws on the local system—not a one-off pilot with no real legs in the Kenyan healthcare community.

Singhal noted the importance of building strong interpersonal relationships around what partners are doing, and why. NCDs are complex, and partners will eventually run into problems. Yet if partners have trust and solid relationships in place, they can clearly explain issues and work together to meet joint objectives.

“Our CEO says, if you need a legal agreement to figure out a partnership, you’re already off to the wrong start,” she said. “If you can do a handshake, that’s the partnership you want to be in.” Trust is an ongoing journey, and it takes work to sustain.

The collaboration is paying off. Before the partnership launched, 1,500 patients were already enrolled. By the time COVID-19 hit, the partners registered ten times that number. Almost half of the patients that followed up had shown meaningful improvement. Medtronic Labs and Novartis are now looking to replicate the model elsewhere, with additional partners. Early engagement, trust, and transparency with all partners helped set the stage for success.

Getting in on the Ground Level

In public health, dozens of people need to sign off on treatment models to ensure alignment on policies, systems, what medicines are used, and how. From the start, Singhal’s team shared Medtronic Labs’ ideas and goals with key stakeholders, soliciting their input and engagement. By including a wide array of stakeholders in the planning phase, the team helped ensure a sound program design and strong collaboration from all those who would influence outcomes.

Singhal was quick to point out the critical role of on-the-ground staff when engaging local communities. In Kenya, her team spoke with everyone from the government’s office to community health volunteers to church elders and incorporated their perspectives into the model’s design.

“My team has been amazing on the ground with what they’ve been able to accomplish,” she said. “When you say you work in the community, you really need to be a part of the community. It’s not just a slogan you put on a slide.”

Global Health’s Missing Stakeholders

Singhal's answer was unequivocal when asked which players have traditionally been left out of global health innovation and acceleration: patients and their caregivers. She emphasized how often healthcare practitioners design systems without their end users in mind. In Kenya, her team actively engaged with local communities to incorporate patient and caregiver perspectives.

Patient voices and input should shape the design of medical solutions and how those solutions are implemented and scaled on the ground. This helps ensure that new health solutions aren’t isolated from or even at odds with the surrounding healthcare ecosystem. Singhal illustrated her point with an example of how Medtronic Labs developed a model to reduce ear infections and hearing loss in India. The model employed community health workers who used a handheld Medtronic device to perform hearing examinations in underserved areas. However, “we would never have had the uptake if we hadn’t designed the healthcare delivery system around it,” she said.

The team worked with medical professionals, NGOs, and schools; trained community health workers; and provided telecounseling to build an accessible, patient-friendly healthcare model. In the end, Medtronic’s solution was less about their medical device and more about the delivery model that allowed on-the-ground health providers and patients to use it effectively.

In Kenya, Singhal’s team measures their end-to-end model by how many patients get better and stay better. It’s a challenging task: diabetes is not a one-time intervention, but a lifelong modification and engagement. Teams must navigate staff turnover and work continuously to align stakeholders. By working through it with a collaborative spirit, full transparency, and a patient-centric approach, partners stand a far better chance of resolving their issues and scaling their impact.

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As Singhal looks forward, she’s focused on how Medtronic can continue to guide new partnerships to improve health outcomes and redesign care delivery systems in emerging markets.  

The pandemic offers a silver lining, in that we now recognize that public health requires a concerted and broad-based effort.

“The amount of funding generated for COVID-19 is incredible. We know that when there’s a will, we can do it—so how do we keep that going with other challenges in global health?”

For those living with NCDs, the success of Medtronic and Novartis’ joint venture in Kenya offers hope that more funding will follow, particularly as their partnership grows to reach more patients. By collaborating across sectors, within local communities, and with patients themselves, these partners have discovered the best way to improve health outcomes: by working together.

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The Inclusive Innovation Exchange showcases the incredible progress that innovators are making in healthcare around the world. We discuss new ideas, successful initiatives, and potential future partnerships to improve health access and outcomes. Learn more.

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