The Evolution of Healthcare in Africa | Omnia Health Insights
Key insights from healthcare leaders following on from Omnia Health Live Africa.
The Evolution of Healthcare – Africa
Key insights and data from healthcare leaders following the recent <strong>Omnia Health Live Africa</strong> virtual event
Introduction
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Introduction
Welcome to the report
Cynthia Makarutse, Senior Conference Producer
Despite initial fears that the COVID-19 pandemic would devastate Africa owing to few doctors and ventilators, with up to 250 million coronavirus cases projected by at least one model, the continent has demonstrated considerable resilience and resourcefulness in handling the first wave.
Africa Centres for Disease Control and Prevention (Africa CDC) is working with Member States in Africa to ensure an effective response. Speaking at Omnia Health Live Africa, the five-day virtual event brought by Informa Markets for the African healthcare community, Dr John Nkengasong, Director – Africa CDC, discussed progress.
"It took the continent 123 days from when the first case was reported to reach 500,000 cases. It then accelerated, taking 30 days to reach 1 million cases. Thereafter it took 58 days to reach 1.5 million cases."
Dr John Nkengasong, Director – Africa CDC
The pandemic peaked in July 2020, he said. Key public health measures helped to reduce the number of new cases.
Dr Nkengasong was joined by other leading speakers during the week, who attributed Africa’s success to date to factors such as effective coordination; telemedicine, fintech and big data providing support; and sheer pragmatism and goodwill, from sewing face masks to converting shipping containers into clinics.
Despite this, the pandemic has thrown up several important questions, from the disproportionate impact of the pandemic on women, to supply chain issues and regulatory challenges.
The following chapters highlight these and other prevalent insights on what is shaping healthcare in Africa today, offered by speakers during Omnia Health Live Africa.
COVID-19 numbers in Africa
(Africa CDC, 22 October 2020)
1.6 million COVID-19 cases in Africa, accounting for 4.1% of total global cases
1.3 million have recovered; 43,000 deaths (3.6% of global fatalities) with a case fatality of 2.4%
Between 14 September and 21 October, 4% weekly new cases in Africa. By region:
-
7% in North Africa
- 6% in Central Africa
- 5% in East Africa
- 5% decrease in West Africa
- 1% in Southern Africa
Over the last 4 weeks, Nigeria has shown a 5% average decrease in cases; Ethiopia, 2% increase; DRC, 0.3% increase; South Africa, 2% increase; Kenya, 4.2% increase.
17.5 million tests have been recorded to date across the continent.
Dr John Nkengasong, Director - Africa CDC
Healthcare technology and **innovation**
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Healthcare technology
and innovation
Prior to the pandemic, the telemedicine market in Africa and the Middle East had been projected to grow to over US$ 5 billion in 2025, with a CAGR of 10.8% over the next five years.
COVID-19 has since accelerated its adoption across Africa – yet questions remain over how best to regulate to ensure data protection and patient safety.
Data emerged frequently in conversation throughout Omnia Health Live Africa. The region's industry leaders view data as a major opportunity to understand healthcare better across different contexts, determine where the gaps lie, and build better solutions and systems.
Using data to identify weaknesses and build systems – for COVID-19 and beyond
According to Estelle Mbadiwe, Founding Partner – Ducit Blue Solutions based in Nigeria, data is key to understanding current strengths and weaknesses in the healthcare system in different African countries, especially as they progress through the pandemic and beyond.
Through understanding where the opportunities lie, healthcare officials will be able to make better-informed decisions beyond public health emergencies.
This includes developing new healthcare strategies, or even building a new health system altogether.
At present only the tip of the data "iceberg" is analysed, leaving much work to do.
Field epidemiologist Dr Abiodun Egwuenu, also based in Nigeria as AMR Programme Manager – Nigeria Centre for Disease Control, advocates a similar approach, believing it important to focus on the data that is needed to drive improvement and see where there are gaps in infection prevention and control (IPC).
However, data alone is not always enough. Dr Sanjana Bhardwaj, MD, Chief of Health and HIV – UNICEF Nigeria, revealed that while UNICEF has access to considerable health data, “everything under the sun”, including where facilities are located, performance and indicators, it’s not possible to change the trajectory of results for women, children and communities without other sectors playing a role.
To enable more efficient resourcing planning and prioritisation, UNICEF is currently working with Nigeria state governments and the state department for planning and research and statistics to develop a portal that has health data with schools and water points plotted in too.
Dr Bhardwaj adds that the GIP mapping and data collection systems from community level upwards, that were originally developed to fight polio, have quickly and easily been leveraged in Nigeria’s COVID-19 response.
Through the data sample, a better understanding has been developed around transportation systems and mechanisms – where the bottlenecks are for example – and preparedness by the facility, for example, checklists completed for oxygen and commodities.
Doctor from UNICEF mission obtaining information from local people
Efforts are ongoing to see how this platform can be made sustainable, not only for national outbreak response but beyond.
Charles Wachira, Software Developer – IBM Research, shares details of a similar system powered by AI. IBM Research is building a system to support intervention planning in Africa. Originally, machine intelligence was used to explore more effective malaria policy interventions.
The primary goal of the system is to generate insights: decision-makers then use AI to interrogate a high-dimensional model. It's powered by AI, he explained, because it's "hard to determine what to do" without it.
Professor Chetty, CEO – KwaZulu Natal Managed Care Coalition Ltd in South Africa, also sees an opportunity to improve healthcare through harnessing data. In his view, telehealth is a powerful opportunity to collect data for making changes in the healthcare system.
He believes that it may also be used to benefit patients: doctors may for example remotely collect data and implement the changes required to treat chronic illness.
A pivotal time for telehealth in Africa
Earlier in 2020, the Health Professions Council of South Africa (HPCSA) amended its guidelines for telemedicine to allow physicians or therapists to use phone or video calls to treat patients.
The new guidelines, permissible in circumstances when there is an already established practitioner-patient relationship, were made applicable during the pandemic only.
In Kenya, a proliferation of telehealth services has emerged during the pandemic – including digital health platform Vezeeta, who stood out in the market by offering an integrated telehealth service with in-person consultations as opposed to virtual alone (thus supporting the continuum of care).
Vezeeta also soft-launched in Nigeria during the pandemic, taking advantage of the country’s own thriving tech startup environment and the opportunity to achieve impact at scale.
Concerns, however, remain over patient safety and data protection, while the emergence of platforms such as Zoom and WhatsApp for teleconsultations raise questions around data privacy.
Akinoso Olujimi Coker, Chief Executive Officer – Lagoon Hospitals, comments that with the rise of cross-border teleconsultations, it is important to ensure that practising doctors have the right credentials to ensure patient safety, explaining that “one can easily foresee a scenario where an Egyptian doctor is looking after a Nigerian patient”.
According to Nana Frimpong, VP, Africa – Vezeeta, the answer lies in a telehealth policy framework that allows patients to safely access doctors across Africa – provided they are licensed and held to the same standards.
Indeed, a well-designed telehealth policy framework, he adds, could prove “revolutionary” for healthcare in sub-Saharan Africa, where there remains a shortage of doctors. It would see greater and faster adoption of telehealth solutions in Africa – so long as policies and legislation are in favour of expanding access.
Katlego Mothudi, Managing Director – Board of Healthcare Funders of Southern Africa, believes that electronic health records and the protection of personal information should also be addressed through laws that support telehealth.
Local innovations solving problems in Africa
Recognised as an early adopter and frontrunner of technology and innovative ICT solutions, Kenya is especially dominant in the fintech space – and this has aided the pandemic response.
Nana Frimpong, VP, Africa – Vezeeta points to the example of mobile money transfer service M-PESA as an example of this, which has grown to become the most successful mobile money application in the developing world.
Commenting on supply chain issues in the pandemic, Njide Ndili, Country Director – PharmAccess Foundation highlights how M-PESA has been “extremely instrumental” in enabling cashless transactions between vendors and suppliers of goods and services, while Kenyan mobile network operator Safaricom (the “home” of M-PESA) allowed transactions under 10 dollars to be free of charge. Mobile money has been successful across the continent.
Ndili adds that Africa’s innovation potential may even surpass Silicon Valley and Singapore in the coming years.
It’s a market of 1.2 billion people, and if successful in markets such as Nigeria, Ghana or South Africa it’s relatively easy to export this to other areas of the continent.
Another factor in Africa’s favour, she stresses, is that Africans are “extremely resilient”.
From the perspective of Laurie Fuller, Executive Coach, Strategic Advisor – Stanford Seed, it’s interesting to see Africa transfer technologies to the US. Medical product delivery startup Zipline for example initially matched blood with hospitals in Africa (Rwanda and Ghana) through the use of a high tech solution – delivery by drone. Zipline is now doing the same in the US. She adds that the use of low-tech when integrated with high-tech solutions is especially empowering in Africa
She offers as an example LifeBank, a company that matches blood with hospitals through using the low-tech approach of motorcycles or “blood riders” in combination with Google Maps.
From your perspective, which is the biggest barrier to telehealth adoption in sub-Saharan Africa?
- Infrastructure / connectivity
- Low smartphone ownership
- Shortage of health professionals
- Quality assurance
- Reimbursement
- Low availability of telehealth services
Patient **safety**
in the pandemic
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Patient safety
Quality control
One of the challenges in patient safety is that healthcare professionals aren't always open and willing to talk about a mistake, and more needs to be done to disclose and explain to the patient if something goes wrong.
Jacqui Stewart, Chief Executive Officer – The Council for Health Service Accreditation of Southern Africa (COHSASA), Cape Town, South Africa, comments:
"Within any healthcare setting, things can go wrong. But what we find is that if the standards are implemented correctly, and people do the right thing, most of the time, when something does go wrong, the system can deal with it. So, people are aware that there's a problem that has occurred, and they're honest and open about discussing it."
"It's about embedding quality in the everyday work of every healthcare professional and ensuring no shortcuts are taken. Right, from the receptionist to the CEO of the hospital, everybody has to take responsibility for doing the right thing,” she added.
Irene Ogongo, Founder and Lead Mentor – Nurses in Africa, based in Nairobi, Kenya, emphasises that when COVID-19 took centre stage, safety took over quality, sharing that, “One of the lessons I quickly learned was that quality is being viewed as something to do after everything else is said and done, which should not be the case.”
While Dr Edgar Kalimba, Deputy CEO – King Faisal Hospital in Kigali, Rwanda, highlights that healthcare workers in his hospital were becoming COVID-19 positive from the community as well as within the hospital and that required the need to change the approach. “Before we were testing only those who showed symptoms, but we quickly changed that to testing every elective admission patient. Based on this we were admitting patients who were asymptomatic or had mild symptoms and this helped in stopping the spread to the healthcare staff,” he said.
Dr Kalimba adds that his hospital also realised that there was a need to allocate teams differently. “We put the doctors and nurses into different groups and teams, and they stick to that group when they do their shifts. So, for instance, if a member of the staff becomes COVID-19 positive it will be only within that team instead of different groups.
"All these measures have helped reduce exposure to staff and helped to control spread within the hospital. One thing that we are looking to do is significantly step up our remote consultations.”
“I think for the future, accreditation has a big role to play. I always say it's not a sprint, it's a marathon because it's about ensuring quality.
"Your first accreditation is actually the first step, the challenge, however, is to stay accredited and maintain those standards,” concludes Stewart.
Creative responses to PPE shortages
The pandemic has exerted unprecedented pressure on healthcare systems worldwide. As described by Dr Adebola Olayinka, National Lassa Fever Research Coordinator – Nigeria Centre for Disease Control, Abuja, Nigeria, a lack of access to PPE has been having a major psychological effect impacting healthcare worker safety.
Elom Otchi, Technical Director, Africa Institute of Healthcare Quality – Safety & Accreditation (AfIHQSA) adds that due to this lack of access, instances of PPE shortages have been partly addressed through pragmatic measures such as the sewing of face masks.
Regina Njima, Co-Founder & Managing Partner – Kizo Ventures highlights how, when faced with over a 1-2 week wait for N95 masks to arrive from China because of supply chain disruption, surgical masks were used in their place.
Despite facing zero clients because of the pandemic, Ghana-based Rabito Clinic did what it could do help the healthcare community amidst rising PPE costs. According to Karen A.S Hendrickson, CEO – Rabito Clinic, there was significant price gouging, and the prices of PPE had quadrupled in some cases. And so the business ordered 10,000 PPE for government nurses and doctors, while 5,000 individual hand sanitisers were given for free to police officers.
There are also ongoing trials taking place to examine how to decontaminate or recycle crucial PPE, such as the N95 masks. Likewise, countries are also providing grants to produce PPEs in a self-sustaining manner.
Stating that “the willingness to embrace the digital economy will separate the winners from the losers,” Hubert Danso, CEO and Chairperson – Africa Investor, speaks of an online solution launched earlier in the year that to date has achieved more than US$ 80 million in sales through shifting 45 million pieces of PPE. This included some products going from Africa to non-African countries.
Healthcare **supply chain challenges** and opportunities
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Healthcare supply chain challenges
and opportunities
Public-Private Partnerships (PPP)
One of the major lessons of COVID-19 has been understanding that preparedness and readiness are crucial. During the pandemic, other countries have been able to step in and support as everybody faces the same battle.
Therefore, it is essential to ensure that the next time a need for crisis management comes around, countries are better prepared. This is where it is important to leverage on public-private partnerships (PPP).
"What I saw in the private sector was that the element of competitiveness was replaced by the need to come together and bond. They are demonstrating an appetite to the region that they can’t thrive on an economy that doesn’t exist. The healthcare industry should work along with the private sector to ensure the possibility of another pandemic ends."
Mories Atoki, Chief Executive Officer – African Business Coalition for Health (ABC Health)
The need for collaboration during the pandemic has uncovered the power of partnership that will change the demographics and life expectancy, according to Dr Amit Thakker, Chairman – Africa Healthcare Federation. Only those countries that have institutional partnerships were able to save more of their citizens through initiatives such as e-learning, supply chain navigation and telemedicine:
“We stand proud as a continent in front of the globe since we started early. We must learn and share with each in order to build a robust healthcare sector. Africans can learn from Africa, and this is the time for us to invest into a trusted partnership between the public and private sector.”
Coordination and harmonisation
Hubert Danso, CEO and Chairperson – Africa Investor, highlights the lack of internal coordination regarding regulatory challenges and export restrictions among agencies during the pandemic as a supply chain issue. In some cases, this has been taking place within regions within a country and leads to confusion, added costs and delays.
He also draws attention to the lack of coordination between countries as another key issue, where some countries are following different approaches – some more stringent than others – creating substantial supply chain problems globally.
According to Rob Botha, Chief of Party: Global Health Supply Chain Technical Assistance (GH-SCTA) – Guidehouse, for any new medical device manufacturer or supplier emerging during the pandemic, understanding the regulatory environment in South Africa has “not been easy”.
He calls for harmonised standards and specifications across Africa, to begin to shape the market that will support local manufacturers. This will help ensure compliance in different African countries.
Ashraf Ismail, Marketing Director at mask-manufacturing Handel Street Automotive in South Africa, identifies not having medical device standards harmonised with global standards as a problem locally.
He also calls for harmonised standards, in line with the EU and US, and working with manufacturers to achieve compliance.
He believes this approach will help South Africa and the general economy of African countries, as well as foster innovation and collaboration.
Danso suggests that harmonising standards across the African Continental Free Trade Area (AfCFTA) will be a crucial first step in facilitating local production and trade across the healthcare industry.
This means deepening pan-African networks on both commercial and policy levels.
However, Danso adds, the AfCFTA is already prioritising regional harmonisation for 2021, as announced in September, and here it is the private sector that is behind the curve.
African **women** in the pandemic
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African women in healthcare
Inequalities in access to healthcare under COVID-19
One of the specific challenges in the past six months has been that women have been dying from a range of ailments during COVID-19, because they were afraid to access hospitals. This was reflected through statistics such as the South Africa cesarean rate dropping because of COVID-19 - because women were not going to hospitals, and neo-natal care dropped. The region also saw a rise in teenage pregnancies, because of school closures, posing another challenge.
Furthermore, as Dr Iman Eweis, a radiologist specialising in breast imaging at a woman and foetal imaging clinic in Cairo, explains, during the height of the pandemic breast cancer radiology services were held back in Egypt:
“We experienced fewer working hours and limited personnel at the clinic. We could only deal with one case at a time. Also, patients didn’t want to leave the house due to the fear of contracting the virus. This reflected in some of the patients' results when they came in later for their routine screening. In some cases, this delayed intervention for a palpable abnormality, and we found many patients with a later stage of the disease at presentation, so COVID-19 has had a significant impact on our practice and patient outcomes.”
She observes that many women at a younger age are prone to breast cancer and that Egypt has a lower age threshold compared to other countries in the world: “Breast cancer is a public health problem in Egypt.”
Another challenge comes in the form of ethical issues raised by COVID-19. Arguments range around personal liberty and right of movement - and some measures that limit access to healthcare.
"In Nigeria, for instance, some people who were really unwell were not able to see their doctors because they couldn’t go out during lockdown. The law enforcement agencies were also brutal in their approach in some instances which raised serious ethical issues."
Prof Felix Nzube Chukwuneke, Chair, UNESCO Bioethics Unit; Chair – College of Medicine Research Ethics Committee (COMREC), Chair – Eastern Nigeria Research Ethics Forum,
Another similar example can be seen when women have been unable to continue the vaccination of their children. While governments were concentrating on COVID-19, leaders were not thinking of the routine immunisation of children that needed to be done and it was completely stopped.
Therefore, most women have needed to create space for themselves, as the pandemic "pushed them further into the background" because of perceptions that the crisis required strengths (associated by men with men). They have had to do their own situation analysis, and provide solutions to gaps, comments Dr Mary Eyram Ashinyo, Deputy Director – Quality Assurance - Ghana Health Service HQ.
Njide Ndili, Country Director – PharmAccess Foundation suggests that while a large percentage of doctors are women, not all are decision-makers.
The issue of access and how to level the playing field needs to be addressed, and that's why innovation in Africa is critical.
Fear and anxiety driving women away from hospitals and houses
The majority of people accessing healthcare are women and children - something they are now fearful to do. Ndili's organisation, PharmAccess Foundation, has made a concerted effort to support the state government in putting out correct information to allay fears.
Prof Maswime, Head of Global Surgery – University of Cape Town, observes that pregnant women in South Africa are anxious during these times as a result of the pandemic,
adding that they require more support. Some are having to give birth alone for example.
Listen to Prof Maswime explain how the pandemic has affected Africa's pregnant women in the following Patient Talk podcast episode - click below:
Meanwhile, Dr Elizabeth Wala, Global Advisor, Health and Nutrition –Aga Khan Foundation, shines a spotlight on how far the challenges reach, revealing that many community workers, the majority of whom are women, fear entering houses due to a lack of PPE.
About the report
The Evolution of Healthcare – Africa report is a high-level look at the latest trends shaping healthcare in the continent, based on opinions voiced by leaders in the healthcare industry.
Prevalent insights were drawn by an expert Informa Markets team from commentary during Omnia Health Live Africa, a virtual event brought by the organisers of Africa Health, North Africa Health, Medic East Africa and Medic West Africa.
Over five days, 12-16 October 2020, Omnia Health Live Africa speakers delivered keynote presentations and panel discussions through 26 virtual sessions. The commentary from these sessions was analysed and distilled into key insights.
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