Beyond doctor-centric models?

by Anjali Sastry on April 30, 2009

What models for healthcare might work in resource-limited settings? Here’s a provocative argument:

Physician-centric, fee-based, Western-style medical-care systems will clearly not work in most of rural Africa or in similar regions in Asia and Latin America. They are too expensive, too unfocused, too haphazard, and there are just not enough doctors. We need to abandon attempts to recreate this business model in the third world and replace it with a team-care model that uses a hub-and-spoke approach to maximize available resources, create new resources where needed, reduce costs, and multiply the quality and quantity of local care delivery. We need people who can provide the basic care villages need—and we need those people to be part of an integrated system. This new model of care would require new categories of basic health care workers who are linked with higher levels of caregivers in more central locations. The frontline caregivers should be the functional equivalent of well-trained military medics—able to diagnose and prescribe drugs for a few common diseases, get advice, and perform first aid, including basic cut suturing, leg setting, and wound repair.

Excerpted from Hub-and-spoke health care by George C. Halvorson, published on McKinsey’s What Matters website on 26 February 2009, this article is one of several that assess key issues in delivering healthcare. Halvorson argues that the Western, doctor-centric model of health delivery cannot be viable in resource-limited settings (and one could argue that at least in the US, we may not yet have a viable doctor-centric model that works here!).  He has worked in Uganda and is now chairman and CEO of Kaiser Permanente and author of several books, including one on Health Care Co-Ops in Uganda. Here’s a link to a 2002 NPR story on the co-ops. For more on Halvorson’s and others’ takes on health insurance in developing countries, check out this World Bank video (December 2006).

{ 2 comments… read them below or add one }

Jon Shaffer April 30, 2009 at 4:25 pm

Interesting post. I think Halvorson is largely right in the assertion that exporting the hospital or clinic based health care model that we have built in the US wont work for Africa. It seems like he is basically arguing for a “community health worker” model where people trained in basic care delivery as well as in recognizing more serious illnesses which need to be treated in a clinic. As anyone who reads this blog probably knows, Paul Farmer and Partners in Health have successfully implemented CHW programs in Haiti, Rwanda, and Lesotho and have seen very high success rates in treating even very complex diseases such as HIV and tuberculosis. (www.pih.org) One thing I would caution though – these types of health delivery systems should not distract us from an ultimate goal which is very high quality medical care for the poor. They should be tools to allow us to achieve equity in global health.

Joost Bonsen May 10, 2009 at 11:24 pm

Hub-and-spoke team-solutions are an excellent idea, being more distributed and resilient and cost-effective by reframing the ways labor is divided. There are industrial world analogs, including “minute clinics” btw, as HBS Prof Clay Christenson has noted — http://danbricklin.com/log/christensenatmimc.htm I found the National Geographic survey piece Necessary Angels — http://www.maximizingprogress.org/2008/12/necessary-angels-essential-rural.html — to be especially compelling. And our MIT Development Ventures alumco (and MIT $100K Entrepreneurship Competition D-Track winner) ClickDiagnostics — http://clickdiagnostics.com/ — is centrally about bringing the latest in mobile technology and resource networks to bear in delivering global health services.

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