Strengthening health systems

The COVID-19 pandemic has demonstrated that fragile healthcare systems limit healthcare interventions and subsequently our ability to respond to public health challenges. This is why we need to continue to do more to strengthen healthcare systems across the globe.

To this end, we collaborate with governments and other partners to lower barriers to healthcare delivery, and we support quality patient care in areas where we can have the greatest impact. We work to empower patients to take ownership of their health and to better understand and manage disease. We also invest in the training and support of healthcare workers to expand their knowledge and improve their ability to help patients.

Humanitarian aid in Bangladesh

Rural communities in Bangladesh are suffering from a massive shortage of skilled healthcare providers. In 2011, Novartis and Swisscontact, an organization that promotes economic, social and environmental development, established ASTHA (Achieving Sustainability Towards Healthcare Access) to help address this gap. The project aims to improve access to healthcare services for rural communities in Bangladesh by training community paramedics, with a focus on maternal and child health, family planning and basic primary healthcare services. These paramedics can later return to their villages and deliver care in hard-to-reach areas. The program has a positive health impact in communities and helps lift individuals out of poverty by providing a steady income.

Since 2015, 464 young adults, including 244 women, have completed the two-year training, and 78% work as community paramedics. More than 135 000 people in rural communities have received healthcare services from project-supported community paramedics.

Additionally, since 2018, Novartis has assisted the Swiss Red Cross in building four primary healthcare centers in the world’s largest refugee camp, located in Cox’s Bazar in Bangladesh. Here, approximately 1 million refugees reside, and around 30 000 babies are born every year. In the Kutupalong expansion site, the largest cluster of camps, the population density is 40 000 persons per square kilometer, making it one of the world’s most densely populated areas. There is only minimal infrastructure and very little clean drinking water. To date, four primary healthcare centers providing basic medical care to more than 100 000 camp residents have been built. A fifth center is currently under construction.

For example, in collaboration with the government of Vietnam, Harvard Medical School Center for Primary Care, and the World Economic Forum, we began implementing a new initiative that aims to strengthen the delivery of primary care at the community level by strengthening community-based healthcare services at 26 blueprint commune health centers. We initiated activities in the first two provinces (Hà Tĩnh and Khánh Hòa) during 2020, conducting education and outreach to encourage patients to seek care for treatable conditions at community-based primary care centers to alleviate pressure on district and central level hospitals. These activities led to 6 000 people receiving screening and health education in primary care centers.

One Novartis health system strengthening framework

One Novartis health system strengthening framework (Graphic)

In India, Novartis began its journey to help strengthen health systems for breast cancer care in 2018 with a national assessment that showed there was little knowledge of breast cancer detection and diagnosis, and limited access to early screening. Further, capabilities to screen and diagnose breast cancer were centralized at national and state teaching facilities and centers of excellence. Together with Jhpiego, a nonprofit health organization affiliated with Johns Hopkins University in the US, and the government of India, Novartis launched the PRARAMBH program to increase access to breast cancer care. Through capacity-building activities, the program is designed to enable early detection in primary care facilities and strengthen disease management at the secondary care level.

385 000

Healthcare workers in LMICs received training on prevention, diagnosis and management of COVID-19

During the COVID-19 pandemic, the partners led India’s first virtual stakeholder consultation on breast cancer with physicians, patient groups, patients, policymakers and researchers. We also virtually trained more than 60 healthcare professionals on delivering breast cancer care. Further, we developed screening algorithms for community-based healthcare providers, and mapped referral pathways to help women in rural and hard-to-reach areas access breast cancer diagnosis and treatment.

By 2021, PRARAMBH aims to reach 25 000 women between the ages of 30 and 65 with early breast cancer screening and diagnosis. The initiative is also working to expand access to treatment, and increase the number of facilities that can cover the full breast cancer continuum of care.

“For nearly two decades, we have been working with partners to improve access to our most innovative cancer therapies. We are committed to helping ensure that our medicines are accessible to as many patients as possible, and that everyone living with cancer gets the treatment they require”

Susanne Schaffert, President of Novartis Oncology

The Novartis US Foundation strives to improve health in underserved communities in the US by creating innovative and sustainable solutions to expand access to healthcare and build trust within the healthcare system. In September, the foundation announced an additional commitment of USD 15 million to develop partnerships and fund community organizations and programs that address health inequities, building on the more than USD 10 million committed to date. A key area of focus will be addressing the under-representation of minorities, including Black Americans, in clinical trials. Diversity in clinical trials is critical to understanding how medicines will work in all patient populations impacted by a disease.

The Novartis global health alliance

The Novartis Global Health Alliance (GHA) helps support Novartis country organizations with targeted health system strengthening programs. In July, with GHA funding, the SSA unit successfully implemented the MedShr Heart Failure pilot project. This platform connects healthcare professionals via a smartphone app to share knowledge and experience on CV diagnosis, treatment and care, and also provides access to case studies on heart failure. In 2020, MedShr’s heart failure education program reached more than 95 000 doctors and community health workers across the region. Approximately 85% of participating clinicians are general practitioners and community health workers, with cardiologists and internists comprising the rest.

Additionally, GHA helped expand the remit of MedShr’s COVID-19 education program, delivering training to over 385 000 healthcare workers on the prevention, diagnosis and management of the disease in LMICs.

Over the past years, Novartis has supported an extensive capacity-building program to train doctors in Kenya on CV care. In 2020, with support from GHA, 30 handheld Butterfly iQ™ ultrasound devices used to diagnose CV diseases were provided to the University of Nairobi Enterprises and Services, and to The Heart Center, significantly enhancing their training and community outreach capabilities. Since February 2018, 115 doctors have completed the center’s cardiac diagnosis and echocardiogram short-course training. More than half of them were fully sponsored by Novartis Kenya.

GHA continued its support to strengthen access to evidence-based clinical research tools in SSA, working with the Better Evidence program at Ariadne Labs – a joint health system innovation center of Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health in the US. The digital portal provides more than 20 000 healthcare professionals across 124 countries, including 36 in SSA, with online and offline access to regularly updated, peer-reviewed, evidence-based information for guiding the diagnosis and management of a wide range of diseases, including COVID-19. The program in SSA has partnered with 50 training facilities across 16 medical schools, filling a critical gap for clinicians in low-income settings who otherwise would face major challenges in accessing information needed to provide quality care.

Investing in scientific exchange

Novartis trains and supports researchers, scientists and healthcare workers to help expand their knowledge and improve their ability to help patients. We offer mentorship opportunities for multidisciplinary partners to share expertise and build collaborations that advance the research and development of new therapies for major global health problems in ways that benefit both local research institutions and Novartis. More than 265 scientists and clinicians from 37 countries have participated in these programs over the past decade. These partnerships have also helped establish a global network of future leaders across academia, industry and government in LMICs.

In 2020, we brought our core scientific exchange programs under a common framework called Global Health Scholars. Going forward, this will help ensure we harness synergies and lessons learned across initiatives to maximize impact.

Many of these activities were affected by COVID-19 and related travel restrictions. However, we still made progress. We conducted our first virtual internship with six international students from Kenya, Malawi, Mexico and India in the vaccinology and drug development master’s program at the University of Siena in Italy. For five weeks, the interns trained in clinical trial management and patient safety, and received insights into key functions that support drug development.

Novartis continued to co-fund a European & Developing Countries Clinical Trials Partnership (EDCTP) career development fellowship call with at least five fellowship opportunities (to a maximum value of EUR 750 000) for proposals in the areas of maternal and child health, focusing on the interaction between poverty-related infectious diseases and NCDs. The scope of the fellowships was extended to include sickle cell disease in 2020.

Through EDCTP, Novartis also hosted two research fellows from Mali and Nigeria in 2020. These mentorship opportunities help strengthen the competencies of scientists who could later assume leading roles in clinical research at their host institutions. Further, the Novartis Institutes for BioMedical Research (NIBR) hosted a research fellow from Colombia through the WHO-TDR Clinical Research and Development Fellowship program to develop early-phase clinical trial management skills.

Training community health workers

Recognizing the important role of community health workers in building stronger healthcare systems in LMICs, Novartis continued its commitment as a founding partner of Last Mile Health’s Community Health Academy through our USD 1 million contribution over three years. The academy provides university-quality courses delivered virtually and in person through coaching, mentorship and discussion. To date, more than 31 000 health workers from over 200 countries have accessed this content for health system leaders. The program helps community health workers deliver quality care within government-led primary healthcare systems.

The Community Health Academy has also helped ensure that community health workers are equipped to support the response to COVID-19. Alongside a consortium of partners, the academy launched the COVID-19 Digital Classroom, which provides medically reviewed training and education material for frontline health workers and communities. To date, more than 1 000 health workers across 79 countries have accessed these materials.

Tackling cardiovascular health in low-income settings

Cardiovascular diseases are the leading cause of death worldwide, with most of the disease burden concentrated in LMICs. By 2050, 70% of people will live in cities, increasing their exposure to unhealthy lifestyles and health risk factors. For instance, against this backdrop of rapid urbanization, health officials in LMICs are reporting new cases of heart disease at alarming rates. The Novartis Foundation is forging multisector partnerships to leverage data, digital and artificial intelligence (AI) solutions to strengthen population health in LMICs.

Partnering with local and national government agencies and an array of civil society organizations, in 2017 the Novartis Foundation launched Better Hearts Better Cities in three cities in LMICs: São Paulo, Brazil; Dakar, Senegal; and Ulaanbaatar, Mongolia. While activities were tailored to the unique conditions of each city, we applied a common strategy called CARDIO, based on six pillars: improve quality of care; ensure access; reform policies; leverage digital technology; create an intersectoral coalition; and ensure local ownership.

With this approach, the Novartis Foundation was able to achieve significant improvements in cardiovascular health outcomes. In São Paulo, preliminary data showed that the percentage of patients diagnosed with high blood pressure who had it controlled increased from 17% to 55.9% in just 18 months. Preliminary data from Dakar showed an eightfold increase in blood pressure control from 3.4% to 27% in two years, while in Ulaanbaatar, 90% of the target population with high blood pressure is now being treated.

Leveraging digital health solutions

Embracing digital health technologies, advanced analytics and AI is a top priority for Novartis. These solutions have the power to radically change the way healthcare is delivered, especially in LMICs. Novartis is engaged in key partnerships to strengthen health systems and bring digital health solutions to patients.

To enable sustainable health system strengthening, Novartis co-founded the STELLA CoE (Strengthening of Translational Ecosystems for Lifesaving Local Access Center of Excellence) with the University of Basel Innovation Office and the Swiss Tropical and Public Health Institute. Launched in November, the STELLA CoE is a collaborative ecosystem that aims to address health system challenges in LMICs by bringing together the right partners to apply innovative digital solutions while supporting local entrepreneurship and ownership.

Several projects have already been initiated under the STELLA CoE umbrella, notably a collaboration with the Department of Informatics at the University of Oslo in Norway. The university developed the District Health Information Software 2 (DHIS2), the world’s largest open source, web-based health management information system deployed in LMICs.

The STELLA CoE is also addressing supply chain inefficiencies, a major cause of drug stockouts. Through the SMS for Life program, Novartis pioneered a logistics management information system to tackle stockouts at the last mile. Novartis will transfer knowledge, experience and lessons learned from SMS for Life to DHIS2 to enable a robust, scalable and sustainable logistics solution for LMICs.

Through a partnership between Novartis, Medtronic Labs and Management Sciences for Health in Kenya, we are investing in digital technologies to create value for patients, providers and the healthcare system. We are supporting an integrated end-to-end solution for hypertension and diabetes care that links patients to community health workers, pharmacists and clinicians.

The core of the program is a dedicated screening app linked to an online platform. Once people have been screened and registered on the platform, they are able to access blood pressure checks at community-based locations. Clinicians can view patient data, provide feedback via text message, and write electronic prescriptions that are accessible through participating pharmacies. The program also provides training on NCD treatment guidelines to community health workers and facility health providers so that they can provide quality care. Since launch in 2019, the program has reached more than 200 000 community members with education on diabetes and hypertension, and has screened more than 20 000 people (with 6 500 screenings completed prior to launching the digital app).

AI has tremendous potential to make health systems proactive, predictive and preventive. To help drive the adoption of AI for health within countries, the Novartis Foundation and Microsoft – co-chairs of the Broadband Commission Working Group on Digital and AI in Health – led the development of a major new report in 2020 called “Reimagining Global Health through Artificial Intelligence: The Roadmap to AI Maturity.” Based on a landscape review of more than 300 use cases of AI in health, the report presents a roadmap to help governments and their partners implement AI to transform their health systems.

The Novartis Foundation is also working with partners in countries to implement AI solutions. In Brazil, the Novartis Foundation together with Instituto Tellus supported the Hospital das Clinicas of the University of São Paulo AI nucleus to establish an AI-driven tool for detecting COVID-19 using CT scans and chest X-rays. The hospital adopted the solution and has used it to speed up COVID-19 diagnosis. Together with the hospital and Instituto Tellus, the Novartis Foundation also built an innovation platform that empowers local partners to apply data science and AI in other disease areas beyond COVID-19. Additionally, the Novartis Foundation and Instituto Tellus supported the São Paulo state government in developing a public policy roadmap to procure new technologies, and helped launch IdeiaGov, an initiative that sources innovative ideas to respond to government challenges such as COVID-19.

In 2020, together with Microsoft AI for Health and Apollo Hospitals (one of India’s largest private healthcare providers), the Novartis Foundation initiated AI4BetterHearts, the first global data collaborative on cardiovascular population health. The collaboration aims to integrate heart patient data from the primary, secondary and tertiary healthcare levels, as well as from global partners, and use advanced analytics to change the way cardiovascular population health is managed, predicted and prevented. This knowledge can help empower policymakers, health system managers, health workers and patients to make more informed decisions. For example, it can help policymakers understand where they can best allocate resources for addressing cardiovascular disease at the population level.

Using a mobile clinic to provide healthcare services in Uganda

Through its Healthcare Access Challenge (HACk), Sandoz invites entrepreneurs and innovators in the field of digital technology to submit ideas with the potential to complement – or even positively disrupt – established approaches to driving access to healthcare. Andrew Ddembe, founder and CEO of mobiklinik, a mobile clinic using an app and a mobile van to provide door-to-door maternal healthcare services in Uganda, was among the three 2019 winners.

In 2020, Mr. Ddembe continued his journey to provide access to basic health services to 42 million Ugandans living in last-mile villages (rural areas and peri-urban areas). His mobile application, which connects city doctors to community health partners providing health services to patients in rural areas, is now available in one of the largest districts of Uganda. The service is helping to expand the reach of medical services, improve medical information, scale knowledge transfer, and integrate patient referrals into the healthcare system. So far, mobiklinic has supported 80 expectant mothers, 350 patients with general healthcare needs, and more than 1 000 people who attended free medical camps.