This summer we have witnessed amazing things by athletes from across the globe.
We have been in awe of the best, be they from the UK, US, Jamaica, China, Uganda, the Dominican Republic or elsewhere. The country has been immaterial.
Yet when it comes to seeking good things to learn from in healthcare in other places, the country of origin is usually very material, developed and Anglo-Saxon being the reference of preference. This is blinkered.
Emerging countries have had to innovate in delivering healthcare because of scarce resources. Their innovations can help us as we enter a lengthy phase of resource constraint over the next decade or so, created by a demographically driven rise in demand, and anticipated low growth in GDP in the developed world for the foreseeable future.
The recent Global Health Forum, and its reports, demonstrated several examples of innovations in emerging countries that are transferable. In one region of Mexico, the first point of primary care contact is by mobile phone. The physician-staffed call centre works under rigorously monitored clinical governance systems with evidence-based decision making tools from the US, allowing 62 per cent of queries to be managed at first contact.
Following the earthquake in Szechuan province, China, the authorities developed a new delivery model around digital technology. A three-year US$50m public-private partnership involving Cisco systems and non-governmental organisations set out to recreate health services. They established three mobile clinics, technology enabled 66 healthcare organisations and developed 32 virtual hospitals, along with telehealth networks and regional healthcare internet services connecting rural villages to full-service hospitals. This investment in mobile and broadband infrastructure has made it possible for 7,000 clinicians support 300,000 patients per month.
A sophisticated integrated electronic medical record has been central to the Family Health programme in Brazil, which contributed to reducing infant mortality by 60 per cent. It has also been integral to increasing primary healthcare coverage in Turkey from 67 per cent to 95 per cent in three years.
Meanwhile, in India’s Swasthya province, an affordable computer tablet combines physiological sensors and diagnostic equipment with electronic patient records and decision-support systems. Healthcare workers can learn to operate it in under five minutes, an innovation in itself for clinical software systems.
In China, lay community health workers deliver a salt reduction and health promotion programme that has reduced blood pressure significantly. Community workers are also the cornerstone of the Family Health programme in Brazil.
In Tonga, a self-management programme for asthma encourages a greater degree of self-management than in the UK. It aims for patients to manage their own condition with minimal clinical supervision. In the 12 months prior to the programme, two thirds of patient had an asthma emergency. In the 12 months following the patient training this fell to 18 per cent of patients, and asthma attacks reduced by two thirds.
These and other examples all have two common themes. First, recognising the benefit of broadening healthcare providers’ skills, using trained community staff to carry out specific tasks and recognising most patients can manage them themselves for most of the time.
Second, investment in smart mobile technology to transform the model of healthcare delivery; this already occurs in most other industries. That will change, and emerging countries are showing the way.
Emerging countries are beginning to explore that paradigm shift. At its heart will be a wider access to knowledge on health previously locked in the minds of professionals. In the future, face-to-face consultations will not be the main route to healthcare. People will use technology to seek answers to symptoms. They will manage problems themselves with remote assistance, or pull in formal input as they choose.
People in emerging countries are beginning to include these alternative mechanisms in their healthcare systems, driven by a lack of human and financial resources, but nonetheless with the grain of societal shift.
This year, India became the first country where smartphone sales exceeded those of PCs. We will all follow. Emerging economies cannot afford our model of healthcare, and soon neither will we - so we must all work out a different way. Looking at what these countries have done is a good start.
Sir John Oldham is national clinical lead for quality and productivity and leads the DH’s QIPP workstreams on long-term conditions and urgent care.