Cases presented from Peru, USA, South Africa, Kosovo and India
This article first appeared on The Dartmouth Center for Health Care Delivery Science's website.
The third day of the Salzburg Global program 'The Drive for Universal Health Coverage: Health Care Delivery Science and the Right to High-Value Health Care' included sessions that addressed how to apply a rights-based approach and citizen engagement in different contexts, what low-income countries can learn from other countries' mistakes, and how reverse innovation can drive health care value up and costs down.
During the first session of the day, Dr. Jaime Bayona of TDC and the World Bank Institute described providing the first ambulatory treatment for MDR-TB in Peru, noting the importance of providing social and other support beyond just medical treatment.
Dr. Bayona discussed cancer care in Peru, tuberculosis in South African mineworkers, and community participation in health councils in Brazil with the three panelists.
In Peru, Club de la Mama has provided social support for women with breast cancer since 2006. The group promotes breast cancer awareness and facilitates knowledge sharing between patients, empowering them and providing an important service beyond medical care.
In South Africa, the high tuberculosis burden in mines is difficult to address due to the prevalence of migrant labor and little governmental accountability across borders.
A lack of patient engagement has hindered past efforts to address the epidemic, though the main challenge now is how to include ex-mineworkers under the care system being developed.
Integration of care, decentralization, and citizen participation are codified in Brazil, and the Brazilian team spoke about local and national health councils that include user, government, provider, and professional association representation to shape health policy in a bottom-up manner.
Several participants seemed interested in how this model could be adapted to their country context. In yesterday's session focused on learning from problems in different countries' health care systems.
Dr. Bob Drake of the Dartmouth Psychiatric Research Center described his experiences developing community-based mental health care programs in the United States. He encouraged participants to build mental health care programs that focus on vocational training and strengthening natural support systems.
Dr. Drake cautioned against building mental health care systems reliant on institutionalization, polypharmacy, and isolation of mental health care services from primary care—all pitfalls of the American system.
Most patients, he said, are interested in functional recovery and community integration, not the complete annihilation of their symptoms. In the same session, both Peru and Kosovo said they see high rates of post-traumatic stress disorder in their populations.
In 1999, after the Kosovo War, 25 percent of the population over 15 suffered from PTSD, and the country's mental health care system was in shambles.Working with the World Health Organization, the Kosovar government developed a plan for mental health care that centered on seven community-based mental health care centers.
Kosovo said that traditional healers can also serve as an entry point to mental health care and should be integrated into systems as capacity is built.
In the afternoon, Dartmouth's Chris Trimble moderated a panel of five Indian medical entrepreneurs, who explained how standardization, task shifting and capacity innovation have helped them reduce costs for procedures such as cataract surgery and dialysis by as much as 90-95 percent.
In Dr. Srinivasan Aravind's eye care centers, a cadre of midlevel ophthalmological personnel—trained in a program developed by the Aravind Eye Care System—allows doctors to perform a much greater number of surgeries than otherwise would be possible.
One panelist remarked that health care is about process, protocol, and price. In India, the primary health care system is hampered by a lack of general practitioners, an out-of-pocket payment system, and a lack of integration of vertical programs.
The importance of sustainability in building primary health care capacity was emphasized -- altruism is not enough to guarantee the success of a system.
The panelists urged budding entrepreneurs to seek out new opportunities, persevere in the face of setbacks, and focus on working well with a team to realize health care innovations.
Country teams met for a second time to more thoroughly investigate the core issues and questions they identified on Monday. Today, the teams will draft change strategies and action plans to further refine how they hope to address specified issues.
The teams—composed of a mix of government officials, practitioners, those from the non-profit sector, civil servants, entrepreneurs, and others—represent the following countries and regions:
- Brazil
- Costa Rica
- Mexico
- Peru
- East Asia
- Kosovo
- Egypt
- Morocco
- India
- United States and Canada
- Uganda
- Rwanda
- South African and Swaziland
Yesterday evening, participants tapped into one another's expertise and gathered for conversations addressing personal topics of interest, ranging from metrics for impact investing to translating health care innovations across country contexts. Some of these discussions will continue today as part of the Knowledge Café session.
Emily Fletcher, Presidential Fellow in Global Health, joined the Dartmouth Center in Salzburg for the session, 'The Drive for Universal Health Coverage: Health Care Delivery Science and the Right to High-Value Health Care.'
