How can we fix our health systems?

Dr. Ernest Darkoh and John Sargent are Schwab Foundation 2015 Social Entrepreneur of the Year Awardees.

The World Health Organization provides an excellent definition of health: the physical, social, and mental well-being of an individual and not just the absence of infirmity or disease. Sadly, there is barely a country, rich or poor, where achieving good health on an individual or population basis is not a monumental challenge. And the challenges are usually related to health systems.

What is a “health system”? The simplest way to define a health system is to map all the direct and indirect factors that contribute to an individual’s current state of being. For a particular outcome  –  for example, life expectancy  – these factors and how they interact to create an outcome collectively define the health system as related to that particular outcome. In essence, if we define a “healthy” 95-year-old who has required minimal services from hospitals and clinics as the gold standard to which we should all aspire, the health system that produced this 95-year-old is the combination of all the factors that have differentially contributed to this achievement: nutrition, safety from physical or psychological harm, protection from toxic environmental exposures, access to quality health services, etc.

These factors usually interrelated, and each factor is in turn the result of constellations of other interacting factors.

Are our health systems generally broken? In our experience, the problem is often not so much that our health systems are broken, but rather that the systems are not intrinsically designed or configured to yield the outcomes we desire. On the contrary, consistently poor outcomes are the products of perfect systems precisely configured to yield those bad results. So, by omission or commission, we are reaping the results of our creations. If we agree with the WHO definition, the lifetime achievement of “good health” is the result of linking many dots across many stakeholders — something that most current health systems, which are heavily biased toward clinical interventions — were never designed to do in the first place.

This is not a critique of the curative model, because we are grateful for those hospitals and clinics being there when we need them to treat our accidents, diabetes, or cancer. It is simply a statement of fact that hospitals and clinics do very little to prevent those conditions in the first place, and they rarely address the health-detracting factors outside their walls.

These factors, often referred to as “social determinants” of health, disproportionately take away our health and include such things as improper nutrition; lack of physical activity; harmful substance use; lack of safe water, electricity, and proper shelter; violence; traumatic accidents — the list goes on. A model that is primarily predicated on addressing ills after they occur is not a “health” system; it is a disaster management system. And it rarely results in desired intentional systematic outcomes.

Even within the hospital- and clinic-based health care milieu, there is often a devastating disconnect between the many dots that need to constructively collude for a patient to have a good outcome. The blind spot tends to be around the back-end functions, which are critical for frontline service delivery but are often inadequately planned for or synchronized. These are factors such as planning, management and leadership, policy and guidelines, human resource management, procurement, finance, data, and strategic information.

How do we fix our health systems? 

The first step is to change our thinking about what the health system actually is and, by extension, who the leading mandatory actors and contributors must be. Large-scale “better health” as an outcome is a team effort across many functions, sectors, and role players — the owners of all the different “systemic dots” that need to be effectively linked together. This means formally acknowledging and including actors who currently exist well outside of the traditional ambit of ministries of health, hospitals, and clinics, such as the ministries of water affairs, housing, energy, social services, education, police, labor, transportation, and vital registration services; a wide variety of private organizations, funders, NGOs, and civil society actors; and, most important, the communities and individuals themselves. All own critical pieces of the health puzzle that must be brought together in the right way.

The second step is to design and configure better systems that deliver actual results. This can be done only if we understand the problems and become much better at linking the critical dots to create the results we actually want. Such understanding can come only from better utilizing the currently available data and information to gain the best insights about what is actually going on and to help us problem solve, predict things before they happen (to the extent possible), conceive the right solutions that will actually work at large scale, and develop effective implementation and tactical plans. The “big data” movement urgently needs to focus on health care to empower the key stakeholders with the right information at the right time.

The third step is to implement and monitor these plans much more effectively and to enable all the actors to collaborate and share information in ways currently not possible. Concrete, well-funded operational mechanisms that bring together and coordinate the right constellations of actors around certain key priorities are critical. Philanthropists such as Bill and Melinda Gates and Sir Richard Branson have advocated for a “war room” approach to the big challenges of our time. Accompanied by a long-term developmental mind-set, this is precisely the approach required. Success is predicated on the ability of all key actors to be networked in a way that rapidly creates unprecedented scale, maximizes their respective comparative advantages, and allows them to coordinate and interact in real time with the best available information on hand.

As cases like the recent Ebola outbreak have highlighted, most current health systems are not configured for purpose, and the next pandemic will play out exactly the same way if we do not begin to get this right.

Finally, all actors — be they government, private sector, NGOs, or individuals — have a role to play, and we must be willing and courageous enough to do things differently if we are to see meaningful change in our lifetimes. Currently, we largely live in a world where being healthy is the difficult option. We must instead create systems that make it as difficult as possible to be unhealthy. We live in times of unprecedented innovation, and these challenges are inherently addressable if we can figure out how to work together in positively disruptive ways and if at least a few leaders have the courage to stand up and trailblaze game-changing approaches that will redefine our conceptual horizons.

This article is published in collaboration with Medium. Publication does not imply endorsement of views by the World Economic Forum.

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Author: Dr. Ernest Darkoh and John Sargent are co-founders of BroadReach Healthcare. Both are Schwab Foundation 2015 Social Entrepreneur of the Year Awardees

Image: A nurse poses for a photo in a trauma center of the University of Mississippi Medical Center in Jackson. REUTERS/Jonathan Bachman.