Achieving Universal Health Coverage through a sustainable business model

INTRODUCTION

Sustainable Development Goal 3 which stands for “Good-Health & Well-Being” is one amongst the 17 goals established by the United Nations in 2015 as a part of the 2030 Agenda. Efforts in this direction are gauged through 28 indicators which measure progress towards 13 targets. These targets were developed with a global perspective and released by the Inter-Agency and Expert Group on SDG Indicators (IAEG-SDGs) at the 48th United Nation’s Statistical Commission held in March 2017. [5] [7]

The journey thus far has not been easy, in fact each generation, each decade, each year, brings with it, its unique set of health and wellness challenges, but no single event has reversed decades of improvement like COVID19 has. So, let’s put the impact of the pandemic into perspective – [11]

Measles immunization campaigns have been suspended in 23 countries affecting almost 80 million eligible children
Illness, and deaths due to communicable diseases is expected to spike globally with malarial deaths estimated to increase by 100% due to service cancellations in sub-Saharan Africa
With all schools closed indefinitely in 143 countries, 368.5 million children have been denied their daily school meals
Patients with TB and HIV/AIDS are at higher risk of the developing resistance to therapy due to discontinuous access to medicines

One has to understand that a disease not only affects an individual, but it weakens societies, burdens resources and most importantly squanders potential. So providing protection for illness is fundamental to sustainable development and providing equal opportunity to prosper. The distressing reality, however, is that governments and organizations across the country have still not managed to provide essential health services to even half of the world’s population.[12]

INDIAN PERSPECTIVE

India has made significant strides towards reaching the SDG goals of 2030, more so in the domain of health and nutrition, through the implementation of well-formulated schemes. For instance, the Janani Suraksha Yojana, which is program that provides cash assistance for safe motherhood, has helped India reach 113 maternal deaths per lakh live births, thereby putting India on track to reaching 70/1,00,000 live births by 2030. Other notable schemes such as Ayushman Bharath have improved overall health coverage and targeted schemes like Poshan Abhiyan have directly combated the vicious cycle of malnutrition, stunted growth and infection predisposition. [8]

In addition to routine efforts, certain projects and initiatives driven by community participation and global partnerships have played a tremendous role in bolstering the health ecosystem. For instance, The Ministry of Environment, Forest and Climate Change, in partnership with UNDP, has actively supported the conservation, processing, sustainable use and export of medicinal plants in three ecologically fragile states – Arunachal Pradesh, Chhattisgarh and Uttarakhand. In the latter half of the decade the Government of India, with the support of philanthropic organizations like Bill & Melinda Gates foundation successfully designed and rolled out the electronic Vaccine Intelligence Network (eVIN) which has significantly improved the efficiency of Universal immunization program. The IOT enabled network to have improved policy making and execution in terms of vaccine planning, procurement and delivery. More impressive is the fact that, eVIN forms the basis for the COWIN-20 platform that would be used for vaccinating the country on priority basis and need basis.[9]

SDG 3 in the Indian Context(source: https://in.one.un.org/page/sustainable-development-goals/sdg-3-2/ )

BUSINESS IMPLICATIONS

Sustainability is the name of the game now, with the exponential increase in conscious consumerism. Just to put things into perspective, here are some stats published by PWC

71% of businesses say they are already planning how they will engage with the SDGs
13% of businesses have identified the tools they need to assess their impact against the SDGs
41% of businesses say they will embed SDGs into strategy and the way they do business, within five years
90% of citizens say it’s important for business to sign up to the SDGs
78% of customers are more likely to buy the goods and services of companies that have either signed up for SDGs or have committed to making their processes more efficient

Now let's focus on what goals most businesses are prioritizing and if there is inherent self-interest driving such selection. Globally, companies across the board have ranked SDG 8 (Decent work and economic growth) as the SDG that will have the greatest impact on their business. However, as an outlier in many respects, the countries of the middle east have prioritized SDG 3 as their number one priority.

It is not surprising that all the firms in the healthcare value chain right from providers, payers, health-tech firms, health-data firms and more importantly pharmaceuticals have become the champions of SDG 3. Research also shows that firms belonging to this ecosystem also prioritize SDG 8,5,4, and 9 in descending order of importance.

The SDG engagement survey shown below shows the blatant gap between SDG 8 and SDG 3 when it is mapped with impact and opportunity in perpendicular axes.

An important reason for the same could be that these firms are already covering the health and wellness needs of their employees through expensive insurance coverage schemes. However, the importance to mental health is still an emerging concept. Both multinational firms and national firms in India need to go a long way to understand the impact of stress in order to prevent burn out. It is a well proven fact that happy and health employees are far more productive than their polar opposite counter parts. But very few companies like Google, Novartis and Apple have incorporated policies that ensure upkeep of mental health through systemic breaks and EFL sessions (energized for life).

With regards to making progress in the deliverables under SDG 3, these firms usually pair up with regional and international NGOs. The focus in primarily seen in 2 areas – Maternal and child health along with three diseases – HIV, AIDS, & Malaria.

As can be seen from the above perception map, SDG 3 is neither swaying towards high weightage for citizen importance or for business opportunity, again showing that there is considerable scope to impact both ends of the spectrum through this route.

The following are the key business themes addressed by this SDG -

Occupational health and safety
Access to medicines
Access to quality essential health care services
Air quality
Water quality

In terms of business action, here are some business solutions that are helping organizations align themselves in an optimized manner to achieve SDG 3

Aligning human resource policies in a manner by adopting the gold standard practices that ensure upkeep of mental, physical and social health of an employee along with ensuring equitable distribution of rights and opportunities across the board
Partner or invest in firms that take are tackling challenging healthcare problems through their product or service offering
Leverage resources (R&D, manpower, technology) to empower the malnourished, and the low-income population

ANALYSIS AND THE PATH AHEAD

The sustainable Goal 3 is the one in which maximum difference exists between the developed and the developing nations. The lack of primary and secondary healthcare facilities is the major contributor for this large gap in the levels. When it comes to India, the situation is not very different from other developing economies. With the intervention of the subsequent governments, the overall trends in the area of healthcare have been positive. The National Health Mission has been extended by merging the Urban and Rural health missions [1] in the form of a concentrated effort to provide healthcare for all Indians. Consequently, India is targeting goals under various heads ranging from primary healthcare to investing in R&D keeping in line the targets set by United Nations. The specific goals are as follows [2][3]:

Targets:[6]

Reducing Maternal and Newborn Mortality by 2030: Reduce the maternal mortality ratio to less than 70/100,000 live births and the mortality of children below 5 years of age to less than 12/100,000 live births.
Having targeted missions for specific epidemics: End the epidemics of AIDS, tuberculosis, malaria and other tropical diseases by 2030.
Reduce 1/3rd of mortality from non-communicable diseases. The mental well-being of the population is also classified under this goal.
Prevention and the treatment of substance abuse in the population.
Universal access to reproductive health care services: According to this mission, universal access to birth control means, and the requisite information about the general sexual well-being would go a long way in curbing the population boom and the prevalence of sexually transmitted diseases in the population.
Achieving Universal Health Coverage: The Ayushman Bharat Program aimed at the bottom 50% of the population was a huge step towards achieving Universal health coverage of the population. The future scope of this would be to increase the penetration of this scheme to all the states and union territories of the country so that maximum people are able to avail this scheme.
Reducing health externalities related to water/soil/air pollutions by 2030.

Means of Implementation Targets:

Strengthening the implementation of WHO Framework Convention on Tobacco Control.
Supporting the R&D of vaccines and development for communicable and non-communicable diseases primarily affecting the developing countries.
Training and successful retention of healthcare workforce in the country: One of the major roadblocks in achieving the goals set in SDG 3 when it comes to the specific case of India is the dismal ratio of doctors to patients in the public health care system (0.08) [4]. Hence, achieving this goal would act as an enabler for the other goals to be achieved.
Strengthening the capacity for early warning, risk reduction and management of health risks.

To streamline efforts, organizations must choose apt KPIs or invent new ones to accurately capture impact. Moreover, firms must collect data and leverage existing tools to take insight driven decisions.

The following represent KPIs that are globally accepted

Access to Medicine Index, C.III.1
CEO Water Mandate’s Corporate Water Disclosure Guidelines, GRI G4
Sustainability Reporting Guidelines, G4-LA6:
Oxfam Poverty Footprint, PF - 14.4 (B):

Some of the tools available are as follows

Social Hotspots Database/Portal (SHDB)
UN Global Compact-Oxfam Poverty Footprint Tool
Corporate Human Rights Benchmark (CHRB)

In order to meet the SDG 3 deliverables and hopefully to over deliver, corporate participation is vital. There needs to be a tectonic shift from “make sustainability a part of the business” to “make sustainability your business”. And this shift cannot happen unless health and wellness is championed by the leading industries in their respective domains.