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NEWS ANALYSIS

Companies and communities ready to help African health systems

World Economic Forum identifies radical solutions for healthcare capacity in sub-Saharan Africa.

SUMMARY: According to a World Economic Forum workshop in Gabarone part of a Global Health Initiative that will report to the influential African Summit in Capetown in June - there is help for African health systems at both ends of the track. The corporate sector is offering help in the management of health systems and in quality control; and research in remote rural areas and slum communities has shown ordinary people also willing and able to assist.

(May 06)

The second health systems workshop of the World Economic Forum’s Global Health Initiative, meeting last month in Gabarone, Botswana, reached two striking conclusions: that the private sector was offering “enlightened” help with the provision of effective health care in Africa; and that several research projects had shown that remote and vulnerable communities, under the right conditions, were also ready and able to assist in the provision of their own health care.

Conclusions of this and an earlier meeting in Nairobi, Kenya, which advised that African health systems were troubled by mismanagement as much as by poor resources, are significant – as they will form the foundation of a White Paper from the GHI to the Forum’s influential Africa Summit of political and business leaders in Capetown in June.

Through this workshop, therefore, community-level research results may reach the highest levels of power in Africa.

So what are the main management problems in African health systems? In Gabarone, a senior representative of an African Ministry of Health was asked for her analysis. Immediately she raised the problem of juggling multiple donors with multiple and different reporting conditions and requirements. “It’s important sometime to say no,” she said. There is “a flood of new players” agreed another participant.

But then a representative of one major pharmaceutical company said “we can help”.

“We have to work with dozens of partners too” he said – “and we have an alliance management function to do it.” The company offered training in that service.

There could also be assistance on management of individual projects, he said. For example, Estonia had been struggling with a multimillion-dollar HIV/AIDS proposal to the Global Fund. Ministry staff had had no idea how to cope with such sums of money, or how to introduce effective monitoring and evaluation to satisfy the Fund’s requirements. The company advised, and solved their problems.

Corporates also showed themselves ready at the workshop to provide management advice on procurement, to prevent stock outs, control quality and reduce costs. Companies have “operational excellence” units to ensure just that. Again, advice was proffered.

Another strategically useful offer was made – training in how to draw on the most successful units in ministries, to communicate their methodologies to the least effective. This would compensate somewhat for the conflict between “vertical” disease programmes driven by donor funding and holistic, “horizontal” health system needs. “Management consultants could do that well” said one – “that’s their bread and butter”.

“What’s lacking? Just an effective national, regional and continental means to broker our offers with the public sector and create real trust” said one speaker. So proposals were made on how to achieve that brokerage, and thus create concrete assistance on two levels: for dealing with Ministries’ immediate management needs; and for providing long-term, strategic management training. However it must be certain that the skills provided will be tuned to real African needs, in the African context, with African examples, it was emphasized.

And what is the scale of the offer? Some 10s of major companies working in Africa are ready to create the structures and pioneer the process, said one participant, with “100s of companies are ready to do it long term.”

In similar vein, corporates are also showed themselves abundantly ready to aid in improving maintaining the quality of laboratory and hospital facilities. The quality of diagnostic laboratories and drug quality assurance could thus be improved.

Why are corporates ready to step up to this line? “Candidly, enlightened self-interest” said one. Companies strengthen their internal morale, and improve public image in other countries where they have much larger markets, by showing themselves willing to help countries and communities in need. Clearly such action also helps to stabilise their markets in the countries they help.

However, while these strategic, Africa-wide offers were placed on the table, it was however made abundantly clear that corporates no longer felt Ministries should think of them as sources of cash – their new role and offer would be primarily in the form of expertise, they said.

“The role of the private sector is evolving” said one “from the time 5-6 years ago when there were no huge donors funds like the Global Fund and PEPFAR, and we were initiating huge multi-million-dollar programmes around HIV/AIDS and other issues.” Thus at least some corporates think major funding is “no longer our role or appropriate”.

Funding should be addressed though the major donors and new mechanisms such as support for schemes like social health insurance, the meeting heard. African health systems were drastically under-funded, but better management would attract more funds, it was argued.

Private companies also showed themselves willing, in Gabarone, to assist in quality assurance and relevant training at many levels, from the performance of diagnostic and analytical laboratories to the monitoring of whole district hospitals.

One company providing diagnostic equipment reported that it already works strongly in training and quality assurance, training African trainers to train other lab workers in an exponential chain of training. The benefit is clearly mutual, as this not only improves African facilities – but increase demand for the company’s products. For success in any action, even in health, there must be interests on both sides.

Right at the other end of the track, research has shown that mothers, small private enterprises like shops and video shops have shown themselves to be ready and willing to play a strong role in providing both health products and information. In Gabarone, the African Medical and Research Foundation (AMREF) reported success with community drug distributors in Uganda, and received a case study on the work of the Special Programme on Research and Training in Tropical Diseases (TDR) on the home management of malaria [see this issue pp 10-11].

The meeting also heard that the African Programme for Onchocerciasis Control, impossible without the free drugs supplies from one of the corporates present, has created 216 000 community drug distributors in 19 African countries, but only through TDR research which trialled and developed direct involvement of the community in selecting distributors and agreeing and managing their exact mode of work [see this issue pp 6-9].

AMREF Director Michael Smalley reported that similar results had been achieved in urban informal settlements, though the task was much harder and took longer. Respect for the community and local ownership of a programme were among the key conditions for success.

Thus the World Economic Forum was alerted to the fact that the communities that are hardest to reach with good health care, from the remotest village to urban slums, can be mobilised to “draw down” their health care from the system, rather than acting as passive recipients. - RW

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