Access Accelerated and PATH have partnered since 2018 to support people living with NCDs by working closely with ministries of health and local partners to build scalable and sustainable solutions and improve service delivery and access to NCD care. PATH sought to strengthen health systems in Kenya, Ghana, and Vietnam by focusing on primary health care, supply security, and data-driven decision making, based on the evidence that these factors are key levers for change. The five-year partnership between Access Accelerated and PATH has led to catalytic change — testing and scaling new PHC models for NCD services reaching hundreds of thousands of people with prevention and care in the community, supporting strong governance and collaboration through quality data and visual analytics, and creating innovative solutions to break down barriers to access to medicines and health products. PATH created new partnerships and opportunities for enhanced collaboration between industry, ministries of health, and local stakeholders that have laid the foundation for service delivery models to be scaled nationally and transform NCD care.
PATH
ACTIONS, OUTCOMES AND IMPACT IN 2022
PATH’s projects in Ghana, Kenya, and Vietnam, through five years of partnership with Access Accelerated have generated remarkable results, with several of them scaling nationally. PATH’s programs, focusing on data quality, primary health care, and supply chain strengthening led to the largest increases in patient-level data including the number of people diagnosed, treated, and screened for NCDs between 2021 and 2022. In one year, PATH increased the number of people diagnosed by over 6,000 times, the number of people treated by 114 times, the number of people screened by 150 times, and the number of healthcare workers trained by 12 times. This notable growth is a result of PATH’s unique value contribution as a large implementer that is focused on health systems strengthening and collaboration with local governments.
PATH’s approach to health systems strengthening recognizes the importance of primary health care as an entry point to bring NCD services closer to the communities and increasing access to care. In 2022, the Communities for Healthy Vietnam project continued offering screening for hypertension and diabetes in convenient locations such as grocery stores, pharmacies, and nail salons as the project scaled to cover more of the country. Creating these points of care, used in conjunction with digital tools, supported the identification of new cases that would have otherwise gone undiagnosed, and it also enabled patients to adhere to treatment. Over time, this project retained of patients, which is significantly higher than the national average of 13%. PATH presented the Communities for Healthy Vietnam project to the government in early 2022 and the Prime Minister included it in the “National Plan on NCD Prevention and Control 2022-2025” as a way to screen more people for NCDs. This primary health care approach is adaptable in other country contexts — as demonstrated in Makueni County in Kenya. PATH introduced the model in several facilities in Makueni County in 2020 and it has since expanded, screening more than 50,000 people in 2022. Recognizing the relevance of primary health care in strengthening service delivery for NCDs enabled PATH to leverage existing infrastructure. This is an essential component of PATH’s success: PATH encourages collaboration and innovation while embedding new ways of working into established systems of service delivery.
PATH’s approach similarly worked to enable data quality to improve governance and identify gaps and barriers to NCD care in 2022. A flagship product of PATH’s partnership with Access Accelerated is the NCD Navigator, which provide information on NCD initiatives; the respective implementers, funders, and beneficiaries; the geographic distribution of these NCD initiatives within the country; and alignment of these initiatives with the national strategy. By the end of 2022, the Navigator was in use nationally in Kenya and Ghana. PATH’s Journey of the Pill NCD supply chain assessments provided a common understanding of the unique barriers or combinations of barriers impeding access to NCD commodities and brought organizations together to co-create solutions. Two examples are the Supply Chain Technical Working Group established as part of the Interagency Coordinating Committee in Kenya; and two the partnership between PATH and the Kenya Medical Supplies Authority, to develop a digital stock tracker for NCD commodities that provides greater visibility across the supply chain, strengthens distribution and reduces stockouts — a common barrier found in the Journey of the Pill assessment.
The PATH and Access Accelerated partnership also resulted in important changes for supply security in Ghana. Because of these efforts, in 2022, NCD medicine suppliers were included in framework contracts, Ghana’s Logistics Management Systems were expanded to primary health care facilities, and standard operating procedures and guidelines for integrating insulin into vaccine cold chains were developed.
Access Accelerated was a member of the Coalition for Access to NCD Medicines and Products. The Coalition worked with an expert technical working group to develop a unique forecasting program. Kenya was the first country to contextualize and test the approach with leadership from the ministry of health and PATH technical support developing Kenya’s first five-year costed forecast for hypertension and diabetes medicines and associated products. This critical planning effort was also undertaken in Uganda and is now being implemented in Ghana and with its strong rationale has helped to mobilize funding for NCD commodities.
CASE STUDY: Health systems strengthening and the need for a systems approach
A vast array of interventions and technologies exist to cure disease and prolong life, yet gaps in health outcomes continue to widen, particularly for those living with NCDs. No single intervention or technology has the capacity to overcome population-wide challenges, which is why strong health systems are essential to achieving universal, equitable access to quality and timely care. PATH’s approach to strengthening service delivery is a unique example of how co-creating with local partners as well as through upfront investment in people generates health solutions for NCDs that are readily adopted, locally owned, and sustainably scaled.
As not all primary health care delivery provides equal access to prevention, diagnostics, and treatment for NCDs, PATH works with national and local governments to transform primary health care to better serve people’s needs throughout their life. To do this well, PATH builds health workforce capacity to support NCD care in primary care facilities, partners with community health workers and volunteers to provide follow-up and support, and leverages digital health innovations to increase demand for services as well as access to affordable care for diabetes and hypertension by bringing diagnostic services closer to communities, such as in the case of the Communities for Healthy Vietnam project. Increasing the availability of NCD services at the primary care level is a key pillar of PATH’s approach, because regular interactions with primary care providers can identify risk factors for NCDs and help prevent the development of serious illness. By changing how people with NCDs experience care delivery, PATH is enabling a transformation in both demand and supply of services, thus enriching the care experience for both patients and practitioners.
Recognizing that primary health care is the face of a national health system, PATH also works to strengthen its backbone through supply chain management. Not only does a reliable supply chain enable countries to meet demand for medicines and associated health products, but they also safeguard a country’s investment in health commodities, which is often lacking for NCDs. PATH strengthens supply chains by working closely with health authorities and providing them resources to identify and address challenges. To do this, PATH undertakes diagnostic assessments to identify strengths and inefficiencies in national supply chains, including tracking stockouts and price mark-ups. These provide a thorough overview for countries to understand which actions to take to strengthen commodity security. These assessments are essential as countries work towards universal health coverage and transition into more sustainable financing for NCD commodities.
Lastly, PATH’s approach enables countries to use data to guide their decision-making. A key example of this is their pioneering digital technology which collates and visualizes the sub-national NCD burden, national NCD initiatives, implementers, and funders — the NCD Navigator. The Navigator is fundamental in providing evidence that helps countries to allocate resources efficiently and to coordinate stakeholders effectively. Beyond decision-making, having these types of data enables health systems to really question what key gaps exist in service delivery and for whom.
In addition to the three areas of PATH’s systems approach, PATH adapts its programs to each country’s specific context, thus ensuring the acceptability of technologies and tools while encouraging local ownership. This continuous engagement over time allows projects to become embedded at national level, creating a rigorous approach to implementation, coordination, and stakeholder engagement.
PATH’s approach offers lessons on how health systems can be strengthened to support NCD care, in turn revealing the multiple low-hanging fruits for NCD action. The tenets of PATH’s work: primary health care, supply chain management, data-driven decision-making and working with local partners showcase that sustainable change is possible and feasible. PATH’s success stories in national scale-up demonstrate that siloed approaches are not the only options available for NCDs. Instead, having a simplified proof-of-concept pilot, compounded by long-term funding is deeply transformative for systems-wide change.
CASE STUDY: Using data to positively impact NCD care
One of the key principles of PATH’s approach to strengthening health systems for NCDs is the generation, management, and strategic deployment of data. Across programs, products, and project planning, quality data is a key component of evidence-based decision making to improve NCD outcomes.
A pioneering NCD data tool — PATH’s NCD Navigator — was created to provide policymakers and program implementors with the data to plan comprehensive and collaborative NCD action plans. This includes information on local NCD initiatives, such as their respective implementors, funders, and beneficiaries. The NCD Navigator displays geographically specific information on the burden of different NCDs among different target populations. With this open access data at their disposal, public health authorities and leaders in civil society can make informed decisions around strategic partnerships and resource allocation. This digital resource was debuted in 2018 through a partnership with Kenya’s Ministry of Health, expanded to Ghana in 2020, and is now being prepared for adaptation to other contexts within and beyond the African continent.
Beyond the planning phase and into project implementation, ongoing data capture is essential to learning and improvement. PATH provides partners with digital tools to generate novel data that highlights the needs of people living with NCDs, illuminates gaps in care, and demonstrates tangible impacts of NCD initiatives. In Vietnam, PATH deployed complementary digital applications for both patients and providers, generating robust data on patient health, clinic visits, treatment status, and more. In addition to facilitating patient management and referral, these digital tools provide valuable insight on patient adherence to treatment and loss to follow-up. Data points across the entire continuum of care allow for comprehensive evaluation of NCD service delivery, which can reveal pain points for patients and providers.
With support from Access Accelerated, innovations to strengthen the supply chain for NCD medicines and products have been implemented. In partnership with the Kenya Medical Supplies Authority (KEMSA), PATH has rolled out digital resources including a stock tracker for NCD commodities that provides end-to-end visibility to the medicines within the public system. In addition, a forecasting initiative for NCD medicines and products, developed by the Coalition for Access to NCD Medicines and Products, has been implemented thereby building the capacity of health and supply chain systems to forecast NCD medicine and product needs.
Each of these innovations strengthens the overall supply chain by generating data on the supply and demand of major NCD products. This data shows public health officials where drug supplies are ample, where they are scarce, and where resources are being allocated inefficiently. The forecasting initiative resulted in Kenya’s first five-year costed forecast for hypertension and diabetes medicines, giving the Ministry critical data for decision making. PATH’s digital tools for supply chain strengthening have been fully adopted by KEMSA and the Ministry of Health, preventing people living with NCDs and medical facilities across the country from struggling to access NCD medicines.
The relevance of data for NCDs is foundational in transforming perceptions of how widespread and pressing NCD needs truly are. Recognizing that no action is possible without data, PATH’s work to improve the data quality and quantity in turn builds an enabling environment for evidence-informed policy making. Because NCD action is still nascent, fostering such knowledge and data-centric approaches is essential for priority-setting, while also helping to simplify the complexity of NCD needs.
