What will it take to achieve Universal Health Care?
Marwa Nasir was born with a congenital heart defect. Based in rural Pakistan, and with a low income supporting five other children, her family had no way of accessing the health system to get her the life-saving treatment she needed.
That was until Dr Sania Nishtar met the family during her efforts to map the extent of the country’s so-called “abandoned poor”. That’s people who exist on the margins of society and are excluded by a medical set up that only some 27% are able to benefit from, owing to the convoluted structure of private and public provision, where healthcare can be a gamble for the rich and poor alike. Within days of Dr Nishtar’s visit, Marwa’s case was reviewed and in another 72 hours, she was admitted for heart surgery. Without that intervention, doctors say Marwa may not have made it past her third birthday.
Marwa’s story is just one of those told in a powerful new documentary, Choked Pipes, released as the great and the good convene to discuss the Sustainable Development Goals in New York this week (September 2015).
This year is the 70th meeting of the UN General Assembly and global healthcare is at the top of a packed agenda. Ensuring healthy lives and promoting well-being for all at all ages is the noble and much needed declaration of Goal 3 of the SDGs. It echoes the World Health Organisation’s aspiration to achieve Universal Health Care by 2030.
In the film, Dr Nishtar, one of the leaders of a new movement in Global Health proposing the reform of entire health systems, shows that there is real hope of achieving those goals — given the right combination of ambition, innovation and political will. Speaking to the award-winning director Randall Wright, she explains:
“A health system has to satisfy the people, it has to cater to the needs of the rich and the poor, and it should ensure that patients don’t face financial catastrophe when they fall ill. Innovation is the use of technology in an innovative system — it’s systems innovation, technology innovation and partnership innovation. When you get all those three things together, then you can create something that will make a quantum change.”
Choked Pipes, directed by Rockhopper TV (producers of the Survival series and The Health Show documentaries) is based on Dr Nishtar’s 2010 book of the same name. It’s an astonishing and timely portrayal of an urgent situation — in Pakistan health care isn’t yet considered a human right. The smallest of medical conditions can therefore be a question of life and death. 73% of a population exceeding 200m lack access to health coverage, according to Dr Nishtar.
And yet as Michael Therein of the World Health Organisation says in the film: “The major healthcare problems in Pakistan are the ones that shouldn’t be here. Pakistan is a mid-income country, with a lot of resources, knowledge and great people. If health care reform is possible here, it is possible anywhere.”
By drawing on Pakistan’s culture of philanthropy, the proliferation of mobile technology and the good will and talents of the country’s clinicians, Dr Nishtar demonstrates how thousands of people’s lives could be dramatically improved.
Staffed by just 17 people in a building on the outskirts of Pakistan, her NGO Heartfile connects patients with clinicians using texts, email and Skype. Cases are assessed in terms of clinical and financial need, and services are sourced from the public and private health system to ensure the best outcome for all, based on each patient’s circumstances.
It’s an approach that has generated extensive debate and attracted universal plaudits from other health experts, such as Dr Seth Berkley of the Gavi Vaccine Alliance, who points out that health systems the world over could benefit from the kind of reform Dr Nishtar is proposing:
“Sania has shown how technology can be used to drive forward the types of reforms that are needed in many wealthy countries, as well as places like Pakistan.”