REPORT: Healthcare in Africa 2013-The Patients Perspective

Cape Town, South Africa, February 20-21, 2013

SECTION 1: THE EVENT

Introduction

Organised by the Economist, Healthcare in Africa gathered180+ influential healthcare stakeholders from government, providers, suppliers and patient groups to explore the key issues around healthcare systems in the continent.

The 2013 summit focused on identifying healthcare solutions designed to meet the needs of patients – rather than the needs of doctors, governments, companies or donors.

Patient-centric approaches are starting to become mainstream in developed healthcare markets, where they are coming to be seen as the best way to make good healthcare available to everyone at a manageable cost. The summit addressed whether the same is true in Africa or is taking the patient perspective an unaffordable luxury for most countries?

Ms Joy Rosario. Vice Chair of PiNSA and Board member of IPOPI attended from South Africa. This invitation was extended by IAPO (International Alliance of Patients’ Organisations) which paid registration, transport was paid by IPOPI.

The presenters included:

  • Richard Sullivan, Professor, King’s Health Partners Integrated Cancer Centre
  • Lord Nigel Crisp, Chairman, Global Health Workforce Alliance; Co-Founder, Zambian UK Health Workforce Alliance and former Chief Executive Officer, National Health Service UK
  • Regina Namata Kamoga, Country Manager Uganda, Community Health and Information Network
  • Khama Rogo, Head of Health in Africa Initiative, Lead Specialist, International Finance Corporation
  • Mark Britnell, Chairman Global Health Practice, KPMG International
  • Akin Osibogun, Chief Medical Director, Lagos University Teaching Hospital
  • Bisi Bright, First Vice Chairman and Chief Executive Officer, LiveWell Initiative (LWI)
  • JJ van Dongen, Chief Executive Officer and Vice President, Philips Africa
  • Elizabeth Matare, Chief Executive, South African Depression and Anxiety Group

SECTION 2: PROGRAMME AS PUBLISHED

The summit started with an introduction by the Chair, Anne McElvoy, Public Policy Editor, the Economist and Katharine Pulvermacher, Director Africa, the Economist.

Last year, discussions focused on public funding for health and the role of private healthcare providers and the challenges of preventing the rise of chronic diseases, while communicable diseases are still dominant. Our panel of ministers and experts will outline their successes and failures in these areas and discuss the main issues on their agenda now from healthcare financing to outcome-based healthcare.

  • Uzziel Ndagijimana, Permanent Secretary, Ministry of Health Rwanda
  • Khama Rogo, Head of Health in Africa Initiative and Lead Specialist, Investment Climate Department, The World Bank Group
  • Jeffrey Sturchio, Senior Partner, Rabin Martin

FLASH OF INSIGHT: PUTTING THE PATIENT AT THE CENTRE – WHY IT MATTERS IN GLOBAL HEALTHCARE

Durhane Wong-Rieger, Chairman, International Alliance of Patients’ Organizations (IAPO)

THE BIG DEBATE: IS PATIENT-CENTRIC HEALTHCARE RELEVANT TO AFRICA?

Patient-centric healthcare is gaining ground in Europe and the US, in part because austerity is pushing policy-makers to rethink expensive legacy systems and ensure that good healthcare available to everyone at a manageable cost.

Would putting the patient at the centre of healthcare in Africa help remove constraints to access, affordability and quality of healthcare or is it an unaffordable luxury for most countries?

What would patient-centric care mean concretely – would it be similar to community-based healthcare? Could it address the shortage of health workers?

How could patient groups, policy-makers, healthcare providers and aid organisations collaborate differently to put the patient at the centre of healthcare?

Moderated by: Katharine Pulvermacher, Director Africa, Economist Corporate Network

Regina Namata Kamoga, Country Manager Uganda, Community Health and Information Network (CHAIN)

Mark Britnell, Chairman Global Health Practice, KPMG International

Babatunde Osotimehin, Executive Director, United Nations Population Fund

Elizabeth Matare, Chief Executive, South African Depression and Anxiety Group

CASE STUDY: EMPOWERING COMMUNITIES – HELPING PATIENTS HELP THEMSELVES

Aggrey Willis Otieno, Founder, President and Chief Executive Officer, Pambazuko Mashinani

PRESENTATION: PATIENTS AND THE BIG PICTURE

Lord Nigel Crisp, Independent Member, House of Lords; Former Chief Executive, NHS; Permanent Secretary, UK Department of Health; Author of ‘Turning the World Upside Down’; KPMG Associate

TOWARDS SOLUTIONS – WHAT IS WORKING AND IMPLEMENTING LESSONS ELSEWHERE?

Throughout the afternoon, we identify concrete initiatives to tackle specific challenges and constraints, examine what was effective, and look at what can be learnt from others countries or communities

GLOBAL INSIGHT: CAN YOU GET WORLD-CLASS HEALTHCARE ON A SHOESTRING?

The best hospitals globally use clear processes and checks to improve safety and the quality of care, while keeping operating costs low. We look at how this has worked in a country with similar problems to Africa.

Bas Hoefman, Founder and Director, Text to Change (TTC)

PANEL DISCUSSION: ACCESS TO AFFORDABLE MEDICINES

The medical supply chain is weak in many African countries. Just getting a supply of medicines that people can afford is difficult, especially with few drugs produced on the continent and question marks over the future of imported generics from India. It’s also challenging to ensure hospitals are able to keep supplies in stock and people can get medicines even in remote areas. A panel of experts will discuss initiatives to improve the entire supply chain and develop a list of must-dos to overcome remaining problems.

Moderated by: Katharine Pulvermacher, Director Africa, Economist Corporate Network

Valter Adão, Managing Director Healthcare Africa, Deloitte

William Rodriguez, Chief Executive Officer and Co-Founder, Daktari Diagnostics

Linus Igwemezie, Executive Vice-President and Head Malaria Initiative, Novartis Pharma

PANEL DISCUSSION: THE FUTURE OF DONOR-FUNDED HEALTHCARE

Donors’ focus on single diseases – TB, malaria, polio and AIDS – has produced significant progress in recent years but also led to discrepancies with government policy aims and often unintended substitution of national spending. With international donor flows under pressure, how are donors and governments changing the way they work together?

What needs to be done now to ensure that donor funding continues to support African healthcare?

Charles Griffin, Economist and Senior Adviser Eastern and Central Asia, World Bank

Farid Fezoua, President and Chief Executive Officer, GE Healthcare Africa

Biju Mohandas, Head of Health and Education Sub-Saharan Africa, International Finance Corporation (IFC)

PANEL DISCUSSION: GETTING TOUGH ON NON-COMMUNICABLE DISEASES

How can Africa’s healthcare systems accelerate progress in the fight against chronic disease?

How can we increase health literacy and patient empowerment? What is the role of technology and the internet, and how should public-private partnerships be structured to best effect?

Moderated by: Katharine Pulvermacher, Director Africa, Economist Corporate Network

Peter Mehlape, General Manager East and Southern Africa, Becton Dickinson

Bisi Bright, First Vice Chairman and Chief Executive Officer, LiveWell Initiative (LWI)

Jose Fernandes, District Manager Southern Africa, Philips Healthcare

Enrico Liggeri, Country Manager Nigeria and East African Region, Pfizer

WHAT’S NEXT FOR HEALTHCARE IN AFRICA – WHAT WE’VE LEARNT

Anne McElvoy, Public Policy Editor, The Economist

SECTION 3: EVALUATION

Summary of some issues facing Africa (from Tunis to Cape Town – 900 million population) include the following;

  • infant mortality
  • maternal mortality
  • reproductive disease
  • doctors relocating overseas
  • distance
  • lack of finance
  • lack of equipment
  • cost of chronic diseases e.g. HIV/AIDS
  • lack of accountability
  • corruption e.g. donated ambulances used by medical officers for private use
  • poor supply chain management
  • lack of records
  • lack of maintenance e.g. instructions only in Chinese
  • disease patterns changing, chronic disease through lifestyle on the increase
  • lack of political will
  • donors dictating to government
  • Universal healthcare unaffordable
  • only some patients have access to specialised care in other countries
  • over use of painkillers and indiscriminate use of antibiotics
  • non-compliance of medication by patients (no monitoring mechanism)
  • policy but no implementation
  • stigma of non-communicable diseases (NCD)
  • using technology including cell phones for communication, information and training
  • using radio
  • patient education (expert patients)
  • focus on prevention
  • focus on healthy lifestyle
  • focus on personal responsibility (incentivise)
  • be innovative
  • leverage local resources
  • integrate systems for service delivery including across government departments
  • ensure political will and government leadership
  • scale up what is working (not endless pilots – pilotitis)
  • include communities in accountability and responsibility (community-based care)
  • recognise success
  • realisable regulation
  • ensure cross-border co-operation (intergovernmental)
  • share best practice
  • regulate to minimise corruption
  • lean principles reduce/eliminate waste
  • everyone is accountable patients/community/health service/government
  • spread the responsibility so the GP can focus on medical care
  • engage/empower/enable all constituencies (patients become partners)
  • identify social determinants of health and mitigate (Western diet)
  • ensure access to preventative medicine
  • ensure access to water and sanitation
  • educate around cleanliness (no cross-infection/cross contamination)
  • maximise on skill mix
  • doctors should be agents of change (not patriarchal)
  • keep it simple, effective, timely and cost effective
  • mobile diagnostic labs
  • readiness

Summary of some antidotes;

SECTION 4: BREAKFAST MEETING WITH IAPO, PHANGO, IMSA and OTHER PATIENT GROUPS

I was invited to join this meeting and this made the attendance even more worthwhile in terms of networking and further collaboration. Durhane Wong-Rieger if IAPO gave a short but effective presentation on an advocacy model, as did Shakira Ramlakhan from IMSA. See web links below.

SECTION 5: CONCLUDING REMARKS

A really important aspect of attending both events was meeting the other attendees and also the presenters. I have come away with new friends who share common issues and have also benefited greatly from advice on South Africa. I thank IAPO and IPOPI for allowing me the opportunity to attend.

 

Joy Rosario

PiNSA: Vice Chair

25 February 2013

Pretoria