In 73 UN member countries, the right to medical services is codified as a constitutional right and the situation is trending upward.
The reality on the ground, however, is much different. Whereas many governments may publicly support health care for all, resourcing for adequate health care remains a challenge. Only 18 countries, which include Canada, Australia and several European countries, offer true universal health care coverage. Others aspire to meet the medical needs of their citizenry, but often fall short in resourcing. Only 14% of countries worldwide guarantee public health.
While life expectancy and child mortality continue to steadily improve, more people are seeking treatment for issues related to mental health. The World Health Organization reports that one in four people in the world will be affected by mental or neurological disorders at some point in their lives. The Centers for Disease Control estimates that depression is the second most common cause of disability in the world (after heart disease) with secondary effects on family, friends and communities. Yet services for mental health are poor, and there are worldwide shortages of professionals like psychiatrists and nurses and mental health institutions. Connecting with care is an uphill battle – from both an institutional and individual perspective.
The challenges of access to treatment and stigmas were a prominent issue being tackled by 24 of the 2019 Ashoka Fellows. From mental to maternal health, Fellows are improving community cohesion, problem-solving, and awareness across the globe.
Destigmatizing mental health and addiction
Around the world, mental health issues affecting children are often overlooked and often stigmatized. Parents are embarrassed by children who are differently abled or who display mental health challenges and very few understand the roots of mental issues and lack the knowledge of what support would truly look like.Michael ElNemais Fawzy realized that customs, taboos and culture need to be taken into consideration while building a new healthcare model that targeted parents and teachers. HOPE is a dynamic resilience program to help children who need mental health support. Recognizing that parents would not trust strangers to treat their children, he works holistically with family, teachers and other key individuals in a child’s life. Parents, teachers and social service providers are trained to know the difference between challenging but typical developmental behaviors and those that can cause concern. When there is reason for intervention, the different parties work together to buffer and protect the child in all the settings where they have interactions. Each segment of individuals is equipped with tools like positive reinforcement, safety and inclusion, child psychology or positive parenting. Michael has influenced 3,000 people to set healthy living and learning environments for children in eight governates across Egypt. He’s also creating a Resource Bank of tools to enable people to replicate the model across the Arab World.
Drug and alcohol addiction is a public health crisis that affects over 21 million individuals in US. As a disease of isolation, what is most needed for individuals to improve is to rebuild positive connections devoid of stigma.Scott Strode builds healing communities of people in recovery and uses fitness tool to harness the transformative power of human connection. His series of Phoenix gyms provide activities like rock climbing and yoga which in turn create spaces for physical and emotional safety, inclusivity and accessibility. The only membership fee to join a Phoenix gym is 48 hours of sobriety and the gym is entirely staffed by people in recovery who were trained to address their own trauma and can serve as peer role models for others. This approach increases the numbers of caregivers and builds community to support those working to overcome addiction.
Networking providers for systemic change
In Zambia, only 47% births are attended by a skilled health worker at a health institution. In addition to limited governmental healthcare facilities and a doctor-patient ratio of 1 to 12,000, mothers who give birth at healthcare institutions are also required to bring birthing materials. This leads to many women deciding to give birth at home attended to by an experienced family member or a community birth attendant.Muzalema Mwanza’s Safe Motherhood Alliance is growing a network of trained Traditional Birthing Assistants who are supplied with affordable pre-packaged birth kits that contain essential sterile birthing material. With the National Ministry of Health, they train attendants in modern birthing practices and support the delivery of babies. The network has increased community knowledge on birthing practices, demystified unsafe practices and increased connections for expectant and new mothers with clinics. 1,000 babies have been delivered safely in 5 health centers and clinics by 30 traditional birth attendants since the birth kit was launched. Muzalema’s partnership with the Ministry has enabled her to begin expansion to all 3,500 clinics around the country.
Health and medicine are a mirror on society, and this is evident in Haiti where a fragmented healthcare system underutilizes the rich resources of nurses.Claudia Thomas Riché creates change by transforming nurses into change agents who lead innovative solutions to address Haiti’s public health challenges. The Education Collaborative for Haiti (NECH-CIEH) is a network of nurses who are expanding their knowledge and bridging health and community development within and beyond clinic walls. Nurses at NECH-CIEH train others in the field to become hygiene ambassadors and educators by promoting effective handwashing techniques, installing alcohol-based hand sanitizer dispensers, soap dispensers and other equipment in clinics. She advocates for nurses to have access to the same or similar trainings as doctors. Through NECH-CIEH, nurses not only provide hospitals and clinics with needed materials for necessary proper hand hygiene, they are at the forefront in changing behaviors toward greater hygiene for patients and guests.
Germana Soares contracted the Zika virus during her pregnancy with her first child who, subsequently, was born with microcephaly. Recognizing the challenge of raising a child affected by Zika, she set up União das Mães de Anjos – the Union of Mothers of Angels.
Innovation in eating disorder support
Without good information or effective communication strategies, young adults often struggle with another common, but complicated mental health challenge – eating disorders – and do not know how or when to ask for help.Simona Sinesi works to reframe eating disorders and destigmatize an issue that is prevalent in Italian society. Self-discovery is the most important tool for young adults and teenagers to dig deeper into their personal habits while dealing with food- related illnesses. The Never Give Up Experience is an emotional audio-visual food workshop that is held at public spaces like concerts and schools, to create acceptance around the issues of food-related disorders. The program breaks down the stigma of asking for help by providing free, on-site support from a psycho- therapist team, with an assurance to respond to emails within 24 hours. While still in early stages, Never Give Up is focusing on advocacy, early diagnosis and evidence-based treatment and post-treatment resources.
In the US, 1 in 10 individuals experience an eating disorder in their lifetimes. To eliminate the barriers to treatment, Kristina Saffran’s Project HEAL is challenging the mental healthcare system to think differently about access.
As part of a continuing commitment to systemic change in the field of health, Making More Health, Ashoka’s long-term partnership with Boehringer Ingelheim, continues to host the popular online professional development course on Social Intrapreneurship for Innovation in Health. Drawing from the insights of Ashoka Fellows working in health and focused on topics like the business case for social intrapreneurship, co-creation, challenges and opportunities, and strategies for advancing social intrapreneurship within institutions, the course has enabled health professionals from a diverse mix of public and private sector health professions, social entrepreneurs, students and business executives to connect. Nearly 500 participants participate annually with 70% pledging to start an intrapreneurial project or action after the course.
 “A Constitutional Right to Health Care: Many Countries Have It, but Not the U.S.” ScienceDaily, 2013.
 "A Constitutional Right to Health Care: Many Countries Have It, but Not the U.S.” ScienceDaily, 2013.
 National Institute on Drug Abuse. “Nationwide Trends.” Drugabuse.Gov, 2019.