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How does African healthcare get back to normal and what does the new normal look like?

September 22, 2021
by Healthcare World

Learning the lessons of the pandemic is vital for future growth

Our 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.

“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.

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 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.

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 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 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.

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