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Namibia: A New World of Health Care
Date Posted: 10/Oct/2014
TRADITIONAL health-care systems are in trouble. In the OECD, costly hospitals and clinics dominate health services, and account for 97% of the United States' health-care spending. These systems are struggling in the face of cost constraints, public demand for higher quality, and exaggerated expectations.
 
But there is a different system, widely practiced in poorer countries that cannot afford Western-style hospitals, and centred on community-based healthcare. We need both approaches; and we need them to work together. Indeed, the growing gap between the promise and the reality of health care has created room - in developed and developing countries alike - for new players who are concerned more with social behavior than with biology.
 
In his seminal 1996 article in the Harvard Business Review, W Brian Arthur identified the important distinctions between a health-care system defined by planning, hierarchy, and control and one characterised by observation, positioning, and flattened organisations. The first type of system, he argued, is concerned with materials, processing, and optimisation. It is principally focused on access to medical care, and typically faces diminishing returns.
 
By contrast, the second type of system is a networked world of psychology, cognition and adaption. It can increase returns through its agile structure and ability to meet varied, locally determined, needs. It is not driven by the interests of any specific industry, and it complements, rather than competes with, high-cost health-care systems. It prioritises wellbeing, healthy behaviour, and how health choices are made.
 
The latter approach is particularly relevant to conditions such as heart disease, hypertension, and diabetes, which most closely reflect individual behaviour, physical context, and socioeconomic factors.
 
Consider diabetes. A few major pharmaceutical companies compete for a finite group of diabetics by offering new formulations, marginal improvements in blood-sugar control, competitive pricing, and strategic partnerships with insurers and health-care providers. These incumbents are primarily concerned with defending their market position. Their activities do not extend to helping the hundreds of millions of obese people at risk of diabetes, or to those who respond poorly to existing treatment.
 
But the key to living well with diabetes is a nutritious diet, an active lifestyle, social support, and coaching that is tailored to each individual's circumstances. This basic formula also forms the foundation of efforts to prevent diabetes, as well as most chronic diseases. And it benefits healthy people, too.
 
Indeed, traditional medical care accounts for only a small share (perhaps 20%) of our quality of life and life expectancy, while the rest is determined by healthy behaviour, social and economic factors, and the physical environment. Dealing with the global epidemic of chronic diseases requires us to address this 80%, and doing so cannot be left to traditional health-care organisations alone.
 
Instead, many successful initiatives, built upon existing social infrastructure, solve known health problems and even uncover new issues. Examples of this new approach include technology companies such as Omada Health, which delivers customised online health coaching at home for people at risk of diabetes; social enterprises, such as the Grameen Bank, which is building low-cost primary care systems on the back of its microlending networks; and the One Million Community Health Worker Campaign, which teaches ordinary citizens how to provide care in their own communities, based on lessons learned from similar models in Ethiopia, Rwanda, and elsewhere in Sub-Saharan Africa.
By Prabhjot Singh
All Africa

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