KLAUS LEISINGER: Toward Health for All
Interview by Mary Hoff
What do you see as the biggest health threat in developing countries today?
The biggest health threat at the moment is noncommunicable disease, which is growing at a really fast and unchecked speed in low-income settings. This is a huge new burden on countries that still have not overcome the burden of communicable disease. Most of the innovative medicines available for the chronic diseases are beyond purchasing power of people in the developing world. We will need to develop new patterns of cooperation and find new financial models to provide access to health care in these markets.
What are the big levers?
One really big thing is the improvement of medical care at the community level. Most community health workers in rural areas know enough and have the ability to handle about 60–70 percent of the problems and solve them. About 20 percent they can’t solve—and patients would have to be referred to a different level of the health care system. Often the referral system functions, but secondary health care institutions are far away, and people may not be able to travel if they are too sick.
One way to alleviate these problems is to empower community health workers by equipping them with cell phones. This way, if they run into a problem they can’t solve or haven’t seen before, they can call each other. If they’re not able to solve the issue, they can contact a call center with fully trained medical doctors 12 hours a day, seven days a week. This is what we do in cooperation with the Millennium Development Project in Ghana. In that project there is even the possibility to call a health center in Switzerland. In this way, you can connect the highest competence in an industrialized country to a village in rural Africa and allow transfer of knowledge in ways that have never been possible before in human history.
If you could change one thing in the way we deal with health in developing countries, what would it be?
It would be to introduce a mandatory multistakeholder solution approach. So often different actors work in isolation; the result is a fragmentation of efforts. If those who can make a significant contribution to sustainable solutions would sit together and coordinate their efforts, if they were willing to bring in their important pieces of the puzzle, all efforts would have a much broader impact and would be more cost effective. For me, a real stakeholder is not someone who sits on the fence and tells the rest of the world what’s going wrong. It is someone who brings in skills and is willing to cooperate and willing to compromise, who measures his or her success in terms of the overall success and progress we are making—and who accepts unorthodox partners.
If I have learned something in nearly 40 years of working in developing countries, it is to appreciate complexity and approach it with humility: Do I understand the local cultural, social, economic and political situation correctly? On whose foot am I stepping—whose interests are affected by the change I want to create? How can we make sure everyone has ownership of what is achieved? If there is no local ownership, you might get approvals that are just lip service. To be successful in what you do, you need the people with and for whom you work to identify with what you are doing. This is not just the case with people in the developing world. All over the world, people want to make sure their own interests are properly considered—or at least they are compensated in some way if and when they are negatively affected. That is fair and understandable. Therefore, let us pose such questions and put potential conflicts of interest on the table. Not talking excludes part of the reality, and that is dangerous.
Do we have the needed infrastructure, or is a better mousetrap needed?
We always need better mousetraps—and many development stakeholders are busy inventing them or modifying them to fit specific circumstances. But a lot can be done with the competencies, skills and resources that are known and tested. This is why we need more coordination and cooperation, and here a lot can be improved. The UN, with its many specialized organizations, is the only internationally accepted convening institution that can bring people together from all countries of the world to have a say. But sustainable solutions that are agreed on a high political level need to be contextualized. The problems with sustainable development are fundamentally different, e.g., in countries like Mali or Tanzania compared with, e.g., Russia, China or the U.S. There is no “one size fits all,” as the differences in the dimension and complexity—as well as in the initial conditions—have to be properly considered.
How can the private sector, government and civil society best work together to solve global health challenges?
By overcoming stereotype judgments, by sitting together and analyzing what exactly is the problem and what is the relevant context—and then brainstorming the most appropriate solution. Then one can look for the most appropriate responsible parties and partnerships. Form follows function.
There is a societal division of responsibility: A national government, a civil society organization, the media and the business sector each has a different responsibility and function for sustainable development. What should not happen is that the obligations and dues that are governmental and international are pushed onto the private sector. First, the private sector is not legitimized to do that. Secondly it’s unfair to expect them to do that.
For example, Novartis gives away all drugs necessary to eradicate leprosy. But if there are no skilled doctors or health assistants, we might not get a right diagnosis and hence a wrong therapy. If things are fine on that side, you’re not sure that patient will comply with the 6- to 12-month therapy. Yes, you need the drugs—but you also need a health system that functions. You need quality health care that treats patients as customers. And you need health education, patient education.
A lot of investments in these areas are also in the long-term interest of the pharmaceutical industry. So, clever marketing will look at what premarket investments make sense in what kind of areas. Corporate philanthropy and strategic social investment have also their role—and local authorities and civil society organizations have valuable knowledge and skills. Let’s all talk together in a constructive, honest and transparent way, so that we know what we can expect from each other. And then do it for the benefit of the world’s poor patients.
HEALTH POLICY EXPERT KLAUS LEISINGER
As chairman of the Novartis Foundation for Sustainable Development, Klaus M. Leisinger works to alleviate poverty-related health problems in the developing world at three levels: on-the-ground assistance with health care services and medicine; connecting global health-advancing resources with each other and with those who can benefit from them; and conducting high-level research, policy and communication work to catalyze sustainable health outcomes. Leisinger shared his thoughts with Momentum and Terry Waghorn of Forbes recently on how we can best work together to shape a healthier world.
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Last modified on January 23, 2012