Healthcare in Africa: Three Questions to Yvonne Mburu

On 19 June, Institut Montaigne held a breakfast meeting to discuss the challenges healthcare systems are facing in Africa. Yvonne Mburu, Kenyan doctor in immunology and oncology, founder of Nexakili - a social enterprise dedicated to connecting the global community of African scientists and health professionals -, and member of President Macron’s Presidential Council for Africa, took part in this discussion and shares in what follows her vision on these issues.

What are the main challenges the African continent is facing regarding the organization of its healthcare systems?

The first is to define a clear vision for the healthcare system each country wants and then establish a national strategy that takes into account the local priorities in health. This is crucial, since priorities and disease patterns differ from country to country. For example, some non-communicable diseases like cancer and heart disease are high on the priority list of some countries, but not others. So the priorities for Kenya may not be the same as those of Senegal or Niger or Zimbabwe. Likewise, HIV might still be a priority area in eastern and southern Africa but not so much in the Sahel. Healthcare systems in Africa must thus be built with country-specific priorities in mind. Funding organizations and decision makers must adapt their models to reflect the heterogeneity of Africa’s 54 different countries.
 
Over the past decade and a half the overall trend by international development organizations has been to fund vertical solutions, with particular attention to HIV, tuberculosis and malaria. However, the relative burden of these diseases differs significantly from country to country, which means that some countries receive far fewer funds (because they have a lower disease burden) even though they are struggling with other crucial health issues. Rather than fighting specific diseases, the priority should be to build sustainable healthcare systems. African countries must advocate for international partners and foundations, which fund a significant percentage of health care budgets in Africa, to back country-specific priorities in health.
 
We must also put in place the funding mechanisms and governance structures to achieve universal health coverage, which is an objective within the United Nations Sustainable Development Goals. This will require a balance between a strong public sector that also acts as the regulator and a virtuous private sector to ensure access, quality and affordability of healthcare to everyone.

What role can digital technologies play in the pursuit of this goal?

In the vast majority of cases, technology only amplifies already existing realities. It is important to understand that technology cannot replace visionary leadership and good governance. It can however help leapfrog many of the healthcare-related challenges in Africa.

• For example, training health workers can be achieved for a fraction of the cost by using digital education platforms.
   
• The deficiency of human resources can be circumvented by technology. Indeed, telemedicine is revolutionizing access to health professionals and particularly to specialists from all over the world, including for patients located in rural areas.
   
• Blockchain technology can be helpful in improving access to medicinesand disrupting counterfeit medicines.
   
• Technology can also help to create innovative funding models to improve the access and affordability of care. For example, in Kenya financing models are being built into mobile money platforms to send, save and spend funds specifically on medical treatment.
   
• Finally, adopting e-health systems ensurestraceability and patient follow-up throughout the continuum of care. This would be a big step towards keeping digitized medical data and creating secure systems for medical information sharing. Already, medical “big data” is finding interesting applications in machine learning and artificial intelligence to improve care.

In the next few weeks, I will be launching a brand new platform, designed as a professional network, to connect the global community of African scientists and health professionals. My vision is to create a global platform for African professionals to exchange knowledge and collaborate across regions, sectors and disciplines with other professionals all over the world. I intend to use digital technologies to address the shortage of human resources in health and science. This is particularly important because an enormous share of African doctors and scientists are not located on the African continent. If we are to build strong knowledge-driven economies in Africa, we must begin by identifying and mobilizing our experts no matter where they are in the world. Indeed, one of the key objectives is to mobilize African expertise to address Africa’s challenges, and to accelerate the availability of innovative research on the continent.

What role can the healthcare sector play in the relationship between France and African countries?

France has a great healthcare system for which it is globally recognized. Many African countries could draw inspiration from the country’s virtuous practices in both the public and private sector. Yet, Africa doesn’t wish to merely copy existing models, in fact Africans must seize the opportunity to “build from scratch” futuristic models of what a healthcare system should look like in the 22nd century. The rising use of “smart” electronic gadgets and sensors is already revolutionizing the practice of healthcare. African expertise coupled with the emerging digital technologies in health will be important assets in conceptualizing these future healthcare systems.
 
France also has a major role to play in the global healthcare agenda, especially in defending the implementation of the Universal Health Care (UHC) principles within the funding models of multilateral organizations. This is important because, despite the positive UHC discourse on the international scene, global funds are still mostly allocated vertically to specific diseases, rather than horizontally to the restructuring of the entire healthcare system. France has the legitimacy to take strong leadership on this issue and be a strong voice in favor of Africa by inciting multilateral partners to re-orient their funds towards the UHC goal. 
 
Finally, medical and scientific diplomacy could allow to renew relationships between Africa and France, and significantly contribute to Africa’s development. France is a global leader in biomedical research, and its soft power could benefit from a collaboration with African centers of excellence on new projects and skills transfers. For instance, the Institut de Recherche pour le Développement (IRD), the Institut Curie and the Institut Pasteur, all renowned French institutions for scientific research, are already present in several African countries. Epicentre, the research branch of Médecins sans Frontières (MSF), is involved in vaccine and tropical disease research, and is working on the current Ebola outbreak in the DR Congo. Finally the French Institute for Research into Cancers of the Digestive System (IRCAD) will soon launch a campus in Kigali. As a member of the Presidential Council for Africa (CPA), I actively defend these levels of progress, while remaining attentive to the impact this new soft power might have on the African population, and defending African ambitions with international partners.