This blog FROM NCD Malaysia is part of OUR MEMBER-AUTHORED SERIES ON NCD INVESTMENT.

For decades, health systems in many countries, including my own country of Malaysia, have been built around the premise of acute illness. Individuals would have an episode of illness, be treated for it, and end up either succumbing to the illness or getting better. Arguably, even maternal care is clustered around a single, lengthy episode of ‘illness’ which resolves with childbirth. Why was this premise important? It allowed planners to accurately forecast the financial costs of these acute illnesses.

But this entire premise has been thrown out with the bathwater by noncommunicable diseases. A lifelong ‘bout’ of illness, with additional complications arising the longer individual lives with the disease; costs continuing to skyrocket amidst inflation and economic challenges; and, of course, the innovations which assist in enabling better management of the disease. These impossible-to-compute costs have never fit into a predictable economic model, and underpin the catastrophic inability of health systems to finance NCDs in a comprehensive and sustainable manner.

This challenge is compounded many times over in low-and-middle-income countries (LMICs), which have small tax bases for financing national healthcare needs, a distinct lack of national health insurance for funding NCD treatment, and few protection mechanisms to help alleviate the socio-economic costs of chronic disease management.

So, what can be done? Improving NCD financing may need to come in part through mechanisms beyond the health landscape - and this is especially true in LMICs. For instance:

1. Strengthening existing social protection mechanisms to also finance NCD care. In many LMICs, like Malaysia, existing social protection mechanisms such as social security organisations only offer social protection for work-related physical injuries. Within the larger context of work-related NCDs and NCDs among the working population, a strong case could be made to broaden the scope of protection to fund chronic disease care.
2. Inclusion of NCD micro-insurance schemes amongst other saving schemes and programmes; i.e. national, regional and organisational Employee Provident Funds, Central Provident Funds or pension chit funds. Special NCD micro-insurance schemes will have smaller premiums and larger savings components, payable as a lump sum upon a certified diagnosis of a catastrophic health issue, such as an NCD. This will enable the subscriber to fund the startup costs of undergoing initial NCD care - which is usually the largest part.
3. Inclusion of NCD micro-insurance schemes within larger financing schemes such as loans for small and medium enterprise (SME) startups. Clients seeking these loans can be mandated to also subscribe to NCD micro-insurance schemes embedded within these loans, which have small premiums which can be serviced alongside the loan payments. The financial protection stays in place as a stand-alone benefit long after the loan has been repaid.
4. Retooling religious or spiritual institutions’ welfare schemes to assist in financing care. Religious or spiritual institutions in many LMICs have been strong pillars in the financing and provision of welfare programmes. In some countries, they even provide specific health services. Utilising the social capital and financial strength of these institutions to assist in the funding of long-term chronic care may go a long way to providing sustainable across-the-board care for NCDs.

Though nowhere near being exhaustive, these options represent a conscious perspective of looking beyond the healthcare landscape to fund NCDs in LMICs. Admittedly, getting the required buy-in for such initiatives may not be easily done in the short-term, and may require a mid-term to long-term approach. But in the end, such out-of-the-box funding strategies may be essential in order to enable health systems to close the care gap for NCDs.

One thing is for sure. The first step of engagement and exploration into fleshing out these new ideas will require intensive efforts from civil society organisations (CSOs) within the NCD landscape. Advocacy and awareness across the stakeholder landscape may help transform these organisations to enable their coverage to be extended to also finance some or many aspects of NCD care amongst their subscribers. This will only be possible through the active strategies of CSOs to create the ‘buy-in’ required from these ‘new’ partners as we try new ways to tackle the age-old problem: Where do we find the money?