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South Africa’s MISSION HEALTH

Published 2 years ago
By White Ink House

Executive Forecast

“We didn’t’ see this coming”

– Bill Gates in last year’s annual letter as Chairman of the Gates Foundation.

No, he wasn’t talking about COVID-19; Gates was referring to other surprise megatrends in global healthcare, one of the most complex, regulated and challenging sectors, which demands principled executives who can safely helm our Mission Health. Gates’ worthy list informs the 2020 edition of Executive Forecast’s South Africa report which covers a greater understanding of the true economic impact of health, redefines the catch-all term of “access,” and explores financing mechanisms, breakthrough technologies, and empowerment of the historically disadvantaged.

Mission Health highlights how we can work together to navigate the complexities in restoring investor confidence, attracting investment, and ultimately, achieving the “triple bottom line” in a South African context.

Strong Health, Stronger business

If we needed any greater evidence of the massive impact of health on the economy, witness the single biggest market decline since the Great Recession of 2008, sparked by the COVID-19 pandemic. But the impact can also go the other way: investing in health is always good business. South Africa’s business and government communities understand that you can’t invest in what you don’t plan for—and you won’t invest in what you don’t understand. Together, they’re driving planning and greater understanding through formal and informal channels.

“We are a proactive government and prioritize the people’s needs. We are creating platforms for the private sector to participate and invest in the country.”

Thembi Siweya, Deputy Minister of the Planning Department.

“We have been pushing for investment and growth which is a critical issue in South Africa, as nothing happens without them,” says Cas Coovadia, Director of Business Unity South Africa (BUSA). “It is a matter of changing the narrative and it is in our hands to do this, government, business and labor together. We need leadership that understands our role in the global economy and what needs to be done to get our economy going.” Stavros Nicolaou, Chairman of Pharmisa, a South African industry trade-group stresses the importance of implementing structural reforms, and that the business community is fully behind President Ramaphosa’s drive to restore governance, liquidity, and sustainability in state-run enterprises.

Risenga Maluleke, Statistician-General and Head of Statistics South Africa, emphasizes the importance of knowing as much as possible about the population you’re planning for. “We collect data from households, from industry, from administrative records from schools, clinics and police. Statistics must be independent, facts can be stubborn!” Maluleke asserts. “There have been several initiatives championed by the President to encourage Foreign Direct Investment into the country,” says Thulisile Manzini, CEO of Brand South Africa. “These include the launch of the South African Investment Conference with a clear target of U$68 billion over 5 years. Of the inaugural U$17 billion investment, approximately U$14 billion worth of projects is in the implementation phase across different sectors. Last year’s SA Investment Conference also saw an investment commitment of U$21 billion pledges made from various investors.” Manzini also points towards a new “One Stop Shop” concept which removes red tape for investors by providing more coordinated, streamlined, and professional services to companies, bringing together special economic zones, provincial investment agencies, local authorities, and government departments. Talking about economic spillover, “there is a whole domino effect in coming up with innovative medicines and treating patients,” says Dr Konji Sebati, CEO of IPASA, the Innovative Pharmaceutical Association of South Africa. “We create a virtuous cycle of life. Few people are aware of the contribution that pharmaceutical companies make to human welfare. Not only do their medicines save lives, it improves health, and prolongs and enhances quality of life, but medicines also reduce overall healthcare costs.”

“FEW PEOPLE ARE AWARE OF THE CONTRIBUTION THAT PHARMACEUTICAL COMPANIES MAKE TO HUMAN WELFARE”

DR KONJI SEBATI, CEO OF IPASA

Shifting disease maps

Africa has historically been the epicenter of a multitude of global health initiatives. Notably, the world’s largest publicly-funded antiretroviral (ARV) program, increasing life expectancy by over a decade, an unprecedented achievement that has led to unprecedented business opportunities. However, partly as a result of its successes, the disease profile of the continent has been shifting—and its healthcare system along with it. South Africa must continue to develop expertise in managing both communicable diseases and non-communicable diseases, whose treatments must coexist in a fragile balance. Through collaborative know-how and coordinated effort between public and private initiatives, people on both sides of the equation believe it’s possible to re-engineer the country’s healthcare system. The National Health Insurance (NHI), is a universal health coverage scheme being implemented over a 14-year period starting in 2012.

“These types of reforms have been done before in other countries and are working well,” says Rhulani Nhlaniki, Pfizer Cluster Lead of Sub-Saharan Africa, echoing the general consensus among executives that the NHI is a good idea, in principle the challenge will be around funding and implementation in a market divided between public and private, with 80% of medical spending incurred by 15% of the population in the private market.

 “We believe that it can work in South Africa,” Nhlaniki continues. “The reason for my optimism is that when a system is overhauled or reformed, it presents a unique opportunity to rebuild something that is better than anything that exists.” The government has given Nhlaniki just cause for his optimism, doubling down on its Commitment to NHI in the budget review. Minister of Finance Tito Mboweni announced that the Treasury reprioritized U$3 million to the Department of Health to increase its capacity in phasing in the NHI and U$1.5 million has been set aside for the National Quality Health Improvement Plan, a project of the Presidency to improve the quality of healthcare facilities to ensure that they can be accredited for the NHI. An additional U$200 million will be allocated over the next three years for medical students to complete their training.”

Dr. Zweli Mkhize, Minister of Health of RSA, echoes Mboweni’s focus on investment with a broad appeal to “further build infrastructure where needed, looking particularly at hospitals,” and leveraging on entrepreneurs to drive innovation, which he says will be crucial to bridge the dichotomy in the system: “On one side, it seems a first-world economy: successful, sustainable, connected, fiscally competitive with quality products; then, there is another side that has been left behind.”

Two sides of the same coin

The disease profiles for the private and public healthcare sectors are very different. The fact remains that each system is specialized in its own treatment silos for unique disease profiles. Dr. Ryan Noach, CEO of Discovery Health, elaborates, “On the one hand, the private healthcare environment looks like that of a developed country’s environment,” with low rates of infectious diseases, including an HIV rate below 2%, and greater chronic diseases rates. In contrast, for the public hospitals, Noach says that “HIV and TB are the predominant issues concerning the public sector, with lifestyle diseases being an important secondary cause of disease burden.”

Reflections from the NHI Cabin

Dr. Anban Pillay, Deputy Director General for NHI reflects on the opportunities and challenges he faces.

Challenge: “Being able to provide a broad set of benefits within South Africa’s resource limited market requires a highly efficient system, getting the cost of the goods as low as possible and at the same time making sure the population participates in prevention and health promotion.”

Bright Side: “the benefit package designed is directly linked to the budget. Given that limitation, we can’t design an NHI that is not affordable. We can roll out an ambulatory healthcare package that will be accessed by the entire population and will go a long way in providing healthcare to citizens that have no coverage at all.”

NHI, Seen from the C-Suite

STAVROS NICOLAOU, CHAIRMAN OF PHARMISA: “The South Africa healthcare scene has 2 fronts; the NHI dealing with the future of health, and the Presidential Health Compact dealing with the current issues”— a 2019 pledge committed to providing equitable access, increasing hospital and clinic capacity, and establishing well-staffed centers of excellence).

TARYN PURDON, GM OF PIERRE FABRE MEDICAL: “We need to work together in a collaborative way with a strategy for NHI. We must have a clear strategy with regards to the timing and implementation. NHI will most likely impact the providers and the hospital side first. However, NHI alone will not solve South Africa’s healthcare problems. That can only be achieved through collaboration between NHI and other health services.”

DR. RYAN NOACH, CEO OF DISCOVERY HEALTH: “It is an opportunity and we support a move towards Universal Healthcare. We must do something structural to change how healthcare works in South Africa and seize the opportunity in making a more robust system. We should leverage the strength of an excellent private healthcare system, not break it down. Private healthcare has been perceived as expensive in South Africa, but on a Purchasing Power Parity adjusted basis, we deliver some of the best quality healthcare that money can buy anywhere in the world.

SHELLEY HORNER, COUNTRY PRESIDENT, NOVARTIS SOUTH AFRICA: “The biggest issue is around what I call equitable healthcare. The two ends must be brought together while still allowing people to have a choice. In a democratic society, choice must not be removed.

DR. MORENA MAKHOANA, CEO, BIOVAC: “It is about evolution and adapting to that evolution. From a business perspective, we know we will always adapt to the new norm. I don’t think NHI is a threat to business because these changes tend to be gradual. We will see the changes as they come and we will adapt as we go.

VACCINES: A SHOT IN THE ARM FOR PREVENTION

“When we first started working in global health, we were shocked to learn how many children in low-income countries were still dying from diseases that could have been prevented with vaccines,” says Melinda Gates, co-founder of the Bill and Melinda Gates Foundation. Africa accounts for more than half of all deaths due to Vaccine Preventable Diseases (VPD), and with over half a million African children under 5 dying from VPDs every year, the continent has been a central vaccine focus for international organizations like UNICEF and the WHO. But more is needed than merely international aid. “African countries are donor-dependent to the likes of UNICEF and GAVI. By virtue of the procurement being done through UNICEF (and not by the governments themselves), companies like Biovac do not have direct access to the countries,” says Dr. Morena Makhoana, the company’s CEO. Makhoana heads the only domestic vaccine manufacturer in southern Africa, which started in 2003 from a public partnership when the South African government realized the need for a local vaccine-manufacturing presence. Biovac currently supplies South Africa’s own vaccination program, EPI, while partnering with other private players. “For public-private partnerships to work, 25 to 30 years are needed in order to build the capability that the government on their own would not be able to build,” Dr. Makhoana stresses. “It must be a long-term commitment.”

Pfizer is one such partner who, alongside Biovac, is building up local manufacturing capacity for a pneumococcal vaccine—which could be responsible for eliminating up to 400,000 preventable deaths worldwide each year, with 275,000 in Africa alone. “We will contribute to continued security of supply of the pneumococcal vaccine, thereby continuing to make a significant impact in the reduction of childhood pneumonia in South Africa,” says Rhulani Nhlaniki, the company’s South Africa Country Manager. Another such partner, Merilynn Steenkamp, GM of Sanofi Pasteur SA, elaborates, “Our long-term partnership with Biovac is essential to continue to build on our expertise and capability within South Africa.” As the market leader in Africa, Sanofi Pasteur currently supplies a range of vaccines that cover 17 different communicable diseases while also being the first in Africa to launch acellular pertussis combinations and conjugate meningitis vaccines. “The technology transfer to Biovac is for the most innovative vaccine globally, as it covers six diseases in one vaccine,” Steenkamp says. Regarding the market share of vaccines, Dr. Makhoana highlights that vaccines used to represent 2% of global pharma sales and have now risen to over 5%. “It still continues to be very small,” he says. “However, it will continue growing over time as we shift to a preventative approach to healthcare.”

There is additional economic spillover linked to vaccines’ preventative potential. In Africa alone, VPDs result in an estimated $13 billion annual burden on the already stressed healthcare system. Additionally, Pfizer’s Nhlaniki emphasizes, “The technology transfer process has enabled significant knowledge transfer, job creation, and direct investment, strengthening South Africa’s standing as a research and development hub in Africa.”

There have been considerable investments in other areas of Africa. In regards to the global polio initiative, Steenkamp details Sanofi Pasteur’s efforts: “We are the number one partner to the Global Polio Eradication Initiative, and in the past 10 years, we have delivered 1 billion doses of polio vaccines globally, including Africa. Sanofi Pasteur is in partnership with various stakeholders on the continent. One of our strongest partnerships is with the WHO where we are stockpiling to help with outbreak control.” However, manufacturing vaccines is still a tricky business. “Production and supply of vaccines can still be quite complex,” Steenkamp cautions. “A single product can take up to 36 months to manufacture and supply and distribution can be a challenge. Long term commitments with governments and partners are imperative to ensure sustainability of vaccines.”

Sandra Lambert, current Managing Director of Baxter South Africa, and former Chief Commercial Officer for Biovac, notes that “with local manufacturing, the only way to reduce your costs is to increase volumes—basic economies of scale. In order for Biovac to be competitive 5-10 years from now, they need to supply vaccines to expand their reach in Africa. Local manufacturing of medicines is incredibly important for Africa”

THE ONGOING HISTORY OF BLACK HEALTHCARE

The Clinix Health Group is the latest link in a proud chain of tradition, when activists like G.M. Pitje and Dr N. Motlana strove to provide accessible healthcare to disenfranchised communities. “I came later and am now part of the journey they began when I was given the opportunity to invest with them

back in 1992,” says Clinix’s founder, Dr. Khamane Matseke. Now operating several hospitals in historically underserved communities, Clinix provides affordable, high-quality, primary to tertiary care. To expand access, they have heavily integrated technology; from remote health-status monitoring to minimally invasive surgeries, technology is transforming the cost and quality of healthcare Clinix provides. “Because of gadgets such as cell phones and watches, patients are able to monitor health status remotely,” says Dr. Matseke, adding that doctors are also able to access such information remotely. “This sees us moving into a future where a large percentage of our medical needs can be catered for without even having to physically see a medical practitioner.” The biggest challenge, Dr. Matseke notes, is people. “The younger generations adapt quickly, however for older people, technology is more difficult to trust. Going into the future, healthcare providers also have change the way we are doing things.”In addressing the importance of government collaboration, Dr. Matseke says,“In Limpopo, we had a partnership with the Department of Health where a Dialysis Centre of Excellence was established. It is our belief that the future of healthcare lies in cooperation between the Public and Private sector.” He believes that the government still needs to continue in its vital role to train medical personnel and specialists, but that there are also opportunities for the private sector to assist in teaching and training, and that the presence of Clinix hospitals in lower-income areas produces further downstream effects. Citing the economic spillover of Clinix, Dr. Matseke states, “We not only employ local people; we also expose communities to a very varied skills development opportunities. When providing for a healthy community, there are returns which are guaranteed on many levels, for a very long time to come.”

RIGHT MEDICINE, TO THE RIGHT PATIENT, AT THE RIGHT TIME

“With the whole supply chain, there are often unforeseeable consequences,” says Carel Bouwer, the General Manager of Clinigen South Africa, a group that brings together five synergistic businesses focused in three areas of global medicine supply—clinical trials, unlicensed medicines, and licensed medicines. “You might have a factory burn down or have difficulties with the regulation. Anything can happen.” However, it is under uncertain circumstances where Clinigen is specially qualified to help. “If a product is discontinued, we would like to provide a solution or to take it over even if it’s for a smaller market. If a supplier is out of stock, we would partner and provide access to that medicine for the period that they’re out of stock,” Bouwer explains. Clinigen also specializes in medicines that are currently not licensed but are often safely prescribed for rare or pediatric conditions and that often requires collaboration with the government. Bouwer elaborates, “When there’s a local supply that’s out of stock, we work with the government to provide access for those lines for that short period of time.” He adds that Clinigen has grand plans for overcoming South Africa’s supply problems: “The aim going forward is to be able to press a button and source that medication globally.”

SANOFI’S FORMULA FOR SUCCESS

THIBAULT CROSNIER LECONTE IS THE COUNTRY CHAIR & GENERAL MANAGER FOR THE FRENCH BIOPHARMACEUTICAL GIANT SANOFI

THIBAULT CROSNIER LECONTE, GM OF SANOFI SOUTH AFRICA “There are the 3 pillars of access: equity, efficiency, and education.”

EF: YOU HAVE SEEN HEALTHCARE CHANGE SUBSTANTIALLY IN THE THREE YEARS YOU HAVE BEEN GM FOR SANOFI IN RSA. HOW HAS YOUR MISSION EVOLVED?
TCL: One of South Africa’s main challenges is the way the healthcare system is structured. The private sector caters for 8 to 9 million people while the public sector provides for the rest of the 47 million people. The private system is similar to the US system. The more one pays, the more one can access innovation and technology.

EF: HOW DOES SANOFI’S PORTFOLIO CATER TO THE SOUTH AFRICAN DISEASE MAP?
TCL: We have a diverse product portfolio which seeks to address South Africa’s healthcare needs in key therapeutic areas particularly Diabetes, Mental Health, Tuberculosis, Rare Diseases, and Vaccines. There has also been an explosion of non-communicable diseases like diabetes, and Sanofi is well positioned to play a meaningful role in combating these emerging diseases.

EF: HOW DOES SANOFI ENSURE SECURITY OF SUPPLY IN SOUTH AFRICA?
TCL: For years we’ve focused on affordability. However, for the new innovative therapies, affordability becomes a challenge. This will be a key consideration during the NHI transition. We have a local manufacturing facility which addresses a major public health need, i.e. TB. With our local plant, we can respond quickly to the demands of the country.

EF: HOW CAN TECHNOLOGY ENABLE EFFICIENCIES IN THE SYSTEM?

TCL: In 2018, Sanofi introduced Vula Mobile to the National Department of Health (NDOH) and was easily accepted and put to use in all provinces. Vula Mobile is a medical referral app that makes it easy for GPs & primary healthcare workers to get advice from specialists and refer patients to them. The aim of the app is to give health workers – particularly those in remote rural areas – a tool that helps to get patients quick and efficient specialist care. Consequently, the demand for specialist services is reduced because HCP’s at lower levels can manage patients without the need for upward referrals.

EF: WHAT SORT OF IMPACT WOULD YOU LIKE TO ACHIEVE IN YOUR SOUTH AFRICAN TENURE?

TCL: Whatever I do must have an impact on healthcare and on patients, not only through the supply of medicines, but through supporting the healthcare system. I’m striving to have an impact through empowering medical officers with education and helping the government improve efficiencies for the benefit of the patient through investing in innovative ways to reach and service the patient irrespective of their geographies. Sanofi has a legacy of forming partnerships. My ambition is to strengthen this partnership paradigm to have an even bigger impact on patients and their quality of life. The launch of a new treatment option for latent TB is a prime example of such a partnership with the government and various other stakeholders. Patients will now have access to an innovative treatment solution that shortens a 12-month treatment to 3 months. This medicine will be a game changer for patients with latent TB as it is a simplified regimen which will make it easier for both HCPs and patients in managing their treatment.

5 FACTS ON WALTLOO PLANT

  • 1 Waltloo produces the full range of tuberculosis treatment medicines combining up to 4 different drugs in one tablet. 70% of the volume of TB medicines is produced for the public sector
  • 2 The site is recognized as a global center of excellence for the production of antituberculosis medicine, which is exported to 13 countries including Europe, Australia, UK, Brazil.
  • 3 In addition to the production of TB, the site also produces medicine for epileptic disease and medicines for central nervous system, with a dedicated complementary medicines facility for the production of consumer health product range.
  • 4 In the last 5 years, Sanofi has invested approximately R27 million in expanding and upgrading infrastructure to increase manufacturing capacity for TB medicines.
  • 5 The expansions at the factory has resulted in Sanofi being able to retain and create new employment opportunities for 300 employees.

Chief Technology Health Officers

South Africa’s innovation profile is supported by global indicators such as the Good Country Index, where it ranks 18th out of 163 countries for Science & Technology—but in the area of medical technologies, South Africa has traditionally been a distributor market.

“The main product areas in terms of value is general consumables, diagnostic imaging, and then orthopedics and prosthetics,” says Tanya Vogt, Executive Officer of SAMED, which represents over 160 medical device companies that serve a market expected to grow from U$72 million in 2018 to U$99 million by 2022. “Our market ties in quite nicely with our disease burden,” she adds, “because diagnostics is needed for TB and HIV, more so now that in non-communicable diseases, we are seeing a huge increase in diabetes, obesity, hypertension, and cardiovascular.”

Yet, at its foundation remains the need to not lose sight of the most fundamental aspects of health.

“From an African perspective, it is about basic healthcare needs at a primary care setting that will impact patients’ lives in the long term,” says Ian Wakefield, Africa General Manager at BD. “Many Africans don’t have access to that right now. If we could provide access to as many patients as possible, we will change the lives of Africans, thereby impacting productivity and quality of life. It’s great to have innovative technology to provide a solution for a sophisticated disease area, but Africa’s needs are much more basic. For example, there is need for preventative interventions such as cervical cancer screening and for the delivery of basic healthcare services such as providing education and treatment to diabetic patients. If that level of care is provided, we could truly elevate the lives of Africans.” Mark Flint, CEO of Siemens Healthineers South Africa, speaks to the importance of technology as process, not just product. “When a person goes to a public hospital they are registered, tests are done, and prescriptions are given,” he says. But, if a month later there is follow up at another hospital, “the patient has to be registered again, get another CT scan, another prescription for drugs, etc. We need to have a system where the patient data can be viewed at all the state hospitals through South Africa. The medical history of a patient that lives in Cape Town should be instantly accessible in hospitals in Pretoria or Johannesburg if the patient happens to have an accident there.” Flint suggests that NHI has the potential to dovetail with his sensible vision of the future. “It’s going to happen because today there are 40 million people without access to care, and this is a huge challenge. In Limpopo, there is no mammography machine in the whole state and the mortality rate for breast cancer is high. Innovative solutions can be found, such as mobile breast-screening clinics that transmit data by 4G or satellite, giving a pool of doctors access to data that can be sent anywhere. “The productivity that comes out of this is enormous, saving people’s time and resources.”

“We did it in the past,” says Sandra Lambert, MD Baxter South Africa & SADC Region. “We eradicated smallpox. How did we do that? Many years ago, with none of the technology that we have today. Every person got vaccinated. I do believe it’s just a matter of commitment.” Lambert has seen it first hand: in a remote village in the middle of Uganda, all the villagers have a mobile phone. “How is it possible that we’ve made smartphones reach everyone’s hand, but we haven’t been able to make healthcare reach everyone?” she asks. “Surely the infrastructure for mobile technology had to be created? I think that this is because the focus has to been 100% dedicated to healthcare.” Lambert has given a lot of thought to the right PPP (private-public partnership) models that might inspire such effective interventions. “When you know what the need is, then you know how to build a public-private partnership that will work,” Lambert says. “People don’t often take the time to understand the country, the issues. Sometimes it’s so simple but it can make a huge difference. Sometimes the PPP offer is so complicated that it will never be able to be implemented. I like to build PPPs that actually add value. “What I would like to see is PPPPs: private-private-public partnerships. I wish there were companies that would sit down together and contribute complementary products/services. If we collaborate with other companies and go to the government together, we can make such a difference.”

BUSINESS MODELS, REMODELED

“We need business models that will help foster a deeper sense of human satisfaction and purpose at work,” says Amanda Wilde of Umsinsi Health Care, the first South African company to adopt the UK John Lewis Partnership Business Model, a co-ownership structure where employees democratically help determine several key aspects of the business. Wilde explains that the model was originally set up to achieve social-class reconciliation, and Umsinsi—a licensed Medical Device Company and Social Enterprise dedicated to providing innovative, cost-effective products and services, while achieving fairness and reconciliation in the healthcare industry—has successfully applied it to the persistent challenges of social class, race, and gender in South Africa. This socially-driven business model has resulted in initiatives like the Love Skin Campaign, an initiative focused on the varying responses of different skin types in wound healing and wound care. Wilde notes, “We would appreciate investment, support, and people behind us, who understand that placing social objectives first will help achieve improved business outcomes. Because they are intrinsically tied together.”

SATELLITE Interviews

Vikesh Ramsunder – Clicks Group CEO

EF: You grew in double digits in 2019. What is Clicks’ secret to such growth in a time when the rest of retail is down?

VR: Mindset and leadership are most important. With a negative mindset, costs are cut and there is no belief in the future of South Africa. In my mind, irrational decisions result from the wrong mindset. I am a South African and I understand the dynamics of the country. I am aware of all the challenges we face. However, these challenges have been around for the past decade. You can either complain or adapt to these challenges. Today, the most important thing to a consumer is value, so we work to save our customers’ money. We are the most affordable healthcare retailer in the market. We have invested and increased our efficiency, which allows us to  pass on savings to customers. There have been, on average, 40 new shops opened a year over the past three years and we continue to take market share.

We have a threefold strategy around retail:

  • i) Convenience. This is why we open up new stores. 
  • ii) Differentiation. A large share of our business is private labels and exclusives (more than 20% of our sales). We spend an enormous amount of time and money on our own-brand products. 
  • iii) Loyalty. Our ClubCard programme currently has more than eight million members.

Our mindset is on growth and we have strategies to ensure our business continues to grow.

Vikash Singh – Managing Director of UPD (United Pharmaceutical Distributors)

EF: What are some skills that are transferable from healthcare to other sectors of the economy? Are other sectors aware of the importance of healthcare to the general economy?

VS: I believe logistics can add a substantial amount of value to the broader supply chain of the country. Employees dealing with medicines at a UPD warehouse have a very specialized skillset. Due to the temperature control, timing, and regulations surrounding the job, these employees are overqualified for logistics in other areas since pharma is at the top end of compliance. We have started the UPD Supply Chain Academy in the company with the aim to train people and receive a formal qualification. This qualification helps them to be re-employable in the healthcare supply chain as well as other supply chains.

Heindrich Pienaar, Regional Lead Africa & Middle East at PPD

EF: What do these operations represent for PPD global in terms of strategy, access to market or revenue?

HP: Africa is still the place to find treatment-naïve patients in comparison to the rest of the world. Africa has a large pool of patients and many countries have first-world medical facilities. I have been in this industry for a long time, and the challenges we have had in the past in Africa no longer exist today. We now have excellent sites, as well as experts and key opinion leaders in many therapeutic areas. Many of these African countries have clinical research sites just for conducting clinical trials with excellent infrastructure and equipment. South Africa is the gateway to conducting trials in central and southern African regions, as well as the Indian Ocean Islands. We have a strong predictable and enabling regulatory environment, which is a very satisfying environment to work with. Conducting the trials in lower- to middle-class countries really increases research standards, and also brings health improvements to the countries where the trials are done. As there is no access to some medications in these countries, trials serve as a gate for post-trial access, which is standard procedure for regulatory authorities. This has a great impact on the patients in those countries. CROs have a huge role to play in Africa because of the populations and type of country we service, which of course is great news for us.

Priya Agrawal –Managing Director for MSD – South Africa and Sub- Saharan Africa Cluster

EF:What are the trends that you see will have the biggest impact in our sector?

PA:I think the most obvious one is the impact of big data and digital business. They are interlinked and have the potential to really transform health in a fundamental way. There has been a lot of focus on the power of digital transformation in the developed countries, but it is in this continent and countries like ours where digital can help us really leapfrog. Already in many African countries, a whole generation jumped from no internet to accessing internet on their phones – completely leapfrogging dial up on their desktops. This is where data and digital can enable a fundamental shift in how we seek and provide healthcare. Here is where digital and data could help a shift to prevention before treatment. Digital could really enable a huge leap in health literacy. Better use of big data could enable evidence-based policy and decision making. It’s a huge opportunity. There is a lot of digital innovation in South Africa and also on the continent, a lot of which is not being recognized or integrated at scale. In South Africa there is an opportunity with NHI to enable scale of many of these innovations for improved health. Its a very exciting time to be in this sector. I (and MSD) are invested in a healthier Africa and look forward to partnering with others towards the goal of helping Africans live longer and healthier lives.

Ivan Leon Saltzman – Founder of DIS-CHEM

EF: Since you and your wife founded Dis-Chem in 1978, how have you seen the healthcare and pharmacy sector evolve?

ILS: In the past, the majority of our profit came from the medicines we sold. Today, we depend on the front shop for profit while the pharmacies cover their own expenses. Once the customer comes in for a prescription, we can sell them anything. The advent of SEP changed our strategies from discount medicine focus to a front shop focus. In the past, to open a new pharmacy, you had to be a registered pharmacist. Today our main competition is other corporations. The two big changes in healthcare for us are the competitions of non-pharmacists and the introduction of the single exit price (SEP) and we have adjusted to both those changes.

‘Executive Forecast’ was produced by White Ink House LLC.

  • Publishers: Ines Nandin & Stephen Gray
  • Editorial Consultant: Arthur Thuot
  • Business Development: Santiago Grandi, Sasha Ding
  • Collaborators: Charley Luo, Isa Crosta, Flora Mackinnon

For exclusive interviews please log onto www.executiveforecast.com

Copyright: All rights reserved. No part of this publication may be reproduced in any form or by any means, whether electronic, mechanical or otherwise including photocopying, recording or any information storage or retrieval system without prior written consent of White Ink House LLC. While every attempt is made to ensure the accuracy of the information contained in this report, neither White Ink House LLC. nor the authors accept any liabilities for errors and omissions. Opinions expressed in this report are not necessarily those of the authors.


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