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Institute Report
Scaling-Up Inclusive Healthcare Initiatives in Low- and Middle-Income Countries
Assessing the landscape of innovative approaches
May 31, 2022
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Web Summary

Non-communicable diseases (NCDs) are on the rise in low- and middle-income countries (LMICs), increasing the financial and health burden affecting these vulnerable populations. To reverse this trend will require not only resources, but also new business models for LMICs that can overcome the barriers patients face to receiving care, such as unaffordable, unavailable, or inaccessible healthcare services and treatments, and limited awareness of disease and preventative care.

Over the past decade, a new wave of pioneer healthcare initiatives has emerged that aims to improve the quality of care and access to healthcare of vulnerable populations in LMICs by building commercially viable and scalable enterprises. These pioneers are developing novel delivery models – inclusive clinics and hospitals, pharmacy-based, community-based, and risk-prevention models – and are innovating to solve patient pain points by making use of mobile and digital technologies, offering financing and insurance solutions, and improving access to preventative and primary care.

This report reviews the preliminary findings of a study performed by the IQVIA Institute for Human Data Science, together with Hystra – a consultancy specialized in inclusive business solutions – to learn from pioneer organizations what underlies their early successes and what is limiting them from reaching further scale or impact. It reviews the landscape of global inclusive initiatives and identifies innovations that can strengthen the impact of businesses. This work is intended to feed a later phase of research whose ultimate intent is to identify and scale up effective inclusive businesses.

In that second phase of the analysis, which will be presented in a future report in this series, an in-depth analysis will be conducted of selected initiatives deemed to be promising, to understand the reason for their success, their scalability challenges, and concrete solutions to solve these issues. The intent will be to build on these lessons to share with partners high-potential localized blueprints offering concrete opportunities to target non-communicable diseases.

Key Findings

  • Though low- and middle-income countries are experiencing a rising prevalence of noncommunicable diseases such as diabetes, cancer, and heart and lung diseases, and now account for 57% of NCD deaths globally, NCDs account for only 1% of development assistance for health to these areas in 2018.
  • Led by pioneers, promising inclusive initiatives are emerging to address, in a holistic way, the rising chronic disease burden and improve diagnosis, treatment, and care for those in low- and middle-income countries.
  • Initiatives can be categorized based on their approach to improving health into one of four business models — inclusive clinics and hospitals, and pharmacy-based, community-based, and risk-prevention models — which differ in the level of care they provide and their setting.
  • However, the speed at which these models are being developed remains slow, and only few have reached their ambition for economic sustainability and scale.
  • Analyzing the global landscape of current inclusive healthcare initiatives, along with factors influencing their effectiveness and efficiency and barriers to reaching more significant scale, can help identify which approaches are most likely to be successful in LMICs.
  • Among 244 health initiatives identified and profiled, 41% of these are based in Sub-Saharan Africa, 29% in South Asia, with the rest in Latin America and Southeast Asia.
  • Inclusive businesses provide goods, services, and livelihoods to people living at the base of the pyramid through commercially viable and scalable enterprises and bring poor and underserved individuals into their value chain as suppliers, employees, distributors, retailers, or customers.
  • Inclusive health initiatives can be categorized based on their approach to improving health, into one of four business models, which differ in the level of care they provide and their care setting:
    • Inclusive clinics and hospitals:
      • Present in urban areas where population prevalence and density justify the brick-and-mortar investment, these models have developed breakthrough innovations that reduce costs or increase affordability for low-income and at-risk populations.
      • Many have aimed to increase their reach into more rural areas via hub-and-spoke models, and by leveraging telemedicine and other technologies, while several pioneer organizations have also succeeded in reducing health costs via task optimization, frugality, and the adoption of new technologies.
      • Some questions remain such as how to replicate such businesses so they can grow from a few successful facilities into widespread networks, how to increase the scale of hub-and-spoke models, how they can be adapted to the specific requirements of NCDs, and how to make those models further affordable in the absence of universal healthcare.
    • Pharmacy-based models:
      • These models constitute a vibrant sector of digital start-ups with business-to-business models that aim to build relationships with existing formal and informal pharmacies in LMICs and leverage technology to address supply chain challenges (drug traceability, drug availability, stock management) and, by doing so, can improve affordability and accessibility of products for patients.
      • For instance, many pharmacy-based models provide support in sales and inventory management to pharmacies in their network, and aggregate demand to get better price points, improve cost-efficiency of delivery, and optimize logistics. Some also seek to offer more holistic solutions beyond drug access, for example, by developing preventative and primary care services around pharmacies or improving adherence.
      • The main questions with these models are whether the savings from economies of scale can be passed on to patients, how these can meet the specific needs of patients with NCDs beyond the supply of medicines (e.g., referral to HCPs, improving adherence to treatment, improving access to insurance and savings, etc.), and how they are leveraging existing touchpoints in LMICs to enhance access to primary care.
    • Community-based Models:
      • Community-based models offer preventative and primary care to healthy and at-risk populations, predominantly in rural settings, but also sometimes in urban slums. In some cases, they can also sell basic drugs, depending on the country’s authorization.
      • This model has historically relied on community members to reach populations at the last mile. The rise of digital technologies and telemedicine has enhanced these models; broadening the range of health services they offer.
      • Although community-based models offer ways to serve the health needs of populations at the last mile, questions remain on how these businesses can strengthen their revenue model to be economically sustainable – most of these have been developed with the support of philanthropic private or public funding – and how they may become embedded into formal healthcare systems.
    • Risk-prevention models:
      • Risk-prevention models are responsible for the provision of health insurance and preventive care to both healthy and at-risk populations. These sometimes involve financial solutions like standalone health insurance to reduce the financial burden and risks that patients face or provide solutions for patient disease self-monitoring.
      • Notably these models are becoming more holistic and integrated, sometimes combining platforms that help patients to mitigate health risks through both, financial solutions and behavior change programs. These have also increasingly harnessed mobile technologies to expand their reach and improve their services (e.g., streamlining their client relationships and claim processes).
      • Among the key areas that need to be further investigated for businesses in this area are how they could encourage vulnerable populations to invest in prevention despite there being a future uncertain benefit, how co-payment and innovation financing models can lower the costs of risk prevention for patients, and how risk-prevention models relevant to NCDs can be developed to encourage healthier behaviors.

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