HealthCare Africa - May/June 2022 by FW Africa

IN THIS ISSUE: CAROLINE WANGAMATI | ZAMBIA | RE-EMERGENCE OF POLIO | EVENTS REVIEW

HealthCare AFRICA

O’HEALTH: Nigerian telemedicine start-up opens new opportunity to improve access to healthcare ETIHAD CARGO : Bridging the gap in global immunization against COVID-19 EXECUTIVE INTERVIEW - DR.MERCY MWANGANGI Chief Administrative Secretary, Ministry of Health, Kenya

Dr. Kanyenje K. Gakombe Metropolitan Hospitals Founder & CEO on Utilizing Technology to Transform Healthcare WWW.HEALTHCAREAFRICA.INFO WWW.HEALTHCAREAFRICA.INFO

YEARYEAR 1 | ISSUE NO. 2NO. MAY/JUNE 2022 1 | ISSUE 2 MAY 2022

MAR 30-APRIL 1, 2023 Sarit Expo Centre, Nairobi, Kenya

THE BIGGEST HEALTHCARE & PHARMA EXPO IN EASTERN AFRICA

WHAT’S ON SHOW AT THE EVENT Africa

Hospitals & Care Expo

Africa

Medical

Africa

Medilab

Why the Kenya Nutrition, &Diagnostics Devices Health &Expo Expo Wellness Exhibitions

General & Specialty Hospitals • Medical Clinics & Consultancies • Ambulance & Emergency Services • Care & Rehabilitation Centres • Mental Health Care Centres • Wellness Centres • Food Supplements & Nutraceuticals Diet and Weight Loss Products • Baby Health & Food Products • Natural, Organic and Nutritious Foods

Electrical Medical Equipment • Patient Monitoring Equipment • Surgical Equipment • Storage & Transport Solutions • Patient Mobility & Support Solutions • Acute Care and Procedural Equipment • Mobility, Software and Logistics Solutions to Hospitals etc • Consumables for use in Medical Facilities

Medical Laboratory and Diagnostics Services • Testing, Consultancy and Training Services • Diagnostic Equipment and Solutions • Medical Laboratory and Diagnostics Consumables • Sanitation, Cleaning and Hygiene Solutions

The Kenya Nutrition, Health & Wellness Exhibitions are a range of weekend consumer expos and seminars that are targeted at creating and improving the consumer Africa awareness on healthy living and general well being. Africa Health Nutrition Supply Chain & Animal TheHealth expos are held over Logistics the weekend to ensureHealth the & Wellness & Care Expo Expo Expo attendance of the entire family. Baby and Mother Care Products Aviation, mobility solutions and Africa

Animal Health Products • Pet Nutrition & Products • Veterinary Services and Products • Equipment and Services for Animal and Pet Care

services • Warehousing and Storage solutions • Cold chain Solutions • Contract packaging • Traceability systems • Supply chain optimisation solutions • Supply chain and logistics software and systems • Security, track and trace systems • Fraud detection systems etc.

and Services • Food Supplements • Vitamins And Minerals • Botanicals and Tinctures • Personal Care & Beauty Products • Personal Wellness Services • Exercise and Fitness Products and Services • Cosmetic and Reconstructive Surgery • Diet and Weight Loss Products

The goals of the Kenya Nutrition, Health & Wellness Exhibitions are: • Provide a forum for food and beverage processors, distributors and importers to interact directly with Africaof informing the consumers Africa consumers, with a goal Africa Health Healthtech & Financing Pharma of the unique features and benefits of their products Insurance Expo Expo Expo in relation to healthy eating& Packaging and living;ICT and software solutions • Pharma Manufacturing Financial services • Insurance & Solutions • Supply Healthtech apps and systems • services • Consultancy and • Provide a forumEquipment for and providers of• health, personal Chain Storage Solutions Digital health technologies and capacity building in financial Construction, Plant and Infrastructure services • New technologies such services • FinTech and InsurTech Installations • Mobility, Software and and home hygiene products to interact directly as IoT, AI, VR/AR,with blockchain, software and technologies Logistics Solutions • Utilities and etc. • Payment systems and Support Services and Equipment technologies • Inventory consumers • Refrigeration, Hvac Systems • management solutions • Renewable Energy & Sustainability Cybersecurity applications • Bring together medical, nutritional, healthcare and etc. Solutions wellness experts and practitioners face to face with consumers to discuss disease management, lifestyle choices, diet management, wellness goals info@fwafrica.net and practices with a view to imparting the right knowledge the consumers; +254 725 to 343932 • Provide a platform for a number of industry www.expo.healthcareafrica.info associations and corporates to interact with consumers and the community, with a view to reaching out to them with their services

EDITORIAL

Better governance key to healthcare delivery in Africa that needs to adapt to rapid changes in order to provide continuous and coordinated people-centred care. Further, delivery faces increasing public demand for greater access. Recent debates have emphasized how to make progress in strengthening the health systems, achieving universal health coverage and making progress towards meeting the SDGs. This issue is privileged to have secured an executive interview with the Chief Administrative Secretary at the Ministry of Health Kenya Dr. Mercy Mwangangi and she takes us through some key achievements in health in Kenya in the past 5 years. She speaks also about pandemic management and preparedness, National Health Insurance Fund (NHIF), Universal Health Coverage (UHC), training of healthcare workers and investments in healthcare.

ealthcare governance is key to quality, affordable and accessible service delivery in the African countries. Africa is diverse and growing in terms of health care, while governments face a number of challenges, including lack of funds and poor

infrastructure. This has been recently compounded by the Covid-19 pandemic and other disease outbreaks, poverty and the brain drain of homegrown doctors. Varying wildly from country to country and region to region, public healthcare does exist but most urban populations will want to use the private sector or seek treatment abroad. A country requires to have a number of key basic requirements such as people, processes, supplies and institutions to deliver health care services to those who need them. Good governance is considered a core component of resilient health systems, and while governments are the primary drivers of governance, non-state actors – from practitioners to civil society – are critical in making sure that health systems achieve goals of improved health status, improved health system responsiveness to people’s expectations and reduced financial risk to users of the health system. That’s why in this issue of HealthCare Africa we focus not only on the government’s angle of ensuring attainment of healthcare through programmes like universal health coverage, but also look at the role the private providers play to improve health systems. Healthcare today occupies a fragmented environment HEALTHCAREAFRICA.INFO

IN THIS ISSUE – METROPOLITAN HOSPITAL AND MORE Improving the delivery capacity of national health services in Africa goes beyond declarations to bringing in private sector investors to invest in health. One such company is Metropolitan Hospital, a level 5 hospital service serving the middle-class population in Nairobi’s Eastlands area. The CEO and Founder of the hospital Dr. K.K Gakombe takes us through the journey the hospital has taken since it came to being 26 years ago. With our new section on Country Focus shedding a light on Zambia, you will get enlightened on the opportunities, challenges and market trends in one of the rising regional giants in Africa. Further, we have interviews with the First Lady of Bungoma County in Kenya, Ms. Caroline Wangamati on the status of healthcare in the county, plus a special coverage of leading digital health business in Nigeria, O’Health. As we welcome you to the second issue of HealthCare Africa magazine, our goal remains: we are focused on becoming the leading voice in the health space in Africa by informing key decision makers of the business opportunities, innovations, research and trends they can take advantage of. With a readership across the private and public, nonprofit, development partners, academic and research institutions in Africa and globally, we would like to be a key part of strengthening the health systems in Africa through our magazine, events and other activities. We wish you a good read Francis Juma Publisher MAY/JUNE 2022 | HEALTHCARE AFRICA

Contents

YEAR 1 | ISSUE NO. 2 MAY/JUNE 2022

Editorial 5 News Updates 11 Supplier News & Innovations 13 Appointments Updates 14 Events Review

COMPANY FEATURES

20 2

METROPOLITAN HOSPITAL Utilizing Technology to Transform Healthcare in Nairobi and its Environs

MAY/JUNE 2022 | HEALTHCARE AFRICA

O'HEALTH Nigerian telemedicine start-up opens new opportunity to improve access to healthcare

ETIHAD CARGO Bridging the gap in global immunization against COVID-19 HEALTHCAREAFRICA.INFO

EXECUTIVE INTERVIEWS

COUNTRY FOCUS: ZAMBIA Prioritizing health service provision as a pathway to achieving middle income status by 2030

DR. MERCY MWANGANGI UHC and Covid-19 response lay foundation for better health in kenya

MRS. CAROLINE WANGAMATI Bungoma’s blood donation advocate and ambassador

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THE REEMERGENCE OF POLIO How African countries battled and contained spread of the highly infectious virus MAY/JUNE 2022 | HEALTHCARE AFRICA

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PUBLISHED BY: FW AFRICA P.O. Box 1874-00621, Nairobi Kenya Tel: +254 20 8155022, +254725 343932 Email: info@fwafrica.net Company Website: www.fwafrica.net HealthCare Africa (ISSN 2307-3535) is published 6 times a year by FW Africa. Reproduction of the whole or any part of the contents without written permission from the editor is prohibited. All information is published in good faith. While care is taken to prevent inaccuracies, the publishers accept no liability for any errors or omissions or for the consequences of any action taken on the basis of information published. HEALTHCAREAFRICA.INFO

NEWS UPDATES

by www.healthcareafrica.info DIGITAL HEALTH

Abu Dhabi Sovereign Fund buys 3% stake in Intas Pharma

Morocco starts construction of US$599 million Ibn Sina Hospital to bolster healthcare MOROCCO – Moroccan King Mohammed VI has officially initiated the construction of US$559 million Ibn Sina Hospital with a capacity of more than 1,000 beds to strengthen healthcare delivery in the Rabat-SaleKenitra region. The construction of the Moroccan Ibn Sina Hospital involves a hospitalization tower, a medicaltechnical center with five floors, 11-floor tower dedicated to the National League for the Fight

THE FACILITY WILL OFFER QUALITY HEALTH SERVICES INCLUDING INTENSIVE CARE, OUTPATIENT CARE, EMERGENCIES, SEVERE BURNS AND FOLLOW-UP CARE, & REHABILITATIVE SERVICES

against Cardiovascular Diseases, a Conference Center, Training Center and a Boarding School. The facility will offer quality health services including intensive care, outpatient care, emergencies, severe burns and follow-up care, rehabilitative services, respiratory illness treatment, dialysis care among other medical services. The hospital tower project covering an area totaling 11.4 hectares meets the standards of bio-climatic and sustainable development and it is estimated to be complete in 4 years. It will be 140 meters high with 34 floors and 3 floors below ground level.

HEALTHCARE DELIVERY

Apollo Hospitals introduces new foot reconstruction treatment for diabetic patients INDIA – Apollo Hospitals has opened a unique multidisciplinary Centre of Excellence for Diabetic Foot Management (CoEDFM) for diabetic patients who are known to be prone to foot-related ailments at its Jubilee Hills location. Apollo Hospitals will offer a novel Diabetic Foot Reconstruction & Management procedure for the first time in India to patients at the new multidisciplinary health facility in collaboration with King’s College Hospital in London. CoEDFM will use a multidisciplinary treatment protocol for diabetic foot ailments, which can be traumatic and HEALTHCAREAFRICA.INFO

life-threatening. The new technique employs the international fixation method, which includes the use of special devices such as beams, bolts, and specially designed plates and nails.

UAE – The Abu Dhabi Investment Authority (ADIA), a sovereign wealth fund owned by Abu Dhabi Emirate has acquired approximately 3% of Intas Pharmaceuticals for US$250US$270 million (2,000 crore) at a valuation of US$8.5 billion (65,000 crore). ADIA is set to purchase 3% stake from current investor Temasek Holdings, which currently owns about 10% of the Indian drug company. ADIA, which has property worth approximately US$800 billion, has received a lot of attention in India, and has invested more than US$3 billion in India since 2018. It has invested in major Indian companies like Flipkart, Reliance Retail, Mindspace REIT, HDFC Capital, Mphasis, Paytm, Nykaa and Mobikwik. The Chudgar family, Intas’ promoters, currently owns 84% of Intas, while homegrown PE fund ChrysCapital owns 6%.

Pfizer to buy Biohaven in US$11.6 billion deal, marks comeback in neuro arena USA – Pfizer Inc has announced that it will pay US$11.6 billion for Biohaven Pharmaceutical Holding Co, a large bet on the company’s ability to increase sales of the top-selling pill in a new class of migraine drugs. The acquisition follows a Nurtec commercialization agreement signed by the companies in November 2021. The current transaction follows Pfizer’s US$6.7 billion acquisition of Arena Pharmaceuticals to gain access to the latter’s S1P modulator for inflammatory diseases. In a smaller deal, Pfizer will pay US$525 million for respiratory syncytial virus specialist ReViral.

MAY/JUNE 2022 | HEALTHCARE AFRICA

NEWS UPDATES Kenya unveils sexual and reproductive health online platform KENYA – Kenya’s Ministry of Health has launched a digital platform dubbed Lifeyangu.com to improve access to sexual and reproductive health-related information among young people. The health ministry inaugurated the platform in partnership with a consortium of local and international organizations led by Deutsche Stiftung Welbevölkerung (DSW) and Bayer East Africa to address information gaps in areas of reproductive health. The Lifeyangu.com platform will provide credible information about relevant reproductive health facilities, contraceptive options among other topics on sexual reproductive health services to Kenyans aged between 18 to 24 years. It enables users to access sexual and reproductive health services in a confidential manner by identifying nearby health facilities near as well as providing a safe environment for the youth to share information. It will address the challenge of accessing credible reproductive health specialists and information online while covering the growing need to

INNOVATIONS

Letshego inks partnership deal with BrandMed to promote digital health solutions

UGANDA – Africa’s inclusive finance

provider Letshego Group has entered into a strategic partnership with healthcare group BrandMed to launch an instant digital access to wellness and affordable health solutions for African communities. The collaboration will enable Letshego to offer quality digitized wellness services, health facts and advice to communities including virtual medical consultations through a multichannel digital platform called LetsGo Digital Mall. The online platform provides instant digital access and affordable health solutions in various dimensions while supporting customers with better health, fitness, nutrition and

promote additional information about sexual health to the youth. The platform will also enhance youth’s access to comprehensive information about sex, knowledge about the risks they may face and their vulnerability to adverse consequences of unprotected sexual activity along with ability to access sexual health care. 6

MAY/JUNE 2022 | HEALTHCARE AFRICA

THE COLLABORATION WILL ENABLE LETSHEGO TO OFFER QUALITY DIGITIZED WELLNESS SERVICES, HEALTH FACTS AND ADVICE TO COMMUNITIES

wellbeing awareness. In partnership with BrandMed, wellness services in the LetsGo Digital Mall will be the first in Letshego’s LetsGo Lifestyle series of solutions and offerings aimed at improving

healthcare delivery and saving lives. The partnership with Letshego Africa will allow BrandMed to fully leverage the Group’s regional digitalization strategy to promote equality in accessing wellness solutions that assist in closing the gap in broader communities being able to expert medical care. Moreover, it will help bridge the gap between demand and delivery of reliable, quality healthcare at a time when the ongoing COVID-19 pandemic has exposed the health inequity existing across communities. HEALTHCAREAFRICA.INFO

DISEASE NEWS

South Sudan intensifies efforts to contain cholera outbreak SOUTH SUDAN – The South Sudan

Government has collaborated its health sector partners and stakeholders to conduct two rounds of oral cholera vaccination in Rubkona County, Unity State. The rounds conducted in January and March 2022 were aimed at containing a Cholera outbreak that has been ravaging the country. South Sudan’s Ministry of Health also deployed a rapid response team in Rubkona county to support the state-level response as well as to provide adequate medical supplies to aid in the investigation and treatment of cholera cases.

In addition, the health ministry has activated a national cholera taskforce at the onset of the outbreak to coordinate all response interventions

as well as heighten surveillance in the Internal Displaced Persons camps and at community levels. South Sudan has further collaborated with relevant partners to support ongoing cholera preparedness, prevention, vaccination drive and response training efforts to protect people and save lives. Moreover, the government has urged the general public to observe all the precautionary measures to prevent community transmission in populations with inadequate access to safe drinking water, poor personal hygiene and inadequate access to improved sanitation facilities.

HEALTHCARE DELIVERY

South African National AIDS Council secures US$547M grant in fight against HIV

SOUTH AFRICA – The South African

National AIDS Council (SANAC) has been awarded a grant of US$547 million from the Global Fund to support prevention and treatment programs for HIV/AIDS and tuberculosis across the country for the period April 2022

– March 2025. The funding will further support the SANAC in bringing together government, civil society and the private sector to create a collective response to HIV, TB and STIs with the ultimate goal of eliminating the three epidemics as public health threats in South Africa. In addition, a new highly effective, long-acting injectable HIV preventive treatment has been rolled out by UNITAID in South Africa to bolster the fight against HIV virus. The South African Health Products Regulatory Authority also approved the use of the monthly dapivirine

vaginal ring for women 18 years and older to help reduce the risk of developing HIV resistance.

THE FUNDING WILL FURTHER SUPPORT THE SANAC IN BRINGING TOGETHER GOVERNMENT, CIVIL SOCIETY AND THE PRIVATE SECTOR TO CREATE A COLLECTIVE RESPONSE TO HIV, TB AND STIs

Advocate Aurora, Atrium Health unveil mega merger, creating US$27B system USA – Advocate Aurora Health and

Atrium Health have announced a merger agreement to form a six-state, 67-hospital nonprofit juggernaut with US$27 billion in combined revenues. According to a joint announcement, the merger plans have been approved by each system’s board of directors HEALTHCAREAFRICA.INFO

and are now subject to regulatory review. The joint system would serve approximately 5.5 million patients, operate over 1,000 care sites, employ 148,000 people, and provide US$4.8 billion in annual community benefits under the new Advocate Health brand. MAY/JUNE 2022 | HEALTHCARE AFRICA

NEWS UPDATES

Amref Health Africa selected to host Gavi’s Civil Society Organization platform

REGULATORY AND APPROVALS

US National Institutes of Health warrants Covid-19 technologies to WHO and MPP

AFRICA –

Gavi, the Vaccines Alliance has appointed Amref Health Africa as the new host of its Civil Society Organization (CSO) platform effective from 1 January 2022 for a period of 3 years ending 2024. Amref has been selected to host the CSO platform to support implementation of immunization policies and programs through engaging the civil society to amplify the community voices and work with all partners at global, regional, national and subnational levels. The organization will mobilize and support civil society organizations working to strengthen health systems and deliver immunization services to underserved communities. It will also oversee that all countries supported by Gavi allocate at least ten percent of their combined Health System Strengthening, Equity Accelerator Funding and Targeted Country Assistance ceilings for activities undertaken by CSO partners. Consequently, Amref will collaborate with civil society partners to help Gavi to strengthen its political commitment and accountability, build trust in vaccines and support delivery of immunization services for all.

USA – The US National Institutes of Health (NIH) has agreed to license 11 Covid-19 technologies to the Medicines Patent Pool (MPP) via the World Health Organization’s Covid-19 Technology Access Pool (C-TAP). The US government announced the move during the second Global Covid-19 Summit, co-hosted by the US, Belize, Germany, Indonesia, and

Senegal. The technologies include SARSCoV-2 stabilized spike protein, early-stage vaccine and diagnostic candidates, and research tools to aid in vaccine and therapeutic development. The list the research tools include an RNASEH-assisted detection assay for RNA, detection of SARS-CoV-2 and other RNA viruses, and a high-throughput diagnostic test. The global and non-exclusive licenses will enable manufacturers to work with MPP and C-TAP to use the technologies to make Covid-19 diagnosis and treatment available to people in low and middle-income countries. During the summit, developed countries also committed to provide an upwards of US$960 million in to help establish a new Pandemic Preparedness and Health Security Fund.

HEALTHCARE DELIVERY

Nigeria launches National Essential Diagnostics List in partnership with WHO NIGERIA – Nigeria has introduced the Nigeria National Essential Diagnostics List (NEDL) in partnership with the World Health Organization and the Global Fund to enhance diagnostic testing in healthcare. The overall goal of the Essential Diagnostics List is to improve access to testing, diagnostic capacities amid the ongoing COVID-19 outbreak along with affordability, regulation and quality of the diagnostic test. The introduction of the Nigeria National Essential Diagnostics List is also in line with the Federal Ministry of Health mandate to implement policies aimed at strengthening the national health system for effective, efficient, accessible and affordable delivery of health services.

MAY/JUNE 2022 | HEALTHCARE AFRICA

Moreover, Nigeria flagged off the dissemination of the NEDL to boost access to qualitative and affordable diagnostic testing services in an effort to accelerate diagnosis and treatment of infectious diseases.

THE OVERALL GOAL OF THE ESSENTIAL DIAGNOSTICS LIST IS TO IMPROVE ACCESS TO TESTING, DIAGNOSTIC CAPACITIES AMID THE ONGOING COVID-19 OUTBREAK HEALTHCAREAFRICA.INFO

DIGITAL HEALTH

Elton John AIDS Foundation grants US$1M to Triggerise Kenya for mental healthcare

KENYA — Triggerise has received a US$1 million grant from Elton John AIDS Foundation to empower young people in Kenya to take control of their mental and physical health. The grant will fund essential mental health offerings that will be fully integrated with Triggerise’s preexisting sexual and reproductive health services for young people between the ages of 15 and 24 over the next three years. Triggerise partnered with the

Elton John Foundation to ensure that Triggerise associated clinics in Mombasa County, Kenya provide mental health screening and other related services. The partnership will also ensure that pre-exposure prophylaxis and antiretroviral therapy services are a part of Triggerise’s established offerings in Mombasa together with boosted access to reproductive health services. Triggerise will collaborate with its existing private sector network of clinics and expand its platform coverage to incorporate public sector clinics that provide essential HIV services as well as to support young people who test positive for HIV. In addition, HIV positive people will be enrolled onto Triggerise’s mobilepowered platform to connect them to appropriate health services at no cost while allowing youth to give feedback on service experience.

DISEASE NEWS

Kenya intensifies efforts to contain Yellow Fever outbreak KENYA – Kenya has put in place a national incident management structure to manage Yellow Fever after an outbreak was recorded in Isiolo County. The country declared an outbreak of Yellow Fever in March 2022 which has seen 53 suspected patients presenting with fever, jaundice, muscle pain and joint pain including six fatalities reported so far. Subsequently, Kenya has developed a public health response plan to contain further spread of the viral disease such as deploying a rapid response team to Isiolo and neighboring counties to determine the extent of the outbreak. The national health authorities are also identifying the at-risk population, implementing integrated vector

HEALTHCAREAFRICA.INFO

control measures, conducting a risk assessment along with initiating risk communication and community engagement activities. In addition, the Kenyan government is working together with the World Health Organization and partners including Amref Health Africa, Kenya Red Cross, World Vision, Action Aid among other global institutions to pull resources to help support response activities.

Uganda introduces US$38M malaria control project in partnership with the US UGANDA – The Ugandan Government has introduced a new US$38 million health project with an aim to reduce malaria infections in the country by 50 percent over the next five years in collaboration with the United States government. The Uganda Malaria Reduction Activity will also help reduce malariarelated deaths by 75 percent in regions with the highest malaria burden, namely West Nile, Lango, Acholi, Karamoja and Busoga. It will facilitate malaria control and elimination to save lives, ease access to medical supplies to communities and health facilities as well as efficiently train health workers to properly diagnose and treat malaria.

Samsung Biologics shells US$2.3 bln to complete acquisition of Samsung Bioepis SOUTH KOREA – Samsung Biologics has completed the US$2.3 billion acquisition of Biogen’s stake in the Samsung Bioepis joint venture after signing a stake acquisition agreement in January of this year. According to the terms of the agreement, Samsung Biologics made an initial cash payment of US$1 billion and fully acquired Samsung Bioepis as its wholly owned subsidiary. The proceeds will be used to support Samsung Biologics’ strategic growth plans. The acquisition of the joint venture will provide Samsung Bioepis with increased autonomy and agility in business operations, resulting in faster sales growth and higher operating margins. It will also provide the company with biosimilar development expertise as well as future performance in new drug development.

MAY/JUNE 2022 | HEALTHCARE AFRICA

SUPPLIER NEWS & INNOVATIONS Hologic secures FDA approval for Aptima CMV Quant assay, poised to challenge Abbott, Roche

USA – Hologic, a medical technology company based in the United States,

has received FDA approval for its Aptima CMV Quant assay. The test has been approved to assess cytomegalovirus (CMV) viral load in patients undergoing solid organ or stem cell transplants, allowing Hologic to compete with companies such as Roche and Abbott. Following last year’s CE mark, the FDA’s approval of the Aptima CMV Quant assay allows Hologic to sell a post-transplant pathogen detection and monitoring test for its Panther

system in the United States for the first time. The recently approved Aptima CMV Quant assay will aid in the detection of post-transplant pathogens and improve patient outcomes. It also adds to the company’s existing portfolio of HIV-1, Hepatitis C, and Hepatitis B diagnostic and viral load testing. As COVID-19 testing declines, Hologic is looking to transplant assays to help drive growth.

Siemens Healthineers launches “integrated” cath lab imaging system USA – Siemens Healthineers has expanded its cardiology portfolio with the introduction of the Artis icono biplane, an angiography system with detectors that have been optimized in size for integrated use in the cath lab. The system incorporates new features for diagnosing and treating cardiac arrhythmia, coronary heart disease, and structural heart disease. It also simplifies clinical workflows while providing excellent image quality at a low radiation dose. Artis icono biplane allows for simple positioning of the C-arm for complex cardiovascular diseases and their interventional treatment,

especially when displaying images at steep angulations. Furthermore, it allows capturing of images from various angles at the same time.

Meanwhile, Siemens Healthineers has launched revolutionary new imaging technology, which has been described as the most significant breakthrough in CT technology in more than a decade. Siemens’ NAEOTOM Alpha scanner combines CT with artificial intelligence to help identify patients at risk of heart attacks. The new system employs a novel detector material known as cadmium telluride crystals, which converts X-ray photons directly into electrical signals, improving imaging quality, thereby avoiding the information loss seen in conventional CT.

Sysmex America introduces first hematology analyzer for malaria detection USA – Sysmex America, a subsidiary of

Japanese-based Sysmex Corporation has introduced its XN-30 research use only automated hematology analyzer for malaria detection. The XN-30 RUO analyzer can distinguish Plasmodium falciparum from non-falciparum species and determine the life cycle staging of the parasites detected using specialized reagents, a violet laser, and advanced algorithms. The XN-30 RUO can

report the level of parasitemia in an ethylenediaminetetraacetic acid (EDTA) sample with a sensitivity as low as 20 malaria-infected red blood cells per microliter in as little as one minute. The analyzer is intended to boost the productivity of research labs that currently use manual microscopy for malaria detection or rely on rapid diagnostic tests to screen symptomatic patients.

MAY/JUNE 2022 | HEALTHCARE AFRICA

THE ANALYZER IS INTENDED TO BOOST THE PRODUCTIVITY OF RESEARCH LABS THAT CURRENTLY USE MANUAL MICROSCOPY FOR MALARIA DETECTION HEALTHCAREAFRICA.INFO

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Electrical medical equipment Patient monitoring equipment Surgical equipment Storage & Transport solutions Patient Mobility & Support solutions Acute care and procedural equipment Software solutions Consumables for use in medical facilities And many more ....

info@fwafrica.net +254 725 343932

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SUPPLIER NEWS & INNOVATIONS Medtronic India launches MiniMed 780G for diabetes management

INDIA – Medtronic, a global leader in healthcare technology has launched MiniMed 780G, an automated insulin delivery system in India. MiniMed 780G is a next-generation closed-loop insulin pump system for the treatment of type 1 diabetes in patients aged seven to eighty. The system automates the delivery of both basal insulin and correction boluses every five minutes, making it easier for diabetics to avoid highs and lows. The MiniMed 780G system personalizes glucose goals with an

adjustable target setting as low as 100 mg/dL — lower than any other advanced hybrid closed-loop system — and is designed to help stabilize blood sugar levels and improve glucose control. The system is part of a new Medtronic insulin pump portfolio that includes smartphone connectivity via Bluetooth technology. Users and their care partners can now view real-time glucose data and trends on compatible iOS and Android smartphones via apps.

THE SYSTEM AUTOMATES THE DELIVERY OF BOTH BASAL INSULIN AND CORRECTION BOLUSES EVERY FIVE MINUTES, MAKING IT EASIER FOR DIABETICS TO AVOID HIGHS AND LOWS.

Abbott introduces upgraded digital health app for neurostimulation

USA – Abbott Laboratories, an American multinational medical devices and health care company with headquarters in Abbott Park, Illinois has launched an updated version of its Neurosphere MyPath digital health app. The medtech company has created an advanced app with enhanced functionality to assist doctors in closely 12

monitoring their patients as they test Abbott neurostimulation devices to relieve chronic pain. Abbott’s digital health app is available for both Apple and Android devices, and it provides a doctor, their staff, and the patient with a unified view of patient-reported results at each stage of the treatment journey. Meanwhile, Abbott has received FDA approval for its latest 3D cardiac mapping platform, which is intended to help physicians target abnormal heart rhythms. The EnSite X EP system inserts a catheter into the heart to map out the regions of the cardiac muscle where unsteady electric pulses can cause irregular heartbeats, and then guides surgeons through ablation procedures to treat those areas.

MAY/JUNE 2022 | HEALTHCARE AFRICA

FDA okays BD’s newest molecular diagnostics machine and its first test USA – BD (Becton, Dickinson and

Company) a global leader in medical technology, has announced the FDA approval of its new, fully automated, high-throughput infectious disease molecular diagnostics platform in the United States. On the BD Cor platform, the MX system joins the previously cleared PX and GX instruments. Overall, the platform is intended to fully automate the workflow in molecular diagnostics labs, from sample processing to result delivery—all at a relatively fast and large scale. Along with the release of the MX component, BD was given the goahead to release the instrument’s first assay: a three-in-one test that detects the most common nonviral sexually transmitted infections, including chlamydia, gonorrhea, and trichomoniasis. When combined with the BD Cor PX and GX systems, the MX platform can accept 1,700 samples for testing. It can run for up to seven hours without interruption before needing more samples or reagents to continue processing. Thanks to a combination of robotics and automated algorithms, the system can generate up to 1,000 test results every 24 hours, largely without the need for hands-on supervision from lab workers.

HEALTHCAREAFRICA.INFO

APPOINTMENTS UPDATE

Dr. Amit Thakker appointed new Chair of Kenya Health Professions Oversight Authority

Prof. Gibson Kibiki appointed as new Chief Executive of Africa Research Excellence Fund Africa Research Excellence Fund (AREF) has announced the appointment of Tanzanian medical scientist Professor Gibson Kibiki as the Chief Executive Officer. Prof. Gibson Kibiki MD, MMed, PhD brings in-depth industry expertise in all matters of health, policy formulation and health-related research from his years of experience in healthcare and innovation. Kibiki is the Founding Executive Secretary of the East African Health Research Commission of the East African Community (EAC). He is credited for the establishment of the Digital Regional East African Community Health (Digital REACH) Initiative with implementation approval by the EAC council of ministers of health and endorsed by the presidents of the EAC countries. Kibiki was also actively involved in the establishment of the PanAfrican Consortium for the Evaluation of Antituberculosis Antibiotics, the Malaria Capacity Development Consortium, the African Poverty Related Infection Oriented Research Initiative among other research capacity building programmes.

TANZANIA – KENYA – Kenya’s Cabinet Secretary

for Health Mutahi Kagwe has appointed DR. Amit N. Thakker as the Chairperson of Kenya Health Professions Oversight Authority for a period of three years, effective March 25th 2022. The Kenya Health Professions Oversight Authority is at the moment providing technical assistance to counties in inspection of health facilities for quality of care improvement. Dr. Amit Thakker will now head the project aimed at ensuring compliance to quality of care measures and standards by health facilities. Thakker is the current President of the Africa Healthcare Federation and the Executive Chairman of Africa Health Business whose interest is to promote the role of the private sector to strengthen health systems across Africa. He co-founded Avenue Healthcare in 1996, became the first Chairman of the Kenya Healthcare Federation in 2015 and later helped set up the East Africa Healthcare Federation as well as the Africa Healthcare Federation.

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Clinton Health Access Initiative names Buddy Shah as new CEO USA – Dr. Neil Buddy Shah has been named CEO of the Clinton Health Access Initiative, signaling the global health organization’s shift toward growth in low- and middleincome countries and the use of new philanthropic efforts to help fund the expansion. Dr. Neil Buddy Shah succeeds interim co-CEOs Joy Phumaphi and Ann Veneman, who will remain on the CHAI Board of Directors. Buddy will collaborate with the Board, CHAI’s Senior Leadership Team, and staff to develop and implement CHAI’s transformational change strategy in service of the initiative’s government partners. Shah is currently the managing director of GiveWell, a global health and development research and funding organization, and was previously the co-founder and CEO of IDinsight, a data analytics and advisory firm. Shah, who is also a leader in the “Effective Altruism” movement, will begin his new position at the Clinton Health Access Initiative (CHAI) effective June 14, 2022.

MAY/JUNE 2022 | HEALTHCARE AFRICA

EVENT REVIEW

The Africa Healthcare Awards and Summit 2022 - Zambia

enith Global Health hosted the Africa Healthcare Awards and Summit in Zambia in April 2022. Zenith Global Health, continues to ensure that discussions that were held foster partnerships and collaboration amongst the different countries that were present. The summit highlighted the opportunities for businesses not only in Zambia but across the continent as emphasis was placed on Southto-South Collaboration. “Coming together is a beginning, staying together is progress, and working together is success." – Henry Ford. The Summit was well attended by to dignitaries from across Africa amongst them Minister for Technology and Science- Zambia, Deputy Minister of Health- Angola, State Minister of Health- Nigeria (virtual), Permanent Secretary of Health- Administration- Zambia, Permanent Secretary of Health- Technical Services- Zambia, High Commissioner of Nigeria to Zambia- Zambia, Former Commissioner of Social Affairs- African Union-

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Ethiopia- Virtual, Country RepresentativeWorld Health Organization- Zambia, Southern Africa Regional Collaborating Centre- Africa CDC, CEO/CVO- Medland Hospital and President- Healthcare Federation of South

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21–23 April, 2022 – Lusaka, Zambia

COMING TOGETHER IS A BEGINNING, STAYING TOGETHER IS PROGRESS, AND WORKING TOGETHER IS SUCCESS. Africa- South Africa. The 3rd Africa Healthcare Awards and Summit (AHAS2023) will be held in Angola. It has been a journey and Zenith Global has achieved mileage and progress with the help of both the public and private sector. Africa Healthcare Awards & Summit has had an illustrious journey, with the first event held in 2021 in Nigeria, followed by the one in Zambia.

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Henry Ford

MAY/JUNE 2022 | HEALTHCARE AFRICA

EVENT REVIEW

Kenya Association of Private Hospitals (KAPH) & Kenya Medical Practitioners Dentists Council (KMPDC) Convention

he Kenya Association of Private Hospitals held a 2-day engagement meeting on the 17th -18th February 2022 in partnership with the Kenya Medical Practitioners and Dentists

council. The convention brought together over 150 guests from hospital owners, health professionals and other industry players. The participants discussed various issues under the theme of the convention which was “Role of Private Hospital in Achievement of UHC”. The subthemes included Quality health, technology, and health financing towards achievement of UHC. The Kenya Medical Practitioners and Dentists Council was the main partner of the convention. Dr. Eva Njenga, the KMPDC chairperson opened the convention urging private Hospitals to discuss the issue of cost of healthcare and give proposals on the issue of multiple licensing of health facilities. There is a need to address some costs from aspects of licenses, most recently being charges by the copyright agency on audiovisual use in health facilities.

MAY/JUNE 2022 | HEALTHCARE AFRICA

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17-18 February 2022 - Nairobi, Kenya

THEME ROLE OF PRIVATE HOSPITALS IN ACHIEVEMENT OF UHC Some of the Key presentations from the convention included Role of Private sector in achievement of UHC, Role of HCW in delivery of Quality Healthcare Toward UHC, Public Private Collaborations in Healthcare and Medical Malpractice. Hospitals and health workers were urged to keep proper documentation and to respond to requests by the council to give their side of the story in every complaint. People are becoming more aware of their rights and avenues for seeking justice when aggrieved in pursuit of healthcare services.

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MAY/JUNE 2022 | HEALTHCARE AFRICA

EVENT REVIEW

The Africa Health Business Symposium VII Nairobi, Kenya

he Africa Health Business in February 2022 organized yet another commanding symposium on the role of the private sector in advancing women’s health in Africa. The symposium focused on Creating Enabling Environment for Advancing Women’s Health in Africa, Reducing the Cancer Threat for Women, Women’s Empowerment through Reproductive, Maternal, Newborn and Child Health (RMNCH), Recognising African Leaders in Advancing Women’s Health on the Continent and Strengthening Health Systems in Africa. “Between 30% and 40% of cancers can be prevented by avoiding known risk factors and implementing evidence-based prevention strategies” The Symposium explored various issues surrounding women’s health on the continent and how we can advance it for the generations to come. There have been discussions on policies and implementation, and making women’s voices heard and be at the forefront for policy change. There has been talks on empowering women to make the right

MAY/JUNE 2022 | HEALTHCARE AFRICA

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24 February 2022 - Nairobi, Kenya

choices for themselves as well as showcasing innovations that will advance women’s health on the continent. “In low- and middle-income settings clinical laboratory testing is the cornerstone of healthcare delivery and provides essential data for making medical diagnosis” Discussions have been had on how to entrench women’s health within UHC frameworks and how African leaders need to be at the forefront of women’s health in Africa. The continent has a lot to offer and vast opportunities to advance women’s health and as we talk about advancing women’s

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In low- and middleincome settings clinical laboratory testing is the cornerstone of healthcare delivery and provides essential data for making medical diagnosis health on the continent, we must not forget the men too. Africa Health Business would like to hand over the official health shield to the Chairman of the Kenya Healthcare Federation, to signify that in November 2022, there shall be an Africa Health Business Symposium focusing on Africa Men’s Health in Nairobi, Kenya “To build strong primary healthcare systems based on UHC, investing in health systems is a win for women’s health as well as for women’s economic empowerment” MAY/JUNE 2022 | HEALTHCARE AFRICA

METROPOLITAN HOSPITAL Utilizing Technology to Transform Healthcare in Nairobi and its Environs 20

MAY/JUNE 2022 | HEALTHCARE AFRICA

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MAY/JUNE 2022 | HEALTHCARE AFRICA

COMPANY FEATURE: Metropolitan Hospital

Metropolitan Hospital main building view from Rabai Road

By Achieng' Odundo

e wears several hats: from a humble background, he is the current Chairman of the Kenya Healthcare Federation (KHF), the voice of the private health players in Kenya, the Founder of Alliance Healthcare and an investor in Creswave Limited, which focuses on healthcare IT, a Medical Doctor by training, with a subsequent degree in Strategic Management. And most importantly, he is the Founder and CEO of Metropolitan Hospital. Meet Dr. Kanyenje Gakombe as he takes us through his journey of founding and running one of the leading private hospitals in Kenya. When you first meet Dr. Gakombe, he strikes you as a no-nonsense fellow, but when you engage him, you meet this warm, well-versed person, with an inordinate sense of humor. We are at the Metropolitan Hospital in Buruburu estate in the east of Nairobi, under the warm

MAY 2022 | HEALTHCARE AFRICA

mid-morning sun, and he is relaxed and ready to share with us his journey through transforming the health sector over the years. “I am all yours,” he says, as we sit down for an interview on the green, neat and well-tended lawns of the hospital. After graduating with a Bachelor of Medicine and Bachelor of Surgery (MBChB) from the University of Nairobi in Kenya, Dr. Gakombe alongside other young doctors saw an opportunity beyond the overcrowded public healthcare facilities and a few private hospitals that were relied upon by millions of Kenyans to access healthcare: a middle class who could not access quality healthcare and could not afford healthcare in the existing private hospitals. They then sat down and came up with a concept that would bridge the gap by taking care of this middle-class and providing them with quality, cost-effective healthcare. Buruburu estate then was the largest middle class single HEALTHCAREAFRICA.INFO

estate in the city of Nairobi and played a perfect location to this dream facility. “There was the gap between the congested public sector and the expensive private sector, that’s the space we chose to sit in and that’s the space we are still occupying” he says. That was 28 years ago in 1994 – and the rest is history as the original idea of Metropolitan Hospital has since metamorphosed into providing healthcare services to not only the residents of Buruburu and those living in the eastlands area of Nairobi, but also to the surrounding counties beyond Nairobi. FUNDING ACCESS CHALLENGES AT THE START Dr. Gakombe and his partners faced a number of challenges, chief of which was the idea of starting a hospital as young graduates. He says that back then, unlike today, a lot of people had trouble with the youth, as they were not considered old HEALTHCAREAFRICA.INFO

enough to qualify to start and manage a hospital. “We were not considered to be old enough to qualify to start and manage a hospital, that was one of the hurdles,” he says. He also says that he has grown to support young future medical pioneers and he offers mentorship programs at different levels to bridge this gap, due to the challenges he and his colleagues faced as they sought to start the hospital. They were further dismissed by the Capital Markets Authority and the banks as they sought funding to start the hospital and later grow it. As a result, the team engaged older doctors who were passionate and more experienced to join their board, and give it more mass as they forged ahead. He further adds that lack of capital was a major impediment at the start, as borrowing rates then were in the 30% range. Moreover, banks were not lending to the healthcare sector, as they considered healthcare a social enterprise and at the time private investors were very few. Dr. Gakombe and the team later solved the above challenges by selling shares to the public. With a prospectus, they knocked on every door of relatives, friends and family members, selling shares to those who were interested in putting their money into the hospital, with many of the investors being healthcare professionals. “The biggest investor was a British gentleman, the late Ancrum Evans who believed in me as i had worked as his investment manager for 3 years during my medical training and internship”, he informs the HealthCare Africa team. He reveals that in the 1990s Kenyans had very little disposable income, so investors were asked to put in KSH. 10,000 as a minimum to buy 500 shares in the company, from which they raised KSH. 20 million and borrowed KSH 10 million from a local bank, then known as Daima Bank.

Dr. Gakombe reveals that in the 1990s Kenyans had very little disposable income, so investors were asked to put in KSH. 10,000 as a minimum to buy 500 shares in the company.

DIagnostic Imaging(CT-Scan, X-Ray and Ultrasound)

Dialysis

Adult Ward

Pharmacy

Critical Care

Dental

Maternity

Operating Theatres

Pediatric Ward

Casuality? Accident & Emergency

Ambulance

Outpatient

Laboratory( Covid PCR and Antigen Testing)

Inpatient

Isolation Ward

Diagram showing inpatient and outpatient services at Metropolitan Hospital. MAY 2022 | HEALTHCARE AFRICA

COMPANY FEATURE: Metropolitan Hospital

Dr. Gakombe shares humorously how much times have changed over the last 28 years. Today, he states that banks are willing to lend to the private healthcare sector and the society has accepted that it should be possible to have private for-profit hospitals. Today, the focus is on what it costs to get a particular service provided and whether the quality is acceptable. There are more and more private for-profit providers, which is important since it contributes to the sub-sector growth. Take for instance the faith-based and the charity run organizations who are waiting upon donations to operate or expand - donations can only go so far and is sometimes not impactful in terms of sustainability. “We have shifted focus from ownership of healthcare business to the patient value proposition of the health facility” “Government facilities with subsidized rates also depend a lot on taxes, looking at our tax revenues verses our 50 million population, there isn’t much available to spend on healthcare per Kenyan. This leaves the private for-profit subsector as the only sector which is likely to grow much faster as it can easily attract global capital. This also ties up with provision of quality healthcare due to healthy competition amongst various providers.” Dr. Gakombe goes on to highlight that today there is private equity money, which wasn’t available back then, is available and more accessible, adding that back then foreigners were funding healthcare through the Ministry of Health while today they are willing to invest in private facilities directly. He informs us that today the stock exchange is also more open to start ups and a company doesn’t need to have been profitable for five years to get a listing in the stock exchange as per Kenya’s Capital Markets Authority. He adds that by joining the Ibuka Program, which was launched in late 2018 with the aim of preparing micro, small and medium-sized companies at the Nairobi Securities Exchange, Metropolitan has the potential opportunity to raise financing for expansion, which they would not have been able to access before. According to Dr. Gakombe, acceptance by the community and the patients around and beyond the neighborhood of Buruburu has been one of the many successes Metropolitan Hospital enjoys, as there has been a steady growth in the number of patients over the span of 28 years. He reveals that the real breakthrough for the company came after the 2002 elections in Kenya, 24

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Metropolitan Hospital's modular theatre

IT IS IMPORTANT THAT OUR OWN PROFESSIONALS PROVIDE THE SERVICES AND IN TURN GAIN THE EXPERIENCE, TO KEEP THE HEALTHCARE PROFESSIONALS IN THE COUNTRY. Dr. K.K Gakombe - CEO & Founder , Metropolitan Hospital

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when the cost of money went down, the dollar stabilized, the economy was more liberalized, thereby enabling the hospital to import directly the materials it needed. Further, he reveals that the decision to computerize and digitize the hospital’s operations in 1999 turned out to be a key game changer for the business, enabling it to turn around from a loss-making entity to register surplus from its operations. Through the use of data and automations, the vision of the hospital is to improve the patient experience as well as that of doctors, insurers and corporate partners amongst other stakeholders. This has been reflected in the initiatives championed by the hospital such as the recent initiative to share Covid-19 statistics with government facilities to drive efforts on improved vaccinations and reduce transmissions of the pandemic. Metropolitan Hospital was the only private hospital chosen by the National Hospital Insurance Fund (NHIF), the state parastatal offering medical cover to the public, as a pilot site for the new and upgraded e-claim system, and are currently working on an integration with the Ministry of Health for real-time transmission of medical data required by the government. HEALTHCAREAFRICA.INFO

SERVING THE COMMUNITY BEYOND NAIROBI Located in the heart of Nairobi’s Eastlands area, Metropolitan Hospital serves not only the neighboring middle class population around it, but also attracts massive populations across Nairobi and its metropolis due to the quality and specialized care offered at the facility. A level 5 facility, Metropolitan Hospital is one step away from being a Teaching and Referral Hospital as they are yet to teach and train doctors. The facility otherwise is a multispecialty hospital offering services across a number of specializations as well as training healthcare assistants across all cadres. In 2013, the leadership started an aggressive expansion drive to grow the physical infrastructure and expand the scope to tertiary/ specialized care and in 2017, the hospital attracted private equity funding that has enabled the hospital to grow and become the leading hospital in the eastern parts of Nairobi. This was done objectively to not only offer better and swift care to patients but also to stop the medical care traffic to India and other destinations Dr. Gakombe expresses with passion the need not to export dollars in the name of medical travel yet there are innumerable opportunities to be explored in the country. This upgrade also gave the highly specialized doctors who have worked with the hospital over the years

IN NUMBERS

1999 THE YEAR METROPOLITAN HOSPITAL DIGITIZED ITS OPERATIONS

Metropolitan Hospital's Accident and Emergency Unit

MAY 2022 | HEALTHCARE AFRICA

COMPANY FEATURE: Metropolitan Hospital

IN NUMBERS

160 METROPOLITAN HOSPITAL'S BED CAPACITY

a place to practice. “It’s important that our own professionals provide the services and in turn gain the experience, to keep the healthcare professionals in the country. One of the key lessons learnt from COVID-19 is that healthcare by necessity has to be local. It’s impossible to fly a patient with a heart attack for instance, out of the country without initial life-saving treatment, thus the need to offer specialized care in the country and most importantly at the community level.” With the upgrade, the facility is now well equipped to offer different services under the Outpatient, Inpatient and Specialist Clinics. The facility can conduct both open and non-invasive spinal surgery, which is not common in Kenya. Neurosurgery, Neonatal ICU, Orthopedics with specialization in ankle, knee and shoulder joints are some of the specialty services available at Metropolitan Hospital. Some of the specialist clinics at the facility include, Gynecology, Family Planning, Nutrition, Ophthalmology, Endoscopy, Cardiothoracic, Medical Outpatient Clinic (MOPC) and Dermatology clinics. Other units include Urology, Oncology, General Surgery, Cardiology, Neurosurgery, Gastroenterology, Plastic Surgery, Mother & Child Health, Well Woman/ WellMan,Pediatric, Surgical, Occupational Therapy, Antenatal Clinic, Comprehensive Care, Youth & Adolescent, Ear, Nose and Throat,

Metropolitan Hospital's Inpatient Ward

MAY 2022 | HEALTHCARE AFRICA

Metropolitan Hospital's Neonatal ICU Orthopedic Surgery, Physiotherapy, Midwife, Counseling Psychology and Psychiatry. The hospital is now a 160-bed capacity facility, with over 350 staff, scores of 100 visiting doctors and consultants, with an upgraded parking lot fitting 189 cars and a 6-floor Doctors Plaza that houses different specialties. It is accredited as a Level 5 hospital in Kenya and boasts a Level F accreditation for its laboratory - both the among the highest level attainable by a hospital in Kenya. It has also installed a new Accident and Emergency unit, Modular Operating theatres, as well as ultra-modern ICU and Maternity units. The hospital is also working towards a COHSASA accreditation by end of the year 2022. “Today Metropolitan has a Class F laboratory, that’s the highest level of a laboratory you can have in a clinical setting, is a PCR testing center for travel, also still an isolation and treatment center in case of COVID-19 another wave. The facility is also much better equipped digitally to provide care through telemedicine and all the applications that came that allow digital communication.” THE COVID-19 PANDEMIC OPPORTUNITY He describes COVID-19 during its first stages as the pandemic of fear, but which has enabled the hospital to build its capacity and skills in key areas of the facility. “Like most people, our first response to COVID-19 was to try and keep it at bay. However, we were lucky that our Chief HEALTHCAREAFRICA.INFO

Nurse had been part of the response team for Ebola in West Africa, which came in handy in building our capacity to respond to the pandemic in the early days of the pandemic,” he says. He continues to say that his staff were the hospital’s first priority to protect them from COVID 19. The facility therefore quickly trained its staff, acquired enough PPEs that enabled them pass

through the first wave without any impact on its workforce. The hospitals later acted as one of the main care facilities during the second wave of the pandemic, when the government facilities got overwhelmed and private facilities had to come through as care and isolation centers, converting one floor in the hospital building in to a large isolation and treatment center of 43 beds, with ICU and HDU capabilities - infrastructure that was not there before COVID-19, just like in most private hospitals in Kenya. By becoming an isolation and treatment Centre, the hospital later on through tele-training trained other practitioners on how to handle COVID-19. “Then we came to the point where oxygen became the major problem – the facility installed an oxygen plant at the roof top to cater for oxygen needs and offered surplus to others. By the time the Omicron wave arrived, our ICU and HDU capacities were twice as large as they were in the beginning, and the facility had digitized a lot more because contact was being limited. At the point when the COVID-19 vaccine came through in early 2021, our hospital became one of the first vaccine centers and later on a travel and testing center.” He advises that the evolution of the COVID-19 pandemic was a demonstration of the fact that no one player can afford to cater for the needs of everyone in the country – neither the private nor public sector. Globally, there was also the

Like most people, our first response to COVID-19 was to try and keep it at bay. However, we were lucky that our Chief Nurse had been part of the response team for Ebola in West Africa, which came in handy.

Metropolitan Hospital's Theatre Central control panel

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MAY 2022 | HEALTHCARE AFRICA

COMPANY FEATURE: Metropolitan Hospital

demonstration that no one country is wealthy and equipped enough to deal with its population if a significant number of people fall sick at the same time, he adds. “We not only needed the health sector but the whole country, the citizens, the army, the agriculture sector and everybody else to participate when a pandemic like the COVID-19 pandemic hits.” A MORE DIGITAL FUTURE Metropolitan Hospital continues working towards its vision of becoming a one-stop shop for health and medical requirements by offering end-toend services in a highly digitized environment. It is also striving to better its offering of quality, cost-effective and affordable health care services with the goal of becoming the leading hospital in Nairobi and across Kenya. “We want the patient to be their own doctor, we want to enable patients to take care of themselves, or their caregivers to take care of them right at home by providing technological support. Metropolitan Hospital is a means to an end, it was never an end in itself,” he asserts. At a personal level, his dream has always been on mentorship, thus his first focus is on mentoring the next generation of healthcare leaders in Kenya and beyond. At the corporate level, initially the hospital had a vision of being present in every province in Kenya, as they were referred to back then, a vision that was derailed by cost of money and the lack of capacity to expand. The facility in future will pursue the hub and spoke model, where the main facility in Buruburu gets equipped and thereafter duplicated in different regions across the country. With the availability of human capacity at their disposal, the hospital is looking for partners and investors to expand its multispecialty hospital model with new facilities in key locations across the country. Dr. Gakombe reveals that the hospital’s key area of specialty going into the future will be on improving care to those with long term illnesses. “Too often patients who are diagnosed with, for example, hypertension and fail to follow up on medication, later on come back to the hospital with a stroke; another diagnosed with diabetes and after a while comes back with kidney failure - all because of poor care of the first illness which escalates to a more dangerous condition. With the current digital capabilities, Metropolitan Hospital can track care right from digital monitoring tools at home, to the ICU. These people who have long term diseases can be kept healthy and productive in the community, as opposed to spending money 28

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Metropolitan Hospital's Critical Care Unit in a hospital.” He describes the future of healthcare to be just like the banking and financial sector. “We want the patient to be their own doctor, we want to enable patients to take care of themselves or their caregivers to take care of them right at home by providing technological support.” The intention of the hospital from the beginning has been to raise the quality of care by providing essential care and more importantly by influencing the quality of care provided by the country. The hospital founders were cognizant of the fact that not all Kenyans would fit in its facility and as such Metropolitan Hospital is just a part of the whole healthcare system in Kenya that needs to be managed to have greater impact on people’s lives and the nation’s economy. Despite Metropolitan Hospital being a private hospital, Dr. Gakombe is very keen on what happens to public healthcare since it is the first foundation to care in Kenya. He believes that engaging with the county and national government to raise the competitive bar of care across the country is key to improving care. He gives the example of the competition in schools in the education sector, and this he recalls with nostalgia. “While at Mangu High School, our natural competitor was Alliance High School, so every day we were worried about what they were doing and our teachers didn’t spend a lot of time convincing us to study: they just needed to remind us the competitor was studying. If healthcare is run like education, then we will raise the bar and even patients will know how to compare and choose wisely which hospital to go to for certain procedures and what results to expect.”

The facility in future will pursue the hub and spoke model, where the main facility in Buruburu gets equipped and thereafter duplicated in different regions across the country.

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A SPECIAL PAVILION AT

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THE BIGGEST HEALTHCARE & PHARMA EXPO IN EASTERN AFRICA

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DR. K.K GAKOMBE CEO & Founder , Metropolitan Hospital

MAY 2022 | HEALTHCARE AFRICA

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LEADING THE Private Dr. Gakombe is an outspoken voice about the importance of a vibrant and sustainable private health sector in Kenya and the region – a trait he connects to his early schooling days at Mang’u High School and at the University of Nairobi, where he says he was taught and shaped to be a thinker and a responsible citizen who must be able to stand for what he believes in, and be willing to articulate it to everyone, including to higher authorities, at all times. Besides being involved in advocating for health to be prioritized as part of the Big 4 Agenda, he was also instrumental in the initiation and development of the Standard Service Agreement and Claim Form between Association of Kenya Insurers and Kenya Association of Hospitals which was adopted in October 2006. He is passionate about the enabling role of ICT in health and has been instrumental in the design and development of Hospital Information Management Software (HIMS 2000) currently in use in several hospitals and E-care, the first digital catering platform in a hospital. His recent elevation to chair the Kenya Healthcare Federation after a number of years on the Board, has given him the platform to continue with his passion for the healthcare sector in the country. “Private for-profit healthcare facilities take a beating in the market for allegedly profiting from people’s illness and that’s why it’s very important that we focus on value. The ownership of the healthcare infrastructure should not be the key subject: it is the users of the service, whether it’s companies, individuals, or the government buying healthcare. Given the right quality, how much does the right service cost? This way there is more value and accountability for the tax money because we will be paying not for the inputs but for the outputs when the service is provided, as opposed to where we give money with the hope that services will be provided.” He echoes his desire to see more accessible, equitable and affordable healthcare systems in Kenya, and HEALTHCAREAFRICA.INFO

Sector TO HIGHER Impact

where the public, private and faithbased organizations contribute side by side, with the consumer given more choice and experience. He adds that the achievement of Universal Healthcare (UHC) in Kenya will be grim if digitization and automation are not embraced across the health value chain, with the use of paperwork and manual forms still rampant across the country. He gives an example of the insurance claims process. “In the case of managing insurance claims, if each of the 40 million plus Kenyan adult population make approximately 4 visits to a healthcare facility per year, this is a total of 200 million paperwork claims that need people to go through and subsequently pay. This is in itself a bigger barrier to

PRIVATE FOR-PROFIT HEALTHCARE FACILITIES TAKE A BEATING IN THE MARKET FOR ALLEGEDLY PROFITING FROM PEOPLE’S ILLNESS

attaining UHC that leaves us with just one solution: embracing technology and digitally integrating the entire health sector value chain to better services.” “Healthcare is labor intensive since a lot of the cost is driven by what the healthcare workers earn. Healthcare is also highly specialized as the care givers are well trained and highly specialized persons. Many inputs used to offer care like the equipment in Kenya are mainly imported, as well. There are various opportunities for cost savings and one of those is task shifting, with technology support we can decide that these tasks are very patient centered and not provider centered. If patients can selfregister, then we provide tools so that they self-register, you don’t have to pay anyone for doing the registration.”

“Taking a look at the financing side, can NHIF do it alone or do we need multiple approaches for financing? And if you look at COVID-19 pandemic again, it taught us that even NHIF was not strong enough financially to pay for COVID-19 care, as this was excluded by NHIF. There is what NHIF can do, there is what private insurers can do and there is what the state will have to do.” Dr. Gakombe contends that there is need to come together and address the finance and the human resource pillars of the health sector, and by doing so address the supply chain and the technological access issues, and thus build a more resilient health sector. And if the regulation side is also better, then all the players within the health sector will do their bit and contribute to a better healthcare system in the country, he emphasizes. He further adds that devolution offers an opportunity to vastly improve healthcare services across Kenya in several ways. “The public will start comparing the level of care in different counties and our leaders will be forced to benchmark in successful counties, as they will be losing money when their people start travelling to other counties to seek care. That benchmarking will mean that our leaders will be under pressure to improve the quality of care and because healthcare is the most devolved function, devolution offers an opportunity for intercounty benchmarking and therefore raise the bar. It’s therefore important to work with the counties and the national governments to ensure that healthcare structures in the country is such that it encourages all players to be patient centered, in trying to achieve access and better cost outcomes and more fundamentally better clinical outcomes.” Dr. Gakombe is fully aware that the only way to truly influence the world, is not just by a country’s doing but through knowledge. The ultimate influence across generations comes from sharing knowledge and ideas, not by having the largest pot of money legally or illegally acquired, he says.

MAY 2022 | HEALTHCARE AFRICA

O'HEALTH Nigerian telemedicine start-up opens new opportunity to improve access to healthcare By Elly Okutoyi

COMPANY: O'Health COUNTRY: Nigeria WEBSITE: www.ohealthng.com EMAIL: contact@ohealthng. com TELEPHONE: +2348110175635 32

he runs one of the fastest growing healthtech startups in Africa. Listening to Dr. Temitope Farombi gives confidence and reassurance to healthcare seekers that they are in safe

hands. Dr. Farombi, a neurology specialist is the founder and Chief Executive Officer of The Online Health Company Limited, based in Ibadan in central Nigeria, the third largest city in the West African country. O’Health Nigeria, as it is popularly known, was launched in 2020 to leverage on the role of nonphysician providers in Nigeria, where there is a doctor-patient ratio of 1:6000, using telemedicine to improve access to the healthcare system. “Virtual consultation has eliminated location barrier, reduced self-medication and irregular medical check-up where patients can now report early signs of or any health concerns,” says Dr. Farombi. “O’Health Odoctor” is a telemedicine app developed by O’Health, that bridges the gap between health consultants and healthcare seekers, bringing both parties together on-air for effective health delivery. As one of the fastest growing startups in Africa, O’Health has seen itself grow to employ seven members of staff, put up one hospital, installed five laboratories, three pharmacies and two HMOs. Having been started in early 2021, in only eighteen months of existence, the company has so managed to handle 35,000 consultations across 28 specialties with over 11,000 subscribers in its database. The company has over 130 doctors. “We have also expanded our reach by signing deals with two HMOs to serve over 150,000 of their enrollees,” she adds. Professionalism is key in the company’s code of ethics, where provision of high standards

MAY 2022 | HEALTHCARE AFRICA

and quality health care services is the ultimate goal. This has prompted recruitment of highly qualified staff not only with high training but also good experience as well. STRONG TEAM WITH HUGE AMBITION Dr. Farombi, who is the team leader at the startup, is a graduate of the University of Ibadan in MD, FMCP (Neurology). She also trained in internal medicine at the University College Hospital (UCH) and Neurology at UCH Ibadan Nigeria. She then proceeded to Kings College London where she obtained a Master’s degree in Clinical Neuroscience. Temitope is a consultant Neurologist at the Chief Tony Anenih Geriatric Center University College Hospital, the first Geriatric Center in West Africa sub-region. She was a visiting scholar to the Northwestern University Chicago, USA and Haceteppe University, Ankara Turkey. She is also an international keynote speaker on many issues of chronic neurological diseases in the elderly. She is a member of many learned societies including Movement Disorder Society and the Nigerian Society of Neurological Sciences. She happens to be a regular presenter at conferences and has published articles in scientific journals. She sits on a number of local and international institutions. Dr. Farombi enjoys playing golf in her spare time. She is the Former Lady Captain of the prestigious Ibadan Golf Club (IGC). The HR department of O’Health is led by Oluwadamilola Adelaja (Dami), a graduate of the Olabisi Onabanjo University in Microbiology and a Master’s degree from the University of Ibadan in 2019. She has also attended many training courses and programs in Business Administration including at the Tekedia Institute, Boston USA and a training on leadership and heath management at the University of Washington in 2019. HEALTHCAREAFRICA.INFO

DR. TEMITOPE FAROMBI Founder, O'Health

HEALTHCAREAFRICA.INFO

MAY 2022 | HEALTHCARE AFRICA

COMPANY FEATURE: O'Health

Prior to joining Online Health Company, Damilola was a program officer for the Heartsmiles Emotional Care Foundation and also worked as a Research Officer in the study project for Patent and Proprietary Medicine vendors. Their clients included The World Bank, among others. ICT, which is the backbone of the company is headed by Femi, a graduate of Federal University of Technology, Akure. He holds a degree Electrical and Electronics Engineering. Femi joined Online Health Company having had stints at WhottDev as an IT manager, Euphil Computer Institute as an instructor and at UltraBrain Computer Institute of Technology as a PCB designer and an IT instructor. The other key member of the team is Femi, who is the Chief Technology Officer. Femi has attended several trainings as a certified developer, some of which include Interconnecting Cisco Networking Devices (ICND1), CCNA, Certified Information Systems Security Professional (CISSP), Ethical Hacking (Cyber Security), Diploma in HTML5, CSS3 and Javascript (Web Development) and Python. Having put together this strong team, Dr. Farombi are focused on delivering on their ambitious goals of providing easy accessibility to health care services and thus making people live a fuller and healthier life in Nigeria – and in future, the rest of Africa. TECHNOLOGY AT THE CORE Dr. Farombi notes that the company has a strong DNA and technology that make it stand out not only in Nigeria but in Africa at large, as a result of its pay-as-you-go service. She reiterates that other than the one-off or subscription model, the affordability of healthcare services on its platform allows a patient to consult any specialist of their choice with approximately US$5 per consultation. “We have over 130 doctors, which cuts across 28 specialties that ranges from dentists, ophthalmologists, obstetricians and gynecologists, ENT surgeons, orthopedic and trauma surgeons, neurologists, nephrologists among other specialties,” explains Dr. Temitope. Besides, O’Health has started a B2C operation in which it focuses on combing the grassroots areas in the country, where accessing health care services has been a daunting challenge.

O'Health team during one of their events

It has engaged the services of marketers, who in turn engaged customers one-to-one, enabling them to consult doctors with their smart phones seamlessly. However, the company’s 18-month journey has not been without setbacks. One of the challenges has been lack of smart phones among people to access doctors online. O’Health resolved this by setting up telemedicine centers in rural areas to enable people without smart phones to consult doctors. This was achieved when the company decided to train agents who man the centers. She adds that to enable them meet their goals, the company’s investment priorities in the past year have been towards strengthening its technology and infrastructure as well as employing experienced staff in key areas of growth to provide seamless access to its services – thereby positioning itself as a one-stop shop for healthcare needs through the application seamless technological services. “We are on the path to filling

We have over 130 doctors, which cuts across 28 specialties that ranges from dentists, ophthalmologists, obstetricians and gynecologists, ENT surgeons, orthopedic and trauma surgeons, neurologists, nephrologists among other specialties 34

MAY 2022 | HEALTHCARE AFRICA

HEALTHCAREAFRICA.INFO

the gap and reducing the effect of lack access to healthcare, as well as strategic partnerships across the countries.” A SUSTAINABLE FUTURE Currently, the company offers primarily teleconsultation, online pharmacy, e-insurance, laboratory bookings, electronic medical record (EMR) and preventive health package for men and women. In the next five years, Dr. Farombi informs us that they look forward to expand O’Health services into other west and east Africa countries. O’Health currently serves the Nigerian market of over 200 million people and looks forward to spreading its wings across Africa, a market of about 1.5 billion people in the next five years. The telemedicine company is seeking new ways to adopt various methods to meet the raising need for more sustainable business operations and a better cleaner planet. It is gradually getting to automate its services and also adapt to the post COVID-19 way of doing business to expand its reach. The company has managed to organize and attend outreach activities in the country, where we its staff give free health talks, conduct basic health checkups on the spot and provide on-site consultation with its doctor on the ground at little or no cost. For those who need further evaluation the company schedules consultation time for HEALTHCAREAFRICA.INFO

them at an affordable cost and also provide an e-insurance platform for them to enroll. By doing this, the company has contributed to improving the health of the local communities, which translates to personal and economic growth for Nigeria. Due to its focus and implementation of an elaborate healthcare plan, O’Health has received various accolades for its unique and devotional way of doing things. Among the awards is The Global Start-up Ecosystem Award as well as the Future Female Entrepreneur of the Year Award, which was bestowed upon Dr. Farombi. The company’s key priority areas over the next five years include building and strengthening its technological infrastructure for a wide usage, increasing its reach to rural environments where there is little or no internet facility, as well as expanding into the emergency response care. Once these ambitious goals are achieved, it will seek further expansion out into other countries in Africa. As far as potential sources of funding for future growth are concerned, the company is considering taking Government investment/ funding and Angel investment. She reiterates that as a growing innovator in the healthcare sector, O’Health has potential to diversify and reach the unreached through advanced services and technologies, adding that it also has potential to change the healthcare system through advocacy, awareness creation and engagement with policy makers for enactment of the right regulations that will lead to better healthcare indices in Nigeria for its growing population. With the likes young, tech-savvy startups like O’Health, African countries stand to gain economically as a result of improved and affordable healthcare, thereby going a long way to realizing the Universal Health Coverage, which is gaining traction across the Continent.

The company’s key priority areas over the next five years include building and strengthening its technological infrastructure, increasing its reach to rural environments, and expanding into the emergency response care.

O'Health mobile app MAY 2022 | HEALTHCARE AFRICA

ETIHAD

CARGO

Bridging the logistics gap in global immunization against COVID-19 By Benjamin Opuko

COMPANY: Etihad Cargo COUNTRY: UAE WEBSITE: www.etihadcargo.com

EMAIL: Cargocontact@ etihad.ae TELEPHONE: +971 2 599 0099 36

fter only 16 years of flying, Etihad Cargo, the cargo and logistics arm of Etihad Aviation Group, found itself in a precarious situation when the Covid-19 pandemic struck in 2020. Instead of scaling down operations, the company co-founded the Hope Consortium, a UAE-based public-private partnership aimed at promoting the global availability of COVID-19 vaccines. We interviewed the manager of Global Cool Chain Solutions, Etihad Cargo, Mr. Fabrice Panza, on what it takes to fly critical medical supplies to an extensive destination network that includes Africa, America, Asia, Australia, Europe and the Middle East. HCA: what was the gap in the market that your company was meant to fill during the covid-19 pandemic? MR. PANZA: Etihad Cargo is a customercentric organization. When the pandemic took the globe by storm in early 2020, we championed our commitment to continue delivering for our customers. The national carrier operated Mini Freighter series even though all passenger flights were suspended. Through Etihad Cargo’s ever-expanding portfolio of partnerships and collaborations, the HOPE Consortium played a significant role

in meeting global vaccine demand amidst the challenges that rocked the aviation supply chain. Utilising our specialised products, network, fleet and belly capacity, we worked closely with our partners and managed COVID-19 challenges by facilitating the movement of vaccines and medications treatments worldwide to support the global market demand. Despite the challenges, the dedication of our team and trusted collaboration with partners and stakeholders resulted in an outstanding performance across Etihad cargo operations. Hca: what products and services does your company offer? MR. PANZA: The carrier’s premium cool chain products include its award-winning PharmaLife, which leverages investment in specially designed, temperature-controlled equipment and assets to ship pharmaceuticals swiftly while complying to the highest industry standards. Another product is FreshForward, which simplifies the movement of fresh fruit, vegetables, dairy, fish, meat, and flowers, as well as LiveAnimals and SkyStables, the specialist products for the speedy and safe transportation of animals and horses respectively. Other premium products whose delivery will be in heightened focus include FlightValet, which simplifies and speeds up the door-to-door global

FABRICE PANZA Manager - Global Chain Solutions, Etihad Cargo

HEALTHCAREAFRICA.INFO

MAY 2022 | HEALTHCARE AFRICA

COMPANY FEATURE: Etihad Cargo

Attendant loading Etihad Cargo dedicated freighter

Etihad Cargo is the only Middle East airline to hold IATA’s CEIV Live Animals, CEIV Fresh, and CEIV Pharma certifications,

transportation of high-value vehicles, FlyCulture, the tailored service for the secure and discreet transportation of rare and valuable art works and musical instruments, and SafeGuard, the dedicated secure transportation service for valuable cargo. Lastly, AirMail simplifies the global dispatch of letters and packages for registered businesses. Etihad Cargo is the only Middle East airline to hold IATA’s CEIV Live Animals, CEIV Fresh, and CEIV Pharma certifications, reinforcing its position as the region’s leading certified international air cargo carrier. Hca: what are some of the key achievements your business has managed so far? What have been some of the learnings from these achievements? MR. PANZA: Etihad Cargo acquired UAE General Civil Aviation Authority approval to expand dry ice carrying capabilities across our Boeing Dreamliner and Boeing 777 fleet, which has supported the carrier’s ability to handle vaccines including Pfizer, Moderna, and Sputnik, all of which need to be stored between -70°C to -18°C. In collaboration with the Hope Consortium, Etihad Cargo played a crucial part in the creation of a pharma air corridor between the UAE

MAY 2022 | HEALTHCARE AFRICA

capital and Belgium, prompting operational and regulatory change internationally.” As a co-founder of the HOPE Consortium, we have highly contributive in the handling of more than 250 million vaccines doses in less than 18 months, this has been possible through an important, intense, and fully transparent collaboration with all stakeholders of the pharma supply chain. It has been an incredible journey till date marked by vaccines distribution in more than 40 different countries, where we directly engaged with local pharma supply chain in anticipating the flows by providing specific equipment and devices such as PPE and also freezers alongside assuring an appropriate training have been delivered. The carrier also reconfigured five aircraft for cargo in-cabin loading, supported customers, as well as UAE Government aid programmes, and collaborated with UNICEF on pharma and aid initiatives, utilising its pharmaceutical expertise and global connectivity. We currently operate across more than 1,100 IATA CEIV Pharma/GDP certified trade lanes, which ensure the integrity of products during transportation and our expertise in this sector has resulted in reporting a 45 per cent year-onyear rise in pharma shipments in 2021 under our HEALTHCAREAFRICA.INFO

agreement with SPEEDCARGO to utilise its Artificial Intelligence (AI) products to boost cargo capacity on flights as only the second aviation company worldwide to leverage the CARGO EYE dimensioning system. HCA: What was your role in covid-19 vaccine distribution in africa MR. PANZA: World Health Organisation illustrated the need for additional airlift into Africa to support a vaccination drive across the continent, and so it was natural for us to evaluate how we could provide this. We already had a strong network of flights into Egypt, Kenya, Morrocco, and South Africa, and through our SLA agreement with Astral Aviation and Kenya Airways we will be able to aid and support the African market. Etihad Cargo is committed to providing the best solutions and features in the market when we have challenges with certain destinations and the pandemic has placed an emphasis on the requirement for collaboration in the global fight against COVID-19.

specialised PharmaLife product. HCA: Highlight any external partners you have worked with to help deliver on your organization’s goals and the roles that each of them played. MR. PANZA: Etihad Cargo provides tailored solutions to handle all temperature-control requirements from -80°C through to +25°C. We have worked with a number of Unit Load Device (ULD) manufacturers to develop containers that maintain temperature parameters including Envirotainer, Csafe, Dokasch, and Va–Q-tec to offer premium leasing options for pharmaceutical and life science shipments. Our active and hybrid solutions mean that shipments are always stored and transported safely and securely at the correct temperature and provide ourselves and our customers with real-time monitoring and tracking. Our third-party partnerships, which include the introduction of Validade, online booking platforms, and other initiatives such as Cargo. One, Cargo.Ai and WebCargo by Freightos have presented additional convenience and visibility for our customers, which remains a core focus for our digitalisation strategy. We have also entered into a Proof-of-Concept HEALTHCAREAFRICA.INFO

HCA: What is the role of technology in your company and how have you used it to grow? MR. PANZA: Technology continues to play a vital role in cargo and logistics and has become a pillar of support throughout the pandemic. We have worked closely with a number of technology partners to support our digitalisation ambitions

ETIHAD CARGO IS COMMITTED TO PROVIDING THE BEST SOLUTIONS AND FEATURES IN THE MARKET WHEN WE HAVE CHALLENGES WITH CERTAIN DESTINATIONS

MAY 2022 | HEALTHCARE AFRICA

COMPANY FEATURE: Etihad Cargo

Etihad cargo freighter airplane belly

Etihad also has an ergonomic website, which has optimized the users experience with handsome returns.

whether it be through connectivity, enhanced data sharing, or streamlining processes. The innovation of active and hybrid container suppliers is providing a valuable data tool, which has supported both ourselves and our customers to be able to monitor, track and record important temperature and location data throughout the airline ecosystem. Other advancements have included Online Lane Risk Assessment, Online SOP, and Online Tracking, each of which have contributed to our ability as a carrier to create and enhance our compliant and transparent Pharma Corridors across our network. Over the past year, the carrier has been laser-focused on boosting its digital presence and capabilities with investment in a series of initiatives and transformation programmes. The Cargo Control Center, which is built upon the iCargo SPRINT system technology has enabled the airline to establish the nerve centre for 24hour real-time monitoring, tracking and active management of all shipments, flights, and UAE road feeder services. Etihad also has an ergonomic website, which has optimized the users experience with handsome returns. The new-look website now includes quicker booking processes, streamlined flows, and a personalized dashboard for targeted recommendations and dynamic pricing. This resulted in receiving more than 1,500 bookings from 600 users during its first week, while users of the new portal have increased 70 per cent on its previous. We have also worked with leading third parties to introduce additional booking platforms to support its own direct booking functions through a revamped website and the Etihad Cargo mobile app.

and adapt to disruptive technologies in the healthcare industry? MR. PANZA: In collaboration with the Hope Consortium, the National Carrier has played a crucial part in the creation of a pharma air corridor between the UAE capital and Belgium, prompting operational and regulatory change internationally and bringing full transparency on the supply chain by using IoT and secure data sharing. As discussed, Etihad Cargo has partnered with third party booking portals to provide the most convenient solutions to our customers. In addition to the Proof-of-Concept agreement with SPEEDCARGO. HCA: What are some of the opportunities and challenges that your company sees in the healthcare industry and how do you intend to take advantage of them to enable your business to thrive in the marketplace, now and into the future? MR. PANZA: As an IATA CEIV Pharma certified carrier, and a recognised industry leader, accommodating these requirements during the COVID-19 pandemic was not new to us, and through our dedicated cool chain solutions within our hub and on our aircraft, we have continued to provide service excellence for all pharmaceutical shipments. In addition to our certification, Etihad Cargo actively participates into associations such as pharma.aero, the Cool Chain Association, and IATA. Through our involvement, we are working closely with all stakeholders to share experiences and explore new innovations as a collective which further elevates the whole industry’s capabilities. Our customers and stakeholders are at the core of everything we do, and we will continue driving our innovation, so we remain their air cargo partner of choice.

HCA: Wow are you strategizing to face 40

MAY 2022 | HEALTHCARE AFRICA

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A SPECIAL PAVILION AT

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COMPANY FEATURE: Penda Health

DR.MERCY MWANGANGI Chief Administrative Secretary(CAS) Ministry of Health, Kenya

MAY 2022 | HEALTHCARE AFRICA

HEALTHCAREAFRICA.INFO

UHC AND COVID-19 RESPONSE Lay Foundation For Better Health IN KENYA Dr. Mercy Mwangangi, Kenya’s Ministry of Health's Chief Administrative Secretary (CAS) is a passionate health economist. The Health Care Africa team had a chat with Dr. Mwangangi on Kenya’s fight against Covid-19 and its journey towards attainment of Universal Health Coverage.

hat is the role of the Chief Administrative Secretary (CAS) in the Ministry of Health? DR. MWANGANGI: My role as the Chief Administrative Secretary ensures that the Office of the Cabinet Secretary for Health gets additional support to discharge its mandate. My key terms of reference include overseeing communications to ensure we relay government agenda to the public. I also interact with the public to get feedback on what gaps are there and what needs to be done at the community and grassroots level. I also foster partnerships with different stakeholders – it is up to my office to engage with the private sector in the ministry. I have a heavy leaning towards health financing. By training, I am a health economist and policy analyst and so, beyond my mandated tasks, I do also engage a lot with the National Health Insurance Fund (NHIF) on the universal health care program. I also engage in health financing architecture interventions within the health sector as an area of my specialty to bring technical expertise. What are some of the reasons kenya was successful in its response to mitigate the covid-19 pandemic? DR. MWANGANGI: Before March 2020, the government already had in place a response plan for pandemics. Two years before March 2020, Kenya had sent a team to the Ebola response in West Africa. We therefore had the benefit of having close to 30 officers who had experience with a viral outbreak and our teams were on their toes immediately the pandemic was confirmed HEALTHCAREAFRICA.INFO

in the country. The ministry also had disease surveillance units that had been in existence for quite a while and a National Strategic Preparedness & Pandemic Response Plan. The only disadvantage that we had, and which was similar to that of the rest of the countries across the world, was that this was a new disease which required of us to deal with it without having a lot of knowledge on what we were dealing with. From the onset, under the leadership of the Minister of Health Mutahi Kagwe, we quickly put into place teams that specifically dove deep into dealing with the COVID-19 pandemic. President Uhuru Kenyatta also took upon himself to secure the country - he ensured we had the facilities we needed for isolation and most importantly, even to have the structures that were set and put in place beyond what we had even envisioned ourselves as the Ministry in our strategic plan for preparedness. We had other ministries sitting around the table with us, elevating the pandemic to a threat of national security and we had other subsidiary structures that were supporting us. I think that is one of the reasons that the response in Kenya was so successful. We must also appreciate the Harambee culture in Kenya - we had a lot of support, not just financial support, even just man hours from all sectors of society who came forward and wanted to help in fighting the pandemic. We actually ended up then forming a third tier of governance structure for the pandemic response, where we had active participation from the private sector, not just the healthcare related ones but non-health actors such as banks and manufacturing, soap and communication companies. Architectural firms

By Loraine Wangui

NAME: Dr. Mercy Mwangangi

CURRENT ROLE: Chief Administartive Secretary, Ministry of Health Kenya COUNTRY: Kenya SECTOR: Health

MAY 2022 | HEALTHCARE AFRICA

EXECUTIVE INTERVIEW: Dr. Mercy Mwangangi

When COVID struck we had to then invest in what was needed for COVID-19, which included human resources. We were lucky because we had already secured some financing for our UHC program to post healthcare workers to primary health care centers across the country. What we did is that we then reconfigured that staff, who then ended up serving in the COVID-19 response.

stepped forward to assist us, most of the time on voluntary basis. Even the call center is that we were running our activities from was sponsored by private sector players. Before COVID struck, Kenya was in deep planning and was just about to execute the national scale-up of the Universal Health Coverage (UHC) program. At that point, the focus was on looking at the health system and determining if it was ready and strong enough to offer services to those in need. 44

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What are some of the lessons learnt from the pandemic so far? DR. MWANGANGI: COVID-19 reminded us that tertiary services are very important: the primary health care level is the foundation of our system but that does not mean that we then completely forget about the tertiary system. When investing in COVID, we found gaps in our specialized services. For example, we did have ICU infrastructure that was primarily skewed to the urban areas and it was clear that we were required to invest in ICU facilities, which are very expensive. However, the bed is useless without an intensive care specialist, which at the time, we only had about 40-50 in the country. Further, we needed to have specialist nurses, which in the middle of the pandemic, we had to use what we had, since we didn’t have four years to train new staff. We did lot of innovations by clustering our medical staff together for basic on-the-job trainings. We learned clearly from the pandemic that we must invest in specialists across the country. We have now put in place budgets to recruit and train more specialist nurses as well - nurses became a very rare commodity during the pandemic. Again, there were also lessons learned of the need of investing in oxygen capacities in Kenya. As we speak, every county now has a plant and we have more than tripled our reserves in terms of liters of oxygen in the country. Another key element that became very clear was the need to invest in health promotion. This, together with preventive medicine as well as behavior change. Communication in health became absolutely crucial to meet the needs of the health system. The pandemic also shone a light towards other areas we needed to invest in such as mental health. There are increased cases of gender-based violence and mental health disease manifested in different forms such as depression, anxiety, etc. The ministry is clear that this is a field that requires more investments and we are setting up six regional centers across the country that will be offering specialist mental HEALTHCAREAFRICA.INFO

health services. We also plan to relocate the Mathari Referral & Teaching Hospital to Karen area and we shall build right next to it a neuropsychiatric teaching unit and community outreach activities. In Kenya, for the first time ever, we recognized technologists for all their years of practice in medicine. That was a cadre that was not recognized, at least in the schemes of service and the Minister of Health. But with the advent of COVID, we were able to employ scores of them and we posted them to the counties. Additionally, a bigger success through the efforts of the President was the realization that to protect a country’s sovereignty, a country needs to be self-reliant. We are currently putting together our own local manufacturing initiatives, not just for the COVID vaccine, but also identifying strategic commodities that are required locally. I think also there was a new understanding as to what neighborliness means. We learned diseases don't respect borders - both internally and externally. There has been a strengthening of international relations - there are collaborative teams working with all our neighboring countries to deal with the pandemic and beyond. As a result, we currently we have laboratories that are shared within the East African community that are able to perform some of the essential services. We have treaties or agreements that have been strengthened and there is more collaboration and partnership in the region. The pandemic has also highlighted the necessity to invest in mortuary services, for they have received little investment over the years. End-of-life services are a key part of our health system and during this crisis, we have seen and understood what is needed in terms of investments and the urgency to capture deaths better in the country. What is the importance of the right health financing system in response to Covid-19? DR. MWANGANGI: What we saw and what we experienced during the pandemic as a country has been very positive: health budgets went up. We have many advocacy mantras and one of them is that the health sector should get 16% of total government budgets, or 5% of GDP. Health advocates have over the years called

on governments to invest more in health in Africa. Perhaps, then COVID-19 was the tragedy that was needed to make this happen internally. Some experts, however, say there was disinvestment in certain essential services in health - we stopped surgeries at some point and had disruptions in HIV, TB and malaria care, with adverse supply chain challenges on some key malaria commodities. Some of these resources, due to the emergency nature of Covid-19, had to be reprogrammed to ensure that they went into funding interventions in COVID-19 crisis. We needed to get certain materials such as masks to support our health care workers. We needed health information systems, commodities, ambulances etc. There was heavy logistical work needed and then later, vaccines were needed, but government investments went beyond the health sector. The government made investments in such areas as transport and offered social protection to its people - the investments in COVID-19 were huge and they were across all government sectors. So, what does it look like now in terms of financing? We are trying to go back to continuing our essential services. Therefore, some of the money that was channeled through different programs into the pandemic is being redirected back into the strategic programs such as HIV, TB, malaria and immunization. We are also putting in place new infrastructure that will enable a more agile response to the next pandemic by institutionalizing our response. We have put together a structure, which will be like the Centre for Disease Control & Prevention (CDC) in USA. We will have our own Kenya CDC and have secured funds to put up that structure that would allow a more coordinated approach to dealing with pandemics of the future. There has been progress in the formulation of the african medicines agency. How does it create regional opportunities in pharma manufacturing? DR. MWANGANGI: The situation of commodity security - having the medicines and non-pharmaceuticals that you require in the country - was a big lesson in terms of COVID-19

IN KENYA, FOR THE FIRST TIME EVER, WE RECOGNIZED TECHNOLOGISTS FOR ALL THEIR YEARS OF PRACTICE IN MEDICINE. THAT WAS A CADRE THAT WAS NOT RECOGNIZED, AT LEAST IN THE SCHEMES OF SERVICE AND THE MINISTER OF HEALTH HEALTHCAREAFRICA.INFO

MAY/JUNE 2022 | HEALTHCARE AFRICA

EXECUTIVE INTERVIEW: Dr. Mercy Mwangangi

for all African governments. AMA, an initiative of African Union, was already underway before the pandemic, but it was strengthened during the pandemic. The idea of AMA is to leverage on the economies of scale by African countries coming together to create a larger market for medical supplies, since none of the countries would be able to do it alone - you would need to extend beyond the boundaries of your country into larger markets. There are discussions to decide which countries can specialize in different areas, that is still underway. Perhaps for me the biggest message is that we need to support this initiative since AMA provides us an opportunity to break some of the regulatory barriers that inhibit local pharma manufacturing in Africa. When it comes to commodities and pharmaceuticals for that matter, there are many trade conventions that's come into play. There is a lot of geopolitics that comes into play and so AMA is required to shepherd Africa through that process. It is a renaissance period for Africa, for Kenya. I think the benefits of AMA will be appreciated, maybe not by ourselves. 15, 20, 30 years from now, people will appreciate this initiative because it is a revolution in terms of pharma manufacturing and in Africa on our quest for self-reliance. What is the progress in implementing the UHC program in Kenya? DR. MWANGANGI: The idea of UHC is that every citizen should access health care that they need when they need it and that they should do so without incurring financial strain or difficulty. However, an important aspect of this is that UHC services must be of good quality because it's easy to churn out services, but then they should not be poor quality services. In Kenya, the way we have envisioned UHC is that we shall invest and strengthen the primary health care system and then bolster this with investments in NHIF as the vehicle for UHC. NHIF has been identified as the most sustainable mechanism of effecting UHC in Kenya because it will work as the bank that will work closely with patients to ensure that every Kenyan gets the health services needed. It will ensure that when patients need a service, they are able to get it. It will also have the responsibility to ensure providers give good quality services. NHIF is almost as old as our country. It came into being in 1965 and the organization has matured over the years. It is the largest health provider of insurance in Kenya, with its revenues almost coming to almost KSH. 80 billion (US$695 million) per year, which is twice that of the private medical insurance market in Kenya. Hence, it’s the needed instrument that that government requires to implement the UHC program. With the scale up of the UHC program by the President recently, the fund will need to have the capacity to serve 47 million Kenyans, from its current 25 million – it therefore almost needs to double its internal infrastructure to serve all Kenyans. 46

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Further, one of the biggest successes even beyond our handling of COVID-19 for the Minsitry is the passing of the NHIF Amendment Bill, which was championed by the Cabinet Secretary Mutahi Kagwe and the President. The bill mandates that every Kenyan should be insured and under a form of medical cover, with NHIF doing statutory deductions. We are undergoing public participation and then discussions with the houses of parliament to ensure that the bill is implemented. The beauty of this Bill is that for the first time there's accountability in that Kenyans will have a social contract with government that when they pay, they will get the service and that for Kenyans who cannot afford to pay, for the first-time again, government will take responsibility and will pay for them and also ensure that patients get good quality service. Additionally, measures will be put in place through social protection services and the Ministry of Labor and County Governments to identify households that are not able to pay - we have already identified 1.1 million households who cannot pay, while we intend to cover the 5.2 million households who are in this group. Through this law, successive governments will be mandated to ensure that every poor Kenyan is covered. This is why I say this is a legacy project for the President because he made it happen. There are also many reforms within the initiative that are going to deal with fraud, wastage and leakage – for the first time, a health provider will be held liable and not just the hospital in case of any issues. We have also implemented a biometric system, which has elicited a lot of controversy when we were putting it together. But for the first time now, if you have two wives, they have to be identified as two different households. What we do HEALTHCAREAFRICA.INFO

see eventually is that NHIF will grow to be an organization that will deliver quality services with more efficiency. What are some opportunities for healthcare workers realized during the Covid-19 pandemic? DR. MWANGANGI: The human resource question is one that came to the forefront during COVID-19. Across the world, HR was identified as such a strategic resource that different countries are brainstorming plans and strategies on how to increase their human resources and to make it more productive and more available. We do actually have a commission at the African Union (AU) that is looking at investments in human resources for health and the return of that investment and therefore HR investments are at the center of all governments right now in Africa. In Kenya we realize that HR is a scarce resource. It is also a resource that takes a lot to invest in, with most specialties taking at least an average of four years to get the final product. Further, for the specialized ones, it could take 10-12 years to get that resource working. It is clear that we must put in place mechanisms to incentivize, award and enumerate this resource that it is available to us to get the best return of our investments. Additionally, efficiencies are required in how we deploy the resource and how HEALTHCAREAFRICA.INFO

the resource can meet its objectives. During COVID-19, we also came to learn that Kenya is blessed since we have already invested in our HR and that there's now need to look at the transferability of the service across and outside of our borders, not only the East African community and but even beyond. We hosted a health workforce conference in Mombasa in February 2022, where we invited all of the East African community countries and we discussed the issues. We agreed that we need to harmonize curricula across the region because once we do that, then a nurse from Kenya, Ghana or Nigeria can move and offer that service anywhere. Secondly, we agreed on the need to be clear on the scope of work. What does a nurse or radiologist do? Those are some of the emerging issues that need to be looked at. Further, we talked about labor movements and we asked ourselves, “how do we ensure that this resource is not wasted, particularly because of constraints in the fiscal space?” We are not able to hire everyone that we train as government and the private sector is not able to hire the remainder. There are discussions to ensure that these healthcare workers are fit for purpose to deliver on UHC, but to also move across the world. As a country we are in that space where if we do have a nurse or a doctor that was trained and has not been deployed internally, we are working to see how we can look at other markets outside of Kenya. Already outside of government efforts, workers from Kenya have often migrated to other parts of the world. What we want to do is to then have government participate in this process, while still ensuring that we are not suffering from brain drain. We are investing in our own internal facilities to absorb more trained personnel, but also allowing the opportunity for young people to grow and to access opportunities across the world. What final word do you have for young people pursuing different professions outside or in the health sector? DR. MWANGANGI: I am a believer that opportunities are available and young people just need to prepare themselves for those opportunities. There's a lot of work that needs to go in the background for you to ready yourself, but those opportunities require good investments in school.

One of the biggest successes even beyond our handling of COVID-19 for the Minsitry is the passing of the NHIF Amendment Bill, which was championed by the Cabinet Secretary Mutahi Kagwe and the President.

MAY/JUNE 2022 | HEALTHCARE AFRICA

MAY 2022 | HEALTHCARE AFRICA

HEALTHCAREAFRICA.INFO

BUNGOMA’S Blood Donation ADVOCATE & Ambassador The First Lady of Bungoma County Mrs. Caroline Wangamati on her drive to ensure better healthcare in the county and her passion for blood donation

he distinguished First Lady of Bungoma County, Her Excellency Mrs. Caroline Wangamati is one of the front runners for public health in her county. She has spearheaded several projects in different parts of the county, including the empowerment of peripheral health facilities to enable accessibility to proper health care and has strongly advocated for increasing the blood bank in the county and Kenya. As she passionately speaks about her ardent desire to save lives through voluntary and regular blood donation especially by adults, we see the love and care of a mother in her towards her people. Caroline proves to be an iron lady obligated with the duty of proper service delivery to her people - the citizens of Bungoma County and Kenya as a whole. HCA: Please tell us a bit about yourself. CAROLINE: I am Caroline Wangamati, and I have had the honor to serve as the First Lady for Bungoma County for the last four years. As a First Lady I have been involved very strongly in matters pertaining to maternal and child health. HCA: Why are most First Ladies including the first lady of Kenya quite involved in health matters? CAROLINE: When you think of a common Kenyan citizen, one of the one of the challenges that has constantly remained unsolved is their health, partly caused by financial constraints. HEALTHCAREAFRICA.INFO

We are a lower income country, so we haven’t put sufficient money into health and most people struggle to access the healthcare that they need. As such we do not have equity in access to care in the best hospitals or health facilities and mostly a lot of people in the rural parts of Kenya don’t have the access as you and I do. So, you find that as a First Lady, while your husband is busy worrying about improvement of infrastructure and all that, what comes naturally is the health of your people. How are your mothers? How are your children? It is an area that automatically draws you because it is a human story, a social story and it captivates your heart. And if you cannot get the people to be healthy then there’s no productivity you will get from them. I think that’s why most First Ladies go for health - be it cancer, teenage pregnancy, child immunization or maternal health. HCA: You are sitting in a very interesting position where you can influence and at the same time have access to lots of information about your county. Tell us about Bungoma County and the challenges of health, and specifically where blood challenges access is. CAROLINE: Bungoma County is the fifth most populated county after Nairobi, Kakamega, Nakuru and Kiambu. Earlier when health was not devolved, government policy did not take into consideration the various access issues in different corners of the county.

By Benjamin Opuko

NAME: Mrs. Caroline Wangamati CURRENT ROLE: Blood Donation Ambassador COUNTRY: Kenya SECTOR: Health

MAY 2022 | HEALTHCARE AFRICA

EXECUTIVE INTERVIEW: Mrs. Caroline Wangamati

strengthen the peripheral facilities and make sure they can offer emergency care to mothers. So far, I’m very proud because we have been able to install theatres in six of the nine hospitals in the county and they are now able to attend to maternal emergencies. When I think about blood, blood was not devolved because it is an essential and a sensitive product. You need to think quality and make sure that you are not spreading diseases through blood instead of saving lives, so I fully understand the decision around not devolving blood supply in Kenya but it is still an essential commodity. The national number of postpartum hemorrhage mortalities was at 40% and in my county, it was at 50% at the time we took leadership. Therefore, as the First Lady I didn’t have a choice in advocating for blood as an essential commodity in saving lives. It was instinctive and natural for me to go into the blood space to make sure we have sufficient blood in our county. I have gone to schools, markets, street barazas to speak about blood because availability of sufficient blood starts with you and me actually donating blood. Most people only donate blood while in high school, which is very bad.

The national number of postpartum hemorrhage mortalities was at 40% and in my county, it was at 50% at the time we took leadership.

In Bungoma County, for instance, a mother that is trying to give birth in Mount Elgon faces very different challenges compared to a mother trying to give birth in Bumula, which are in the same county. One of the things I highly celebrate about devolution is that it has given the chance for a particular governor for a particular county to address the various health challenges in the area. For example, access to health care in Mount Elgon, which has a terrain issue and Bumula, which has a poverty issue require very different approaches. Hence, the governor is able to look at the problems differently and sort them out accordingly. When I first got very close to this story, I realized that we have centered all our care in one big facility in the county and not empowered the peripheral facilities. Take maternal care for instance - most women give birth at night or on weekends and thus they need to access the health facility during these times. When they go to the referral hospital in the county, they find it congested but the peripheral facilities are more or less idle. My advice is that if we would like to offer easy access to health care in a county, we must

MAY/JUNE 2022 | HEALTHCARE AFRICA

HCA: You’ve done some work in terms of enabling more people to donate blood in your county, talk to us about that. CAROLINE: Blood starts with a donor, and I have always believed that somebody needs to inform the potential donor that it is good to donate the blood. A lot of adults walking around in this country don’t know that they are having a life-saving product in their bodies. So, we first need to tell people because every time I have spoken to someone who doesn’t know about this they are surprised and say, “Why hasn’t anyone told me that?” We can’t manufacture blood; it has to come from you to me in a particular process. But you need to explain to someone that if they donate blood, it could help another person who could bleed to death. Secondly, because people are busy, someone needs to remind them to come in and donate some blood and that they can come with two or three other friends. What we have tried to do in the county is to mobilize people, be it through football or other ways. These initiatives are very powerful in rural areas, including the very popular radio greetings clubs in western Kenya. Our target donor is a mature adult who is able to give consent to be a regular donor and not just high school donors, HEALTHCAREAFRICA.INFO

FROM WHERE I SIT, THERE IS STILL ROOM TO DO MORE BUT WE ARE ON A VERY GOOD TRAJECTORY AND I WANT TO CONGRATULATE THE KENYA NATIONAL BLOOD TRANSFUSION SERVICE who are minors. In Bungoma I think we have tried – I was very impressed: in one of the months, we moved from 2% non-school donors to 68% and I was very proud. I also like the support from the national government because they are giving us the consumables more regularly. We receive the blood bags and refreshments on time and we are able to do more outreach and get in more blood. From where I sit, there is still room to do more but we are on a very good trajectory and I want to congratulate the Kenya National Blood Transfusion Service because they have done a good job. Looking at the numbers today, we are almost hitting 300,000 donors and as a country we should be targeting 450,000 which is about 1% of the national population. I see us getting there with the work that’s being done and it is just working on the donor management, trying to get more donors, retaining the ones we have, trying to recruit the adult donors and moving away from the high school children who are not able to give consent and who only are donating because of the soda and the loaf of bread provided.

use the loud people like myself to pass on this message. I cannot donate blood because my kilos are never right but I’m very loud at this because again, if we put out champions that can attract people into it, it’s going to make a huge difference. HCA: And those champions are not, like you said just political leaders? CAROLINE: Yes! In fact, personally I think you and I are too old to be champions. We need the cool kids on the streets. We need the musicians, the religious leaders. I would love to get the boda-boda (motorcycle) riders because leadership is not about political leadership, leadership cuts across all spheres. And let’s get champions from all these spheres and anybody who can do advocacy. I would love governors to take up advocacy, they don’t have to be donors themselves but they can talk about it. I would love the President to speak about it! We need to saturate the media with stories about blood because most people are not informed that they need to donate blood and we need to try and get them to know that its good and important to donate blood.

HCA: Figures from the KNBTS indicate that for the first time Kenya managed to surpass the target of blood donations, without donor money. It is really impressive that we could achieve this milestone! CAROLINE: Absolutely! It gives me so much hope because for the first time we even surpassed the numbers we attained when we had PEPFAR funding. This tells us we can do it: we are sustainable and with consistent effort, we can have sufficient blood for our population. It will be our own solution and that’s what always makes me a very proud African girl, that we can do it ourselves, for our own people. And you should HEALTHCAREAFRICA.INFO

MAY/JUNE 2022 | HEALTHCARE AFRICA

COMPANY FEATURE: Penda Health

COUNTRY

FOCUS:

Zambia

Prioritizing health service provision as a pathway to achieving middle income status by 2030 By HealthCare Africa Team

ambia is a landlocked country in Southern Africa and covers a total area of 752,612 square kilometers. As a lower middle-income country with a population of about 17 million people and a population growth rate of about 3% per annum, the country has been implementing the Vision 2030 Long-Term Plan since 2006. This is aimed at transforming Zambia into a prosperous middle-income nation by 2030. The successful attainment of Zambia’s goal of being a prosperous, middle-income country by 2030 as stipulated in its Vision 2030 begins with transforming the country into a nation of healthy and productive people. Therefore, the Government of the Republic of Zambia (GRZ) through the Ministry of Health (MOH) has continued to prioritize health service provision as a pathway to achieving this. The MOH’s focus is the provision of a continuum of care with particular emphasis placed on strengthening 52

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health systems and services using the primary health care (PHC) approach. PUBLIC AND PRIVATE SECTOR TEAM UP TO BOOST HEALTH Health services in Zambia are provided by four main players: the Government, faith based (notfor-profit) providers, the mines, and private (forprofit) providers. The public sector is the biggest health provider with 90% of patients seeking care in facilities owned and run by the Government. The Lusakabased University Teaching Hospital, with a 1655bed capacity is the largest public tertiary hospital in the country. It functions as a referral center for serious health conditions and is particularly specialized in general surgery, pediatrics and gynecology. Other major third-level hospitals include the 826-bed Levy Mwanawasa University Teaching Hospital and the 630-bed capacity Kitwe Central HEALTHCAREAFRICA.INFO

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MAY/JUNE 2022 | HEALTHCARE AFRICA

COUNTRY FOCUS: Zambia

Hospital. In total, Zambia has eight third-level hospitals, 34 second-level hospitals, 99 first-level hospitals, 1,839 health centers and 953 health posts. All third-level hospitals are Government owned. The private sector also has a significant contribution to Zambia’s health care with its wide network of hospitals and clinics. Some of the notable health facilities include the CFB Medical Centre, a private non-profit health provider with over 35-years of operation in Zambia, the Progress Medical Centre, and the Mary Begg Community Clinic, which has grown into a Class A private hospital offering specialized services in general surgery, urology, dermatology, pediatrics, gynecology and dentistry. A new entrant into Zambia’s private sector is Medland Hospital, which offers a range of specialized care to the country’s growing, increasingly urbanized population. Specialized private hospitals such as Dr. Agarwal’s Eye Hospital and Vision Care Appasamy Eye Hospital also exist to boost access to specialized care. Faith-based organizations have also invested in healthcare to boost access to proper healthcare services especially serving communities in rural and hard-to-reach areas. Notable facilities include the Coptic Hospital, which provides specialized treatment in neurology, nephrology, cardiology, gynecology, dentistry and general surgery, the Lusaka eye Hospital and the Chitokoloki Hospital in the Zambezi region. Even with support from private and faith-based organizations, the national government is responsible for overall coordination and management, policy formulation, strategic planning and resource mobilization. Several agencies 54

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under the Ministry of Health exist to regulate and coordinate activities in the health sector. The Health Professionals Council of Zambia has the mandate to register and regulate all Health facilities in Zambia both public and private training institutions. Meanwhile, the Zambia Medicine Regulatory Authority (ZAMRA) is tasked with the role of ensuring that all medicines and allied substances being made available to the public consistently meet the set standards of quality, safety and efficacy. The National Health Research

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Authority (NHRA) is mandated to provide a regulatory framework for the development, regulation, financing, coordination of Health research to ensure the standards and guidelines for ethically sound health research in Zambia. HEALTH CARE FINANCING Zambia’s health expenditure is mainly dominated by external funding (42%), followed by general taxes (39%) and out-of-pocket payments (13%). The Government allocation to the health sector in nominal terms has been increasing even though the share of the health sector budget to national budget has been decreasing over the past five years. The proportion of the MOH budget to the national budget was 9.9% in 2014, 9.6% in 2015 and 8.3% in 2016. Declining budgetary allocation keeps Zambia from meeting the target set by the Abuja Declaration of having 15% of government annual expenditure allocated to the health sector. Although budgetary contribution to health has been low, Zambia has made strides in health insurance to enhance access to care. In 2019, it implemented the National Health Insurance Scheme (NHIS) to ensuring sustainable, predictable, and dedicated financing for the health sector and financial risk cover for Zambians. The NHIS is based on the solidarity model, where the risk is redistributed from healthy individuals to sick ones, from the rich to the poor, from the young to the elderly, and from small families to large families. The introduction of the mandatory NHIS poses a threat to the existence of private health insurance (PHI) which was struggling even before the NHIS was introduce. For instance, in 2018, 3% of men were insured while only 2% of women had health insurance coverage. This represents a sharp decline in coverage, from 8 and 9% among women and men, respectively reported in the 2007 Zambia Demographic and Health Survey (ZDHS). Low rates of health insurance coverage imply that most Zambian citizens have to make direct out-of-pocket payments when they seek healthcare services or be catered for under government taxes. This makes them vulnerable to catastrophic health treatment costs and hampers any progress towards the achievement of Universal Health Care. TEAM EFFORTS HELPS DRIVE DOWN ZAMBIA DISEASE BURDEN Zambia has a high disease burden, particularly HEALTHCAREAFRICA.INFO

in terms of communicable diseases with a high prevalence of HIV/AIDS, tuberculosis, and sexually transmitted infections. The country is experiencing a widespread HIV/AIDS epidemic, with an estimated national prevalence of about 11.1 percent among adults (15-59 years) and 14.6 percent among children. Infection rates are highest in urban areas, and women are more likely than men to be infected. A recent study on district-level prevalence of HIV using Small-Area Estimation (SAE) concluded that highest HIV prevalence is found in districts near international borders, along major transit routes, and adjacent to other districts with high prevalence. HIV management has taken a team approach with a number of development partners chipping in to assist the government in taming the disease. The Global Fund to Fight AIDS, The U.S. President's Emergency Plan for AIDS Relief (PEPFAR), and the Center for Disease Control (CDC) have been some of the star players in this field. Because of the synergistic efforts by multisectoral players in fight against HIV/AIDS, the country managed to achieve the UNAIDS 90:90:90 targets in 2019. Annual HIV infections (for all ages) in Zambia have decreased from 60,000 in 2010 to 51,000 in 2019 while new infections among children aged 0-14 years have decreased from an estimated 10,000 in 2010 to 6,000 in 2019. AIDS-related deaths have also decreased significantly, from

Zambia’s health expenditure is mainly dominated by external funding (42%), followed by general taxes (39%) and outof-pocket payments (13%).

MAY/JUNE 2022 | HEALTHCARE AFRICA

COUNTRY FOCUS: Zambia

24,000 in 2010 to 19,000 in 2019, a 30% decrease. Zambia is now focusing on the 95:95:95 targets for 2030. Annual HIV infections (for all ages) in Zambia have decreased from 60,000 in 2010 to 51,000 in 2019. The number of new infections among children aged 0-14 years has decreased from an estimated 10,000 in 2010 to 6,000 in 2019. Annual AIDS-related deaths have also decreased significantly, from 24,000 in 2010 to 19,000 in 2019, a 30% decrease. Tuberculosis (TB) remains a public health concern. The increased incidence of TB can be attributed to the high HIV prevalence. Zambia is ranked 21st among the 30 high TB burden countries, with an estimated burden of 333 TB cases per 100,000 people (approximately 0.33%) in 2019. As a result, TB is one of the top five causes of morbidity and mortality, particularly among young and economically productive adults aged 15-49 years. The CDC is an active player in management of the disease and is assisting the MOH in improving TB testing platforms and increasing access to TB Preventive Therapy (TPT) for people living with HIV. Zambia also suffers from seasonal epidemics such as cholera, which are caused by unequal access to improved water sources, and poor solid waste management, among other factors. Outbreaks are most common during the rainy season. Between January 1977 and December 2018, Zambia experienced 29 cholera outbreaks ranging in size from 14 to 13,500 cases, with case fatality rates (CFR) ranging between 0.5 and 9.3 percent. The majority of cases occur in periurban areas of the densely populated Lusaka and Copperbelt provinces, as well as in rural fishing camps. Zambia has taken the bold and ambitious step of eliminating cholera in Zambia by 2025, well ahead of the global 2030 target. As a result, Zambia has developed its first country Multisectoral Cholera Elimination Plan (MCEP) 2019-2025, which aims to reduce cholera morbidity and mortality and, eventually eliminate cholera from the country. Malaria is also endemic in Zambia and has a year-round transmission pattern and remains the leading cause of outpatient attendance. The disease's burden has a seasonal pattern that is determined by environmental factors such as rainfall, vegetation, and temperature, among others. Although the incidence of malaria has decreased dramatically, there is significant intra-country variation with the northern parts of Zambia posting the highest prevalence 56

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rates followed by central and southern parts respectively. Zambia has also seen an increase in noncommunicable disease (NCD) cases over the years, particularly those related to hypertension, cardio-vascular disease, diabetes, and cancer. According to the 2018 WHO NCD country profiles, NCDs account for 29% of all deaths in Zambia. This is unacceptably high, given that the majority of these diseases can be reduced by changing four major behavioral risk factors for NCDs: tobacco use, harmful alcohol use, unhealthy diets, and physical inactivity. USING INCENTIVES TO ATTRACT PRIVATE SECTOR INVOLVEMENT Since 1992 the Government of Zambia has been implementing health reforms whose vision is to create environments that are conducive to health. The government for instance, made health sector is among the key sectors being targeted for private investment under the Strategic Action Initiative for Economic Development termed as Triangle of Hope (TOH). In 2007, Zambia identified medical services, manufacture of pharmaceutical products, medical laboratory services, diagnostic services, repair and maintenance of medical equipment, provision of laundry service to medical institutions, ambulance services and education & training (human resource for health development) as priority sectors for investment by the private sector. Additionally, Zambia has identified

Annual HIV infections (for all ages) in Zambia have decreased from 60,000 in 2010 to 51,000 in 2019.

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telemedicine, establishment of hi-tech hospitals for treatment of specialized cases, diagnostic centers, drugs logistics supply chain and storage, hospital fleet management and repair, laundry services, repair of medical equipment and training of health personnel (medical school and nursing school) as some of the areas ripe for Public Private sector partnerships. When it comes to pharmaceuticals, Zambia only has 7 manufacturing companies and approximately 50 trading companies. Most of these are engaged in the manufacturing of basic pharmaceutical medicines. The majority of drugs required under the essential drugs list are still being imported. In its quest to provide affordable good quality, safe and efficacious drugs the Zambian Government has extended its investment friendly incentives to the pharmaceutical manufacturing sector. There exists a 5-year tax holiday for existing and future manufacturers to help them establish and cement their presence in the country. Zambia has also waived import duties and taxes on all raw materials, printing and packaging material for the pharmaceutical manufacturing Industry. Import duties and taxes on capital expenditure for the pharmaceutical manufacturing and printing industry have also been waived in an effort to attract both foreign and local investment in drug manufacturing. DIGITALIZATION TO DRIVE ZAMBIA FUTURE HEALTH SPACE The ongoing COVID-19 pandemic shed a light on the importance of integrating digital technology in healthcare in order to provide effective interventions to patients for a sustainable tomorrow. The unveiling of e-health platform Dawa Health, has for instance shown the potential of digital health in accelerating Zambia’s journey to universal healthcare. The platform empowers mothers to receive remote maternal health while guiding them throughout the perinatal period via web, mobile, SMS and the platform’s audio/text chatbot. The launch of Venous, an integrated digital health management system is also heralding a new era for medical records management, where automation and operational efficiencies reign supreme. DelphiCare was also launched at the height of the pandemic to assist in delivery of care. The android app enables health workers to provide longitudinal, expert-level patient management through monitoring, screening for HEALTHCAREAFRICA.INFO

illness, recommending tests, interpreting results, advising on drugs and dosages, and suggesting follow-up. In total, Zambia’s health system is estimated to have 64 digital health tools, which combined, enhance access to healthcare and simultaneously strengthen the country’s health system. The space is also lucrative for investors. OPPORTUNITIES EXIST AMIDST IMMENSE CHALLENGES Amidst the immense challenges of poverty, low uptake of health insurance schemes, and declining share of the health sector budget to national budget, the country still presents opportunities for investment in healthcare. The country’s population, which is estimated at about 17.9 million is growing rapidly at 3% per year, resulting in the population doubling close every 25 years. This trend is expected to continue as the large youth population enters reproductive age creating demand for health care services that outstrips current demand. Private sector players thus have an opportunity to invest in health care facilities to tap into this demand. Setting up will equally

IN NUMBERS

THE NUMBER OF PHARMA MANUFACTURING COMPANIES IN ZAMBIA

not be cumbersome as the government has identified health as a priority sector and relaxed policies to incentivize private sector players. The opportunities in digital health can also not be overstated - the sector is simply too attractive to be ignored by any serious investor. Affordability will continue to be a challenge as most of the citizens are poor, but the national health insurance scheme also provides a great opportunity to provide capitation for hospitals and other health facilities providing services to citizens under the scheme. MAY/JUNE 2022 | HEALTHCARE AFRICA

ZAMBIA – FACTS & FIGURES

1.19

Physicians’ density: 1.19 physicians/1,000 population (2018)

19.1

Population: 19.1 million (July 2021 est.)

2.93

Population Growth: 2.93% (2021 est.)

34.86 Birth Rate: 34.86 births/1,000 population (2022 est.)

4.56

Total fertility rate: 4.56 children born/ woman (2022 est.) 58

MAY/JUNE 2022 | HEALTHCARE AFRICA

Zambia

ECONOMIC OVERVIEW Zambia is a lower middle-income sub-Saharan economy; major copper exporter; high public debt is held mostly by China; one of youngest and fastest growing labor forces; regional hydroelectricity exporter; rural poverty GDP (Purchasing Power Parity) - US$60.12 billion (2020 est.) GDP per capita (Purchasing Power Parity) $3,300 (2020 est.) Key Industries - Copper mining/processing, emerald mining, construction, foodstuffs, beverages, chemicals, textiles, fertilizer, horticulture Agricultural products - Sugarcane, cassava, maize, milk, vegetables, soybeans, beef, tobacco, wheat, groundnuts Exports $8.55 billion (2020 est.) Key Minerals - copper, gold, gemstones, sulfuric acid, raw sugar, tobacco (2019) Key Export partners: Switzerland 29%, China 16%, Namibia 12%, Democratic Republic of the Congo 9%, Singapore 5% (2019) Key Imports - $5.92 billion (2020 est.) - refined and crude petroleum, delivery trucks, gold, fertilizers (2019) Key Import partners: South Africa 29%, China 14%, UAE 12%, India 5% (2019) GEOGRAPHY Border countries (8): Angola 1,065 km; Botswana 0.15 km; Democratic Republic of the Congo 2,332 km; Malawi 847 km; Mozambique 439 km; Namibia 244 km; Tanzania 353 km; Zimbabwe 763 km Total Area: 752,618 sq km - land: 743,398 sq km; water: 9,220 sq km Climate: tropical; modified by altitude; rainy season (October to April) Natural Resources: copper, cobalt, zinc, lead, coal, emeralds, gold, silver, uranium, hydropower

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PEOPLE & SOCIETY Population Distribution: Zambia has one of the highest levels of urbanization in Africa; high density in the central area, particularly around the cities of Lusaka, Ndola, Kitwe, and Mufulira. Urban population: 45.8% of total population (2022) Rate of urbanization: 4.15% annual rate of change (2020-25 est.) Sex Ratio:1 male/female (2022 est.) Age Structure: 0-14 years: 45.74%; 15-24 years: 20.03%; 25-54 years: 28.96%; 55-64 years: 3.01%; 65 years and over: 2.27% Median age at birth: 19.2 years (among women 20-49 years) HIV/Aids – Adult prevalence rate: 11.1% (2020 est.) HIV/AIDS – People Living with: 1.5 million (2020 est.) HIV/Aids deaths: 24,000 (2020 est.) Maternal mortality ratio: 213 deaths/100,000 live births (2017 est.) Infant mortality Rate: total: 37.11 deaths/1,000 live births; male: 40.57 deaths/1,000 live births; female: 33.55 deaths/1,000 live births (2022 est.) Life expectancy at birth: total population: 66.26 years; male: 64.52 years; female: 68.06 years (2022 est.) Drinking water source: Improved - urban: 90.2% of population, rural: 56.6% of population, total: 71.6% of population Unimproved: urban: 9.8% of population, rural: 43.4% of population, total: 28.4% of population (2020 est.) Sanitary facility access - Improved: urban: 76.3% of population; rural: 31.9% of population; total: 51.7% of population unimproved: urban: 23.7% of population; rural: 68.1% of population; total: 48.3% of population (2020 est.) Major infectious diseases: degree of risk: very high (2020) - food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever; vectorborne diseases: malaria and dengue fever; water contact diseases: schistosomiasis; animal contact diseases: rabies Zambia’s high fertility rate continues to drive rapid population growth, averaging almost 3 percent annually between 2000 and 2010. The country’s total fertility rate has fallen by less than 1.5 children per woman during the last 30 years and still averages among the world’s highest, almost 6 children per woman, largely because of the country’s lack of access to family planning services, education for girls, and employment for women. Zambia also exhibits wide fertility disparities based on rural or urban location, education, and income. Poor, uneducated women from rural areas are more likely to marry young, to give birth early, and to have more children, viewing children as a sign of prestige and recognizing that not all of their children will live to adulthood. HIV/AIDS is prevalent in Zambia and contributes to its low life expectancy. Zambian emigration is low compared to many other African countries and is comprised predominantly of the well-educated. The small amount of brain drain, however, has a major impact in Zambia because of its limited human capital and lack of educational infrastructure for developing skilled professionals in key fields. For example, Zambia has few schools for training doctors, nurses, and other health care workers. Its spending on education is low compared to other Sub-Saharan countries. Source: CIA The World Factbook

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6.12

Death Rate: 6.12 deaths/1,000 population (2022 est.)

49.6

Contraceptive prevalence rate: 49.6% (2018)

19.1

Current health expenditure: 5.3% (2019)

2.93

Hospital bed capacity: 2 beds/1,000 population

49.6

Obesity – Adult prevalence rate: 8.1% (2016)

19.1

Underweight – Children under 5 years: 11.8% (2018/19) MAY/JUNE 2022 | HEALTHCARE AFRICA

The re-emergence

of Polio

MAY/JUNE 2022 | HEALTHCARE AFRICA

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African countries battle to contain re-emergence and spread of the highly infectious virus

oliomyelitis commonly shortened to polio, is an infectious disease caused by the poliovirus. In about 0.5 percent of cases, it moves from the gut to affect the central nervous system, causing muscle weakness resulting in a flaccid paralysis. This can occur over a few hours to a few days. The disease is transmitted from person-to-person mainly by the fecal-oral route and by aerosol droplets. While there is no cure for polio, the disease can be prevented through administration of the effective novel oral polio vaccines (nOPV2). Mass vaccinations and supplementary vaccinations are the best weapons for combating the circulation of poliovirus. Every child under 5 years should be immunized with oral polio vaccine regardless of previous immunization status. The recent polio outbreaks are undisputedly interlinked to the COVID-19 pandemic and lockdowns, which resulted in suspension of immunization activities and disruptions to poliovirus surveillance in 2020. Vaccination campaigns have also been hampered by the international spread of poliovirus via travelers. The World Health Organization (WHO) declared the international spread of wild poliovirus a public health emergency of international concern in response to ongoing importations of poliovirus into polio-free countries. Medical and scientific understanding, lifestyles and living conditions, socio-political forces and other determinants play a key role in how nations will control and manage the polio outbreaks in Africa. Let us explore public health responses that have been put in place by various governments and agencies to eradicate the crippling disease:

eradicating polio worldwide. The six partners include the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF), Bill & Melinda Gates Foundation and the vaccine alliance Gavi. The 2022-2026 Strategy underscores the urgency of getting eradication efforts back on track and offers a comprehensive set of actions that will position the GPEI to achieve a poliofree world. The strategy encompasses further integration of polio activities with essential health services like routine immunization and building closer partnerships with high-risk communities to co-design immunization events and better meet their health needs. Applying a gender equality lens to the implementation of program activities along with recognizing the importance of female workers to build community trust and improve vaccine acceptance also plays a central role in furthering the immunization agenda. The scheme also aims to implement innovative new tools such as digital payments to frontline health workers to further improve the impact and efficiency of polio campaigns. GPEI members are currently working to strengthen advocacy to urge greater accountability and ownership of the program at all levels including enhanced performance measurement and

By Loraine Wangui

EXISTING GLOBAL POLIO ERADICATION STRATEGY In 2021, the Global Polio Eradication Initiative (GPEI) launched the Polio Eradication Strategy 2022-2026: Delivering on a promise to overcome the remaining challenges to ending polio including setbacks caused by COVID-19. The Global Polio Eradication Initiative is a publicprivate partnership led by national governments with six international partners focused on HEALTHCAREAFRICA.INFO

MAY/JUNE 2022 | HEALTHCARE AFRICA

DISEASE FOCUS: Polio

IN NUMBERS

2.97M

engagement with new partners such as the new Eastern Mediterranean Regional Subcommittee on Polio Eradication and Outbreaks. In addition to eradicating wild polio, GPEI will strengthen efforts to stop outbreaks of circulating vaccinederived poliovirus (cVDPV) that continue to spread in under-immunized communities across Africa and Asia.

poliovirus and the vaccine for the virus. The Malawian government recently launched the second round of mass polio vaccinations after the country successfully completed the first phase of vaccination campaigns for children under 5 years against wild poliovirus in its four-round vaccination drive. The Ministry of Health administered over 6.9 million doses of oral polio vaccine procured by the United Nations Children’s Fund (UNICEF) targeting 2.9 million children under five in the first vaccination drive. A Poliovirus Outbreak Response Situation Report released by the government states that 2.97 million children aged between 0 – and 59 months have been vaccinated in the campaign representing 102 percent administrative coverage. UNICEF partnered with the WHO and the Global Polio Eradication Initiative including the Bill and Melinda Gates Foundation, Rotary International and Global Alliance for Vaccines and Immunization in supporting the Ministry of Health to vaccinate children. Malawi also instituted risk assessment and disease surveillance measures to contain any potential spread of polio and there have not been any additional cases of polio reported so far ever since. WHO collaborated

MALAWI’S SUCCESSFUL POLIO VACCINATION DRIVE The initial outbreak of polio in Africa in more CHILDREN than five years was declared by Malawian health UNDER THE AGE authorities after a three-year-old Malawian OF 5 ALREADY girl experienced onset of paralysis on 19th November 2021. Sequencing of the virus was VACCINATED AGAINST POLIO IN conducted in February by the National Institute for Communicable Diseases in South Africa and MALAWI the United States Centers for Disease Control and Prevention (US CDC) confirmed this case as poliovirus (WPV type 1). Laboratory analysis linked the strain detected in Malawi to the one circulating in Sindh Province in Pakistan since October 2019 as polio remains endemic in Afghanistan and Pakistan. Subsequently, Malawi promptly launched public awareness campaigns about wild polio to alert the public of the wild poliovirus outbreak as well as provide information about

MAY 2022 | HEALTHCARE AFRICA

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with health authorities to reinforce public health response measures including preparations for the vaccination campaigns. In preparation for the vaccination drives, trained surge teams of national officers have been deployed to facilitate the campaign and ensure that all eligible children are vaccinated. Moreover, the country has set up environmental surveillance for polioviruses in 11 sites across four cities in Lilongwe District that encompasses the capital Lilongwe where the initial and so far, only case was detected. Other sites are in Blantyre, Mzuzu and Zomba cities as well as in health facilities and communities where health teams are collecting samples from the environment and sending them for analysis to laboratories. POLIO DISEASE MANAGEMENT IN MOZAMBIQUE Mozambiquan health authorities declared a polio outbreak on 18th May 2022 after confirming that a child in the country’s northeastern Tete province had been paralyzed by the disease. Prior to the confirmation, Mozambique partnered with the United States to vaccinate 4.8 million children under five years old in the first round of the polio

immunization round in an effort to contain the spread of the wild poliovirus. The immunization drive which has largely exceeded the target of 4.2 million children was in response to cases of poliomyelitis identified in Nampula, Cabo Delgado Provinces, and neighboring Malawi. The Ministry of Health (MISAU) implemented the national campaign with support from the US Centers for Disease Control and Prevention and the US Agency for International Development (USAID) in a step towards eradicating polio worldwide. Mozambique also received funding and technical assistance from local and international partners to support the vaccination campaign including the Mozambique’s Field Epidemiology Training Program, MOMENTUM Routine Immunization Transformation and Equity (M-RITE) among others. MISAU and Global Polio Eradication Initiative partners further partnered with the United States in the second round of the polio vaccine campaign to curb the ongoing circulating polio outbreak. INFECTION PREVENTION CONTROL ACTIVITIES IN UGANDA AND EGYPT Uganda’s Ministry of Health (MOH)coordinated with the Uganda National Expanded Programme on Immunisation to launch a three-day mass polio vaccination campaign targeting 8.8 million children under five years. The country had been certified polio-free in October 2006, but the health ministry declared an outbreak of polio in

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The Global Polio Eradication Strategy 2022-2026 underscores the urgency of getting eradication efforts back on track and offers a comprehensive set of actions that will position the GPEI to achieve a polio-free world.

MAY 2022 | HEALTHCARE AFRICA

DISEASE FOCUS: Polio

The Somalia Polio Eradication Action Plan complements one of the goals outlined in the GPEI Polio Eradication Strategy 2022–2026 to stop cVDPV transmission and prevent outbreaks in non-endemic countries.

August 2021 following confirmation of laboratory tests from samples in Kampala. Subsequently, the ministry partnered with USAID through the Regional Health Integration to Enhance ServicesNorth, Lango (RHITES-N, Lango) project to develop strategies to support the mass polio vaccination campaign. In Egypt, the government launched a national campaign to vaccinate children against polio for free across the country from 27th to 30th March. The vaccination campaign against polio was implemented in all governorates of the republic for every child under 5 years residing in Egypt regardless of their citizenship. The campaign’s work was carried out by 45,000 medical teams with a total of 90,000 individuals trained at the highest level. The Ministry of Health also collaborated with the Ministry of Education, Ministry of Social Solidarity and AlAzhar campaign to facilitate polio vaccination in kindergartens and nurseries. SOMALIA LEVERAGING THE POWER OF PARTNERSHIPS Somalia, members of the Global Polio Eradication Initiative and other key partners have endorsed the Somalia Polio Eradication Action Plan 2022 to reaffirm their commitment to end the ongoing circulating poliovirus type 2 (cVDPV2) outbreak

MAY/JUNE 2022 | HEALTHCARE AFRICA

and keep the country free from wild poliovirus. The Somalia Polio Eradication Action Plan complements one of the goals outlined in the GPEI Polio Eradication Strategy 2022–2026 to stop cVDPV transmission and prevent outbreaks in non-endemic countries. The Action Plan outlines a four-point strategy to contain the spread of the current poliovirus type 2 outbreak which was detected for the first time in the environment in November 2017 and in a child on 11th May 2018. The polio eradication plan aims to direct partners’ efforts and resources towards boosting population immunity through combined efforts to reach high-risk populations like inaccessible and nomadic communities as well as internally displaced persons. The detailed plan targets highrisk populations where children may have missed out on vaccinations to strengthen their immunity, provide routine childhood immunization and strengthen community engagement. The emergency plan will also advocate for stronger cross-border coordination among the polio eradication programmes in Somalia, Kenya, Ethiopia and Djibouti to avoid virus spill over into international borders. Somalia’s polio eradication programme has made progress including stopping outbreaks of wild poliovirus as well as the recent circulating poliovirus type 3 in 2021.The programme has also established a vast network of polio workforce and assets including human and operational resources which will help contain the current outbreak as well as achieve broader health system goals. COORDINATED EFFORTS KEY IN KEEPING POLIO AT BAY The reemergence of Polio in the Africa threatened to roll back years of hard work that medical systems in the continent had put in place to keep the virus at bay. Concerted efforts by health ministries in collaboration with development partners have however been able to contain the spread of the virus. These efforts also prove once again that properly planned and well executed vaccination campaigns are effective in the fight against polio. The reemergence of the virus also underscores the importance of surveillance in the early detection and containment of possible outbreaks. Africa will only maintain its Polio free status if countries remain alert as complacency will only create room for the virus to sneak in from regions such as Pakistan and Afghanistan where it is endemic.

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COMPANY FEATURE: Penda Health

Staying One Step Ahead Of The Malaria Parasite By Christine Elleboode-Zwaans

hierry Diagana and his team are on a quest to discover new therapeutics for malaria. He believes malaria elimination is within our grasp, but emerging drug resistance could jeopardize the hard-fought progress. Thierry Diagana has dedicated his career to unravelling the complexities of the malaria parasite, which he describes as an “incredibly smart enemy that has shown an uncanny way of defeating everything we’ve thrown at it.” At the helm of the Novartis Institute for Tropical Diseases (NITD), a drug discovery research institute dedicated to neglected tropical diseases, he uses cutting-edge science to discover new medicines that support the elimination of infectious diseases like malaria. Despite remarkable progress, malaria continues to take a heavy toll on African children, killing one child every minute. 66

We talked to Thierry to learn about the threat of drug resistance and why we need to stay one step ahead of the parasite to reach malaria elimination.

always been passionate about malaria research, and I’m grateful to have been working with incredibly smart colleagues over the past decades.

What drew you to the field of malaria research? My ancestors are from Sub-Saharan Africa, where malaria continues to be a devastating public health issue. That connection has always been essential to me. I have family members living in malaria-endemic countries, and I grew up hearing stories of how malaria is destroying families. This is one reason that attracted me to malaria. And then, there is the science. The parasite exhibits an extraordinarily complex life cycle, which fascinates me as a scientist. Every time I learn something about the parasite, I am in awe of the almost supernatural intelligence that guides its evolution. For those two reasons, I’ve

Why is it important for organizations like novartis to continue to invest in malaria? It’s the right thing to do. When Novartis took the conscious decision more than two decades ago to make malaria a priority – despite the lack of commercial incentives for companies to conduct research and development (R&D) in the field – it was because as a science organization, we have a moral obligation to drive innovations for unmet needs. And we should be very proud of what we have accomplished. Since the launch of our fixed-dose artemisininbased combination therapy (ACT) in 1999, our industry-leading pipeline has enabled us to put out development

MAY/JUNE 2022 | HEALTHCARE AFRICA

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candidates one after another. We see resistance developing to malaria medicines, in particular to artemisinin. Is this threat real and how can we counter it? The threat of drug resistance is real! Over the years, the malaria parasite has constantly evolved and found ways to defeat the medicines we introduced to combat it. We’re now at a juncture where we could find ourselves in a situation similar to what happened 40 years ago, when chloroquine totally failed because of drug resistance. Gene mutations have occurred in the past 15 years. In particular, the so-called K13 mutations (marker for artemisinin resistance) are associated with delayed parasite clearance, which could be a harbinger for full-on drug resistance. We see these mutations now nearing fixation in Asia and emerging in Sub-Saharan Africa. Further mutations could lead to failure of current antimalarials in the next decade or so, and this is why we need to be prepared. Thanks to our substantial investments in malaria R&D over the years, we now have identified four compounds with novel mechanisms of action that are all effective against these K13 mutants. So, I believe we are in a good position to anticipate and mitigate the risk of drug resistance to artemisinin drugs. Yet, is there a risk that next-generation medicines also become ineffective due to potential resistance? Next-generation antimalarials use new mechanisms of action against the parasite but they all could potentially be defeated by drug resistance, which is why we will only develop them as combination therapies. In addition, we have attempted to minimize the risk of drug resistance in the first place, by focusing on drug candidates with fast-acting activity and a very high barrier to drug resistance in the lab. A malaria vaccine has been introduced recently. Does this change what you are doing, or make your efforts redundant? We absolutely need a vaccine for malaria, and it’s a great complement to the current tools we have. Yet, even if the vaccine prevents people from developing severe forms of the disease, it won’t stop infections. That’s why we shouldn’t take our foot off the pedal, we need both good vaccines and effective therapeutics. COVID is a perfect illustration of this. We have vaccines, yet the HEALTHCAREAFRICA.INFO

world is still in dire need of therapeutics, so we can treat people who get infected. A key point to add here is that besides prevention and treatment tools, what will move us closer to malaria elimination is investment in health infrastructure and capability in endemic countries, and universal access to quality health services. Do you include access considerations in the very early stages of drug discovery? Yes, we think about access very early on, and the best way to do that is to build specific features into a drug’s target profile. For instance, we look at the cost of goods to manufacture our compound with a view to make the end product as affordable as possible. We also consider the drug’s formulation to ensure it is adapted to children, who are the most impacted by malaria. Stability in tropical climates is another parameter we take into account by ensuring the molecule’s physicochemical properties keep the compound stable under hot and humid conditions. Ultimately, we want to remove the hurdles to access by making our drugs as convenient as possible for public health officials and malaria control programs to adopt and deploy. It’s much easier to integrate these parameters upfront than to retrofit those features when compounds have progressed into human studies. What needs to happen to ensure we eliminate malaria for good? That’s a big question! Many things need to happen but first and foremost, we need the perseverance and grit to deal with an incredibly smart enemy. Malaria has shown an uncanny way of defeating everything we’ve thrown at it. We now even see mosquitoes changing their biting patterns and biting in the day rather than at night to defeat insecticide-treated bed nets. There has been a constant battle between man and malaria, and the parasite has always taken us by surprise. We’re in for the long run and our best line of defense is to continue to innovate, stay one step ahead of the parasite, anticipate every one of its moves, and put constant pressure on it. But Novartis is certainly not alone in this fight. We need everybody’s best efforts to eliminate malaria, and the continuing invaluable work of our partners and the entire global malaria community.

Ultimately, we want to remove the hurdles to access by making our drugs as convenient as possible for public health officials and malaria control programs

Thierry Diagana, Head of the Novartis Institute for Tropical Diseases, explains why we need to stay one step ahead of the malaria parasite to beat resistance. MAY/JUNE 2022 | HEALTHCARE AFRICA

OPINION: Critical Incidences

What to do if you experience a critical incident By Dr Linda Wagener

ritical incidents are events that threaten our fundamental wellbeing. They are very often sudden and unanticipated. Accidents, lifethreatening illnesses, physical and sexual assaults, robberies, suicide, murder or other death of a loved one and natural disasters are examples of critical incidents that can happen to almost anyone, anywhere. However, in some parts of the world, the risk of encountering a critical incident increases due to war, famine, civil unrest, or other geopolitical factor. The list of common critical incidents in these contexts is very long and can include shootings, bombings, hostage taking, mob riots, rapes, car-jackings disappearances of loved ones. One needs only to turn on the nightly news to see multiple examples.

MAY/JUNE 2022 | HEALTHCARE AFRICA

WHAT HAPPENS DURING A CRITICAL INCIDENT? If we are suddenly faced with an acute threat, our instinctual brain takes over and activates a flood of physical changes that help us to defend ourselves in the moment. Just a few examples include the flush of adrenaline and glucose to our muscles to give us energy to run or fight, changes in our blood cells to increase clotting in case we are wounded, release of endorphins to protect us from pain and fear, dilation of our pupils to let in more light so we can see more clearly. We often will experience an intense urgency that results in a flight, fight or freeze response. However, our instinctual brain is not very good at observing and analyzing the situation. For that reason, we often need to slow our instincts down HEALTHCAREAFRICA.INFO

in order to make a good decision about how to best survive the incident. What you can do in the moment: • Breathe slowly and deeply • Calm yourself • Connect with others • Observe your surroundings • Get to safety THE AFTERMATH There are many normal reactions that people have after experiencing a critical incident. We need to be prepared for the fact that people may react very differently than we expect. It is common to be jumpy, irritable, have sleep and appetite disturbances, nightmares, inability to concentrate, memory problems, and even “blackouts.” Some people may want to avoid thinking or talking about the event, while others may want to talk about it over and over. It is important to have patience and compassion with ourselves and others. These reactions can continue for weeks and even months after the event. What you can do: • Be with people, even if your tendency is to isolate. It’s ok to just sit together or go for a walk. • Process what happened to you through talking, writing, or just thinking through the event. Allow yourself time to deal with the memories. • Get exercise if you can to help burn off the stress hormones that are lingering in your system. • Make self-care a priority. • Restrict caffeine. Sleep and rest are critical. • Avoid over use of substances. • Surround yourself with reminders that you are safe. • Don’t be afraid of your emotions. Be kind and patient with yourself and others. Seek help if you are feeling compulsions to harm yourself or others, if you feel profoundly depressed or you experience a sense of being cut off from reality.

What you can do: • Build your relationships so that you have a solid network of social connections. • Live a healthy life style that includes good diet, exercise, and sleep. • Make sure that you have many positive experiences in your life to counteract the negative things that you have experienced. Look for moments of goodness, beauty, and awe every day. Find spiritual resources that deepen your connection to life. Practice gratitude. • Make sure you have activities and hobbies that you enjoy. • Use stress management tools for coping such as meditation or yoga. Dr Linda Wagener has decades of experience in clinical psychology, with a particular focus on trauma management. Her expertise includes: mental functioning in hostile and extreme environments, gender security, critical incident staff care, and creating a positive work climate for all types of organisations. She is experienced in working in high-risk environments and has trained hundreds of international aid workers and other students on how to achieve mental and emotional control in critical incidents.

We often will experience an intense urgency that results in a flight, fight or freeze response. However, our instinctual brain is not very good at observing and analyzing the situation.

HOW TO BUILD YOUR RESILIENCE? Resilience is our ability to bounce back from critical incidents. There are ways to engage in a healthy life style that helps us to build our resilience so we are better prepared to survive and even grow if we encounter difficulties. HEALTHCAREAFRICA.INFO

MAY/JUNE 2022 | HEALTHCARE AFRICA

OPINION: Antimicrobial Resistance

4 steps to stay ahead of antimicrobial resistance By Dr. Lutz Hegemann, Richard Saynor

n 1928, modern medicine arrived through the work of a small lab in London where Dr. Alexander Fleming discovered penicillin. Fleming’s discovery of the world’s first antibiotic touched off a medical revolution that transformed health care, dramatically improving and extending lives in the decades ahead. Yet today, as our reliance on antibiotics has grown, so too has the “silent pandemic” of antimicrobial resistance. AMR occurs when microbes evolve to resist antimicrobial medicines, particularly antibiotics. This is a natural phenomenon accelerated by antibiotic misuse and degradation, as well as substandard manufacturing. According to the Global Antibiotic Research and Development Partnership, more than 214,000 babies die each year from AMR infections. A study published in The Lancet found that AMR led to 1.27 million deaths in 2019 — a number nearly twice previous estimates and expected to grow significantly in coming decades. To put the data in context, the estimated AMR-related death toll is approximately equivalent to one death every 25 seconds — or to the combined impact of HIV and malaria in 2020.

MAY/JUNE 2022 | HEALTHCARE AFRICA

As a predominantly natural phenomenon, AMR cannot be eliminated but only controlled. Fortunately, there are practical and interconnected tools to delay the occurrence of resistance and slow its spread. At Novartis and Sandoz, the company’s generics division and the leading global supplier of generic antibiotics, our global AMR strategy is based on four pillars. These pillars are aligned with Novartis’ environmental, social, and governance agenda, which emphasizes access and innovation while promoting sustainability. 1. RESPONSIBLE MANUFACTURING The first step is to promote environmentally friendly production to ensure that antimicrobial effluents don’t leak into groundwater. This requires that the manufacturing process uses limited quantities of resources and is operated with optimal hygiene and waste disposal practices. Together with the Austrian government, Sandoz recently invested more than $150 million to improve antibiotics manufacturing processes along these lines at our plant in Kundl. This is significant, as the plant is the hub of the last vertically integrated antibiotics production chain in Europe HEALTHCAREAFRICA.INFO

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OPINION: Antimicrobial Resistance

— meaning that key processes are not outsourced — with 75 years of quality production experience. Responsibly managing water is essential to responsible manufacturing, which is why Novartis endorsed the global CEO Water Mandate and has committed to be a good water steward everywhere we operate. Demonstrating these commitments, Novartis has been working with local authorities and other private partners in Kenya to rehabilitate three boreholes in Machakos County, expanding access to clean water to more than 100,000 people. 2. APPROPRIATE USE Improper use of antimicrobial drugs drives greater resistance to the bacteria, fungi, viruses, and parasites they are designed to kill. Antibiotics should be prescribed by licensed physicians with knowledge of current guidelines and best practices — and not be available over the counter at pharmacies. Education and awareness initiatives should support these practices by ensuring doctors, pharmacists, and patients understand the risks of contributing to AMR through overuse, underuse, and misuse of antibiotics. This should include guidance on the safe disposal of unused antibiotics. To accomplish this, Novartis has partnered with the Commonwealth Pharmacists Association to support capabilitybuilding programs in low- and middle-income countries with limited access to training and resources. Sharing specific knowledge about antimicrobial use ensures that clinics in these countries don’t become new breeding grounds for AMR. Additionally, Sandoz recently extended its collaboration agreement with Ares Genetics to develop novel, low-cost, rapid genome-based diagnostic technologies, which can help health care professionals make more accurate diagnoses and more efficiently match patients with appropriate antibiotics worldwide. Finally, Novartis incorporates responsible use of antibiotics into various community health care models, such as MedShr — a health staff app for clinical discussion — and Healthy Family programs, which use innovative business strategies to address social issues that impact access to health care in LMICs. 3.. EQUITABLE ACCESS Nearly 6 million people around the world die every year because they don’t have access to quality antibiotics. Often, this lack of access drives patients to buy whatever OTC antibiotics are available, or worse, to buy counterfeit or substandard medicines with insufficient quantities of active ingredients. The result is not only a failure to kill dangerous microbes, but to apply selection pressures that favor the survival and reproduction of naturally resistant ones, further driving AMR. The solution is not reducing appropriate antibiotic use, as these life-saving medicines are vital to solving many global health challenges. Rather, the key is to get the right medicine to the right patient at the right time. Doing this effectively requires better regulation of antibiotics so that they are no longer available for sale OTC, and improving distribution and

supply so that doctors aren’t forced to rely on less appropriate therapies when an optimal one is not available. 4. INNOVATION AND GLOBAL COLLABORATION Antibiotic innovation is an important part of the solution. This means both the development of new molecular entities as well as reformulation of older antibiotics to enhance their efficacy, supported by global mechanisms to fund their development and promote proper use. But new drugs are not a silver bullet. Stronger medicines alone will not eliminate AMR since every new medicine will also eventually become subject to resistance. Instead, manufacturers must collaborate not only to develop evernewer antibiotics, but also to ensure that the elements outlined above are adequately addressed. The barriers to innovating in antibiotics are too great and the problem of appropriately managing AMR is too complex for one company to tackle alone. This is why Novartis has partnered with a broad group of stakeholders, including the International Federation of Pharmaceutical Manufacturers & Associations and 23 of its member biopharmaceutical companies, the World Health Organization, the European Investment Bank, and the Wellcome Trust for the creation of the AMR Action Fund. The fund has already made strategic investments in new antibiotic development, and we’re confident the partnership will catalyze decisive global action.

Even if AMR cannot be entirely beaten, we believe it can be beaten into a corner. This requires action at every level. Patients must understand the threat of AMR and how to use and dispose of antibiotics. Health care providers must consider the AMR-related consequences of every prescription. Policymakers and development agencies must see health systems strengthening to address AMR as a worthwhile investment. And, finally, we call on pharmaceutical partners to join Novartis and Sandoz, and engage together across the four pillars, to urgently address this unprecedented threat to global health and the survival of modern medicine.

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