What Johns Hopkins Medicine International (JHI) does differs in some ways from the more conventional approach to improving health around the world. The more familiar approach, typically driven by NGOs, charitable institutions, and public health agencies and schools, often involves funding efforts that reach poor people in their daily lives with health-promoting supports, be it vaccines, antibiotics, clean-water initiatives, education, and much more. Needless to say, such efforts are hugely worthwhile, and have done vast amounts of good throughout many regions.
JHI, on the other hand, is largely focused on collaborating internationally to build and improve sustainable health care systems, with an eye to providing more people with better access to higher-quality, safer hospitals and improved clinic care globally. The “sustainable” part is a key component of our mission. Essentially, we see health care efforts as sustainable when they are built around public or private models that ensure there will be sufficient ongoing revenues to keep the efforts going, and even expanding and improving them, far into the future.
Everyone deserves good access to high-quality, safe care, and wherever in the world there’s a lack of it, or room for improvement (and I’d argue there's always room for improvement), we’d like to be involved in collaborations. The challenge we face is that undertaking these sorts of revenue-dependent projects in sustainable ways is difficult in less affluent regions of the world. We’re very proud of the work we’ve done, and continue to do, in regions where patient care is funded for most of the population by insurance and government agencies, or where patients can afford to pay out-of-pocket. But it has been a longstanding passion of ours—and of mine—to try to find ways to extend our work to regions where a large percentage of the population are poor, uninsured, and not covered by government health care.
That’s why I’m very pleased that we’ve just formalized our first collaboration in Africa. The effort is centered in Lagos, Nigeria, and is aimed at expanding and improving care at a string of clinics operated by Me Cure, clinics that currently offer diagnostic services and that will be adding outpatient ophthalmic care. We hope to extend the effort beyond ophthalmology in the coming months and years into other areas of specialty care, as well as to expanding it geographically.
Juan Carlos Negrette, one of our regional managing directors, has been working tirelessly in Africa for a couple of years now, building his understanding of the region’s needs and resources, getting to know potential collaborators, and shaping business models that would create productive collaboration opportunities. We understood the challenges of building sustainable health care there, and knew it would take a while. But we were confident we would find ways to make it work, and now it appears we have a solid beginning.
It’s important to understand that we’re not claiming we have a magic formula for providing top-notch health care in a sustainable way in low-resource environments. (No one does.) In countries that lack universal health care, models for sustainable care have to be based on bringing in patients who can afford to pay, either out of pocket or through insurance. That means these programs have to take hold and grow mostly on the strength of an emerging middle class. Nigeria does indeed have a growing middle class, and that segment of the population will largely fuel the growth of this work.
As we see here in the U.S. and in many other countries, the investment that a strong middle class is able to make in their own health care can make it possible to provide affordable care to the poor. That’s the model we’re operating on, and we believe over time we can work with our collaborators to build sustainable health care infrastructure that can serve whole populations in developing countries. (Our Bharat Family Clinic project in India is another example of an effort that will be driven by middle-class patients, but that is expected to also improve health care access to many poor people.)
This progress is energizing. Certainly, it’s just a beginning, and there’s much to be worked out before we can claim success. But I’m convinced that it will come. Needless to say, I’ll keep you posted.