New Rules for a New Africa

Aug 01, 2013


(Getty Images/David Malan)
Africa has long been seen as a caricature of calamity—an object lesson on what not to do in making public health a driver of balanced economic and social development. Ravaged by a potent mix of infectious and chronic non-communicable diseases and political conflicts, the region sat neglected by investors for decades, a destination to nowhere even for companies with a business commitment to better health. The greatest mistake was to consider ­Africa as the "carbon copy" continent: uniformly poor, culturally deprived, and entrepreneurially challenged despite its immense, varied topography and a rich, complex mosaic of ethnic and racial affiliations.

But things change. Africa now deserves a second look, however, especially as growth prospects in the mature markets of Europe and the United States are fading due to aging populations and deepening fiscal constraints in key demand sectors like healthcare. Africa actually now presents a refreshing contrast to this politics of decline, with the world's youngest population and a new highly educated class of business leaders that has benefited from a regional transition to democracy—"regime change" in most countries is now taking place peacefully, through the ballot box.

Just a decade ago, Africa was an uncharted frontier for most of the global pharmaceutical majors. Companies familiar with the structured world of developed markets found themselves without the necessary tools to identify opportunities and build market share in the region. A key concern at the time for African governments was how best to leverage private sector support to find solutions to system-wide healthcare issues like access to medicines. In one of the first examples of public/private sector cooperation, the Abbott Fund and the government of Tanzania formed in 2001 a joint collaboration to strengthen basic health infrastructure. During this time, many hours were spent working closely with the Ministry of Health to highlight critical areas of needs in the midst of what was a chaotic time for many African nations. With more than 23 million people living with HIV/AIDS in Sub-Saharan Africa alone; skyrocketing case loads of tuberculosis, malaria, and other communicable ailments; and woeful under-capacity in essential primary care services, decision makers struggled to know where to start.

As the HIV/AIDS epidemic grew, so did pressure on the global pharma industry to invest in infrastructure and capacity building projects and to provide free-of-cost or lower-cost goods as a subsidy to patients and governments. This left many companies, whose business model focused on serving urban hospitals and the small slice of the population with the means to pay for medicines out-of-pocket, totally unprepared. With countless non-profit and national and multilateral aid organization playing the lead role in managing the health crisis, the pharmaceutical companies' hands-off stance led to them taking a reputational hit, with a spillover impact on the big Western markets where most of their profits were spun.




While clouded with controversy, some industry investments in Africa did play a role in controlling the disease burden, building infrastructure, and even contributed to policy development, in some cases. For example, as part of the Abbott Fund project, an HIV/AIDS wing was built at the Kilimanjaro Christian Medical College (KCMC) in Moshi, Tanzania. After completion in 2003, the beds were quickly filled with HIV/AIDS and tuberculosis patients requiring in-patient care, and over time, the availability of ARVs led to a significant decrease in HIV/AIDS-related hospitalizations in the district. Another example is a recently published impact analysis (BMC Public Health) of Boehringer Ingelheim's Viramune Donation Program, which from 2000-2013 provided free-of-cost the drug nevirapine in 34 Africa countries to mothers and their babies to prevent the transmission of HIV/AIDS. It found that availability of the drug at such a crucial time generated a positive cycle of community demand, which in turn encouraged the uptake of local comprehensive preventive mother to child HIV transmission services and fostered new partnerships with national and international organizations. The feedback helped create the political momentum to institutionalize these services through specific policy directives enforceable at the national level.