By Manasi Mahesh Shirke
MEDxCare is a digital platform that helps governments and private institutions achieve Universal Health Coverage (UHC) and hence create an ecosystem for smarter healthcare. The organisation aims to do so by making use of a rich ecosystem of competencies, innovative IT systems, and robust processes to eliminate gaps and discrepancies in healthcare systems in sustainable ways. This outcome-based approach parallels with the WHO framework for sustainable healthcare design. They extend their services to developing countries by providing remote access to healthcare.
The organisation stems from the unnerving incident of the wrongful diagnosis of the co-founder, twenty years ago. Knowing that thousands of people are faced with the same issues around the world, MEDxCare was created. Founded in 2015, MEDxCare has created an expansive network connecting healthcare providers, seekers, and families on a digital platform that enables access, acquisition, and payment of healthcare services and resources from anywhere around the globe. The organisation has also been recognised for their contributions at VIVATECH Paris 2017.
Understanding Universal Health Coverage
A society with Universal Health Coverage (UHC) would essentially provide people with promotive, preventive, curative, rehabilitative, and palliative health services of sufficient quality while ensuring that the use of these services does not expose the user to financial hardships (1). The movement is summarised by three fundamental dimensions: the proportion of the population covered, the proportion of expenditures prepaid, and the proportion of health services included in UHC—that any given healthcare reform strategy seeks to achieve in some order (2).
UHC can be achieved by recognising the needs of key populations. Once these needs have been acknowledged, policy commitment, defining, and including essential high-impact, evidence-based interventions to address the needs of the key populations must take place. This is followed by their full integration into national health benefit packages; integrated, decentralised, and differentiated health services with involvement, ownerships, and acceptance of communities to ensure equity and quality. Moreover, for key populations to benefit fully from UHC, more effective interventions and service delivery approach, supportive policy and legal environment; measuring progress against clear targets for accountability and program adjustment will also need to be incorporated (1).
The current UHC movement emerged as a result of growing awareness of the worldwide problems of restricted access to health services, inadequate quality of care, and an increasing financial burden. UHC has become a core tenet of the United Nationals Sustainable Development Goal (SDG) 3 (2).
The novel UHC system was introduced in Indonesia in 2014 and has shown rapid grown covering 203 million people, forming the largest single-payer scheme in the world. UHC has improved health equity and service access across the country with the aims of meeting all the sustainable development goals by 2030 (3). Similarly, Thailand in 2002 despite its low gross national income per capita decided to use general taxation to finance the UHC Scheme. This implementation has led to a substantial reduction in levels of out-of-pocket payments, the incidence of catastrophic health spending, and medical impoverishment. Exponential reduction in provincial gaps in child mortality have also been observed. However, the country still faces challenges in preparing for an aging society, primary prevention of non-communicable diseases, law enforcement to prevent road traffic mortality, and effective coverage of diabetes and tuberculosis control (4).
Healthcare Digitalisation and Universal Health Coverage: Interlinked?
In recent times, digital health (DH) has gained a lot of traction globally as an engine for innovation and attainment of UHC. Startups like MEDxCare combine data and technology innovations enabling a value-based healthcare revolution. The digitalisation of healthcare proves to be of tremendous advantage especially for those living in remote areas. Additionally, improvements in safety and quality of healthcare services and products, improved knowledge and access of health workers and communities to health information; cost savings and efficiencies in health services delivery; and improvements in access to the social, economic, and environmental determinants of health, contribute to the attainment of universal health coverage (5).
Malawi has proven to be successful in adopting the national DH (eHealth) strategy in 2003, two years before the World Health Assembly action on digital health. This was followed by several African countries such as Cabo Verde (2007), Ghana (2010), and Kenya (2011) adopting similar strategies. For example, computer-aided detection of tuberculosis by chest X-Ray has been used in Zambia, South Africa, and The Gambia. Whereas, Rapid Diagnostic Tests (RDT) integrated into cloud-based mHealth smart reader system have been incorporated in Kenya, Tanzania, and Ghana. In order to further aid digitalisation, the African Regional Office of WHO (AFRO) partnered with ITU to strengthen intergovernmental coordination between ministries of health and hence improve private sector engagement (6).
However, digital health technologies of sorts can be potentially disruptive when they lead to new partnerships between different organisational sectors and hence alter relationships between individuals, their families, and the usual providers of healthcare. Moreover, challenges such as poor coordination of projects, weak healthcare systems, lack of awareness and knowledge about digital health, poor infrastructure, poor internet connectivity, and lack of interoperability of numerous digital health systems could lead to disruptions in the delivery of healthcare. Universal Health Coverage can be achieved via digital health platforms in the presence of resilient health systems, communities, and access to the social and economic determinants of health. A digitalised UHC system will flourish when citizens' needs are prioritised by governments, and services are offered at scale, in a context-specific and cost-effective manner (6).
Going Global: What can our Governments Do?
The way a country finances its healthcare system is a critical determinant for reaching Universal Health Coverage. Governments across the world can accommodate UHC by creating a regulatory environment that supports research and development, encourages equitable access to technologies and medicines, and protects the public against unintended harms. Upon analysing the link between UHC reforms and governance in countries in Asia, it was observed that each country adapted the design of their UHC programs to accommodate their specific institutional arrangements, and then made further made modifications in response to issues arising during implementation. For instance, Thailand prepared to adopt new governance modes (adaptive response), whereas China and Vietnam continue to work with the traditional hierarchical governance modes (reactive response) (7).
Apposite government contribution can ensure that digital health and other information-based technologies contribute to UHC instead of meeting the needs of a privileged minority, expanding markets for suppliers of drugs, or generating data for commercial use. Such needs will be met when governments collaborate with development agencies and shift investment from pilots to routine efforts and by testing new forms of collaboration between public and private sectors.
In conclusion, although digital health is not a panacea to achieving UHC, a holistic governance framework, resilient healthcare systems, communities, and access to the social, economic, and environmental determinants of health would make substantial contributions to its attainment. Organisations like MEDXCare along with governmental support can help achieve Universal Health Coverage in developing countries globally.
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