“Universal Health Coverage in India can’t succeed with one-size-fits-all approach”

Mentioned Mr Harald Nusser, Head of Novartis-Social Business who shared insights into the Novartis Access that brings affordable treatments for key chronic non-communicable diseases to patients in middle and low-income countries. Read the details below


Mr Harald Nusser, Head of Novartis-Social Business believes that India requires its own homegrown model of health coverage system as the ones already in place in western nations won’t necessarily work here. In an exclusive interaction with the BioVoice News, Harald shared details on how Novartis Access, the social responsibility program of Novartis is committed to increasing access to healthcare by formulating innovative ways to make universal healthcare a reality

BV_icon-150x150Please tell our readers about the objective behind the creation of Novartis Access?

As a healthcare company, one of our main objectives has always been to expand access to medicines in lower-income countries. If you look at WHO figures, there are 400 million people worldwide who don’t have access to essential medicines. This is something Novartis has actively been trying to change: getting medicines to more people who need them, at prices they can afford.

The Novartis Access portfolio was launched in 2015 and specifically targets noncommunicable diseases (NCDs) in lower- and lower-middle-income countries. These are diseases such as diabetes, heart disease, hypertension, and breast cancer. Because of the correlation between these conditions and urban lifestyles, we tend to associate them with high-income countries. What is slipping under the radar is that they are actually a growing problem in poorer countries. In India, for example, they make up more than half of the disease burden. In the developing world, we see 31 million deaths a year from chronic diseases. That’s almost three quarters of the world total.

BV_icon-150x150What have been the achievements of the program so far? 

In terms of what we have achieved, one of our success stories is Kenya, which was the first country to implement Novartis Access. We are building partnerships with organizations on the ground there – to educate the population, to train healthcare workers, to screen for and treat NCDs. Ten out of the fifteen medicines in the Novartis Access portfolio were approved in Kenya last year and we are hoping to have monthly treatments available in all 47 Kenyan counties by the end of this year at a very low cost to health systems.

“There’s a shortage of around 500,000 doctors in India. That’s the number the country would need to meet WHO guidelines for doctor-patient ratio, which should be 1:1000. India’s is about 1:1700”


How do you view the healthcare access scenario in India? What role will Novartis Access play here?

The healthcare access scenario in India is very challenging, leaving millions of people without access. There’s a shortage of around 500,000 doctors in India. That’s the number the country would need to meet WHO guidelines for doctor-patient ratio, which should be 1:1000. India’s is about 1:1700. As always, ingenuity is one India’s great assets and the use of technology is helping the country to overcome this shortfall. We are working with Indian partners on a pilot to give Indian patients with NCDs access to continuing medical monitoring and advice. This work looks very promising.

Out-of-pocket costs are high in India but access to low-cost medicines is not the top problem for most NCD patients. Once the condition has been recognized and diagnosed, it is a question of allowing patients to get access to quality-assured medicines that are affordable.

India is such a vast and decentralized country that it is difficult to implement a program such as Novartis Access at national level. Because health is predominantly a state responsibility, I would not rule out working with one of the states to adapt Novartis Access to the local situation.

However, our main focus in the country is on a program that was specifically developed for India. Arogya Parivar is now 10 years old and offers more than 100 low-cost medications against both communicable and noncommunicable diseases that are prevalent in rural India. It operates in 11 states and covers more than 12,000 villages that are home to 70 million people. Plans are under way to include the Novartis Access portfolio in the Arogya Parivar offering.


Is universal health coverage possible in a highly populous country like India? How?

Yes, but we need to be careful about the term. I don’t think that there is one model of universal health coverage that countries can simply adopt. UHC is not a “one-size-fits-all” approach and models that work in Europe or the US will not work in India. This is why governments need to “home-grow” their systems, so that they are adapted to their health needs. This includes setting the right framework conditions (including up-to-date essential medicines lists and treatment guidelines) but also remaining flexible and open as to how they procure and distribute healthcare products and services.

India is strengthening ways to improve access to healthcare, health insurance being one of them, and these differ across the country. Yet, it is not our job as a company to be prescriptive about how the states or the government expand access. Rather, we want to act as partners and engage as part of the plans set out by the government.

Novartis is part of a World Economic Forum initiative on leapfrogging in health. I really do believe that emerging economies can leapfrog over countries in Europe and North America to find new ways to deliver quality healthcare. And I am convinced that India has the ambition to do exactly that.

“UHC is not a “one-size-fits-all” approach and models that work in Europe or the US will not work in India. This is why governments need to “home-grow” their systems, so that they are adapted to their health needs”


Which are the areas of healthcare in India that Novartis Access will be focusing upon with immediate priority? 

The focus of Novartis Access on NCDs does not mean that we will neglect infectious diseases. Our Malaria Initiative, for example, is still going strong. We are very proud of the work we have done with malaria, delivering more than 800 million treatments since 2001, and currently leading two of the world’s most advanced malarial medicine development program. In India, where one in seven people are at risk of contracting malaria, this is of paramount importance, as many of those afflicted will be from rural areas – the exact areas Novartis is trying to target through our Social Business programs.


Are you planning any collaborations in India to achieve your objectives? 

We launched Arogya Parivar in 2007 to reach out to rural India, where most of the population has limited access to healthcare. We’ve managed to reach millions of Indians with health education meetings and other services. Most importantly, we’ve managed to boost their access to health education, diagnosis and medicines. Between 2010 and 2013 450,000 rural Indians have been diagnosed in health camps in areas that have long been neglected and underserved, and for a range of conditions, including NCDs like diabetes and infectious diseases such as tuberculosis. Most importantly, we have worked closely with the public health systems and with not-for-profit providers around the country.

The Indian experience has led us to adapt Arogya Parivar in Kenya and Vietnam. In Kenya, since 2012, 350,000 Kenyan people have attended health education meetings and 12,000 patients have been diagnosed and treated at health camps.

We plan a further expansion next year. It is so exciting that we have been able to take this idea, made in India, and use it around the world.