By Elena Sterlin
In recent years, demand for dialysis services across emerging markets has grown significantly due to a sharp spike in chronic kidney disease, a condition that often stems from diabetes and hypertension. IFC is working to help meet the needs of dialysis patients and to prevent people from developing the disease by addressing the causes. We do this by directly investing in private providers and also by advising governments on how to structure public-private partnerships (PPP).
Take India, for example, where around a million people need regular dialysis treatment and almost 90 percent lack access to the service. IFC made a direct investment in NephroPlus, a private network of affordable kidney care centers operating in ten states. IFC’s investment in 2014 helped NephroPlus expand its network to meet the critical need for dialysis in the country.
In the public sector, as governments increasingly outsource provision of dialysis services to private operators, we are advising several of them on how to do this. We recently completed public-private partnership dialysis projects in Bangladesh and Kyrgyz Republic and have one in the pipeline with Uzbekistan.
In Kyrgyz Republic, where kidney disease is the nation’s leading cause of death and only 20 percent of patients had access to treatment, the PPP has resulted in the opening of four new clinics covering 75 percent of the population.
In Uzbekistan, the project will increase Uzbeks’ access to affordable, hygienic, high-quality dialysis services through a PPP with a private provider that will invest in new equipment and facilities, and operate dialysis centers in several regions.
IFC’s core goal in these investments and PPP projects is to advance cost-efficient solutions. In researching the segment, we noticed huge differences in the prices charged by providers. For example, a single dialysis session costs on average $450 in the United States, but just $19 in India. Adopting and implementing protocols that ensure quality is also extremely important in dialysis as there is a high risk of cross-contamination inherent.
As we continue this important and necessary work, we are constantly asking ourselves: What can be done to reduce the need for dialysis treatment? Can we better address the causes of this disease?
Dialysis is provided to patients with chronic kidney disease. Typical health problems that lead to this are diabetes and hypertension. About 70 percent of dialysis patients suffer from one or other of these conditions.
Let’s look at diabetes. The share of adults with diabetes increased from 4.7 percent in 1980 to 8.5 percent in 2014, according to a 2016 report of the World Health Organization (WHO). The International Diabetes Federation predicts that the number of diabetes sufferers will increase from 425 million in 2017 to 629 million by 2045. Four out of five adults with diabetes live in low or middle-income countries.
The places where diabetes prevalence is growing fastest are the Middle East, particularly in Bahrain, Oman, Qatar, and United Arab Emirates, and Asia, mainly in India, Pakistan, China and Vietnam. In Latin America, Mexico has declared diabetes a public health emergency. More than 70 percent of Mexicans are overweight, 14 million are diabetic, and 80,000 a year die from diabetes.
We know that the main contributory factors in Type 2 diabetes, the form that afflicts most sufferers, are lifestyle-related, in particular poor diet, lack of physical exercise, and smoking. To reverse the trend, we need to focus more on education and prevention. Doing so will help reduce incidences of the disease’s major complications, including kidney failure, blindness, and leg amputations, all of which can be very costly to treat.
The picture is similar — and just as stark — for hypertension, the other big contributor to chronic kidney disease as well as several other life-threatening conditions, notably heart disease and stroke. And like diabetes, hypertension is in large part lifestyle-related, with unhealthy diet, excessive alcohol, tobacco, too much salt, and work stress being among the biggest culprits.
Several of our partners have a strong focus on diabetes prevention and we are eager to support their efforts. One such example is Clinicas del Azúcar, which IFC recently funded. Founded in 2011, Clinicas is on a mission to disrupt existing models for treating diabetes by creating a one-stop-shop in which doctors, nurses, nutritionists, and psychologists create a coordinated care plan for patients. The goal is to prevent devastating diabetic complications. Patients pay an affordable membership subscription that covers lab tests, screenings, and lifestyle education and coaching. Clinicas has grown to become the largest private provider of specialized diabetes and hypertension care in Mexico.
In India, our client Apollo Health and Lifestyle, a subsidiary of the Apollo hospitals network, has developed a similar model that focuses on prevention of complications and lowering treatment costs. Apollo integrates clinical care with behavioral approaches. Like Clinicas del Azúcar, Apollo provides counseling on diet, nutrition, food habits, sleep patterns, and exercise. But it operates two tiers of care: simplified ‘sugar clinics’ for treating pre-diabetics or diabetics with minor complications, and advanced diabetes management via tertiary care centers at hospitals that address the major complications.
Both Clinicas del Azúcar and Apollo Health and Lifestyle are achieving good results, with improvements in the HbA1c levels, a blood test that measures blood sugar control and risk of diabetes complications, which is helping patients lead a normal life.
Over the next few years, we hope to replicate these models in other countries in emerging markets. Because it’s not enough to tackle the symptoms of lifestyle-related diseases, it’s imperative to address the causes too.
Elena Sterlin is the Head of Health and Education at IFC.
This article was originally published in the July 2019 issue of Healthcare Markets International, a publication of LaingBuisson Media.