At the recently concluded Africa Business: Health Forum in Addis Ababa, a group of private sector champions and their public sector counterparts gathered to chart a profitable course for turning the maxim – health is wealth – into a practical, realistic results. Nearly 350 delegates attended the forum, convened by GBCHealth, Aliko Dangote Foundation (ADF) and United Nations Economic Commission for Africa (ECA).
The Challenge and Opportunity
With projected growth in the working population expected to top 2.5 billion people by 2050 and over $1.3 trillion dollars in consumer spending by 2030, African countries have become inviting markets for investment, business and development partnerships. But this prosperity cannot be guaranteed if the health of its people is not put on a sustainable path. African companies and leaders have an opportunity to harness this wave to shape the development of better health programs and policies in support of healthier, more productive workers building vibrant economies. Creating a lasting impact requires collaboration among a range of stakeholders committed to developing the right tools to promote accountability and coordination, sharing risks and expertise and disseminating learning.
In his welcome address, Aigboje Aig-Imoukhuede, Co-Chair, GBCHealth, highlighted the challenges in Africa’s health sector while making a case for increased funding in the sector. “Healthcare in Africa is constrained by scarce public funding and limited donor support; out of pocket expenditure accounts for 36 percent of Africa’s total healthcare spend. Given our income levels, it is no surprise that healthcare spend in Africa is grossly inadequate to meet Africa’s needs leading to a financing gap of $66bn per annum.”
On her part, Executive Secretary, ECA, and co-convener of the forum, Vera Songwe said, “A healthy Africa is a productive Africa; a productive Africa is a prosperous Africa. Health spending remains largely inadequate to meet the growing healthcare needs. Public sector can’t fund all the healthcare needs of Africa. The private sector has been doing a lot, but more is needed.”
Halima Aliko Dangote, Trustee, Aliko Dangote Foundation, and co-convener, commented that governments from both developed and developing countries are increasingly looking at public-private partnerships (PPPs) as a way to expand access to higher quality health services by leveraging capital, managerial capacity, and know-how from the private sector.” She referenced a concept that her father, Aliko Dangote, has been championing for years in Nigeria, which would facilitate an influx of private sector financing into the heath space by every business committing to invest 1 percent of their profits in the health space.
Public Sector Perspectives
Several heads of state participated in the opening session, including H.E. Abiy Ahmed, Prime Minister of Ethiopia; H.E. Mokgweetsi Masisi, President of Botswana; H.E. Ismaïl Guelleh, President of Djibouti, as well as representatives of the Presidents of Egypt and Kenya in attendance.
Prime Minister of Ethiopia Abiy Ahmed said, “We need to make the health sector our priority …. and recognize that it requires a great deal of inter-dependence between governments and the private sector”.
President Mokgweetsi Masisi of Botswana suggested that potential areas of collaboration could be in hospital services, inpatient and outpatient care and preventative care such as immunization, along with other innovative collaboration in general surgery, training of health personnel, research partnerships and complementary financing of health insurance schemes.
President of Djibouti, Ismaïl Omar Guelleh, highlighted that “No country can achieve economic development without a physically, mentally and socially fit population.” He reinforced that mobilizing expertise, financial resources and innovations would go a long way towards improving Africa’s healthcare.
President Abdel Fattah El-Sisi of Egypt, represented by Health and Population Minister Hala Zayad, commented, “Governments should focus on spending and allocating resources efficiently. It can create a collaborative environment for parties to work together to achieve healthcare goals.”
Kenyan president Uhuru Kenyatta, represented by Sicily Kariuki, Health Cabinet Secretary, commented on Kenya’s successful partnerships with the private sector. “Such investment ($4.5 billion) has a significant impact on the macro and micro economic conditions of any country and PPPs have catalyzed the attainment of healthcare goals in Kenya.
The Great Debate
The plenary provided a robust debate on the feasibility and profitability of increased investments in the African health sector. Leading figures from public and private sectors explored the challenges and opportunities that businesses face in the healthcare sector and what governments can do to create a conducive environment for investors. Panelists included: H.E. Ilyas Moussa Dawaleh, Minister of Economy and Finance, Republic of Djibouti; H.E. Hala Zayed, Minister of Health and Population, Arab Republic of Egypt; H.E. Amir Aman, Minister of Health of the Federal Democratic Republic of Ethiopia; Ngozi Okonjo-Iweala, Chair, GAVI and former Nigerian finance minister; Ajoritsedere Awosika, member of the board, Access Bank; Abebe Selassie, Director, Africa Department, International Monetary Fund; and Gayle Smith, CEO, ONE Campaign.
Ngozi Okonjo-Iweala, noted that, “If we are going into public-private partnerships, the public sector must use the resources it already has to deliver better outcomes before we talk about raising more money.” She raised the issue of communication between health and finance ministers and the timing of disbursement.
Ajoritsedere Awosika, Board Director of Nigeria’s Access Bank, said the organization takes the concept of the public good very seriously and to this end, the bank gives 1 percent of its annual profit to projects in health and the environment. Of this, 40 percent is spent directly on health, with a focus on innovation in partnership. The Bank is doing is own research into the diversity of problems in Africa so it can look at ways to broaden its interventions.
Gayle Smith, CEO of ONE, said, “It is critical for health systems and policies to be built with prevention in mind. We talk a lot about the cost of healthcare and not enough about the cost of not doing things.” Africa is the only continent right now where governments and the private sector are standing together and asking what they can do better. Business can be a catalyst for change in terms of better public policy.
Situmbeko Musokotwane, former Finance Minister, Zambia, said it is important that governments regard health as a key economic sector and find ways to attract investment. Zambia has provided sectors such as agriculture with investment incentives for years, but health has not received the same benefits.
Other issues raised in the debate included:
- Investing in health is not the same as privatizing healthcare.
- Harnessing technology effectively will play a big role in preventative healthcare.
- Data sharing is critical to improving healthcare in Africa – for practitioners and patients.
- Creating better public facilities may help to attract African health professionals back to the continent.
- Efficient utilization of resources is key to increasing the quantum of finance.
- Having a longer-term budget cycle that moves away from the current annual budgeting system may help to attract investors by providing more certainty about spending and planning over a longer period.
- Public-private partnerships can bridge funding deficit.
- Although countries may learn from success stories, they can also learn from what has not worked, “leapfrogging” the mistakes others have made.
- Governments need to look at standardizing medicine registration requirements across borders to make production more attractive and distribution of locally produced drugs easier.
“Healthcare and Economic Growth in Africa”, a detailed report on the state of health vis-a-vis financing on the continent was launched during the forum, and provided the basis for much of the discussion during the day. The report, supported by an ECA-led Technical Working Group, clearly articulated the current realities in the African health space with the aim of guiding investments and shaping narratives around health in Africa.
Africa accounts for less than 2 percent of global health expenditure but 60 percent of the population and 36 percent of the global disease burden. It is only by multi-stakeholder collaboration that this picture can be changed.
The report noted that Africa has among the lowest densities of skilled health professionals in the world. Further, the total spending on healthcare in Africa is in a narrow range of 5% – 6% on average though in per capita terms, it has almost doubled as a result of PPPs. The fact that private healthcare spending remains high reflects ongoing inadequate expenditure by governments.
The report highlighted different ways of mobilizing domestic resources, including increasing tax revenue through new taxes and improved tax administration, reducing the debt burden by increasing borrowing, debt-to-health swaps, and reducing illicit financial outflows, among other measures.
Private sector investment in healthcare in Africa is a significant business opportunity. International consulting firm McKinsey & Company estimates the value of opportunities in healthcare by 2030 at $259 billion with the potential to create 16 million jobs. The report highlights a range of opportunities including: laboratories and diagnostics, service delivery and financing, skills development, research and capacity building, health insurance, and digital health innovations. In addition, more medicines could be manufactured in Africa through PPP engagement, taking advantage of improved access to Africa’s markets as the Continental Free Trade Area gains pace.
Download the full report here. The report will be a valuable tool for prospective investors and other stakeholders in aiding sound investment decisions around the health sector across Africa.
The Launch of ABCHealth
The launch of the African Business Coalition for Health (ABCHealth) was a highpoint of the Forum. ABCHealth is an African-led coalition mobilizing private sector champions through a coordinated platform, to advance health outcomes and shape health markets across Africa. The coalition is poised to lead the charge towards transforming health narratives across Africa, driving strategic investments in the health space while brokering viable partnerships and collaborations amongst private sector champions and philanthropists. The immediate task of the coalition is to ideate and execute tactics and strategies towards bridging the identified gaps in the African health space.
Aigboje Aig-Imoukhuede, co-founder of ABCHealth, and co-chair, GBCHealth said, “Only partnerships will help solve the health challenges the continent faces. Healthcare in Africa is constrained by scarce public funding and limited donor support; out-of-pocket expenditure accounts for 36 percent of Africa’s total healthcare spend. Given our income levels, it is no surprise that healthcare spend in Africa is grossly inadequate to meet Africa’s needs leading to a financing gap of $66bn per annum.” The private sector remains an underinvested stakeholder in the war to fix Africa’s health problems and this is why ABCHealth aims to bring the right parties to the table, and provide a focus for well-meaning individuals or companies who are committed to the health agenda.
ABCHealth’s launch was celebrated with the animated unveiling of the ABCHealth logo and a cake cutting, led by Ngozi Ikonjo-Iweala and celebrated by key government representatives, special guests and of course the co-founders – Aliko Dangote Foundation and GBCHealth. Participants commented that ABCHealth is ‘a necessary platform at the right time’. Click onto the following video to hear the drivers for the coalition from its visionaries and founders:
Deep Dives through Discussion Groups
During the afternoon’s parallel sessions, delegates shared and discussed ways in which healthcare is becoming an opportunity for business. Panels debated how to mobilize domestic funds for health and examined case studies involving innovation in health, and public-private partnerships.
Session One: Domestic Mobilization of Funds for Health
Dr. Senait Fisseha, Director of International Programs at the Susan Thompson Buffet Foundation, and session chair, framed the problem and discussion: very few of Africa’s governments have allocated 15 percent of their budget to health as per the 2001 Abuja Declaration. “If you look at our population, over 50 percent are youth. If we are going to realize our demographic dividend we need to invest in health and job creation.”
Martyn Davies, Managing Director, Emerging Markets & Africa, Deloitte, noted the average spend by African governments on healthcare is $29 per capita, compared to $218 in East Asia. Hippolyte Fofack, Chief Economist and Director for Research & International Co-operation, African Export-Import Bank, linked the importance of spreading healthcare to improved intra-African trade. Olumide Okunola, Senior Health Specialist, IFC, supported the idea that governments must step up their game and suggested tax is an effective way to raise domestic funds. Mamadou Biteye, Managing Director, Africa Regional Office, The Rockefeller Foundation, argued that multiple sources of funding are needed and could include pension funds and DFIs. “We all know there is a gap,” he says. “But gaps are opportunities and we need to build and invest.” John Nkengasong, Director of the Africa Centers for Disease Control and Prevention, agreed that the private sector is vital while reinforcing the role the state plays, too.
Key messages from the session included:
- There is need to increase funding for health across the continent. Deep, honest engagement amongst stakeholders is critical to achieving this critical task.
- Donor funds should be used as catalyst to mobilize other resources going into the sector.
- Cost optimization should be made a priority. It is not enough to source for funds, but ensuring more is achieved with less will help scale up investments in other sub-sectors of the health sector.
Session Two: Successful Public Private Partnerships
The session on Public-Private Partnerships highlighted both the benefits and challenges of these arrangements. The first case study, presented by Carl Maas, CSR Manager of Marathon Oil and H.E. Mitoha Ondo’o, Vice Minister of Health and Social Welfare in Equatorial Guinea, looked at the development and implementation of the Bioko Island Malaria Elimination Project. A partnership between the government of Equatorial Guinea and three private sector partners has, during its 15-year existence, reduced the prevalence of malaria by 75 percent. The government is now working with international experts to develop a malaria vaccine locally, the first African country to do so; it has now reached the clinical trial stage.
The second case study focused on Ethiopia’s experience of implementing PPPs. Dr. Daniel Gebre Michael, former Director General of Medical Services and Advisor to the Minister of Health in Ethiopia, said there was no doubt this collaboration had improved health outcomes and delivery. “For PPPs to succeed, we need political will and consensus as to the needs of the sector and the benefits of engaging the private sector.” A clear legal framework with guidelines for each role is also needed.
Key messages included:
- Coalitions are better for efficient and effective delivery on set objectives as evident in the Equatorial Guinea case study where the private sector joined forces with government to reduce mosquito bites incidents from 1000 to 3 annually.
- Aligning and managing expectations between the government and private sectors will aid seamless collaboration.
- Investing time, money and energy in human capital, research and development could help scale up impacts on specific projects.
Session three: Transforming Health Landscape – Health Research and Innovation
The session focused on case studies of innovation that have delivered healthcare services to the base of the pyramid. Micro-savings, data collection and data sharing have led to many uninsured populations getting access to healthcare at affordable rates and have enabled healthcare providers to build medical history records.
The chair of the Health Research and Innovation session, Dr. Matshisidiso Moeti, emphasized the need for increased locally inspired ideas in the quest for better innovation. “There is an urgent need for home grown innovations, solutions and working through the PPPs network will help with research work to enable innovation. Examples of this were shared by:
- Adama Kane, Founder and CEO of JokkoSante (Digital Community Pharmacy) in Senegal, who created a simple solution for communities to acquire medicine via micro-savings on a mobile phone application.
- Samuel Agutu, Founder & CEO of Changamka Microhealth Ltd in Kenya, who is using the M-Pesa mobile phone platform to enable micro savings that would enable women to have greater access to maternal healthcare.
- Vena Arielle Ahouansou, Founder & CEO, KEA Medicals, Benin, who invented a universal medical identity that uses fingerprints, social security and QR Codes to store medical profiles and make them available to health professionals.
Key messages included:
- The power of an individual – individuals can make a difference as each can inspire an initiative that could spark a revolution in the health sector. However, collaborations will be key to optimizing funding and achieving sustainable development across the board.
- Technology as an important tool and a unifying platform – stakeholders should leverage technology for better penetration and overall impact.
At the end
Co-founder of ABCHealth, Aig-Imoukhuede, closed the forum with an impassioned call to action. “Africans must play their role in this fight to ensure that health outcomes are as equitable in this part of the world as they are elsewhere. Africans have no choice, there is no alternative, and we must ensure that we fix health in Africa.” He asked public and private sector leaders to make their commitments known and to join ABCHealth in making history for the good of Africa.
UNECA’s Vera Songwe said, “This coalition is important for Africa. But we need the support of our partners. If African governments do not invest in health, and the private sector won’t, the donors will lose interest too. As Africans, we must take control and give direction to health.”
Outgoing executive director of UNAIDS, Michel Sidibe, added, “Achieving our health goals is not a matter of political will, it is a matter of political choice. We want to hear ‘I will do the right thing and put my money here, in health.”
Forum moderator, Ibrahima Cheikh Diong summarized some of the key messages from the Forum here:
As various stakeholders begin to consolidate on the discourses at the forum, it is expected that greater collaborations and viable investments in the African health space can truly help to transform the health narratives on the continent. Watch highlights of the event here: