Health for all: Innovation, going to scale and investments in the digital transformation

Dr Christoph Benn is the Director of Global Health Diplomacy for the Joep Lange Institute, an international institute based in Amsterdam that advocates and facilitates innovative models in global health, aiming to make high quality medical care more widely and easily available. His career has spanned 30 years in global health, with a special focus on AIDS and infectious diseases, first working as Doctor-in-Charge of a rural hospital in Tanzania, then as a clinician and public health specialist in Germany and Geneva, Switzerland. He was a member of the founding board at the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2002 and served as its Director of External Relations from 2003–2018.

I’ve always felt it was a huge inequity that people might not have access to prevention, care and treatment simply because of where they were born — not through any fault of their own, but simply because of the economic circumstances of their country.

“I deeply believe in health as a human right that belongs to everybody, with each person being entitled to comprehensive, high quality health services. That is what has motivated me throughout each phase of my career.”

At the outset, I wanted to work in countries where there were fewer resources and less qualified healthcare professionals — places where I thought I could be more helpful than in my home country of Germany. I trained in obstetrics, gynaecology, tropical medicine and infectious diseases then went to work in Tanzania for four years as Doctor-in-Charge of a rural district hospital. I arrived in 1988 which was just at the beginning of the AIDS epidemic in that part of the world, so I was confronted with the huge challenge of a disease that very few people had even heard of in that region. Almost 30% of my inpatients were infected with HIV at that time and I experienced first hand the devastating impact of so many young people dying from a disease that was a certain death sentence during that period. This obviously influenced my professional work quite significantly, as I started to realise that beyond being there for patients on an individual basis and treating them as best you can, it’s vitally important to look at health from a population perspective.

After the frontline experience of working in Tanzania, I began the second phase of my career when I obtained my Masters in Public Health at Johns Hopkins University. Following my postgraduate studies, I worked in many different countries on virtually all continents, advising organisations and governments on how to devise effective public health programmes that deliver the best possible outcome.

At this point I had another realisation: even if you have the best clinical knowledge and the best ideas and knowledge in epidemiology and design of public health programmes, it won’t have a significant impact unless there is sufficient funding.

This is when a third component fell into place in my professional life, when I entered global health politics with a view to advocating for increased resources from the international community. In 2001, I became involved in setting up the Global Fund to Fight Aids, Tuberculosis and Malaria, and for 15 years I was the Fund’s Director of External Relations, talking to politicians, parliamentarians and decision makers around the world in an effort to mobilise the billions that were required to provide prevention, care and treatment for the three major infectious diseases; getting the topic on the agenda of the United Nations General Assembly, the G7 Summits, the World Economic Forum and other critical platforms. We designed a specific form of a replenishment for the Global Fund that raised cumulatively more than 50 billion dollars.

Over those first 20 years of my career, I learned what is needed at every level of infrastructure and investment — be it local health services, public health programmes or international diplomacy — and in 2019 I had the opportunity to create my own centre for Global Health Diplomacy in Geneva as part of the Joep Lange Institute. This has allowed me to move away from individual diseases and towards the critical challenges in health and development of our time — with a particular focus on development finance and the potential of the ongoing digital transformation, with its huge impact in all countries but the biggest opportunities in the poorest ones.

Joep Lange was one of the most eminent researchers in HIV, and we owe a lot of the treatments we have against AIDS today to his many years of research. Very early on, he went beyond infectious diseases research and became interested in health financing, realising that the existence of effective drugs doesn’t help if too few people have access to them. He was ahead of the curve when it came to innovative health financing and the digital transformation, and was keen to pilot programmes harnessing the potential of mobile phones. Tragically, he was killed on the way to the 20th International Aids Conference in Melbourne in 2014, when his flight was shot down over the Ukraine, and the Joep Lange Institute was created to continue his legacy — to provide better health care by using innovative technology to make it more accessible and affordable to those in greatest need.

There are already some innovative and promising examples. In Kenya, colleagues from the Pharmaccess Foundation — also created by Joep Lange — have established a concept called M-TIBA which enables people to use their mobile phones to pay for health services. You register your SIM card and phone on the M-TIBA platform, and you can then connect to various healthcare facilities with assured quality services that are linked to the same platform. People can use the platform as a savings account where they make regular deposits, so it can operate like a prepayment scheme and they don’t need cash on hand to obtain care. Alternatively, it can be linked to their existing health insurance or a donor supported health scheme, eg for maternal and child care. But the idea is always the same: using your mobile phone to access health services without needing to transfer cash, while connecting patients, health care providers and funders to achieve huge gains in efficiency.

Digital health transformation is developing extremely fast in the Global South — that’s the good news. There are great programmes in many countries in the Global South that are working on their digital health strategies and thinking about how they can best utilise new technologies — they are basically leapfrogging wealthier countries where the established healthcare systems are paper-based and more cumbersome.

But there are still obstacles to digital transformation in poorer countries: not everyone in the world is connected to the internet or has a smartphone, so there’s still a lack of basic hardware; patient data is very sensitive, so there are regulatory requirements that need to be met; and, ultimately, it is still a question of resources and a need for investment in digital health infrastructure in resource constrained countries.

The regulatory requirements need to be built in at an international level, because they need to be able to work across borders — this is what the World Health Organisation is working on in collaboration with the International Telecommunications Union, and many other partners. Meanwhile, investment is needed in capacity, training and applied research — it is not enough to have the best technology, but it must be appropriately applied to the conditions in which they are intended to operate.

“So there’s much that is still needed, but this is increasingly being addressed by interest from international actors and organisations, as well as at the national level.”

The key now with digital health is how to scale it up. Once you have proven that a concept works, you then need the big organisations — the WHO, with its reach and it’s normative function, and international funders such as bilateral partners, the Global Fund or the World Bank — to combine with locally available resources in order to scale up and accelerate the digital transformation. This is where the Joep Lange Institute plays a role, in connecting these organisations with one another. We have joined the Transform Health Coalition, for example, to drive collaboration towards health for all in the digital age. As of last year, the coalition has been fully operational in bringing together multiple partners from around the world, with a particular focus on driving engagement amongst the younger generation; the digital natives.

The idea is to create a movement by engaging this generation, and bring about a push for these people to demand healthcare as a human right on a local level. In order to do that, they need to be made aware of what is possible. This is the power of forming such a coalition; to empower individuals acting together to influence politicians on a national and even a global scale, and give them ownership of the future of healthcare through digital transformation.

We’ve seen, during the pandemic, that when pushed governments are able to relatively quickly and effectively embrace the potential of digital healthcare tools like connected diagnostics — many countries will have something similar to the UK’s NHS Covid-19 app, which allows for an immediate two-way transfer of information. Patient data can be anonymised, but a central laboratory is able to gather real-time information on how many people have been testing positive for a disease and in which regions, enabling trends and preventative measures to be identified. At the same time, you have an excellent source of information and communication for patients themselves, providing them with immediate access to the correct advice, as well as to their data in the form of test results and whether they have been in contact with others who tested positive. In essence, it is a quick, safe and valuable form of connectivity that augments the quality of the health service — and one that could be applied to a variety of diseases and health problems.

“What this highlights is the importance of non-traditional digital health startups being able to integrate into the existing medical infrastructure.”

You may have developed a cutting edge health tech tool, but if you are unable to connect it to a national health system then its functionality will be extremely limited and impossible to scale up. The world needs public private partnerships in the truest sense of the term; the private sector is the driver of new technology and is creating amazing opportunities, but ministries of health need to integrate these into their systems so they can provide comprehensive rather than narrow, local functionality. Innovators and public services need to be brought together to create the optimal benefit, and this is another way in which international networks like Transform Health can play a role — by connecting innovators to the right people and organisations that will enable new ideas to have the maximum possible application and impact.

Universal health coverage is a fantastic goal, but there are still major obstacles in terms of the need to overhaul existing infrastructure, increase investment and train more healthcare professionals in order to be able to achieve this ideal. It will be a long and difficult process, but what’s clear is that the digital transformation is going to play a tremendous role in empowering both organisations and individuals to pave the way towards a future of resilient health systems and dramatically reduced inequalities in health.

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