Improving Leadership & Access to Health at WHS 2017
Experts at Berlin’s World Health Summit Weigh in on Decision-Making and the Pharma Supply Chain
Before Berlin’s historic Kosmos club undergoes yet another transformation to host Future Medicine 2017, let’s explore a few outcomes from a recent health conference held there: the 2017 World Health Summit (WHS). German Chancellor Angela Merkel endorses the WHS as a “well and widely respected international forum when it comes to the joint search for effective responses to global health issues.” Two key words stand out here: joint and effective.
The shared pursuit of practical solutions makes this summit noteworthy.
Attracting top minds from science, policy, and innovation, this annual summit focused on three things: building sustainable global health policy in the context of the G7/G20, ensuring health security in the midst of infectious disease outbreaks and global crises, and exploring how big data can link healthcare and communities.
Discussions from two very different panels of experts yielded useful insights in at least two major areas: 1) Health leadership and 2) Health access via the pharmaceutical supply chain, which I’ll share here.
Health leadership and access are massive topics but listening to cross-industry experts including big pharma, medical doctors, patient representatives, the World Health Organization, and the Minister of Health from Ghana, paves the way forward.
And that’s what we need, isn’t it? Navigational guidance through a complex web of global health issues to improve people’s lives.
1. “Come With Me” Leadership in Health
Good leadership is crucial to any successful organization or industry and is based on listening and empathy. As SAP CEO Bill McDermott says of true leadership, we have to ‘listen completely’.
In healthcare, sometimes decision-makers have top-notch medical preparedness but not necessarily formal leadership skills. To close that gap, there needs to be engagement of physicians in leadership training. I learned more about a group facilitating this training called the InterAcademy Partnership ( IAP) for Health Young Physician Leaders (YPL) from a panel in the “Africa” room at the World Health Summit in Berlin.
During this workshop, a panel of experts representing pharma, medicine, and patients debated what leadership is and crystalized new perspectives.
Pharma: With a background in cost-effective gene therapy, Pfizer’s Dr. Clara Craesmeyer discussed pharma’s role in calculating business models to grow sustainable solutions. She says if you want to bring innovation to patients, you have to take risks and build trust. This involves a ‘risk-sharing model’ where patient-centricity is the goal and you create innovation based on a framework of trust, followed by reimbursement.
Medical Expertise: Dr. Mahjouba Boutarbouch is a medical expert and neurosurgeon from Morocco. After working abroad, she returned to her home country to bolster development of medical services, which is counter to the usual outward flow of expertise. She says compensatory healthcare is only available to 30% of Morocco’s population, and as a physician sometimes you often can’t ask for reimbursement for up to 3 years.
Dr. Boutarbouch therefore adamantly says: “It is our responsibility to show evidence-based medicine’s cost-effectiveness to policy-makers, insurance companies, and to be there (in much-needed areas) as long as you can be there.”
For example to justify stent costs, physicians need to go with files and evidence to convince decision-makers of their value. To young physicians, you must emphasize the importance of going to the communities you wish to serve in a “come with me” type of leadership.
Patient Voice: According to Dr. Menat Zanaty who represents patient advocacy, “Patients are powerful stakeholders who fight for their rights. What patients need are accessible, affordable, and patient-centered high-quality services.” She says the current system is fragmented and rigid which falls short of these needs.
So how do we shift to a more flexible system? Patient representatives face challenges, conflict of interest and lack of leadership skills. Training patients representatives in leadership and how to pursue a more democratic approach to healthcare is key.
The Q&A session emphasized how leaders can come from different backgrounds and how leadership is a learned skill. Advice centered on empathy and role-playing: think of your patient as a close-relative and you’ll make the best decision for his or her best interest. Finally, the only constant is change, and the biggest target group will be the aging. Be brave enough to include that group in your focus now.
Themes of trust and accountability were dominant. Effective healthcare companies and institutions need effective leaders to inspire trust. Reach out to young physicians to encourage leadership and patient representation. And consider how that possibility in pharma. You can learn more here.
2. How Can Improving Supply Chain Benefit Health Access?
In line with trust and accountability, an “Access to Health” panel discussed the pharmaceutical supply chain and delivery systems and how they are critical enablers to improving health access. Though the topic may seem dauntingly complex, the panel aimed to simplify the conversation.
Often ‘health access’ is thought of solely in terms of an affordability challenge revolving around price, but that’s a very limited view. The end-to-end supply chain reaches from manufacturing through to communities and bed-side, all the way until monitoring patients.
The moderator, Merck’s Global Head of Access to Health Frédérique Santerre, gracefully maneuvered the expert panel forward on a challenging topic, reaching new levels of exchange.
She wanted to stir interactions between panelists including Dr. Rüdiger Krech from the World Health Organization (WHO), Ghana’s Minister of Health H. E. Kwaku Agyeman-Manu, Novartis’ Philippe Francois, Cristina Castro González de Vega & Manfred Bruch of F.Hoffmann-La Roche’s, and supply chain expert Martin Ellis.
Each person shared valuable expertise and together they mentally sparred about two main things: 1) how to expand the discussion of access to health beyond food, water, medicine to include supply chain and delivery and 2) to have a big-picture, non-disease specific view. Every disease is different and every country is different.
If drug delivery can move in an alliance with key players in a collaborative action plan, then accessibility to health is vastly improved.
Given this unique opportunity to hear distinctive leaders across areas, I’ll share highlights from each viewpoint, and then regroup on next steps.
Ghana’s Minister of Health, H. E. Kwaku Agyeman-Manu believes people have a constitutional right to health and a better supply chain will bring more high-quality care for all. He supports training health workers and deploying them to locations and hospitals with devices. He mentioned that drug pricing in Ghana is very extreme, both high and low, while quality of drugs is vulnerable to counterfeits. “Some drugs are found only in big cities.” Meaning if you live in a rural community and have a rare condition, chances are you’ll spend time traveling for care, if that is even an option. Certain diseases are treated in certain districts. He sees supply chain improvement as critical to price stabilization and accessibility solutions.
Dr. Rüdiger Krech, from the WHO’s Office of the Assistant Director-General Health Systems and Innovation, says intersectional collaboration will help. The WHO wants everyone to have access to health regardless of financial hardship and says the medicines we take should be efficacious. Dr. Krech says the market is out of balance and needs more transparency. Ideally, doctors need to prescribe the right meds at the right time, and patients comply. But he stresses that says countries need to ask the WHO for help in order to obtain it. In other words, a request needs to come from within the countries themselves.
Cristina Castro González de Vega, Africa Strategy PT Program Lead and Manfred Bruch, Head of Partner Collaborations, both from F. Hoffman- La Roche Ltd. focused on the challenge of how do we bring the right product at the right time? End-to-end management is really important, from the first mile to the last, especially when considering vaccines or cancer drugs which have stringent temperature and storage restrictions. Both stressed that new partnerships need fortification in this process.
Martin Ellis of the Global Fund to Fight AIDS, Tuberculosis and Malaria says the supply chain looks different depending on where you stand. He describes it as holistic “Z-shape”, which goes from consumption data to supply. So it is all about that data capture to understand what is needed.
Novartis AG VP, Head of Supply Chain, Philippe Francois, expressed that timing matters most: on time and the right time. Simple processes which are reliable, and understanding how the patient uses the drug, are both important. He says there is an opportunity in the market to think of ways that the supply chain, especially in developing countries, can become more agile.
Outcome: A Global Opportunity to Collaborate
The outcome of this panel discussion – essentially a high-level brainstorming session on solutions – was inevitably more questions. Sometimes responses seem to compete with each other but overall, the idea is to move away from competition towards “coop-itition” as a way to solve global issues.
So, where can we expect collaboration in an interdisciplinary and resilient supply chain?
- The WHO says stakeholders can help but a new system needs to be built, referencing new business models where pricing doesn’t hit extremes.
- The Minister of Health recommends connecting the private sector, minister of finance and pharmacists. He wants a synergistic economy that scales and politicians who actively listen.
- But Ellis says we need to make the supply chain more effective before bringing in the private sector. He says changing from a 3-month to a 1-month supply stock would improve flow, if uncertainty in demand could be sorted out. He considers this a better, more efficient practice with less risk of spoilage, expiration, and waste. He also says there is a 12% carrying cost for heat, trucks, and light which must be factored in.
- The Novartis representative says channels are the most important: create the same pipelines for everyone.
How do we get the discussion on the table and share information across industry regarding training, bench marks and capabilities?
- Roche representatives say we should bring in the private sector when they have capabilities to work with pharma.
- Bruch says consider training and education via symposiums in emerging markets.
- Martin recommends a “product-agnostic” approach, shortening the delivery system as mentioned above, and that supply chain specialists should educate regarding cold chain, volume, and steadiness of the supply chain.
- Castro González de Vega says when it some to improving diagnostics in healthcare, the push has to come from the countries themselves to overcome hurdles.
New Partnerships
This is clearly unfinished business. More dialogue must follow to figure out who is pushing, and who is asking, when it comes to solutions. But new partnerships are a given.
Ghana’s Minister of Health says: “When 2 partners play, one partner seems stronger.” So it’s time to level the playing field.
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