Cultivating Strength in Diversity

Proudly introducing the 92nd edition of Africa Outlook, and the first in my tenure as Outlook Publishing’s new Head of Editorial.

This issue launches on a landmark day in the South African calendar, as the Rainbow Nation celebrates its rich diversity in the annual Heritage Day festivities. When Nelson Mandela gave his address at the event in 2002, he famously cited that Heritage Day was a poignant occasion in “building our nation and consolidating our national identity as one of unity within diversity.”

In the pages of this magazine, you will see this sentiment reflected in some of Africa’s most dynamic businesses, many of whom advocate a vision of unification through diversity. And nowhere more so than at Laeveld Agrochem, the “proudly South African” family-owned agricultural enterprise. For CEO Corné Liebenberg, the company is defined by the strength of its slogan, ‘Together we strive ahead’.

On the equatorial mountain slopes of Kenya, we see this embodied by our striking cover feature, Marginpar Group – the sustainable business making the world more colourful through the year-long supply of summer flowers. The variety and distinction of the flowers that Marginpar nurture is matched by the company culture fostered within, allowing staff, partner farmers, and flower breeders to truly flourish. As CEO Richard, aka ‘Kiki’ Fernandes tells us, “We grow our people; our people grow unique flowers.”

Continuing in Kenya, Dr. Anastasia Nyalita, CEO of the Kenya Healthcare Federation, shares her organisation’s unifying vision of strengthening private sector cohesion on behalf of the health of all Kenyans; “Our foundation was born from the need to have one voice within health to engage the government in dialogue, promote strategic public-private partnerships and champion access to quality healthcare for all,” she tells us.

Turning to the digital realm, IoT.nxt is providing the varied technological solutions to propel the continent forward collectively. “Technology has historically played a significant role in driving the upliftment of the continent’s people, by ensuring a means of enjoying economic participation,” states CEO and avid technologist Shane Cooper.

Elsewhere in the magazine, LafargeHolcim heads up our three construction features, with exclusive interviews from LafargeHolcim Guinea, Lafarge Zambia PLC, and Cimencam (Holcim Cameroon), all of whom are cementing Africa’s communities whilst respecting the varied cultures therein.

Finally, enjoy numerous insights profiling a diverse array of businesses, including Pernod Ricard Western Africa, MTN Benin, the Industrial Association of Mozambique, Busmark South Africa and many more.

Driving healthcare forward by creating intelligent connections with an expansive portfolio of capabilities, technologies, unparalleled data, and global healthcare expertise

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(NYSE:IQV), a leading global provider of advanced analytics, technology solutions, and clinical research services to the Life Sciences/ Healthcare industry.

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With approximately 70,000 employees, IQVIA conducts operations in over 100 countries. At IQVIA, we are inspired to advance health outcomes. Our dedicated public health practice has targeted offerings for African countries and LMICs. Globally, all leading private healthcare companies, government stakeholders, and donor agencies rely on insights provided by us for their business decisions across health system building blocks.

We believe that by unleashing the power of Human Data Science, we can reimagine ways to address the most complex global health challenges.

And we don’t do it alone. Working in partnership with life science companies, medical researchers, government agencies, payers, non-profit organizations, and other healthcare stakeholders, we deliver insights and solutions that make a meaningful difference in global public health. Through collaboration, we hope to overcome some of the biggest challenges facing global health. We are passionate about helping clients in pursuit of this goal, and continuously push ourselves to do more to advance public health efforts and improve health for all.

Africa Outlook (AO): What are some of the key Public Health related challenges you think Africa is currently facing or might face in the coming years? Meshack Ndolo, Account Manager (MN): Africa has the fastest-growing middle-class in the world. The number of middle-class Africans has tripled over the last 30 years. (AfDB defines the middle-class as persons with a per-capita expenditure of $2 to $20 a day, including a ‘floating class’ with daily consumption of $2-$4). This growth is expected to accelerate; by 2050, Africa’s GDP will double to USD 5.5 trillion while consumer spending will increase by more than three times to USD 4.75 trillion.1 Yet, as population expands and the consumption indicators move northward, we think the region shall face a critical health challenge of creating the foundations for long-term inclusive and sustainable growth. I think Africa might need to brace itself for a surge in non-communicable diseases (NCDs), in particular.

AO: Why do you think non-communicable diseases (NCDs) pose a big threat?

MN: Urbanisation is a key driver in Africa’s growth. Of the 2.4 billion people expected to inhabit the continent in 2050, 60 percent will live in urban areas.2 A growing middle class, coupled with urbanisation, is leading to amplified

lifestyle risk factors. This demographic transition within Africa is rapidly translating into rampant unhealthy diets, increased tobacco and alcohol intake (especially among the young economically productive), and extended periods of physical inactivity, thereby causing a spike in noncommunicable diseases. We must consider this shift in disease burden from communicable diseases (CDs) to NCDs. The yearly cost of treatment for NCDs far outweighs such costs for CDs. For instance, in Ivory Coast, the annual cost of treatment for typhoid fever with Clamoxyl is $1, while the annual cost of treatment for diabetes with Mixtard HMGE is $297 and for cancer with Taxotere is $1,764. Since access to health care in Africa is mainly financed by households through direct or indirect out-of-pocket payments, a typical middle-class patient in Africa suffering from diabetes can expect to spend more than 10 percent of their monthly income on a biologic treatment such as insulin. Therefore, access to NCDs treatments is increasingly becoming a challenge for urban middle class. By 2030, the deaths from NCDs in Africa are projected to exceed deaths caused due to communicable, maternal, perinatal, and nutritional diseases combined.³

AO: Could you help expand on the current landscape of drug availability and access?

MN: Unfortunately, we are witnessing a lack of both accessibility and affordability. There is a shortage of NCD drugs and those in the market are beyond reach of the majority because of the prohibitive prices. Africa has a highly fragmented, complex private sector supply chain that limits availability and accessibility to medicines leading to a vicious cycle of complications, high morbidity and mortality with devastating socio-economic consequences to households. It is worth noting that 50-60 percent of the ‘price to patient’ is due to the accumulation of costs and charges incurred in the endto-end supply chain from port of entry to dispensing of medicines to patients. We conducted a study across five therapeutic areas (antibiotics, anti-diabetics, anti-epileptics, anti-hypertensives and respiratory agents) and found that net manufacturer selling price was just ~25 percent of end user price in Kenya, while this was ~60 percent in India and Netherlands and ~50 percent in Russia and South Africa. So clearly, it’s crucial to fix the gaps in service delivery and streamline the supply chains to ensure better access and availability.

AO: What role has IQVIA played in such scenarios? How do you help your clients overcome these challenges? MN: We have a dedicated “Public Health

Practice” with offerings to strengthen health systems with resilience, targeted towards LMICs including African countries.

IQVIA has worked with governments, regulators, institutional donors, large international agencies, multilaterals and NGOs. We mobilise governments and

public health partners and facilitate setting the agenda for public discussions of healthcare topics — ranging from population health management, service delivery augmentation, digitisation of healthcare systems, supply chain assessments and improvement to Universal Health Coverage programme

design and implementation — with regular publications of original, independent reports. We support policy and decision makers with appropriately packaged and sensitive analytics in ways that shape public opinion and influence disease prevention, positive healthcare seeking behaviour towards better health and economic development indicators.

Discussing access to NCD drugs specifically, we recently undertook a project on Improving Cold Chain in Sub-Saharan Africa. We helped build an analytical framework to help our client identify the binding constraints in the supply chain in Sub-Saharan Africa.

Our team provided a recommendation for an industry-wide, collaborative, marketshaping approach outlining its goals, structure, implementation plan, and KPIs. This is how we have been assisting our clients building their way towards better access to NCD drugs.

AO: What are your thoughts on the quality of Africa’s current health systems?

MN: While we see many countries in

Africa have started to take steps towards universal health coverage for their respective populations, still much work lies ahead to truly build a sustainable health care strategy. The challenge of a frail and inadequate health care system in Africa has been exacerbated by the COVID-19 pandemic. Since the emergence of the pandemic, Africa depended heavily on other countries for supplies including testing kits, personal protective equipment (PPE) and more recently vaccine needs – 99 percent of the continent’s vaccines are imported.

This dependence on imports has made the population vulnerable to shortages of these commodities, thereby causing health security challenges to health workers, providers of health care and the citizens. The vaccine shortage indeed triggered a continent-wide crisis that evolved into discourse on the potential for Africa to accelerate local manufacturing of vaccines. Africa’s health systems have to-date largely focused on tackling communicable diseases and maternal, neonatal and child related illnesses, albeit with resource constraints. There is a lack of experience in managing NCDs and the accompanying shifts in healthcare priorities. The pandemic has drastically exposed the soft underbelly of the fragile healthcare delivery system across Africa including the poor healthcare financing

infrastructure. Inadequate human resources for health, inadequate budgetary allocations to healthcare, and poor leadership and management in healthcare have led to the underdeveloped healthcare systems in Africa.

Over the next decade, Africa will need over half a million additional hospital beds, better production facilities and distribution/retail systems for pharmaceuticals and medical supplies, and about 90,000 physicians, 500,000 nurses, and 300,000 community health workers.4 Those are big targets to meet.

AO: What kind of role has IQVIA played in the public health systems and service delivery space? MN: In service delivery, we bring a patient/beneficiary centric approach to all the public health projects we undertake and have a wide range of experience from healthcare surveys to technology to transformational insights. While we have worked on several projects in Africa, especially related to COVID management, I will highlight the Vaccine Manufacturing and Distribution Sector Diagnostic work we did very recently. We conducted an analysis of the vaccines market in North Africa and Frenchspeaking West Africa to aid an international development bank in better understanding the opportunity and feasibility of vaccines manufacturing in a country in North Africa. We recommend that for Africa to achieve vaccine security, it must promote regional vaccine manufacturing hubs on the continent through public-private partnerships with global manufacturers, following a backward integration strategy to develop capabilities.

Another key project is the Healthplug (EMR) Platform Implementation. We used our proprietary Healthplug suite to streamline the government managed healthcare coverage in Egypt. Our solution seamlessly integrates with the insurance system, enabling real-time eligibility checks for individuals at the point of care, minimising misuse and errors. Not only has our inhouse solution helped doctors with rapid documentation via machine learning driven smart consultation capabilities, but it has also enabled direct booking with specialists at hospitals which helped eliminate long queues at hospitals and minimised callcentre traffic.

AO: Any closing thoughts you’d like to share with us?

MN: Investment in Africa’s health systems is key to inclusive and sustainable growth. We need innovative solutions to break the current impasse in service delivery. In order to make any gains on global and regional sustainable development and health agenda – including the Sustainable Development Goals (SDGs), Universal Health Coverage (UHC), and Africa Agenda 2063 – a system approach to improving urban health and addressing urban justice in Africa should be prioritised.There is a need to create and sustain momentum for the design and implementation of renewed public health in Africa through advocacy targeted at different audiences and stakeholders. Essential objectives should be how to change mindsets of key stakeholders to see the need for change toward a more relevant and effective

public health framework and practice, to enable critical investment with high yields for improving the quality of life and economic development targeting: national health departments, regional bodies, global development partners, faith-based organisations, professional associations, academic and research institutions, and regulatory bodies. At IQVIA, our goal is to work with our clients to strengthen the health systems by working across health system building

blocks. I would like to close with a very impactful assignment we did for a premier international development agency. Our data and benchmarking services helped them to better understand the procurement and management of contraceptive, malaria and maternal child health commodities in East African countries such as Kenya.

Our objective was to minimise negative outcomes — particularly in vulnerable and underserved populations. After implementing the project, two-thirds of all family planning commodities were supplied free of charge.

Sources:

1. AfDB – Africa Progress in Figures

2. Africa Union Agenda 2063

3. The Rise and Rise of Chronic Diseases in Africa 4. Health Care in Africa: IFC Report Sees Demand for Investment