Africa can improve access to healthcare for all

Africa bears one-quarter of the global disease burden, yet has only 2% of the world’s doctors. To improve the delivery of healthcare, the continent needs to leverage digital technologies, improve knowledge, skills and resources, and create channels for collaboration and consensus among key stakeholders.

The UNICEF CAR Mother and Child Survival programme vaccinated 700 000 women against tetanus in 2008. (Image: Pierre Holtz for UNICEF)

Sulaiman Philip

To fight Boko Haram in the north-eastern Nigeria stronghold of Borno, the central Nigerian government stopped the flow of resources into the area. As fighting between government troops and the insurgents intensified, the population fled to camps around the state capital or into neighbouring countries.

Residents starved, malnutrition rates rose and with it resistance to common diseases. Measles spread; rains brought malaria and diarrhoea. Borno State is also the only place in Africa where polio is still circulating.

Nigeria has done an excellent job of eradicating polio so far. A vaccination programme begun seven years ago reduced cases of the disease by 95% in a year. Eradicating this last pocket of polio will take persistence, but it can be done.

“When that happens, Africa will celebrate one of the biggest victories ever in public health,” said Bill Gates. “While 95% might seem like success, as long as a single child remains infected, children across Africa and around the world are at risk.”

The Bill and Melinda Gates Foundation had a presence at the recent WEF Africa meeting in Durban, which ran from 3-5 May. Foundation representatives were there to highlight the work they are doing in Africa with Nigerian billionaire Aliko Dangote.

Infectious diseases such as malaria and HIV/Aids cause 69% of deaths in sub-Saharan Africa. This number can be lowered by a more widespread use of vaccines and treatments. However, as Dangote has pointed out, the shortage of infrastructure is the real challenge in Africa. “Africa bears one-quarter of the global disease burden, yet has only 2% of the world’s doctors. This is unacceptable, and we need to take steps to address inadequate healthcare infrastructure now.”

Over the years, Dangote and the Gates Foundation have refined the way they work in Africa. They have moved on from reacting to emergencies to formulating a long-term plan to improve healthcare access for all. In this they are in sync with the way the public health sector and other private sector partners are beginning to look at heath in Africa.

Researchers predict that non-communicable diseases such as diabetes, cancer and cardiovascular disease will overtake communicable and nutritional diseases by 2030. Right now communicable diseases such as malaria, pneumonia, Ebola, HIV/Aids and even leprosy have a negative effect on continental growth.

A 2016 study by Frost & Sullivan, a global research and consulting firm, found that healthcare in Africa was benefitting from the global shift towards value-based healthcare. Advances in e-health technology and point of care testing have been embraced by Africa as cost-effective ways to bring primary healthcare to the largest number of Africans.

Aditi Bhalla, Frost & Sullivan industry analyst for global transformational health, pointed out: “Despite the poor economic status of African countries, there is a collective drive to reduce and eliminate the incidence of life-threatening diseases.”

The way forward

Life expectancy in Africa is 15 years lower than the global average because the continent has to deal with the significant burden of epidemics without the infrastructure to fight them. The continent is, according to the Gates Foundation, a mix of new and persistent healthcare challenges.

Partnerships between the public and private sectors are the future of successful healthcare. The WEF Africa summit panel discussion on Combatting Diseases of Poverty highlighted the importance of partnerships to improve continental healthcare. The private sector, the panel concluded, had the resources to invest long term in people and science, while governments needed to invest in infrastructure.

Dangote and the Gates Foundation, along with companies such as Vodacom, Novartis and IBM, are focused on three areas to improve the delivery of healthcare in Africa: leveraging digital technologies; improving knowledge, skills and resources; and creating collaboration and consensus among key stakeholders.

Swiss pharmaceutical company Novartis is working with American technology group IBM and South African communications firm Vodacom through their Foundation for Chronic Disease Management (FCDM) to link public sector community health workers and private doctors. The programme uses mobile technology to bring cost-effective primary healthcare to patients in their homes.

Orange, the international telecommunications corporation, is collaborating with USAid to find innovative ways to access and share health information and services across Africa. These kinds of public-private partnerships are the future of affordable, innovative and effective healthcare in Africa.

A Novartis funded malaria researcher at the Novartis Institute for Tropical Diseases (NITD), a drug discovery research institute against infectious tropical diseases. (Image: Novartis AG)

In this vein, mobile phones are changing healthcare in Africa. In Uganda, for example, public sector health workers use a mobile-based system called mTRAC to track medicine stocks. This scheme helps patients find out, with the help of community health workers, which clinic is most likely to have the medication they need.

National health departments, in addition, are embracing the importance of data to improve the effectiveness of limited resources. A pilot programme in Nairobi and Mombasa will build on and improve mTRAC. Novartis is trialling mHealth, a supply chain app designed to ensure that the right medicines reach the patients who need them most, when they need them. Pharmacists register their patients and medicinal needs, and the app maps locations to allow medicines to be shipped to where they are needed.

Data allows community health workers to pinpoint communities running low on vaccine supplies, identify gaps in vaccination coverage, and to connect mothers with babies who need immunisations to clinics that have them in stock.

SMS For Life was an anti-malaria programme that evolved into Novartis’ mHealth app. (Image: Novartis AG)

Gates and Dangote funded the development of a vaccine carrier that can keep vaccines at a stable temperature for up to five days, even in tropical heat. This allows health workers to reach patients in even the most remote, inaccessible parts of the continent. For them, vaccines remain the best and most cost-effective tool to prevent epidemics.

In the long term, strengthening the continent’s health system relies on training the next generation of African scientists. The English medical research charity, Wellcome Trust, and the American National Institutes of Health fund the training of local scientists and Afrocentric research. The Human Health and Heredity in Africa (H3Africa) programme funds African scientists and institutions researching the genomic and environmental bases of health issues prevalent on the continent.

Novartis has helped to build H3-D, a drug discovery and development centre at the University of Cape Town. The aim of the facility is to train Ghanaian, Zimbabwean, Kenyan and South African scientists who are looking to develop treatments for diseases that are prevalent in Africa.

Consensus at the WEF Africa panel discussion on health was that strengthening the continent’s healthcare would take time and persistence. The future of healthcare would require people working together to build a system that served all of Africa’s people.

For Dangote, a better healthcare system is the first step in breaking the cycle of poverty and disease. “Everyone should have access to good health, no matter where they live. This is how we kick start a virtuous cycle of health, productivity, and prosperity.”

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