The COVID-19 pandemic was the ultimate stress test for overburdened global healthcare systems, exposing the stark health disparities that often resulted from fragmented care delivery. However, the pandemic accelerated tremendous innovation and resolved to bridge gaps in access to care to ultimately improve health equity amid these challenges. A recent panel of leaders in health and medicine in Kigali explored the importance of building on these innovations in order to create sustainable systems that provide the level of service and breadth of care that universal health care requires. A key piece of this work entails moving toward inclusive models of healthcare that offer quality, cost-effective and integrated care options for everyone, regardless of social or economic status. These models often use digital innovations in new ways to expand access to care. There are a number of inspiring examples of this around the world. In Rwanda, one standout example is the Rapid SMS programme that has helped the nearly 60,000 community health workers to report and refer cases, including emergencies that need urgent attention at healthcare facilities. The rapid intervention system is credited with helping reduce maternal and infant mortality rates, while it has also played a key part in fighting Malaria. In addition, the technology links community health workers to the Ministry of Health, thus allowing the latter to regularly monitor the impact of community health workers on the country’s health care system. Such innovations will continue to play an instrumental role in promoting universal health coverage in Rwanda, especially as the current model of community health workers is under review for further improvement. In South Africa, the Unjani Clinic Network for low-income and underserved groups has adopted an inclusive model that allows employed but uninsured people to access affordable, high-quality primary care services delivered by nurses who own and operate the primary care facilities. Importantly, the clinics feed patient care data to the larger national system, ensuring patient experiences are captured, in order to inform health policy and resource allocation. Being able to create a digital footprint and record for patients allows Unjani Clinics to go to the private sector, government and partners to show impact, share learnings and make the case for support. While providing timely and convenient primary care to those who didn’t have this option before, these clinics also free up capacity in public clinics to better serve more vulnerable patients who truly have no other option at all. Another example comes from mothers2mothers, an organization which Gilead has supported over the years. Mothers2mothers employs and trains women living with HIV in several African countries as community health workers. While their primary role is to deliver HIV care, these “Mentor Mothers” support healthcare needs far beyond HIV, providing access to other essential health services including sexual and reproductive health and family planning. This unique model has recently evolved to thoughtfully combine innovative digital tools with in-person services, which has allowed mothers2mothers to achieve successful outcomes with their clients during the height of the pandemic and beyond. In fact, mobile applications and services have enabled Mentor Mothers to reach significantly more clients, provide increased support, rapidly respond to client needs and identify areas for improved services. Mothers2mothers’ work in integrating in-person and digital tools has been so successful that it was recognized by the African Union Commission, who selected the organization to serve as a member of its Digital Health Strategy Taskforce. Mothers2mothers is now working with the Commission to strengthen health research, innovation and technological capabilities to achieve the Africa Health Strategy 2016-2030. The inclusion and digital innovation conversation in global health is just beginning - and there is still much to uncover in order to discover what works, scale these solutions, rigorously evaluate their impact and accelerate progress towards universal health care. Gilead’s Global Patient Solutions unit is invested in learning about unexpected models of healthcare that use innovative solutions to bring diverse socioeconomic groups under one tent and deliver a fundamental level of quality care. It is our hope that these examples will provide a way forward for all stakeholders and decision makers to achieve our collective goal of quality, cost-effective healthcare for all. Digital innovations could be the great equalizer, if we invest in their design and implementation appropriately. This work will require the experience, local wisdom and involvement and trust of end users, local experts, public and private sector partners to be sustainable and effective. The Unjani Clinics and mothers2mothers programmes show us what’s possible when we leverage these innovations in a person-centered way to improve access to care - and build solutions that are inclusive of all the communities impacted. Sue Hoosain is Network General Manager, Unjani Clinics, South Africa,& Harald Nusser Head, Global Patient Solutions, Gilead Sciences.
