Delivering Healthier Futures for Women, Children and Adolescents: What is the role of business?

Health
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ATNI prioritizes breastfeeding and complementary feeding (CF) in its programming. In terms of innovation, ATNI publishes breast milk substitute (BMS) and CF standalone reports which track the behavior of the world leading BMS and CF manufacturers. This provides a robust baseline and monitoring reports which are essential to ensuring good nutrition reaches mothers and young children.

Infant and Young Child Nutrition – Access to Nutrition

One of ATNI’s newest projects is about developing a global product profile for complementary foods that concern infants and children, aged 6m to 36m. As this period of a child’s life is considered crucial for their development, WHO has developed specific guidelines about the formulation of products for this age group, and based on those a new model for assessing the nutritional quality and labeling of these products. ATNI is using the WHO Europe’s 2022 Nutrient and Promotion Profiling Model for Foods for Infants and Young Children to analyze the products of the largest 6 CF manufacturers in 10 countries. This will be the first report of its kind globally and we hope that it will contribute to the conversation and to the improvement of the nutritional quality and marketing of commercially produced complementary foods.

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Apart from this, we are also planning to do a programmatic intervention to improve compliance of iron supplementation among female workers. We will undertake, a 360-degree approach to social behaviour change wherein the project will focus on two major implementation areas – improving the provision of iron folic acid and deworming tablets for anemic women, and using a mix of one-to-one counseling and other digital platforms to change the dietary behavior of female workers.

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We also see great opportunities in rapid diagnostic tools; and in micro-insurance

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Also I believe, sustained innovation in maternal and child health is crucial for several reasons:

  1. Prevention and Early Detection: Innovative approaches can focus on preventive measures and early detection of health issues. This can include innovative screening methods, vaccines, and diagnostic tools, enabling healthcare providers to identify and address potential problems before they escalate.

  2. Accessibility and Affordability: Innovations can make healthcare services more accessible and affordable, especially in remote or low-income areas. Telemedicine, mobile health applications, and community health worker programs are examples of innovations that bridge the gap between healthcare providers and underserved populations.

  3. Maternal and Child Nutrition: Innovative approaches to nutrition, including fortified foods, supplements, and educational programs, play a significant role in ensuring the health and development of mothers and children. Proper nutrition during pregnancy and early childhood is vital for physical and cognitive growth.

  4. Reduction of Health Disparities: Innovations can help reduce disparities in healthcare access and outcomes among different socioeconomic and demographic groups. By addressing specific needs and challenges faced by vulnerable communities, innovation ensures that healthcare services are more equitable.

  5. Data-Driven Decision Making: Innovations in data collection, analysis, and management enable healthcare providers and policymakers to make informed decisions. Data-driven approaches identify trends, monitor progress, and assess the effectiveness of interventions, leading to more targeted and efficient healthcare strategies.

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Q2. What are the challenges and opportunities for business to partner with other sectors in support of governments’ efforts to strengthen health systems for women, children and adolescents?

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ATNI holds a fairly unique position in the NGO world – we engage with the private sector regularly while never receiving PS funding. The public and private sector need to trust each other more and we aim to play more of a brokering role and to build more private sector accountability.
The opportunity for open and transparent collaboration is huge. We need to explore areas of mutual benefit, where agendas are genuinely aligned and build from there. Understanding that sustainable solutions need to involve all sectors is critical, which is why ATNI works with the companies, investors, policy makers and consumer group to drive change.
We should look to support the design of better and enforceable regulations – those which level the playing field and support consumer health.

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A fundamental challenge is the major financing gap for women’s, children’s and adolescents’ health and nutrition. On top of having too little financing, the financing that countries do have is heavily fragmented, with households covering a large share of these health costs through out-of-pocket spending. This makes addressing equity issues particularly difficult.

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Engaging in collaborative initiatives spanning various sectors to reinforce government endeavors in strengthening health systems for women, children, and adolescents is both a challenge and an opportunity for businesses. Businesses encounter the intricate web of regulatory compliance governing health systems, aiming to ensure healthcare quality and safety. Navigating these diverse regional regulations proves daunting. Additionally, bureaucratic procedures entrenched in government systems often cause delays in decision-making and implementation, impeding the flexibility of businesses involved in healthcare projects. Sustaining long-term commitment becomes demanding, especially when immediate returns on investment are not visible. Establishing effective Public-Private Partnerships (PPPs) adds complexity, requiring a profound understanding of each partner’s roles and responsibilities. Mismanagement or lack of clarity in these partnerships can lead to conflicts and eventual project failures.

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However, it is evident that the government alone cannot significantly enhance health and nutrition outcomes; collaboration with businesses is essential to improve service delivery and implementation. Amidst these challenges, opportunities abound for businesses to substantially contribute to health system-strengthening initiatives. Businesses can leverage their innovative capabilities and technological expertise to create solutions that enhance healthcare delivery.

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m-mama was created as, and remains, a public health initiative rather than a standalone ‘IT solution.’ The m-mama system was developed in collaboration with the President’s Office for Regional and Local Government (PORALG) in Tanzania and its adoption and now national scale up has been conducted with the support of both the Ministry of Health and the Ministry of ICT. This integration and support are reflected in the agreements with governments in Tanzania but also in Lesotho, where the ownership, sustainability and financing of ongoing costs has been met by those governments from the outset.

Through partnership and collaboration with USAID, and with the Governments of Tanzania, Lesotho and Kenya, m-mama has expanded, with public sector sustainability hard wired from the outset and aims to make existing systems more efficient, engineering a solution affordable to government. From the onset, a financial agreement and implementation plan was agreed with respective government upfront. In Tanzania, the government provided all dispatch staff and a proportion of transport budget from day one. m-mama is not replacing the government’s system, moreover, creating a solution that makes the system more effective.

We need to collaborate more though across initiatives that support at different points. Using successful innovations as a launch pad to enable other interventions to succeed.

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The challenges can be transformed into opportunities with the right partnerships. For example, amending regulation to allow for remote diagnosis and health advice, providing better internet connectivity, training local health workers to work with specific innovations and on general IT skills, working towards integrating health data into a comprehensive health record and building trust in digital solutions, which are usually among the main challenges to bring innovative solutions to those who require them the most are all excellent opportunities, where governments and the private sector can work together by analysing the existing system, identifying leverage points and opportunities for collective action.

You can only identify the gaps and leverage points in a system, if you have all ecosystem players at the table, but once you have done that, you can move into collective action, where the combined resources of the stakeholders can be mobilised to address systemic issues.

In support of TechnoServe, Endeva has worked on facilitating an industry-led coalition in staple food fortification which will launch on the 20th of October (called Millers for Nutrition). Together with our partners, we identified the gaps and opportunities in large scale food fortification and saw the way to unlock this potential is to set up an incentive structure for millers who are at the heart of food fortification and being able to scale it up and reach those those that do not have access to diverse diets. The aim is to do this by encouraging, celebrating and rewarding millers that fortify. Food fortification is extremely useful in the first 1000 days of a baby’s life and during pregnancy to avoid neural tube deficiencies.

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These financing challenges have become more acute in recent years with increased cost of financing for LMICs, a growing debt crisis, and the impact this is then having on available fiscal space. This situation is also raising financing costs for the private sector as well as investors become more risk averse and can find “safer” returns in developed markets. Here’s an example from today’s newspaper in Kampala.

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Moreover, existing laws and regulations provide certain provisions for workforce safety and health, but specific targeted nutritional interventions are lacking. There is an urgent need for businesses and corporations to focus efforts on integrating nutrition into their policies. Enhancing the health and nutrition of employees can have a cascading impact on a larger population. A study (you can refer it here- https://www.chathamhouse.org/sites/default/files/07-08-business-case-investment-nutrition-wellesley-et-al.pdf ) across 19 countries highlighted significant losses in businesses due to malnutrition, leading to reduced productivity and substantial economic losses. Workforce nutrition programs, as defined by the Global Alliance for Improved Nutrition (GAIN), encompass interventions addressing fundamental aspects of nutrition among employees and supply chain workers, aiming to enhance access to and demand for safe and nutritious food. Businesses and employers, alongside the government, can implement nutrition programs for their workforce, maximizing returns and utilizing existing human capital. This can be achieved through funding healthcare and nutrition projects, showcasing a commitment to social welfare. Additionally, integrating sustainable supply chain practices into the business procurement mechanism ensures the availability of necessary resources, especially during emergencies.

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Agree - We need to be speaking the same language, but we all know too well that across sectors the acronyms at the very minimum mean different things. The challenge is communicating a shared goal whilst setting the boundaries around different roles and responsibilities of those involved. The opportunities come from sharing this language – you might have different regulatory environments – but you can share a common goal. How can funding models enable pooling of resources to support better allocation depending on the sector which has the most experience in that issue. For example, routing health literacy programmes through the WASH sector (and MHM programmes).

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Innovations in nutrition, such as nutritious food products, have been crucial in the treatment of malnutrition in children as well as boost maternal health. Additionally, nutrition education programs for mothers teach them about balanced diets and proper feeding practices.
Scaling Up Nutrition Business Network (SBN) supports various enterprises in advancing these nutritious rich products to reach the population especially the base of pyramid. By advancing practical business solutions and support, to improve their business practices for nutrition. This includes facilitating access to finance, technologies, technical assistance, innovation, business partnerships, and strategic knowledge-exchange opportunities. SBN has organized innovation challenges both at the global level and in various countries to promote the financing and advancing of these nutrition centered businesses.
Example of a global level innovation challenge EatSafe Challenge.
Example of country initiatives to upscale nutrition initiatives by SMEs: https://www.lightcastlebd.com/cases/gain-mapping-private-sector-activities-in-nutrition-and-developing-a-sun-business-network-strategy-in-bangladesh/

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This increase in the risk of doing business with governments in developing markets really constrains the kind of business models that are needed to reach the poor and vulnerable. An investment in a specialized care facilities focused on high-income households is a more attractive bet than investing in primary healthcare – where much of our health impact will be delivered – even when there’s an available public subsidy or national insurance payment. This is where de-risking approaches become particularly important.

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Both the private and public sector play a critical role to advance public health, especially for the most vulnerable to malnutrition. Effective public and private sector partnership represent a systematic and collaborative lever to food systems transformation.

However, there are multiple barriers that make such partnerships challenging, more notably, lack of trust, power imbalances, conflict of interest and insufficient accountability mechanisms.

Public sector and academics often prefer not to engage with the private sector because of the conflicts of interest between F&A industry profit and public health outcomes. The lack of trust comes from past and current industry transgressions in the nutrition space, such as the violation of the World Health Assembly-adopted International Code of Marketing Breastmilk Substitutes. However, if we want to accelerate food systems transformation, all food systems players need to be involved in open multi-stakeholders discussions, bringing together greater variety of expertise, perspectives and resources.

In 2017, WHO published a draft approach to help prevent and manage such conflicts of interest and support countries to assess when to engage with private sector entities. The Partnership for Maternal, Newborn, and Child Health (PMNCH), for instance, offers an example of framework to support the engagement, alignment and accountability of public and private sector partners towards women’s, children’s and adolescents’ health and well-being.

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We see supply chain as a key area where businesses can partner with governments efforts to stregthen systems for women, children and adolescents. As innovations in last mile delivery and direct to consumer delivery expand access to affordable products, we need to find ways for governments to leverage some of these systems especially when these systems offer delivery cost savings.

Additionally, as we have seen in the last few years drug shops and pharmacies play an increasing role in expanding access to care as well as an opportunity to influence behavior and grow purchasing power.

One challenge we see in these areas is a difficulty in linking public and private markets. We see companies that would like to expand and provide service to the public sector but don’t necessarily know how to “break into” that market. Additionally, access to capital, particularly working capital, can be difficult.

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https://www.unicef.org/innovation/health/life-saving-maternal-innovations

Social and digital innovations for pregnant girls

Adolescent pregnancy is the leading cause of mortality in girls aged 15 to 19, and their babies face greater risks from low birth weight, preterm birth and severe neonatal conditions.

Pregnant girls and parenting adolescents often struggle to access critical information on maternal health care before, during, and after childbirth that could help reverse these statistics.

Free, digital peer counselling on sexual health and rights

Through SMS BIZ, adolescent boys and girls can send questions via their mobile phones and receive real-time SMS responses from youth peer counsellors on sexual and reproductive health and rights, HIV, violence prevention and pregnancy-related issues and queries.

Over 350,000 adolescents have already used the platform. Piloted in Mozambique, this innovation will be scaled to three more countries in the Eastern and Southern Africa region in 2023.

The innovative pregnancy tests jointly developed by the Rhodes University Biotechnology Innovation Centre (RUBIC) and UNICEF use nucleic acid strands (RNA/DNA) instead of the traditional antibodies, which considerably lowers their cost while conserving their accuracy and increases their stability across a wider range of temperatures and humidity.

Life-saving innovative products

Severe bleeding after childbirth is the leading direct cause of maternal mortality worldwide. Life-saving interventions are often inaccessible in many countries. UNICEF’s Product Innovation Centre provides low-cost, easily accessible devices to prevent and treat post-partum haemorrhage (PPH).

Life-saving vests

The non-pneumatic anti-shock garment (NASG) is a life-saving compressive suit inspired by NASA technology that reduces excessive bleeding after childbirth by squeezing the limbs to push blood to the head, buying critical time (from 30 minutes to 48 hours) to transfer the patient to the nearest health facility for life-saving care. So far, over 4000 units have been delivered to 14 countries around the world.

(https://www.unicef.org/innovation/innovation-portfolios).

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Challenges-
Policy environment; Lack of systems to support public/private partnerships not just learning spaces but also providing a channel for private innovations to support in providing solutions and support to already existing public provision of services.

Opportunities-
In a rapidly digitizing world, technology offers a bridge to knowledge, connectedness and opportunity
There are so many opportunities where private sector/ innovations can support governments’ efforts and some of these are- Distribution of commodities (I know this is already happening in some countries); reaching the last mile; channeling information especially when we are talking about adolescents- How can reach them and provide the health information in the language they speak!

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