Tom Achoki
Tom Achoki, a former Sloan fellow at MIT, is an adjunct faculty member at Baylor University and Co-Founder of the Africa Institute for Health Policy, a research and advisory agency based in Nairobi, Kenya.
NAIROBI – Corporations are increasingly moving into the public-health domain. Companies like Amazon, Google, and Microsoft are being “pulled” by market opportunities for non-traditional actors to “disrupt” health care. Others are being “pushed” by the imperative – highlighted by events like the COVID-19 pandemic – to act as responsible community stakeholders, such as by helping to address health inequities.
When such pull and push forces intersect, there are often important opportunities to align economic and social objectives. But if strategic corporate philanthropy is to improve public health, those charged with making decisions and allocating resources must have a deep understanding of the health system, including the institutions, organizations, and resources that comprise it, and the complex interactions among them. According to a framework established by the World Health Organization, health systems have six pillars: service delivery; development and deployment of a health workforce; collection, analysis, and use of critical health information; provision of essential medical products, vaccines, and other health technologies; financing; and effective leadership and governance. To meet a population’s health needs, all six must work in harmony, in an elaborate process involving inputs, activities, outputs, outcomes, and impact.
Consider COVID-19 vaccination programs, which depend on inputs – including financial resources, workers, equipment, and the vaccines themselves – that are partly outputs from activities like medical-product development and service delivery, with all the logistics, infrastructure, personnel training, and supervision this entails. Together, all these factors lead to an outcome – getting a large enough share of the population vaccinated – with the impact being a reduction in mortality and morbidity from COVID-19.
As the WHO also explains, an effective health system is fair and equitable, both in the distribution of health goods and services and in the way it is financed. It emphasizes efficiency and cost-effectiveness as well, and responds to the legitimate non-health expectations of those seeking health care, such as respect and compassion. Ultimately, an effective system ensures that anyone in need of a specific health good or service can access it and derive the relevant benefits.
This framework should guide corporations – and all stakeholders – as they engage in the public-health domain. So should the principle that any direct investment in the health system must serve to strengthen one or more of the framework’s six pillars. To this end, a clear, data-based strategy for measuring health-system performance is crucial.
Only a comprehensive monitoring and evaluating plan – identifying not only what data need to be measured, but also how, when, and by whom – can ensure that decision-makers have the information they need to plan, organize, and implement effective public-health programs. For example, it can help to ascertain high- and low-priority areas, as well as areas where services are being duplicated, thereby improving the allocation of scarce resources. It can also show which public-health interventions are making the biggest difference, and be used to track progress in health outcomes, potentially revealing gaps between segments of the population.
Organizations seeking to engage in public health can use such data – together with a broader understanding of the health-system framework – to identify where they are best suited to make a difference, based on their competitive or comparative advantages. The better they know the terrain they are entering, the easier it will be to pinpoint unmet needs and anticipate their actions’ likely impact (including possible unintended consequences).
Health actors need to engage effectively with other stakeholders, because public-health programs often involve diverse groups with different priorities and objectives that must be harmonized to meet overarching health goals. For such engagement to work, however, trust and credibility are key. An effective impact-measurement strategy can help here, too, by supporting transparency and accountability.
For example, while basic principles of privacy and confidentiality must be respected, organizations should share the results, positive or negative, of any public-health investment or intervention – including relevant datasets, where feasible – with other stakeholders. Beyond fostering confidence, letting others know what works and what doesn’t would accelerate progress on improving health outcomes. Independent evaluations of programs would also help here.
All of this requires a set of key performance indicators to be established at different levels of the framework used to measure short-, medium-, and long-term changes resulting from any given program. There is no need to reinvent the wheel. On the contrary, KPIs should be aligned with global standards, as established in existing policy documents, so that stakeholders are all using the same language.
The final critical insight for companies entering the health-care domain is that not only are health systems highly complex, but they also operate within an environment in which they must continually interact with various political, socioeconomic, and sociocultural forces. All of these forces – not just interactions within the health system – shape public-health outcomes. The better newcomers understand these interactions, the more likely they will be to have a positive impact on public health.
