Harald Nusser, Global Head, Novartis Social Business and Defeat-NCD Partnership Board Member
It was in October 2015 and I remember how pleased I felt that Novartis Access and the Government of Kenya were signing a Memorandum of Understanding. Our company was now going to be able to bring a portfolio of affordable drugs to treat non-communicable diseases (NCDs) to Kenya, a country plagued – like so many other lower-income countries – by the rising incidence of chronic illnesses.
At the same time, I knew we would need to overcome many challenges to impact Kenyans in a meaningful way. For several reasons, the main one being its novel portfolio approach, Novartis Access called for a paradigm shift, from itemised tendering to a portfolio basket of high-quality and affordable medicines.
When I met Mary a few days after the launch, I saw first hand the reality that NCD patients face and the devastating consequences of limited access to care. Mary, who was 65-years-old at that time, lived in Kirinyaga county, a region known as the rice basket of Kenya, sitting at the foothills of Mount Kenya, 100 km from Nairobi.
Mary had been diagnosed with diabetes at a very late stage, when she could hardly walk anymore as a consequence of her untreated diabetes. She had to stop working as a rice farmer, a job she had been doing for decades, and was now earning a very meagre living on small sewing repairs while sitting in a wheelchair. She had to pay more than USD 7 each month for her diabetes medicines. Yet, as she earned so little, she could not afford to buy monthly treatments but had to purchase her medicine for 1-3 days at a time at the local chemist. Thanks to her treatments, Mary’s glycated haemoglobin (indicating the level of her average blood sugar) had decreased from 21% to 10% (the normal level is less than 6%); yet her diabetes was not adequately controlled, and she was still at risk of developing further diabetes-related complications.
When we asked Mary why she was not entering the Kenyan health insurance system, which would allow her to get free medicines, she said she could not afford to pay the monthly fee of USD 5 at once. Like many daily wage earners in Kenya, this meant she had to pay for her treatments out-of-pocket.
Beyond affordable medicines, to effectively manage chronic diseases, one needs to address everything from patient awareness and education to supply chain management. Activities to train healthcare workers to accurately diagnose and treat illnesses effectively must also be included.
Supply chain management and quality control are also absolutely essential for getting the right medicines to the right patients at the right time. Health players, global and local, private and public, need to work together to find the most effective means of bringing medicines to the most remote areas.
But a medicine is only as good as the system that delivers it and today healthcare systems in many lower-income countries are simply not geared up to appropriately manage NCDs. This means that capability building to train healthcare workers to diagnose and treat diseases is at least as critical as affordable pricing.
The task of improving care for chronic disease patients around the world is so huge that even with the best intent and the best programmes, no one can do it alone.
When the Defeat-NCD Partnership approached me to join their Governing Board, I immediately accepted because I know that together, we are better able to provide the care people like Mary need. Defeat-NCD is a ‘public-private-people’ Partnership that is trying to break down the silos to include the talents, knowledge and capabilities of governments, multilateral agencies, civil society, academia, philanthropic foundations, and the business sector. Through its four tracks, the Defeat-NCD Partnership is working to mobilise global and national knowledge, tools, capacities, and finances to benefit resource-poor countries and the millions of people like Mary.
Unfortunately, more and more of these people will suffer from the devastating consequences of chronic illnesses unless we change the health paradigm. Industry can make drugs more affordable; governments can change how they procure medicines; thanks to digital technology, we can leapfrog how we educate people, train health workers and deliver care to remote communities; and we can be more bold in how we partner and finance healthcare. These are just a few examples of what we can do, but much more is needed. Unless we pool our energy, expertise and resources, we won’t be able to make an impact at scale.
As the head of Novartis Social Business, my responsibility is to help ensure that people like Mary have access to the drugs they need. The journey we have embarked is fraught with challenges, but when I meet people like Mary, I feel re-energised and I hope that we do not let her down.