The Untapped Opportunity in African Healthcare: How to Establish a Stronger Private Sector by Giving Doctors a Voice
There is a huge opportunity for private sector innovation in Africa’s healthcare market. As of 2019, Africa has around 16% of the world’s population but accounts for a significant percent of the global disease burden (23%) – including both deaths from communicable diseases, and a large increase in the prevalence of non-communicable diseases over the last decade.
In African healthcare, the private sector should be well-placed to address these challenges. Private healthcare providers can offer several advantages over their public sector counterparts: In contrast to government providers, which can’t take any action without approval from their country’s Ministry of Health, private providers have more freedom in their decisions, expediting everything from the use and implementation of new technology, tools and equipment, to research and initiatives aimed at addressing and overcoming specific health challenges. This creates new opportunities for innovation, enabling these providers to test and adapt new medicines, devices and business models, and to make a more immediate impact. This impact can be great, given the importance of healthcare to the region’s economy, as it’s widely recognized that better health services can not only improve health outcomes but can also drive economic growth and boost progress towards other development goals.
However, across the region, for-profit healthcare providers are dealing with shortcomings that are impacting their ability to access needed equipment, information and resources, and hindering the growth of the private sector. As African countries continue working towards universal healthcare and SDG3’s goal of good health and well-being for all, it’s becoming increasingly important that private sector providers obtain the support they need to reach their full potential. Below, I’ll explore the key challenges these providers – and the broader private healthcare sector – are facing, and discuss how businesses like mine are working to overcome them.
Challenges Facing the Private Sector in African Healthcare
First, the private sector in Africa is fairly new, and it’s still in the process of adopting the standards, practices and regulations that are common in health systems in the U.S. and Europe. But unlike in these more developed regions, which have more established medical associations and institutions with longer histories and track records, these organizations are still in the early stages of being established and expanding in many African countries. For instance, there is no African equivalent of the American Medical Association – which is a standard-bearer for best practices and guidelines for physicians in the U.S. (and which many other countries also look to for guidance). This sort of association is absent on a multi-national level, and in many individual countries, the medical associations that do exist are limited or cost-prohibitive (as public physicians’ salaries are often quite low).
Standards are also changing (or still being established) around everything from data storage and privacy practices to acceptable equipment and medications. That means areas like Continuing Medical Education – which provides doctors with updated training on new innovations, best practices and other developments – can be lacking. As a result, both medical associations and private sector providers themselves need to continually adapt, as their countries’ health sectors move towards policies more similar to the likes of the E.U.’s GDPR and the U.S.’s HIPAA to guide their regulatory approaches. Meanwhile, without set standards or a track record of best practices that can guide their interactions with government, there is an arbitrary element to some of these certifications and associations – which in some cases were created with the hopes of outpacing their competitors and becoming a new standard bearer. This introduces confusion about which associations physicians should join, and which truly have the expertise and connections to provide valuable guidance.
As a result of this fragmentation and lack of access, there is no simple way for private sector companies to reach African doctors as a whole, to explore collaborations, market new products, etc. Instead, this lack of standards and established practices creates an overly decentralized system, while in the healthcare sector, it is important to have best practices and standards that are well-established, consistent and based on science, safety and security.
Second, many individuals who enter Africa’s private healthcare space – from consultants to physicians – come from the public sector or have hybrid backgrounds, and lack the true private sector experience that someone coming from a consulting firm or for-profit hospital system may have. Working at a government agency, multinational organization or NGO is different than working at a private firm like McKinsey or Deloitte – and quite different than running your own business. There is a different skill set and set of expectations involved in working at self-sufficient businesses that must generate their own revenue, versus working at organizations that rely on donations, grants and aid. For instance, individuals who come to the private sector with a public or development sector mentality are often more tolerant of bureaucracy, which can result in more inefficiencies and additional cost and waste. This can lead to private entities that operate similarly to those in the public sector, in which solutions that could be easily or immediately implemented can’t get launched without the decision-maker falling prey to “paralysis by over-analysis” and unnecessary red tape – resulting in the loss of vital time and money. This can also impact the product or enterprise’s chance of success, and lead to missed deadlines and avoidable perceived failures. This runs counter to true private sector approaches, in which any doctor or facility can make their own decisions independently, embracing innovation and creating a more immediate impact with less bureaucracy.
These individuals may also be more comfortable with non-profit, donor-dependent funding models, which can make it difficult for them to execute successful for-profit approaches. For example, instead of the for-profit model of completing a pilot, demonstrating transparent results then leveraging that success to solicit additional investment, their organizations often seek the funding first, before establishing a track record that can form the basis for ongoing success.
Third, a true private sector requires a free market that fosters open competition. But in many African markets, there are a limited number of organizations or individuals that act as gatekeepers who decide which companies and products can be accessed by private physicians. If these gatekeepers prevent promising for-profit solutions from entering the market, then doctors often aren’t aware of these solutions, and are unable to select those that are best for their practice. This prevents a thriving private sector from taking root – especially if politics enters into the decision-making process of these gatekeepers, leading them to favor ineffective solutions at the expense of good ones, and preventing doctors’ voices from being heard.
Lastly, the lack of success stories in Africa’s private healthcare sector creates more hesitancy and doubt on the part of donors, investors and others. There is a perception of “increased risk,” which limits the opportunities for worthy businesses to acquire much-needed capital, raising the bar that companies must clear during investors’ due diligence processes, and requiring them to demonstrate a stronger track record before an investor or donor will support them.
The Need for More Awareness of Private Healthcare Solutions Among African Doctors
Despite these obstacles, Africa’s private healthcare sector has great potential – not only to generate immediate impacts of its own, but also to highlight successful approaches that can be replicated in the public sector. The private sector has an opportunity to drive change quickly, but for that to happen, it will need to establish professional standards and adopt national and international best practices. And importantly, doctors will need to gain awareness of, and access to, the kinds of for-profit healthcare solutions that are available in other markets.
This raises a key question: In light of the current limitations in connecting doctors to these solutions, how can private healthcare companies get more access to doctors to make them aware of the products and services that can help them and their patients, and benefit their organizations and communities?
That is a difficult question to answer – and it’s a challenge my company, PocketPatientMD, is dealing with directly. PocketPatientMD is an electronic health record platform designed to offer truly universal health records that meet the needs of providers, patients, Ministries of Health and other healthcare stakeholders. The service is customizable, interoperable, offered in multiple languages, available online and offline, and provided at no cost to users. We designed the platform to be provider-centric, with an emphasis on meeting the needs of clinicians and healthcare workers, for the benefit of the entire healthcare ecosystem. As a result, a key part of our business model involves connecting directly with physicians to introduce the platform, solicit feedback and ensure that our services meet their needs.
This has proven to be easier said than done in Africa’s fragmented private healthcare sector. While there is a clear order and process when dealing with the public sector, we often face more bureaucracy and unnecessary politics on the private side. This includes medical groups and private physician organizations promoting “pay-to-play” techniques – i.e., those that charge an arbitrary cost to service providers that hope to engage with their doctors, even when the services on offer are free of charge and can benefit their members, as in our case. While this practice is not necessarily corruption, it does run counter to a truly open private sector, and to the mission or stated goal of many private health businesses, which is to enhance the healthcare sector by giving doctors, organizations and health workers increased access to the tools that they need.
Working around this obstacle is an ongoing challenge for our business. Every Monday for the past six+ months, I have directly contacted the maximum number of doctors and health professionals I could across various platforms – one of many weekly routines we’ve employed to reach out to private physicians and facilities to make them aware of our services. This is a lot of work for a company with a track record like ours on the continent: We serve on an Africa CDC Health Information Exchange Task Force; we’re a founding member of the American Chamber of Commerce in the Republic of the Congo (Brazzaville); we have Ministry of Health approval for pilots in six African countries, and additional pilots set up in many others with private facilities, NGOs and other organizations; and we are a partner or collaborator of several key organizations on and off the continent, including the Health Finance Institute, the Wellbeing Foundation Africa and HIMSS.
Even with these challenges, we have managed to continue to establish partnerships, and get our platform directly into the hands of healthcare workers and organizations themselves. This has required me to travel directly to over 35 countries in Africa alone, to meet these healthcare workers and health leaders in person. This approach has brought results, but without widely accepted professional associations and other industry standard bearers, it is difficult for the people I meet – from companies and doctors to investors and donors – to understand which organizations and products they can trust, and who can actually help them reach their goals.
Despite all of this, the opportunities for private businesses to make a positive impact and improve health in the African market are immense. As these businesses build credibility, it creates new opportunities for themselves and their peers. And as technology improves, it becomes more difficult for healthcare organizations to create unnecessary barriers that prevent emerging solutions from reaching the doctors and other providers that can benefit from them – or (as happens in some extreme cases), to deliberately exclude some service providers in favor of others that financially benefit the organization or its decision-makers. This will gradually lead to the emergence of a true, free private sector, where healthcare workers have a voice and can choose the best solutions for their needs – and the products and services that are most likely to improve the health and resilience of their patients, organizations and communities.
If you are interested in learning more about PocketPatientMD, or exploring ways to work with us or support our mission, please reach out at PocketPatientMD.com or contact me on LinkedIn.
Mark Wien is Founder and CEO of PocketPatientMD.
Photo courtesy of Dominic Chavez/World Bank.
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