By Hoda Abou-Jamra, Founding Partner

One of the world’s biggest killers are chronic diseases. Chronic illnesses or noncommunicable diseases (NCDs) account for over 60% of global deaths – and people with underlying health NCD conditions, have a higher risk of severe COVID-19 disease. The top four are cardiovascular diseases (CVD), cancers, respiratory diseases, and diabetes. Together, they account for over 80% of NCDs-related premature deaths[i]. At TVM Capital Healthcare, we are focused on addressing market gaps in healthcare for the Middle East and North Africa (MENA), and Southeast Asia regions. Chronic illness or noncommunicable diseases accounted for a staggering 74% of all deaths in these regions in 2018. This number has been steadily growing. There is a high prevalence of chronic disease risk factors:

For MENA:

  • 25% of the MENA population suffer from high blood pressure
  •   High obesity levels in adults aged 20 years or older
  •  CVDs, cancer, and diabetes represent one-third of the disease burden[ii]

For Southeast Asia:

  • One in three adults in Southeast Asia have been diagnosed with high blood pressure and 1.5 million deaths in the regions are associated with this risk factor[iii].
  •  One in five adults are currently overweight. Lowest prevalence of obesity and overweight versus other regions but there is a sharp rise over the past 10-15 years[iv].
  • Risk factors for chronic diseases rising rapidly and affecting younger populations than higher-income countries. These include, high blood pressure, high blood sugar, overweight and obesity, high cholesterol, low fruit and vegetable intake, and physical inactivity[v].

The rise in chronic diseases is due to unhealthy lifestyle choices – many of which can be addressed through better awareness and preventive health measures[vi].

One of the main pillars of our investment approach is to address unmet healthcare needs and provide access to affordable quality healthcare services and products.

We partner with leading corporations as technology providers and renowned medical institutions as clinical allies to deliver superior care. Our portfolio companies create new, innovative, and integrated solutions designed to reach every individual – even in remote areas.

Together, we develop integrated, patient-centric care throughout our target regions.

Why patient-centric care for chronic disease management?

1.     Chronic illnesses are complex, systemic conditions that are often connected to each other. They require holistic, patient-centric care.

Take cancer as an example. In the developed world, tumor board meetings where multi-disciplinary experts meet to evaluate every patient’s case are now standard of care. However, in developing regions, while top-tier cancer centers may follow this approach, there is an urgent need to implement this throughout a region.

Additionally, treating diabetes and heart disease also needs an integrated approach. People with diabetes are more likely to develop heart disease and have a higher risk of heart attack and stroke. Making things worse, diabetes masks the symptoms of heart attacks and can lead to fatal ‘silent’ heart attacks. People with diabetes are also at a higher risk of developing eye problems like diabetic retinopathy, gum inflammation, and even depression. Visiting a diabetologist is not enough. An integrated approach must involve advice from a diabetologist, cardiologist, eye care specialist, oral hygienist, dietician, and more to slow down disease progression.

2.     Success depends on long-term patient compliance with prescribed medication, therapy protocols, and recommended lifestyle changes.

Only 50% of patients with chronic conditions take their medications as prescribed. While this number applies to the developed world, it is lower in developing nations. Medication non-adherence is a significant factor that accelerates disease progression and increases healthcare costs to the patient and the system. This may also lead to the onset of more chronic illnesses.

The main reasons for non-adherence to medication protocols are:

  • Affordability of medication.
  • Too many medicines with complicated instructions for use.
  •  A tendency to stop taking medication when symptoms subside.
  •  Depression – people with depression are less likely to take their medications. Unfortunately, depression is related to many chronic illnesses.
  • Lowered motivation without regular communication from their health team.
  • No time to get regular blood tests and check-ups.

Adherence needs a multi-disciplinary approach.[vii]

3.     Early detection saves lives, but many chronic conditions do not have symptoms until the disease has progressed. Preventive measures and awareness are necessary

Hypertension is known as the ‘silent’ killer because it has no symptoms until it is too late. However, it is linked to many chronic illnesses, including CVDs, diabetes, and more. Similarly, insulin resistance during pre-diabetes and earlier stages of diabetes does not have symptoms. Only voluntary preventive screening and early detection can help. Many cancers may also remain undetected early without preventive screening and awareness-building.

Digital technology platforms can help

  • New healthcare delivery models are needed. Improved diagnostics and preventive services can go a long way in preventing the onset of chronic diseases.
  • Digital wearables and apps can help patients control and track their health parameters. Additionally, regularly reporting symptoms and progress to healthcare professionals can help motivate patients to stay on track.
  • Regular reminders and notifications can help patients stick to their medication schedules.
  • Streamlined and hassle-free digital platforms that help patients get their medication refills on time can help keep them on track.
  • Many who want to take care of their health are often unable to take time off work or leave home due to caregiving priorities to get blood tests or check-ups. Advancing the home healthcare sector in MENA and Southeast Asia can help improve patient compliance and empower early detection.
  • Artificial Intelligence-powered (AI) predictive analytics that integrates end-to-end healthcare delivery can offer great insight and help identify and de-risk individuals most likely to develop chronic disease.

TVM Capital Healthcare is an emerging markets-focused healthcare private equity investment firm. We invest growth capital in specialized healthcare services, digital health solutions, pharmaceuticals, medical devices, and diagnostics. Our investment approach combines strong commercial value creation and returns with responsible investing.

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Sources:

[i] Noncommunicable diseases. (n.d.). Retrieved December 13, 2021, from Who.int website: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases

[ii] Aggarwal, A., Patel, P., Lewison, G., Ekzayez, A., Coutts, A., Fouad, F. M., … Sullivan, R. (2020). The Profile of Non-Communicable Disease (NCD) research in the Middle East and North Africa (MENA) region: Analyzing the NCD burden, research outputs and international research collaboration. PloS One, 15(4), e0232077. doi:10.1371/journal.pone.0232077

[iii] World Health Organization, “Noncommunicable diseases country profiles,” 2018, https://www.who.int/teams/noncommunicable-diseases/surveillance/data/profiles-ncd

[iv] Obesity and overweight. (n.d.). Retrieved January 3, 2022, from Who.int website: https://www.who.int/southeastasia/health-topics/obesity

[v] Dhillon, P. K., Jeemon, P., Arora, N. K., Mathur, P., Maskey, M., Sukirna, R. D., & Prabhakaran, D. (2012). Status of epidemiology in the WHO South-East Asia region: burden of disease, determinants of health and epidemiological research, workforce and training capacity. International Journal of Epidemiology, 41(3), 847–860. doi:10.1093/ije/dys046

[vi] Antonio Dans, Nawi Ng, Cherian Varghese, E-Shyong Tai, Rebecca Firestone, Ruth Bonita. (2011). The Rise of Chronic Non-Communicable Diseases in Southeast Asia: Time for Action. The Lancet, 377(9766), 680–689.

[vii] World Health Organization (WHO). (2003). Adherence to Long-Term Therapies: Evidence for Action. Retrieved from https://www.who.int/chp/knowledge/publications/adherence_full_report.pdf