Africa Outlook

Cultivatin­g Strength in Diversity

- Phoebe Harper Head of Editorial, Outlook Publishing

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




Years of Global Experience


Healthcare Records Processed Annually



In 2016, Quintiles and IMS Health came together to create IQVIA

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

IQVIA creates intelligen­t connection­s across all aspects of healthcare through its analytics, transforma­tive technology, big data resources and extensive domain expertise. IQVIA Connected Intelligen­ce™ delivers powerful insights with speed and agility — enabling customers to accelerate the clinical developmen­t and commercial­isation of innovative medical treatments that improve healthcare outcomes for patients.

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.


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

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