Crowdfunding for Global Health: a novel solution or temporary fix? 

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Katia Cnop

Katia Cnop

Katia Cnop is a medical student at Burrell College of Osteopathic Medicine and a volunteer and researcher with Wuqu' Kawoq | Maya Health Alliance in Guatemala.

By Elizabeth Sherwin and Katia Cnop

Elizabeth Sherwin was the Watsi Fellow working with Maya Health Alliance in Guatemala for 2016-2017.

Katia Cnop is a medical student and Maya Health Alliance volunteer and researcher.

 

Juanita sits on her mother’s knee, bobbing up and down as her mother listens intently to a pair of community health workers. They traveled hours through the mountains and trekked up a dirt road to arrive at Juanita’s home, an adobe mud structure surrounded by a patchwork of coffee and cornfields. “See how the dot from today is below the red line?” one health worker says to Juanita’s mother while pointing to the printed sheet. “That means she is underweight and also not very tall. We have some ideas to help with this.” While the national language in Guatemala is Spanish, they speak in Kaqchikel, the primary Mayan language of the region. Juanita is receiving treatment for chronic malnutrition, or stunting, a condition with long lasting effects on neural development and potentially fatal complications. In rural Guatemala, the nearest health centers are miles away, and financial limitations and linguistic barriers often prevent indigenous inhabitants from accessing much-needed health care. Here, chronic malnutrition has become the new normal, and therefore even more challenging to detect and treat [21]. To identify patients and deliver subsequent care, medical providers must go door-to-door or set up temporary clinics. Juanita’s treatment was financed on the website Watsi, a crowdfunding site that allows donors to give as little as five dollars to fund patients around the world.

Juanita is from Guatemala, a Central American country of roughly 15 million people with a high maternal mortality rate, one of the highest rates of chronic childhood malnutrition in the world, and a rising burden of other chronic non-communicable diseases (NCDs) such as cancer, diabetes, and cardiovascular disease [5]. Here, NCD treatment and surgical interventions are often out of reach for the 45% of the population who identify as indigenous Maya, in part due to the low concentration of public services in rural, indigenous areas and language barriers in an exclusively Spanish-speaking public sector [1,5,7,11]. Eighty percent of physicians practice solely in the capital city, requiring many patients to travel long distances in search of care [3]. Excluded from a failing national public health system, Guatemala’s Maya population is increasingly seeking care from both private settings and the non-profit NGO sector, especially for treatment of NCDs [1].

This story is not isolated to Guatemala. Insufficient global health funding and access to care in low and middle income countries (LMICs) is projected to cause over $7 trillion in economic losses over the next 20 years due to death and disability linked to NCDs [2]. Juanita’s condition, chronic childhood malnutrition, has been shown to lead to reduced education attainment and decreased earning potential in adulthood [17]. Over 70% of the world’s population lacks access to necessary surgical care, representing 143 million additional surgeries needed every year to close this gap [6]. This deficiency disproportionately affects LMICs. The poorest third of the world’s population accounts for only 3.5-6% of total global surgical volume [6,18], and three-fourths of the total NCD deaths (28.5 million in 2014) globally occur in LMICs [19,20]. This is compounded by low donor interest in funding NCDs and the myth that surgery is expensive and therefore simply unattainable in poor resource settings [2,8]. Private and nonprofit sectors have attempted to fill the gap in surgical need and the growing NCD burden [1,6,9]. However, these sectors are limited by the ever-increasing competition for funding and support from a fixed donor pool [11].

To finance medical endeavors for people like Juanita, crowdfunding has emerged as a novel mechanism. Initially, most online crowdfunding supported creative enterprises and business start-ups through websites such as Kickstarter and Indiegogo. However, the science and global health communities have taken notice, and crowdfunding efforts have expanded to include small global health interventions (e.g., CaringCrowd; Catapult), scientific research, and clinical trials in global health [10,12,16]. Founded in 2012, Watsi was the first global health crowdfunding platform that allowed donors to give to individual patients. To date, 23,246 donors have funded 14,483 patients from NGOs in 24 countries through Watsi’s site, thus taking on some of the fundraising burden non-profit organizations typically experience in LMICs. Based in San Francisco, Watsi was the first non-profit to go through Y Combinator, a startup accelerator in the Silicon Valley. They market to tech-oriented millennials who want to make a difference in the world, and have acquired big name investors such as China’s tech giant Tencent. Donors and companies are particularly attracted to Watsi’s transparency; not only do they guarantee that 100% of donations go directly to patients, they also share a Transparency Document on their website that discloses financial reports. Donors can browse through patient photos and stories and decide from the comfort of their own homes if they want to help a young boy in Kenya receive a hernia repair or an older woman in Cambodia get cataract surgery. Watsi plays to donor preferences by allowing them to give to an “identifiable victim,” a strategy research has shown increases emotional response among donors when compared to giving to an unidentified group [4,13]. By donating directly to a patient with a name, face, and story, and through receiving updates after the patient has undergone treatment, donors trust where their money is going and share in the patient’s success. Treatment for Juanita’s chronic malnutrition was funded by Watsi donors who felt they could make a direct impact on her life and wellbeing.

A Maya Health Alliance community health worker shows a Guatemalan mother her child’s growth curve.

Juanita sits on her mother’s lap while her family receives medications, food supplementation, and interactive education to support her recuperation from chronic malnutrition. She receives successful treatment due to the ability of Maya Health Alliance, the Guatemala-based NGO responsible for her care, to crowdfund the cost ($492) through Watsi. In fact, Maya Health Alliance cited Watsi donations as 35% of their annual budget in 2016, 75% of which covered NCD and chronic malnutrition treatment over roughly three years. As Maya Health Alliance volunteers, we have seen firsthand how crowdfunding has allowed the organization to expand programs, hire new staff members, and support hundreds of children like Juanita. Crowdfunding has provided the funding necessary to overcome financial and geographic barriers to critical medical interventions, such as surgery and chemotherapy, that are available through the public system but out of reach for many patients. In this way, crowdfunding does not duplicate a fragmented health care system but strengthens it through provision of transportation, interpretation, and long-term follow-up care. Crowdfunding has also assisted Watsi’s other medical partners in covering the cost of complex patients, particularly with surgical care. Our analysis of Watsi’s database of all patients funded across 24 countries over three years revealed 80% of cases to be surgery. But as popularity in crowdfunding has surged over the last few years, the question of sustainability and donor retention is also growing.

As Jeremy Snyder notes, the growth of medical crowdfunding in both the developed and developing world indicates that health systems are failing to meet of the needs of their populations [14]. While crowdfunding fills a particular deficit in global healthcare funding, its expansive growth also breeds dependence on the mechanism itself. If the fad fades, and donor retention falls, who will step up to finance the ever-increasing prevalence of NCDs and need for surgical intervention? Rather than emphasizing the systemic injustices that lead to disparities in health care, crowdfunding sites focus on individual stories and tend to frame patients as victims of tragedy, ignoring the fact that lack of access to care is the core problem that should be addressed [15]. Crowdfunding for global health certainly provides patients and NGOs with immediate and much needed funds, but this direct financial infusion to patient care can also delay construction of urgently needed infrastructure at a systems level, such as interpretation services, reliable medication supply chains, and staff training. And, as quickly as crowdfunding has grown, a plateau and decline is possible, and it may span out to be a temporary, ephemeral fix when what is really needed is sustainable healthcare reform.

We have seen how crowdfunding allowed Maya Health Alliance to serve more patients and develop sustainable health programs in Guatemala, setting the foundation for stronger health infrastructure. And we love that crowdfunding is an inclusive approach that invites everyday people with a few dollars to spare to connect with and help others around the world. However, Watsi has shifted their model away from crowdfunding and is now exclusively financing surgical care and technology development. It remains to be seen what this change means for their NGO partners and the patients they serve. While we do not know what the future of crowdfunding holds, we are hopeful that it can shift focus away from individual patient and towards more sustainable global health interventions.

As sites like Watsi shift their focus the question becomes, is there a way to make crowdfunding more sustainable? It certainly will not last if start-ups like Watsi lose popularity, funding, or interest in the mechanism. Without crowdfunding NGOs will have to fund patients through traditional and more complicated routes such as grants and private donations, and must cover a larger patient population and profile or risk turning away those in need. To be sustainable, crowdfunding donations must be funneled towards solution-based interventions in recipient countries, such as collaborations with partners that build health infrastructure rather than just place a Band-Aid on the problem. Through seeking out projects and programs that build stronger health systems, crowdfunding will have a more lasting impact.

In a world facing complex challenges related to disease, climate change, and population growth, the need for more creative and interdisciplinary funding sources is greater than ever. Public-private partnerships as well as non-profit and for-profit collaborations are becoming increasingly popular for connecting funding and resources with those who need them most. One such example is MSR, an outdoor gear retailer that teamed up with PATH, a Seattle-based NGO, to develop a portable water-disinfecting device that is now being used in the developing world to prevent diarrheal diseases. Additionally, the growing field of social entrepreneurship is proving that having a positive impact and being financially sustainable are not mutually exclusive. While we do not suggest that there is one mechanism that will solve all the world’s problems, we believe that crowdfunding can be one of many avenues to lead us toward a healthier planet, especially if governments, companies, and NGOs can work together to leverage their ideas, workforce, and resources to build lasting change.

 

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