The past three years have had a massive global impact, in which the healthcare industry has become the center of all focus. The ability of healthcare to adequately find solutions to address the COVID-19 pandemic and other possible future pandemic outbreaks found the systems wanting, regardless of where in the world the pandemic was. The unfolding impact of an uncontainable and possibly fatal virus which needs mass hospitalizations such as COVID-19 has been predicted in the past.
Former U.S. President Barack Obama warned his country in 2014 about the potential for a coming pandemic and pushed for billions in emergency funding. Fortunately, this pandemic did not have apocalyptic results. This was not a unique event in itself. Almost 100 years prior, in 1918, the world was hit by the Spanish influenza.
Both the COVID-19 and 1918 influenza pandemics caused significant negative impacts on the global economy, affecting international relations and causing a considerable delay in their diagnosis, treatment, and vaccines. The pandemics largely differed in their highest risk population and the mechanism of death, but the long-term conversations have now moved to healthcare. At some point, Africa became the focal point when the COVID-19 pandemic gathered momentum, with speculation that the pandemic would hit the continent the hardest.
The first case on the continent was confirmed in Egypt on Feb. 14, 2020. There were fears that the new virus would quickly overwhelm the largely fragile health systems on the continent. So, right from the start, most African governments took drastic measures to try to slow the spread of the virus.
Many African countries have since waged an effective campaign to combat the spread of the coronavirus, despite the continent’s reputation for having failed and incompetent state health systems. The continent, which has a population of more than one billion, has had about 12.1 million cases of COVID-19, according to data compiled by The Johns Hopkins University.
These figures are far lower than those in Europe, Asia, or the Americas, with reported cases declining. Africa has recorded about 254,000 deaths, compared with roughly 3.28 million in the Americas, 1.84 million in Europe, and 1.43 million in Asia.
The case-fatality ratio for COVID-19 in Africa is lower than the global CFR, suggesting that the outcomes have been less severe among African populations, according to a recent continental study by the Partnership for Evidence-based Response to COVID-19, which brings together several private and public organizations.
As the discussion on the fragile healthcare system in Africa continues, there is also innovation coming forth from the continent. The growing population and the fact that Africans have been living steadily longer lives over the past 20 years have been the drivers. The average life At birth expectancy at birth in Sub-Saharan Africa is only around 61 years – by far the lowest globally and over ten years lower than the world average of 72.6. Over the past two decades, longevity increased due mainly to reductions in childhood mortality, increased access to medical treatment for AIDS/HIV, and improved nutrition. As the population on the continent gets older and larger in size, the continent’s healthcare system is a focus that needs more investment.
The World Health Organization in 2007 proposed a framework that describes healthcare systems in terms of six core components or “building blocks”: i) service delivery; ii) healthcare workforce; iii) healthcare information systems; iv) medicines and technologies; v) financing; and, vi) leadership/governance. Most African countries have been unable to meet the basic requirements for good healthcare systems. Poor governance and human resource challenges are linked to the ineffective integration of services in resource-limited nations.
Challenges in basic access to medicine were highlighted during the COVID-19 vaccination distribution.
Most African countries are not able to produce the vaccines needed to protect their populations against only COVID-19. Africa is home to only four local drug substance vaccine manufacturers — two more are in development — and two “fill-and-finish” facilities that rely on imported vaccine substances to produce distributable doses. Supply-chain disruptions during the COVID-19 pandemic showed just how risky this dependence on imports of critical medical supplies can be. In most of sub-Saharan Africa, pharmaceutical imports comprise as much as 70 to 90 percent of drugs consumed. This dependence on imports leaves citizens vulnerable to medication shortages— a problem that triggered a continent-wide crisis during the pandemic.
The crisis that affected Africa during the pandemic was found in other areas outside the actual COVID-19 virus itself. Healthcare was impacted by Africa’s low capacity to control its medical supplies and its reliance on buying externally. In Rwanda, small pharmacies and large medical stores ran out of stock of critical drugs. In South Africa, it has become nearly impossible to fill prescriptions for psychiatric medications and oral contraceptives. In Kenya, oncologists complained about challenges in treating their cancer patients. And in Nigeria, stocks of antihypertensives and many other treatments to manage chronic illnesses, including HIV medicines, dipped critically low.
In 2015, 1.6 million Africans died from malaria, tuberculosis, or HIV/AIDS — all preventable or treatable diseases — because of chronic drug shortages. More local manufacturing of medications and active pharmaceutical ingredients could strengthen health systems throughout Africa.
An ever-growing number of healthcare practitioners, regional organizations, and industry analysts are advocating for building up pharma manufacturing hubs within Africa. Some officials are considering promoting more local production from private pharma companies that produce generic medications and companies that manufacture active pharmaceutical ingredients or APIs (Active Pharmaceutical Ingredients, which are the primary components in the manufacture of drugs).
This localization of drug manufacturing would help health systems in Africa lessen their vulnerability to supply chain disruptions. The scarcity of pharmaceuticals in Africa has been a problem for decades. According to the WHO, roughly half of Africa’s 1.1 billion people lack regular access to even the most essential medicines.
This lack of access to medicine each year contributes to millions of deaths in Africa, and, “The burden falls mainly on the poor, women, and especially children,” the British Medical Journal has noted. Fortunately, initiatives are being created to help meet the challenges. In 2012, the AU Development Agency published the Pharmaceutical Manufacturing Plan for Africa (PMPA), which proposes technical solutions to many of the pharmaceutical manufacturing industry’s challenges. By enabling the creation of economies of scale, the implementation of the African Continental Free Trade Area should also support progress in realizing the PMPA.
The glaring fact is that healthcare in Africa is strikingly underfunded compared to the global average. Sub-Saharan African governments spend, on average, one-quarter of the global average government health expenditures in terms of relative budget share. While some of the difference in spending is offset by private and public development assistance funds, current health expenditures per capita are less than 10 percent of the world average. According to the World Health Organization, Africa shoulders 24 percent of the world’s disease burden, but only three percent of the world’s health workers work with less than one percent of world health expenditures.
To face these challenges, many have found creative and innovative ways to improve different aspects of healthcare in Africa. Governments are using data and technology to enhance healthcare despite the financial constraints and focus on optimally delivering specific services. The private sector has stepped in to provide results where they are needed most. The following companies and projects showcase Africa’s exceptional ability to solve problems by inventing and adopting new systems and technologies.
LifeBank – Nigeria
Patients often need a blood transfusion to stay alive, but not all hospitals have enough blood for all their patients. Temie Giwa-Tubosun founded LifeBank as a “technology and logistics startup.”
The company uses technology to identify available blood, communicate the whereabouts and availability of the blood to the company’s clients, and then pick up and deliver the available blood based on the client’s request. Lifebank works with motorcycle riders who store the blood in cooling devices while awaiting notifications on where to transport the blood.
The company’s app also helps users sign up as blood donors, further optimizing the blood supply chain. LifeBank was quick to mobilize during the coronavirus pandemic by diverting its resources to create a national register of hospitals with working and broken ventilators, respirators, and ICU beds to prepare the country for the treatment of the future COVID-19 patients.
Zipline – Rwanda
This California-based company partnered up with the Rwandan government to kick start the use of drones in the health sector. Rwanda’s hilly terrain and lack of extensive road networks make it hard to transport goods and provide services to areas far from the capital city, Kigali. Patients in such remote locations are vulnerable to succumbing to many treatable illnesses because they can’t get a blood transfusion or medical supplies on time. Zipline solves this problem by using drones instead of traditional trucks to transport vital health products across the country. Since 2016, Zipline has transported blood and medical supplies to some of the most remote parts of Rwanda, sometimes cutting delivery time from over three hours to fifteen minutes.
In 2019, Zipline expanded to Ghana, delivering much-needed vaccines, blood, and other health products on demand. It continues to scale its operations and has plans to expand further within and outside of Africa.
Praekelt.org – South Africa
In 2019, one-third of the population in South Africa, or around 22 million people, used smartphones — and this number continues to rise. Increased smartphone penetration has made it easier for the government to communicate efficiently with its citizens and relay critical public health information.
South Africa has had the largest number of coronavirus cases in Sub-Saharan Africa to date, but the government reacted quickly and efficiently using the means at its disposal. A strict lockdown proved effective in slowing the spread of the virus. With the rise in smartphone use, the South African government has saved lives by delivering urgent information concerning the coronavirus to its citizens.
The South African government partnered with Praekelt.org, a local non-profit, to develop a Whatsapp bot that would reply to South Africans’ questions on the pandemic. The service answered questions on various topics related to the pandemic, including symptoms, available treatments, and debunking myths. After 2.6 million South Africans successfully used the platform to receive accurate and potentially life-saving information about the virus, the World Health Organization (WHO) adopted the technology.
Hello Doctor — presently available in 10 African countries, including Kenya.
Hello Doctor provides free essential healthcare information updated daily. The app provides access to healthcare advice, answers to health-related questions in live group chat forums, confidential one-on-one text conversations with a doctor (also in local languages), and the ability to receive a call back from a doctor within 60 minutes.
SIsu Global Health is a company that designs and commercializes medical devices with and for emerging markets. The company launched its first patented product in Africa: Hemafuse is a highly effective, mechanical alternative to donor blood. With a simple push and pull of a handle, Hemafuse can salvage and recycle blood from internal bleeding in trauma. Based at Nairobi Garage, Sisuu Global has raised VC funding from investors like Revolutions’ Rise of the Rest (Steve Case) and non-dilutive grants from groups such as USAID.
The company is proving the commercial model for medical devices in emerging markets and changing the statistic that 80 percent of the world’s medical devices are designed for 10% of the world’s population.
TakeStep — Egypt
TakeStep is an Egyptian health tech startup that uses mobile phones to help people struggling with addiction. It’s a full-stack platform designed to address addiction’s complexity. They help people quickly and discreetly access professional counseling, but they also stay engaged throughout the recovery process to prevent relapses. Their platform works by “connecting all stakeholders… in the addiction recovery process,” including patients, guardians, treatment facilities, and supervisors. In addition to exhibiting at Web Summit this year, TakeStep has already moved into the U.S. market. The startup moved its headquarters to Albuquerque, New Mexico, in 2017 to help fight the state’s addiction crisis.
Flare is a digital response platform that allows patients or hospitals to see available ambulance options and request help quickly. The platform’s “Rescue” system allows subscribers to call one hotline during a medical emergency, from which they are instantly connected to an extensive network of quality providers. The medical team is active 24 hours a day, seven days a week, ensuring help within 15 minutes. Based in Nairobi, Kenya, the company is scaling up its presence in Nairobi and other major cities in Kenya. Using Flare, people can easily track and communicate with the dispatched team until the ambulance arrives. Ambulance drivers are equipped with smartphones and Google Maps, with the exact location of pickup and directions that account for traffic. Like Uber, a percentage will be taken off each ride booked on Flare. Globally other platforms offering a similar service include Amber Health, an app for calling emergency services in Delhi, and a Dubai-based emergency services app, MUrgency, which is now in seven cities in Asia and the US. Red Cross Kenya also launched its app for emergency response.
Ilara Health brings accurate and affordable diagnostics to rural Africans through a miniature, AI-powered diagnostic devices integrated via a proprietary technology platform and distributed directly to primary care doctors. Statistics show that 70 percent of medical decisions require diagnostics, like blood tests. But there are more than 500 million people in Africa who struggle to access or afford a simple blood test. But thanks to advances in robotics and AI, there are companies creating new diagnostics that are smaller, lower cost, and can work directly in the doctor’s office, providing results in minutes! Ilara Health partners with robotics and AI companies to integrate their devices into their technology platform.
The company then distributes the equipment to peri-urban and rural doctors, where 70 percent of patients live. The company also offers financing, which is very important for the doctor as they cannot afford to buy the equipment up front.
The company then charges the doctors an affordable subscription or pay per test. They then continue to help the doctor grow their revenue by providing new diagnostics and services. The young company seeks to offer affordable diagnostics to millions of rural Africans while digitising the African clinic and plugging in the innovations that make sense!
Baobab Circle is an African-grown health technology company creating health solutions for Africa. With its best-in-class health service called Afya Pap, Baobab has helped reduce diabetes and hypertension by equipping patients in the following areas; patient education, diet, physical exercise, health monitoring, mental wellness, and medication. Afya Pap has both smartphone and feature phone versions, meaning it works with 100 percent of phones, and all people with diabetes can use the app.
Matibabu Malaria is one of the deadliest diseases in the world and the biggest health problem in sub-Saharan Africa. In fact, until recently, Malaria was ranked among the top ten causes of death in Africa by WHO. However, Code8 – a team of four young Uganda techies – created Matibabu, a smartphone app that helps diagnose Malaria without a blood sample. Using a custom-made piece of hardware (matiscope), which consists of a red LED and a light sensor, it can pierce beyond the skin to reach the Red Blood Cells. A finger is inserted into the device to diagnose, and the results are viewed via a smartphone. This provides users with their malaria status in the shortest possible time.
mPedigree is a phone-based anti-counterfeit ICT software application that allows pharmaceutical retailers and users to verify the authenticity of a drug. This is done for free by text-messaging a unique code found on the product to a universal number.
The system helps to tackle the problem of counterfeit medicine by partnering with different pharmaceuticals to create a short code on the package of products. These codes are typed in a simple text message, and a message is sent to verify the product’s authenticity.
mPedigree is not only helping poor people who are vulnerable to purchasing fake drugs; it is also helping to restore confidence in the healthcare system.
With innovations around AI and robotics gaining more momentum now than ever, we can’t wait to see how the Health Care sector in Africa will be transformed by these companies and others in the healthcare space.
As we continue to see a world rushing towards Tech solutions and innovative answers to its problems, the opportunities in Africa make it a ripe ground for the right investment growth in the basic needs sectors.
Tsitsi Mutendi is a co-founder of African Family Firms, an organization that aims to facilitate the continuity of African family businesses across generations. She is also the lead consultant at Nhaka Legacy Planning and the host of the Enterprising Families Podcast.