Feature: EPiHC provides ethical base line for improving access to healthcare

Diaverum, a global renal care service provider focused on haemodialysis, became a signatory to EPiHC in July. It is one of the latest companies to join a cohort of firms aiming to improve access to high-quality, affordable healthcare by committing to an ethical operating benchmark for the sector. HMi spoke to Diaverum and EPiHC founder IFC to review progress

Ethical Principles in Health Care (EPiHC) is in the business of building stronger healthcare providers and stronger healthcare systems. Signatories to EPiHC voluntarily adopt its core values in the belief that by embedding ethical principles into their operations, they develop more-sustainable businesses that strengthen trust among all stakeholders. Members join a community of likewise ethically motivated organisations in a forum for sharing best practice.

The ten agreed principles, developed in consultation with a broad array of healthcare professionals, policy experts and investors are:

1. Respecting Laws and Regulations
2. Making a Positive Contribution to Society
3. Promoting High Quality Standards
4. Conducting Business Matters Responsibly
5. Respecting the Environment
6. Upholding Patients’ Rights
7. Safeguarding Information and Using Data Responsibly
8. Preventing Discrimination, Harassment and Bullying
9. Protecting and Empowering Staff
10. Supporting Ethical Practices and Preventing Harm

‘When you see something like EPiHC, where the idea is so simple and so right, you ask yourself, “why hasn’t this always been here?”’ said Kirsty Bashforth, chief people and communications officer, at Diaverum.

‘Seeing a group of companies come together to create a global platform, one that provides a collective voice for the industry across all different angles of healthcare, it makes sense, and it made sense for Diaverum to become a signatory. It fits in with what we’re about as a company – enabling fulfilling lives.’

First steps

Unveiled in March 2019 by the World Bank and International Finance Corporation (IFC), the Bank’s finance institution focused on the private sector of developing countries, the EPiHC principles are intended to help providers build transparent and resilient operating systems that meet the highest ethical standards.

The origin of the concept stems from internal discussions held over more than ten years within the IFC itself.

‘We’re an active investor in private healthcare in emerging markets,’ said Chris McCahan, IFC sector lead for health and education services. ‘So, when we look at our own investment programme then it is fundamental to us that we invest in like-minded, ethically-minded health care providers.’

It is not just enough for IFC to fulfil its obligation to improve and increase global access to health care.

‘It’s got to be quality healthcare, provided by hospitals and clinics that are run in a way that provides the best outcomes for people,’ said McCahan.

The idea may have started out as an internal due diligence process for determining appropriate investees, but it also seemed a relevant tool for operating in the broader healthcare sector, one that is undergoing a period of rapid expansion and one negotiating the impact of Covid-19.

Global commitment

In an attempt to reach universal health coverage by 2030 while, at the same time, mitigating the effects of the pandemic on their populations, cash-straitened governments are seeking ways to leverage the private sector into providing solutions. Closer interaction between the public and private sector, however, brings with it an element of suspicion, resulting in a ‘trust gap’.

Governments may be wary of private healthcare providers overcharging and over-servicing patients, while the private sector is circumspect as to a government’s willingness to fulfil its obligations. The gap is not only confined to interactions between public and private operators but is an issue across all areas of healthcare.

Unfortunately, not everybody entering the market for healthcare does so with full integrity. Nevertheless, providers that operate ethically tend to succeed in the long run and tend to avoid the risks associated with public scandal.

Agreeing a base line for ethical and responsible conduct engenders trust and is a necessary requirement in achieving health goals.

‘We felt we needed something to help bridge this distrust,’ said McCahan. ‘It was really important to promote the evolution of healthcare systems, and that’s why we thought EPiHC was relevant not just to our investees but to the whole ecosystem.’

That was the impetus for turning an in-house best-practice procedure into a collective action initiative. It became the driving force behind inviting healthcare organisations in the private sector and investors to adopt EPiHC. Diaverum is one such signatory.

‘We are a healthcare company but we are all about serving patients and for us to continue to do well and do good, we need to be trusted,’ said Bashforth. ‘People need to have confidence in us and the EPiHC framework provides a point of reference. Becoming a signatory is a transparent signal that a company operates to a minimum set of standards. It can only be good for everyone.’

Growing importance

As of August 2021, some 167 signatories, which together own or manage over 4,000 healthcare facilities in more than 70 countries, had signed up to the principles. EPiHC has moved on from its IFC funded roots to become intentionally independent, with its own secretariat.

Although still in the early stages of development, as the number of members grows, so does its value as a global community.

‘At the moment it is all about building a collective. We’re all at the stage of learning together and learning how to implement the principles,’ said Bashforth.

The next step for EPiHC is to reach a critical mass of members, according to McCahan, and reaching that target is not far away.

‘We’ve been very focused on getting to 200 signatories. That is a number where we think we can really start having conversations within the group,’ said McCahan.

At the current rate of uptake, McCahan reckons on a September/October timeframe for a kick-off meeting (albeit a virtual one) to start introducing signatories to each other, to embark on the cross fertilisation of ideas, and to discuss in which way the focus of EPiHC should develop.

‘We’re also planning to form an advisory board,’ said McCahan. ‘It will be mostly drawn from signatories but is also likely to include leading experts in the field of ethics. Forming the board will help inform the initiative as to what to do next.’

For the here and now, however, the importance of a set of ethical standards has been made stark during the ongoing pandemic.

‘If nothing else, Covid-19 has shown us that no matter where you are, no matter how sophisticated you think your healthcare system is, you can’t take health for granted,’ said Bashforth. ‘People are going to need and expect access to healthcare. And we need some sort of benchmarking to ensure it is delivered with integrity.

‘The EPiHC principles provide a very transparent benchmark by which all areas of the healthcare sector can work together with a consistent voice and with integrity for all stakeholders. I think it is very powerful.’