The pace of change can often prove frustratingly slow for those who live in the developing world. Sure, many countries have advanced beyond all recognition from just a few decades ago, but there is much more still to do. Take the cities of Delhi and Shanghai, for example. Cranes and skyscrapers may adorn their respective skylines but far too many of their residents still endure lives of deep-rooted poverty.
Of the many social and economic priorities facing developing countries, strengthening their health systems consistently looms large. This should come as little surprise. Better health leads to stronger economies, helps protect people from hardship and is a foundation for a happier, more productive society. Given that simply tracing the steps of mature economies is not feasible – too slow, too expensive and highly inefficient – there is increasing recognition that developing countries need to set their sights higher and seek to ’leapfrog‘ their way to a healthier future. How can they do this?
The good news is that emerging economies possess many advantages over their more developed counterparts. (Now there’s a sentence you don’t read every day.) But it’s true. Not only can they learn from the past mistakes of developed countries, they are also less weighed down by vested interests and can now access myriad technological and organisational innovations to power their progression. And it’s these innovations that are key.
To be considered a leapfrog, an innovation must satisfy three criteria. First, it must accelerate a health system’s development by reducing the time to results. Second, it must be cost-effective by achieving current or better results at lower cost. And third, it must be scalable.
Leapfrogging is enabled by three types of innovation – new technology, new operating models and new behaviour patterns. It is also a mindset, a way of thinking about problems and opportunities with a view to speeding up a system’s development. This can take place at two levels. It can be as small as rethinking the diagnostics and care models for diabetes in Jakarta or as large as transforming the entire delivery of primary health care in Ethiopia.
Looking to government
Unfortunately, many innovations fail when they reach the scale-up phase. They often fail to integrate into the health system and can also be uncoordinated with other initiatives, which limits their impact. This lack of strategic planning means that determining the right scale-up approach is critical to a leapfrog’s ultimate success.
Governments have a crucial responsibility in this regard. Of course, investing in health today creates a healthier population, leading in turn to economic growth and sustainable development tomorrow. But in emerging economies – and despite limited capacity – policymakers have multiple roles to play, such as steward, provider, payer and investor. They also have to fill gaps, because demand for health care may be low, infrastructure may be insufficient, local markets may be underdeveloped and some stakeholders may be absent or inadequate. And that’s not all.
Other sectors such as agriculture, finance and infrastructure are all influenced by health. For example, when the ministry of health succeeds in improving health standards, its departmental counterparts benefit from a more productive workforce. In return, other ministries have a big role to play by influencing socioeconomic determinants of health outcomes, such as the environment, employment and equality. Health, then, should really be the focus of all government officials and not limited to those within the health ministry. Governments need to think in terms of broad health systems, not diseases or provision of care.
With this in mind, government has the ability to frame an overall health vision and agenda, to find a balance between all the different views and interests, and to coordinate stakeholder efforts. While health system transformation also depends on the private sector and other stakeholders, such as international organisations, public investors and NGOs, there is little doubt that – in emerging economies – focusing on the government and its ability to create an enabling environment is a key first step.
Over the horizon
It’s important to note that transforming any health system towards sustainability is far from easy – especially for an emerging economy. What services should be prioritised? Which funding methods should be deployed? How can a health system best service its citizens? It’s clear that questions – and challenges – abound. Equally clear, though, is the fact that leapfrogging over arduous and expensive development stages is the most practical way for emerging economies to establish resilient, effective and sustainable health systems.
But the clock is ticking. Hundreds of millions of people around the world still suffer from extreme poverty and health systems that remain ill-equipped to meet their needs. There’s no time to lose.
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