Healthcare World #001 by TheTradeAgency

L E A D I N G T H E D E BAT E I N I N T E R NAT I O NA L H E A LT H CA R E & L I F E S C I E N C E S

Issue One | Spring 2021

Rebuilding the world’s healthcare

Finance, funding and futureproofing

THE NHS IN INTERNATIONAL MARKETS | FUSING PUBLIC AND PRIVATE IN MIDDLE EAST HEALTHCARE | THE RISE OF GLOBAL DIGITAL SOLUTIONS

Dubai: A Destination for Health Investment

Contact:

Dr. Ibtesam AlBastaki, Director | +971 4 219 7644 | IIALBastaki@dha.gov.ae Ahmed Faiyaz Sait, Advisor | +971 4 219 7695 | afsait@dha.gov.ae Investments and PPPs Department

EDITOR’S WELCOME

Welcome to Healthcare World

elcome to the first Healthcare World Festival. We’re delighted to present this inaugural event following an unprecedented year of global pandemic. Yet thanks to COVID-19, healthcare has become top of the agenda for all governments and nations as we all battle together to overcome this novel virus. For this reason we have brought together some of the foremost experts in healthcare, infrastructure, financing and thought leadership to consider how the world should move ahead in the face of such threats. The pandemic has exposed the huge divide in health equality, and underlined the necessity for countries to have proper policies that prioritise the health of their citizens as a matter of urgency. It’s undeniable that good health goes hand in hand with robust economies. And it’s also clear that stronger countries need to extend support and assistance to those nations that are struggling under the burden of coronavirus and other diseases. For what affects them affects us all – we need to reopen our borders and allow free movement globally. Our first panel, chaired by Barry Francis, considers financing in African healthcare infrastructure. Panellists include Oluranti Doherty, Export Director at Afrexim Bank, infrastructure consultant Paul da Rita and Dr Nicholas Crisp from the South Africa Department of Health who will discuss the many challenges to hospital building on the continent. The second session looks at the rise of global digital healthcare and how it can be harnessed properly. Chaired by Niti Pall, KPMG Global Health Practice, the panel includes global health consultant Dr Mwenya Kassonde, Simon Swift, MD of Methods Analytics, Dr Anushka Patchava UN Deputy

Sarah Cartledge Group Editor Chief Medical Officer, and Dr Senait Beyene, Senior Adviser to the Ministry of Health Ethiopia. Professor Ged Byrne, Emma Sheldon MBE, Mott MacDonald’s Lucy Palmer, and Dr Shola Dele-Olowu and Asma’u Abiola from the Clinton Health Access Initiative (CHAI) are among those who look at the future of African aid funding post COVID. Former UK Health Ministers Patricia Hewitt and Stephen Dorrell discuss the NHS in international markets with Carly Caton from Bevan Brittan, Chris Born from the UK’s Department for International Trade and Emma Sheldon MBE. Our Middle East session looks at the fusion of public and private healthcare as the way ahead for the region’s healthcare. Dr Ibtesam Al Bastaki, Director of PPP and Investments for the Dubai Health Authority, Manny Hussain from the Saudi Health Ministry and Dr Dirk Richter, Senior Adviser Health Authority Abu Dhabi are among those looking at this topic. Finally we return to Africa to consider rebuilding African Healthcare. Chaired by Anoushka Coovadia of KPMG South Africa, panellists include CHAI’s Dr Chizoba Fashanu & Asma’u Abiola, public health data analyst Dr Funmi Akinlade alongside Dr Senait Beyene and Dr Mwenya Kassonde. Alongside this, Medilink have some fascinating speakers in their breakout sessions including Marta Valeska Garcia Argenal from the UN Procurement Department. It promises to be an illuminating event. You can keep track of all the latest news via our Festival page. The Healthcare World magazine will be updated weekly with reports and new features, so if you have anything you would like to include do email me – sarah@thetradeagency.co.uk. 3

Contents 3

Editor’s Welcome

Steve Gardner - Healthcare World Managing Director 2021 and beyond in healthcare

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The Healthcare World Team

Healthcare World Festival Chairs and Speakers The importance of international trade events

Tom Elliott, Medilink International Director, says it’s time for face-to-face business to restart

Financing African healthcare infrastructure

There’s much to do in financing and delivering adequate infrastructure, says Barry Francis Infrastructure Correspondent

Meet the faces behind the Festival and the Magazine

All the experts and Festival sessions

Healthcare for the economy

Paul da Rita, Principal of PdaR Infra Advisory, discusses opportunities and barriers to financing healthcare infrastructure

An ironic impact of COVID-19

Will the pandemic finally put digital health on the path to reducing health inequalities at scale in emerging markets? ask Michal Matul and Niti Pall, AXA

Changing attitudes towards valuebased healthcare

HWF’s Steve Gardner speaks to Simon Swift, MD of Methods Analytics, about developing an outcomes-based system

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Sharing digital learning with Australia

The NECS’s Capacity Tracker is helping to fight COVID both at home and abroad, says Service Manager Jason Speck

Pathway and workflow management for better clinical efficiency

Cloud-based clinical solutions are the way forward, says Piyush Mahapatra, Director of Innovation at Open Medical

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Building the hospitals of tomorrow

Richard Cantlay, Mott MacDonald’s Global Head of Healthcare Facilities, on his vision for a new era of hospital design and planning

Taming the Lion’s Stare

Bruce Benton, Manager of the World Bank Riverblindness programmes, on how their success can impact COVID vaccination rollout in Africa

Why 2021 could be a good year for malaria eradication

Malaria survivor Dr Benji Pretorius, founder of Erada Technology Alliance, sees significant strides this year

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Healthcare World Magazine | Issue One

Investing in Dubai’s healthcare sector

Dubai is fast becoming an international hub for innovations and partnerships, says Dr Ibtesam al Bastaki of Dubai Health Authority

Reducing South Africa’s healthcare burden

The Heart and Stroke Foundation South Africa aims to improve cardiovascular health through lifestyle and education tools

Saving money on procurement processes

Data is an invaluable tool in streamlining costs across healthcare organisations, says Mat Oram, CEO and cofounder of AdviseInc

Brave new world

Carly Caton, Partner at Bevan Brittan, examines how COVID has changed the international market for NHS organisations

Producing doctors

Dr Ken Grant of Mott MacDonald tells us what Africa can learn from Asia

Taking a hands-on approach to digital innovation

Rob Hurrell, Business Development Director at Aire Logic, outlines the need for digital solutions as we emerge from the COVID-19 pandemic

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52 54

Ensuring the effective use of medicine

WellSky’s medicine management solutions are helping hospitals and clinics across the world to prescribe and manage their medication use, says CEO Rob Blay

Visiting big venues safely

Alleviating capacity shortfalls in hospitals NIGHT For Nurses

Helping start-ups navigate the complex world of funding

Building back better

Peer-to-peer networks are the bedrock of a sustainable global health system for Health Education England

Building Africa’s healthcare infrastructure

Oluranti Doherty, Director Export Development, reveals Afreximbank’s plans for African Centres of Excellence

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Making the mental health of nurses, midwives and healthcare assistants a priority

Phundex provides a platform to make the journey easier, says founder Heather-Anne Hubbell

InstantAccess powered by Xtrace is a one-stop solution for opening our doors again, says MD Stan Shepherd

Halving avoidable conditions acquired in hospital can free up to 10 per cent of ICU capacity, says Richard Jones of C2Ai

The call for collaboration

The work of The Clinton Health Access Initiative in Nigeria during the pandemic

Financing future infrastructure in African healthcare

The first session of the Healthcare World Festival finds that vision, collaboration and government participation are key

Perspectives on the rise of global digital healthcare The second session agreed that data needs to be used purposefully but there are many obstacles to surmount

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UK/US partnerships

Ernesto Chanona of CSSi Life Sciences introduced strategies for entering the US market

106 Middle East opportunities

Market entry to Dubai and the Middle East requires patience, perseverance and partnerships

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Projects via multi-lateral development bank’s funding Insight into the workings and practices of the major aid development banks from Cristina Pirela and Rebecca Nowlan of the UK Department for International Trade in Washington DC

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Insights into the health system in South Africa Mott MacDonald’s Myles Ritchie gives perspective into the health system and its inequalities

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UN procurement opportunities for healthcare companies

The first of our trade mission sessions welcomed Marta Garcia, UN team leader, to outline how to navigate the complexities of UN procurement

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The International Affiliate Network

Imperial Private Healthcare’s latest venture to ensure a better patient experience

Translational Research

The University of Toronto HealthEdge innovations approach challenges students to think differently to champion change

The future of aid-funding in Africa post-COVID

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The virtuous circle

130 Opinionated

Chaired by former UK Health Secretary the Rt Hon Stephen Dorrell, this main session offered valuable insight

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The road back

Our final session examined how Africa can get back to ‘normal’ and what the new normal could look like

Partnership with the UK NHS can help providers to deliver long term sustainable clinical services, says Steve Gardner, MD at The Trade Agency

Healthcare World Trade Mission Delegates We’ve lost so much because of COVID, let’s not lose what we’ve gained, says Steve Gardner

Tackling fear, uncertainty and doubt

Healthcare World CCO and Director of Consultancy Emma Sheldon MBE examines the ways in which businesses can grow post-pandemic

The NHS in international markets

This session examined how the UK’s NHS can expand into the international market

NHS international opportunities

A specialist breakout session looked at pathways for NHS and overseas organisations to develop opportunities

From bench to bedside

Translational Health covers the innovation journey from concept to reality

The fusion of public and private partnerships

The most popular session examined the way forward for Middle East healthcare

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2021 and beyond in healthcare

ondon, Miami, Dubai, Singapore, Dehli, Rio, Geneva, Düsseldorf - just some of the destinations that were inked into my diary for 2020 for meetings and events around the international healthcare space, all cancelled because of an unprecedented global pandemic. The same global pandemic that means I haven’t left home is also the reason I’m introducing the inaugural Healthcare World Festival today. Over the last twelve months, our healthcare concerns have changed dramatically. A year and a half ago, the big international conversations were about the coming workforce crisis. They were also about our hopeful march towards universal health coverage for every citizen of the world, the funding and implementation of global public health and infrastructure programmes, and the rising tide of digitisation in advancing and automating healthcare delivery to preserve much needed resources. These topics of conversation have not gone away, but for the last year they were superseded by the more pressing international concerns. The overwhelming of our healthcare systems and up scaling at extreme pace to cope with unprecedented demand, and the development and rollout of a vaccine became the

Steve Gardner Managing Director

understandable priority for every government and healthcare provider. The vaccines themselves have been the product of unprecedented international collaboration and we should take a moment to acknowledge the achievement of their development in such an incredibly short space of time. The Covax programme is an outstanding example in ensuring the vaccine is rolled out across the world to lower and middle income countries, though the recent scenes in India have reminded us that there is still much work to be done and there may be more harrowing scenes for us to witness before this is over. The new conversations It is undeniable that the events of the last twelve months will change the way we think about and the way we deliver and pay for our healthcare forever. And there have been some positives that have come out of the last year. As our session on digital healthcare on 5 May will show, the cause of digital healthcare has been advanced hugely by the pandemic. With traditional healthcare settings overwhelmed by Covid patients and the need to keep

HEALTHCARE WORLD FESTIVAL

potentially infectious individuals out of hospitals and clinics, the remote delivery of healthcare in the home through the use of mobile technology has become the norm for many. Our panel will consider how we ensure we build upon the last year to create lasting and effective global digital healthcare delivery. Of more concern, though, are the questions around the funding of healthcare in lower income countries. With wealthier countries slashing their aid budgets, how will nations that rely on aid provide for their citizens? How will this affect the UN’s development goal of full UHC by 2030? Our panel on 11 May will consider this question. Funding is also at the heart of the discussion at our opening session on 4 May. Hospitals and clinics are urgently needed across sub Saharan Africa, but where will the money come from to build them and how can this be done sustainably? One thing that is clear in our coming post-pandemic world is the need to share our knowledge and experience. One country that has traditionally been at the forefront in delivering its healthcare on a tight, publicly funded budget while ensuring complete and comprehensive care for all its citizens is the UK. On 12

May, festival attendees will get to hear from key figures in the UK’s NHS system to understand how they can help health economies around the world to develop solutions to the problems that face them. The funding of healthcare is always at the heart of our ability to deliver quality of care to our global citizens and our session on 18 May considers that, even in the comparatively wealthy nations of the Middle East, the future of healthcare is not just the responsibility of Governments. We will discuss the nexus of government, provider and payer and the role of partnerships between public and private in the delivery of ambitious healthcare programmes. Rich or poor, no healthcare system can deliver without the fusion of public and private money. Finally we cycle back, on 20 May with a session on the future of healthcare in Africa, asking the question of what a new normal will look like for the continent. What is clear throughout is that our new normal in healthcare will look very different to the one I remember discussing the last time we were allowed out into the world. It must be one in which we’re ready for the next global healthcare crisis. Because there will be one and it may come sooner than we think.

The Healthcare World team

Emma Sheldon MBE

Steve Gardner

Sarah Cartledge

Managing Director

Campaign Director

CCO & Head of Consultancy

Joe Everley Designer

Emma Williams

Fabian SutchDaggett

Scarlett Windmill-Last

Sophia Kurz

Operations Manager

Website Editor

Health Correspondent

Features Writer

Our Sessions & Speakers Financing Future Infrastructure in African Healthcare Tuesday, May 4, 2021 10:00 AM Chaired by World Healthcare Journal Infrastructure Correspondent Barry Francis, this session will examine the different ways in which major and much needed healthcare build projects can be funded across the continent.

Barry Francis Barry Francis Consultancy

CHAIR

Oluranti Doherty

Director, Export Development African Export-Import Bank

Ralph Martin

Paul da Rita

Richard Cantlay

Dr Nicholas Crisp

Procurement Coordinator Contracta Construction UK Ltd

Principal PdR Infra Advisory

Global Health Portfolio Leader Mott MacDonald

Deputy Director General (National Health Insurance) Department of Health, South Africa

Chris Bonnett

Project Development and Infrastructure Leader EMEA at GE

Perspectives on the Rise of Global Digital Healthcare Wednesday, May 5, 2021 10:00 AM Chaired by Niti Pall, Global Medical Director at KPMG and featuring international investors, technologists, providers and governments, we will consider the future of digital healthcare and data, and its impact on the delivery of healthcare around the world.

Niti Pall

CHAIR

Global Medical Director KPMG’s Global Health Practice

Emma Sheldon MBE

Managing Director Methods Analytics

Anushka Patchava

Consultant and Former Specialist Lead of the NHS Export Catalyst Project at Healthcare UK

Expert Advisor, Artificial Intelligence and Blockchain / Deputy Chief Medical Officer United Nations / Vitality

Jaivir Pall

Dr Mwenya Kasonde

Dan Morris

Stan Shepherd

Dr Senait Beyene

John Hubbell

Co-Founder Harbr

Partner Bevan Brittan

Senior Advisor to the Minister of Health Ethiopian Ministry of Health

Simon Swift

Global Health Consultant and Thought Leader

Group CEO Instant Access Medical

Chairman - HealthEdge Innovation Inc and the Environs Group

SPEAKER PROFILES

The Future of Aid Funding in African Healthcare Post Covid Tuesday, May 11, 2021 10:00 AM Chaired by former UK Health Secretary the Rt. Hon. Stephen Dorrell, this session offers insight into the ‘aid and trade cycle’ and the ways in which aid funding can lead to longer term trading relationships. Looking through the lens of the current cuts to wealthier nations’ aid budgets post pandemic, we look at three examples, Uganda, Kenya and India which are all at different stages of their development.

Stephen Dorrell

CHAIR

Dr Senait Beyene

Former UK Secretary of State for Health

Senior Advisor to the Minister of Health Ethiopian Ministry of Health

Professor Ged Byrne

Dr Mwenya Kasonde

Lucy Palmer

Francis Omaswa

Director of Global Health Partnerships Health Education England

Global Health Consultant and Thought Leader

Technical Director of International Health Mott MacDonald

Asma’u Abiola

Sustainable Health Financing Associate at the Clinton Health Access Initiative

Executive Director - African Centre for Global Health and Social Transformation

Dr Shola Dele-Olowu

Deputy Director of the Vaccines Programme at the Clinton Health Access Initiative

The NHS In International Markets – How can the UK’s world renowned provider ‘Go Global’? Wednesday, May 12, 2021 10:00 AM Sponsored by leading law firm Bevan Brittan and chaired by former UK Health Secretary the Rt. Hon. Stephen Dorrell, this session will examine the opportunities for one of the world’s most well known and revered healthcare systems to influence and partner around the world. What can the NHS teach and learn from working internationally?

Stephen Dorrell

CHAIR

Carly Caton

Stephen Dorrell Former UK Secretary of State for Health

Partner Bevan Brittan

Professor Ged Byrne

Emma Sheldon MBE

Patricia Hewitt

Alistair Russell

Former UK Secretary of State for Health

Director of Business Development, Imperial Private Healthcare - Imperial College Healthcare NHS Trust

Altaf Kara

Chris Born

Director of Global Health Partnerships Health Education England

Strategy and Commmercial Director - South London and Maudsley NHS Foundation Trust

Consultant and Former Specialist Lead of the NHS Export Catalyst Project at Healthcare UK

Head of NHS Collaborative Exports at Healthcare UK - Department for International Trade

The Fusion of Public and Private – The Way Ahead for Healthcare in the Middle East Tuesday, May 18, 2021 1:00 PM Chaired by Niti Pall, Global Medical Director at KPMG, this session will focus on the huge ambition the Middle East region has shown in terms of its vision for the delivery of healthcare in the coming years, and the ways in which, by harnessing and combining the power of both public and private sectors working together, those ambitions can be met.

Niti Pall

Global Medical Director KPMG’s Global Health Practice

CHAIR

Ben Furneaux

Senior Director and Board Member Cigna

Dr Ibtesam Al Bastaki

Vincent Buscemi

Manny Hussain

Simon Swift

Senior Advisor Strategic Purchasing & Provider Management - Ministry of Health, Saudi Arabia

Managing Director Methods Analytics

Richard Cantlay

Stan Shepherd

Director of Investment and Private Partnership Dubai Health Authority

Global Health Portfolio Leader Mott MacDonald

Partner and Head of Independent Health and Social Care - Bevan Brittan

Group CEO Instant Access Medical

Dirk Richter

Senior Advisor Abu Dhabi Health Authority

How Does African Healthcare Get Back to Normal and What Does the New Normal Look Like? Thursday, May 20, 2021 2:00 PM Chaired by Niti Pall, Global Medical Director at KPMG, this session will focus on the huge ambition the Middle East region has shown in terms of its vision for the delivery of healthcare in the coming years, and the ways in which, by harnessing and combining the power of both public and private sectors working together, those ambitions can be met.

Dr Anuschka Coovadia Head of Healthcare for Africa KPMG

CHAIR

Dr Senait Beyene

Deputy Director General (National Health Insurance) Department of Health, South Africa

Dr Chizoba Fashanu

Senior Advisor to the Minister of Health Ethiopian Ministry of Health

Deputy Director of Essential Medicines, Sustainable Health Financing and Malaria at the Clinton Health Access Initiative

Asma’u Abiola

Dr Funmi Akinlade

Sustainable Health Financing Associate at the Clinton Health Access Initiative

Dr Nicholas Crisp

Health Strategy and Delivery Foundation (HSDF)

SPEAKER PROFILES

Breakout Sessions & Speakers UN Procurement Opportunities for Healthcare Companies Monday 10 May 3pm Marta Valeska Garcia Argenal UN Procurement Department

International Opportunities and the NHS – A guide Emma Sheldon MBE

Consultant and Former Specialist Lead of the NHS Export Catalyst Project at Healthcare UK

Wednesday 12th May 12pm

Carly Caton Partner Bevan Brittan

UK/US Partnerships in Healthcare: Entering the US Market Tuesday 18 May 4pm Ernesto Chanona CSSi Life Sciences

Opportunities in the Middle East featuring speakers from the Dubai Health Authority and experts from health systems across the region Tuesday 18th May Public procurement in Africa – A masterclass on winning Governmental business in Sub Saharan Africa Thursday 20th May Myles Ritchie Mott MacDonald

The importance of international trade events Since 1999, Medilink has been delivering industry-leading international events, and now is a crucial time for face-to-face business to restart, says International Director Tom Elliott

ince the start of the coronavirus pandemic, trade has dramatically changed. With face-to-face meetings, offices, and exhibitions a distant memory for many, the entire world has been forced to adapt to the trials of this new reality. Despite the circumstances, many have hailed the benefits which remote working and virtual meetings have brought to the table. Long gone is the commute, the jetting from one office to another, and the struggles of utilising half-baked technology. COVID, for better or worse, has revolutionised the way in which businesses operate - and it’s important to recognise these benefits. However, there are many aspects of international trade, which despite our best efforts, cannot be improved by the benefits of virtual working. Conversations in healthcare have stalled, and at no worse time than during a pandemic itself. Organisations need to be enacting trade missions, developing new partnerships, and engaging with thought leadership - and the absence of the traditional exhibition has made this incredibly difficult. This is why we need to get things back on track. International trade works best faceto-face, with organisations taking a bold step out into new fields, with new partners on new ventures, who may never encounter each other outside of an event setting. That

Tom Elliott International Director Medilink

“International trade works best face-to-face, with organisations taking a bold step out into new fields, with new partners on new ventures”

is the benefit of trade missions - you never know who you might end up meeting or even doing business with. Together with the international team at Medilink, we can deliver specialist advice, support and consultancy to your business regarding exhibiting internationally. With more than 50 years international trade experience within the life sciences industry, we can ensure that the transition back into in-person exhibition is as seamless as possible. Still, the world is not quite ready for the old status quo just yet. Many nations and businesses are still struggling through the pandemic, and those who may have begun to see the light on the other side are still reeling from the ordeal, which sadly means that we will not see a return to in-person trade events at this current time. However, it’s not all doom and gloom. With the current vaccination campaigns in action across the world, the hope is that we will be able to return to these types of events this year. In the meantime, the world hasn’t stopped turning. Virtual events have proven to be hugely successful throughout the pandemic, and while they may not deliver the same experience as the ones pre-COVID, they still deliver the key thought leadership, networking, partnership-building, and conversation - just from behind a monitor rather than at a convention centre. In partnership with Medilink, Healthcare World Festival will provide the key conversations. Questions considered during the festival will focus on where healthcare can go next, and how international healthcare systems, providers, suppliers and governments can work together to create a more connected world of healthcare - which is a conversation needed now more than ever. While the Healthcare World Festival will be virtual, Medilink has many more events planned for this year - both virtual and in person. As we move out of the COVID-19 pandemic, we can look forward to many more promising events on our schedule, such as:

1st – 3rd September 2021: FIME (Miami, USA) - The largest healthcare exhibition for companies interested in expanding throughout the Americas. FIME is tradefocussed with thousands of attendees that visit annually from across South, Central and North America. 6th – 9th October 2021: Rehacare (Düsseldorf, Germany) - Rehacare is the leading global trade fair for the care and rehabilitation sector. The event covers six exhibition halls and attracts more than 700 global exhibiting companies and tens of thousands of visitors from a total of 81 countries. 26th – 28th October 2021: Africa Health (Johannesburg, South Africa) - Africa Health is the largest market access platform in Africa, drawing in delegates

HEALTH SYSTEMS Medilink

and visitors from across the continent. The event regularly attracts around 11,000 delegates and 600 exhibitors across five exhibition halls. 15th – 18th November 2021: Medica (Düsseldorf, Germany) - Medica is the world’s largest healthcare and Life Sciences exhibition. For more than 40 years this event has held a significant place in the calendar for exhibitors, visitors and clinicians. In excess of 5,000 exhibitors showcase their products and services to around 120,000 key global decision makers. 24th – 27th January 2022: Arab Health (Dubai, UAE) - Arab Health remains the largest healthcare exhibition in the MENA region but has now transitioned into a truly global event. This prominent and wellattended exhibition draws international

recognition and thousands of key decision makers from around the world each year. Join other UK companies on the British pavilion and take advantage of our full preevent and onsite support, and access to any available regional and national funding for eligible companies. 31st August – 2nd September 2022: Medical Fair Asia (Singapore) - Medical Fair Asia continues to be Southeast Asia’s most definitive event for the medical and healthcare industry, gathering the region’s hospital, diagnostic, pharmaceutical, medical and rehabilitation sectors in one convenient location and providing the perfect platform to discover the latest industry innovations, to network and do business. This event is the sister exhibition to Medical Fair Thailand (both events run bi-annually).

In addition to the partnership between Healthcare World Festival and Medilink, Healthcare World magazine will produce editions and attend each one of these events alongside Medilink. If you are interested in any of the events on our schedule, please contact the team at Medilink UK for more information on their specialist services or the exhibitions.

Contact Information

international@medilink.co.uk www.medilink.co.uk

Financing African healthcare infrastructure

Most multilateral organisations identify the benefit of harnessing private sector capital and skills in delivering healthcare, including the built environment, and many governments embrace that concept, whether through some ‘partnership’ model

There is much to do in financing and delivering adequate infrastructure, says Barry Francis, Infrastructure Correspondent.

look forward to moderating the session at the Healthcare World Festival on 4 May when experts from diverse backgrounds will discuss this complex subject from a variety of perspectives. I am not going to pre-empt the ideas and solutions which will emerge from the discussion – I will review those later - but I will raise some questions and share a few thoughts which have emerged from work I have been doing. 16

Finance must be seen in the context of the projects it supports and we are, of course, considering a wide range of projects in different economies. For the most part, I will not address the question of aid which is a huge subject in itself and will be covered in other sessions during the festival. We should, however, consider many needs and demands. And it is demand- the market and the ability to finance- which will be key.

Barry Francis Barry Francis Consultancy

“Most multilateral organisations identify the benefit of harnessing private sector capital and skills in delivering healthcare”

INFRASTRUCTURE African Healthcare Infrastructure

or recognising the role of private health provision. Healthcare infrastructure, certainly that designed to meet secondary and tertiary healthcare needs, is expensive, complex and usually financed over the relatively long term. Against this background, I have some questions: Which financing approaches are the least and the most problematic: direct corporate lending? Supplier financing, project finance? and so on. What are the key decision factors in the current environments? To what extent is government participation needed successfully to finance a project beyond licences and permits? When is a sovereign guarantee needed and what are the alternatives?

There are many private sector operators. What are the key issues to attract finance and minimise its cost? Where the state or a ministry is sponsoring a hospital or clinic, what are the most effective financing routes? And what are the impediments? For major projects or programmes, what is the role, if any, of government to government arrangements (G2G)? What would be the best things to include, or exclude in those arrangements ? ( finance? knowledge transfer?....) What roles can export credit agencies best play in healthcare infrastructure development and what are the principal advantages ( apart from financing cost) and what are the impediments? Would it be better for ECAs to be involved proactively early in the process? To what extent is that feasible? We see many proposals for ‘one off’ projects. Is it thought that there will be trend towards programmes of development? How serious is any concern about political risk and how are those concerns best managed? Many sponsors identify need and propose solutions but the absence of seed capital to develop feasibility and business cases prevents the ideas being realised. Is this just a fact of life or is there a solution? Where could sponsors go to access early stage finance? Hospitals and other healthcare facilities are expensive and complicated organs. Solutions which include serviced facilities or equipment ( such as laboratory services) are also complex. Do steps need to be taken to help manage the procurement and management of these contracts. If so, what is the most effective type of capacity building? Is this of concern to financiers? Is it feasible in the shorter term to develop state or private insurance arrangements which will assist financing through the provision of data and increase the certainty of long term and regular revenues? Apart from the importance of reliable data in healthcare planning, the identification of need and trends is important in assessing the ‘market’. Modern methods of construction (off site construction) are increasingly finding favour for cost, speed and environmental reasons. Is that the case in all or some African countries? And there is emphasis on mobile or moveable/ semi- permanent

structures. To what extent are financing requirements such as risk/ ownership transfer and step in affected? In the planning and design of healthcare facilities, there is growing emphasis on adaptability. That is to build in the ability to respond to changing healthcare needs and the technology and medical science to treat them as well as the need to respond to surges in demand. Long term finance can get nervous about unknown change. To what extent can design address such nervousness? Or is it just a question of financial covenants?

Barry Francis Barry Francis Consultancy

“Healthcare infrastructure, certainly that designed to meet secondary and tertiary healthcare needs, is expensive, complex and usually financed over the relatively long term”

And bringing these and other questions together, what issues differ depend on the type of facility: clinic or other primary or community care building, secondary or tertiary hospital, hub and spoke model, research facility, location (urban, rural, deep rural) or the intended focus on the patient ‘market’? And, more broadly, what things should be done to increase sound investment in healthcare infrastructure in Africa? I have identified a host of questions and only hinted at some possible answers. There are other matters to consider depending on particular circumstances. I look forward to addressing all of these in my forthcoming article after the webinar session on 4 May. Please join the session which will start at 09.00 UTC /10.00 BST,WAT/ 12.00 EAT on 4 May. Contact Information barry@barryfrancisconsultancy.com

Healthcare for the economy Paul da Rita, Principal of PdR Infra Advisory, discusses opportunities and barriers to financing healthcare infrastructure

n looking at the potential for investment, and the need, it is helpful to contextualise the situation across many African countries. For instance, relative to OECD countries, countries in Africa spend little on healthcare: an average of 100 USD per capita, just a quarter of the average OECD country spend. And more than 70 per cent of the healthcare spend across Africa comes from out of the pocket expenditure (OOP), pockets which are often emptied by other basic necessities such as food. Healthcare systems across Africa were already under significant stress before the pandemic and the post-pandemic recovery cannot simply be business as usual. Where significant proportions of a health economy’s expenditure is financed by the state or by social or private health insurance programmes, data can be gathered and revenues modelled to forecast demand upon which financing decisions can be based. The absence of that feature is a significant inhibitor to large scale development of healthcare infrastructure, or indeed healthcare systems more broadly. Investment, whether public or private, is greatly 18

hindered by the absence of stable healthcare systems. The need to develop such stable systems is recognised and we see social health insurance schemes being developed in many countries across the continent. A good example is in Rwanda where a community based social health insurance has been significantly expanded as a key feature of its progress towards Universal Health Coverage (UHC). The commitment made by the government in Rwanda to support the health system has also encouraged private sector financing. Among the examples of the strides being made in Rwanda, and the benefits of social insurance in attracting inward investment and expertise, is the 2020 partnership between the Rwandan government and Babylon Health under which Babyl, Babylon’s Rwandan focussed subsidiary, will provide primary care, via digital consultations, to all citizens, funded by social health insurance. This enables Rwanda justifiably to claim to offer Africa’s first universal primary care system. Another example of Rwandan innovation and success is the increase access to healthcare by delivering medical supplies

via drone supported by USA headquartered Zipline. Paul da Rita, Principal of PdR Infra Advisory, points out that leapfrogging into “the most progressive technologies” gives African countries the opportunity to be pioneers in the healthcare space. So, how exactly has Rwanda managed to attract the interest of multilateral organisations and Silicon Valley entrepreneurs? “The government takes their healthcare obligations seriously,” says Paul. “They have a stable plan with a progressive outlook, which produces progressive outcomes.” The importance of political will and a political consensus cannot be stressed enough. When it comes to financing and delivering healthcare infrastructure, long term commitments mean that relative certainty and the ability to manage political and other risks is a major issue. The need for policy and regulatory environments Sub-sovereign state actors are often in control of healthcare initiatives across many countries, which leads to a lack of consistency and creates risk for private investment. In order for finance options to become available to projects throughout Africa, national governments need to commit to long term policy and regulatory environments. The Rwandan experience demonstrates the ability to create long term partnerships

HEALTH SYSTEMS Paul da Rita

between the public and private sectors. In order to create successful PPPs ( which can be structured and finaced in a variety of ways) , governments need to carefully consider the fiscal impact of a project for the lifespan of the contract, as well as a demonstrable long term interest in prioritising healthcare. Internationally, there is a wealth of investment for infrastructure projects, “billions of dollars can be made available,” says Paul. However, the lack of focus on healthcare infrastructure is clear. Healthcare and economic growth Most investors and governments tend to focus on economic infrastructure as a first priority. This is beginning to change - for instance, the Global Infrastructure Facility, hosted by the World Bank Group and one of the largest project preparation facilities, is now able to consider the financing of early stage health projects. Alongside that Multilateral Development Banks (MDBs) and others are now developing blended finance options in order to assist with long term affordability and long term fiscal sustainability. So-called economic infrastructure has always taken precedent; focus has remained on transport and energy, with the social sectors some way behind. In order to attract more attention, healthcare needs to be billed as an essential building block of economic activity. “Investing in healthcare

provides not just economic output in terms of healthy people, it actually provides economic stimulus in the location it is built,” Paul adds. The importance of healthcare as a key factor of economic activity must be recognised, whether it be as directly in local job generation or as indirectly by increasing population health and long term productivity. In order for this to happen, governments need to recognise healthcare as a pillar of economic growth at a national level. A shift in focus to allow healthcare to take a seat at the national table would bring wide reaching benefits across Africa. Challenges to investment One of the largest roadblocks to getting more private investment into health infrastructure, continues with the lack of well-prepared and developed projects. The development of good feasibility studies and business cases, and the capacity to design and manage complex procurements and to manage long term contracts will be an essential feature of any successful programme. For progress to be made, initial stage finance must be accessible to carry out these feasibility studies and build capacity within the public sector. MDBs, such as the World Bank, have a critical role to play in this area. The lack of capacity is not the only hurdle to generating a project pipeline. Instability of the regulatory environment

Paul da Rita Principle PdR Infra Advisory

“Investing in healthcare provides not just economic output in terms of healthy people, it actually provides economic stimulus in the location it is built” causes huge uncertainty and exposes investments to high levels of risk. There is a desperate need to move from opaque processes to following clear, transparent procurement processes. In order to access available financing, governments need to buy in to these schemes and follow in the footsteps of Rwanda. One lesson we must take from Rwanda is the recognition of private, foreign investment providing skills, knowledge and technology as well as financial support. Digital tools, telehealth networks and the use of innovative technologies such as drones alongside artificial intelligence can tackle some of the issues faced by countries all over Africa. E-learning initiatives and the integration of AI can work towards addressing workforce issues acutely felt by many healthcare systems – it is important to recognise that building infrastructure alone is unlikely to solve the issues. Moreover, many geographical barriers can be overcome by innovative delivery systems, allowing access to medical care to reach through conflict areas and the most rural villages. A national commitment to long term healthcare systems, and the infrastructure needed to operate them, as an economic tool, bringing technology partners and international private investors, will allow African countries the opportunity to become world leaders in health. But for this to work, it is equally important that the conditions conducive to attracting investment are also in place. Contact Information pauldarita@pdrinfraadvisory.co.uk www.pdrinfraadvisory.com

An ironic impact of COVID-19 Will the pandemic finally put digital health on the path to reducing health inequalities at scale in emerging markets? ask Michal Matul and Niti Pall, AXA

OVID-19 and its associated lockdowns have worsened access to healthcare and widened health inequalities around the world. But at the same time the crisis has offered a solution to the problems it has caused, by opening the door to healthcare via telemedicine or other digital services. Since the outbreak started, digital health services – such as doctor consultations through online chat or over the phone – have experienced tremendous growth in both developed and developing countries. Now, as a vaccine promises to bring a gradual end to the pandemic, the big question remains: Can the digital health services that have become the new normal in the past year help to close inequalities in access to healthcare over the longer term? 20

How digital healthcare can address growing health inequalities COVID-19 has increased existing health inequalities within countries and regions, with higher infection and death rates among people from poorer backgrounds who live and work in crowded conditions. Not much data is available for emerging markets, but the data from Europe clearly illustrates this health equality divide. Between the start of March and the middle of April 2020, age adjusted death rates in the poorest areas of the U.K. were more than double those in the wealthiest areas. This discrepancy might get even worse, for three main reasons. First, low- to middle-income people are more prone to develop a chronic disease, which

often remains undiagnosed – and which can increase the severity of COVID-19 infections. In France, the odds of developing severe COVID-19 are seven times higher in obese patients, three times higher in diabetics and 3.5 times higher in patients with hypertension. Second, lowerincome people are often fearful of visiting healthcare facilities, which may lead to delayed treatment of COVID-19 and other serious illnesses. Third, the farther you go down the income ladder, the more mental health disorders are a taboo – and the more professional support is limited. As a result, pandemic-induced anxiety and depression are ravaging low- to middleincome people – a population that’s already more likely to be laid-off and to live in precarious conditions, which can further exacerbate mental health issues. The gap in access to healthcare is more acute in emerging markets, where the majority of the population has unequal access to health services. The WHO estimates that about 150 million people around the world suffer financial catastrophe from out-of-pocket health expenses each year, while 100m people are pushed below the poverty line. Low-

HEALTH SYSTEMS Niti Pall

to-middle-income consumers often forego treatment, as they can’t afford it, can’t navigate the health system, are not diagnosed for chronic conditions and rely on informal medical advice. That means they often end up in hospitals when their condition becomes too serious to manage, leading to costly and often tragic results. Creating a successful digital health model Discussion of the promise of digital health is nothing new in global health or development circles. It has long been recognized that there are major benefits to offering high-quality standardised advice through digital services. This approach allows providers to detect issues earlier, keep patients out of the hospital unless necessary, and engage them on daily health maintenance issues, to raise their awareness and improve their lifestyle. The concept has been proven to work in low-income context by Telenor Health in Bangladesh: It created Tonic, one of the first successful digital health

deployments in emerging markets. Using both freemium and paid-for models, it offers several packages that include a limited call-a-doctor service, health tips, a discounts network and the option to book appointments with relevant specialists. The company has served more than 8m people over the last two years. Digital health is not just about offering a medical hotline: It is about creating a comprehensive health ecosystem to improve access to quality, standardised care. As shown in the diagram below, the first component of a successful digital health model is to become a trusted advisor on health, and to offer nudges that can change patient lifestyles for the better. The second is to provide access to medical advice over the phone, and to create a medical record that can be used to better advise patients in the future. Continuity is key, as well as maintaining high quality through detailed, standardised clinical pathways and appropriate clinical governance. The third component is to provide access to offline services at a discounted price, especially to labs and specialists. And the fourth is about offering financial protection in case of catastrophic health expenses. The first three components make the value proposition tangible to patients in the short term, while insurance cements the proposition and makes it relevant in the long term. Digital health can only work if it focuses on customer engagement The key lesson is that continuous engagement is vital, to make sure people discover the service and keep using it in a consistent way. If people use the service

Michal Mittal Head of VAS Access AXA Emerging Customer

“Digital health is not just about offering a medical hotline: It is about creating a comprehensive health ecosystem to improve access to quality, standardised care” once or turn to it only for emergencies, digital health will not fulfill its potential to reduce health inequalities. Instead, these services need to become a trusted navigator that helps people to change their lifestyles and seek care at the right moment and in the right places. The COVID-19-driven digital health revolution is just beginning. The jury is still out, but ironically the pandemic may actually accelerate the closing of the healthcare access gap in emerging markets. Adoption remains a challenge, and emerging customers are different from affluent ones – hence, different engagement approaches are required to get them to discover digital health services and sustain their usage. Other building blocks, such as technology and mass-scale distribution, are already in place. Today’s technology allows stakeholders to create a health ecosystem that is efficient even in low-cost environments. Contact Information www.axa.com

Changing attitudes towards value-based healthcare HWF’s Steve Gardner speaks to Simon Swift, Managing Director of Methods Analytics, about developing an outcomes-based system

alue-based healthcare, at its most basic definition, centres on paying for outcomes, the value delivered, as opposed to paying for activity. At present, most of the health systems around the world operate on an activity-based model - systems are providers which respond when a demand arises, and it presents itself to them; but this cultivates some poor attitudes. “What such systems drive is a behaviour within provider organisations to increase activity and decrease cost, which often isn’t the most beneficial for the patient,” says Simon. However, payment within a value-based system operates entirely differently. Rather than the focus being on the quantity of care which can be provided efficiently, the focus rests on delivering the value to the patient and system. 22

Say for instance, a provider wants to pay for an operation such as a hip replacement, instead of the focus being on minimising the cost, and ensuring the activity is delivered, a value-based payer model incentivises the achievement of high-quality care through the promise of reimbursement for a successful and high quality outcome. “It could be a binary model, such as: we will only pay if readmission rate is below this percentage, one year infection rate is below that percentage, patient satisfaction is above that score, etc.,” says Simon. “What is more likely is a base fee will be paid for treatment, and then if you achieve these outcome thresholds, there’s a kicker in the contract. What you’re doing is you’re incentivising

increase in value by defining what value means and building it into contractual mechanisms.” Problems faced by value-based models The issues with value-based healthcare are, however, deep-rooted. Over the years there has been much hyperbole and noise thrown around the term, but as we are yet to see large examples of value based healthcare in use, so can it actually work in practice? Or, is it simply a good idea which cannot be instilled in practice? The main problem, Simon states, lies in one key aspect of all business - trust. “What makes a value-based contract successful is that the payer has to believe in and trust that the data they are being presented by the provider is meaningful and measured reliably. The providers need to be able to surface that data and share enough of it with the payer, so that trust is developed,” says Simon. “We have worked to design a model which enables trust, because if you can get a provider and a payer to agree on the principles of value and the define outcomes, the rest of it is simply about ensuring that the connections between the two are as strong as possible.”

HEALTH SYSTEMS Methods Analytics

With a transparent information model sitting between the payer and the provider for a value-based outcome, both parties in the agreement can rest assured that firstly, they aren’t being misled to about the quality of care, and secondly, they are able to achieve the targets which are being set to achieve the required standard of care. “It’s really quite simple at the base level. The payer states their outcome goals for the work - what they want to incentivise, what they want the outcome to be for the patient or cohort - and obviously how much they will pay. The provider then presents their plan for fulfillment, and we help them to understand what data to measure and what thresholds to set,” says Simon. “The way we’ve done this is as an escrow service. We receive, and work on, the raw data that is generated by the provider. As a trusted third party, we implement the maths that produces the contract values, the KPIs, the threshold metrics, and we surface enough of the data to the payer that protects governance while ensuring trust and, of course, the provider can see all the data as it is their data.” Value-based healthcare in practice Obviously, one of the questions which springs to mind with this model again rests on payment. For instance, if a provider is treating a long-term condition where impact may take months or years, how do you set the payment if the targets are less visible? Simon tells us that in order for this to be remedied, they have been working towards a modification of the model used by the Accountable Care Organisations within the US. “Here in the UK, a payer is effectively given ownership of the health of a group of people, normally a geography; but effectively they are given the ownership of the health of a group of people, and they are given the budget to spend on services. “But, the way I’ve seen this work in America is they give the provider the budget and outcome targets, and if it costs them more than that budget to deliver the outcomes, that’s tough - but if it costs them less, they own the upside. So, they’re incentivised to improve the health of that group.” However, it’s not quite as simple as that. To make this system work, organisations have to ensure that there’s lots of detail in the definition and measurement of

Simon Swift Managing DIrector Methods Analytics

“What makes a value outcome-based contract successful is that the payer has to believe in and trust that the data they are being presented by the provider is meaningful and measured reliably” outcomes, what they mean by the health of such groups, and make sure it is done carefully. Yet, this is not the only model for a valuebased provision of healthcare. “To look at another way to do it, which is probably more likely to gain traction, let’s use an example,” Simon explains. “Say we want to instill this model for a group of people with COPD - a long term condition. Firstly, we need to do some underlying baseline assessments. How many are there? What does their care currently cost? What are their current health outcomes? “Then, we can build some prediction into that. What is the course of the condition going to be over the next one year, three

years, five years? From that, what do we think it’s going to cost for this group over the next five years? And what do we think of the outcomes that are going to be achieved? Then you can put in place a contract to say ‘for this group of people, we will pay this much money as a baseline, a retainer to deliver the service might be paid up front, and then we will pay this much more if the outcomes expected are exceeded.’” “On top of that, you can build in a number of additional higher level outcomes thresholds over time, which increase or decrease the value of the contract, they can be incentives or penalties. I tend to believe in a model based on incentives, but that’s between the provider and the payer.” It’s a big leap to make the transition, but as we have seen recently, healthcare has to change with the times. The next challenge is to find a way to deliver better health within large but ultimately finite budgets, and value-based healthcare could well be the way forward. Contact Information

simon.swift@methods.co.uk www.methodsanalytics.co.uk

Sharing digital learning with Australia The NECS’s Capacity Tracker is helping to fight COVID both at home and abroad, says Service Manager Jason Speck

he North of England Commissioning Support Unit (NECS) developed the Capacity Tracker for the UK market back in 2017. The Capacity Tracker was originally a digital insight tool to help protect hospital capacity and minimise delayed transfers of care between acute hospitals and nursing and residential care homes. During COVID, the tool was quickly adapted and mandated by National Health Service England and the Department of Health and Social Care to track COVID cases in more 24

than 15,000 care homes across England as well as other care settings such as community rehabilitation, hospices and substance misuse facilities. The UK tool captures information such as PPE requirements, COVID status and workforce requirements. This gave commissioners of the service intelligence to identify when an aged care facility needs additional support or needs to be closed to admitting new patients due to COVID prevalence levels. Information has also been summarised and reported to the

Department of Health and Social Care and national NHS England teams to inform responses at a national and regional level. As the need for data changed, Capacity Tracker evolved, almost weekly to provide Government with the required intelligence in care home settings. It quickly became the single source of contemporary relevant information across the aged care sector. It is proven technology and has been essential in the UK’s response to COVID. Sharing with Australia During 2020, NECS launched the Capacity Tracker in Australia. The tool was purpose built for the Australian market to allow residential aged care facilities (RACFs), GPs and Pharmacies to share their so-called ‘business continuity’ information in realtime. This allows Primary Health Networks (PHNs) to have a ‘single version of the truth’ and enables them to quickly offer targeted

DIGITAL HEALTH NECS

The tool is currently live in 4 PHNs across Australia (Hunter New England and Central Coast PHN, Western New South Wales PHN, Gippsland PHN and Central Queensland, Wide Bay, Sunshine Coast PHN). The Capacity Tracker has proven to be a vital tool in the response to COVID-19 in the UK and Australia. It also offers longer-term benefits which protect hospital capacity by improving patient flow and allowing acute hospitals to see aged care bed vacancies as well as building resilience and governance into a health system. Learning Points The key ones to take from NECS work in Australia are:

support when it is required and also better support the coordination between primary care and aged care. For PHNs, the Capacity Tracker is a valuable tool which provides real-time information about COVID infections, workforce, PPE supplies and residential aged care bed availability. The system’s functionality also offers standardised

Jason Speck Service Manager NECS

“The Capacity Tracker has proven to be a vital tool in the response to COVID-19 in the UK and Australia”

reporting including real-time status, trend analysis and the use of visual mapping which gives even greater insight for PHNs. For providers, the tool takes seconds to update and, because it is web-based, there is no software to install and it can be accessed via mobile devices. By linking RACFs, GPs and Pharmacies, the tool can also offer an effective response for PHNs in other, non-COVID, emergency situations such as bushfires or cyclones where it’s imperative to quickly re-home affected residents. With the current roll out of COVID vaccinations across Australia, the Capacity Tracker has been further refined in collaboration with PHNs to capture the vaccinations of patients and staff in RACFs and GPs as well monitoring the supply of the vaccines in RACFs, GPs and Pharmacies. This gives PHNs realtime oversight over the success of their vaccination programme.

• International organisations are often interested to understand what’s worked well in the NHS. Sharing learning from the NHS can be extremely valuable for non-UK markets. • When NECS entered the Australian market, COVID was at its peak and a pared-back version of the UK Capacity Tracker was introduced as the Australian market needed a solution at pace. NECS have now set up a Customer Forum to consider pertinent features from the UK version as well as collaboratively determine new priority features applicable to the Australian PHN network. • NECS is an organisation that prides itself on continuous improvement and has a pedigree of working with customers in an agile way to ensure its products remain fit for purpose. They are currently exploring how the tool could be developed further to support other areas such as Mental Health capacity or any other situation that requires multiple users to access contemporary real-time intelligence. • There are mutual benefits to sharing information across systems. A good example is how NECS incorporated the Primary Care functionality in the Australian version into the UK version. Contact Information jason.speck1@nhs.net www.necsu.nhs.uk

Pathway and workflow management for better clinical efficiency Cloud-based clinical solutions are the way forward, says Piyush Mahapatra, Director of Innovation at Open Medical

n the age of coronavirus, we have seen a dramatic rise in the need for innovative services to better manage our workforce across a wide range of sectors. However, perhaps where this is most urgently needed is in the clinical setting, where the need to ensure maximum efficiency is a continual process. 26

However, as many of us know, the current tools to manage workflow and patient pathways are often severely outdated, inefficient, and can pose a great danger to care if left unchecked. The need for a comprehensive, modern, and easyto-use system is immediate, and this is where Open Medical comes in.

Tackling inefficiency in orthopaedics In clinical trauma settings, the need to deliver urgent care quickly and reliably is at the absolute pinnacle of priority - as it should be. However, this means that systems such as patient management, staff management, and even IT in general, can be left by the wayside. These systems can be improved, but are not impacting the quality of care ‘directly’. If it isn’t ‘broke’, then don’t fix it. Thinking in this toxic mindset has resulted in an enormous lack of innovation and development in how clinics, and even trusts at large, manage patients and staff alike. While it may not seem like these systems require immediate improvement, they really do.

HEALTH SYSTEMS Open Medical

Piyush Mahapatra Director of Innovation Open Medical

“In addition to the workflow and pathway solutions offered through Pathpoint, we offer specific technologies catering to many different requirements”

“In pretty much every hospital, there’s a trauma board - usually a physical whiteboard - and this is how outpatients who are awaiting surgery are managed. One morning, we came in to see that the whole whiteboard had been wiped off,” says Piyush. “There were about 10 to 15 patients waiting at home, nobody really knew who they were, and it was a mad scramble to look through old documents and scraps of paper to try and find them. We thought that there had to be a better way to manage patients than this.” This was where eTrauma V1 was born - a simple, local database for managing patients. It later developed into Pathpoint: a cloud-based, clinical coordination platform, designed to replace the whiteboards of days past - and provide

clinicians with the ability to customise and streamline patient care and clinical workflow. “The gap in the market was that the current systems which are available, such as electronic patient record systems, are good for documentation, but they’re very poor for clinical process and workflow; and that is what we were trying to address. We’re all practising clinicians, so we had a good understanding of what those challenges were and how to build a system to address that need,” says Piyush. Since its initialisation, eTrauma has rapidly expanded across the NHS. As the market-leading solution for patient pathways in the sector, more than 22 NHS Trusts are using eTrauma in hospitals and clinical settings. On top of the proven effectiveness and uptake of eTrauma as a service, it also incorporates integration with every major EPR solution including Cerner’s EPR systems - opening the doors to Cernerbased organisations, wherever they are in the world, at the flick of a switch. “As with many cloud-based systems, we require no installation or resource on the ground from the organisation. The platform is provided as a software-as-a-service solution with no lock-ins to ensure that healthcare organisations have access to the best technologies that meet their needs at that time”, says Piyush. Multiple solutions for multiple pathways and international scope However, Pathpoint does not only provide solutions for orthopaedics but a wide range of specialities, incorporating dermatology, perioperative care, plastics, ophthalmology, intensive care, rehabilitation services and with many more on the way.

“In addition to the workflow and pathway solutions offered through Pathpoint, we offer specific technologies catering to many different requirements - for instance we have a clinical trial management system, a digital consent system, virtual waiting lists, the list goes on,” says Piyush. “One of the significant benefits is that we’re very agile. We can match with the changing requirements which come along throughout the process, and incorporate it seamlessly. We’re integrated with the NHS Spine and working quite closely with NHS Digital.” Furthermore, Pathpoint is not limited to UK-based or NHS providers indefinitely. While Pathpoint has not yet ventured out of the UK market, Piyush says that Open Medical are currently considering which international markets would best suit their product line. “In terms of our international objectives, it’s a question we’ve been debating, and we are very much looking into what would be the best market for Pathpoint. Currently, the Middle East might be a point of access, while the US, Canada and Australia are all options,” says Piyush. “In addition to this, we use a very structured model utilising the international vocabulary standard, Snomed CT. It’s a very transportable vocabulary code and it can be translated. So, if we wanted to incorporate a Spanish system, for instance, we could use the Spanish translation and it would work the same.” All in all, Open Medical’s clinical solutions provide an efficient and straightforward pathway to ensuring better patient care, benefiting the clinician, the management, and the organisation at large - with no need for large scale upheavals of IT and modern systems. Pathpoint was born from the idea of fixing the simplest of problems, and has grown into one of the best systems to tackle clinical inefficiency and workflow issues - and it’s not done yet. Contact Information

piyush@openmedical.co.uk www.openmedical.co.uk

Brave new world Carly Caton, Partner at Bevan Brittan, examines how COVID has changed the international market for NHS organisations

he global health industry was worth around $8.5 trillion in 2018 and is expected to be worth around $10 trillion by 2022. Healthcare takes more than 10 per cent of the GDP of most developed countries. So against this backdrop, what role does the NHS have to play in the global health market? And how has that changed in the past year due to the COVID-19 Pandemic? We have been supporting our NHS clients’ international journeys for more than 10 years (from advising on some of the first international healthcare ventures the NHS 28

entered into overseas (such as SLAM and Moorfields in the Middle East) to some of the more recent international partnerships to be entered into for the provision of specialist consultancy and education services). It is unlikely there will ever be a huge number of NHS organisations opening up branches of their hospital all around the world, but we will see more of our expertise in training, education and specialist services being shared globally and more contracts of this nature being entered into.

Our health market has a lot to offer internationally and is at the forefront in many areas such as mental health, specialist services like cancer, cardio and maternity and primary care systems (which are not well developed in many parts of the world). The evolution of the health system as a whole and our experience of joined up working is also a selling point. While we still have a way to go ourselves in becoming truly integrated, we are well ahead of the game compared to many countries. The COVID effect In terms of how COVID has affected the work the NHS is doing, or wants to do internationally, there has obviously been an impact. But there have also been opportunities. The NHS showed

HEALTH SYSTEMS Bevan Brittan

Carly Caton Partner Bevan brittan

“The NHS showed that it was able to rapidly mobilise fully-equipped, additional critical care facilities through partnerships with private sector organisations”

that it was able to rapidly mobilise fully-equipped, additional critical care facilities through partnerships with private sector organisations. And at a national planning level we developed the predictive modelling tools required to understand the system impact of the virus on a given population. The outputs from this informed regional and local systems in future proofing essential capacity and facilities to plan effectively for any further surges. We have seen an increased interest in surge hospital projects and remote healthcare systems from countries around the world and this is something we are able to respond to. In the Healthcare UK Annual Review it states that, despite COVID, the team still worked on a pipeline of 158 opportunities across the year with the focus on infrastructure projects and

digital health. For the coming year, they say opportunities lie in new infrastructure projects (such as cancer centres), remote assessment, diagnostics and smart diagnostics, treatment and case management, patient-facing education and monitoring and cutting edge medical technology. Another issue which has been difficult for the NHS in continuing its international work during the COVID pandemic relates to workforce and travel. Obviously there has been no international travel which has stopped any face to face meetings or relationship building (which is so important in certain parts of the world and which cannot always be replicated online). The rapid adoption of Teams by the NHS as a way of communicating has been really successful for some clients and enabled them to keep their international

collaborations moving along. There has also been the issue of staff not being able to fly out to provide services under their international partnering arrangements – as well, of course, as the issue of not being able to rely on staff coming from outside of the UK to work for our NHS here (but that is a different matter). Finally, the directors and managers within the NHS organisations that generate income from international contracts have been diverted in to all sorts of other jobs for periods of times during the last year. This has meant that the time they would have normally spent on securing new business and opportunities has been very limited, and it has been slower to progress discussions in relation to international partnerships. Having said that, in the last few months we have seen a definite upturn in the amount of activity we are supporting our NHS clients with, and we are hopeful this will continue. So has COVID changed the way the NHS will work internationally? I think the answer is that COVID has changed the way everybody will do everything. There is little to nothing that remains untouched by it. It has slowed things in the interim, but has also brought opportunities. The type of work which the NHS may do internationally moving forwards could be quite different as the global healthcare market reflects on its health systems, how they work well and how they could work better. Contact Information

carly.caton@bevanbrittan.com www.bevanbrittan.com

Investing in Dubai’s healthcare sector Dubai is fast becoming a global hub for innovation and partnerships thanks to its unique investment climate, Dr Ibtesam Al Bastaki, Director, Investment and Partnership Department, Dubai Health Authority tells Sarah Cartledge

s the world still continues to fight the COVID-19 pandemic, most countries are focusing on their healthcare systems as an urgent need. Yet few have been as strategic as Dubai, which has in place its 2016-2021 strategy that has helped it cope with the viral assault. While the focus is firmly on the future, it has inbuilt resilience to deal with unexpected occurrences. The vaccination programme is proving successful and case numbers are declining in the emirate, down from 4-5000 cases a day to 1600. Travellers are returning and some of the hotels are up to 70 per cent 30

occupied. Despite this, most business is still being conducted online, a by-product of the global situation. For Dr Ibtesam Al Bastaki, Investment and Partnership Director at Dubai Health Authority, the increase in online communication is an unexpected benefit. “It will open up opportunities because we are going as per the demand and supply. COVID’s impact is kicking off more technology companies, particularly in telemedicine,” she says. “The whole country is working on a building a proper policy for telehealth at the federal government level and of course,

boosting a lot of public private partnership projects,” she adds. “By distributing equally the risk between the public and the private sector, it offers better cost effectiveness and better efficiency.” She feels the COVID outbreak has moved the focus away from the heavy budgetaryled government methodology, changing the whole working culture. “It’s like a knowledge transfer - learning from each other – and is one of the reasons why we want to do more PPP projects.” Working in partnership The Dubai Health Authority oversees the regulatory environment in the emirate as well as investment based on its Certificate of Needs programme. As part of its mission to transform Dubai into a leading healthcare destination, it fosters innovative and integrated care models and enhances community engagement. Many of world’s largest hospitals and specialised centres have invested in Dubai’s healthcare sector thanks to the city’s unique investment climate, which provides

HEALTH SYSTEMS Dubai Health Authority

a number of investment incentives in the healthcare sector. Various investment free zones offer attractive incentives and set up support for companies focusing on health technologies and innovations. There are several incubator programmes in Dubai to support health technology innovation, and DHA’s efforts with the Dubai Future Accelerator Program is a testament to the commitment and support to develop a robust health eco-system. For smaller companies there is clearly opportunity within DHA’s vision and guidelines. “The market has a good competition level, so they have to be prepared for that,” Dr Al Bastaki says. “We have lots of clinics as well as big hospitals that are looking for small companies to provide their technology and software. Some of those are starting integration, so small companies really need to do their due diligence coming into the market to understand the business very well. They have to work out where they want to pitch or where the needs are.” NABIDH – integrating public and private healthcare systems DHA has already created NABIDH, a health information exchange platform that connects public and private healthcare facilities in Dubai to securely exchange trusted health information. The platform eliminates the need for physical exchange of health records between facilities, reducing the risk of clinical errors while increasing patient safety and experience. Through NABIDH, DHA aims to enhance the quality of healthcare services provided to its citizens and residents of Dubai. “We have more than 2000 clinics in Dubai and we want them all to speak to each other,” says Dr Al Baskai. “At the end of the day it’s about connecting the various clinics or hospitals that one patient might visit,

Dr Ibtesam Al Bastaki Director Investment and Partnership Department Dubai Health Authority

“By distributing equally the risk between the public and the private sector, it offers better cost effectiveness and better efficiency”

and making sure they have all the necessary information. It’s also where the payment methodology comes in. At a federal level we are looking to speak one language to ensure the safety and security of patients.” Dubai is also looking at personal health records which will enable any hospital to have the necessary information to treat a patient. “Some information needs to be kept confidential between the patient and the specialist.” PPP opportunities within Dubai For Dr Al Bastaki and her team, the preparatory work behind any government initiated project is extensive and thorough. Balancing the ability for private players to enter the market, they look at the supply and demand gaps, identifying the opportunity for the private sector to enter. This is followed by an RFQ and an RFP process, workshops and discussions before the shortlist is drawn up. “It depends on the size of the project,” she says. “Some projects are very simple and you can close the partnership, while others have a 25 year commitment from the government to the private sector so they work quite differently, depending on the size and value.” At the moment a large infrastructure project, the Cardiology Centre of Excellence, is about to be announced and should be closed by the end of the year. “Hopefully within a couple of months we should be in a position to invite the private sector to manage, operate and complete the facilities for the long term,” she says. Another area of need in Dubai is long term rehabilitation and home care is a big

demand. The country has a rapidly ageing population, with an estimate 4.6-5.5m inhabitants by 2030. It is one of the fastest growing populations in the world and the number of UAE nationals over the age of 60 is expected to increase to eight per cent in 2030. In addition, a high prevalence of chronic and non-communicable diseases increases the need for healthcare services and associated tertiary care expertise and chronic care management. “For this reason we prefer to partner with the private sector where they can manage the facilities they operate and as well as equipping them,” Dr Al Bastaki says. Further PPP projects will be launched at Expo 2020 later in the year, along with the latest investment guide listing the top requirements for the country. For Dr Al Bastaki, PPP is the future and way forward with the private sector. “You actually create more jobs because you open the market for different opportunities. It brings innovation into place, leading to more cost effectiveness and more efficiency, and thus quality of care. Partnering between the public and private sector brings many and unforeseen benefits.” https://www.dha.gov.ae/Asset%20Library/ Investment/EN/DHIG.pdf Contact Information

iialbastaki@dha.gov.ae www.dha.gov.ae

Building the hospitals of tomorrow Healthcare World Editor Sarah Cartledge speaks to Richard Cantlay, Mott MacDonald’s Global Head of Healthcare Facilities, about his vision for a new era of hospital design and planning

s we examine the healthcare needs of the present day, hospitals are facing a growing need to be more fit for the future. With the cost of care rising, populations expanding, larger patient need for specialist care, and the delivery of care

systems through personal solutions such as eHealth, how can we begin to build modern hospitals that can meet the challenges of the 21st century? Richard Cantlay shares his vision of how we can best develop the hospitals of tomorrow and provide better levels of care with higher efficiency, moving

towards the ultimate goal of improving patient experience. Over the coming editions of WHJ, experts in healthcare systems and infrastructure from Mott MacDonald will offer worldleading analysis and perspective on how we can prepare hospitals for the future, the best strategy for achieving this, and how we can improve not just our hospitals but our workplaces and homes to cultivate health. Providing the vision of the future hospital Richard Cantlay has been involved within the development of healthcare facilities for more than 15 years. A chartered civil engineer, Richard has extensively

HEALTH SYSTEMS Mott Macdonald

where they recognise that they have a huge healthcare need but often their approach is to build huge hospitals without really looking at integrated systems.” The process of designing, planning, procuring and building a hospital itself is a time-consuming and lengthy process. As the growing need for hospitals and specialist care increases around the world, and clinical teams begin to recognise this, time is precious when it comes to developing new healthcare facilities to meet current needs. However, it is important that in doing so, hospitals aren’t just built for current requirements, but also ready for what the future may hold.

Richard Cantlay Global Health Portfolio Leader Mott MacDonald

“It’s very hard to predict the requirements for 10 years’ time. So, the question is, how do you make facilities that are more adaptable for the long term?” “Clinical teams are often only thinking about how they operate now and then design a facility, rather than how they might operate in five or ten years’ time,” says Richard. “And it’s very hard to predict the requirements for ten years’ time. So, the question is, how do you make facilities that are more adaptable for the long term ?” worked as a technical advisor to the NHS, leading teams to deliver healthcare system planning, architectural expertise, engineering cost consultancy and advisory on healthcare systems and facilities that are built within the UK. Richard also supports work in multiple regions around the world. He develops and implements a global healthcare development strategy supported by regional strategies, and secures the appropriate delivery teams to deliver this goal. In February this year Richard was appointed to Healthcare UK’s advisory board, promoting UK healthcare services abroad as well as supporting overseas organisations with healthcare systems

development, and assisting with the development of the strategic direction of HCUK. As a result, Richard has an unparalleled perspective on the issues that are currently faced in building the next hospitals for the world. Through witnessing first-hand the approaches of different geographies, cultures, and governments towards healthcare and hospital building, Richard can see what needs to be changed, and how we can begin to change it. “We’re all at different places in terms of healthcare systems,” he says. “If you take the UK for instance, it is more advanced in terms of integrated healthcare, albeit we haven’t quite cracked it just yet. However, at the other end, for instance, is China

Four key strands Richard proposes that the best way to begin is with a dedicated plan incorporating key areas of development that are currently either neglected or not even considered during current hospital development. While there are many aspects to this, four key strands are as follows: • Efficient models of integrated care • Adaptable hospitals • Healthy buildings • Digital Infrastructure These can be achieved in any project, so long as the correct direction and guidance sits behind it. 33

“These strands are all relatively easy to implement,” says Richard. “It’s all about doing so at the right time and knowing when this is, which will ultimately result in cost savings, better clinical efficiency, and better patient outcomes.” Efficient models of care Keeping integrated models of care in mind when planning hospitals is the first stage. Within the UK, hospitals and clinics are part of more integrated models, and these continue to evolve with new developments in fields such as the digital front door. “The first component of efficient models is building the hospital as part of an integrated care system. The second is getting clinical teams to think about how they might be working in 5, 10 or 15 years’ time. In this way, they achieve a more streamlined, efficient clinical model for their hospital,” Richard says. However, in other parts of the world integrated healthcare systems aren’t seen as a priority as the demand for care is so great. Building large capacity hospitals as centres for the majority of care is a common approach across the globe. Yet, this may not be the best way to develop new care systems, according to Richard. “For instance, in China, they often consider building big hospitals. But, instead of building a 2000-bed hospital, they could build a 200-bed hospital and surround it with community facilities, which are surrounded by home services and e-health facilities, so that people can “step-up” through the healthcare system as and when they need to, meaning the clinical services are more accessible, delivered in the most appropriate setting and more efficient. Adaptable Hospitals The hospital of the future needs to be able to face any challenges that the future may throw at it. For this reason, a vital part of building the hospitals of the future is to give them the capability to utilise their space, technology and staff in different ways to ensure that, in any situation, hospitals are always working as efficiently as possible. “The outcome from building more adaptable facilities is to embrace the changes that come along in terms of clinical equipment and technology so you are able to keep up to date more easily, as 34

carrying out a construction project in a live hospital is never good. It also becomes more cost effective to implement those changes, all leading to a better patient experience and better patient outcomes,” says Richard. Healthy Buildings Hospitals as buildings should cultivate and restore health, not damage it. If the hospital of the future can curate an environment which is healthy and comfortable, patient recovery times will improve; diseases transmitted in hospitals will decrease; and workload will be reduced across services, as the amount of time patients spend in the hospital will go down. In addition, healthcare workers who operate within hospitals reported more indoor and workplace related symptoms than any other types of workers, according

to Motts. Working for long, continuous hours, being surrounded by sick patients, no designated rest areas – all of these factors contribute to poor concentration levels, work ethic, mood, and physical health as well. Some of the most innovative and commercial organisations in the world are putting huge effort into designing their working environments to be healthier, more comfortable, and better places to work in. Having a good working environment is a key consideration for people when looking for work nowadays. If hospitals can do this, their capability to attract and retain staff will increase massively. If organisations which aren’t involved in healthcare are designing their workspaces to be as healthy as possible, then why aren’t hospitals doing so? “Hospitals that put health and wellbeing at the heart of the design process will have

HEALTH SYSTEMS Mott Macdonald

positive outcomes,” says Richard. “Better recovery of patients; less risk of hospitalacquired infections; the ability to attract and retain staff; more productive and effective workforce; better visitor experience – an ultimately better patient experience.” Digital Infrastructure The impact that digital technology and smart solutions bring to healthcare infrastructure cannot be understated. Monitoring and tracking software can give live, real-time data on how buildings are being used, this allows for predictive building maintenance and the utilisation of equipment in the best way possible. Richard refers to a “digital twin” which provides a digital, live model of a building, which can then be used to monitor the building’s performance. “Real-time data is sent back to the ‘digital twin’ at all times, giving an up-to-date

Richard Cantlay Global Health Portfolio Leader Mott MacDonald

“Building hospitals for health and healthcare will have positive outcomes”

representation of the asset and how it’s performing which allows you to make better decisions surrounding your building.” In conclusion Building the hospital of the future is a process that won’t happen overnight and won’t be easy. It will require the integration and cooperation of clinical teams, patients,

procurers, contractors, engineers, and architects to develop the hospital of the next 5, 10, or 15 years. The ultimate goal of Mott MacDonald isn’t just to improve hospitals for better efficiency and cheaper running costs, but also to improve the patient experience throughout the entire process. Mott’s experts see these four key strands as essential in moving forward with everimproving digital solutions and making hospitals more able to face the new and unique problems that the future might hold. Motts plan for the hospital of the future - if implemented - will provide a better quality of care for all.

Contact Information www.mottmac.com

Taming the Lion’s Stare Bruce Benton, Manager of the World Bank Riverblindness programmes, on how their success can impact COVID vaccination rollout in Africa

ith the emergence of COVID-19 there is more awareness of how not just novel but also neglected diseases can affect a global population. With questions around how Africa will deal with the current pandemic and manage the vaccine rollout, the success of the river blindness programmes in West Africa is a salutary example of cooperation and dedication to controlling and eventually eliminating a devastating, widespread infectious disease. 36

The OCP (Onchocerciasis Control Programme) in West Africa and the follow-on APOC (African Programme for Onchocerciasis Control) covering the rest of the continent were partnerships co-sponsored by the World Health Organization, the World Bank, the United Nations Development Programme and the UN Food and Agriculture Organization. These control efforts were led by World Bank official Bruce Benton, an economist with an interest in public health who had been shocked by the widespread

devastation of local communities and personal suffering wreaked by the disease. Onchocerciasis is caused by a parasite (Onchocerca volvulus) transmitted by a blackfly (Simulium damnosum) that lays eggs in and around rapidly flowing rivers and streams throughout sub-Saharan Africa, six countries in Central and South America, and Yemen. Once reaching adulthood in the body, the 2 ½ foot long parasite spawns millions of microscopic parasitic worms that cause unbearable itching, skin disfigurement and eventually irreversible blindness. On average, victims of the disease become blind at 30 years of age. Onchocerciasis is known locally as the Lion’s Stare, due to the fixed, lifeless gaze of those blinded by the disease. It affects huge swathes of rural populations numbering more than 10m across the

HEALTH SYSTEMS River Blindness

Bruce Benton Manager World Bank Riverblindness

“What was so amazing about OCP and APOC was that they were led by a wide-ranging partnership comprised of more than 100 diverse partners who all pulled in the same direction”

African continent that are often unable to work due to disability and are trapped in absolute poverty. Running from 1974 to 2015, OCP and APOC pulled together 27 donors, dozens of NGOs, 31 African governments and more than 100,000 local communities into a diverse partnership that led the control effort. The success of the West African programme has enabled populations to resettle and cultivate some of the best land near rivers that had previously been abandoned due to the severity of the disease. Ambitious beginnings Covering 35m people in 11 countries, the OCP relied principally on vector control, i.e. aerial spraying with insecticides, to

prevent the blackfly from reproducing and transmitting the parasite. “It was a very successful control strategy that effectively halted transmission of the disease throughout the West African region,” says Bruce, whose book Riverblindness in Africa, Taming the Lion’s Stare is now published by Johns Hopkins University Press. “There was no drug at the time. So the only way we could control the disease was to prevent the fly from transmitting it. Vector control worked effectively for more than 25 years and largely eliminated onchocerciasis throughout most of West Africa.” During the 1980s the wonder drug, ivermectin, was found to be effective against onchocerciasis by scientists at the American pharmaceutical

giant, Merck. In collaboration with the Kitasato Institute in Japan, ivermectin was discovered from a compound found in a soil sample on a golf course in Ito, Japan. Through clinical trials it was learned that ivermectin, given once per year, killed off 95 per cent of the microscopic worms (microfilariae) in the human body with virtually no side effects. However, it did not kill the adult worm, which continued to live in the body for up to 15 years. Hence, ivermectin needed to be given at least once a year for the 15-year lifespan of the adult worm. By killing the microfilariae, ivermectin stops the itching, prevents blindness and halts transmission over time. Because onchocerciasis is concentrated in the poorest populations in remote rural areas in some of the poorest countries in the world, Merck decided in 1987 to donate ivermectin, under the brand name Mectizan, for “as long as needed to as many who need it.” It was the first major drug donation for a disease in the developing world and set a precedent that has since led to follow-on drug donations from other pharmaceutical companies for all of the major neglected tropical diseases. “Mectizan became available through Merck’s donation program in the early 1990s. Under OCP, it was used as a supplement to vector control and enabled that West African programme to be brought to a successful conclusion in 2002,” says Bruce. “However, the drug became central to the control strategy for the follow-on programme, APOC, covering the rest of Africa. Many of the countries covered by APOC were heavily forested which prevented insecticide spraying via helicopters. The availability of Mectizan permitted oncho control to be widened 37

to cover 20 additional countries in East, Central, and Southern Africa. In 2009 it was discovered under APOC that where the drug had been used for 15-17 years, the disease had completely disappeared. Consequently, the objective under APOC shifted from control to elimination of the disease throughout Africa via sustained Mectizan treatment.” Learning the lessons Under the OCP there were more than 1000 people working on the programme, many working as flycatchers on river banks to catch and dissect flies to determine whether they were infective with the parasite. “OCP was high tech and expensive because we used a fleet of helicopters to spray up to 50,000 km of rivers a week, more than twice the lengths of the Mississippi, the Missouri, the Ohio, and the Columbia Rivers combined. Although the overall cost was high, it averaged out to less than $1 per person protected per year,” Bruce says. “Vector control under OCP worked well, although the fly eventually became resistant to temephos, the cheapest and most benign insecticide available at the time, causing a crisis which nearly doomed the effort. Eventually we overcame resistance, for the first time ever, by using operational research to discover backup insecticides that were environmentally safe and used them in rotation to defeat resistance - a huge achievement, really.” Under the second programme, APOC – which was launched at World Bank headquarters in 1995 – the control strategy was based solely on drug distribution

Bruce Benton Manager World Bank Riverblindness

“It was particularly strong on cooperation, operational research, and fund mobilisation over many years, which enabled the programmes to weather crises and take advantage of new technologies and other new opportunities”

through local communities. Once it was determined that Mectizan treatment could stop transmission, the objective shifted from eliminating the disease as a public health problem to eliminating the disease entirely. APOC ended in 2015, but elimination of the disease remains the objective under a third programme, ESPEN (Expanded Special Programme for the Elimination of Neglected Tropical Diseases). Through operational research under APOC, a method was found to reach a high percentage of the infected population in remote areas by delivering Mectizan through local communities. The method became known as Community-Directed Treatment, or ComDT. “Under ComDT, the communities selected volunteer community distributors who took responsibility for ensuring that all those at-risk in the community would receive a dose of Mectizan at least once a year. That proved to be extremely effective in ensuring that a high enough percentage of the at-risk population received the drug to stop transmission over time and eventually eliminate the disease,” says Bruce. “Up to 35 NGOs worked to help train the community-directed distributors on how to deliver the drug, recognise potential side effects, and keep records to ensure that the drug was safeguarded and readily available when needed.” “What was so amazing about OCP and APOC was that they were led by a wideranging partnership comprised of more than 100 diverse partners who all pulled in the same direction. This was possible because the programme objective and the strategy to achieve that objective were kept simple and consistent over time. Hence, all the partners had the same understanding of the end goal and what was needed to get there. Also, the various partner groups – donors, African governments, sponsoring agencies, NGOs, and research entities – had different, but complementary skill sets, which led to synergistic results through a division of labour. Managing the partnership We went out of our way to recognise each partner as responsible for the success of the effort. Spreading credit around liberally was important in ensuring that each partner would stick with the programme over the long haul,” says Bruce. “It also helped the partners – be they governments, foundations, or NGOs – retain support domestically as the word got out that they

were responsible for the success. The continuation of support was remarkable. The original nine donors that launched OCP in from 1974 were still supporting the effort 35 years later. “There are a lot of lessons to be learnt from how the partnership was put together, held together, and sustained over decades. It was particularly strong on cooperation, operational research, and fund mobilisation over many years, which enabled the programmes to weather crises and take advantage of new technologies and other new opportunities. We learned it had to be a regional approach, rather than country-by-country

HEALTH SYSTEMS River Blindness

effort due in part to the up to 500 km flight range of the blackfly. If the disease was eliminated in one country it would return quickly via re-invading infective blackflies from a neighbouring country. The regional nature of the programmes also had the advantage of producing high-value regional public goods benefiting all participating countries, such as Africa-wide operational research, the application of new technologies, and the development of common concepts and methodologies.” Currently, according to the WHO, 205m people are at risk of contracting onchocerciasis, with 20.9m infected –

99 per cent of whom are in sub-Saharan Africa. To date 1.1m people suffer from blindness due to onchocerciasis. And NGOs such as Sightsavers International undertake important work in helping to train community distributors to distribute Mectizan, providing more than 513m treatments to alleviate suffering and prevent blindness. “The success of the OCP and APOC programmes along with the continuing efforts of NGOs to combat onchocerciasis have alleviated tremendous suffering over the past 40+ years and have promoted economic development in sub-Saharan Africa by increasing human

productivity and opening up arable land to resettlement and cultivation,” says Bruce. “I am extremely proud of the results we achieved to create a situation where many of the poorest of the poor are now free of suffering and have regained the ability to lead productive lives.” Riverblindness in Africa, Taming the Lion’s Stare by Bruce Benton is now published by Johns Hopkins University Press. Contact Information www.sightsavers.org

Why 2021 could be a good year for malaria eradication Dr Benji Pretorius, founder of Erada Technology Alliance and malaria survivor, shares an insight into why the next 12 months will see significant strides forward in the global mission to eradicate malaria

020 will be remembered largely because of the COVID-19 pandemic and the disruption to ‘normal’ life which came with it. While efforts to contain the virus featured prominently in world headlines, malaria prevention programmes ensured that more lives were not lost. In the most challenging of circumstances, malaria prevention has remained resilient. Vital measures and prevention programmes have largely continued, preventing the World Health Organisation’s ‘worst case scenario’ of malaria deaths doubling from becoming a stark reality. However, according to the latest World Malaria Report, published in November 2020, we as a global community have strayed off course from current eradication goals. It is easy to look back at 2020 in a negative light, especially with the picture painted by the World Malaria Report, but there have been some silver linings. For instance, insecticide treated nets (ITNs) deployment programmes have continued across Africa. One area which has seen a notable success is in Benin, which not only undertook its fourth mass distribution of nets in 2020, but also adopted digital tools to gather vital insights into the size of the country’s population and to ensure that ITNs were deployed in the areas in greatest need. Digitalisation also ensured that households had the correct number of ITNs, thereby affording the local authorities the ability to plan in greater detail the level of distribution. The digitalisation of the programme was made possible through the use of smartphone data, which gathered insights into the size of individual households, ages, and genders. Each household was granted a unique QR code, which allowed authorities to confirm the right number of ITNs had been distributed and no households were missed. The data also revealed that, from around 3m registered 40

households, 14.5m persons needed access to a net. Consequently, Benin’s authorities have been able to bring in a sufficient quantity of ITNs, with the aid of international partners. The Benin case study has shown what is possible with strong government support and the use of data in fighting malaria. Given that Benin’s digitalised ITN deployment took place during the COVID-19 pandemic, it also further highlights that it is not only possible for malaria prevention to continue amongst other pandemics, but programmes are continuing to evolve and adapt. Perhaps the most encouraging sign that we have turned a corner came at the end of 2020 with the announcement that a malaria vaccine set to enter the final stages of testing this year could be available by 2024. While this is, undeniably, welcome news and which should be celebrated, the speed in which a vaccine for COVID-19 has been developed does raise the question of why one for malaria – a disease which could claim ten times more lives – is still some way off being ready. The answer to this question is that malaria is often one step ahead. New research to understand the genetics of the Plasmodium parasite is released on a regular basis, highlighting everything from the impacts of climate change to specific mutations which could render some antimalarial drugs ineffective.

Dr Benji Pretorius Founder Erada Technology Alliance

“While a vaccine for malaria would be the pinnacle of preventing the disease, it must be the result of careful research”

While a vaccine for malaria would be the pinnacle of preventing the disease, it must be the result of careful research. Malaria is, after all, one of the oldest diseases in the world, yet we are still finding out the best way to fight it effectively. In the absence of this definitive answer, our focuses should remain on educating vulnerable communities, maintaining support for prevention programmes like in Benin, and ensuring access is granted to frontline workers carrying out remote testing and treatment ‘in the field’. Rapid diagnostic tests (RDTs) will be essential in providing early intervention,

TECHNOLOGY Erada Technology Alliance

especially with technology playing its part in making tests increasingly accurate. It has been encouraging that RDTs continued to be deployed even in the face of COVID-19, especially as our own test is close to beginning the next stage of its practical field trials. As figures in the 2020 World Malaria Report show, nearly 2bn RDTs have been distributed throughout the last two decades, including 348m in 2019 alone. Steps have been taken to position RDTs in community facilities as more affordable tests become available. The foundations have been laid in bringing malaria tests to the communities most at risk, as has also

Dr Benji Pretorius Founder Erada Technology Alliance

“The global fight against malaria is one that we are both in control of and taking forwards”

COVID-19, but make no mistake, the global fight against malaria is one that we are both in control of and taking forwards. The collaboration between frontline health workers, medical professionals, and governments has not only continued during the pandemic, but has led to critical discoveries and developments, all of which will be essential as we fight for a Contact Information

happened for COVID-19. We now need to ensure that tests translate into treatment at an earlier stage. It may have been overshadowed by

www.eradatechnology.com

Kooth Pulse 2021:

The state of the UK’s mental health through the pandemic

Working in partnership with the NHS, Kooth’s digital mental health service is often the first point of contact for those reaching out for support. We’ve crunched the data from the last 12 months to provide a unique insight into how the mental health of the nation has been impacted by the

pandemic, the trends in presenting issues, and the key challenges that the NHS and society will face as we navigate through to a new normal. May 2021 State of the Nation Report

Download the 2021 Pulse analysis (April 2020 – March 2021) at

explore.kooth.com/pulse2021

Kooth Pulse 2021 Report

An in-depth look into how COVID-19 has affected the mental health of the United Kingdom, and the data trends that support the narrative.

Trends: •

Self-Harm and Suicide ideation

•

Eating Difficulties

•

Black, Asian, and Non-white communities

•

Families, parenting, and home-schooling

•

Children and Young People

•

University Students

•

Working age Adults

koothplc.com

Welcome to Kooth’s annual State of the Nation report for 2020/21. This paper uses data from

HEALTH SYSTEMS DEVELOPMENT Mott MacDonald

Producing doctors - what Africa can learn from Asia In Asia there has been an exponential expansion in private medical schools over the last decade, says Dr Ken Grant, Technical Director International Health Mott McDonald

frica is short of doctors. Not just short - very short. At the start of the Ebola crisis in Sierra Leone in 2014 there were 136 doctors for 6m people. The 2017 Global Health Workforce update makes depressing reading with most sub-Saharan African countries having fewer than five doctors per 10,000 population. Many have less than one per 10,000 (e.g. Zimbabwe 0.7, Burundi 0.4, DRC 0.9., Ethiopia 1.0). Most OECD countries have between 25-30 per 10,000 population. While doctors are not the only health worker they are probably the most important both for their leadership qualities and for their overall understanding of disease causation, prevention and treatment. They also possess the clinical and public health skills needed for successful interventions at both the individual and population level. Migration will always be an issue. It will always be cheaper and easier for OECD countries to rely on attracting trained doctors to augment their own inadequate production programmes. Doctors from Africa and Asia will always be able -with some exceptions -to earn much more in OECD countries. We have to accept this. The answer, surely, has to be to keep producing more doctors. Better Human Resource planning does not seem to be the answer. WHO, through its global health Workforce Alliance, has tried recommending better political engagement, 10-year workforce plans and other initiatives. None of this has worked

sufficiently. Perhaps it is time to let the market try and deliver what public planning has failed to do. This is happening in Asia where there has been an exponential expansion in private medical schools over the last decade. Nepal with a population of 30m has 20 medical schools, 12 of which are private. India (population 1.3bn) has 183 government medical colleges and 215 private colleges, while Bangladesh (population 165mn) has 36 public medical schools and 54 private. There is a big demand to enter medical school and the private sector has responded to meet the demand.

Dr Ken Grant Technical Director Mott MacDonald

“Perhaps it is time to let the market try and deliver what public planning has failed to do” There is the obvious question around quality, but all private medical schools are regulated by the country’s respective medical councils and for those wishing to emigrate they must take the respective entry qualifications of the counties they wish to practice in. If there are concerns around quality, the answer is to work to

improve it through better regulation and quality assurance rather than restricting the market. In contrast, in Africa (population 1.2bn) private medical schools have been slow to develop. The most authoritative study on African medical schools is a 2012 study by Chen et al. They point out sub-Saharan Africa suffers a disproportionate share of the world’s burden of disease while also struggling under some of the greatest health care workforce shortages. Twelve per cent of the world’s population lives in sub-Saharan Africa, yet the region suffers 27 per cent of the world’s total burden of disease, has only 3.5 per cent of the world’s health care workforce and 1.7 per cent of the world’s physicians. They identified 146 medical schools of which 22 were private, but only seven of these were for profit. The Cuban solution Cuba has 25 medical schools from which 11,000 doctors graduate annually. South Africa decided to take advantage of these schools and from 1996 it sent up to 100 students each year. It was expanded in 2012 when 1‚000 students were sent to study in Cuba. At that stage‚ South Africa’s eight medical schools were graduating about 1‚200 doctors a year. The plan then was to continue to send a further 1000 students a year. However, there were issues in absorbing the returning students into the South Africa system. The Cuban students had a focus in their training and on primary care and prevention and needed further training on return in curative medicine. There was difficulty in absorbing them in further undergraduate training and finding early training posts for them. The jury is still out as to whether this was cost effective and whether it would have been better to train more doctors within South Africa itself. There are obviously constraints to the expansion of medical schools – physical facilities, access to clinical environments and above all good quality teaching staff. All were identified in Chen et al’s study. However, perhaps it is time to see if the market can respond better in addressing these issues than the public sector has done. If Asia can do it, Africa can do it. Contact Information www.mottmac.com

Reducing South Africa’s healthcare burden The Heart and Stroke Foundation South Africa aims to improve cardiovascular health through lifestyle and education tools, says Sophia Kurz

n South Africa, cardiovascular disease (CVD) is responsible for almost one in six deaths, while 225 people die every day from heart disease or stroke. Ten people an hour suffer a stroke in the country, yet 80 per cent of heart attacks and strokes can be prevented.

Many people are unaware that lifestyle changes can dramatically improve cardiovascular health. The Heart and Stroke Foundation South Africa aims to halt the rise of premature deaths through cardiovascular disease and cerebrovascular disease (CVD) by promoting

the adoption of healthy lifestyles. Since its inception, the Foundation’s goals have been to provide information, tools, and support to build healthy communities, advocate at all levels to minimise South Africans’ risk of developing heart disease and stroke, and support research for improved tools and methods of CVD prevention. Cardiovascular disease is a condition that affects the heart or blood vessels. There are four different ways that this disease may manifest itself, including coronary heart disease, strokes or transient ischaemic attack (TIA), peripheral arterial disease, and aortic disease. Cerebrovascular disease is similar to cardiovascular disease. A condition that

HEALTH SYSTEMS South Africa Heart Foundation

affects the blood vessels and blood supply of the brain, it may present itself in a variety of ways, including strokes and TIA, but also aneurysms and vascular malformation. Current CEO of the Foundation, Professor Pamela Naidoo, says that the Foundation has had a “very productive” first quarter of 2021, but there’s still more to accomplish. Getting the message across Rapid urbanisation in South Africa has seen a change in food consumption patterns where people are consuming more kilojoules, sugary beverages, processed food, and fewer fruit and vegetables. This, in combination with other rising CVD risk factors such as physical inactivity and

tobacco smoking, has resulted in a steady increase in deaths due to CVD in recent years. CVD places additional pressure on an already heavily-burdened healthcare system and impacts the livelihood of many South African households. The Foundation has developed various programmes to promote cardiovascular and cerebrovascular health. The Health Promotions Programme sets out to encourage South Africans to adopt healthier lifestyles by educating and advising them on CVD. The Nutrition Science Programme aims to ensure that all nutritional information that the foundation communicates to the South African public is understandable, evidence-based, and practical.

But changing lifetime habits doesn’t happen overnight. Many of these health messages are complex, so the Foundation aims to nudge changes to unhealthy behaviour by consistent and clear messaging. Despite the advent of the COVID-19 pandemic, the Foundation is still innovating. “Our focus on common risk factors indirectly assists in reducing the burden for other disease conditions, such as COVID-19,” says Professor Naidoo. “Our public health messaging about the ill-effects of tobacco smoking, excessive alcohol abuse, poor diet, physical inactivity, hypertension, obesity and diabetes Type II has educated the broader public and our specific target groups about how to develop health behaviours to achieve better health outcomes.” Professor Naidoo is a Registered Clinical Psychologist and holds a Master’s in Public Health, as well as a Doctorate in Philosophy (Behavioural Medicine). She is a public health specialist with 29 years’ experience in the health sector across non-communicable and communicable diseases. Non-communicable diseases (NCDs) – a collective term for cardiovascular disease (CVD), cerebrovascular disease, diabetes, cancer, chronic respiratory disease and mental disorders – are the leading cause of deaths worldwide. NCDs cause more than 60 per cent of the world’s deaths, 80 per cent of which occur in developing countries like South Africa. It is anticipated that by 2030 NCDs will overtake all other causes of death in Africa. “The epidemiological pattern of NCDs, CVD in particular, makes us relevant and indeed provides the impetus for the work we do at the Foundation,” she says. ‘The complexities that drive the modifiable and unmodifiable risk factors for CVD sets the backdrop for our programmes and indeed our multiple valuable partnerships both locally and abroad. “By driving education and public awareness campaigns to further raise interest and share information on CVD prevention, we empower members of the public to take charge of their health status.” Despite the current pandemic challenges, the Heart and Stroke Foundation South Africa continues to operate ‘with heart’ towards impacting the health of South Africans as individuals and as a nation. Contact Information www.heartfoundation.co.za

Saving money on procurement processes Data is an invaluable tool in streamlining costs across healthcare organisations, says Mat Oram, CEO and co-founder of AdviseInc

he sudden arrival of the COVID-19 pandemic threw hospitals and health systems into disarray. Struggling to keep up with the overwhelming demand for PPE, ventilators and other vital equipment, procurement teams in the UK tried and failed in many instances to maintain supplies in the face of huge demand and competition. Fortunately help was at hand within the shape of AdviseInc, a healthtech company co-founded by Mat Oram and Philip Stoyle, who both had spent decades working in and around the NHS and healthcare, particularly in procurement. They were also experts in the field of data and analytics, so they offered 46

their services to the NHS or National Health Service for free to deal with the situation. Originally driving procurement transformation, finding alternative suppliers and price benchmarking products, they went on to create StockWatch, an online application and analytics solution to answer important questions around the availability and location of PPE. By removing the reliance on Excel spreadsheets and paper trails, UK hospitals, care homes and healthcare organisations were able to keep an accurate real-time track of supplies. “Our data feeds Gold Command across multiple regions and our analytics have

been used to help organisations running out of stock like gowns, by providing visibility and enabling prompt mutual aid. Without our tool, this would be difficult,” says Mat Oram, AdviseInc’s CEO. Price benchmarking With around 220 NHS trusts in the UK, there is no one central procurement and pricing system. Lack of transparency and clarity over pricing has led to wildly varying costs, with unnecessary overspending frequently taking place. To resolve this dilemma, Mat designed a Price Benchmarking (PB) tool. This online tool takes data from the majority of NHS trusts and hospitals across the UK to provide product price benchmarks, helping healthcare professionals make sense of what they are spending on medical and general supplies. “We take data from many hospitals across the UK and we compare apples

HEALTH SYSTEMS AdviseInc

Working internationally

with apples. So, if you bought a clinical product, we could tell you what price everybody else in the NHS paid for that same product. For example, the price of an orthopaedic spinal screw can vary from £160 to almost £600. By simply ordering the lower price screw, the hospital can make substantial savings. Multiply that across the number of products, procedures and hospitals and the system can save over £100 million.”

Mat Oram CEO and co-founder AdviseInc

“We are able to help organisations save money while not compromising on care”

Mat and his team work with clinical teams across the health service to explain the benefits of, for example, not using ten different screws when one would be more cost effective. This would reduce the nursing training required and would enable the department to run more economically. “Very often clinicians are not aware of the bigger economic picture and we work closely with them where we can to deliver the change,” he says. When AdviseInc presented PB to the then Health Secretary Jeremy Hunt, he immediately requested that the Price Benchmarking solution be rolled out across Britain. AdviseInc’s customers now include 90 per cent of NHS trusts in England, all of Wales and Northern Ireland and a growing number in Scotland. Many organisations see returns on investment of more than 100:1, with AdviseInc’s tool saving NHS Wales more than £1 million a year, and Manchester University NHS Foundation Trust over £400,000.

The PB tool has been used in Australia, the USA and Europe, helped by the fact that the pandemic has reduced the necessity to travel. “Most clients are happy that we are based in the UK and trusted with hundreds of millions of rows of data. If they have concerns about data leaving their shores, then we use local Cloud Services and the data remains in their country,” he says. For new clients they can deliver benefit almost immediately. “We start off with a low cost product which is benchmarking and that allows customers to see the value we can deliver,” he says. For hospital groups they start with price harmonisation – for example in Ireland they worked with three organisations that were being charged different prices for the same products. They then move to more advanced Spend Analytics, Catalogue Checking and Category/ Contract Management analytics. “It’s relatively low cost for us to deliver and high value for the client,” he says. “They can see immediately how they can save hundreds of thousands, if not millions of pounds. Procurement for a single hospital is a massive task on its own; the sheer number of items required makes in-depth, product-by-product comparison unfeasible for individual managers and teams without massive resource. Overspends are often unavoidable.” With its StockWatch and Spend Analytics tools, Mat is confident that AdviseInc can help current situations globally. “We would be able to help with tracking COVID vaccines,” he says. “If local healthcare workers keep track of the vaccine numbers, we would get regional or national visibility that can be scaled up. Then we can attach a barcode scanner so there would be an understanding of where the vaccines have been rolled out and what the numbers are.” He also maintains that the company would be able to deliver this with a low cost model to allow governments to roll out the system. “We are able to help organisations save money while not compromising on care,” he says. By providing cost effective analysis and solutions, AdviseInc can make budgets stretch further, and make sense of complex disparate data sources. Contact Information support@adviseinc.co.uk www.adviseinc.co.uk

Taking a hands-on approach to digital innovation Rob Hurrell, Business Development Director at Aire Logic, outlines the need for digital solutions as we emerge from the COVID-19 pandemic

igital solutions have been on a meteoric rise over the past 10 years. If we consider where we were at the beginning of the 2010s, it’s a frightening thought as to how we may have dealt with the coronavirus pandemic without them. Efficiency, for one, would have been irreparably damaged - and this is not only due to coronavirus. As we have seen throughout the digital age, solutions in all sectors, not just healthcare, have helped to increase drastically the speed at which organisations and individuals operate. However, the digital revolution is nowhere near finished. We must strive to continue to develop, research, and implement new technologies where they are necessary - and remove the obsolete systems which are a hindrance to proper practice. Within the health sector particularly, organisations have pushed for years and years to implement digital solutions as a tool to reduce cost and improve patient care. But this is far too broad a task to tackle, and results are often slow to materialise, and even slower to develop. COVID has actually helped in this regard, as we can see what we can achieve under pressure. Lessons learned Aire Logic’s ethos was formed out of the lessons learned from the NHS National Programme for IT - to see how we could do things differently - and more successfully. Some of these ideas didn’t bear fruit but many of them did, and the potential for value was immediate. We think strategically and begin with a minimum viable product that will rapidly scale into a platform that will have an immediate benefit. That’s the aim of the game. Our chief platform, Forms4Health, is an intuitive, easily integrated form system, designed to place an organisation in

full control of their own IT - and enable both the patient and the clinician to take charge of their information without the need for convoluted (and outdated) processes. Our platforms work on a phone or on a tablet – in fact, on any common device. You could be a clinician or a patient, and you can use it in any context you need without having to keep up with user portals or remember logins. Generally, people tend to stop using patient applications and portals after a time. However, receiving a link and a text, saying you’ve got an upcoming appointment or a vaccine booking, gets an excellent response - as it eliminates the need for unnecessary effort at the user end. At Leeds Community Healthcare, for example, we were able to reduce the number of people who were given six-month appointments for chronic conditions. Often, these consultations would consist of the patient arriving at their appointment, reporting that they were healthy and their symptoms were managed well, and then leaving within five minutes, with another appointment booked in six months. This was a clear waste of time for both the clinician and the patient. But still, it was necessary - patients had to check in, and clinicians had to ensure that their patients were still healthy and that their symptoms were well managed. However, these are questions that can be asked in five minutes on a form. In implementing our solution for this purpose, we reduced unnecessary appointments by more than 50 per cent. The knock-on effect was that clinicians were able to treat all the complex cases more effectively, and patients didn’t have to make the journey to the hospital or clinic when they knew the appointment would only last five minutes - even more valuable in the age of coronavirus.

Building services from the bottom up One major problem we have encountered is that many providers have a desire to improve their services through digital health solutions, but cannot quite pin down the areas where they want it, or even require it. In many organisations, there is a real understanding of the importance of moving forward - but no idea how to implement and integrate with new technology. This is an important recognition you can’t fault organisations for want of trying. So if someone comes to us looking for a new solution, we don’t just say come back to us in six weeks with your specification. Organisations won’t

HEALTH SYSTEMS Aire Logic

know what a solution is going to look like at the initial stages of a project. But, if you have a solid starting point with four or five key things that you’re looking to

Rob Hurrell Business Development Director Aire Logic

“In many organisations, there is a real understanding of the importance of moving forward - but no idea how to implement and integrate with new technology”

achieve, we will find something that you can trial and instill in your organisation. Then we can develop - which is a far more rapid route to a working solution. Our work with Leeds Teaching hospital started with a very simple forms engagement. We took a paper form that was a bit clunky by and provided additional utility by allowing the clinicians to develop the form through the user experience, rather than with a focus on technology. That is how our offering works, especially our platform - it consists of very simple building blocks. You don’t have to be a developer or coder to understand it - and it’s very quick and intuitive for people to create those forms on our platform themselves for whatever needs they have.

From this single-use case, Leeds Hospital developed and built a system of their own IP and our forms section is the basis of their electronic patient record. It is by some measure the largest in the country, surpassing around 1.8m form submissions a month using our solution. The crux of Aire Logic is to provide something useful that can expand very quickly, particularly with clinical involvement. Organisations can see the power of practical use immediately through an application, and realise the potential of digital solutions with ease. Contact Information robert.hurrell@airelogic.com www.airelogic.com

Ensuring the effective use of medicine WellSky’s medicine management solutions are helping hospitals and clinics across the world to prescribe and manage their medication use, says CEO Rob Blay

edicines often represent the most expensive part of a patient’s care, and must be managed, prescribed and administered safely to maximise the effectiveness of the resource. WellSky is dedicated to providing medicines management solutions to hospitals across the world to optimise patient healthcare outcomes. Their solutions are present in more than 250 hospitals, with locations in the UK, Ireland, South Africa, Norway, Sweden, Belgium and the Netherlands. 50

The platform itself draws upon decades of domain expertise and puts patient safety first, while also ensuring operational efficiency and financial sustainability, which all directly contribute to how well a hospital can care for patients and staff alike. Encompassing an Electronic Prescribing and Medicines Administration (EPMA), a pharmacy solution and a chemotherapy management solution, together WellSky’s system ensures an integrated workflow with easy links to related hospital

applications such as patient record and management systems. Proven success in South Africa In South Africa alone, WellSky has worked to deliver an Enterprise-based pharmacy solution, which has been deployed across more than 100 facilities including hospitals and community clinics on a

Rob Blay CEO WellSky

“WellSky’s cancer solutions are developed in close collaboration with oncology prescribers, pharmacists, and nurses”

HEALTH SYSTEMS WellSky

Digital solutions for prescription and medicines

single, user-friendly platform to manage the procurement and supply of medicines. The primary goal of the solution at present is to develop a shared patient record which can be accessed and updated wherever the patient attends for treatment - no matter if it is their local clinic or the major hospital. The system itself uses a concept called a ‘Locality’ to group individual facilities together within the Western Cape. Within each Locality, the system allows local configuration while sharing concepts such as drug files, procurement contracts and patient records which are common to all. Improving chemotherapy treatment As the premier European supplier of patientcentric, anti-cancer therapy management solutions to hospitals and to networks of hospitals, WellSky’s cancer solutions are developed in close collaboration with

oncology prescribers, pharmacists, and nurses who work in university hospitals and leading specialist cancer treatment institutions across Europe. In Norway, WellSky is the strategic partner to the south-eastern and western regional areas - serving a population of more than 2.6m. As such, WellSky have provided a full end to end chemotherapy solution allowing for the prescribing, preparation and administration of chemotherapy to patients throughout the whole process. This single, regional chemotherapy system interfaces into to a regional EPR, Laboratory and Pharmacy Stock system, and serves more than 22 hospitals in total, and is linked to more than five chemotherapy drug production units. All these sites use a common drug reference file, national prescribing protocols and a standard paper-light workflow for chemotherapy preparation to GAMP-5 standards.

In the UK, the WellSky Electronic Prescribing and Medicines Administration is the most widely used EPMA solution. WellSky’s EPMA forms a critical element in regional healthcare economies’ drive to improve the safety and quality of patient care. By investing in WellSky, EPMA healthcare organisations can reduce the prescribing and administration errors that left unchecked may result in medication errors and adverse drug events; errors that cause avoidable harm and waste vital healthcare resources. Integrated seamlessly with WellSky Pharmacy and shortly chemotherapy solutions, WellSky offers a medicines management platform that allows clinicians to access patient medication details and prescribe across multiple systems with single sign on functionality. On mobile platforms, WellSky MAPP offers a versatile suite of apps to support a wide range of hospital processes and closed loop patient management. The apps combine to deliver improved safety and operational efficiencies. In support of the UK’s Covid-19 pandemic response, WellSky created a reporting function within its customer systems to enable daily reporting on the location and quantity of vaccine stocks, amount of vaccine administered daily and identification of vaccine wastage to the NHS. Flexibility and standards WellSky’s flexible and dynamic approach to healthcare challenges is facilitated by a commitment to industry standards including FHIR and HL7. WellSky offers the most complete set of solutions and services in medicines management. Today, care providers of all types and disciplines are confronting dramatic change and looking for a partner who can help them solve challenges and thrive. WellSky is that partner. Contact Information

contact@wellsky.com www.wellsky.org

Visiting big venues safely InstantAccess powered by Xtrace is a one-stop solution for opening our doors again, says MD Stan Shepherd

t’s been a long haul for event organisers and venues. Closing the doors to attendees has driven events online, but networking just isn’t the same. Customers are keen to return in person and now they can return to global venues safely. Many venues identify attendees with wristbands that allow entry to the event. At Instant Access Medical we have come up with a simple solution that incorporates

smart software in the wristbands. Powered by Xtrace, the bands will inform the wearer if they have come into close contact with someone who later tests positive. So how does it work? The event or venue will work with Instant Access to provide wristbands to everyone who attends. Attendees will pair the wristband with a downloadable app to

populate with their own COVID data, including vaccinations and immunity status. To attend the event, visitors must legally warrant their data is accurate at the point of entry. On arrival, wristbands now containing the data will be scanned by IAM’s Sentinel Readers. If the light is green, they are safe to enter the venue. Once inside, the wristbands will scan all those within 2 metres for more than 10 minutes. These ‘at risk’ encounters are stored in the Instant Access Cloud. During the event the attendees will be contacted immediately, so they can get tested as soon as possible to make sure they are still safe. If someone later tests

HEALTH SYSTEMS Instant Access Medical

Helping schools monitor their COVID exposure It’s not only parents but students who are happy they have returned to school, but how can they be reassured that classrooms are really safe? InstantAccess wristbands powered by Xtrace contain the answer. Vaccination and immunity information is stored in the wristband which is paired with an app. If anyone uploads a positive test, students are alerted via the Cloud and can request another test at school. Schools can be reassured they are doubling their testing efforts by using InstantAccess. IAM’s Sentinel Readers can be installed at the school doors and any student without the required vaccination or immunity can be identified at this point. It helps to keep students, teachers and their families safe and secure. It’s easy to manage and can be overseen by the school’s administration.

positive within 14 days, all those within the range will be instantly notified. All they should do is go for a test and remember

Stan Shepherd Managing Director Instant Access Medical

“It doesn’t mean every opportunity for enjoyment is risk free, but everyone can control their exposure much more successfully and feel confident going out”

to upload the results in the app to keep everyone else safe. If they have been infected, they will know immediately and can take the necessary action. All data is secure and doesn’t rely on location, so individual information is personal and confidential. Best of all, everyone has an up to date record of their own health status that they can show to anyone anytime. Reopen safely and securely For venue owners and conference/concert organisers, the solution is easy to operate. By installing IAM’s Sentinel Readers and providing data-driven wristbands for attendees, visitors can be screened at entry

points and refused access if they do not have the required vaccination or immunity status. As a result, owners and operators will know their venue is safe and their event is only attended by those with negative COVID tests or those who have been vaccinated. Even if a visitor tests positive afterwards, the client base will be informed if they have been within 2 metres of the person who has tested positive and will be able to update their own information accordingly. The app doesn’t use location services so any positive tests will not reveal the venue as the point of contact. It doesn’t mean every opportunity for enjoyment is risk free, but everyone can control their exposure much more successfully and feel confident going out. Contact Information stan.shepherd@instantaccessmedical.com www.instantaccessmedical.com

Alleviating capacity shortfalls in hospitals Halving avoidable conditions acquired in hospital can free up to 10 per cent of ICU capacity quickly and potentially save one life for every hospital bed, says Richard Jones, President and Chief Strategy Officer C2-Ai

OVID-19 looms over healthcare globally and will continue to have an effect for years to come. However, there are ways to alleviate issues in countries suffering capacity shortfalls in hospitals, and to return to ‘normal’ as quickly as possible. While the rates of infection may be levelling off in some areas, and some countries are well advanced with their vaccination programme, there are many including India that are suffering severe capacity issues. Hospital staff globally have done a wonderful job throughout this pandemic, 54

showing their dedication and hard work at every turn, despite all the physically tough and emotionally exhausting challenges. Unfortunately, some patients contract conditions in hospital that are avoidable. One common condition is hospitalacquired kidney injury (AKI). A study by researchers at University Hospital Southampton NHS Foundation Trust, found that AKI was a significant factor for COVID-19 admissions to ICU and deaths. AKI was present in 31 per cent of COVID-19 hospital patients, and the condition (along with Hospital Acquired Pneumonia - HAP) was associated with 27 per cent

of admissions to ICU. The findings also showed that more than twice the number of COVID-19 patients with AKI died, compared to those without it. Taking our performance in hospitals for this approach and working with Indian colleagues, we estimate that an Indian hospital could save one extra life per bed over a 12-month period through the reduction in cases of these avoidable conditions and increased availability for COVID-19 patients. There are also obvious benefits longer term in reductions in patients moving on to suffer from life-changing conditions such as Chronic Kidney Disorder. Accurately assessing risk Hospital-acquired AKI and Pneumonia (HAP) cause an average of six and eight additional days in hospital, respectively. They are also found to increase the risk of death in COVID-19 patients, with AKI in particular being highlighted as problematic in guidelines issued by the National Institute for Health and Care Excellence (NICE) in the UK.

DIGITAL HEALTH C2AI

C2-Ai’s COMPASS mobile app provides clinical staff with a tool for accurately assessing every individual patient’s risk of developing the conditions in hospital, so that appropriate action can be taken to prevent significant numbers of AKI and HAP cases, reduce admissions to intensive care, and decrease associated morbidity and mortality. To be clear, this is prevention of these conditions – not identification when they have been acquired by a patient. No complex integration is required and the app can be downloaded and supporting assessments in minutes. C2-Ai has been named by HealthcareUK as one of “10 Essential Digital Health Ideas for a COVID-19 UK National Response” in part because of this approach. This technology helps decrease patient morbidity and mortality but also reduces pressure on staff. The Compass app from C2-Ai can be downloaded onto a smartphone and used by clinicians immediately, without the need to integrate or store data. The app can evaluate a range of comorbidities and circumstances more quickly than might be done manually,

Richard Jones President & Chief Strategy Officer C2-Ai

“Preventing conditions from developing will always be quicker and demand less clinician time than treatment and, naturally, will be better for the patient” with guidance on how to treat the patient provided. It is being used and trialled by several NHS trusts, based on approaches that have worked to reduce these conditions in several countries already. By assessing patients on admission for their risks of acquiring hospital-acquired acute kidney injury and pneumonia, the system supports clinicians with specific advice on care tailored to each patient – reducing the number of patients acquiring the conditions and so preventing harm and saving lives.

“I’ve been trialling the new C2-Ai App for AKI & HAP, both of which are phenomenal and work incredibly fast…delighted and excited as to how this tool can help us identify these patients early and put in place simple measures, which all have a significant impact”. Consultant General Surgeon – NHS

Based on data from healthcare organisations using this technology, it is anticipated that this preventative approach can reduce overall AKI levels by 50 per cent through significant reductions in hospitalacquired AKI and reduce Hospital-Acquired Pneumonia by a similar amount. Preventing conditions from developing will always be quicker and demand less clinician time than treatment and, naturally, will be better for the patient. In addition, by freeing up bed capacity – particularly in ICU – such measures would also help hospitals save money. The reductions in these avoidable conditions could reduce direct costs by $9m annually in some countries during ‘normal times’, save up to 500 lives per hospital and also free up to 1000 beddays monthly (with up to 10 per cent of ICU capacity being freed). At a time when there is huge pressure on hospitals, these tools are clearly beneficial. Contact Information r.jones@c2-ai.com www.c2-ai.net

NIGHT for Nurses Making the mental health of nurses, midwives and healthcare assistants a top priority

he advent of COVID-19 has impacted the United Kingdom in ways that no one could predict. So far, the UK death toll numbers 127,000 individuals with more than 4m cases. The virus has affected not just patients and their families, but also healthcare workers. Working long hours at risk of contracting the virus, they also have to deal with the heavy 56

stress and pressure placed to keep their COVID infected patients alive. “Nurses are suffering the brunt of the COVID-19 pandemic. They are physically and mentally exhausted. Particularly, within critical care, there are significant levels of post-traumatic stress evident, which is extremely worrying. This is simply not sustainable,” said Nicki

Credland, chair of the British Association of Critical Care Nurses. The Nightingale Initiative for Global Healthcare Transformation (NIGHT) was founded earlier this year by Peter Arndt and Chris Campbell. It is aiming to raise funds in order to provide confidential mental health services to NHS nurses, midwives and healthcare assistants when required. “We probably got one of the fastest approvals in the history of the Charity Commission,” says co-founder Peter Arndt. “We handed in the application on 20 December, two hours before they shut down for the year and we got the approval three hours after they opened up on 4th

HEALTH SYSTEMS NIGHT for Nurses

Peter Arndt Director Night for Nurses

“It has always been challenging for healthcare professionals, but the unprecedented pandemic has brought this into sharper focus and has undoubtedly taken its toll on their mental wellbeing”

January.” NIGHT’s ambition to help NHS workers is fuelled by the alarming number who experience mental health issues, but do not reach out. According to the charity’s website, “The annual suicide rate within nursing is nearly 25 per cent above the national average” and “85 per cent of medical practitioners have experienced problems with mental health but have never sought out treatment.” NIGHT is a unique charity in that they aim to provide professional help to sufferers, in contrast to other mental health charities who often utilise volunteers to speak with individuals. “There are about 25 to 30 mental health charities in the United

Kingdom, but they don’t have clinicians because clinicians charge to treat someone. No charity is out there that spends several hundred pounds on each afflicted person that their charity looks after,” says Arndt. Yinka Winzenburg is NIGHT’s first benefactor. His life was changed forever in December 2017 when a fall at an outward-bound course caused a severe spinal cord injury which threatened to leave him paralysed. He was treated at St. George’s Hospital, where he underwent a seven-hour operation. A month later, he was transferred to The Royal Buckingham Hospital in Aylesbury (Florence Nightingale was personally involved in the original

design for the hospital) for rehabilitation and physiotherapy with traumatic injury specialists, the first civil pavilion planned hospital to be finished and in use in the United Kingdom. Three months after the accident Yinka took his first steps unaided. Yinka is actively pursuing his ongoing recovery and he is adjusting to his ‘new normality’ with the invaluable therapeutic input in mind. Yinka received compensation for his accident and used some of the funds to help establish NIGHT on behalf of The Royal Buckinghamshire Hospital. “Yinka wanted to give something back to all the healthcare professionals who helped him following his accident, both public and private,” says Peter. “Alongside Chris Campbell, Managing Director of The Royal Buckinghamshire Hospital, the idea for NIGHT was formed, with the Covid pandemic only highlighting the incredibly difficult circumstances all nurses and all other healthcare professionals are working under during normal times.” “It has always been challenging for healthcare professionals, but the unprecedented pandemic has brought this into sharper focus and has undoubtedly taken its toll on their mental wellbeing.” With this ambitious goal in mind, the charity is currently seeking funds to help the many NHS workers who have borne the brunt of the pandemic in the UK. Contact Information pete.arndt@nightfornurses.co.uk www.nightfornurses.co.uk

Helping start-ups navigate the complex world of funding Phundex provides a platform to make the journey easier, says founder Heather-Anne Hubbell

s most start-ups will testify, it’s not enough to have a great idea. Without investment the idea will never come to fruition, but many entrepreneurs have little financial expertise to back up their brainwave. In today’s world, particular for digital healthcare, there seems to be a plethora of possibilities, but grasping them is much more difficult than it should be. 58

Lawyer and serial entrepreneur Heather-Anne Hubbell has experienced funding pathways from end to end. As a former consultant, banker and risk manager she has helped businesses transform their processes by leveraging technology, and came to the conclusion that a single platform would be the easiest way to simplify structure and avoid task duplication.

“It’s so labour intensive and manual that I thought there had to be a more streamlined way to make funding accessible,” she says. “The genesis was all the pain points I have encountered over the years and the need to eliminate as many as possible. We are building a digital pathway between investors, issuers, advisors, administrators and those with capital needs.” Creating a coherent pathway Phundex helps everyone to have a single place to reference information, undertake activities and follow along the process to be able to get to market faster. “It makes the activity more streamlined and frees up capabilities,” she says. It leaves you free to do the value added activity with the people that you’re working with.”

HEALTH SYSTEMS PHUNDEX

the workflows they require. “We have the data attributes set up as individual pieces so that you can gather that information in and populate the documents you want with the necessary processes so you can do the reporting you’re looking for. “It’s the full workflow which automates the activity and passes it on. You don’t just have a series of tasks that roll up to a project, but you have a workflow that takes people through to the next step, identifying what they need to do and the next person they need to reach out to.” Linking the entrepreneur and the investor

Each party to a transaction has a different role to play and uses different tools. “I thought if I could create a platform that has a golden source of data as the base, one that can create workflow activity that people can follow, it could bring all those parties together and simplify the funding experience,” she says. “No matter what part of that role you play in the ecosystem, you can put your piece in and be able to see what everybody else has done and ensure that you’re following the process where you need to be. You can be sure you’ve got the right inputs and you’re giving the right output and people will get what they need to see. It is effectively a collaboration hub for all the parties to join together.” The concept behind the platform is a series of workflows with examples and suggested templates. Alternatively, clients can start from scratch and build

There is often a translational issue between an innovator and an investor. It hinges on how well the entrepreneur tells their story to enable the investor to make a decision. The platform offers a verification and validation process for start-ups to help them build up their commercial offering. According to Heather-Anne, traditionally in U.K. funding non-institutional investors require an incredibly complicated series of information that may take several days to complete. With Phundex the documents are available to such investors and do not need to be replicated each time. Phundex also serves as a due diligence platform where all the information can be accessed at different levels depending on the requirement. “There are many investors that focus specifically on digital health and given where we are with Covid and all of the other medical, digital medical opportunities are out there,” Heather-Anne says. “There are many interested investors including the institutional investors that are looking at the whole ESG aspect - the environmental, social and governance and the health tech space really resonates in that area as well.” Phundex can be used effectively by anyone in the investment life cycle from a start-up, a large incubator that feeds into a venture capital business or the VC itself or a regulated fund services business. “We are building additional models that talk about the scorecard, which allows investors to reach decisions, but not everybody will want a standard scorecard,” she adds. “They will have their own, but they can build the process to put together the information from a decision-making perspective.

Heather-Anne Hubbell Founder Phundex

“We are building a digital pathway between investors, issuers, advisors, administrators and those with capital needs” “It also allows you to go through phased approaches. So if you’ve got a number of stages that your project transaction funding role needs to go through, you can actually set those up as separate steps and take it through as you bring all that information through to the end. And that means that everybody’s seeing the same information, which makes the decision making much easier and faster.” As a SaaS (software as a service) platform, there is an on-boarding fee and a monthly licencing fee for a certain number of people to use it based on the type of user and the customisation they would like. The platform itself does not provide regulatory compliance but it can be customised to enable clients to meet their regulatory requirements. It validates the jurisdictions they operate in and can assess at a very high level if there are any challenges that they may have in terms of where the data is stored. Phundex will launch in September but it already has some clients on the Beta platform. For Healther-Anne, it’s not just a healthcare solution but one that will resolve issues for entrepreneurs across all sectors. “I think it will meet many different types of businesses,” she says. “We’re currently looking for partners to develop complementary roles - I see it as being a collaboration hub that continues to expand its network of API capability and to enable more and more activity to happen on the platform.” Contact Information hello@phundex.com www.phundex.com

Building back better How do we support peer-to-peer networks as the bedrock of a sustainable global health system? ask Thomas Hughes, Head of Development Partnerships and Ged Byrne, Director Global Health Partnerships, Health Education England

ollowing the global pandemic, we need to consider how to support the front-line staff of the NHS to continue and enhance their engagement in global health work. Future pandemic ‘preparedness’ and global health security more generally, is dependent on the ability of health workers everywhere to collaborate in providing the world’s populations with a more equitable and safe access to lifelong health and wellbeing. Shared experience, peer-to-peer and institutional partnership can be built through participation in such work. Health Alliances can foster the individual and institutional links which can provide the 60

solidarity to enable us to ‘build back better’, but current enthusiasm to build new and enhance existing Alliances need political and financial support to do so. Health Education England, with the help of the Tropical Health and Education Trust (THET) hosts two such alliances (Uganda and Myanmar) which continue to promote and support health partnerships, and we are currently brokering the development of several more. HEE is fully supportive of these Alliances because, as the education, training and workforce development arm of the NHS, we know that there are few better learning environments for our staff to develop the critical skills necessary

(resilience, leadership, adaptability, cultural intelligence) to maintain the NHS’s ability to deliver the highest quality healthcare to the UK population. We also know that through these Alliances we can equitably contribute to global sustainable health system strengthening efforts. Now more than ever we see the importance of a truly global approach to global health. There have always been strong ties between the NHS, the quintessential internationalised organisation, and the rest of the world. Professional and personal ties between the UK and a plethora of countries exist at all levels, not least due to migration from overseas, with at least one in seven NHS staff being born and qualified outside the UK. There is a strengthening desire in the NHS, from the boardroom to the ward, to support global health work. The previous UK ODA funded Partnerships for Health Scheme trained more than 100,000 health workers in LMICs using NHS volunteers from more than 130 NHS organisations.

HEALTH SYSTEMS Health Education England

brought about by COVID-19 have led to the evolution of virtual fellowships delivering the same high quality QI programmes but through technologybrokered partnerships and relationships. Alliances

HEE and new ways of working Early in the pandemic HEE made all NHS COVID related e-learning materials available for free online. Online educational materials have the potential to be a global good – but the evidence suggests that behaviour change and sustainable impact comes from blended educational programmes and peer-to-peer role modelling which cannot be delivered by technologically enhanced learning alone, but requires real conversations between peers, educators and system leaders. HEE have developed a series of pilot programmes to promote the development of these relationships but are eager to increase partnership participation. An example of such an HEE-led programme is the ‘Improving Global Health Fellowship Scheme. Initially this scheme, following a period of intense training, placed young health workers from the UK as part of teams delivering Quality Improvement Programmes in LMICs. Travel restrictions

At a recent Healthcare World panel on the future of healthcare in Africa post-aid, it was striking how a discussion which might once have used the language of aidto-trade had moved to a space of peerlearning and a dialect of mutual interest and mutual commercial gains. Well-managed healthcare alliances work to bring together NHS and UK-based partner organisations (Higher Education Institutions, charities, commercial entities) with their peers overseas to work in partnership under a Governmentto-Government agreement. This aligns health workers’ desires to work and learn alongside their peers tackling pressing global health issues with the requirements of ministries of health, as well as commercial interests in both countries providing a seamless ‘top down and bottom up’ approach to bilateral partnerships. These Alliances also facilitate an economy of scale for those working within partner countries by creating a consortium/collaborative approach to capacity building and shared learning. Within the Uganda-UK Alliance there are several consortia, whose members have used their shared interests and collaboration to produce a scaled-up approach to capacity building through sharing logistic support, providing sustainable presence and preventing duplication. One such consortium working in West Nile has brought together an extraordinary breadth of partners ranging from Everton in the Community and the English Premier league through the African and International Red Cross to several secondary care trusts based in the UK. This consortium has focused, to date, on improving the mental health of refugees through sport and wellbeing coaching. The way forward? COVID-19 has not simply reminded us that healthcare is all about people and that we can use technology to develop and maintain high quality relationships.

Ged Byrne Director of Global Health Partnerships Health Education England

“We must recognise that health workers are at the centre of the new world of global health”

It has also demonstrated that we can only be globally prepared for any future global force majeure if we recognise that cross border, organised, robust peer-to-peer networks are the building blocks of health security. We would suggest the following three lessons from the pandemic should be acted upon by us all: 1. We must recognise that health workers are at the centre of the new world of global health. However, security must come not just from increasing their numbers but from empowering them as agents and of change and catalysts for improvement. 2. We must explore new mechanisms for funding overseas volunteering programmes and alliances through public private partnership and rely less on traditional governmental funding mechanisms. This can be achieved by the first, second and third sector organisations in every bilateral partnership recognising that there is much to be gained from such investment. 3. We must support NHS Volunteering programmes and recognise the role such programmes can play in development of individuals skills, improving mental health, and driving improvements in the NHS. If, in 2019 there was a desire to link NHS organisations and health workers with their peers in LMICs, in 2021 there is a requirement to do so. Contact Information ge@hee.nhs.uk www.hee.nhs.uk

Building Africa’s healthcare infrastructure Lack of resources and finances are hampering the continent, but Afreximbank has plans for African Centres of Excellence, Oluranti Doherty, Director Export Development, tells Infrastructure Correspondent Barry Francis

frica has a unique set of challenges when it comes to healthcare. West Africa in particular suffers from a severe shortage of healthcare facilities and, coupled with further issues unleashed by COVID-19, a new way of thinking is taking shape. For Oluranti Doherty, Export Director at Afreximbank, the underlying reasons are clear. “Healthcare is predominantly within the domain of governments who are responsible for funding healthcare 62

infrastructure projects, but if you look at state reallocation of healthcare across Africa, you see that has been low compared to global standards,” she says. “Lack of investment and lack of opportunity in the private sector drives healthcare professionals overseas to pursue their careers,” she adds. “Along with the lack of political will to invest in healthcare and support its businesses and systems, not to mention challenges in international financing, there is a huge hurdle to overcome.”

Changing the mindset Currently, most West African hospitals are underfunded, underequipped and inaccessible to most patients in non-urban areas. Only 4 of 14 West African countries assessed have more than one doctor per 10,000 people. Nigeria currently has the highest ratio at 4 doctors per 10,000 persons. The acute shortage of healthcare workers and an even greater deficit in skilled specialist personnel feeds and has led to a massive brain-drain in the sector. Much of this is due to inadequate investment in capacity development, and failure to comply with the 2001 Abuja Declaration where African countries committed 15 per cent of their budget to healthcare. In addition, West African countries are characterised by a disproportionately large contribution of private spending to total health expenditure and this directly impairs the accessibility and quality of healthcare services within the region. Healthcare across specialist areas are mostly supplied at the

HEALTH SYSTEMS Oluranti Doherty

tertiary care centres, and sometimes at secondary level, while referral systems are generally poor. Changing lifestyles have led to an increased incidence of NCDs, with cardiovascular ailments, cancer and haematological disorders representing 81 per cent of NCD mortality. The result of all these factors is often medical tourism to such countries as India, the USA and the UK in search of specialist solutions. The African Medical Centre of Excellence In response to the critical state of healthcare in the region, Afreximbank has commenced plans to set up a 500-bed, world class African Medical Centre of Excellence (AMCE) in Abuja, Nigeria. The Bank itself was established in Abuja in October 1993 by African governments, African private and institutional investors as well as non-African financial institutions and private investors for the purpose of financing, promoting and expanding intra-African and extra-African trade. Headquartered in Cairo, Afreximbank also has operations Cote D’Ivoire, Zimbabwe and Uganda with a mandate to stimulate African trade and operate as a first class, profit-oriented, socially responsible financial institution. And nowhere is this more applicable than in the healthcare sector. “We commissioned King’s College Hospital London to undertake a study for us in 2015,” Oluranti says. “One of their proposals was to change the trend of things by looking at regional centres of excellence as a way of addressing the infrastructure gap and creating an ecosystem that would speak to medical personnel on the continent. At the same time the staff would receive adequate training and address the problem of outbound medical services.” In 2017 the Bank selected Nigeria for the pilot. “The Nigerian government was very cooperative. They gave us two acres of land in Abuja and committed to provide nonphysical incentives to support the project to ensure it will be sustainable. “We’ve been very fortunate that King’s London have done this before in places like Dubai, Abu Dhabi and China. So they come with a wealth of experience to do these kind of projects in environments that are not as perfect as the West. They have been able to bring on board their skill set to support us in working on this project and they are now a major partner for us.”

Oluranti Doherty Director Export Development Afreximbank

“Many healthcare professionals know the right people but they struggle to access the finance for their schemes. We are willing to look at their projects and to provide the funding where appropriate” The 500 bed centre will offer a full spectrum of medical services in oncology, cardiology and haematology along with world-class research, education and development capabilities to ensure it remains at the leading edge of delivering clinical services. The services will be offered to both low and highincome patient groups while demonstrating a viable method for quality healthcare that can be replicated across Africa. Afreximbank are taking a significant portion of equity – 50 per cent – and attracting private investor financing to supplement it. “We are looking at working with like-minded institutions as you can’t have a marriage of strange bedfellows,” says Oluranti. “We’ve seen keen interest from GE Healthcare not just in supplying the equipment, but also providing some form of equity and other forms of financing to ensure that this project is sustainable.” They are inviting partners for the second phase following the proof of concept with the first phase, which is due to be completed within three years. It will have differentiating facilities, including PET and CT imaging which are not currently available in Africa and will provide patients with the continuity of care required to achieve superior health outcomes compared to other centres in the region. Service delivery will be led by King’s College Hospital at a level similar to its operations at King’s College Hospital Dubai and King’s College Hospital India. Medical staff will be sourced from KCH’s network along with exceptional Nigerian medical professionals currently practising in Europe, Middle East and America. World class development partners (project managers, development and design

consultants) with experience in executing similar projects in Nigeria have already been engaged to facilitate the project development Positive impacts The project is strongly aligned with the United Nation’s 2030 Sustainable Development Goal (SDG) to ensure healthy lives and promote well-being for all at all ages. The provision of quality healthcare to more than 5000 patients annually includes free or discounted medical services to the poor and uninsured patient groups. Much of Nigeria’s healthcare expenditure is out of pocket, with no social insurance in place for the less well- off. “The government is trying to scale up insurance schemes,” says Oluranti. “Some states such as Lagos have moved quickly while others haven’t. There is also aid in place to fly severe cases abroad for medical treatment, so we’re looking at a combination of processes to provide for those unable to pay.” She’s also keen to utilise the returning medical expertise to improve the healthcare provision on the continent. “Many healthcare professionals know the right people but they struggle to access the finance for their schemes,” she says. “We are willing to look at their projects and to provide the funding where appropriate. We have also supported public sector projects including a $1m facility to support the manufacture of medical equipment and consumables on the continent.” Afreximbank recently collaborated on the Africa COVID-19 financing initiative by providing a $2bn guarantee facility for the acquisition of doses of the Johnson & Johnson vaccine to support the country’s acquisition of vaccines in a timely manner to reduce the burden on African states. “Afreximbank has always been an institution that rises up to challenges it’s part of our responsibility to catalyse sectors,” Oluranti says. “When we’ve been able to attract private sector stakeholders into the sector, our objectives will have been achieved and we will be able to show that such a project is possible.” Contact Information odoherty@afreximbank.com +20 122 299 9066

The call for collaboration Health Correspondent Scarlett Windmill Last learns about the work of the Clinton Health Access Initiative and the lessons learned during Covid-19

ccording to the Lowly Institute’s Covid Performance Index, Nigeria has outperformed most of Europe and the Americas in response to the pandemic. The government swiftly enforced a national lockdown and institutionalised testing of entrants to the country, allowing international travel to continue throughout the pandemic. Mobilisation of the private sector, and cooperation with the government allowed a struggling healthcare system with fragile infrastructure to avoid a state of emergency. With the support of independent health organisations, the government has been able to roll out an impressive vaccination programme throughout the country, with plans to vaccinate 70 per cent of the population during the course of the next 64

two years. A major player in this scheme has been the Clinton Health Access Initiative (CHAI), which operates throughout Africa and across low-and middle-income countries. CHAI works tirelessly to provide equitable access to healthcare in more than 35 countries worldwide by strengthening the government and private sector to create and sustain high-quality health systems. CHAI’s innovative oxygen therapy programme was built to tackle the million preventable deaths caused by paediatric pneumonia and hypoxemia in low-income countries. During the Covid crisis, CHAI worked in collaboration with the government and local state actors to provide widespread oxygen access. “When Covid came, we were really prepared,” says Chizoba Fashanu, Deputy Director of

Essential Medicines, Sustainable Health Financing and Malaria at CHAI. New oxygen plants were installed to rapidly expand oxygen supply in the country and oxygen treatment centres were erected in order to provide testing and care in Lagos state – the hardest hit state during the pandemic – covering hard-to-reach areas to support those with limited access to basic primary care services.

Chizoba Fashanu Deputy Director of Essential Medicines, Sustainable Health Financing and Malaria CHAI Nigeria

“The heart of it is ensuring equitable access to lifesaving commodities, lifesaving interventions for children, women, and their families too”

HEALTH SYSTEMS Clinton Health

Collaboration is key

Being able to draw on CHAI’s resources and in-depth knowledge during the pandemic enabled the government not only to support wide-reaching testing, but also to produce a comprehensive vaccine programme. From the point of delivery, through the last mile and administration, CHAI has provided unrivalled in-country expertise and support, alongside GAVI and support from others partners such as UNICEF, to deliver Covid-19 vaccinations to the Nigerian population. “We saw a very unprecedented response from the private sector in Nigeria for Covid,” says Asma’u Abiola, Sustainable Health Financing Associate for CHAI Nigeria. Global press coverage led to an initial hesitation in the acceptance of a Covid-19 vaccine in every corner of the world. This was acutely felt by Nigerians, who have a history of slow uptake of vaccination programmes, as seen by the polio immunisation campaign in 2003. A risk communication campaign and consistent education championed by CHAI and GAVI is proving particularly successful, with half the population now in support of vaccination.

CHAI’s work has been crucial not only in shaping Nigeria’s response to the Covid crisis, but in the future of national immunisation. Nigeria’s malaria response proved CHAI’s place as a major player in the national healthcare landscape. Through collaborative programmes with both the public and private sectors, CHAI facilitated the increase of diagnostic testing and treatment access to millions of people. Providing the necessary operational support, CHAI has replicated this model and supports more than 20 countries in the global fight against malaria. CHAI’s history of success in Nigeria doesn’t stop at malaria. Since 2007, CHAI has been spearheading efforts to increase access to vital medications and vaccinations throughout Nigeria, by negotiating sustainable programmes on both a national and state level. CHAI has been providing paediatric and adult HIV treatments, which have contributed to the country cutting their HIV prevalence down by half, according to UNAIDS. In light of the success of the HIV programme, CHAI developed a wide range of initiatives to address the health concerns of vulnerable sections of society. The focus of these programmes revolves around sexual, reproductive, maternal, newborn and child health. A family planning initiative has worked to empower women to take control of their sexual health. Chizoba says that “the heart of it is ensuring equitable access to lifesaving commodities, lifesaving interventions for children, women, and their families too.” Chizoba is currently working with the government to provide universal health care, with a focus on primary health care coverage. Challenges and solutions However, there is still a long way to go. Across Nigeria, especially in the Northern regions, immunisation programmes are struggling. “The last mile delivery, particularly at the lowest levels of healthcare delivery between local cold stores to health facilities,” causes delay in the delivery of essential medicines, according to Shola Dele-Olowu, Deputy Director of Vaccines Program for CHAI Nigeria. Part of the problem for CHAI is access to health workers. “There aren’t enough

workers being produced,” says Shola, “and getting them to go to some of those difficult areas is problematic.” Before the Covid crisis, CHAI focused on a peer-led initiative to carry out Nigeria’s Expanded Program on Immunization (EPI). This saw the traditional, text-heavy, lectures partially replaced by onsite training and mentorship learning programmes in a bid to increase the skill levels of healthcare workers across the country. As Covid-19 swept across the globe, this programme had to adapt. A new e-learning system became a crucial part of CHAI’s response to continuing the training of healthcare workers. The use of technology since February 2020 has laid the foundation for a dramatic increase in the use of digital tools to carry out key immunisation programmes, from malaria to Covid-19. “The pandemic has made us realise how much we need to use digital tools; they are so important in training for the Covid vaccine rollout,” Shola adds. Not only has the use of technology played a vital role in training, digital tools have also allowed increased surveillance for active cases and detection. Through community health programmes, digital tools will be able to provide accurate data to support key immunisation initiatives. Patent and Proprietary Medicine Vendors (PPMV’s) across Nigeria provide 60 per cent of primary care to malaria patients. Through a collaborative effort between the national government and CHAI, simple digital tools are helping provide essential patient records and real time data through PPMVs. “By deploying simple digital tech to these drugstores, we can collect essential information and continuously track the malaria burden,” Chizoba points out. Although strain has been put on the country as a whole due to the Covid Crisis, CHAI is optimistic that healthcare can become a focal point as a result. “One lesson that we have taken from Covid is how the private sector was able to mobilise in a very organised way,” says Asma’u. “It was a perfect example of how we can collaborate.” Contact Information www.clintonhealthaccess.org www.clintonhealthaccess.org/nigeria

Financing Future Infrastructure in African Healthcare 4-May 2021 - 10:00 HRS Speakers:

Financing future infrastructure in African healthcare Vision, collaboration and government participation are key to success, as HW Editor Sarah Cartledge reports

he Festival began with a session on the funding of infrastructure projects in Africa. With an audience of 1,115 the session was chaired by Barry Francis, a former infrastructure lawyer and consultant. The panel comprised Ralph Martin, Procurement Coordinator Contracta Construction UK , Richard Cantlay Global Health Portfolio Lead at Mott MacDonald, Chris Bonnett, Project Development and Infrastructure Leader EMEA at GE, Oluranti Doherty, Director Export Development African Export-Import Bank, Paul da Rita a healthcare consultant formerly of the IFC, and Dr Nicholas Crisp, Deputy Director General (National Health Insurance) Department of Health, South Africa. The group acknowledged the many issues facing African healthcare infrastructure, and agreed that, somewhat ironically, the pandemic has actually helped highlight potential solutions. For African countries, there is a good opportunity to rethink the whole concept of delivery and to improve health systems by making sure that the focus is around healthy populations. The increasing use of digital methods will lead to identifying how much healthcare can be delivered outside hospitals to broaden the offering. They discussed the need for a cohesive strategy in each country, underpinned by the concept of universal health coverage or UHC, that takes into account the population concentrations, the rural distances and the lack of basic facilities 66

Barry Francis Barry Francis Consultancy

CHAIR

Ralph Martin

Procurement Coordinator Contracta Construction UK Ltd

Richard Cantlay

Global Health Portfolio Leader Mott MacDonald

Chris Bonnett

Project Development and Infrastructure Leader EMEA at GE

Oluranti Doherty

Director, Export Development African Export-Import Bank

Paul da Rita

Principal PdR Infra Advisory

Dr Nicholas Crisp

Deputy Director General (National Health Insurance) Department of Health, South Africa

HEALTHCARE WORLD FESTIVAL Financing African Healthcare Infrastructure

such as water in many areas. They even considered the idea of a pan-African vision but identified that the differing political and environmental climates might prove too difficult to resolve. “it’s important that governments retain control of healthcare systems,” said Paul da Rita. “They clearly have a long term role in thinking strategically about healthcare and the infrastructure needs. But we also need to recognise that across the continent more than 50 per cent of all healthcare is already delivered in the private sector, so it will have a critical role to play as well. But the strategic direction and the leadership has to begin with the public sector.” Delivering healthcare strategically He went on to observe that if UHC is a strategic pillar of any government, then it

Paul da Rita Principal PdR Infra Advisory

“It’s important that governments retain control of healthcare systems”

can’t stand back and let the health system go in its own direction. “You have to provide it with leadership and ultimately with regulation and oversight. That is the role of government, not necessarily to deliver health care services,” he said. He gave the example of Rwanda, which has created a new national healthcare structure in the wake of the civil war. The

country has adopted technologies such as drones to deliver medicine to provide healthcare services to more remote populations, thereby avoiding the need for the population to travel to big urban centres or to provide much more built infrastructure in those urban centres. Chris Bonnet, a Kenyan by birth, offered the example of a forward-thinking Kenya strategy. “We’re currently building a hub and spoke oncology model for the Kenyan oncology system. We’re supporting the Ministry of Health in all areas from software and clinical design through to the physical development of buildings and infrastructure. GE is a technology company, but our real job is to help public and private systems work.” To change the health care infrastructure of South Africa requires a massive focus on primary care, according to Nicholas

Crisp. This step would go a long way in removing some of the burden from the secondary and tertiary hospitals. “If you keep building the wrong things in the wrong place then you create even more problems,” he said. “We need to consider the facility running costs and then how to maintain them in the long term. For Richard Cantlay there’s an opportunity to implement more standardisation in the design of hospitals that doesn’t require architects for each new facility. We need to design smaller, smarter, more decentralised and less grand,” felt Nicholas Crisp. So, by designing the national healthcare system and then creating a strategic vision to deliver projects in manageable chunks, projects can come together in a joint and coordinated manner. Financing the future Paul da Rita stressed the magnitude of the challenge, given that health systems across Africa were already under stress before the pandemic. As many African governments move towards universal health coverage, the investment required to do so is well beyond the means of many of those countries. It is also important to recognise that infrastructure investment across the economies of Africa is much more than just about healthcare. Current healthcare spending is only a small proportion, so clearly new financing models are required in both the public and private sector. Public private partnerships (PPPs) are becoming an increasingly popular way of financing and procuring infrastructure across Africa as well as the rest of the world. But again, one solution is not going to be the whole answer. And in some cases, donor financing should be examined to see how it can be adapted to deliver long term infrastructure in innovative ways. “The bottom line for us is always how are we going to pay for it?,” said Nicholas Crisp. “Even public private partnerships have to be paid for. And if you’re moving towards a national health insurance like ours, where everything is ultimately paid for with tax, it means the taxpayer wants to see a return on investment. And that return on investment is not measured the same way when you’re talking about healthcare, because we see healthcare as a public good, not as a tradable commodity.” 68

New methods of financing Oluranti Doherty of Afreximbank offered a unique perspective on financing. “We see a correlation between trade and health. In Africa we have the lowest life expectancy because of NCDs and non NCDs; we have lack of healthcare infrastructure and there is a huge gap in the system,” she said. “Governments cannot meet their needs, so at Afreximbank we came up with the initiative to help finance infrastructure progammes. Under that we have debt financing instruments such as CONMED to help with construction of heathcare facilities and provide debt financing to both the public and private sector.

Through this we have supported facilities in Uganda and Liberia. We also helped in Ghana with financing of public sector hospitals. We also have seed funding for smaller businesses.” Afreximbank came up with the decision to try to resolve the lack of healthcare infrastructure as part of its remit. Working with partners such as King’s College Hospital London it is setting up Medical Centres of Excellence across Africa, starting in Abuja Nigeria, in conjunction with national governments. Afreximbank are taking a significant portion of equity – 50 per cent – and attracting private investor financing to supplement it.

HEALTHCARE WORLD FESTIVAL Financing African Healthcare Infrastructure

Chris Bonnett Project Development and Infrastructure Leader EMEA at GE

“Don’t be scared of working in Africa. It’s an amazing place with amazing potential!”

But aside from this ambitious project, she says it became clear that CONMED was not going to meet the additional need. The African Finance bank has instigated meetings for African banks to look at projects and then assess which bank will work with them. “There is no centralised pool but we work together on co-financing across the continent,” she says. “We bring in government, stakeholders, financial institutions and regional economic communities. In 2019 we offered financing for developers to take them through their projects - we see this is a huge issue and if we solve this we can get more projects to be bankable.”

Paul da Rita highlighted political will which is critical to secure private sector investment in many African countries. “Related to that is political stability,” he said. “If we’re entering into long term financing arrangements and contracts, then that that stability is an absolute necessity. And what that means is that we can’t we can’t have projects driven by a single minister, rather it has to be policy across the government.” Conclusion For Ralph Martin, the issue has been convincing UK suppliers that Africa is a viable market. “It seems to be a fear of

the unknown but most of the time they can work with advance payment for reassurance,” he said. GE has more than 700 people on the ground in Africa to support their hospitals with training and education teams. Chris Bonnet felt that the key to success is a very effective ministry of health with a good vision and that’s prepared to listen and work with others to get it done. “If you just go with standard procurement, you’ll get what you’ve always purchased, which is some items, and that doesn’t build a health care plan and it doesn’t build infrastructure. “The combination of an intelligent EPC contractor, great banking facilities, good policy, really helps develop health care. If you just go with standard procurement, you’ll get what you’ve always purchased, which is some items, and that doesn’t build a health care plan and it doesn’t build infrastructure.” The feeling was that PPPs are a good way to achieve more infrastructure, with a focus on digital healthcare as a key part of delivery, especially now that interoperability has been achieved in many countries and they can work towards harnessing the data. The potential for leapfrogging was also raised, as Africa can use new technologies and create its own standards that truly reflect its needs. “One of the key things from this session is the need for collaboration with the government, the public sector, the private sector, financial institutions - putting our heads together to be able to come up with solutions,” said Oluranti. “And the solutions may not be grandiose, rather small solutions that fit in with what individual country’s infrastructure needs are. We need to have efficiency at the core of what we are doing and to be able to work together to get things moving.” The final though went to Chris Bonnet. “Don’t be scared of working in Africa. It’s an amazing place with amazing potential!” 69

Perspectives on the Rise of Global Digital Healthcare 5-May 2021 - 10:00 HRS Speakers:

Perspectives on the rise of global digital healthcare Data needs to be used purposefully for patients, but there are many obstacles to surmount first, says Sarah Cartledge

ne of the few positives of the pandemic was the development and acceleration of digital healthcare creating remote consultation as the future of healthcare. In this session Dr Niti Pall and her panel explored the future of global digital healthcare, its continued funding, development and opportunity. Emma Sheldon MBE Consultant and Former Specialist Lead of the NHS Export Catalyst Project at Healthcare UK, Dr Mwenya Kasonde Global Health Consultant and Thought Leader, Dan Morris Partner and Digital Health Lead at Bevan Brittan, Dr Senait Beyene Senior Advisor to the Minister of Health, Ethiopian Ministry of Health, Simon Swift Managing Director Methods Analytics,

Stan Shepherd Group CEO Instant Access Medical, Anushka Patchava Expert Advisor, Artificial Intelligence and Blockchain / Deputy Chief Medical Officer United Nations / Vitality, and John Hubbell Chairman - HealthEdge Innovation Inc and the Environs Group formed the expert panel.

Niti Pall

Global Medical Director KPMG’s Global Health Practice

Emma Sheldon MBE

Consultant and Former Specialist Lead of the NHS Export Catalyst Project at Healthcare UK

Dr Mwenya Kasonde

Global Health Consultant and Thought Leader

Dan Morris Partner Bevan Brittan

Dr Senait Beyene

Senior Advisor to the Minister of Health Ethiopian Ministry of Health

Simon Swift

Managing Director Methods Analytics

Anushka Patchava

Expert Advisor, Artificial Intelligence and Blockchain / Deputy Chief Medical Officer United Nations / Vitality

Stan Shepherd

Group CEO Instant Access Medical

John Hubbell

Dr Mwenya Kasonde Global Health Consultant & Thought Leader

“Timely, accurate and secure data really are the foundations for making very much evidence-based decisions and importantly, allocating resources effectively and of course, tracking communities left behind”

CHAIR

Chairman - HealthEdge Innovation Inc and the Environs Group

HEALTHCARE WORLD FESTIVAL Digital Health Session

As digital solutions enter the healthcare environment, it’s clear there are a plethora of options for governments and providers to consider. And while many solutions have been invaluable during the pandemic, there is the much wider debate around data and security, interoperability, collaboration and financing so that more solutions come to the fore and aren’t lost in the digital wilderness. How to use data purposefully for patients The starting point for this part of the discussion was confidence in the data. Emma Sheldon felt that patients are beginning to be more accepting in the data behind their treatment, while practitioners are more comfortable with patient care data to inform patient flow and decision making. Anushka Patchava gave credit to the pandemic as the digital catalyst in healthcare, with higher percentages of the population now accustomed to telemedicine. The answer for Dan Morris lay in the solutions that simply kept the world turning during the crisis, supporting

administrative roles, remote working and shared care records. There was a recognition that the usefulness of data depends on the local context, particularly relevant to countries in Africa where the challenges include poor resources, lack of power and telecommunications systems, and huge distances. Dr Senait Beyene from Ethiopia noted that people are more interested in the legitimacy of the data, rather than the data itself. Dr Mwenya Kasonde from Zambia stressed you cannot digitise a facility that has no electricity. But she also observed the huge advancement in mobile penetration on the continent. “You cannot improve what you cannot measure,” she said. “Timely, accurate and secure data really are the foundations for making very much evidence-based decisions and importantly, allocating resources effectively and of course, tracking communities left behind. We also need to think about the status of health information systems, research technologies, and other types of data that reflect the accountability to meet the

needs of marginalised people, specifically in emergency and non-emergency contexts.” She also referenced Safaricom, a Kenya telecoms company that has partnered with the M-TIBA platform to allow customers to set aside funds for healthcare only via their mobile phone. “You can imagine the data that has been generated from such innovation and, of course, the ability to track marginalised communities which are often the ones that suffer the most in terms of healthcare needs,” she said. The benefits of patient-centred data Stan Shepherd, MD of Instant Access Medical, highlighted the importance of personal care records that would allow patients to be in control of their healthcare data in the same way they have access to their banking and shopping data. “The data needs to be patient-centred and then patients can choose whether to make it available for research and public health benefits,” he said. In addition, the patient can correct the errors and make the data easier to clean.

By allowing people to see how their behaviours influence their health, the opportunity opens up for the focus prevention and wellness rather than sickness. For John Hubbell, digitisation of healthcare records would allow the physician to spend more time on healing the patient rather than on administration. “One of the key areas is data fluidity,” said Vitality’s Anushka Patchava. “How do we enable data fluidity to flow between the payer, provider and tertiary care? If we can crack that and give patients the access to control our data, we can better resource our health care systems. She agreed with Stan Shepherd that doctors do not have a holistic view of patient’s data in the way that major retailers do. “ If we can crack that with the data, it will lead to much better health outcomes.” Dr Senait stressed the need to consider the perspective of digital literacy, even though patients want to be involved in their treatment and management. Not everyone has a smart phone so other solutions have to be available. Dr Shepherd agreed, saying that everyone has a right to access their data and technology should not be a barrier, while Niti Pall referenced a satellite telecommunications client who is investigating a satellite solution to bring capability to regions in Africa with no internet. From a legal perspective Dan Morris acknowledged there have been gains made in data sharing as a result of the pandemic. He felt that patients would accept the use of commercialised anonymised health data under certain conditions and requirements where it’s for the greater good. He agreed with Dr Senait that where the data is lacking in transparency there would be less willingness to cooperate. “That is quite clearly because data and the security of data raises some questions about security, trust and indeed equity. Unless we address those issues, the regulatory and legal framework is never going to get to grips with data sharing.” Funding considerations Investor John Hubbell addressed the issues around money being poured in to innovation and potential in start-ups, but less funding being directed towards the actual functionality of these fledgling businesses. He cited statistics that show 90 per cent of all angel investment and 75 per cent of venture capital investment fails in 72

the second year, so many good ideas never make it beyond this time frame. To combat this he has spent the past two years designing a fintech platform that puts the analysis of the money of the right places, rather than looking at the potential. “We are putting together an innovation scorecard. We invest once we are comfortable with the analysis process and the validation or verification of the business opportunity and the viability of the valuation of the business,” he said. The huge failure rate of start-up businesses

Dan Morris Partner Bevan Brittan

“Security of data raises some questions about security, trust and indeed equity. Unless we address those issues, the regulatory and legal framework is never going to get to grips with data sharing”

requires the investment at an early stage to be made into the vision and the problem they are trying to solve, then commercialisation in a safe fashion. The market tends to be frothy and excitable, felt Simon Swift, and as a result money is not being used purposefully and is actually being wasted. “Unless we have an intervention which can impact on somebody’s risk, then we’re all wasting our time and money,” he said. Role of government and policy makers He went on to say that investors should require innovators to measure the impact of their solution as governments pay for value impact. By using data exhaust to measure the value that’s being delivered, the government can know that policies are benefitting the citizens. Niti Pall and others recognised that many countries, even middle income ones, don’t necessarily have the data for measurement. Stan Shepherd commented that most payers pay for processes rather than outcomes, while Anushka highlighted the problem of what she called the 5 Ps – politicians, providers, payers, physicians

HEALTHCARE WORLD FESTIVAL Digital Health Session

and pharma – acting territorially. “At the end of the day, if we have clear collaboration across the system, we can create the full user experiences that deliver and create value for healthcare, for governments and for the consumer, which is the patient.” Value-based pricing can offer new innovations opportunity and the environment to thrive. Dr Senait considered the most important thing that the government should do is engage the private sector and investors, including private providers, in the development of strategies, standards and regulatory products. “We strongly believe that the private sector is a key player in the digitisation process as a whole, so the government will actively support start-ups and new innovators, even if they’re not registered as businesses, particularly in response to COVID,” she said. Dan reiterated the need for a change in regulation and legislation before digitisation can become truly integrated, with the emphasis on data protection legislation reformation in the UK. For Mwenya the issue is at a completely different stage in Africa, citing a recent WHO score report that found up to 90

per cent of deaths go unreported on the continent. “If deaths are not registered, then how can countries make policies that respond to the pandemic,” she asked. Conclusion There was consensus that digital healthcare is here to stay, but many of the panel foresaw huge policy changes from governments as vital to its success. Collaboration was again mentioned as key to moving forward, through partnerships and sharing information in a constructive and productive manner. For Mwenya, the issue of interoperability in African countries is a big obstacle to both healthcare digitisation and the goal of universal health coverage (UHC) by 2030. Regulation and standardisation is thin on the ground for developing countries, felt Dr Sanait. The world has to be digitally prepared for the next pandemic, but it also has to address the fallout from the current crisis in terms of reduction of workforce due to burnout and the burden of other diseases that have been pushed to the back of the queue.

Anushka elaborated on the new concept of phydigital, the coming together of physical and digital solutions. “Phydigital is actually a way to not only generate cost savings, but you can also create more effective health outcomes through nudging, through communication, through empowering patients and consumers. With that data and their own health behaviours, I think it will it will take off.” She stressed the importance of challenging ourselves to come up with new business and pricing models to support entrepreneurs, particularly given the inevitable economic, social and environmental consequences of the pandemic. With more emphasis on consumer input, there will be changing models as patients learn to conduct tests at home and take advantage of the huge wearables market. “The last word is the digital economy is going to be an increasingly important role in building back better systems and increasing economic growth and ultimately sustainable development, “ said Mwenya. And for Stan Shepherd the outcome was clear. “If digital health solutions are not available for patients, they will create their own and the systems will have to follow.” 73

TRADE MISSIONS UN Procurement Opportunities for Healthcare Companies 10-May 2021 - 15:00 HRS Speakers:

UN procurement opportunities for healthcare companies

Marta Valeska Garcia Argenal UN Procurement Department

Marta Garcia, a team leader in healthcare procurement at the United Nations, explains how the UN operates from a healthcare point of view, the opportunities that exist, and how to access them, reports Sophia Kurz

he United Nations - an organisation whose sole aim is to maintain international peace and security among countries are to promote economic and social development worldwide. Marta Garcia began by explaining the goals of the UN, aside from maintaining peace and security among countries. The other objectives of the organisation are to promote economic and social development and to promote human rights. There are different organisational entities within the UN that help to achieve certain outcomes to this end. According to the UN website, ‘The United Nations is part of the UN system, which, in addition to the UN itself, comprises many funds, programmes and specialised agencies, each of which have their own area of work, leadership and budget.’ The Funds and Programmes entity umbrellas different office branches of the UN. The United Nations Environment Programme (UNEP), headquartered in Kenya, is “the voice for the environment within the UN”. This programme, therefore, falls under the jurisdiction of the Funds and Programmes sector of the UN. There are other departments under the Funds and Programmes umbrella, such as the United Nations Human Settlements Programme (UN-HABITAT), The United Nations Children’s Fund (UNICEF) and The United Nations Development Programme. The Secretariat branch is the administrative side of the UN that carries out the substantive and administrative 74

HEALTHCARE WORLD FESTIVAL UN Procurement Opportunities

work of the United Nations as directed by the General Assembly, the Security Council and the other organs. At its head is the Secretary-General, who provides overall administrative guidance. “Each organisation has a distinct and separate mandate covering the political, economic, social, scientific, technical, and humanitarian fields”, explains Garcia. Depending on what it is you or your respective organisation offer, you will need to identify UN organisations that might acquire your goods and services. Supply chain management “Supply Chain Management basically covers everything to support rapid and effective solutions for peacekeeping, special political and other field missions around the world” says Garcia. “We need to provide the people in the field doing

the difficult work with the best solutions, products and services in the fastest time possible to help them navigate their markets where they need them at the best price as they go.” The focus for the UN is supporting 36 peace operations in more than 30

Marta Valeska Garcia Argenal UN Procurement Department

“Sometimes we need to deploy a mission or open up a hospital very quickly because a tragedy has happened”

countries. “We administer a combined annual budget of over $7bn and we serve more than 270 duty stations very directly and indirectly. We have different places where we work, but we concentrate more on the African and Middle Eastern region. We have some small scale operations in the Americas, as well as a headquarters in New York. The supply chain is super important because we operate life-saving services.” The mission of these peace operations is to help countries navigate off the path of violence, and towards peace. The necessity and importance of supply chain management comes into play in these scenarios. Their job is to equip peacekeepers, uniformed or civilian, with primary and life-saving healthcare services, when and if needed. “Basically, if you’re wounded in the field and you need to be stabilised, we

support hospitals and small clinics to be in those different and sometimes inaccessible places, so it’s really important that what we do is always just in time to support these operations.

“Last year we bought $5.6m from British suppliers and only $4.2m for my health category, which is why we’re here. We’re trying to encourage you to check our opportunities and see if it’s the best fit

for you because we know you have great suppliers and vendors.” Major medical commodities procured include vaccines, outsourced medical personnel, blood products, malaria tablets,

HEALTHCARE WORLD FESTIVAL UN Procurement Opportunities

surgical drugs, basic care drugs, various pharmaceuticals, medical equipment and medical consumables. At the moment, the available opportunities within the next six months include positions for medical personnel (AMET teams & damage, control surgery teams, medical personnel to staff a level 1-2 hospital), pharmaceutical and vaccines manufacturers (drugs for surgery, malaria prevention, vaccines including COVID-19,), and medical consumables (diagnostic equipment, reagents and consumables, rapid test kits, sutures and ICU equipment). “Sometimes we need to deploy a mission or open up a hospital very quickly because a tragedy has happened. So we will depend on your good relationship through your whole supply chain to supply any emergency orders, as well as looking at recommendations for transport of dangerous goods.” Factors to becoming a UN supplier If you are interested in working with the UN in a healthcare environment, Garcia recommends the following strategy: • Be prepared – register, pick the right commodity to supply, update contact details, review business positions and strategies, learn what the organisation has bought in the past and from whom. • Deciding to bid – keep abreast and respond to Expressions of Interests (EOI’s) and Requests for Information (RFI’s), understand how bids will be evaluated and the buyers’ requirements, create an in-house tendering data repository. • Planning your bid – know the strategy to win each type of solicitation, don’t underestimate the time required to prepare a bid, decide who in your company should be involved, ask for more time if the deadline is unrealistic/ unmeetable. • Think like a buyer – assume the organisation doesn’t know your company and answer questions as completely as possible, read the instructions and respond in line with the criteria, be precise and substantiate your responses with past experience evidenced.

• Maximise your competitive advantage – demonstrate your added value and strengths of your company, be aware of your competitors and what they may bring to the table (and if you can strike a better deal), and set prices realistically with full cost recovery, but also competitively. • Study the terms – read the contract template and T&C’s and share with legal counsel, understand the UN has privileges and immunities, use the correct tender templates. • Prepare a bid document you are proud of - prepare a professionally presented proposal and proofread it, be precise and detailed, remember quality is better than quantity. • Make sure you get feedback – If you are not successful don’t give up. UN vendors who participate in high value procurement (more than $200,000) have an opportunity to obtain additional information on their unsuccessful bids through a debriefing period. “We need suppliers that are either wholesale manufacturers or connected to their supply chain with specialised manufacturers that will provide us with the best items of the best quality possible in the shortest time and at a good price,” says Garcia. “Another challenge is chain shipping. We’re trying to engage with suppliers that have great relationships that will ensure we’re quoting shipping from end to end. Sometimes we send pharmaceuticals and even blood to places where airports don’t have air conditioning and we are transporting items into the actual mission compound in a very high heat environment. “We need to make sure that the items that we’re purchasing arrive at the place that we’re going to need them in intact condition - providing supplies efficiently and accountably helps us with demand management. We do a lot of different management and inventory management and distribution as we see it in certain compounds and then send out to different places and outflows. “For example, in Somalia, we work and we have a main office in Mogadishu, but we send out to all the clinics that we have in different sectors in Somalia. That’s

Marta Valeska Garcia Argenal UN Procurement Department

“We need to make sure that the items that we’re purchasing arrive at the place that we’re going to need them in intact condition”

why we always try to have multiple sourcing because we need to avoid supply chain disruptions. Last year with COVID, the fact that we had multiple sources for the same products and health care providers provided us with the opportunity not to have an interruption in our supply. “We’re also looking for suppliers that are keen on innovation and align with our agenda of sustainable development so we can invest in these items, especially equipment that will help our missions for a long time.” The UN procurement manual is publicly available and Garcia recommends downloading it and studying it carefully. It details how contracts are awarded, bidding, shelf life for products, registration on the EPR system which is mandatory to be invited to bid, in short the whole process. Also important is the UN Procurement mobile app which lists current business opportunities. She also recommends using a generic email from a company as buyers are always checking the database. “These tools are a gateway to understanding the UN and making sure that that you can work with us,” she says. “Our idea is to be able to identify bidders from all over the world that have different solutions. It usually takes bidders two tries to be successful and win a contract because you have to learn the process and the process is complex, but please don’t lose heart. Don’t give up and understand how you can be better. If we have your names, if we know what you’re capable of doing something, we’ll invite you directly.” 77

The Future of Aid Funding in African Healthcare Post Covid 11-May 2021 - 10:00 HRS Speakers:

The future of aidfunding in Africa post-COVID Chaired by former UK Health Secretary the Rt. Hon. Stephen Dorrell, this session at the Healthcare World Festival offered valuable insight

he challenge we face as a global community in restarting the world economy following the pandemic is stark. Particularly within the health economy, the relationship between aid and trade will be vital to enabling developing nations to deal with the longerlasting impacts of the virus, and the future development at large. The big question is, how do factors such as aid, trade, funding, development, and partnerships work together - and how can we take advantage of them to benefit healthcare post-COVID, or even as we continue to deal with it? Chaired by the Rt. Hon. Stephen Dorrell, panellists from across the international and African healthcare sector joined to discuss and tackle the issues including Dr Mwenya Kasonde; Dr Senait Beyene of the Ministry of Health Ethiopia; Professor Ged Byrne of Health Education England; Lucy Palmer of Mott MacDonald; Francis Omaswa of the African Centre for Global Health, Asma’u Abiola and Dr Shola Dele-Olowu of the Clinton Health Access Initiative, and Dr Isabel Maina and Dr Rebecca Kiptui of the Ministry of Health Kenya. Effectiveness of aid in response to COVID At this point in the pandemic, we can now see many nations ‘turning the corner’ in regards to COVID-19. However, this is not the case universally. Many developing 78

nations are still struggling tremendously, and despite the vaccine rollout programmes which are now in place, it is not the immediate effects of the virus that will cause a lasting impact, but how quickly these nations will be able to recover from the pandemic at large. Offering a perspective on how aidfunding has operated in response to the pandemic within Nigeria was Dr Shola Dele-Olowu. “The response in Nigeria is similar to that across other countries. There has been a lot of funding in response to COVID, but also towards health generally. Donor funding accounts for significant progress that we have seen in the health space, yet still accounts for only around 10 per cent of total health expenditure. However, with COVID, the dramatic and swift response we have seen has been very significant, and has played a key role in the early and late stages of the pandemic,” says Shola. “It’s really critical, but in terms of the overall economic impact, due to so many people paying out of pocket for healthcare, it’s difficult to see the impact which this funding has had on the economy at large. Yet overall, these intensified efforts underscores the need for countries like Nigeria to do more with domestic mobilisation, especially as funding dwindles.” Dr Mwenya Kasonde, joining from Zambia, also offered her perspectives on the effectiveness of aid and the steps that need to be taken moving forward to

Stephen Dorrell

Former UK Secretary of State for Health

CHAIR

Professor Ged Byrne

Director of Global Health Partnerships Health Education England

Lucy Palmer

Technical Director of International Health Mott MacDonald

Asma’u Abiola

Sustainable Health Financing Associate at the Clinton Health Access Initiative

Dr Isabel Maina

Ministry of Health – Kenya

Dr Senait Beyene

Senior Advisor to the Minister of Health Ethiopian Ministry of Health

Dr Mwenya Kasonde

Global Health Consultant and Thought Leader

Francis Omaswa

Executive Director - African Centre for Global Health and Social Transformation

Dr Shola Dele-Olowu

Deputy Director of the Vaccines Programme at the Clinton Health Access Initiative

Dr Rebecca Kiptui

Ministry of Health – Kenya

HEALTHCARE WORLD FESTIVAL African Aid Funding

ensure that healthcare systems continue to develop. “In order for us to address our healthcare systems during and after COVID, we must realise what the system was like before COVID,” says Kasonde. “There was a lot of difference across the world in regards to the maturity of different healthcare systems, and the baseline with which they tackled COVID. In regards to aid, it has a very important role to play - but it is simply not sustainable. For instance, in Zambia right now, our health system is about 50 per cent donor funded. In order to transition out of this method of healthcare systems, we need a very clear roadmap for how to do so.” Clearly, aid is crucial, but the unsustainability of it at this point is a

key roadblock which many nations need to tackle - and one which can only be addressed through clear and determined efforts by governments and health services working together. Individual contexts and issues Following on, both Dr Isabella Maina and Dr Rebecca Kiptui presented to the panel the current situation regarding health financing within Kenya, providing valuable insights into where funding can be improved in order to develop health systems at large. Dr Isabella provided a list of recommendations, including: • Increasing public spending on health to international and regional targets

• Mobilising domestic resources to ensure sustainability and the transition from donor aid • Expanding health insurance to reduce high out of pocket premiums • Exploring alternative financing methods, such as PPP’s • Improving efficiency in the utilisation of existing resources • Aligning spending to address health outcomes and disease burden For the full presentations of Dr Maina and Dr Kiptui, please watch the recording of this session on youtube, which provides

in-depth analysis of the financial model and structure of the health system within Kenya. The relationship between vaccines and aid funding The main worry with vaccination was always going to be the issue of rollout. Once the world developed a vaccine for COVID, it was inevitable that it would not be available to everyone on the planet on the same day, which raises the question of the role that aid plays in the rollout of coronavirus vaccines. “It’s a clear example of some of the inequities that we see - vaccines is just one aspect of it. The vaccine issue clearly shows that developing countries cannot be fully dependent on aid and must be able to prepare for the transitions that will come,” says Shola. “Obviously, it would have been impossible to give everyone the vaccine at the same time, but as we have seen from the rollout, there is still a disparity. If it was not for the GAVI alliance, there would have been very limited access to these vaccines for many nations.” 80

“The main issue for me is how we operate our relationship with the World Health Organisation. I don’t think that the western economies have really bought into the power of a pan-global response in notion or in concept. The underpinnings of the COVAX programme are robust and evidence-based, but I believe that the reason it has stuttered is due to the lack of buy-in from western economies and developed economies across the globe,” added Ged Byrne. “None of us are safe until all of us are safe. I appreciate what the US government

Dr Shola Dele-Olowu Deputy Director Vaccines Programme Clinton Health

“The vaccine issue clearly shows that developing countries cannot be fully dependent on aid and must be able to prepare for the transitions that will come”

has done recently, but I believe that developing nations really need to focus on more issues - for instance in lower and middle income countries. We have the capacity; we have the raw materials; we have the skills and the business models, and we need to be doing more in this area. The conversation has moved on from just asking the West to help us - we need to focus on our partnerships and look inward,” said Isabella Maina. In Conclusion Overall, aid funding is a system that has been deeply ingrained into many developing nations health systems, and there is a genuine risk that if there is no change, and no development, these systems will begin to fail. The COVID-19 pandemic has been an enormous trial for nations around the world, but it also displayed how effective global healthcare responses can be when we face a common enemy. The most important lesson is to recognise the failures and successes which have occurred over the past two years, and implement what we have learned.

HELPING COMPANIES NAVIGATE THE INTERNATIONAL HEALTHCARE MARKET Speak to one of our experienced team to see how you can expand your business now Contact Steve Gardner or Emma Sheldon MBE steve@thetradeagency.co.uk / emma.sheldon@thetradeagency.co.uk

C O N S U LTA N C Y | P U B L I S H I N G | M A R K E T I N G | E V E N T S

The virtuous circle Partnership with the UK NHS can help providers to deliver long term sustainable clinical services, says Steve Gardner, MD at The Trade Agency

reating better healthcare infrastructure, unfortunately, does not create better healthcare. The big issue for healthcare commissioners and providers is who provides that healthcare, which is only going to get more difficult in the coming years? Who will operate and provide care to our patients? We’ve all heard the figures - the world is expected to be 18m healthcare workers short globally by 2030. Thus the market for high calibre staff is becoming increasingly competitive and there are fewer and fewer healthcare workers for more and more vacancies. Traditionally, health systems will look to import staff from elsewhere but, with countries like India developing their own universal healthcare systems, the sources of imported labour are drying up. Perhaps it not surprising, then, that the most frequently asked question in healthcare

globally is about where you can find a reputable healthcare operator to take the problem off your hands. As a globally renowned operator of healthcare facilities it’s probably not surprising that this question is commonly asked of the UK and its National Health Service or NHS. But the priority of the UK’s globally renowned healthcare system must always be its own citizens and, as an organisation paid for by the taxpayer and providing care free at the point of delivery, the NHS model is not compatible with delivering healthcare on a paid-for basis overseas. There have been rare occasions where NHS providers have worked in partnership with other nations for hospital operation services, but this is not generally something the UK NHS can offer. It does however have a very interesting model to offer to the rest of the global healthcare market. This is because the UK

model is funded directly from government and provides the very best access to quality healthcare for its citizens at one of the lowest costs per capita of any wealthy nation. When it comes to value-based healthcare, the UK clearly knows what it’s doing. This experience is something it feels it should share globally. Although it won’t and can’t operate hospitals, it can help create a long term and sustainable clinical operational mode. The NHS can help providers, whether public or private, government or insurerled, insourced or outsourced, to create or develop the people, skills and systems to deliver the best healthcare, at scale for the lowest cost. Partnering for success Creating a strong clinical offering does not need to be daunting with the right partner on board. Healthcare in the UK is built on partnerships, with primary care, mental health, social care and acute care delivered by different Trusts that work together, share clinical records and move patients between their differing services. The NHS can also offer partnerships overseas. It’s important to consider that the social requirements, culture, disease profiles, regulatory systems and funding models will differ from jurisdiction to jurisdiction. By working in partnership with providers in country, we are able to help design clinical services specifically for the needs of the population. From the outset, the NHS Trust does not see clients but partners. This subtle distinction allows it to work together to identify the needs, requirements and standards in the operation of a healthcare facility. It begins a virtuous circle model of healthcare provision. Working with the provider, the first phase is to understand the healthcare requirement, volumes of patients and to design a workforce plan that allows for delivery of healthcare at scale and to the highest possible standards. Recruitment and training The NHS partner organisation will work with the provider to identify firstly the appropriate individuals to lead, using initially some of their own experience and senior staff to help identify the right

HEALTH SYSTEMS TTA

individuals. Subsequently, it’s about filling out the roster of quality staff and ensuring that they are given the right education and training support to ensure a common and high standard of competency and care across the facility. Recruitment and training, then, are the core activities at phase two of the virtuous circle. Delivery and operation With the leadership and staff trained to the correct standards, they need to be supported by the right clinical systems. The NHS partner will use the experienced gleaned in more than 70 years of UK clinical delivery to work in partnership with the provider to ensure that the workforce planning, clinical systems and organisational requirements are all in place to ensure an efficient and effective facility designed around the needs of the patient. At the operational phase of the project, we should have a facility that delivers

efficient and high value healthcare for a population to the standards dictated by the client and their NHS partner. But this is a virtuous circle and therefore not where the story ends. Partnership is about the long term and it would be naïve to expect everything to work smoothly and efficiently from day one. With this in mind, phase four is the point at which, as all businesses should on a regular basis, we take a step back and evaluate what has been achieved do far. Specifically the

Steve Gardner Managing Director The Trade Agency

“Creating a strong clinical offering does not need to be daunting with the right partner on board”

question needs to be asked of whether our partnership has delivered what we set out to back in phase one, where are the cracks in the system and how can we improve our efficiency, quality, value and outcomes. Which of course, takes us back to phase one and the identification of where the partnership needs to go next. As healthcare evolves, as more care is delivered digitally or in the home, as we move towards the hospital of the future, what remains consistent is the need for the very best quality healthcare workforce, and for that workforce to be deployed efficiently and effectively. The experience of the NHS and its constituent trusts is second to none in terms of its ability to deliver the very best in value healthcare. Contact Information steve@thetradeagency.co.uk healthcareworldmagazine.co.uk

Tackling fear, uncertainty and doubt Healthcare World CCO and Director of Consultancy Emma Sheldon MBE examines the ways in which healthcare businesses can grow post pandemic

he pandemic has changed the way we live and work, from the newly remote nature of our interactions to the focus of our customers in dealing with new problems and systems. Our businesses have been subjected to unprecedented levels of uncertainty over the last year or so, with a lack of clarity and understanding about everything

from the state of the global economy to questions as simple as whether we’ll even be able to go into our offices. That uncertainty leads to fear and doubt and there has rarely been such a shared volatile business environment in which to operate. Yet even a volatile business environment offers the potential for significant opportunity when your offer matches the new needs.

We have all experienced the same global pandemic, but from different perspectives and through varying filters. Our usual routines have been disrupted to the extent that many of our usual ways of engaging with others have been removed and are only just starting to re-emerge. What remains constant is that with change comes opportunity, with problems comes collaboration, and with a shared global focus comes innovation at an unprecedented pace and unusual scale. Smart businesses have seen opportunities to match their innovations with need, to speed up adoption of their technologies, to improve patient care, and to share their successes as widely as they can to help others. To support our entrepreneurs and businesses they need the right advice, the right people, and the right money.

HEALTH SYSTEMS Consultancy

Planning your move In order to understand where you are and where you want to get to, there a number of critical areas to consider: • Proposition development o Crafting and shaping your proposition for the best chance of success. • Marketing o Making an impact in the right places, generating leads and strengthening your message with strong targeting and significant amplification. • International planning o Ensure you have the right strategy for specific international markets, with good external intelligence, recommendations, insight and support. • Strategy Development o Tailor your strategy, including a review of your business, the current situation and your ambitions, the competitive landscape and the strategic imperatives for success. • Preparing for investment o Identify the key criteria to support the right investment, and ensure you tell your story succinctly and correctly.

This requires a massive investment of time and effort. Sometimes we’re running so hard at our goal that we fail to take the time to reflect on the changes that have impacted us, or to understand where our offerings can best fit. We aren’t able to shape and hone our strategy in the right way, or we don’t have the time to refine our messaging to make an impact with the right people. This is where an experienced and independent pair of eyes is invaluable, equipped to support you in assessing where you are against where you want to be. They help you to plot your path to success, providing a diagnostic to help you identify and address any gaps in your business planning in a way that allows for the best chance of success.

• Recruiting for growth o Design the resource strategy for your business, develop role descriptions, and support in finding the right people for your team. Remember that poor, costly recruitment decisions can be the most expensive mistakes you can make and ensure you engage the right people for the design of your organisational culture as you grow. • Market and customer analysis o Focus is critical when growing a business but narrowing down which markets or sectors can sometimes stop progress for business owners who are conflicted by numerous choices. Prioritise markets, sectors and customers, and design in metrics that will help you see how your choices are making a difference and ensure you are able to quickly assess when to change direction. • Business Development o Once your strategy and messaging are where you want them to be, reaching

Emma Sheldon CCO & Director of Consultancy Healthcare World

“Even a volatile business environment offers the potential for significant opportunity when your offer matches the new needs” the right potential customers quickly and efficiently is vital. Use contacts, strong networks (like those of Healthcare World) to ensure you’re getting to the right customers. Throughout the life cycle of any business, all these elements will be required, and never more so than now, as we live through a situation which is delivering a complex and fast changing landscape for our businesses, people and ideas. I’ve spent my whole career working in and around the international healthcare space. With Healthcare UK I helped UK NHS Trusts to make their first steps to sell their services overseas. At Vernacare we exported a UK product to more than 50 countries around the world and I was lucky enough to be awarded an MBE for services to export. In all cases, the kind of strategic insight and work I’ve outlined above was absolutely critical to the success of our endeavours. It provided the confidence and context to get beyond the fear, uncertainty and doubt that plagues any business in uncertain times and particularly in the current climate. Here at Healthcare World, the team and I are able to offer all the above, to give you the support you need and more through our experience, knowledge, contacts and expertise. And let’s not forget to mention the fantastic network that Healthcare World Magazine and the Healthcare World Festival brings to the table. Contact Information Emma Sheldon emma.sheldon@thetradeagency.co.uk

The NHS In International Markets – How can the UK’s world renowned provider ‘go global?’ 12-May 2021 - 10.00 HRS Speakers:

The NHS in international markets Chaired by the Rt Hon Stephen Dorrell, this excellent session at the Healthcare World Festival examined how the UK’s world renowned provider can expand into the international sector, says Fabian Sutch-Daggett

he NHS has long been a bastion for world-leading healthcare provision. However, as we have seen through the coronavirus pandemic, even the world’s best systems can be put under immense strain and pressure in the most trying times. Despite this, the NHS has managed to perform remarkably. There has not been another time in modern history when health systems across the globe committed so fully to innovation and collaboration on such a massive scale. The reason that this innovation occurred was not ideal, however, the lessons we have learned from this must not be cast aside as the world begins to turn the tide against coronavirus. At present, the UK is at long last moving out of its coronavirus restrictions, largely thanks to lockdown measures and vaccination uptake. However, many nations are still in a deep struggle with the virus, and it must not be assumed that while some countries are seeing the light at the end of the tunnel that all are. The question is, how can the NHS contribute to these nations, and foster good relationships not just to end the pandemic, but for the future as well? Speaking at this panel alongside the Rt Hon Stephen Dorrell was Emma Sheldon MBE, former Specialist Lead of the NHS Export Collaborative, Professor Ged Byrne of Health Education England; Carly Caton, Partner at Bevan Brittan; Alistair Russell, Director of Business

Development, Imperial Private Healthcare; Altaf Kara, Strategy Director at South London and Maudsley NHS Trust, and Chris Born, Head of NHS Collaborative Exports at Healthcare UK.

Stephen Dorrell

CHAIR

Stephen Dorrell Former UK Secretary of State for Health

Professor Ged Byrne

Director of Global Health Partnerships Health Education England

Altaf Kara

Strategy and Commmercial Director - South London and Maudsley NHS Foundation Trust

Carly Caton Partner Bevan Brittan

Emma Sheldon MBE

Consultant and Former Specialist Lead of the NHS Export Catalyst Project at Healthcare UK

Going digital Alistair Russell kicked off the session by highlighting one system which we have all become very accustomed to - online meeting software. Despite many of us originally believing this to be a quick-fix for a few weeks, the benefits of this enormous uptick in digital meetings will leave the NHS in a far better place to do business abroad: “The key thing that has changed for me is the NHS adoption of Microsoft Teams. It has quite literally transformed our ability to communicate globally. We are currently in the closing phases of negotiating a big international partnership, and all of that has been done virtually. This would never have been possible before the pandemic as we can distribute a lot of information to a lot of people much more easily.” Altaf Kara echoed these sentiments, stating that the “massive realisation of what can be achieved electronically” has been a major learning point throughout the pandemic. He went on to examine how despite the benefits which have arisen from the pandemic, they do in fact result in a paradox - as the impact of the pandemic continues to hinder the services within the NHS limiting capability to operate outside of the organisation itself.

Alistair Russell

Director of Business Development, Imperial Private Healthcare - Imperial College Healthcare NHS Trust

Chris Born

Head of NHS Collaborative Exports at Healthcare UK - Department for International Trade

“The paradox lies in the fact that we all have to deal with the impact of the pandemic at home: enormous waiting lists, for example, and I think that makes it very difficult for both the NHS centrally and Trusts themselves to operate externally,” says Mr Kara. Adding to the discussion, Emma Sheldon noted that the rise of digital communication has not only changed the way in which we operate. “Communication has blown away the cultural norms around how we do business internationally - but to add to that, the ways of doing business digitally have completely changed our business models. The pace of innovation, the scale of change - the way that we’re actually doing business with each other,” says Emma. “What really struck me was the collaboration of teams around a problem. It’s a very unique situation for us all to

HEALTHCARE WORLD FESTIVAL The NHS in International Markets

be facing the same problem globally. Hopefully we will never face it again, but the teamwork between organisations globally was a real strength.” Chris Born also stressed the importance of connection, highlighting his experiences in helping internationational organisations collaborate with domestic organisations, and vice-versa. “One of the big realisations of the pandemic is how inter-connected we all are. We all face similar challenges, some greater than others - and we have a responsibility to help one another, and work towards unblocking barriers to innovation and collaboration between organisations across the globe,” he said. “We’ve found ways of making healthcare more accessible to patients, when access

has been restricted for all. The complete shift of primary care has been a remarkable achievement, and a skill which we can offer far beyond the pandemic.” As such, organisations must be willing and ready, not only to continue utilising digital innovations after the pandemic is over, but also to reach a point where they are strong enough to divert resources to international opportunities. Only time will tell if the NHS is up to the task. Shifting focus Another major change which has been seen throughout the pandemic, in the NHS and overseas, is the dramatic shift of focus onto frontline services. While international business may now be

made easier through the enormous improvement and widespread uptake of digital communications, the complete halt of travel, health tourism, and patients from overseas have decimated many business models. The question is - what can we do about it? “Because conventional travel and international business hasn’t been possible, people have entirely changed their outlook on how we communicate and forge partnerships,” said Carly Caton of Bevan Brittan. “However, that lack of travel and inbound patients has had a big impact on many of our partners. What we have seen is that they have totally diverted from their normal operations within international partnerships and business

development overseas towards frontline, COVID roles.” “This shift has created a vested interest in surge hospitals and remote healthcare systems, which the NHS has done really well over the past year, and is something that we could perhaps bring internationally.” Despite the horrific circumstances which forced many nations around the world to build surge hospitals and rapidly implement brand new systems for large influxes of patients, the pandemic has proved it is indeed possible to do so - and to do well. This will be a lesson not forgotten after COVID is over - and something which we must take forward into the future - whatever it holds for us. The knowledge economy During more than 70 years of experience, the NHS has learned many lessons, suffered many failures, and had fantastic successes. However, all of this is for nought if the NHS cannot utilise this 88

information on an international scale. Elaborating on the need for the NHS to capitalise on the value of experience and knowledge was Professor Ged Byrne, speaking from both his experiences in both frontline and arms-length roles throughout the pandemic. “What I’ve learnt over the last 15 months is the important opportunity, and even moral obligation, for the NHS to focus on the knowledge economy,” he commented. “The reality is we have decades of experience making every mistake in the world in order to deliver the highest quality healthcare, and that knowledge is exceptionally useful, whether that be for systems, leadership, transformation, or improvement. Not only are there potential opportunities for the NHS here, there is an immediate moral obligation - we are privileged to have this information, and we must share it.” In addition, he emphasised the need for smaller-scale, peer-to-peer relationships from within the NHS to overseas. “Most of the bespoke solutions for the pandemic as they’ve been managed within the NHS have

been developed from the bottom up. There are differences between every provider, there are nuances involved, and we’ve made a real error over the last few decades by not recognising the importance of those front-line individuals, and the impact that they can have on a global stage.” In conclusion In all, the challenges which the NHS has faced - not only in the pandemic - provides us with an invaluable resource for doing good within the global healthcare market. Although COVID has hindered operations, turned systems upside down, and forced us to adapt and to change our systems entirely, we can continue to grow and develop the solutions which have worked, and also continue to collaborate and fix the issues with systems we haven’t quite figured out yet. All this, however, can only be possible through international partnership - and there is no better time to work together than at this critical moment in the history of healthcare.

HEALTHCARE WORLD MAGAZINE | HEALTHCARE WORLD FESTIVAL

Leading the debate in international healthcare

As the healthcare sector around the world evolves and adjusts to a ‘new normal’ post Covid, Healthcare World creates a new kind of business to support the international healthcare sector, international collaboration and the business of healthcare. To find out more contact Steve Gardner or Emma Sheldon MBE steve@thetradeagency.co.uk emma.sheldon@thetradeagency.co.uk Healthcare World is a brand name of The Trade Agency Ltd

TRADE MISSIONS International Opportunities and the NHS – A guide 12-May 2021 - 12:00 HRS Speakers:

A guide to international opportunities and the NHS A specialist breakout session examined the pathways for NHS and overseas organisations to develop opportunities

ollowing on from the previous session on the NHS in international markets at the Healthcare World Festival, a breakout session was held to discuss, debate and discover the best methods for international organisations and the NHS to operate in partnership. Also joining the panel from the previous session was Chris Born of Healthcare UK, hoping to unravel some of the intricacies of exporting healthcare services in the UK. The panel itself was held in a Question and Answer format, allowing guests from wherever they were in the world to interact with the speakers directly. The session began with a question from the audience focused on how the NHS can best function in a competitive global market. Q: There is plenty of competition in global healthcare markets - the NHS is a huge player, but there are many others out there. How can the NHS best operate within this context? Emma: Competition is inevitable. There may be competition between individual trusts, markets, healthcare systems, or different businesses. What I would say is there is huge opportunity out there - and mostly that rests on finding your ideal position to meet it. In any situation it may be that you’re not able to meet demand, but it is important is to scope out what you have to offer, and what competitive landscape exists in that field. I would guard against having the 90

Steve Gardner

Managing Director at Healthcare World

CHAIR

Carly Caton Partner Bevan Brittan

Emma Sheldon MBE

Consultant and Former Specialist Lead of the NHS Export Catalyst Project at Healthcare UK

Chris Born

Head of NHS Collaborative Exports at Healthcare UK - Department for International Trade

HEALTHCARE WORLD FESTIVAL NHS International Opportunities

mindset that competition is a bad thing for your business. There is so much opportunity, and it could be counter-productive if you find your place but worry about the competition rather than your ability to deliver. Carly: If you’re clear about your offer, then you can be on the front foot when you’re entering a competitive international market, and you can avoid opportunities which don’t best fit your individual offer. When marketing our own company globally, I have seen a genuine happiness to join up as part of a UK offer - different organisations from within the UK joining together as part of a cohesive offer - oncology, for example. Individual organisations can be much more powerful on the global market when part of a well-organised group.

Chris: The NHS probably lacks the cut and thrust of some of the private competitors who are used to trading on a very commercial basis, but what we do have is something very special: the largest public health system in the world. The fact that there is a very strong ethos for the NHS to do a great job for the patients and the community that they work with, and it not solely a commercial interaction, provides great value to providers in these markets. Q: From the legal perspective, what are the key issues in getting stronger propositions together across different organisations in collaborative offers? Carly: In terms of joint offers from organisations who are working together

on an opportunity, there are various steps you can take with regards to bidding for an opportunity. You have to consider what each role will be - you’ll want to put NDA’s and confidentiality agreements in place at the outset. Once you have that, you figure out how you want to work together - who’s bringing what, who’s doing what, and you can build a contractual arrangement surrounding the commercial offerings, and how the parties will work together - either in the ‘bidding’ phase or the ‘doing’ phase. It will be very dependent on what is being offered - but there is always a way of writing that down and making it contractually binding. It would also depend if it was just a one-off arrangement, or a partnership which may be long-term. The key things to ensure that are embedded very clearly are the

Chris Born Head of NHS Collaborative Exports Healthcare UK

As long as there is clarity from the beginning, and issues which arise are tackled quickly and effectively, risk can be minimised”

expectations of each of the parties; what are they doing, how are they being rewarded, how any commercial income is going to be shared or split and how the liabilities are shared between them whether that’s with a partner who is a lead, or if it’s on a joint partnership level. Getting yourself protected initially is always a good idea.” Q: How much thought is being given not just to NHS organisations collaborating with each other, but NHS organisations collaborating with private organisations? Chris: We did a survey of NHS Trusts who were interested in export, and the sort of partnerships they would envisage. Most said that they needed to evaluate each opportunity on its own merit, but more than half of them agreed that the private sector should be involved. Private sector companies can benefit from the broader expertise and clinical offer of the NHS, alongside their own expertise in their individual specialities. It doesn’t happen as often as we would like, but it can really add value to an offer. We absolutely want to see more of this happen and we need to discover why it isn’t happening already. Q: In terms of categorising NHS Trusts and their readiness to go international, will this information be available to private organsations? As businesses, we could be working with these Trusts in the UK, but have no idea of their aspirations in the international sector. Chris: We do have a list, but we operate a filter. Trusts get approached by lots of people for lots of different reasons, and it can be more helpful if we can link private organisations to the Trusts which are 92

best suited for them,so it ends up being more than just a cold call. We might not be publishing the list, but opportunities to work with Trusts will always be available for private organisations. Emma: Speaking from my experience as a business selling internationally, we certainly wanted to be engaging with the NHS. It would offer us an advantage

on the international market, but more importantly, the products we were selling were in about 95 per cent of NHS Trusts. However, they were scarcely used outside the NHS. Therefore, we offered a point of difference which the NHS could be pushing - and we definitely weren’t alone in this. Even though we were operating in the healthcare space, with an innovative way of doing things adopted by the

HEALTHCARE WORLD FESTIVAL NHS International Opportunities

NHS, we ended up making our own way internationally, rather than alongside the NHS. Many organisations would jump at the opportunity to work with the NHS, share the learnings, and break down the barriers between the NHS and private sector.” Q: What tangible actions can private organisations take to partner up with NHS Trusts?

Emma: For me, it comes back to making yourself relevant around the real area that you have to offer. Be very aware of the markets and service you want to be involved in. No ‘market’ has ever bought an offer or a service - a person within it has. You have to make yourself known to the people within that area, and don’t think too widely but on the narrow and individual level. Consider who you specifically serve best and then align that to a Trust.

Q: We’re doing really well in markets such as AI and machine learning ,for example. What are some of the other markets which you think are in need of services? Chris: We have tended to focus on the big emerging markets: China, South East Asia, the Middle East, but we are now looking at places such as Japan and the US from where we have brought investment in to the UK. These countries are realising that they want niche services from the UK. We would always recommend focusing on one or two to start with - we can always support individual organisations as well as partnerships, and are always interested in finding more companies that we can promote. Q: How can existing export schemes help to mitigate risk in regards to international partnership? Chris: We had an experience recently with two NHS organisations and a private hospital customer who were deep in discussions, but realised that they hadn’t actually understood each other at all, as the NHS wasn’t able to come and operate the service. So you really have to work hard in the countries to make sure that conversations pin down what can be provided, and what the limits are, which reduces the risk. Again, we want to be much more closely involved in opportunities, and the whole process of taking on projects and then delivering them. We want to help NHS Trusts to manage the delivery well, and similarly, if there are issues with the customer, we want to iron out those issues through our resources in the countries themselves. As long as there is clarity from the beginning, and issues which arise are tackled quickly and effectively, risk can be minimised.” In conclusion, the steps that can be taken by private organisations in and outside the UK to do business with the NHS are many - and the systems which exist can help fledgling or even well-established businesses break into new markets, or into the NHS itself. With the expertise of organisations such as Healthcare UK and experienced legal practitioners in the international healthcare market, the pathway to opportunities can be made painless - and definitely worthwhile. 93

An Introduction to Translational Healthcare and its Impact on Commercialisation in the Sector 17-May 2021 - 12:00 HRS Speakers:

From bench to bedside

Steve Gardner

Translational Health covers the innovation journey from concept to reality, HW Editor Sarah Cartledge learns

Jane Kinghorn, PHD

he new buzzword in healthcare is translational health, but what is it and how does it work? This was the main thrust of the session and was clearly explained by the panellists who have been working in this field for several years. Jane Kinghorn, Director of the Translational Health Research Office at University College London, previously worked in drug discovery for a multinational pharma company. She has seen translational health from both sides, and describes it as putting into action the steps and support for researchers to move their ideas into action and address unmet needs. Joseph Ferenbok, Director of the Translational Health Program at the University of Toronto, built on her definition by saying that many people think their Eureka idea will instantly change the world, but the reality is much more banal. “Just because it works in one context and in one hospital or in one community centre, it doesn’t magically work everywhere in the globe. Each application of research or knowledge has contextual differences that make it important to be able to work out some of these ideas beforehand to ensure better implementation and success that is more effective, less costly and with benefits to people.” Behind all of this research and application lies the funding, an area in which Heather-Anne Hubbell of Phundex is situated. For her, it’s a question of whether the innovation is a solution to an actual need, and then how it’s effectively commercialised. The realisation that funding can be a slow and painful process for innovators has led her to create Phundex, a platform to simplify the necessary steps for everyone involved. 94

Managing Director at Healthcare World

CHAIR

Director of the Translational Research Office at University College London

Dr Austin Gibbs

Director at The Allan Lab

Heather-Anne Hubbell CEO at Phundex Limited

Paul Guthrie

Co-Founder and Chair at VALR, CoFounder and EVP at Envelop Risk

Joseph Ferenbok, PHD

Co-Director of the Translational Research Program at the University of Toronto

HEALTHCARE WORLD FESTIVAL Translational Health Session

The importance of co-operation It’s quite clearly not enough to have a brilliant idea that can change the world. That’s just the first step. Bringing it to market can be a long and complicated process that is made all the more convoluted by the lack of structure to follow through in a formal and regulated manner. The panel emphasised the many silos that exist traditionally within academia and funding, leading to people following their own paths – from researchers moving to the next idea to get the next grant, to the lack of patient involvement to determine

whether an innovation does indeed have a practical and beneficial application. As a result, many universities have found themselves in a situation where they are handling the development of ideas created by their researchers. At UCL they have embedded the scientists with knowledge from industry and support to show them how to move forward. As a result of the close association with University College Hospital they are actively trying to address the patients’ needs, so the clinicians are also researchers, particularly in gene and cell therapy. “Ten years ago there was no

commercialisation of the market so the medical council decided to address this and now we have spun out 10 companies in 10 years,” says Jane. In Joseph Ferenbok’s Health Innovation Hub, some of the 450 companies have gone on to outstanding success. “The key is to fail fast and to fail early,” he says. “Identify a legitimate need that actually exists and is not in your head. Step out of the research environment and speak to the patients, users, clients and see what they want. Then frame the need in the jurisdictional, legal and regulatory context within which you’re going to have to build out.”

It was a point picked up by Dr Austin Gibbs, Director at The Allan Lab in Jersey, a former emergency doctor who worked across the globe. “In healthcare, the moment you put something in the hands of a patient or a doctor, things happen to it that you could not possibly have predicted, either beneficial or negative,” he said. “There needs to be a much closer link between the front line and research so there’s a rapidly exchange of ideas and needs.” For him, commercialisation of innovations is a powerful Darwinian selection mechanism – those who survive in a commercial world have probably worked closely with their end users. Cultural change is needed to figure out how to bridge the gap, but in many respects it’s being driven by the patients themselves who don’t understand why, if they can manage their own affairs online, healthcare is so behind in this regard. The commercialisation of ideas and data In fact, patients themselves are comfortable with the idea of citizen scientists. In today’s world anyone can come up with a concept and the successful ones secure funding. But healthcare has specific issues mostly around patient data, which is vital for research and validation of ideas, and the absence of effective communication between the different silos in the early stages of development. The lack of incentives for academics, healthcare workers and healthcare organisations to participate was identified by the panel, while the drivers for clinicians to make an impact for their patients was recognised. Austin referred to the commercialisation of healthcare data and the terabytes of data that are lost every day, also citing conversations taking place in Jersey at the moment around recognising that data belongs to the patient. By making this data available to researchers who would reward the patient for allowing its use, the patient is actively involved in research which will enable better treatment and potential outcomes. This patient feedback makes life easier for the clinicians with outcome-based measures of time and money, which will drive innovation further. “We are moving away from doctor knows best in healthcare generally, so we should move away from the doctor being the data owner as it’s actually all the patient’s 96

personal information,” he said. “The patient should truly be at the centre of everything and not squeezed into a box each time.” Access to data has traditionally met ethical, practical, cultural and traditional barriers. Joseph acknowledged that some of the most valuable insights can take place just by observation on a ward, which are of immense value to engineers and scientists who are often working from a theoretical standpoint. But ethical review boards often relate to publications and output rather than innovation, and they limit patient input at the beginning of the commercial cycle. In his opinion, each patient should have the right to decide whether they want their data to help themselves or other sufferers. The question of fair value for the data was discussed, with the agreement that it needs careful consideration and debate around

what data can be ringfenced for academia and what can be used commercially. “It’s about interesting ideas being accessible and available to the public,” said Heather-Anne Hubbell. “The key is regulation and to build a sustainable process that enables every party to have a place in that process and ensures they are rewarded for the aspect they bring to the table.” Need for a systemic approach The panel agreed that translating an idea from a business concept to secure funding requires a tried and trusted process to validate it. Currently it’s a messy and complicated space that can kill good ideas, so it’s about changing the language to allow an entrepreneur to translate their idea into a commercially viable proposition.

HEALTHCARE WORLD FESTIVAL Translational Health Session

Within each phase there can be multiple teams taking unstructured steps. A systemic approach, along with guidelines about vetting and selecting concepts and moving them to the next steps in the process, will enable good ideas to progress. But currently there is a lack of funding to translate ideas as most funding goes into development. “This is the bigger problem and is crucial to the future of innovation. We need better relationships with industry and more focused governments,” said Joseph. Heather-Anne emphasised the need for giving potential funders an understanding of the necessary steps via a collaborative hub where everyone can work together and share successes and failures. The panel agreed that getting investors in earlier gives a much better approach as they can de-risk

their investment discussions, while good investors will have a sector roadmap of 2030 years to filter ideas. Conclusion The development of the COVID-19 vaccine was singled out as a the perfect example of translational health in action. Vaccines used to take 10-15 years to launch, but now several have been rolled out in the past 18 months for this novel virus. The fundamental research has been in train for decades but the expedited collaboration between multiple labs and researchers, between governments and industry to cut down pathways and barriers to a fraction, has been unprecedented. Talking early and sharing was identified as the key, along with the superhuman

effort round the clock by everyone working on a singular goal with clear aims and objectives with one coherent incentive. This shared knowledge base, along with implementing a feedback loop, is vital in evaluating how best to mobilise knowledge in particular contexts. But for translational healthcare, most important of all is a collaborative approach between stakeholders to develop a set of practices and adapt them when needed to better innovate in the future, making sure it’s sustainable. This set of guidelines will give each participant in the process a clear understanding of their place in the roadmap, the reward for their involvement and a shared vision of the ideal outcome – a solution to an identified need that will improve patient experience and clinical outcomes. 97

The Fusion of Public and Private – The Way Ahead for Healthcare in the Middle East 18-May 2021 - 13:00 HRS Speakers:

The fusion of public and private partnerships HW Editor Sarah Cartledge discovers why they are the future for Middle East healthcare.

he most well attended session of the festival, this lively discussion was chaired by Dr Niti Pall and focussed on the partnership between private and public in the development of healthcare across the Middle East. The particular accent on the utilisation of outcome-based payment models and the creation through those models of a nexus between provider, regulator and payor really caught the imagination of our large audience. More than 1900 attendees tuned in to hear the views of our distinguished panel that comprised Dr Ibtesam Al Bastaki, Director of Investment and Private Partnership Dubai Health Authority, Dr Dirk Richter Senior Adviser to the Abu Dhabi Health Authority, Richard Cantlay, Global Health lead for Mott MacDonald, Simon Swift MD of Methods Analytics, Dr Stan Shepherd CEO

Richard Cantlay Global Health Portfolio Leader Mott MacDonald

“I’m a strong believer that the public sector always needs to be the owners of the strategy – after all, they are responsible for delivering health services and outcomes to their populations”

of Instant Access Medical, Ben Furneaux Senior Director and Board Member Cigna, and Vincent Buscemi, Partner and Head of Independent Health and Social Care at Bevan Brittan. Dr Ibtesam Al Bastaki began by saying that Public Private Partnerships (PPPs) were established in Dubai law in 2015 for better collaboration between the public and the private sector. She felt there has been more appetite for PPPs since the pandemic, not only in design and build but also in running services and distributing the risk between sectors more cost effectively. In her view, better processes ensure good focus on the patients by providing the best solution. In both Abu Dhabi and Dubai, the challenge for regulators is to balance the cherry-picking approach so the nonprofitable patients don’t only go to the public sector. But, as Dr Richter observed, the private partner needs to earn money and asked why it should be any different in healthcare, otherwise providers don’t deliver quality. There are big hospital groups in the region that are doing more complex procedures such as oncology, where before it was only simple outpatient cases, leading to more competition between public and private providers. The changing face of healthcare Richard Cantlay felt that healthcare is at a real juncture where the sector can think in a much wider context about PPP models, with more emphasis on preventative measures to address the healthcare burden at source to prevent

Niti Pall

Global Medical Director KPMG’s Global Health Practice

CHAIR

Dr Ibtesam Al Bastaki

Director of Investment and Private Partnership Dubai Health Authority

Richard Cantlay

Global Health Portfolio Leader Mott MacDonald

Dirk Richter

Senior Advisor Abu Dhabi Health Authority

Ben Furneaux

Senior Director and Board Member Cigna

Vincent Buscemi

Partner and Head of Independent Health and Social Care - Bevan Brittan

Simon Swift

Managing Director Methods Analytics

Stan Shepherd

Group CEO Instant Access Medical

increasing demand on healthcare systems. “I’m a strong believer that the public sector always needs to be the owners of the strategy – after all they are responsible for delivering health services and outcomes to their populations,” he said. Simon Swift agreed there is potential to significantly broaden the PPP concept to think about it from a population wellness point of view. He felt it would bring a true partnership between governments, patients, providers and insurers across the primary, secondary and tertiary space. This alliance would enable them to think about the different motives of each part of that system and knit them together to provide improved health outcomes that are better for people, cheaper for governments and insurers, and reduce the burden on providers as everybody would be compensated and

HEALTHCARE WORLD FESTIVAL Middle East PPP’s Session

focused on wellness rather than delivering sickness services. “A PPP model with a value-based lens on it is a really exciting way to do this, but I’ve not seen that broad piece of thinking put into place yet,” he said. The importance of data for outcomebased approaches There are very few countries that have a healthcare system that is exclusively public or private; it’s usually a mix of both. The citizen is neither public nor private and lives in both worlds, so their data needs to include both. For Stan Shepherd, the data needs to be portable and the citizen needs to be the primary data owner who takes this data between public and private. “It’s about moving the centre of gravity,” he said. “It’s not about patients seeing doctors’ data, but doctors seeing patients’ data. The whole PPP envelope needs to encompass that.”

The US was cited as an example of how data has been collected successfully, while Dr Ibtesam explained the plans in Dubai to link patient data between the private and the public sector. There was consensus among the panel that there is a role for government, payers, providers, pharma and the client to create a balance that includes transparency. This is particularly important for the payer who needs to have sufficient visibility of the data to be assured the outcomes they are expecting are delivered. Equally, governance around data was highlighted. In Simon Swift’s opinion, outcome-based approaches fail on lack of trust, but data transparency can deliver that trust and thus the outcomes. Delivering innovation at speed The next part of the discussion focused on innovation with the recognition that it comes from citizens themselves. So how

do governments include citizens in PPP strategy and design in healthcare? Stan Shepherd felt that we need finer granulation of the data than hitherto. “In healthcare we find the things that are easiest to measure and then we give them greater significance than they deserve,” he said. “Full function recovery should be measured by the patient, as value for the patient is different and we need to capture that data at a personal level.” The Australia example was cited where the entire population data has been brought together in a single source and is being used for many projects. It was agreed that such data use can help governments understand problems at a macro level so they can design services, while individuals can understand how their behaviours can contribute to their own health as well as that of their family and country health. “Making it as visible as possible is crucial,” said Simon Swift. 99

From a lawyer’s perspective, Vincent Buscemi felt the data was vital in any model, particularly value-based remuneration where payers are asking providers to take on more risk and deliver better service with fewer resources. He also highlighted the importance of the business relationships between the two parties and observed that providers may take the risk but may not necessarily share the rewards. Creating and regulating the future Ben Furneaux emphasised that at Cigna they are focused on innovation for global markets as this will drive better outcomes. Certainly, innovation is key in the UAE where both Abu Dhabi and Dubai have innovation hubs that work closely with regulators to enable regulation in new areas. This regulation of the future is vital to move healthcare forward in today’s world without the traditional delays that have always characterised it to date. 100

“In Abu Dhabi we enable regulation and learn as an entity to regulate the future even though it’s unknown, and the best way is to work with innovators,” said Dr Richter. He went on to cite the example of the pandemic when Abu Dhabi worked with start-ups to help with solutions to COVID-19 and enabled them to modify their business models to fit with regulation.

Dirk Richter Senior Advisor Abu Dhabi Health Authority

“In Abu Dhabi we enable regulation and learn as an entity to regulate the future even though it’s unknown, and the best way is to work with innovators”

Dr Ibtesam agreed, citing the work of the innovation hub and future accelerator in Dubai. “Depending on the size of the concept it can go into our facilities, but if not we can link them with a more mature concept,” she said. “Our work with the regulators depends on the company and what will add value to the market.” Thus the future of healthcare in the UAE is dynamic and evolving. Public Private Partnerships have been around for a long time, but it’s clear PPPs could be better and more commonly used in the delivery of healthcare by bringing together the regulator, the private sector, the provider and the insurer. If healthcare design can also be integrated with urban planning along with wellness and lifestyle concepts, there can be greater emphasis on prevention rather than treatment or cure. Currently the models still focus on the traditional methods, but PPPs offer the chance of a greater vision and collaboration between all parties at every stage of healthcare projects to deliver better outcomes for patients.

British surgeons are improving outcomes for cancer patients by pioneering the use of robotic surgery for increasingly more procedures. For improved patient outcomes, choose the UK.

Urological robot North Bristol NHS Trust

gov.uk/healthcareuk

TRADE MISSIONS UK/US Partnerships in Healthcare: Entering the US Market 18-May 2021 - 16.00 HRS Speakers:

UK/US partnerships in healthcare: entering the US market Breaking into the U.S. healthcare and life sciences market, specifically as an international body, is daunting to say the least, discovers Sophia Kurz

ntering the US market for overseas companies is a difficult and complicated process, but one that can be achieved with advice and due diligence. A breakout session with US healthcare specialist Ernesto Chanona, Director of Business Development at CSSI Life Sciences, guided trade delegates through some of the footsteps and pitfalls in an extremely valuable meeting. Non-US based companies already have a vast disadvantage breaking into the market as they potentially lack real estate, investors, and partners. For a company, particularly a small one, the key to success in the US is to start off with a strategic road map. “The road map prompts entities interested in entering US markets to narrow their plans and strategies,” said Chanona. “The major points are to define goals and objectives, consider what the desired product attributes are that differentiate from other similar products, how you can create shareholder value, which stakeholders and market channels are important, and where the product will be marketed.” Reasons to partner with the US specifically include incentives such as tax credits from various government bodies as well as government resources, building connections to local entrepreneurs, real estate, academic researchers, introductions to local investor groups, reimbursement, and supply chain access. 102

Entering the market – first steps Research and partnerships are key in the early stages. Chanona advocates integrating with one of the many life sciences hubs across the country, where businesses will find strategic partnerships as well as real estate, talent, development incentives, introductions to stakeholders, all vital to accelerating the commercialisation of their technology. He also stressed the importance of approaching the state government or the county government within a state where biotechnology hubs reside, as opposed to the federal government which is big and difficult to navigate. One way for UK companies to enter the US market is by finding a US based company to represent and support them. As a result, UK companies are subjected to benefits such as Government support (which may mean funding), access to resources, US subsidiary establishment, and other assistance. Partnerships with the service industry (such as CSSI Life Sciences) offer “established regulatory strategy for product development, whether it be MedTech or drugs, and then plug in all the CRO’s (contract research organisations) necessary for the appropriate testing for regulatory approval, and then foster those introductions to the payers and the buyers for those who are interested in those strategic assets.”

Ernesto Chanona CSSi Life Sciences

There are several other partnership options as well, such as in academia, government, and public-private partnerships, each with their own unique benefits. Along the way there is business support and funding for companies so it’s critical to be connected in this regard.

HEALTHCARE WORLD FESTIVAL UK / US Partnerships in Healthcare

Tightening the mentor group who will help launch the technology is also a key component. “We find it’s not the technologies that fail but the founders who fail because they aren’t ready or prepared to have those conversations,” he said. Regulation US investors like to see a commercial plan that incorporates regulatory approval in some form. CSSI takes companies to the JP Morgan Healthcare conference each January and organises partnering events that have raised more than $700m for them. “We don’t charge for taking businesses there but if they raise funds then we hope they will choose us as their regulatory partner,” he said. It takes 10 years to commercialise a drug and around $1.4bn to achieve it, so less than 12 per cent of drugs entering Phase 1

Ernesto Chanona CSSI Life Sciences

“We find it’s not the technologies that fail but the founders who fail”

are actually approved. Many companies fall into the ‘Valley of Death’ between discovery and pre-clinical research which is why a regulatory partner is so important. Meetings with organisations such as the FDA are very structured and he stressed that companies should be clear on the regulation they think should sit around their product, as relevant regulation may not exist at that point. He advocated strongly

having expert advice at this point, because if the FDA raise red flags it will take time and expense to overcome them and may eat up resources. MedTech companies do not require proof of compliance at the time of regulatory submission but the FDA enforces compliance through random inspections, so again regulatory companies are invaluable to set up systems in advance. FDA fees are cheaper and approval more likely for domestic companies. Funding and capital access Trade organisations, biotech and tech development organisations may seem to be government institutions but are actually PPPs that handle public funds and are sheltered from the vagaries of political tides. The Maryland Technology Development Corporation is a prime

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example and is the venture capital part of the state. It doesn’t have the reach of VCs or private equity companies, but it invested $1700k in 2020 in six life science companies. Such organisations also have market databases, pitch competitions, and grant labs. Academic and government labs can be found across the US and have a lot of programmes that support businesses. The NIH (National Institutes for Health) is a government organisation dedicated to turning discovery into health and has a pool of wide-ranging experts who can advise and work with new technology. They also have intellectual properties 104

for licensing without demanding royalties, working not just with US companies but businesses all over the world.

Ernesto Chanona CSSI Life Sciences

“US investors like to see a commercial plan that incorporates regulatory approval in some form”

The federal government provides funding via their SBIR programme in two phases for companies that have more than 50 per cent stock owned by a US citizen with more than 500 employees as a for-profit organisation. The Federal Lab Consortium is another group with their own funding programmes, with intellectual property available for licensing and specific lab programmes to help companies with their development. In addition, the US military has substantial budgets set aside for basic research science all the way through to the commercialisation if they are interested in purchasing it.

HEALTHCARE WORLD FESTIVAL UK / US Partnerships in Healthcare

Entering the hospital supply chains In the privatised US healthcare ecosphere, hospital systems are incredibly fragmented spaces. Departments don’t talk to each other, so sometimes it’s easier to find a physician champion and work with them to get a product or a solution considered at committee level by the hospital. Conversations with key personnel is the only way to achieve this, according to Dr Chanona. Equally, it’s important to identify the CPT code for reimbursement even for a novel technology where possible. Reimbursement consultants are not cheap but hospitals won’t buy if they don’t know how they are going to be reimbursed, so knowing where the product or solution will fit in is vital for success. Primary care will have to code a medical device in the same way as a hospital, so again it’s important to know how reimbursement will be handled. For small companies, keeping in contact with hospitals to know when they might need your technology is part of the process. For larger companies who can provide volume, there are distributors who will be able to help at scale. Another key piece of advice is to establish relationships with procurement teams at government level, whether at city, county, state or federal level. Each has a procurement website with details of relevant people to create meaningful relationships. Conclusion

The US market or lack of one Post FDA approval it’s a maze of opportunity and possibility. This is where the research comes in. “There isn’t such a thing as the US market,” Chanona says surprisingly. “Each hospital is a semi-independent universe.” For those companies engaged with the National Health Service in the UK, the concept of a fragmented health service is very familiar. “You need to look at individual regions and institutions and then grow from there,” he says. Chanona advises researching individual institutions and gauging their needs. “If

you look at Baltimore and Johns Hopkins, for example, you would need to connect with the Maryland Technology Council and the economic development corporations because they know the local market. That’s all you need to be successful.” Dr Chanona was part of the team that signed the life sciences trade agreement between Maryland and the UK Midlands. “We were incredibly active at pairing our companies at trade delegations together,” he said. They visited several high profile events such as Arab Health in Dubai and were very proactive in putting their portfolios together to matchmake companies.

Entering the US market could be a daunting process, but armed with knowledge and good relationships there is no reason why a company cannot navigate its way to success. There is plenty of funding available for technologies that fulfill a need, along with consultants in the regulatory and reimbursement fields to guide you through the process.

Contact Information echanona@csslifesciences.com Tel: 001 919 316 8520 www.cssilifesciences.com

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TRADE MISSIONS Opportunities in the Middle East 19-May 2021 - 12:00 HRS Speakers:

Opportunities and market entry to Dubai and the Middle East

Steve Gardner

Managing Director at Healthcare World

CHAIR

Dr Mazin Gadir

Director of Strategic Partnerships, Bid Management & Client Relationships at IQVIA Middle East & Africa

Dr Niti Pall

Patience, perseverance and partnerships are the key, HW Editor Sarah Cartledge discovers

ollowing on from our hugely successful ‘main stage’ session on healthcare in the region, this breakout session provided attendees with an understanding of ‘where to go next’ in terms of setting up in the region and particularly Dubai. Dr Mazin Gadir ,Director of Strategic Partnerships, Bid Management & Client Relationships at IQVIA Middle East & Africa, Dr Niti Pall, Global Medical Director KPMG’s Global Health Practice, Marwan Abdulaziz, Managing Director at Dubai Science Park, and Vincent Buscemi, Partner and Head of Independent Health and Social Care at Bevan Brittan, provided invaluable advice to UK and other companies looking to enter the potentially lucrative Middle East market. The audience of just under 1000 attendees were treated to the insider’s guide to market entry. Niti Pall began by stressing the importance of understanding local systems and mechanics before deciding that your solution is the right one for the region. She spoke about the vibrant private sector but also the importance of the public health sector and the interplay between the two. The combination of different factors driving growth in demand, particularly the rapid rise of digitisation in the past 12 months, has led to remote consultation and monitoring, and the growth in the use of AI in the field. It provides excellent opportunities for UK medtech companies to work in both the public and private 106

Global Medical Director KPMG’s Global Health Practice

Ben Furneaux

Senior Director and Board Member Cigna

Vincent Buscemi

Partner and Head of Independent Health and Social Care - Bevan Brittan

Marwan Abdulaziz Managing Director at Dubai Science Park

HEALTHCARE WORLD FESTIVAL Middle East Opportunities Session

sectors, according to lawyer Vincent Buscemi. He also noted that the Middle East is now facing the same issues as other countries, such as an ageing population and increased life expectancy, while lifestyle choices are creating a surge in non-communicable diseases (NCDs). There is also greater emphasis on wellness and prevention rather than responding to sickness, providing opportunities for new models of care and services. A shortage of workers and skills has led to overreliance on expatriate healthcare workers, so there are further opportunities for upskilling and training. With his additional roles as a PwC healthcare advisor and also with Cerna’s digital health transformation in the region, Dr Mazin Gadir highlighted the importance of value-based care, associated care

Vincent Buscemi Partner and Head of Independent Health and Social Care Bevan Brittan

“Most clients come without understanding what entering the market will entail”

systems reimbursement, shared risks and contracts between payers, providers and regulators. Universal Health Coverage or UHC is becoming the regional trend, he said, and commented on the importance of local supply chains, procurement and

capabilities. He cited the example of Africa’s vaccine supplies that were immediately impacted once the scale of the pandemic in India became apparent, and the need to secure and produce local supplies of vaccines. Preparing to enter the market The panel went on to discuss the various ways to enter the market, either directly or with the aid of consultancies who are embedded in the region. The key is to have the right partners on the ground, so networking and partnerships are crucial. Accelerators such as Harbr scan startups to make sure they are in the right position for market entry. “We look at the product, localise it, and identify how to commercialise it,” said Niti Pall. “We also introduce to the right docking

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Marwan Abdulaziz Managing Director Dubai Science Park

“There has been a shift in investment away from bricks and mortar to improving efficiency in services and digital health”

stations, the right providers, distributors and also the government which is the biggest distributor of healthcare. In addition we also have a big network of investors in the Middle East, London and other places.” At this juncture, working with the right legal entity is also vital. At Bevan Brittan they prefer to come in early to help clients negotiate the tricky waters of different cultures and business environments. “Most clients come without understanding what entering the market will entail”, said Vincent Buscemi. “We revisit the market research to narrow down the model they want to follow as each comes with different solutions and ultimately differing processes.” The initial debate can be around whether to opt for a free zone or to stay local. “It depends on whether you want to work with a healthcare authority or have a regional business,” said Dubai Science Park MD Marwan Abdulaziz. “Because the UAE is a small country, most would say start in UAE or Saudi Arabia and then go to other countries. The free zone model gives more flexibility than the local model and from 1 June most sectors can be owned 100 per cent by foreigners. This levels the playing field for the free zones and the mainland, and puts pressure on the free zones to offer more. However, if your business is healthcare services then opting for local makes a lot of sense, but if you have tech and want to expand I would say free zones would be much better.” Dubai Science Park is the region’s first free zone community that serves the entire value chain of the science, health and pharma sectors, fostering an environment that supports research, creativity, innovation and passion, ensuring a supportive ecosystem for businesses to establish sustainable and positive change. 108

Founded in 2005 it currently has more than 400 business partners with 3,600 professionals. Incorporating hotels, schools, residential areas as well as warehouses, retail and healthcare, it’s one of the foremost areas for companies to base themselves, especially tech and start-ups. “We want to help companies throughout their journey and we have built our park around this concept. We do two things – hardware and software. We invest in infrastructure that is fit for companies and we look at the value chain from R&D to manufacturing to distribution and storage, and end with offices for marketing - an investment around $500m. ‘With software companies, we introduce them to other companies for joint

ventures, local manufacturing, or testing capabilities. We also help with discussions with the regulators, and we can connect to investors if needed. I’m proud to say this has resulted in more than 400 companies being part of the Dubai Science Park,” Marwan concluded. Accessing investment Investment is much more than about money; it’s also about partners supporting your growth with knowledge and contacts. “Going into the market with an understanding of what you’re trying to achieve and who can help you is hugely important,” said Vincent Buscemi. “Speak to the experts and make the connections who know where the money is. You can

HEALTHCARE WORLD FESTIVAL Middle East Opportunities Session

waste a lot of time if their investment criteria is completely unknown to you, so at Bevan Brittan we facilitate introductions to investment houses because we understand who companies should be talking to.” Niti Pall stressed that many start-ups trying to access capital don’t target it. “There is a vibrant investment community in the UAE, Jordan and Saudi Arabia, but you need to understand their investment strategy. For example, biotech is becoming really big on the back of test and trace. The investors feel it is very tangible so they are investing much more in it.” “There has been a shift in investment away from bricks and mortar to improving efficiency in services and digital health,”

added Marwan Abdulaziz. “Governments will support if they like the idea, but it depends on where you are in your life cycle and what kind of partner you have.” Conclusion Entering the Middle East market is a process that pays dividends if you put the work in at the start. “Take early advice and don’t wait until you think you’ve nailed all the answers,” was key for Vincent Buscemi. He also stressed the importance of understanding the market, selecting partners carefully, understanding practice and customs, being aware of yourself and body language, and understanding how your hosts expect you to behave and communicate.

According to Mazin Gadir there are many Middle East opportunities in the next six months as the world approaches recovery. He emphasised patience, perseveration and relationships as key to success, while Niti Pall advised speaking to people who have already done it to learn as much as possible. For Marwan, the goal is to find your niche and competitive edge. Finally, it’s about understanding the need and finding the advocates. The most important allies are the Dubai Health Authority, the Dubai Science Park and the British embassy which also has many links to key contacts in the region. Then you can take the plunge and reap the rewards. 109

TRADE MISSIONS How to Work in Projects via Multilateral Development Banks’ Funding 19-May 2021 - 16.00 HRS Speakers:

How to work in projects via multi-lateral development banks’ funding Emma Williams discovers valuable insight into the workings and practices of the major aid development banks

or many companies, the idea of taking part in aid funded projects may seem daunting, especially as the funding would come from some of the world’s largest international financial institutions (IFIs), such as the World Bank. Cristina Pirela, Vice Consul and International Trade & Investment Officer, and Rebecca Nowlan, Trade and Investment Executive, joined Healthcare World from the Aid Funded Business Team at the British Embassy in Washington DC for a breakout session on how to carry out international healthcare projects using funding from these IFIs. As part of the UK Department for International Trade, Cristina and Rebecca focused the session on how the process works, and how both small and large UK companies can get involved. International financial institutions and health projects The Aid Funded Business Team in Washington DC works with four IFIs who are headquartered there. These are the World Bank Group, the Inter-American Development Bank, the US Agency for International Development, and the Millennium Challenge Corporation, and these institutions provide financial, technical and advisory services to client countries. Moreover, these banks fund a multitude of projects in various sectors worldwide 110

through low-cost loans, credits and grants. These projects provide UK companies with the chance to bid for ventures that support developing countries in underfunded areas such as healthcare. The Aid Funded Business Team works with UK companies by providing contacts and information within and surrounding these banks, identifying specific projects that companies may be suited to, resolving any issues that may arise, and offering support throughout the process. Why the World Bank? The World Bank is not only the world’s largest multilateral institution, but offers a wealth of choice and opportunities for companies looking to work on World Bank funded projects. With the opportunity to work globally and in developing markets, the World Bank offers billions of dollars’ worth of business. “In 2020, there were $262 billion worth of total commitments from the World Bank, and over 1700 projects in 144 countries,” Rebecca said. With a demand for a variety of specialisations, companies can rest assured that there will most likely be a project or contract that is well suited to their expertise, ranging from small to large contracts, and from SMEs to large multinational corporations. Healthcare is one of the World Bank’s priorities, and current projects focus on Covid Preparedness, Universal Healthcare, Nutrition, Infectious Diseases

Cristina Pirela

UK Department for International Trade – Washington DC

Rebecca Nowlan

UK Department for International Trade – Washington DC

and Vaccinations, Mental Health and Reproductive, Maternal, Child and Adolescent Health. In the past year, there has been the largest focus in Western Africa, Nigeria, the Democratic Republic of the Congo, Cambodia and Pakistan, as well as a $200 million Emergency Health and

HEALTHCARE WORLD FESTIVAL Banks’ Funding

Nutrition Project in Yemen which aims to strengthen basic health and essential nutrition, water and sanitation services. On large projects like these, companies can expect to work with organisations such as UNICEF as well as the WHO. The World Bank isn’t the only institution offering projects like these. The InterAmerican Development Bank (IADB), focused solely in the Caribbean and in Latin America, offers projects on strengthening health systems, with this being the top priority area out of the $4bn already spent. A current example is a $600m project in Peru which aims to improve protection of vulnerable people in areas such as public healthcare, violence against women, and social policies. How to get started “The first thing we always say is reach out to us! Come speak to us, tell us what you’re working on, what services you

Rebecca Nowlan UK Department for International Trade

“In 2020, there were $262 billion worth of total commitments from the World Bank, and over 1700 projects in 144 countries” provide and goods you’re creating and we’ll help you get started,” said Cristina. Perhaps the most important step is to identify which sector and which countries to enter out of the 180 plus countries that these institutions support. This strategy requires filtering countries where UK companies’ expertise are best suited, along with any involving previous experience and in depth knowledge. Signing up to email alerts and understanding both the

procurement guidance and the bidding process are imperative, along with when to engage with those institutions. Similarly, it’s wise to have a general awareness of the competition, and also to note who could become a potential partner, as this may increase the chances of winning a project bid. Various projects of interest can last for a couple of years or longer, therefore getting involved as early as possible will create the best chances to gain a deeper understanding of the project and its processes. Finally, it is also worth reviewing current projects or future projects by assessing the partnership frameworks within the chosen country. “We really support British businesses who are looking to export abroad, who are looking to invest into the UK and negotiate market access and trade deals, and champion free trade,” said Rebecca. “Where we come in is really helping you understand what these projects are that they’re looking at. How can you get involved? How do you find the key links?”

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Benefits vs challenges Naturally, working with the Aid Funded Business team in DC provides companies with great advantages that will often last on a long-term basis. While they are able to establish local presence and successful growth, they are also benefiting populations of developing countries. Not only this, but the international trade experience becomes invaluable within company history and references, particularly if a company decides to bid for future projects. This collaboration is a secure way to operate in new markets, which will also produce advantageous long term opportunities. While these benefits do exist, there are also multiple challenges that companies may face if they choose to go down this route. Projects can often have long lead times ranging from five to six years, so a company must have the longevity and consistency to take part. Although payment is guaranteed, it may be slow, and in order 112

to win a bid, companies should be aware that the projects are extremely competitive, as companies from all around the world will be bidding for them.

Cristina Pirela UK Department for International Trade

“Banks often go with companies who understand the environment that they’re doing a project in, and understand what the challenges are on the ground. So being able to have a holistic understanding of what’s happening is very important”

Moreover, there are occasions where projects appear and close within the space of a week. Therefore, companies must take the first step to understand any information that is released as soon as possible by contacting their local embassy which will help to navigate and use the data as efficiently as possible. Finally, some companies in developing countries often have preferences or a very narrow criteria for the companies they choose to work with. “Banks often go with companies who understand the environment that they’re doing a project in, and understand what the challenges are on the ground. So being able to have a holistic understanding of what’s happening is very important,” Cristina explained. The key message is that although working with aid funding may seem daunting, the procedures ensure that companies are guided through the process and, if successful, will be rewarding and open up further opportunities as a result.

HEALTHCARE WORLD FESTIVAL South Africa’s Health System

TRADE MISSIONS Insights into the Health System in South Africa 20-May 2021 - 12:00 HRS Speakers:

Insights into the health system in South Africa Myles Ritchie, a senior health advisor at Mott MacDonald working in South Africa to strengthen the healthcare system within the public sector, gives perspective into the health system and its inequalities in South Africa, says Sophia Kurz

outh Africa’s healthcare system is separated into two distinct sectors – private and public. Both sectors, at their respective base, have the same components necessary in order to operate, including providers, facilities, devices, equipment, supplies, and medicines. Healthcare in South Africa is under the jurisdiction of the Department of Health. In 2019, a survey conducted by Statistics South Africa (StatsSA) found that 71.5 per cent of South African households used public healthcare facilities whenever healthcare was required, while 27.1 per cent of South African households used private healthcare facilities. Ritchie explains the breakdown of funding provided by the South African government to different federal branches and developments, in which 12.3 per cent of the budget is granted to healthcare (229.7bn Rand or £11.5bn).

regional hospitals, and public specialised care units. In private health facilities, there are 35,000 beds available, with the majority of the beds belonging to private general hospitals (30,543 beds). The remainder of the beds belong to private psychiatric units, sub-acute care facilities, and private day hospitals. Within the public health sector, responsible for the health of the majority of the population, there is 184bn rand of health expenditure, and 136bn rand in the private sector. The public health sector has approximately 14,000 GPs and

Myles Ritchie Mott MacDonald

4,700 medical specialists, while the private health sector has approximately 13,000 GPs and 8,000 medical specialists. This can be ratioed by 1 doctor for every 2,457 persons (public sector) and 1 private doctor for every 429-591 persons. Ritchie stresses the complete imbalance between the two sectors, and further outlines how the private sector “accounts for approximately 50 per cent of total health care spending” while only providing healthcare for the minority of the population. Prevalent health concerns in South Africa South Africa has what is described by Ritchie as “a quadruple burden of disease”. This burden consists of the HIV/AIDS/ Tuberculosis (TB) epidemic, high maternal & child mortality rate, high levels of violence & injury, and the growing rate of NCD’s (non-communicable disease).

The state of the health sector now South Africa’s population is roughly 60m people. The public healthcare sector is used by around 42m South Africans, while 87m use the private sector. The public health facilities, in terms of beds available, is around 93,000, with a majority of those beds belonging to public district hospitals. The remaining beds are divided between public psychiatric hospitals, public central hospitals, public tertiary hospitals, public 113

Ritchie further attributes these disease burdens to what he describes as “social detriments of health”. These detriments include unemployment, poor housing, inadequate water and sanitation, a suboptimal food environment - poor diet, alcohol or substance abuse - and low levels of social cohesion. “This translates to an unaffordable and over-serviced private healthcare system and a public health system that’s really battling to provide services,” adds Ritchie. Barriers and enablers for working in this market At the moment, there is a policy uncertainty particularly concerning the private sector. The bill for the new National Health Insurance Fund proposes the creation of this fund as a means to drive South Africa on the path towards universal health coverage (UHC). 114

Ritchie adds that “it will have to be a single find and it will have to make provision for coverage across the country. Therefore contracting mechanisms and rates are going to be kept and definitely lowered in terms of current rates being offered by specialists in the private sector, so there’s a lot of uncertainty.” To improve public medical coverage within the country, the Medical Schemes Amendment Bill was introduced and had goals to calculate premiums based on income level, widen prescribed minimum benefits and eliminate co-payments. There was a “rather scathing and cutting” health market inquiry a few years ago, which exposed the issues in the private sector surrounding hyperinflation, high in-hospital claims, high utilisation and ICU admission rates, and a domination by three big hospital groups in South Africa. There were accusations made against the hospitals, including that of collusion, which

has caused great uncertainty within the country. Other barriers in South African healthcare include hyperinflation in health, rise in corruption and other factors affecting investors’ confidence, COVID-19 and related economic downturn, and issues doing business with certain medical facets (such as telemedicine and other digital healthcare). Another barrier, apparently more specific to South Africa, is businesses redressing measures to retender their eligibility with winning government contracts. This is a barrier specifically to international firms wishing to enter the South African healthcare market. Ritchie suggests remedying this by partnering with local firms to try and build a base from there specifically. On the opposite end of the spectrum, key enablers in South African healthcare have been a political priority to improve the

HEALTHCARE WORLD FESTIVAL South Africa’s Health System

Myles Ritchie Mott MacDonald

“This translates to an unaffordable and overserviced private healthcare system and a public health system that’s really battling to provide services,” Opportunities in pharmaceuticals

quality of the health system and lifelong treatments for HIV (which makes for a high life expectancy). The growing reputation of South Africa as a powerhouse for life sciences and academia within Africa, as a convenient location for firms wishing to enter the African market, as well as regional firms looking to expand, makes it an attractive destination. Opportunities in the health infrastructure For those looking to break into South Africa’s healthcare infrastructure, there are several opportunities. Within the public sector, Ritchie suggests that the best options for breaking in would be to: • develop and lease (find land, build a facility, then enter into a long-term lease agreement with a private sector

company of the health department) • develop, lease, and operate (essentially the same gist as solely developing and leasing, except you would be responsible for the maintenance and developments of the facility) • independent project evaluation services (these services can range from performing due diligence on projects, reviewing project designs and making sure they comply with standards and requirements, etc.) Within the private sector, opportunities exist for new competitors who are able to visualise facilities that have the ability to treat both insured and uninsured patients within the same environment. Another option would be to develop small – midsized (10-30 bed) specialised health centers (medical and surgical), which Ritchie notes would appear attractive to insurers.

Pharmaceuticals is an ever-expanding industry which has numerous career opportunities and is arguably the backbone of healthcare. Breaking into pharmaceuticals in South Africa has many benefits, especially if you’re looking to break into the African pharmaceutical market, since South Africa is the only country on the continent that meets the WHO standards to manufacture pharmaceutical products. Other benefits include overhauling of regulatory processes to be faster and more transparent, active pharmaceutical ingredients can be produced domestically, large-scale vaccine manufacturing is achievable, and local manufacturing capacity is possible (if enough capital is available and if the right partnerships are established). Conclusion South Africa is home to a unique health care system, which also makes for a great environment for business opportunity and expansion. The COVID-19 pandemic presented opportunities (especially with digital medicine and vaccine manufacturing/dispersal) within the healthcare infrastructure that local firms have the potential to add on to. With attractive investment opportunities the South African market has great potential to grow and expand, so South Africa may very well become a healthcare hub one day. Contact Information Myles Ritchie linkedin.com/in/myles-ritchieb7b6006

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The Road Back. How does African healthcare get back to normal and what does the new normal look like? 20-May 2021 - 14:00 HRS Speakers:

How does African healthcare get back to normal and what does the new normal look like? Learning the lessons of the pandemic is vital for future growth

ur closing session was a really strong discussion and debate about the future of healthcare across Africa, encompassing the depth of the COVID-19 crisis, the need to vaccinate in huge numbers and the inequity of the African health economy. This debate captured the huge needs and opportunities that Africa represents in healthcare, as well as highlighting that there is really good work and progress in spite of difficult circumstances. Chaired by Dr Anuschka Coovadia, Head of Healthcare for Africa at KPMG, the panel included Dr Senait Beyene, Senior Advisor to the Minister of Health, Ethiopian Ministry of Health, Asma’u Abiola, Sustainable Health Financing Associate at the Clinton Health Access Initiative, Dr Amit Thakker, Chairman of Africa Health Business, Dr Nicholas Crisp, Deputy Director General (National Health Insurance) Department of Health, South Africa, Dr Chizoba Fashanu, Deputy Director of Essential Medicines, Sustainable Health Financing and Malaria at the Clinton Health Access Initiative and Dr Funmi Akinlade, Health Strategy and Delivery Foundation (HSDF) Nigeria. Dr Coovadia began by noting that all African countries have been facing severe resource and infrastructure provision, despite the aim of moving towards universal health coverage (UHC) by 2030. The impact of COVID-19 has been huge and has detracted from some plans already in place, but has expedited others. 116

Dr Anuschka Coovadia Head of Healthcare for Africa KPMG

CHAIR

Dr Senait Beyene

Senior Advisor to the Minister of Health Ethiopian Ministry of Health

Asma’u Abiola

Sustainable Health Financing Associate at the Clinton Health Access Initiative

Dr Amit Thakker

Chairman of Africa Health Business

Dr Nicholas Crisp

Deputy Director General (National Health Insurance) Department of Health, South Africa

Dr Chizoba Fashanu

Deputy Director of Essential Medicines, Sustainable Health Financing and Malaria at the Clinton Health Access Initiative

Dr Funmi Akinlade

Health Strategy and Delivery Foundation (HSDF)

HEALTHCARE WORLD FESTIVAL African Healthcare and the ‘New Normal’

“South Africa was hit very badly by the pandemic and we had to look at how to deliver healthcare. We provided services to the first and second peak, then we looked at how we could upscale our diagnostics and now we’re rolling out our vaccination campaign,” she said. Healthcare challenges and the COVID effect Her colleague Dr Nicholas Crisp felt COVID was a major wake-up call in South Africa as the economy totally shut down. “People never realised their health was everyone’s health. Providers, financiers and suppliers worked together vastly better than before and there was a lot of relationship building to prevent second and third waves. The world will never be the same again and I hope we learn from this,” he said.

Dr Nicholas Crisp Deputy Director General Department of Health, South Africa

“The world will never be the same again and I hope we learn from this”

In Ethiopia the picture was slightly different, according to Dr Senait Beyene. “We have a triple burden of NCDs, non NCDs and road traffic accidents which are a prominent challenge. We also have infrastructure systems problems, systems challenges, healthcare financing and management challenges. We were trying to solve all the problems at once, then COVID emerged.”

She went on to explain how they learned from their responses to COVID and integrated this response into the existing healthcare system. Rapid reorganisation of leadership around public health emergency management and engaging the private sector significantly enabled them to respond quickly in a more organised and sustainable way. “We implemented digital systems for data management generation and analysis for decision making, test and trace, utilising available resources, and we manufactured PPE in country which helped in preventing COVID among healthcare workers. The diaspora has also really helped,” she added. The response in Kenya was equally as rapid and strategic. Amit Thakker identified that partnership and leadership played a central role. “Never before has lack of partnership been more

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exposed when you track how countries have been able to save lives through public and private working together,” he said. “It’s clear that leadership and government working along with other partners, including private ones that provide half the healthcare on the continent, will transform healthcare systems.” Many garment factories in Kenya repositioned themselves to manufacture PPE and now nearly all is made in Kenya where previously 90 per cent was imported. A large proportion of pharma and vaccines comes from outside Africa, but the drive is for more manufacturing on the continent. Similarly, when the pandemic broke only two countries, Senegal and South Africa, could carry out PCR testing, but 50 per cent went on to be provided by the private sector, making tests very accessible. “With regard to treatment and vaccines, we can’t rely on COVAX,” Dr Crisp said. “We need to get the private sector involved in aggregated purchasing from the 30 per cent of COVAX to 65-75 per cent instead.” The panel agreed the pandemic showed that the countries who didn’t take partnership seriously or have a good public private engagement have faced the brunt of COVID. “In Nigeria, we have fragile health systems and the COVID challenge was just an add on,” said Asma’u. “The major change was coordination between public and private sector. The private sector response was unprecedented - we had a coalition of banks and other private sector companies working with the government in the presidential taskforce.” For Dr Chizoba Fashanu, “it was an epiphany that we could mobilise the private sector, pool resources and deploy them in an efficient way. It showed how much more needs to be done in terms of forward planning. I head our oxygen programme working with private sector, and I see the national and local government building better capacity to enter into more long term business models and engaging the private sector.” Creating strong foundations Dr Funmi Akinlade commented that the pandemic raised issues such as the dwindling healthcare workforce and the brain drain to the US and Europe, underscoring the need for quick action. “There’s a role for tech and innovation to help free up our human resources to help breach this gap in the meantime,” she said. 118

Maternal and child mortality in sub Saharan Africa is unacceptably high, and the panel agreed that this needed to be addressed urgently. Asma’u highlighted the need for primary care to function at a certain level to cater for the needs of the vast majority of Nigerians. Along with Funmi, she felt this could be achieved via

Amit Thacker Chairman Africa Health Business

“Government has had trouble with the multiplicity of healthcare solutions and have been scared of engaging the private sector

the chemist network. “Outlets such as chemists are a good place to start health education, and encourage good health and health behaviours,” said Funmi. “There’s a huge opportunity and market, and if we can leverage it through these outlets in conjunction with the private sector then we will see the changes we’re looking for.” Most of the COVID mortality in Nigeria, as in many other countries, occurred in patients with underlying conditions. “In most developing countries we focus our resources on infectious diseases, but we need to focus on a preventative mode of care rather than treating diseases when they happen,” Funmi added. As a result of the crisis, South African doctors came together in a telehealth programme called Doctors on Call, a pro bono service to provide medical advice to patients who didn’t have access to doctors. 500 doctors across multiple specialities

HEALTHCARE WORLD FESTIVAL African Healthcare and the ‘New Normal’

worked with nurses and psychologists in different towns and cities, with support from banks, corporate bodies and civil society bodies. Oxygen was also a major part of the South African response, with a focus on greater volumes and supplying bottled oxygen to rural areas. In the early days when ventilators were thought to be necessary, entrepreneurs, buyers and suppliers worked together to produce them. In Kenya, a programme called Wheels for Life provided free pick up for pregnant women to visit healthcare facilities for delivery, a total of 36,000 in all. In Ethiopia, free transport was also arranged for case management, along with home follow ups and teleconsultations. Refresher training was carried out virtually with practitioners and healthcare providers who were not practising, extending the workforce.

Facing the third wave The panel agreed that there have been clear lessons learned from the first and second waves. The digital explosion in healthcare has brought rapid innovation to the fore, but it also has highlighted the gaps in connectivity and communications which needs to be improved at government level. Nevertheless, most training is now carried out via internet platforms, including for the vaccine rollout. There is a real hope that the partnerships between public and private sectors will not only continue but will expand. Senait Beneye noted that vendors and innovators are now beginning to speak to each other, while there was a strong feeling that there should be solutions pertinent to Africa and its particular issues. Amit Thakker cautioned that although digital health is now at the fore, there are still issues with telemedicine and telehealth. “How easy is it to see a doctor even though you’ve filled out a form?” he

asked. “Government has had trouble with the multiplicity of healthcare solutions and have been scared of engaging the private sector, although now Kenya has licensed 70 telemedicine providers.” Future digital health issues will lie in terms of adoption, scale and becoming commercially viable, but overall Africa now has the tools to face a future pandemic. There was concern that there might be a return to ‘normal’ with lessons forgotten – Sanait Beyene stressed that Ethiopia has incorporated systems created for COVID into the national systems already. There was also a sense of urgency that Africa needs to work together to build stronger and faster health systems quickly. “We need to hit the ground running,” said Asma’u. “If we can treat our healthcare issues as an emergency, such as maternal health and childbirth, and keep up the momentum for about three years, then maybe we can make headway and scale up.” A feeling that government departments need to equate good universal healthcare with economic potential was clear. No longer should health costs be an irritation, rather an investment in the people. Greater investments in healthcare should be non-negotiable, felt Amit Thakker, while Chizoba Fashanu stressed the importance of innovative financing methods. “We are facing macro-economic challenges on the back of dwindling donor financing,” she said. “We do have to find a way to finance it but there are bigger opportunities than crises going forward,” Dr Crisp added. A need for evidence-based policies was also stressed, with leaders prepared to take the hard decisions and lay the groundwork for people to work together. The key areas for improving healthcare system efficiencies involve integrating community health workers, focusing on the importance of digital solutions and how to implement them at scale. There is also a need to digitise the health workforce and create systems at national rather than local levels. The main takeaway was the importance of collaboration – between the public and private sector, between national and regional governments, between innovators and clinicians, and between healthcare systems through interoperability. More accessible quality data should be used for decision making, but above all there needs to be political commitment for implementing far reaching changes and reaping some return from the devastation of the pandemic. 119

The International Affiliate Network – a pathway to better patient care Sarah Cartledge speaks to Alistair Russell, Head of Business Development at Imperial Private Healthcare about their latest venture to ensure better patient experience

nsuring the best patient care is a constant battle for healthcare institutions around the world. It starts from the bottom up – to ensure a quality standard of care, an entire organisation must be operating efficiently throughout, and always striving to improve. For this reason, Imperial Private Healthcare is developing a new collaborative membership, the International Affiliate Network, to ensure care pathways are seamless between Imperial Private Healthcare and member organisations, and promote the development and training of healthcare. Imperial Private Healthcare is managed by Imperial College Healthcare NHS Trust, one of the largest teaching hospital groups in the UK, and has private patient units on each of its five hospital sites across north and central London: • The Lindo Wing at St Mary’s Hospital • The Thames View at Charing Cross Hospital • The Robert and Lisa Sainsbury Wing at Hammersmith Hospital • The Sir Stanley Clayton Ward at Queen Charlotte’s & Chelsea Hospital • The Western Eye Hospital

Alistair Russell Head of Business Development Imperial Private Healthcare

“The key point for us is that we are really invested in improving and advancing healthcare at the local level and building from there”

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“Each of the five hospitals has a long track record in the research and education sphere, influencing clinical practice nationally and worldwide. We provide private patient healthcare in dedicated facilities on our sites, including our prestigious flagship facility, the Lindo Wing at St Mary’s,” says Alistair. Building an international presence The vision of the new project is to create a global network of aspirational healthcare organisations from all corners of the world, working with Imperial Private Healthcare to improve patient care. “The network’s ethos is principally around developing healthcare capability around the world, improving healthcare in the regions where we continue to receive patients,” says Alistair. “It’s about supporting the patient experience. We work collaboratively with healthcare professionals to complement and develop local healthcare by advancing clinical services and extending pathways of care with an overseas referral pathway to Imperial Private Healthcare.” Dedicated relationships In order to develop new care pathways and improve existing ones, member organisations work with a dedicated relationship manager to agree a programme of bespoke education and advisory services which are specifically tailored to their own objectives. Crucially, especially in the age of coronavirus, this programme can be delivered online, locally, or at Imperial Private Healthcare’s London facilities. “The pandemic has actually helped because these days we’re used to doing everything remotely,” says Alistair. “Now Imperial Private Healthcare is set up with so many digital solutions that we’re in a

HEALTH SYSTEMS Imperial Private Healthcare

much better place than we were six months ago. But you can’t take away the fact that our clinicians will be having an in-person relationship with member hospitals. Our teams will go out to the hospitals and support them in their development, and to perform teaching and training. We also hope to welcome them to Imperial Private Healthcare.” Furthermore, establishing complex overseas care pathways will potentially enable patients to be discharged back to their local hospital sooner than they would be with a standard overseas referral, making the patient journey that much easier. The Imperial Private Healthcare advocacy service will also make an invariably

challenging experience as straightforward as possible for those who may find themselves in an entirely unfamiliar part of the world – benefiting both patients and hospitals. In addition to the mutually beneficial patient pathway, members also receive tailored benefits – allowing them to receive dedicated advisory services surrounding clinical change, pathway design, technological integration, and governance advice. “We want to help our member hospitals improve as individual organisations and build a referral network on a global scale,” says Alistair. The network is available to overseas members now and the first affiliate will be in place this year. “Our plan is to

expand the International Affiliate Network worldwide and we will always be open to conversations”,’ he says. “The key point for us is that we are really invested in improving and advancing healthcare at the local level and building from there.” If you would be interested in joining Imperial Private Healthcare’s International Affiliate Network, please contact Alistair Russell, Imperial Private Healthcare: Contact Information alistair.russell1@nhs.net imperialprivatehealthcare.co.uk

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Translational research The University of Toronto’s HealthEdge Innovations approach challenges students to think differently to champion change

he importance of Translational Research (TR) has taken centre stage. Governing bodies, including the National Health Service (NHS), National Institutes of Health (NIH), and Health Canada, have made TR a strategic priority. But what is TR? The popularity of the term has increased to the point where it has been defined and redefined by a multitude of organisations from a variety of disciplines worldwide. 122

In reality, much like the discipline it represents, the term is ever-changing and adapting to the environment it serves. There is no definitive definition, as there is no single approach to TR. Rather, the approach is adapted to suit the situation. Put simply, TR is the application of knowledge to improve health. While scientific literature is filled with original empirical and theoretical knowledge in the natural and social sciences, TR attempts to

apply this knowledge to solve real-world health problems. While this concept may sound straightforward, applying knowledge in the real world is riddled with complexities, challenges, and barriers. The laboratory of the real world is highly complex. It involves individual people with unique biology who think, act and react in distinctive ways. Knowledge acquired in the laboratory is not easily translated into the real world, not only because of the variation in people’s biology but because results are also dependent on their environments and behaviours. TR is a strategic approach to developing novel tools, mechanisms, services, drugs, techniques, policies, and protocols that

HEALTH SYSTEMS Translational Research

takes these complexities into account to address the health needs of individuals and populations. The Translational Research Program HealthEdge Innovations’ (HEI) approach to TR is based on that developed by its founders Dr. Joseph Ferenbok and Dr. Richard Foty, at the University of Toronto Translational Research Program (trp. utoronto.ca). Now in its seventh year, the Translational Research Program (TRP) is a 2-year Master’s Degree that challenges students to think differently in order to champion change and improve health, medicine and care. The heart of the program is the Ferenbok and Foty’s Toronto

Translational Framework™ (TTF™), which helps students expedite translation systematically, strategically, and purposely. There are no strict ten steps to follow that will guarantee successful health innovation. Instead, the TTF serves as a guide to navigating translational problems. The TTF has six stages: 1) Discover, 2) Define, 3) Frame, 4) Ideate, 5) Translate and 6) Implement. The true start of translation begins with a question, or more specifically, an unmet health need. Without a need, an innovation is nothing but a solution to a non-existent problem. If there is nothing to improve upon, there is no real market. In the space of health innovation, if there is no health case, there is no business case.

The first few stages of the TTF ensure that researchers engage with their target populations (end users) to identify and really understand their health needs before defining the problem to be addressed. The TTF also stresses that key stakeholders must be engaged throughout the translational process and that innovations must be co-created with those they intend to serve. Involving these voices and perspectives in ideation and development leads to better innovations that closely align with stakeholder needs and facilitate implementation and uptake. TR is a highly interdisciplinary endeavour that requires expertise beyond the boundaries of traditional research. As such, TR cannot be conducted in isolation. For this reason, during their first year of study at the University of Toronto, TRP students participate in highly collaborative and practical seminars. Their learning is rooted not in textbooks but in “doing”; by engaging with their peers and experts; through their own research and real-world experiences. This coursework grounds learners in necessary knowledge domains (e.g. intellectual property, funding, ethics, regulation, and policy), processes (The TTF), and research methods (e.g. qualitative and quantitative). In addition, TRP students are trained in specialised skills necessary to facilitate TR, including critical thinking, creativity, leadership, collaboration, relationship management and effective communication. The TRP culminates in a 2nd-year Capstone project, in which students work in teams to collaboratively apply their learnings to tackle a health problem of their choosing. Students earn their degree by demonstrating their mastery of the knowledge and competencies necessary for effective translation. At HEI, we have taken these concepts and applied them to the commercialisation of health innovation. HEI operates at the nexus of public, private, and academic sectors, bridging industries, knowledge, and TR expertise to give our clients a competitive edge. Using the TTF, proprietary algorithms and our extensive international network of key opinion leaders, our team verifies the unmet health need before validating the ability of an innovation to address it. This systematic and independent assessment of the innovation’s future potential based on current risk helps investors to make informed decisions and reduce risk. 123

Healthcare World Festival Trade Mission Delegates WorkSafe Design Ltd In response to the emerging COVID-19 pandemic and the urgent need for greatly improved Personal Protective Equipment (PPE) for medical staff, we recognised the need for innovative breathing solutions. As such, we are in the final stages of production for a re-usable, anti-pathogen, air-fed hood (AirHood), that fully covers the head and provides pathogen-free air to the wearer. This type of hood is known as a Personal Air Powered Respirator (PAPR) and is widely accepted as offering higher levels of protection than the standard face mask, also reducing bruising of the face (the AirHood is not a tight-fitting device), wearer fatigue due the inability to expel hot exhaled air, and the ability to operate under positive pressure, pushing contaminated air away from the breathing zone. Originally designed for the medical market especially aimed at surgeons, anaesthetists and ‘front line’ staff, the

AirHood has undergone many trials within a number of UK hospital trusts. As a result of these trials, the application range has been significantly expanded to all those working in a medical environment, especially for those who are unable to use a face fit mask. Additional potential users identified include dentists, paramedics, A&E personnel and others. The device itself operates at a much lower noise level than other hoods on the market, enabling the wearer to make phone calls without removing the hood whilst allowing full 360-degree visibility, enabling normal conversations to be held between users, colleagues and patients thereby ensuring a safe working and relaxed environment. Contact Information www.worksafedesign.com E: enquiries@worksafedesign.com

Discover Medics

At Discover Medics, we are passionate about discovering the world’s highest skilled medical practitioners – doctors, nurses and other healthcare professionals – from across the world. As a group of highly skilled, international, specialist recruiters, we are fully dedicated to engaging with employers to project manage a seamless hiring process, including relocation packages. Our local expertise and network are invaluable in ensuring a smooth transition for both 124

clients and candidates. Our clients are private and public sector hospitals, clinics, community services, medical centres, nursing homes, dental clinics/surgeries, laboratories, pharma companies and research institutes. Much of what makes us unique comes from our core values, built on many years of experience. To truly live our values, we have applied them to everything we do: Honesty - With clients, candidates and

colleagues alike, we believe in openness and sincerity in everything we do. Knowledgeable - We deliver relevant, tailored and real world end-to-end solutions for all your recruitment needs. Quality Standards - Our candidates and clients can have absolute trust in our worldclass systems. Innovation - We research and test new ideas that provide practical recruitment solutions in the UK & UAE – delivering real savings and efficiencies to clients. Passionate - Our desires are the same as yours. Finding the best global medics to work in the world’s best facilities. Care - Winning the hearts and minds of our clients and candidates is our key goal. Contact Information www.discovermedics.com T: (+44) 01915018577 E: himal@discovermedics.com

FESTIVAL TRADE DELEGATES

Healthcare World Festival Trade Mission Delegates Pneumatech Medical Gas Solutions Pneumatech MGS manufactures medical gas pipeline products, supplying these products through companies around the world for the last 45 years. Recently, Pneumatech Medical Gas Solutions completed a product supply at ISPAT General Hospital for medical gas pipeline products in Rourkella, India. The project was a 400 bed complex. Through our local dealer of 20 years the project was manufactured, delivered and

commissioned over a 12 month period. With the current crisis in India, medical air and medical oxygen are critical to support life. This will make our 90th hospital we have completed in India over the 20 year period. Compressed air treatment systems play a critical role in protecting your equipment, products, and people. When you reach out to our competence team at Pneumatech, we work with you to understand your specific air treatment needs and recommend a solution that works best for you.Engineered to be adapted to the specific requirements of your industrial application, our world-class solutions are built to be reliable, long-lasting, and high performance, and are backed by responsive service that spans the globe. Our compressed air treatment range helps you to protect your upstream equipment, ensures your compressed air system to run more efficiently, avoids humidity and the build-up of rust, supporting you in your

quest for the best quality end product. Our gas generators for nitrogen and oxygen teamed up with a compressor provide you with industrial gas on-site without the cumbersome handling of bottles - cost efficient and easy. At the purity level required by you. If you are looking for a complete compressed air solution that provides maximum energy savings, we’re the answer. We are familiar with the full production process for compressed air and nitrogen generation so we can offer you a complete installation together with renowned compressor suppliers. Contact Information www.p-mgs.com /en T: (+44) 1246 474242 E: martin.berry@p-mgs.com

Active Tagging Limited (XTAG Medical) At XTAG, we design and manufacture electronics that are used to protect vulnerable patients in the medical environment. At present, our primary product is infant protection (baby tagging) and we are the market leaders in the UK/ NHS. Looking towards the future, we aim to engage with businesses that have contacts with nurse call or security ties to other countries so we can expand our product overseas. Based near Leeds in the UK, we have been trading since 2002, and have successfully developed an impressive portfolio of over 50 NHS Trusts. Our mission is to provide a reliable and efficient infant protection system using the latest technology, and we continually invest in research and development to ensure we offer the best possible product to our customers. Aftercare is paramount to us, and we give full training to midwifery staff, and offer

telephone support 24 hours a day, 7 days a week, so there is always technical support available if you need help. In addition to this, our administration team check our Baby Tagging Systems remotely on a daily basis to ensure everything is running smoothly. We also offer a number of service packages, and our engineers will do a thorough maintenance check of the System periodically depending on the level of cover,

and provide a full report for your records. “Good Hope Maternity installed XTAG in early 2011. The system has proven to be easy to use and very quick to administer. The individual ward monitors provide at a glance on screen all the babies located on the ward and local audible alarms alert the ward team to loose tags or tags tampered with. The tags are very easy to attach, and the system has been welcomed by parents and their families. “The remote access helpline has proven to be an asset and any concerns have been dealt with at a timely manner, even at weekends and throughout the night.” -Matron & Supervisor of Midwives, Heart of England Foundation Trust. Contact Information www.xtag.co.uk T: (+44) 07775512970 E: chris@xtag.co.uk

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Healthcare World Festival Trade Mission Delegates KRTS International solutions for managing the risks posed by the human impact of workplace crises and trauma. KRTS International’s solutions help any organisation, large or small, to strategically prepare for and respond to workplace trauma. With a history of working with the National Health Service, private and public sectors across the UK and globally, our services include: Many organisations feel out of their depth when it comes to managing psychological trauma. It is a highly specialised area but this doesn’t mean that people should feel confused about what to do or why they should take an action. Our guiding principle is to demystify, simplify and appropriately educate, developing a collaborative partnership with our customers and assisting them in crucial policy making decisions. This is why at KRTS International we offer a range of preventative and responsive

• KRTS Power to Respond®: a groundbreaking crisis mental health app that allows organisations to immediately respond to crises and emergency situations (including man-made and natural disasters) www.powertorespond. com • CPD certified, digital and blended training courses on the management of organisational trauma such as violence, acts of terror, accidents and sudden death. • KRTS Power to Recover®: a blended eHealth trauma support programme.

The programme has been successfully delivered in the NHS and the private sector www.powertorecover.com/ blended-e-health-trauma-programme/ Whether you are responsible for planning the response or supporting employees after a crisis or traumatic event in the workplace, we have the expertise to help. The Directors have over 45 years’ handson experience as well as being international authors, speakers and consultants. If you want genuine credibility and effective solutions, then KRTS International is the company to speak to. We are looking to collaborate with healthcare providers, the public and private sector. Contact Information www.krtsinternational.com T: (+44) 03339 398 650 E: liz.royle@krtsinternational.com

Innovestech Building for the future in today’s rapidly evolving environment means taking bold chances and making insightful decisions. At Innovestech, we provide help to organisations who are looking to transform their business. We strive to map out the needs of your business, and provide you with the necessary tools to achieve a successful future. We are a Market Insight, Coaching, and Strategy Consulting Firm ready to deliver tailored solutions that help you take your business to the next level. If you’re looking to develop your business but unsure where to start, or need help planning or executing your next project then let us guide you. We are here to help with vision, focus, and resources to support you in achieving your goals. With our one-to one Business Coaching service, we help you to understand your 126

vision and goals, tailored to you and your business, and set and develop key goals. With an operationally experienced business coach, a coaching package with us provides direct access, two sessions per month, all delivered over the course of six months.

Contact Information www.innovestech.com T: (+44) 07483819105 E: emma@innovestech.com

FESTIVAL TRADE DELEGATES

Healthcare World Festival Trade Mission Delegates Anetic Aid There isn’t a hospital in the UK that hasn’t acquired an Anetic Aid product at one stage or another. As the UK market leaders in innovative design and manufacture of medical equipment to an exceptionally high standard, we source world-class materials and components, take pride in our workmanship, all while offering second-to none customer service support and expert service and maintenance. Established in 1977, Anetic Aid has been supplying its highly regarded products to hospitals both in the UK and overseas export. Over the years, Anetic Aid has grown from strength to strength, expanding the company and offering a wide range of flagship products including QA3 Patient Trolleys, QA3 Emergency Trolleys, QA4

Mobile Surgery Trolleys, AT4 Tourniquets, Stainless Steel Furniture as well as a range of operating theatre patient positioning devices, mattresses, support pads and general accessories. We have also developed partnerships with like-minded product innovators and manufacturers, Trulife, Hillrom Amatech, Reison and Opitek. Our products are developed, designed and manufactured in our renowned factory in Havant, Hampshire and are supported by our sales, customer service and AnetiCare service centre in Baildon, West Yorkshire. In addition, all our premium products carry a 10-year lifetime warranty so you can rest assured that they will be looked after with the greatest care by our team of dedicated engineers who collectively cover the whole of the UK.

Contact Information www.aneticaid.com T: (+44) 01943878647 E: siobhan.thomas@aneticaid.com

Horizon Strategic Partners

At Horizon Strategic Partners, we provide advanced and intuitive mobile application solutions to the healthcare sector. Our flagship product, Induction Guidance (formerly known as Micro Guide) has been implemented into more than 150 healthcare environments in 18 countries. These range from the United States to Iceland to New Zealand. Induction Guidance consists of three components; our Content Management System, Mobile App and desktop Web Viewer. The CMS is used to created all

content, which is then consumed via the app on a mobile device or the web viewer on a desktop. It enables medical organisations to create, manage, edit and publish localised clinical guidance to their clinicians’ mobile devices, so that they always have the latest guidance at the point of care. With guidance downloaded directly to each device, there is no need to worry about internet connectivity in the hospital or organisation. Users will always have access to the content they need locally,

including search functionality. With instant full search capability across entire guide sets, on average guidance is accessed on the app every 8 seconds. Functionality includes medical calculators and algorithms available in the app. Users can view and inspect calculations in real time. All content updates are automatic. Once a new version of a guide has been published it is automatically downloaded in the background to every device that has previously subscribed to it, with the user receiving a push notification message. Used in around 75 per cent of all UK NHS Acute Trusts, and in countries around the world, more than 100,000 clinicians use Induction Guidance on a monthly basis, accessing their localised guidelines over one million times per month. Contact Information www.inductionhealthcare.com T: (+44) 0113 388 4895 E: mike@horizonsp.co.uk

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Healthcare World Festival Trade Mission Delegates Automedi: The Tesla of Manufacturing Automedi is the world’s first circular decentralised factory for healthcare equipment. It combines 3D printing, circular economics, renewable power and novel 3D models into a compact, all-in-one desktop system that’s as easy to use as a vending machine and operable anywhere in the world. Each Automedi subscription includes everything health establishments need to produce their own care products on-site. No need to deliver supplies or for specialist skills to manufacture diagnostic and scientific equipment. Automedi simply makes it from a living catalogue inside the devices, which is managed through our Quartic cloud platform. Topping-up supply chains, delivering equipment faster and reducing the carbon and plastic footprint at exactly the same time. Automedi’s versatile configuration groups devices together into fleets that act as one “digital twin” factory. Letting community pharmacies group together as care suppliers or individual hospitals to make equipment on-site reduces the

minutes plus 5 seconds for a layperson to fit the frames compared to classical equivalents costing between £35 and £85, with a 10-day delivery lead time. Automedi is more than an edge manufacturing platform. It is a leading circular plastics economy. Not only eradicating all delivery emissions, it also uses novel bioplastics made from cropwaste. Ensuring farmers get the most from their yield, without consuming more land to grow material sourced for plastics. All plastics consumed are recycled into new raw materials. Automedi is taking steps to export to international markets, introducing its technology into Asian markets, and is also seeking to work with partners and licensees to make supply shortages a thing of the past. delay and dependency of international manufacturing. Inappropriate or insufficient supplies are a major risk to health and social care staff and the patients they manage. Automedi’s moulded frames are created in 1 hour 13

Contact Information www.automedi.co.uk T: (+44) 07593 079 818 E: hello@automedi.co.uk

Spirit Health Group Spirit Health Group has been around since 2009 working with healthcare providers both in the UK and worldwide, developing innovative products and service solutions that improve the lives of patients, and provide the very best value for healthcare providers. With offices in the UK, Czech Republic and Australia, we focus on value-based care that enables digital technology to achieve better outcomes for patients, clinicians and health systems. We

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combine years of health and social care experience with technology expertise to deliver CliniTouch Vie, a CE marked proven solution which combines remote monitoring, patient education and patient self-management, to reduce exacerbations and keep people out of hospital. The platform uses cloud-based technology to enable patients to monitor and manage long-term conditions from the comfort of their own home, reducing unscheduled hospital admissions and offering more cost-effective patient care. Our published clinical evidence has demonstrated benefits for patients, healthcare professionals and health systems by: • Reducing hospital admissions • Enhancing case management capacity • Preventing acute exacerbations

• Improving efficiency and collaboration • Promoting patient self-management We pride ourselves on knowing how healthcare works, and with more than 150 years’ collective experience in health and social care across the team, we’ve developed our remote monitoring solution to match the needs of clinicians and their patients. We are passionate about the ability of our technology to solve more health challenges and welcome collaborations with healthcare providers, research organisations or the pharma sector. Contact Information www.spirit-health.co.uk T: (+44) 07880 195 958 E: su.konganda@spirit-digital.co.uk

FESTIVAL TRADE DELEGATES

Healthcare World Festival Trade Mission Delegates Accentus Language Services by Radical Thinking LTD Based in the UK, we are the experts in intercultural marketing communications for UK and European businesses exporting into Latin America, the USA and Canada. We specialise in all Latin American varieties of Spanish, Canadian French and Brazilian Portuguese. We are the go-to, full service communications partner for exporters who are penetrating or growing into multicultural markets in the Americas. Simply converting one language to another can be risky. A computer-generated translation won’t take cultural differences into account. Accentus focuses on bridging the regional differences, including dialects and origins. Whether you’re a small business or a global corporation, we can help you gain a competitive edge. Speak to your audience and potential customers across the world. Our translations help you to:

• Minimise communication errors • Deliver strong international presence • Bridge the cultural gap for your customers across the world We enable readers to understand the subject matter easily, without having to read the same sentence several times to get to the point. Our linguists have a high standard

of experience in their given business fields, whether it’s marketing, medical, technical or the legal sector. Our language service providers make sure that information is consistent, smooth, and focused. We adjust vocabulary to suit the audience, with regard to dialect and cultural differences. Through our innovative process and proprietary software we help our clients with everything from assessing and adapting product names and branding for cultural appropriateness to re-designing labels and localising content and media, including artwork, desktop publishing, app and software localisation, and audiovisual translation. Contact Information www.accentuslanguages.co.uk T: (+44) 07432 633541 E: gabriela@accentuslanguages.co.uk

Medilink UK

Formed in 1999, Medilink UK is the largest health technology business network in the United Kingdom, providing access to world renowned services including product innovation, market access, communications and internationalisation. Medilink UK brings together the NHS, academia and industry to stimulate innovation and support the growth of the sector. We provide specialist consultancy services that span strategic planning, project

management, access to finance, NHS market access, PR & marketing, regulatory affairs, events and conferencing, international strategy development, market specific consultancy, and global exhibition and mission services – all tailored to meet the needs of health technology and related life science businesses. We provide you with the essential knowledge and connectivity to innovate and internationalise. Our greatest asset is our regional

connectivity and national presence that comes from having nine offices located across the United Kingdom, allowing members to be supported at a local level whilst making a national impact. On an international platform, Medilink UK supports companies as they access overseas markets and sell their products and services around the world. Medilink’s international programmes, exhibitions and trade missions have supported hundreds of UK businesses and manufacturers to access global markets. With more than 50 years’ experience, our team can also deliver specific exporting projects, advice, support and consultancy to your business - tailored to your objectives. Get in touch with our team to find out more. Contact Information www.medilinkuk.com T: +44 (0) 114 232 9272 E: international@medilink.co.uk

129

OPINIONATED

We lost so much because of COVID, let’s not lose what we’ve gained

hat a year and half it’s been! When I returned from Arab Health in February 2020 I never could have imagined the way in which a disease, that at the time had four verified cases in the UAE and none in the UK, would have on the global population, the global economy and on the life and liberty of every human being on the planet. Truly we have lost so much - loved ones, social interactions, educational opportunities and a year of our lives. But we have gained some things and, while they might feel insignificant measured against the losses, the pandemic will see our lives change forever and for the better in some respects. Nowhere is this more in evidence than in the healthcare sector. Firstly and most obviously, the pandemic has changed the way in which we think about digital healthcare and the point at which our healthcare is delivered. I have argued for some time and in this column that the point of delivery in healthcare will and needs to shift from infrastructure, hospitals, clinics and surgeries, to the home. The crucial factors in the delivery of safe effective healthcare are technology and data rather than bricks 130

and mortar. The pandemic has accelerated that development massively, and we are now all far more familiar with the friendly face of our doctors on our mobile phone screens than across a desk.

Steve Gardner Managing Director Healthcare World

“Working together, taking ideas, new tech, drugs and innovation around the world is how to achieve the best healthcare outcomes for the world’s population”

Data and analytics in healthcare have also grown massively in importance over the course of the pandemic. Population health and data modelling have been used across the world to predict and project the rates of infection and spread of the disease. Perhaps more importantly, they have been

used to project and predict the efficacy and rollout of our vaccines to help us shortcut a development time of ten years into just a few short months, something that will hopefully help us to venture beyond our front doors, and indeed beyond our countries’ borders, over the next few months. As we emerge from the pandemic, the vaccine development has hopefully demonstrated that we’re ushering in a whole new era of global collaboration in healthcare. Multi-disciplinary teams working together across the globe in a race against time to develop a vaccine for a disease which threatened the whole population is an incredible example of what can be achieved. Let’s hope that the COVAX programme and the global rollout of vaccinations will be too. This pandemic should also have taught us that our healthcare is the healthcare of our brothers and sisters around the world. Until more than 70 per cent of the global population has been vaccinated, there will be no safety from COVID. While there are pockets of the world without vaccination, there will be breeding grounds for mutations and new strains of the virus that may not be containable with current vaccines. Ultimately though, we have proved that by coming together with a common goal, the global health and life sciences sector can achieve the previously impossible. Now we need to unite again to solve the problems of universal health coverage. We need to work out how to incentivise and train, renew and replace our exhausted global healthcare workforce and build our healthcare infrastructure, both physical and digital. We need to be ready for the next global healthcare crisis. COVID-19 will not be the last crisis or even the last pandemic. But of course, the current situation presents huge commercial opportunities to innovators, operators, investors, suppliers, consultants and technologists to help with the delivery of healthcare beyond their own borders. Working together, taking ideas, new tech, drugs and innovation around the world is how to achieve the best healthcare outcomes for the world’s population. Now is the time for healthcare to become the first truly global industry. We have lost much over the last 18 months, but it has shown us how much we have to gain.

TUESDAY 4 MAY - THURSDAY 20 MAY 2021

A huge thank you! To all who attended the Healthcare World Festival 2021

5,000+

50+

WATCHERS

SPEAKERS

COUNTRIES

SESSIONS

WEEKS

www.healthcareworldfestival.com Healthcare World is a brand name of The Trade Agency Ltd

GROW YOUR EXPORTS WITH MEDILINK’S SECTOR SPECIALISTS WHAT WE DO

MEDILINK’S INTERNATIONAL ADVISORS

The International Resource Service includes, but is not limited to:

Our team have the sector and overseas market knowledge necessary to accelerate an organisation’s export opportunities and growth. Supplementing industry experience and knowledge with overseas contacts and refined research techniques, the international team offer a unique service within the Life Sciences sector.

• Research and creation of a market entry strategy • Prospect and initiate new relationships internationally • Expedite ongoing negotiations to accelerate the process • Up-skilling of existing staff and support for evolving businesses • Interim resource to cover leave of absences, ensuring your export strategy stay on track • Staffing resource at events locally or internationally

Contact our International Team international@medilink.co.uk 0114 232 9292 @MedilinkINT Medilink International Services

OUR INTERNATIONAL EXHIBITION SCHEDULE Our team of specialist international exhibition and trade mission advisers can assist you throughout the booking, planning and delivery process, providing access to a range of discounted services through our partner organisations, and ensuring the best possible return on your investment. Medilink’s current exhibition schedule for 2021/22 • Rehacare: Düsseldorf, Germany - October 2021 • Medica: Düsseldorf, Germany - November 2021 • Arab Health: Dubai, UAE - January 2022 • Medical Fair Thailand: Bangkok, Thailand - February 2022 • Medical Japan: Osaka, Japan - February 2022 • KIMES: Seoul, South Korea - March 2022 • FIME: Miami, USA - July 2022 • Medical Fair Asia: Singapore - August 2022 • Rehacare: Düsseldorf, Germany - September 2022 • Medical Japan: Tokyo, Japan - October 2022 • Africa Health: Johannesburg, South Africa - October 2022