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

Health
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Challenges

  1. There are often no regulations and compliance for innovative business models
  2. Heavily funded interventions in our space often drown out more sustainable initiatives anchored on organic growth.
  3. Many enterprises targeting poor communities struggle with sustainability of the businesses and innovations beyond funding phase
    4.Poor source data systems that feed to the government data collation systems like the DHIS2 can mislead on the priorities
  4. Cultural practices hinder success of some innovations

Opportunities
1.We believe that there is an opportunity in Public-private partnerships, leveraging on public health sector scale and private sector efficiency.
2. There is an opportunity to strengthen data systems and link hospital and community health information systems to guide more efficient implementation
3. Funding models – impact investing, pay for performance, social bonds
4.Corporate CSR engagements may offer an opportunity for alternative funding
5.National health insurance funds that accommodate both public and private actors allow for growth of innovations and promote collaborations

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This environment of tight fiscal space also creates and opening for the private sector if it can support efforts to improve efficiency. There are a lot of good examples of this in health product supply chains – but we need more of these and we need more scale.

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Brendan, couldn’t agree more. We need to find ways to use catalytic grant capital to help buy down the interest on debt as well as finding ways to “de-risk” investment opportunities. Grant capital can play a big role here by helping to reduce the cost of borrowing and even expanding markets. We also see volume guarantees as another opportunity.

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Some Useful Links for you:

WEF Global Health Equity Network Business Case https://www3.weforum.org/docs/WEF_GHEN_Business_Case_2023.pdf

Harvard Business Review: Reframing Health Equity as a Strategic Pharma Imperative

It is important to take a systems approach when looking at the entire value chain of health.

Business plays a key role in healthcare value chains. Much of the conversation to date has been focused on “for-profit companies directly involved in health products and services.” It is important to state the potential for driving positive change that those products and services offer and have already delivered. However, as we enter a post-pandemic world, we understand that many sectors are not only affected but have a large role to play in global health dialogue – to advance it and ensure no one is left behind.

From pharma to technology and from telecoms to logistics and many more, myriad companies around the world have the influence, employee base, or customer base to effect change. When it comes to health and its vital role in a productive economy and society, all sectors are interconnected and have a role to play. Private and corporate entities encompass both formal and informal actors across sectors, including for-profit and non-profit, and all stakeholders will need to find ways to work together, to complement what each one brings to the table. Now, non-traditional health actors, such as global commercial brands, finance and insurance firms, logistics companies, technology firms, telecommunication providers, data and digital enterprises, food and beverage companies are increasingly part of healthcare value chains and can contribute to improving global health.

Recognizing the breadth of business and corporates and the myriad roles they play in healthcare value chains is imperative. In 2016, John Quelch, then a professor with a joint appointment at Harvard Business School and Harvard T.H. Chan School of Public Health, declared that “Every company is a health company” – that the products, services, and policies of all companies leave a public health footprint that impacts the health and well-being of consumers, employees, communities, and the environment.

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Also, there is an opportunity for business to implement health and nutrition sensitive initiatives at their own workplaces. One third of our lives is spent at workplace, that is missed opporrtunity for us. GAIN in partnership with Consumer Goods Forum (CGF) launched Workforce Nutrition Alliance (about - Workforce Nutrition Alliance) to help employers ensure their employees have access to and knowledge about healthy nutrition, breastfeeding support and nutrition-focused health checks. The Workforce Nutrition Alliance’s aim is to support employers to adopt and expand healthier workforce nutrition programmes to reach three million employees in organisations and supply chains by 2025 and over ten million by 2030.

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We see user trust and knowledge as significant challenges in digital health - which could be a strong area of collaboration for business and governments. As businesses continue to improve and expand tele-health and other platforms such as those offered by Zuri Health (https://www.zuri.health/), collectively we need to build patient knowledge and trust of these new delivery models.

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In India, we have engaged with Impact4Nutrition (https://www.i4n.in/) a UNICEF led platform. Together we have sensitized 60+ private sector companies, and are engaging with 20+ private sector companies to introduce nutrition-sensitive programs for their workforce at the workplace itself. The program is based on four major pillars of the workforce nutrition program which include healthy food at work, breastfeeding support, nutrition education, and nutrition-focused health checks. Currently, 18+ companies have started implementing one of the pillars i.e healthy food at work in their workplace as well as reaching to more than 5000 workers.

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Another opportunity for businesses to support the government is through reporting of health and nutrition initiatives undertaken by them under the Environment, Sustainability and Governance (ESG) report. In recent years, there has been a growing emphasis on ESG factors in the corporate world. ESG refers to a set of criteria used by investors, stakeholders, and regulators to evaluate a company’s impact on the environment, its social practices, and its governance structure. Companies are now expected to not only focus on profitability but also on their environmental and social responsibilities. Government can make ESG reporting on health and nutrition indicators mandatory, as it will provide valuable information to the government about ongoing efforts in the private sector. This information can aid in government policymaking and resource allocation.

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COVID-19 displayed the ways in which individuals, governments, and companies impact population health and revealed an essential truth: The responsibility to be a provider of health must extend beyond the sites that host providers of care.

One of the most promising and prominent features of the response to COVID-19 has been the immense cooperation between innovative industry technology and government financing that brought forward, in record time, new vaccines, therapeutics, and diagnostics to control viral spread. The pandemic also helped accelerate business and corporate investments in core service capabilities, ranging from supply chain logistics to digital transformation. Multinational companies are also utilizing their workforce development capabilities to help communities manage pressures on overstretched health systems at the ground level.

These measures represent strategic, structural improvements that can be sustained as we enter the age of post-pandemic to support resilient systems, and for the long term.

Delivering COVAX vaccines to the world.

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Whilst this is not a LMIC focus, and is linked to the NHS model - my role involves looking at connecting peers between the NHS and other health systems to focus on health system strengthening activities. A big part of the NHS focus at the moment is looking at how to look towards private partnerships to improve the system to enable better access to innovations for patients. Report here from the NHS confed looks at the positives / barriers linked to improving access to innovative medicines in the system: Transforming lives, improving health outcomes

Highlights include:

  • Better engagement with industry – removing and reforming rigid pathway structures.
  • Building on partnership model within the integrated care system to identify demand to identify supply needs.
  • Improve patient involvement - supports ownership
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Great point. The enormous mobilization around the C-19 vaccines is a terrific example of what’s possible. More than 5 billion people received a health product that didn’t exist three years ago. That’s not to say there weren’t mistakes along the way, but this shows what is possible when we can align incentives between sectors around a common goal.

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Q3. How can we increase investment in maternal, child and adolescent health? For example, through advocacy and creative financing models.

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Every two minutes, a woman dies during pregnancy or childbirth. Maternal mortality is not only stagnating, it is increasing. We cannot let this continue.

In 2020, about 70% of all maternal deaths were in sub-Saharan Africa. In nine countries facing severe humanitarian crises, maternal mortality rates were more than double the world average (551 maternal deaths per 100 000 live births, compared to 223 globally).

There is an urgent need to double down on our commitment to women and children’s health. Governments, donors and businesses need to come together to find creative – and sustainable – ways of funding solutions.

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After ecosystem players have co-created a systems-wide solution to a particular challenge, most often these solutions would require an investment. One innovative way to increase investment, and to increase it in a way which supports a systems-wide collective action approach to ensure sustainable change is through systemic investment. This means that investors align on the leverage points which need to be tackled and address them with different types of capital, alongside advocacy for accompanying policies.

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We need to use innovative financial solutions to develop high impact investment opportunities that advance our health goals plus crowd in new capital. At the company level, we need to improve access to patient investment capital. We can do that through derisking investment opportunities. We need to better align the risk tolerance of health impact investors to the opportunities in maternal, child and adolescent health. We can support improvements in financial viability for growing companies, we can use grant capital as a first loss tranches for return seeking impact investments, and we can expand markets by linking public and private sectors.

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Through our work with Investors and our partnership with the Good Food Finance Network ATNI is working with 80 institutional investors to drive financing to businesses that are working to be more responsible in a number of topics, amongst them for maternal, child and adolescent health. We want to see more responsible investing taking place.
Thinking more long-term, creating sustainability in financing of projects, Create stable alliances and commit to continuous work on the topic.

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One effective approach is to foster meaningful partnerships between larger organisations and smaller grassroots initiatives. Partnerships is a contested concept – as often there is a power imbalance – but what if the roles between partners were clearly defined, and if the premise of the partnership was to make it easier for the partner with less “power” or “resources” to lead. This could look like:
• Amplifying the Voices of Smaller Organisations which often have innovative solutions for improving maternal, child, and adolescent health but may struggle to secure the necessary funding and attention. By forming partnerships with these smaller groups, bigger organisations, governments or health institutions can bring their ideas to the forefront.

• Enabling Local Innovation: Smaller organisations are often more agile and better attuned to the specific needs of their communities. They can swiftly adapt and implement creative solutions that work best on the ground. By reducing bureaucratic barriers and providing support for these grassroots innovators, we can create an environment where their ideas can thrive.

• Ease Access to Funding: Smaller organisations may struggle to access funding, hindering their ability to expand their programs. We should reduce restrictions on funding and promote collaboration between larger and smaller organisations. By working together, they can pool resources, expertise, and influence.

• Advocate for Policy Changes at the government level: Advocacy plays a crucial role in increasing investment in maternal, child, and adolescent health. It’s important to influence policies that prioritise these areas and allocate sufficient resources. Partnerships between organisations, including grassroots advocates, can strengthen advocacy efforts, but so can system-to-system partnerships such as through the NHS which can co-create/ set out the systems needed for change.

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The focus on pitching and presentations in defining innovations and interventions for funding disadvantages many entrepreneurs for whom English is not their first language. We need to explore other ways of interrogating the viability and endurance potential of innovations. Such an approach will support greater catchment of indigenous innovations.
There is need to support public-private partnerships
We can exploit the opportunity in community health insurance models

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The business community has a very important voice with policy makers around the World. It’s critical that they use this platform to help reframe investments in health and human capital from a “consumption” paradigm to an investment in innovation, workforce productivity, and driver of economic growth mindset. This may mean that the private sector has to share some of these costs to through changes in tax policy and tax efficiency, but it’s critical that this is seen as hedging supply chain risk, for example, rather than being seen as just an increase cost of doing business.

COVID-19 really highlighted the impact that a health crisis can have on economic growth. But even before COVID-19, counties were facing huge economic inefficiencies from poor health and nutritional status. These include huge impacts of under nutrition on cognitive function and the inter-generational impacts of poor health outcomes for women.

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DSM-WFP partnership on fortified food products including fortified rice offers an example of how greater private sector investments and effective collaboration between business and civil society can contribute to improve the nutrient intake of children under 5 years old and pregnant and lactating women.

In order to address potential bottlenecks that could undermine a successful partnership and the outcomes of the project, the partners went through a series of memoranda of understanding and identified joint objectives and agree on responsibility for management, communications, and advocacy for the partnership.

By 2013, the program reached out to 80% of its beneficiaries with fortified food products that help address micronutrient deficiency among the most vulnerable. n 2017 alone, WFP supported 39.4 million people with food that was nutritionally improved by this partnership, meaning essential vitamins and minerals were added to diets, which help address a broad range of physical and mental health needs (DSM and WFP extend their partnership to tackle malnutrition | DSM).

GAIN is supports large scale fortification (LSFF ) programmes in different ways such as by providing technical support and training to food producers to improve the quality of fortified food; supporting governments to establish and strengthen LSFF programmes; and coordinating multi-sectoral efforts. An example of advocacy and educational tool developed by GAIN to streamline LSFF data collection and analysis by the private and public sector is a short digital video made available in wider range of languages to reach to a great number of countries.