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Transforming healthcare in the Global South
Stanford PACS hosted an event to bring together leaders to drive long-term improvements in human health in the Global South.
Priya Shankar with Rohini Nilekani and Nandan Nilekani. / Ritu Marwah
Less than six years remain to achieve the United Nations Sustainable Development Goals, and partnerships, innovation and mobilization of resources are crucial to meeting these goals, said Priya Shanker, executive director, Stanford Center on Philanthropy and Civil Society (PACS). Stanford PAC hosted an event on May.31 to bring together leaders in healthcare, global development, philanthropy, and tech to spur collective action and drive immediate and long-term improvements in human health in the Global South.
At the event, Nandan Nilekani, co-founder and non-executive chairman of Infosys; and Rohini Nilekani, chairperson, Rohini Nilekani Philanthropies, spoke of exponential growth that can be achieved with systems that diffuse knowledge and bring transformation using large-scale platforms.
Nandan spoke of the scale achieved by India’s digital ID, Aadhaar. “About 1.3 billion digital ID were created and they are verified online 80 million times a day. The Know Your Customer (KYC) capability was built on top of 700 million Aadhaar links,” he said.
Nandan led India’s Aadhaar (unique identification system) project. Aadhaar is a 12-digit identifying number given by the Unique Identification Authority of India (UIDAI) which serves as proof of identity and proof of address for residents of India. Today over 95 percent of Indian citizens are registered under Aadhaar, making it the world’s largest biometric ID system.
Nandan also spoke about Project ECHO (Extension for Community Healthcare Outcomes), an unconventionally structured global health and community services initiative founded in 2003 in New Mexico.
He said, “ECHO is a transformational large-scale initiative in the area of healthcare given their effort to scale healthcare to exponential levels in the same way. ECHO has impacted the lives of a billion people and the goal is to get to two billion by 2030.”
Wangari Ng’ang’a Project ECHO Advisory Board Member at the Stanford Faculty Club. / Ritu MarwahECHO is a collective of autonomous clinics joined by a mission to disperse best health practices. ECHO is a learning management system where participants learn in democratic interactions. It’s shared learning as well as mentoring.
“For instance,” said Karthik Garg, CTO of ECHO, “Delayed umbilical cord clamping (not earlier than 1 min after birth) is recommended for improved maternal and infant health and nutrition outcomes.”
ECHO shared the optimal timing of cord clamping for the prevention of iron deficiency anemia in infants with doctors in Sudan, thereby saving a number of babies from anemia. Delaying cord clamping allows blood flow between the placenta and neonate to continue, which may improve iron status in the infant for up to six months after birth. This may be particularly relevant for infants living in low-resource settings with reduced access to iron-rich foods like Sudan.
Similarly, Project ECHO is a program that aims to improve access to hepatitis C (HCV) care for people incarcerated in prisons and living in rural areas. The program connects university specialists with clinicians working in prisons, providing them with continuing education credits and training. Peer educators learn about infectious diseases and drug addiction, and receive public speaking and group facilitation training to help them prepare for life after prison.
“The sharing can be within a defined group if it must be private. ECHO built a private system for the prisons with the government so the data is confidential,” Garg added.
Sanjeev Arora, MD, the founder and director of Project ECHO working as a liver specialist at the University of New Mexico (UNM) School of Medicine for years, was frustrated by his inability to treat all the patients. Those with the hepatitis C virus (HCV) had to wait eight months to access his clinic — and by the time he saw many of them, their conditions had worsened, sometimes terminally.
Arora devised a radical approach to solve this problem by virtually mentoring and training clinicians in remote areas to treat and manage complex health conditions. Primary care clinicians who were interested in establishing centers of excellence for HCV care in their areas signed up to be part of an interdisciplinary team as part of a live remote telementoring session called a “teleECHO clinic” every week to learn how to treat patients with HCV.
Don Berwick, president of Emeritus Institute for Healthcare Improvement, a physician whose work has catalyzed a national movement to improve healthcare quality and safety, said, “Poor quality care is a bigger killer than access to healthcare.”
Jeffrey Bradach, partner and co-founder, The Bridgespan Group, San Francisco, said, “If we know something that works, wouldn't you think people would just follow. It would multiplicate. If McDonalds can do it, why can’t we.”
Don Berwick warns against errors in healthcare. / Ritu Marwah
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