The Health Equity and Inclusion in Action report, commissioned by the biopharmaceutical company Gilead Sciences and developed by the global think tank Observer Research Foundation (ORF), delves into the complex landscape of health equity and inclusion in health transition countries (HTCs). The report highlights innovative initiatives across these countries striving to bridge the gaps in access to healthcare. It provides valuable insights and recommendations for policymakers, healthcare planners, and advocates working towards achieving universal health coverage (UHC) by 2030.

The Pressing Challenge: Dual Health Threats in HTCs

HTCs face a dual healthcare challenge: the persistent threat of infectious diseases and the rising incidence of non-communicable diseases (NCDs). The countries featured in this report, such as South Africa and India, confront unique healthcare challenges, with marginalised communities experiencing greater health disparities and limited access to essential services (Health Equity & Inclusion in Action, p. 10).

The Vision of Health Equity and Inclusion

The report emphasises the overarching vision of a healthcare system that is universally accessible and holistically integrated. It ensures that every individual, irrespective of socioeconomic or cultural background, benefits equally from affordable access to quality healthcare. The report examines various health initiatives across HTCs that pave the way towards a more equitable and inclusive healthcare framework (Health Equity & Inclusion in Action, p. 10).

Bright Spots: Proven Strategies in Resource-Limited Settings

Amidst the challenges faced by HTCs, the report highlights innovative strategies emerging as beacons of hope. These include task shifting, ensuring the quality of health services and medications, and developing novel healthcare delivery models. The pivotal role of community health workers and the transformative impact of quality generic medicines are particularly noteworthy. These strategies are not only improving healthcare accessibility but also making healthcare more affordable (Health Equity & Inclusion in Action, p. 10).

Digital Leap: Technology’s Potential as the Great Equalizer

The report underscores the potential of technology to offer solutions in healthcare that transcend traditional access barriers. Although fundamental challenges such as the digital divide persist, technology is emerging as a crucial tool to democratise health access. The report spotlights initiatives harnessing mobile health applications, decentralised diagnostic technologies, digital health records, and a broader digital health ecosystem. These initiatives have immense potential to elevate care quality, expand reach, and bridge the healthcare divide (Health Equity & Inclusion in Action, p. 10).

Recommendations for a Healthier Tomorrow

The report offers several recommendations to generate progress towards health equity and inclusion:

1. Leverage scarce health system resources: Implement task shifting and digitisation programs to enhance efficiency. Prioritise clear delineation of roles and stringent quality control to ensure effective, context-specific healthcare delivery. Champion the adoption of effective pharmacovigilance programs and address the issue of low-quality or counterfeit medicines (Health Equity & Inclusion in Action, p. 10).

2. Improve access and increase affordability: Amplify funding for initiatives prioritising marginalised and underserved communities, fostering a more equitable and efficient health system (Health Equity & Inclusion in Action, p. 10).

3. Ensure smart use of technology and data to leapfrog constraints: Enhance healthcare with contextually relevant tech, predictive artificial intelligence, and Big Data, emphasising scalable solutions like mHealth to improve efficiency and decision-making. Ensure these technologies are accessible in urban and rural areas, supporting comprehensive care delivery (Health Equity & Inclusion in Action, p. 10).

4. Increase community leadership and inclusion: Actively engage individuals and communities in healthcare decisions, recognising that achieving health equity requires tailored approaches contingent upon generational, cultural, and country-specific contexts. Ensure adequate training and programs are in place to accommodate cultural and linguistic diversity in healthcare settings, preventing misunderstandings and misdiagnoses (Health Equity & Inclusion in Action, p. 10).

Case Studies: Illuminating the Path to Health Equity

The report features 12 case studies from six countries: Bangladesh, India, Morocco, Rwanda, South Africa, and Vietnam. These case studies demonstrate innovation, technology use, financial sustainability, scalability, and health impact (Health Equity & Inclusion in Action, p. 44).

Leveraging Scarce Health System Resources

The case studies in this category showcase strategies such as task shifting, improving the quality of medicines, and innovative healthcare service delivery routes. For example, the Jeeon Foundation in Bangladesh has created the largest digital network of over 35,000 pharmacies and drug shops, aiming to improve the quality of healthcare by connecting informal health practitioners with quality training, health information, and authentic medicines (Health Equity & Inclusion in Action, p. 45). In South Africa, the Central Chronic Medication Dispensing and Distribution (CCMDD/Dablapmeds) program has significantly improved access to chronic medication for stable patients by allowing them to collect their medication from external contracted pick-up points or fast lanes at public facilities (Health Equity & Inclusion in Action, p. 47).

Improving Access and Increasing Affordability for All

The case studies in this category highlight initiatives that aim to improve access to healthcare services and make them more affordable. HEALTHx in Bangladesh is a data-driven digital healthcare venture that offers one-stop essential health services, affordable health plans for patients, and cloud-based service solutions for physicians, clinics, and pharmacies (Health Equity & Inclusion in Action, p. 50). In India, iKure Techsoft has implemented a primary healthcare model that trains local community members to become frontline health workers, addressing the shortage of qualified medical staff and inadequate public health expenditure (Health Equity & Inclusion in Action, p. 51).

Smart Use of Technology and Data to Leapfrog Constraints

The case studies in this category demonstrate how technology and data can help address the constraints that impede healthcare systems’ ability to provide quality healthcare to their populations. DabaDoc in Morocco is an online platform for doctor appointment booking and video medical consultations, helping democratise healthcare access (Health Equity & Inclusion in Action, p. 54). In Vietnam, the Electronic Health Book application, launched by the Ministry of Health, helps manage health information on smart mobile devices, enabling medical staff to easily access patients’ health information and diagnose and treat them more effectively (Health Equity & Inclusion in Action, p. 57).

Conclusion

The Health Equity and Inclusion in Action report serves as a clarion call for stakeholders in the global health community to prioritise and champion the cause of health equity and inclusion. By highlighting innovative initiatives across HTCs that are working to bridge equity and inclusion gaps in access to health, the report aims to inspire collaboration, innovation, and sustained investment in strengthening health systems.

The case studies presented in the report demonstrate the potential of leveraging scarce health system resources, improving access and affordability, and harnessing technology and data to leapfrog constraints. They also underscore the importance of community engagement, cultural sensitivity, and tailoring approaches to local contexts in achieving health equity.

However, the report also acknowledges the challenges that persist, including the financial sustainability of initiatives, quality assurance as programs scale up, the digital divide limiting the reach of tech solutions, and difficulty integrating new programs with existing health systems. Addressing these challenges will require political will, sustainable financing, and a commitment to building equitable and resilient health systems.

As the global health community works towards achieving universal health coverage by 2030, the insights and recommendations provided in this report offer valuable guidance for policymakers, healthcare planners, and advocates. By learning from the successes and challenges of the initiatives highlighted in the report, stakeholders can develop effective strategies to promote health equity and inclusion and lay the foundations for a fairer, healthier future for all.

Appendix: Case Studies

The report includes 12 case studies from six countries: Bangladesh, India, Morocco, Rwanda, South Africa, and Vietnam. These case studies demonstrate innovation, use of technology, financial sustainability, and scalability, and all aim to show health impact. The case studies are categorised by the main health system challenge they seek to address:

Leveraging scarce health system resources

• Bangladesh: Jeeon Foundation
• Rwanda: https://www.babyl.rw/
• Rwanda: https://mizerocare.com/
• South Africa: Central Chronic Medication Dispensing and Distribution (CCMDD/Dablapmeds)
• South Africa: Unjani Clinic

Improving access and increasing affordability for all

• Bangladesh: HEALTHx
• India: iKure Techsoft
• India: YRGCARE

Smart use of technology and data to leapfrog constraints

• Morocco: DabaDoc
• Morocco: National Programme of Telemedicine
• Vietnam: IVIE by ISOFH
• Vietnam: The Electronic Health Book application