Reflections on Shaping the Future of Health in Africa

Maturin Tchoumi, Pharma International Area Head – Africa, Roche

More than 20 years after the Abuja Declaration of 2001, when African countries committed to allocate at least 15% of their national budgets to health, fewer than 5 nations have consistently been able to follow through on this promise. Now with global health financing threatened by the post-COVID-19 shocks and impending global recession, both of which are expected to significantly impact the ability of the continent to strengthen its health systems, what can be done to streamline financing and improve Africa’s health outcomes?

Maturin Tchoumi, Pharma International Area Head – Africa, Roche, shares his insights on the challenges and opportunities in Africa’s path to resilience.

1. What is the biggest hindrance to boosting health spending and spending better on health in Africa?

Achieving the targets set in the Abuja Declaration has proved difficult for many African nations. Until recently, the primary focus has been on spending more, when in reality, we should be creating an environment in which existing funding is being used more effectively.

The Improving Health System Efficiency Report by the World Health Organization (WHO) has highlighted that public resources are too often fragmented, poorly distributed and inefficiently used. The authors found that much of the money that is spent is going to the wrong places. For example, primary care receives less than 40% of public spending and people are having to pay out of pocket to access essential first-contact services.

To change this dynamic, not only to achieve the targets set in Abuja, but to ensure that there is a measurable impact on the health of African citizens, we need a change in the regulations, infrastructure, and broader health systems across the continent. In short, healthcare needs to be approached as an investment instead of a cost, so that all of society can be lifted.

One of the biggest learnings I have taken from my experience working in Nordic countries is that each of these countries has a 10-year healthcare strategy. This is a strategy that is co-designed and co-owned by the Ministries of Health, Economy, Finance and Education. This collaborative approach demonstrates the recognition that investing in health has a far-reaching impact on their economies. Together, these ministries implement the policies and build the incentives that drive innovation.

Fortunately, governments don’t have to be in this effort alone. Industry partners such as Roche are committed to fostering public-private partnerships to develop sustainable models to provide access to medicines and strengthen health systems across Africa holistically. Alongside other stakeholders, including academia and other knowledge-based institutions, patient organisations and non-governmental organisations, we can further support progress by evidence creation or advocating for increased accountability and equity in patient access.

At the end of the day, the measurement that we should all be working toward is not what comes after a dollar or percentage sign, it’s whether the health of our citizens has improved.

2. Africa has traditionally been a recipient of aid for health and development programmes, but lessons from the COVID-19 pandemic and concerns over a reduction in global health financing for poorer nations are resulting in a push for more self-reliance. What changes are required at regional and global levels to reduce Africa’s dependence on external funding for health?

The challenges of COVID-19 have shown us what can be achieved when we mobilise our resources locally, work together and build public-private partnerships that maximise expertise to achieve a common goal. They have also shown us the importance of building sustainable healthcare systems that can withstand shocks. For this reason and many others, it is vital that African countries begin to invest more in their healthcare systems and consider the allocation of their existing resources to ensure maximum efficiency, as we know that healthy individuals are more productive, earn more, save more, invest more, consume more, and work longer, all of which have a positive impact on GDP.

Beyond this, we also need to look at how Africa can create environments for health innovation that will benefit healthcare systems and patients, stimulate local economies, and generate high-paying jobs/economic output. New funding and financing streams for health, including public-private partnerships, can help bring together the resources needed for sustainable growth. Local development of technical skills and competencies is also critical for research and development, manufacturing, regulatory processes, and care delivery. Supporting local talent and entrepreneurs will also encourage local solutions to local challenges.

Globally, we must build on the lessons learned from the pandemic and facilitate continued collaboration to enable access and sustain political and financial commitments to healthcare. I am hopeful that the COVID-19 pandemic increased the receptivity of global, regional, and national leaders to pursue innovative solutions, increase sustainable investments in health and prepare for future health crises, and that it will prove to be a catalyst that pushes these important steps forward.

3. What impact would more strategic partnerships and a shift in mindset – from “charity” or “aid” for Africa to investment – have on health financing on the continent?

Strategic partnerships that involve public-private synergy are required to ensure that funding is effectively utilized and that better health outcomes are truly obtained from health financing. In doing this, we must shift from a mindset of spending on healthcare to investing in healthcare.

Change begins with constructive conversations and a common understanding of both challenges and opportunities. This belief grounds Roche’s approach to partnership, a process that begins by listening and seeking to understand the local experiences of our partners, and then together, designing, agreeing, and investing in solutions.

These public-private partnerships are critical to creating sustainable health systems that can live in perpetuity, as an ecosystem is strongest when stakeholders come together to share their complementary knowledge, assets, networks, and influence. We believe we can help the people of Africa live their longest and healthiest lives possible by bringing to the table everything we have learnt about the effective and efficient delivery of healthcare thanks to all our work with partners around the world.

This shift in mindset and approach has led us to develop a much closer, longer-lasting relationship with our partners. At the end of the day, a prerequisite for all relationships and partnerships is trust and transparency. It has also encouraged our partners to develop new capacities such that when our partnerships come to their natural end, many will be ready and willing to take full ownership of the solutions that we started together.

We believe this approach brings great benefits to all parties, including patients and healthcare systems, and it is integral to our strategy in Africa and all over the world.

4. With so many African countries at risk of mounting and unmanageable debt, are there ways in which they can be supported to increase the efficiency and effectiveness of their health systems, especially regarding health financing and innovation?

To address the health funding gap, we need the greater mobilisation of domestic resources and transformation of public financial systems, and we must shift the way capital markets and the private sector interact with social and development objectives. There is a clear opportunity for the private sector to serve as a thought partner in developing financing schemes, including prepaid schemes, risk pooling, performance-based pricing, and conditional contracts (e.g. International differential pricing).

That being said, no one state, organisation or sector alone can solve all the challenges that health systems face. At Roche, we want to be part of the solution and are committed to being a partner and contributing to innovative solutions that support strong, resilient health systems and address inequities in access to healthcare. That’s why we have outlined and acted upon a set of potential industry contributions that aim to increase the efficiency and effectiveness of health systems across Africa by offering innovative solutions to health financing, which include value-based pricing and procurement negotiations, patient assistance programs to reduce out-of-pocket spending as well as investment in building local supply chain capacity.

For example, for the 125,000 people diagnosed with cancer in Nigeria each year, Roche and the National Health Insurance Authority have established an oncology partnership to provide funding for medication, chemotherapy, and radiation therapy services for people with breast, cervical, and prostate cancers in six public health institutions. In Kenya, a partnership between Roche, the National Health Insurance Fund and the Ministry of Health enables all breast cancer patients who are insured by the NHIF to receive Roche’s breast cancer treatment, without co-payment. This is the first NHIF partnership Memorandum of Understanding for cancer, stretching the public coverage to non-communicable diseases, which is critical if we are going to reduce their burden.

In Côte d’Ivoire, Roche and the Ministry of Health have worked together since 2014 to improve access to cancer treatments, but in 2019, a new partnership began to ensure all Ivorian patients with cancer, hepatitis B, chronic renal anaemia and haemophilia have access to Roche medications for no cost.

Roche will continue to work as a partner to contribute to solutions so that more people can access the care they need without financial hardship.

5. Lastly, what key resolutions and actions are you looking forward to from AHAIC 2023 to improve financial pathways and boost resilience in Africa’s health systems?

We have seen the impact innovative diagnostics and treatments can have on people around the world, yet we know that there is a significant unmet need for patients across Africa. We have a responsibility to do something about it, and while the challenge may be greater than what we can address alone, we have a critical role to play in strengthening health systems so that innovative diagnostics, treatments, and cures can be accessed by everyone, no matter where they live.

The AHAIC meeting presented an important opportunity for us to come together with other key health experts in Africa to focus on:

• How the private sector can contribute to strengthening African health systems – we are open to meeting new partners and deepening our relationship with existing ones.
• What the future of innovation in Africa looks like – thanks to FutureProofing Healthcare we have a good idea of where we are now, but we want to build on our participation at the conference to drive a discussion on what the immediate next steps are and agree on actions together so we can begin to make this a reality.

Overall, we need to think holistically and create connected, smart systems that address the real health-related issues that the people of Africa and those on the frontline of healthcare delivery are facing. We need to build on our collective experiences to keep moving our healthcare systems forward, and we look forward to being a partner in that effort.