The Path to Health for All: Translating the Economic ROI to Financially Investable Opportunities for Private Sector and Governments, July 2018
If you listen carefully, you’ve probably heard the exciting buzz about Health for All- countries are talking about it, patients are voicing strong interest in it and now the focus has become defining what does this look like and how can this be financed. What are the critical must haves, what’s the best way to balance immediate vs. longer term priorities? Given existing health infrastructure, what’s the best way to address these priorities and how do we allocate existing funds and raise new funds, all in service of this goal. As the Director of Innovative Finance at the Financing Alliance for Health, it’s these questions that get me up every morning excited about the work we do.
As those in the noncommunicable disease space know, this is a big year in global health policy. This September culminates in a UN High Level Meeting on Noncommunicable Diseases (NCDs)- a time for Ministers of Health to gather and discuss how to integrate critical NCD services as they build out their package of Health for All. It’s critical to have the right policies in place, but what gets me excited is how to then finance it all. All the evidence shows that “investing” in health (i.e. prioritizing health services) shows a positive economic return on investment- which is the first piece of the equation. But the piece that’s been largely unanswered is how does this then translate into a financially investable opportunity? How should a Minister of Finance pose this opportunity to private sector or intergovernmental investors? Is it truly investable?
With these questions in mind, thanks to a partnership with the Medtronic Foundation, we participated in the WHO Global Dialogue on Partnerships for Sustainable Financing of Non-Communicable Disease (NCD) Prevention and Control, April 9th-11th in Copenhagen, Denmark where organizations from across the globe convened around this exact question: How can Health for All, that includes all patient health priorities, actually be financed? While there, we contributed our perspective on innovative financing for NCDs through integrated primary care packages on a panel discussion with Rachel Nugent, Brenda Killen, Eduardo Banzon and Harald Nusser, organized by Andrea Feigl from the OECD and moderated by Dorje Mundle from Business for Social Responsibility. Next, we engaged in multiple enlightening discussions on the case for NCD financing, partnerships required to successfully address the policy and financing gaps, and potential approaches to financing and country case studies with feedback from Argentina, Bahrain, Uruguay, Jamaica, Ethiopia.
“There is an incredible hunger from countries to make this happen, but a serious need to translate economic ROI to investable partnerships”
In taking a step back, what was clear is that there is a strong interest from countries to make this happen, but a need to translate economic ROI to investable partnerships and once those opportunities are in place, then the subsequent need to align partners’ incentives and resources in the right way. Not an easy task, but something that the Financing Alliance for Health is sharply focused on. In particular, from these conversations and our work helping governments cost-out and develop investment plans for functional health systems, we at FAH believe the following approaches will be critical to achieving Health for All that includes an effective NCD response especially at the front lines:
Translating ROI into Financial Investments
NCD investments promise a 5:1 economic return, and a 10:1 return when including social returns through increased labor force participation, increased productivity and system-wide cost reduction. Our call: make this known to Ministries of Finance (MoFs). Ultimately, MoFs decide short-term investment priorities and reflect those in their budgets. Economic, political and fiscal returns drive these decisions. We have the data to make a compelling and informed case to increase the political urgency and attention this receives.
Emphasizing the Negative Impact of Inaction on the Economy
The NCD burden is projected to result in a 5% decrease in global GDP. This message should be articulated to the right groups of decision makers – through the G7, G20, World Economic Forum etc.
Building the Right Multi-stakeholder Coalitions
Sourcing sufficient capital and attention to attract appropriate NCD investments will require a multi-sectorial approach. The Defeat-NCD Partnership can serve as a platform for this through the development of their financing facility, procurement and distribution facility and advocacy leadership.
Incentivizing Private Sector Investment
We believe there is a tremendous opportunity to engage pharmaceutical companies, diagnostics companies, distributors, insurance providers and other private sector actors operating in health to identify more efficient, at-scale approaches to support this effort. These approaches could include volume guarantees for drugs or diagnostic equipment, national or regional distribution contracts, scaling social insurance programs, task shifting to ensure greater availability of preventive care at the community level etc. Additionally, on the financing front, there are opportunities for equity, debt and blended investments in NCD prevention and treatment efforts, yielding market returns. Private and institutional investors, banks and other financiers should be brought into the discourse to be able to more effectively create products that will ultimately attract private capital. This could take the form of including these groups as critical stakeholders in health-specific task forces, providing invitations to meetings such as the one described above and including them in national coordinating committees focused on health.
Looking ahead, there is a $2-$3T financing gap to scale up NCD prevention and treatment efforts, and ultimately contribute to achieving Health for All. Stated like this, it sounds like an overwhelming resource gap, but broken down it’s closer to an additional $0.90 per person in low-income markets and close to $3 per person in upper-middle income countries – that’s achievable. Let’s work together in bringing private sector, development finance institutions, foundations and ministries of finance to the table. Without them this won’t work. Join us in building investable opportunities for integrated service delivery that help achieve health for all. The time to finance health for all is now.