AFRICA
HEALTHCARE FEDERATION
Growing the business of health in Africa
Growing the bu of health in Af
AFRICA
HEALTHCARE FEDERATION
usiness Africa
Written by Amee S Choksi Produced by Nishit N. Shah
Kenya plays a proud host to the Africa Health Business Symposium (AHBS), an inaugural healthcare focused event taking place from 6th – 7th October, 2016 at the Safari Park Hotel in Nairobi. At this event, the five regional federations of Africa will congregate to form a unified platform, Africa Healthcare Federation (AHF). The platform will promote Public-Private Partnerships (PPP’s) for health in Africa.
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n 2012, the East Africa Healthcare Federation (EAHF) was formed when five East African countries, namely, Uganda, Tanzania, Kenya, Rwanda and Burundi signed a communique witnessed by high ranking government officials and leaders from the health sector. Having made significant progress since the launch of EAHF, the West African region have been truly inspired and embarked on a similar journey of a unified health platform. In July 2016, 15 countries, constituting both Anglophone and Francophone countries – Benin, Burkina Faso, Cape Verde, Cote d’Ivoire, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo came together in Dakar, Senegal to launch the West African Private
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Healthcare Federation (WAPHF), to tackle common healthcare challenges that affect the West African region. This historic event was witnessed by by Dr. Awa Marie Coll Seck, Minister of Health Senegal, Hon. Madina Rahman, Minister of Health Sierra Leone, Mr. Zouma Salifou, Director at West African Health Organization, officials of USAID, World Bank/IFC and the captains of the health industry of West Africa amongst several other dignitaries. At this event, Chairman of Africa Health Business Symposium and Kenya Healthcare Federation, Dr. Amit N. Thakker, met with Hon. Awa Marie Coll Seck, Minister of Health, Senegal at Forum Sous Regional de Alliances du Secteur Prive de la Sante in Dakar to foster the relationship between WAPHF and EAHF, as well as to nurture
Pictured: EAHF Board - Dr. Peter Kamunyo (Kenya), Dr. Dawit Haillu (Ethiopia), Dr. Ian Clarke (Uganda), Dr. Jean Nyirinkwaya (Rwanda), Dr. Mayen Mayen (South Sudan), Dr. Gerard Ngendahimana (Rwanda), Dr. Kaushik Rammaiya (Tanzania), Dr. Amit N. Thakker (Kenya), Dr. Francis Oromo (South Sudan) and Dr. Nazir Arab (Tanzania)
the relationship between WAHO and Africa Healthcare Federation. Similar initiatives are currently ongoing to develop regional federations for the Northern, Central and Southern African regions. The Africa Health Business team together with McKinsey & Co. have identified five game changers that are critical in improving healthcare delivery across the continent. These include:
that is affordable and relieves the customer of financial strains. As opposed to out-of-pocket payments, it does not require immediate payment upon service delivery. This year the United Nations has formally listed Universal Health Coverage (UHC) in the new Sustainable Development Goals to be achieved through 2030 as below: ‘Achieve Universal Health Coverage, including financial risk protection, 1. Healthcare Financing towards access to quality essential health care Universal Health Coverage services, and access to safe, effective, Universal Health Coverage (UHC) quality and affordable essential provides for quality healthcare services medicines and vaccines for all’
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With 2015 as the target year for the MDGs, Africa lags behind in many of the targets due to a lack of Government spending on health with fewer than 10 countries in Africa budgeting at least 15 percent of their national budget for health. Dependency on foreign financial assistance needs to be reduced and the continent needs to lean towards sustainability by focusing on implementing a UHC that has the potential to transform health systems in Africa. World Bank President Jim Yong Kim stated, “The most equitable and sustainable way to achieve the health outcomes we all want is through Universal Health Coverage.’’ There is limited information on financial risk protection in many countries in the region and health insurance schemes are fragmented, leaving out the informal sector—which usually represents a huge percentage of the population. Further, health systems lack the capacity to respond effectively to threats of communicable diseases like Ebola virus disease, as
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the recent Liberian and Sierra Leonean experiences aptly demonstrated. The purpose of UHC is to meet population needs for quality health care, remove financial barriers to health care access, reduce incidence of catastrophic health expenditures, attain national and internationally agreed health goals, and ultimately contribute to poverty alleviation and development. There is evidence that broad health coverage, facilitated by extended risk pooling and prepayment, generally leads to better access to necessary care and improved population health, particularly for poor people. Alternative Financial Models such as Risk-Pooling Arrangements have the ability to contract with provider organizations for the provision of care and thus encourage the development of higher-quality, more organized private sector providers. These are regarded as a more equitable method for financing healthcare as compared to out of pocket payments which currently comprise 75 percent of payments in most African countries. Through such arrangements it is also possible
“The most equitable and sustainable way to achieve the health outcomes we all want is through Universal Health Coverage.” – World Bank President Jim Yong Kim
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to reach the bottom of the pyramid by subsidizing coverage for these groups while encouraging sustainable improvements in health care provision by allowing the private sector to care for those able to pay for their services. Since 2005, there has been an increase in the number of African countries pursuing the goal of providing universal health coverage, including Benin, Burkina Faso, Congo, Democratic Republic of Congo, Ghana, Gabon, Lesotho, Kenya, Nigeria, Rwanda, South Africa, Swaziland, Uganda and Zambia, however, they cover only a small proportion of the population. Achieving UHC and raising sufficient resources to strengthen the health systems is a complex process that involves collaborated decision making among relevant stakeholders, including governments, development partners, donors, etc. to support policies that promote ‘’equity, efficiency and effectiveness’’ within the health system. However, through a unified approach, they can help to significantly expand the number
of people covered by risk pooling arrangements, with substantial benefits to health care, thereby optimizing resource use and maximizing results. .. The underlying question persists, will Africa be able to keep pace with the increasing growth of health expenditures in correlation to the availability of funds for health?
2. Bridging the gap in Human Resources for Health Sub-Saharan Africa, with about 11 percent of the world’s population bears over 24% of the global disease burden, is home to only 3percent of the global health workforce, and spends less than 1 percent of the world’s financial resources on health. As a comparison, The Americas (mainly USA and Canada) are home to 14percent of the world’s population, bear only 10percent of the world’s disease burden, have 37percent of the global health workforce and spend about 50percent of the world’s financial resources for health. One of the common shortages in the African healthcare sector has consistently been an inadequate,
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skilled health work force, as was exposed during the recent Ebola outbreak. According to the above statistic by the WHO, the health personnel to population ratio has been astoundingly low through-out the years. The core of all health systems are a health work force that facilitate the implementation of health care services. Hence, this inadequacy has led to serious impediments in health care delivery and outcomes. One of the important things to consider about this inadequacy is that it is a fixable problem - the inadequacy is not an insufficient number of health workers but an inadequacy in the number of skilled workforce. Additionally, due to lack of better career opportunities at the home country, the trained manpower tends to migrate to developed countries. A systems-strengthening approach needs to be implemented that focuses on building resilient health systems, rather than addressing each problem as it arises, as was the case during the Ebola outbreak and HIV/AIDS response. In addition to the specialists,
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Institutions need to consider training more front line health workers that would help promote sustainable community health systems. This would ensure a more balanced and efficient workforce, but success in taskshifting is contingent upon having the correct mix of skills, supervision and support structures in place. (WHO) The global health workforce crisis can be tackled through effective public-private partnerships and interventions that would provide better career opportunities to ensure that talent is retained within the country. Only when enough health workers can be trained, sustained and retained in sub-Saharan African countries will there be meaningful socio-economic development and the faintest hope of attaining the Millennium Development Goals in the sub-continent. (WHO)
3. Fostering investments through Public Private Partnerships The private healthcare sector constitutes a very important component of Africa’s health care systems. It consists of for-profit
Dr. Amit N. Thakker, Chairman of Africa Health Business (left) engages with Dr. Awa Marie Coll Seck, Minister of Health, Senegal (right) and Dr. Ardo Boubou Bâ, President of Alliance Nationale du Secteur Privé de la Santé Senegal/ASPS (centre) at the launch of the West African Private Healthcare Federation (WAPHF)
commercial companies, non-profit organizations, social enterprises as well as an informal health sector of healers, midwives, and individual medicine sellers who are essential in providing care and in functionality cover all of the elements along the health value chain, including provision, financing, manufacturing, distribution and retail. ‘Of total health expenditure of $16.7 billion in 2005, roughly 60 percent—predominantly out-ofpocket payments by individuals—was financed by private parties, and about 50 percent was captured by
private providers’ (NHA Report) A huge gap in healthcare delivery is filled by the private sector, catering for a large proportion of medical needs for the rural populations that are unable to access government facilities, to providing a higher quality service, or services such as advanced medical equipment and procedures that may otherwise not be available. This not only reduces the strain on the public sector to serve the needs of the increasing population, but also leads to improved and efficient health outcomes across the region.
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L to R: Hon Minister of Health, Zimbabwe Dr Parirenyatwa , Hon Minister of Health South Africa Dr Aaron Motsoaledi and Dr Amit N. Thakker, Chair Africa Health Business at TICAD VI engage to promote Southern Africa collaboration for health
It is critical for the public sector to harness on the entrepreneurial talents of the private sector in order to improve access to health care. The importance of the role that the private sector plays is also being gradually accepted by governments and development finance institutions throughout the region. Investments in the private health sector can lead to long-term, sustainable increases in funding and health infrastructure, and in turn, collaborating with the public sector can help the private sector in capitalizing on funds and support
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from local banks. Institutionalized public private partnerships can prove to be a win-win situation for both the public and private sectors, and also create a ripple effect for wider and far-reaching economic outcomes. ‘When appropriately regulated, private sector enterprises can stimulate higher efficiency and quality standards by competing and complement each other as well as providing competition to, public sector providers.’ The private sector continues to play a pivotal role in improving the health systems in Africa and it is important
to strategize on how best to leverage mutual capacities between the private and public sector through investments and partnerships to achieve synergies within the healthcare sector.
4. Strengthening Accessibility and Efficiency in the Supply Chain Management
changing the shape of the competitive and operational environment in which supply chain managers make their strategic and tactical decisions.
5. Disruptive Innovations in Digital Technologies for Health
Disruptive innovations in healthcare have allowed a whole new population As reform continues to force healthcare of consumers at the base of the organizations to find new ways to cut pyramid access to a product or costs and increase effectiveness, service that was historically only many organizations forget about the accessible to consumers from the processes and supplies needed to middle and higher income classes. keep the business moving. Getting a Advances in healthcare have better grip on managing a healthcare enabled the successful treatment and organization’s supply and demand management of many diseases that will increase cost efficiency for the were often fatal just a generation ago. organization while also increasing Yet our healthcare still falls short of the quality of patient care. its potential and faces costs that are “The supply chain is the second unsustainable and unaffordable. largest and fastest growing expense The two dominant business models for healthcare providers; with only in health care—those of general labor costing most providers more”. hospitals and physician practices— Priorities are shifting as the healthcare are solution shops that emerged in supply chain becomes more complex, an era when nearly all medical care with a rapidly evolving channel and relied on the intuition of highly skilled distribution. Ongoing macroeconomic professionals. But over time, these and regulatory events are constantly institutions have subsumed under
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their organizational umbrellas many activities that are perhaps better suited to businesses based on value-adding processes or user-network models. Established and upcoming disruptive technological models in healthcare attempt to deliver value propositions that are distinct from those of traditional hospitals and physician practices where there is direct medical professionalpatient contact. Because these disruptive businesses focus on specific, rules-based portions of health care, they can deliver care at a lower cost and with higher quality due to the predictable variation of these processes. This type of health service delivery can be transferred from specialists to generalists, from generalists to nurses and other physician extenders, and ultimately to patients themselves. There is need to have diagnostic and therapeutic technologies that allow nurse practitioners to treat illnesses that often requires specialists to treat. Disruptive innovations both small and large could ensure that health care delivery is inexpensive, un-convoluted and more satisfying
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to consumers. The healthcare industry needs to desperately open doors to market forces and not shudder at the thought of it. The question remains: Are these technologies sufficient to narrow the gap for accessing healthcare in Africa? Ministries of Health, opinion leaders and captains of the healthcare industry will converge at this symposium to chart a road map for the much needed stronger health sector in Africa. As a testimony to the impact AHBS is envisioned to have in improving healthcare access in Africa, Mr. Roelof Assies, Head of Healthcare at Philips states, “Philips Healthcare is keen to be part of the movement towards a unified Africa Healthcare Federation. We see ourselves as true healthcare partners focused on improving peoples lives through timely innovations. As a world leader in healthcare, Philips integrates technologies and designs into people-centric solutions.” Similarly, several leading corporates within Africa have joined in this significant effort to re-instate their role in the progress of the continent.
Dr. Amit N. Thakker, Chairman of Africa Health Business officially invites Dr. Cleopa Mailu, Cabinet Secretary of Health, Kenya to be the chief guest at the Africa Health Business Symposium
Safaricom, a leading African mobile technology company, headquartered in Kenya has partnered with AHBS to showcase mobile technology solutions that will positively impact health outcomes on the continent. This October, Captains of the Health Industry will come together to in Nairobi to witness a historic moment in Africa that will unify all the stakeholders. This will be a significant factor that will influence the health outcomes of the continent. The aim of the Africa Healthcare Business Symposium is to provide this platform for intra-regional
discussion so as to further strengthen the roles played by both public and private health sectors with support from development partners to promote an effective PPP dialogue within countries. The AHBS 2016 will play a pivotal role in the beginning of a momentous change by unifying African countries under a single umbrella – the Africa Healthcare Federation towards overcoming challenges and achieving mutual far-reaching outcomes.
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AFRICA
HEALTHCARE FEDERATION
For more information, contact Nishit N. Shah T +254 733 799062 nshah@africahealthbusiness.com w w w.africahealthbusiness.com