doctors

Five years. 40,000 health workers. 11 million people.

What happened when GSK committed to reinvest 20% of its profits from the least developed countries back into those nations’ healthcare systems?

In this story

With five children and a very demanding job, Marion never thought she would be able to go back to school. “How would I fit it all in? How would I afford it?” she recalled. But the 37 year-old is now a fully-fledged midwife in Uganda, where she manages deliveries and pregnancy-related complications.

Marion is a graduate of an e-learning training programme, run by the charity Amref Health Africa and supported by GSK, which has trained 800 midwives across Tanzania and Uganda. Online learning enables midwives and other health workers to enhance their skills without leaving their home and families. “It gave me an opportunity to go back to school,” said Marion. “I have had to get used to people now referring patients to me. They know I am well trained and full of knowledge.”

GSK AMREF healthcare training
GSK/AMREF healthcare training

Midwives, along with nurses, community health workers and volunteers are the backbone of healthy, thriving communities. From educating families to protect themselves against illnesses like malaria and diarrhoea to helping women give birth safely, they provide a vital service for communities who might otherwise have to walk miles to the nearest clinic or hospital. But there are not enough of them. The World Health Organization estimates there is a global dearth of 7 million health workers, leaving communities without access to healthcare and health systems vulnerable to everyday challenges as well as unexpected crises.

Reinvesting profits in the very poorest countries

Six years ago, Andrew Witty – chief executive of GSK – set a challenge. How could GSK move from being simply a supplier of medicines and vaccines to helping those products reach the people who need them? “It is clear that we need to stop saying ‘it’s not our fault there is no infrastructure to deliver healthcare’ and start saying ‘who can we work with to ensure that the infrastructure does exist?,’” he said at the time, in a speech at Harvard Medical School.

The solution was to address this head-on by reinvesting 20% of the profits GSK generated in the very poorest nations – the Least Developed Countries – back into strengthening healthcare systems in those countries. It was an unprecedented step, but is paying off.

  • 40,000

    Health workers trained from reinvesting 20% profits

Recycling one-fifth of profits in the least developed countries has supported the training of 40,000 health workers and reached 11 million people across 35 countries with improved access to healthcare. There are indications that health outcomes in the programme areas are beginning to improve – with vaccination rates rising and maternal and newborn deaths declining. For example, in the programme area in Nepal, maternal and neonatal deaths are falling – 2 and 43 cases in 2014 compared to 18 and 358 deaths in 2013 respectively.

Claire Hitchcock, director for community partnerships at GSK, explained how the reinvestment programme evolved to encompass frontline health workers. “In the first year, we pooled the funds from 20% reinvestment and focused on three to four countries. For example, in Sudan we supported motorbikes to enable vaccine delivery,” she said. While this was effective, there was an impetus to connect programmes more directly to the business in each country. Instead of combining the funds, each nation would receive 20% of the profits generated there – creating a direct link between how business performed in country and how much could be ploughed back into healthcare systems.

Not only did the mechanics of reinvestment shift, but so did the focus – from discrete projects to frontline health workers.

Swelling the ranks of frontline health workers

The question we asked ourselves was: how would you get the best return on your investment? - By building capability in human resources for health.

From our experiences of supporting nurse and midwife training in Indonesia and Thailand, we knew that a better trained workforce could lead to better access to healthcare.”

A turning point was bringing on board three NGO partners who would run the health worker training programmes on the ground: Amref Health Africa in east Africa; Save the Children in west and central Africa; and CARE International in Asia. All three had extensive experience in supporting frontline health workers.

“We already had a long history with Amref and Save the Children, and working with CARE gave us a footprint in Asia,” Claire added. “Working with external organisations allowed us to generate economies of scale and build on efforts that were already being made to strengthen healthcare infrastructures.”

community health volunteer liberia martin Webb
GSK and Save the Children support health worker training in countries including Liberia. (Image: Martin Webb/Save the Children)

Collaborating closely with governments so their training programmes are aligned with ministry plans for strengthening health systems, the three NGOs have supported training of thousands of health workers – from skilled birth attendants who can manage deliveries to community health workers who advise families on how to protect their children from diarrhoea, pneumonia and malaria, which are among the biggest killers of children under five in developing countries.

“Significant funding from GSK has allowed CARE to implement initiatives that are already showing impact on improving the maternal and neonatal health outcomes in the poorest and most remote communities of Asia, by building and improving capacity of frontline health workers,” said Tom Sessions, head of corporate partnerships, CARE International UK. 

A catalyst for change

Originally the hope had been that other businesses would follow suit and make similar commitments to reinvesting profits in health workers. While GSK is not aware of that happening yet, the programmes are nonetheless acting as a catalyst for investment from other quarters. “Community health education activities and advocacy – encouraging governments to invest in health worker training and salaries – ensures that the programmes and their impact will last long beyond the lifetime of our programmes,” explained Daryl Burnaby, director for frontline health worker training programmes at GSK. Following advocacy efforts from Save the Children, nine municipalities in Mali have agreed to pay 50% of the salaries of the 72 Community Health Agents in their district in 2015.

Over the next five years, the partners aim to deepen their training schemes. GSK and CARE International have supported the training of more than 2,000 volunteers and skilled birth attendants in Bangladesh. In September 2015, they expanded their programme with the aim of covering the entire Sunamganj region – a wetland area that is home to 2.8 million people and virtually underwater for almost half the year, cutting communities off from vital healthcare services. Together, GSK and CARE International will support training of 300 skilled birth attendants, 3,600 community health workers and 5,000 community volunteers.

GSK and CARE International support skilled birth attendants in Bangladesh (Image: CARE International)

Health worker training is also diversifying into other areas such as non-communicable diseases – like asthma and diabetes – which pose an increasing threat as developing countries’ economies improve and people’s lifestyles change.

At the same time, business is improving in these countries. Along with committing to reinvesting one-fifth of profits, GSK also capped the price of patented products in the poorest countries at no more than 25% of those in developed countries. This is helping to increase volumes and access. Funds available for reinvestment have more than doubled over the last five years as profits increase. Since 2010, £21m has been reinvested.

Mobilising communities in this way means they ultimately become more demanding of healthcare. And if people can enjoy healthier lives and livelihoods, this creates an environment in which communities and business can thrive.

“We hope that by demonstrating the benefits of investing in health workers this will act as a catalyst for others to invest in and champion health workers.”

Case study: protecting children from malnutrition

Mahmaoudou is four months old and lives in a particularly poor and remote area of Burkina Faso. Both she and her mother were found to be suffering from severe malnutrition following screening by a trained community health worker. Ultimately, Mahmaoudou ended up in hospital for more intensive treatment and recuperation. There, she was found to be thin and weak. But with support from Save the Children, she was provided with care and nutritious food. Her mother was also given support and advice on cooking and breastfeeding. “My baby is still alive and healthy,” she said. “At the recuperation centre I ate properly and now I can breastfeed my baby again.” Save the Children is working to build the capacity of community health workers to identify and refer more children like Mahmaoudou.