Lunch with our Leader: Is low cost, high quality healthcare in Africa possible?
Last week Sven Byl, Head of Healthcare for Africa and South Africa at KPMG, hosted a Lunch with our Leaders session to talk about how to drive low cost, high quality healthcare in Africa, because as countries grow wealthier models of healthcare provision and financing need to adapt to increasing expectations and new demands for African healthcare. We invited you to pose your questions on the topic to Sven and an enlightening discussion developed. Here are some highlights from that lunch hour.
The value of electronic medical records (EMRs)
Q. Many healthcare facilities in Africa still use a manual system to maintain records of patients. This is costing the facilities in terms of space. How can we persuade stakeholders to resort to other systems like digitalizing records with the associated initial cost?
A. The role of IT is an important one and without it we can’t achieve low cost and high quality care. However, patient EMRs [electronic medical records] need to be adopted for our environment – low resource. So, if you put in a system built for the USA or even India – such a system has the chance of slowing down the work rate of medical professionals – as much as up to 30%. With not enough medical professionals to start with, it is important that we match our systems with the requirements of the local healthcare economy and not just implement off-the-shelf systems from other countries without customization. Often that means reducing the complexity of the system to make it easier to use – i.e. less physician order entry at each step.
The problem of the high cost of medical technology
Q. Even if we succeed in reducing costs in labour, hospital building materials and the likes, what about the high cost of medical machinery? Can Africa bank on GE Healthcare or Siemens Health to bring down the cost of machinery?
A. You are right, expensive medical technology is an issue. However, Philips has just come out with a new diagnostic machine that costs just 10,000 USD and is excellent, portable, and connected to the web. So, we are starting to see how medical technology is responding and enabling low cost care. Until now, that would have cost over 25,000 USD – so a real improvement.
Whilst the focus of our work is emerging economies, many of the lessons can be adapted to higher income countries that are increasingly struggling with healthcare costs. Indeed, a client of mine from Toronto, Canada (Murray Martin) said today in the Toronto Star www.thestar.com that the healthcare costs in Ontario (Canada’s largest province) are no longer affordable. That is a rich G7 country with excellent budget management. So tough decisions for everyone….
The worth of Pan-African communication strategies
Q. We have a few Pharma Clients that are considering developing Pan-African communications strategies. There is a tendency to employ tried and tested global approaches. Would you endorse this or suggest bespoke solutions by country? What other advice would you give them?
A. Bespoke is important, but the technology to reach everyone is the same. So you need to think about how you adjust the message to the technology used per country. As they say, the medium is the message….
Is telemedicine a viable option in Africa?
Q. Is there enough drive behind telemedicine? And do you see this as a viable solution?
A. Telemedicine is very important, but we require the IT backbone to support it. This requires high speed internet and that is not always available. So, we need to think about lower tech options like sending medical information in smaller data packets via SMS to remote locations. Some of this is already happening whilst we await for fast internet to arrive.
Supply chain difficulties
Q. Why is it difficult for manufacturers in Europe and North America to supply healthcare equipment under long-term lease arrangement to credible health organisations in Africa?
A. Cash flow is an important issue. Many of these organizations are small scale today, few are chains (unlike in India where they have low cost healthcare chains) and so face challenges. In this market, volume is key and so standardization and reducing variation are the only way to drive volume safely. Do that well, the cash flows start to look better.
The issue of medication quality
Q. Of recent times the public have been crying about the quality of drugs dispensed by healthcare facilities. It seems healthcare administrators focus on low-cost and end up buying fake drugs.
A. In truth, healthcare administrators don’t buy drugs directly. They come via wholesaler or distributor. Sometimes the supply chain breaks down – either because, as you suggest, fake drugs get into the supply chain – other times they don’t know it has happened. The drug makers are working on this mostly via mobile authentication via SMS – which seems to be working. But it is a big issue. It is important to note that delivering low cost care does not require fake drugs. That is not high quality.
Problem of high insurance payments
Q. An average working African who is registered under an HMO is burdened by the monthly contribution deducted from his salary; in establishing low-cost high-quality healthcare, are stakeholders factoring in HMOs?
A. It is a good question. HMOs are limited by type and quality of providers within the healthcare economy. So, if the providers only compete on ‘the quality of the wine list and softness of the carpets’ – this can make insurance unaffordable for the average working family. The key here is to get the HMO to motivate new providers into the market that are low cost and apply the lessons from our report.