Movement Health: How the process works
When working to transform healthcare systems, Movement Health is purposely designed as a ground-up initiative.
We recognise that many of the best solutions are to be found at a local level, which is why our roundtable discussions consist of regional experts from diverse professional backgrounds. These people help us define the key areas where experimental pilots will drive impact and advance the country’s healthcare system.
That said, many other countries are on a similar journey. There are leapfrogging opportunities and ready lessons available, as long as we know where to look. There are also actions that Movement Health and other partners can take to support countries to deliver within their existing budgets via improved data gathering and technology.
Indeed, new approaches often need to be implemented to empower professionals and individuals with new technologies, to help foster care provision and trust, and to better support financially resilient systems. The key is finding the right approaches for each individual country.
Our recent work in Algeria is a good example of our process in action.
Since its independence, Algeria has achieved significant success in the domain of healthcare, mainly in health coverage, capacity building and the management of communicable diseases. However, high dependency on oil and gas exportation, plus stock-market fluctuation, has meant obstacles to delivery. And although Algeria experienced relatively low rates of COVID-19, the pandemic highlighted issues with the public health system as it struggled to provide minimal levels of care.
Moreover, the system has not kept pace with societal transformation. Chronic diseases are increasing, requiring more complex and costly treatment, while life expectancy has increased to 76.5 years. The population is expected to reach 50 million by 2030, from 44.7 million in January 2021.
In September 2022, the government appointed a new minister of health, who identified several key areas of reform. In addition, the health authorities have committed to fostering health education, research and innovation through the launch of an Excellence School of Health Sciences and Medicine, attached to a planned state-of-the-art Hospital of the Future.
What we did
Following the governmental review, Movement Health set up a local expert panel in Algeria to discuss areas where efforts should be directed. This defined three areas of interest where service and system change could make the most impact:
1. Educating the workforce in digitisation
In Algeria, electronic health records (EHR) are being deployed in large and university hospitals, with an estimated 20% completion to date. But without proper education and training, this implementation might face difficulties—if not resistance—by the users.
Algeria has been affected by the departure of retired nurses, technicians and hygiene and sanitation personnel in recent years. This has resulted in the disorganisation of services and the integration of under-qualified personnel, who must now be trained to higher standards and ideally equipped with electronic reporting equipment.
As such, it will be necessary to train doctors and other medical staff for the digitisation of the health sector to ensure its implementation and to allow the optimisation of the patient's journey. Movement Health sees that there are many countries that have faced similar challenges, and scalable solutions already exist that can be adapted to Algeria’s situation.
2. Adapting care provision to societal changes
The Algerian constitution guarantees all citizens the right to access healthcare, and financial coverage for public medical services is provided by the government. But the quality of care is limited by factors such as short-staffing and lack of specialists.
Algeria trains 50,000 medical students and 10,000 post-graduate students each year, the highest number in Africa. However, numerous doctors are leaving the country, many to work in France. On the other hand, Algeria still experiences ‘medical deserts’; in 2020, the average bed occupancy level was as low as 44%. Although Algeria often buys state-of-the-art devices for its public hospitals, it is not used or does not work, either because of a lack of maintenance or training of technicians.
This situation pushed households towards the private sector, thus generating an increase in citizens’ out-of-pocket health expenditure. While the Health Law refers to public and private healthcare complementing each other, the two sectors operate in silos. Some question the utility of the private sector, because while it fills in the gaps of the public sector it only serves those who can afford it.
The Movement Health expert panel sees a number of ways that public and private partnerships can bring meaningful impact to care provision. Tested, scalable solutions exist to support service level changes that mean citizens can get the right care in the right place at the right time. This enhances both patient and professional satisfaction with the health service.
3. Streamlining healthcare financing
The Algerian health system is primarily financed by the state budget and the social-security system. However, as the population rises, social security is struggling to cover all costs and individuals are forced to pay increasing amounts out of pocket.
Health expenditure has increased from 3.5% of GDP to 6.2% of GDP in 2019. While the amount of social security and household spending has increased, Algeria has experienced the so-called ‘scissor effect’ since 2004. The share individuals spend out of pocket (35%) exceeds national health expenditure on social security (26%), and goes far beyond the 10% recommended out-of-pocket spend made by the WHO.
National Health Accounts (NHA) have also not been published in Algeria since 2001 (the only time they were published), even though the WHO recommends that states do so on a regular basis. The NHA provides crucial information on the source of funds allocated to the health sector, their allocation and the contribution of the various financing actors.
Movement Health sees that Algeria needs a mindset shift from budget completion and cost-orientation to efficiency and investment-orientation from hospital managers driven by accurate and meaningful data. In a positive step, the government announced in November 2022 that the 40-year-old social-security system will be comprehensively revised, although no further details are yet available.
What happens next
Movement Health’s expert panel intends to work with the government, entrepreneurs, health providers and patients to prepare the Algerian health system for the demands of the future. Having defined the areas of interest, an innovation challenge will be launched in Algeria in 2023 following our methodology framework, which has already been successful in Latin America and other regions in the world. Regular updates will be posted on our website and social-media channels.
In the meantime, if you feel you can play a meaningful role in Movement Health’s mission, please get in touch.
Dr Adam Selamnia (PhD / MBA) is the Movement Health 2030 country facilitator for Algeria.
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