One of the most significant events to be held on the sidelines of the October UN General Assembly in New York was a meeting of some of the most progressive private sector as well as public sector actors to work on charting out a new direction for healthcare on the continent. New African’s Editor Anver Versi was there.
“We have a saying here: Africa’s problems are Africa’s opportunities. That’s what the stubborn optimists like myself believe. And today, there’s no greater opportunity than improving health care throughout the continent.” This was part of Aliko Dangote’s statement read out for him by his daughter, Halima, on the sidelines of the UN General Assembly in New York last month. She was addressing an audience packed with some of Africa’s most progressive personalities at a specially convened High Level Dialogue on Africa’s Health and Finance.
The meeting of key stakeholders was organised by the global coalition GBCHealth, the Aliko Dangote Foundation and the UN Economic Commission for Africa. The aim was to chart a new, more effective direction for public-private participation in health care delivery in Africa and to prepare the ground for the launch of an excitingly fresh initiative, the African Business Coalition for Health (ABCHealth), in Addis Ababa during the African Business: Health Forum in February. GBCHealth and the Aliko Dangote Foundation are the founders of the new health coalition. It will work to attract the private sector to increase its participation in the ultimate goal of improving healthcare across the continent.
Out of pocket
Faure Gnassingbé, the President of Togo said: “We passed on the responsibility of certain facilities, namely clinics, pharmacies and hospices, to specific private entities who manage them. We’re proud to say that public facilities are as efficient as private facilities, so we have gone on to create another category of facilities that are semi-private, semi-public. We hope that, with this initiative, we’ll be able to reach another level of efficiency.”
Given the rise of African populations, estimated to reach 2.5bn in 2050, the cost of maintaining health systems will overwhelm governments, said Vera Songwe, the Executive Secretary of UNECA. “We need PPPs in health in Africa,” she added. “While the state should provide the basics, the private sector should take some of the burden off the state.” Africa is one of the largest consumers of drugs in the world but it is also one of the largest importers of drugs, said Songwe.
While there was strong political will to improve healthcare on the continent, implementation had not always matched commitment – while spending on the sector had increased in some countries, it had declined in many more. “Out-of-pocket expenditure on health is greater in Africa than it is in rich contries,” she pointed out. Amina Mohamed, the Deputy Secretary General of the UN, said that “much of education and much of health is not in a bad place – it’s in crisis. People are faced with choice-less choices, for instance, having to choose health or water. We need solid institutions to be able to deliver services.” Mohamed added that education and health cannot depend on ODA. “Healthcare systems don’t run on fresh air – they need finance every day of the month.” GBCHealth had laid out the pathways through their work in many countries, she added. “We have to find the initiatives to make this work in Africa.”
Netumbo Nandi-Ndaitwah, Deputy Prime Minister and Minister of International Relations and Cooperation in the Republic of Namibia, said that countries can’t industrialise without a healthy society. “We must stop looking at healthcare as a charitable cause, but as a profitable business that should be encouraged,” he added.
Olusegun Obasanjo, the former President of Nigeria, told the meeting that health was everything, “including wealth”. Health PPPs should be a national priority, he stressed. “If you are born in the West, life expectancy is higher by 15 years than if you are born in Africa.” But leaving aside the health deficits in Africa, healthier populations enable healthier economies, said Dangote in his statement. “Everyone, from students to employees to entrepreneurs, would be more productive, more creative and more enterprising.”
According to the World Health Organisation (WHO), spending an extra $30 per person in Africa would generate $100bn in economic gains five years later. In addition, the increased spending would save 3.1m lives, of which 90% would be among mothers and children and prevent between 3.8m and 5.1m children from stunting. A UNECA report – Healthcare and Economic Growth – specially commissioned for the launch in Addis Ababa next year, had found that in Africa, governments typically control healthcare delivery and they are just not doing enough.
On average, countries devote only 6% of their GDP to health while in the OECD countries, spending is much higher. In Africa, PPPs are not as effective as they should be. Only 10 of the continent’s 54 countries account for half the current partnerships. “Given Africa’s systemic deficiencies, healthcare solutions require a holistic approach that also addresses poor infrastructure, malnutrition and the lack of clean water,” said Dangote.
It is quite clear that governments alone, given their narrow revenue sources, cannot sustain enhanced healthcare delivery. To make it sustainable, they need the full participation of the private sector; but again, no single company can hope to fill the breech. Hence the broad-based African Business Coalition.
The driving force behind this initiative is Nigerian Aigboje AigImoukhuede. For many years, I had known Aig as perhaps the most dynamic and charismatic banker in Africa. I lost contact when, as a result of the Central Bank of Nigeria’s new directives, bank CEOs could not serve more than 10 years in their posts. Then, in 2012, he invited me to New York to attend the GBCHealth conference and awards. I discovered that he had been selected to head GBCHealth as co-chair with Coca-Cola’s Chairman and CEO Muhtar Kent. He was the first African to be given this post.
He told me then that he had been so impressed by the effectiveness of the GBCHealth initiative that he was working on creating an African equivalent. He said he was convinced that “by fixing healthcare, you fix Africa”. The Global Business Coalition on Health (GBCHealth) was created in 2001 by a group of 17 companies under the leadership of US Ambassador Richard C. Holbrooke. It began as the Global Business Council on HIV/AIDS and later became the Global Business Coalition on HIV/Aids, Tuberculosis and Malaria before settling on GBCHealth as its scope widened.
Among its other activities, the organisation worked in collaboration with companies to end workplace HIV stigma and discrimination, in an initiative signed by more than 100 CEOs and covering 5m employees. It has also introduced health protection for over a million employees against malaria and TB and brokered several PPPs between companies and governments.
In 2013, Aig-Imoukhuede, Dangote, Jim Ovia (founder of Zenith Bank), Dr Mohamed Pate (former Minister of Health, Nigeria) and Bill Gates formed the Private Sector Health Alliance of Nigeria, which has successfully mobilised private sector alliances and capabilities to save millions of lives through innovations and impact investments. It seemed only a matter of time before this would be scaled up to the continental level.
The ABCHealth initiative will work with companies to encourage large and small businesses to share best practices and foster healthier workplaces and communities. At the same time it will work to promote complementary policies with governments across the continent. “If we’re able to galvanise a new era of cooperation and improve the overall well-being of this young, fast-growing continent, we’ll create economic growth for all Africans,” said Aig-Imoukhuede in New York. Looking back to my meeting with him in 2012, AigImoukhuede has been true to his word – he has delivered. He has set out to f x Africa’s health – together with Aliko Dangote on whose desk is a framed saying: Nothing is impossible. NA