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Frugal innovation in healthcare-Cure2Children’s contribution

Life expectancy has almost doubled during the past 60 years; a great success primarily due to biomedical advances that have inevitably resulted in unrelenting increases in healthcare costs due to more expensive treatments and increased medical needs of an aging population. These rising costs have stressed even the most stable healthcare systems and drawn increasing attention to cost-containment and comparative effectiveness considerations.
 
International medicine projects dealing with tertiary care in middle-income countries and applying frugal innovation principles aiming at offering affordable quality care may thus be relevant, not only, for fair access to medical assistance for the bulk of the world’s population but also to increasingly resource-restricted healthcare systems in wealthy countries.
 
In most low- and middle-income regions, which as a whole, account for the majority of the global population, especially those under age 18, medical care is largely provided on a pay-for-service basis by profit-oriented private institutions investing very little on prevention or research and development. Even though health workers may have financial gratifications, this system provides little in terms of professional development and motivation and contributes to brain drain, high workforce turnover, and poor professional sustainability.
 
Cure2Children (C2C) is focused on increasing safe, effective, and affordable care of non-communicable life-threatening disorders of children (NCDs) in lower-resource settings aiming at meeting real needs and providing clear value. The focus on hemoglobinopathies, namely sickle cell disease and thalassemia, is because they are the most frequent NCDs of childhood with over 300,000 new cases born worldwide and several millions currently requiring access to appropriate care (>> WHO Bulletin).
 
In Pakistan and India, C2C was able to support both professional and financial growth for a small network of private and governmental institutions offering safe and, importantly, affordable bone marrow transplantation (BMT) for the cure of thalassemia with results comparable to those obtained in Italy (the country with the largest experience in the field) but with on tenth of the costs (>> C2C Publications). After the initial startup phase most BMTs are now covered by locally-raised resources (usually the national public health system which acknowledges the financial advantages of curing kids with thalassemia rather than provide life-long supportive treatment) and most doctors, nurses, and support staff have not switched jobs or emigrated, but rather increased their professional standing in their own country. By implementing only evidence-based expenses, (i.e. those that have been unequivocally proven to favorably impact on outcomes), we were able to leapfrog conventional costly methods while preserving safety and efficacy. Thus C2C has successfully helped local institutions to develop their own innovation programs and improve health.
 
Collaborations of this type are a prime example of successful public-private partnership among corporate hospitals, academic centers, nongovernmental organizations and governments that allow the local health system to (1) make quality healthcare affordable locally (2) develop the local health system and enable it to be globally competitive.
 
Based on these initial positive experiences, C2C is now planning a more ambitious project of a global network of independent institutions sharing common vision and principles, i.e. providing quality and affordable tertiary care on a non-dividend non-loss basis.
 
The role of C2C as a third-party professional organization is to foster collaborations among independent institution willing to use of common protocols and procedures and share quality assurance programs. In addition, C2C may reassure local patients and medical teams in the stat-up phase, decrease unnecessary expenses, facilitate scientific visibility and international competitiveness, support fund-development/sustainability strategies, and provide network referrals. Last but not least, the promotion of screening and prevention programs which are not generally a priority of corporate hospitals.
 
Assessing medical needs, building capacity, and promoting cost-effective innovation are powerful means to realize technology’s potential to achieving better health in low-resource settings as well as globally.
 
Article by Lawrence Faulkner, Medical Coordinator, Cure2Children Foundation, Florence, Italy

 

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