Products to People: Episode 3 – Increasing Private Sector Capacity

Transcript

Tiwonge Mkandawire: You’re listening to Products to People, an integrated public health supply chain. I’m your host Tiwonge Mkandawire, bringing you guests from the global health sector to discuss the importance of integration for building equitable, people-centered, resilient, and sustainable public health supply chains.

If you talk to people in most streets in Africa and ask them about how they access health services, they will tell you about one of two options: there’s the public sector and the private sector. And the difference and ability to access one of those usually boils down to what you can afford as an individual or whether if you have medical aid or not.

The reality, though, is that private sector service providers have a lot of capacity in these low and middle-income countries that, in our opinion, is underutilized. It is an untapped resource that, if maximized, can help strengthen public health supplies availability by improving functions like warehousing, distribution, and also to the point where we can leverage private sector to deliver products right to the people.

One of the key elements though in us being able to tap into this resource that is the private sector is data. How can we get accurate, timely supply chain data from both the public and private sector and make sure that it’s exchanged in a way that facilitates that collaboration? This data can help maximize on the collaborations that aim to strengthen public health supply chains.

However, there are also other challenges that come with this, and I am super excited today to be joined by our guest Remi Adeseun, who is the director of Salient Advisory. Remy, tell us a little bit about yourself and your experiences with this journey of trying to leverage private sector capacity for public health.

Remi Adeseun: Thanks very much, Tiwonge, for having me, and I’m an admirer of the good work you do at VillageReach. I am a pharmacist of about 35 years postgrad now, and I’m a fellow of the Pharmaceutical Society of Nigeria as well as the Nigeria Academy of Pharmacy. If you look at my 35 years, 18 of those first years were in core pharmacy practice. And it spanned across the full spectrum from community pharmacy to hospital pharmacy, ending up in industrial pharmacies, where I left in 2005 as the country manager for Janssen-Cilag.

If I bridge from that, one of the things I’ve done actively is participate in building the ecosystem. I’ve been instrumental in forming quite a number of professional associations, ranging from the association that represents the research and development manufacturing companies in Nigeria. I was also a founding executive of the Healthcare Federation of Nigeria. One of the reasons for that is my interest in health policy and advocacy, something I’ve helped to lead working on Bill and Melinda Gates Foundation-funded projects to advance advocacy for child and family health and also increase in budgetary allocation for health.

Currently, I am director at Salient Advisory, and Salient’s Advisory is a boutique global health consulting firm. What we do is to help global change-makers, and by that, I mean folks like donors, government, investors, better make investment decisions on African health tech innovations. So that’s who I am, and I’m happy to be in this program. Looking forward to an exciting time with you, Tiwonge.

Tiwonge Mkandawire: Thanks, Remi. I like that term that you just used, the change-makers. Because I think when it comes to the conversations that we’ve been having on this podcast, a lot of it is about how we can work together with those key change-makers in the health space. So the government, the regulators, private sector entities, donors who have that authority, and the opportunity to actually influence things. When it comes to the role of Salient in working with these change-makers towards improving health services, towards improving supply chain functionality., can you tell us a little bit about some of the projects that you’ve been involved in so that our audience can better understand what you do?

Remi Adeseun: Thank you very much, Tiwonge. At the core of our work is a realization that it takes ongoing market intelligence to track the innovations on the health tech scene in Africa. And we’ve had a program that conducts this market intelligence on an annual basis, tracking data about innovators in the health tech space, specifically focusing on those that are deploying tech-enabled business models to transform healthcare supply chains. We focused on the healthcare supply chain specifically because we recognize that the public sector health supply chains, which many Africans rely on, are significantly overburdened and underresourced. And clearly, as data shows, people move away from the public sector, and the private sector channels have been and remain a compelling pathway to accessing healthcare services and products on the continent.

What we see, however, is that these channels are faced with their own challenges that impact the accessibility and the affordability of good quality health products. And what we’ve done is identify health tech innovators who are helping to resolve these challenges with commercially viable and, more importantly, socially impactful digital solutions. So the bulk of our work at Salient is advocating for these private-sector companies. We publish an annual report that highlights the trends in this space, and that makes recommendations to these global changemakers. We describe on how best to leverage health tech for critical health program objectives in Africa.

Tiwonge Mkandawire: That sounds very exciting. You mentioned how there are a number of these health tech innovators, and they are faced with a number of challenges. So what are the things that are keeping people and health systems from fully utilizing this capacity that the health tech innovators and existing private service providers bring to the table? And how that relates to your recommendations to those key change-makers?

Remi Adeseun: Yes, indeed. If you look at the building blocks of a functional health system, at the top of it is governance. The reason this is important is that the enabling environment that is required for innovation to thrive also has to balance both the concerns for the patient safety as well as the concerns for encouraging innovation. So one very important aspect which we feel is required for the successful integration of the private sector and its capacity into general public health systems is regulations. And when we say regulations, we are very emphatic in saying innovation-friendly regulations. As other sides of tech have shown, typically, innovation precedes regulation because the innovators are not really waiting for prompts. They see gaps in the market, they have the knowledge and the passion to develop solutions, and they go ahead to release their products. Over time, regulators come to notice, and two types of reactions are possible: one a draconian clampdown on innovation and the second one is a more thoughtful, collaborative, consultative approach to integration. So what we think is very important is an innovation-friendly regulatory environment that supports the activities and growth of the private sector innovators.

The second thing for the successful integration of the private sector is that if we look at the economics of health systems in Africa, a lot of it is influenced by government spending and the international donor spending. But many times, the demand from these public purchasers is not quite clear because there’s not enough understanding between the public purchasers and the innovators as to what kind of innovations that really matter most. So, we feel that this unclear demand from public purchasers is a challenge, but it’s a challenge that can be overcome. And that’s why, again, under a Bill and Melinda Gates Foundation-funded initiative called the Investing in Innovation, it’s called I3, and the whole idea of that is to bring together in a platform the consumers or the potential purchasers of the services of these innovators and the innovators themselves. So those two are what we think is very important: regulatory environment that is enabling unstructured demand from large public purchasers.

Tiwonge Mkandawire: Thanks for that, Remi. When you mentioned unstructured demand, I couldn’t help but almost reflect back to the hundreds of conversations where potential private providers are like, “Well, we could have met this demand, but we were not really sure what they actually needed.” When you think about this situation where public purchases are struggling to provide a bit more clarity around their demand, what are the things that are making it difficult for public purchases to be able to provide better signals of what might be needed now or in the future?

Remi Adeseun: I think a big part of the challenges that public purchases face includes the lack of data to inform supply chain planning. Prashant Yadav and others have written very extensively on these health systems challenges. And we have also seen it in our tracking of the health tech scene that the lack of data for planning procurement, for planning for casting even before procurement, and also distribution is a very big challenge. And that is something that needs to be overcome for more efficient and effective supply chain management. Lack of product visibility across the supply chain is a big problem.

Tiwonge Mkandawire: That’s definitely a concern that’s there across the board. In fact, when you look at the integration framework, one of the pieces that we say is a key enabler is that data piece. Making sure it’s available, making sure the necessary insights are being obtained from the data.

Enjoying the conversation? Shocks and disruptions in a health system prevent people from accessing medicines when and where they need them. Building equitable people-centered, resilient, and sustainable supply chains requires integration. Download the Integration framework now at www.productstopeople.org. That’s www.productstopeople.org. You can also find links to the framework and other materials on this episode in the show notes.

There’s an additional layer, though, that I’d love to hear your thoughts on. In a number of conversations I’ve had, one of the things that keeps coming back as a key block for not being able to share data is a certain kind of intangible lack of trust between the two entities. Is trust an issue in facilitating sufficient collaboration between public and private sectors?

Remi Adeseun: It’s very encouraging to see the congruence in our thought, Tiwonge, because in preparing for this conversation, one of the things that I put down as what we need to discuss is how do we build meaningful collaboration that will be sustained. And trust was the key word that I put down as a major lever. I think there are two ways that make it enduring. One is by design, and the other by intentionality. So what we see many times when you hear about public-private collaboration is typically a top-down approach. Where when the policy has been formulated, the public sector invites the private sector and simply tells them what we have on.

So if we take a look at the online pharmacy regulations, by online pharmacy, we mean direct-to-consumer channels that bridge that gap between the manufacturer and the user, reducing the layers of disintermediating and helping to improve across the functions of availability, accessibility, and affordability. In some countries, like Nigeria and Ghana, they have regulations in place. But one of the complaints from the private sector was that as they’ve been consulted, they would have made inputs that will make the regulations better fulfill their goals. And now there are barriers in those regulations that would need to be resolved, so creating rework that could have been avoided. So building that intentional consultative approach between the public and private sectors from policy formulation stage, not at policy execution stage, is very critical.

The second one I said is by design. The best way to achieve ongoing data availability in a trust environment is by designing a platform that is made to capture that data on an ongoing basis. And this is where a country like Ghana has really shown leadership in being, to the best of our knowledge, the first country in Africa that not only is providing regulations for online pharmacy but is coupling that with creating a national electronic pharmaceutical platform. Now, if you look across, in terms of what we were attempting, a pharmaceutical data platform that should be complemented by design with the pharmaceutical supply chain data sources, so GS1 standards are becoming the gold standard for traceability in Africa. And we are advocating, actually, the creation of what we termed the Pharmaceutical Data Platform, which we combine various data sources from both the pharmaceutical care workflow, meaning the e-pharmacy platforms, as well as the pharmaceutical supply chain traceability platforms, and have that integrated in a repository that includes trusted agencies. You’ve seen some countries like Nigeria, the National Bureau of Statistics is a trusted agency for many of the health datasets that come so deliberately involving and incorporating such agencies to manage such repositories builds the trust. And having these discussions, not just at national level but at regional as well as global levels, will play a major role in overcoming these trust issues.

Tiwonge Mkandawire: Thank you for that. I’m so excited you mentioned GS1 standard. So I was in Zambia for the People that Deliver Indaba, and as a part of it, they took us on a tour to the newly revamped central medical store. So they have it as a pretty much automated system, and they’re able to leverage the GS1 coding standards so that they can basically pick, pack and arrange their warehouse. The one thing that remains an issue is the ability to extend that visibility outside of the warehouse all the way downstream into the health facilities. So the question I have for you is when we think about the work that needs to be done to build up or improve on that infrastructure and the processes that will help us really create that visibility or traceability capacity, what are the potential roles where private sector can be brought in to help move the needle on that development journey?

Remi Adeseun: Yeah, I think that’s a very important question, Tiwonge, and there are quite a number of important considerations that need to be made. So I’ll take some examples from outside of Africa. So if you see how much involvement the government had, let’s say, in the US, for instance, in introducing electronic health records, these are some of the building blocks of health management information systems. And not only did the government have a clear policy that mandated this, they also gave very reasonable timeline for which to be accomplished, longer than ten years. And they also provided support, financial support to help the health establishments to digitize their operations, meaning actively incorporating digital technology and designs into how users, patients, consumers access their products and services. So that conscious effort to have a policy and to have support for this technology infrastructure to be in place is important, so funding is very key.

But in addition to the funding, is also a conscious drive for adoption by the private sector players, so technology infrastructure development and adoption by the private sector backed by policy will be a very important consideration. And the cost of these things is not to be underestimated, and this is where support from the partners in progress with governments, private sector in Africa will be required. Piloting these things and following the example of Ghana and watching how that evolves, monitoring it, and not just assuming that it is all hullu because a launch has happened. Lessons will be learned that can be shared to improve performance of this and its impact on supply chain performance in general.

Tiwonge Mkandawire: Remi, when you made the comment about how exciting it is that our thoughts are aligning, I have to totally agree. When I listen to you talk about how one, the government needs to be right in the forefront, making sure that they’ve got clear plans for what needs to be done, what the starting point is, how much actually needs to be invested to move us forward and create the right policies to enable the private sector to play, I can’t agree with you more. And I think if we have situations like that where there’s more clarity about what’s needed, it makes it that much easier to then work with the other change-makers, the donors, to maximize their investments, to achieve what you’ve just described. One last question and I’m going to take you back a little bit to a comment that you made about some of the work that Salient is involved in with the Bill and Melinda Gates Foundation that’s i-3, Investing in Innovation. Can you tell us a little bit more about that work because it sounds so exciting?

Remi Adeseun: Thank you very much again, Tiwonge. I think the I3 Program, Investing in Innovation in the Health Tech Space, the very encouraging thing there is watching how thoughtful study, insights generation, and recommendations actively acted upon by those who can. This is a major point to be emulated by others where you commission a study, not for its own sake, but to solve a pressing problem. And in many instances, recommendations abound in Africa from well-researched topics that have never been put to application. And the Bill and Melinda Gates Foundation really deserves a kudos for taking on this recommendation that came from multiple studies, by the way. Not just the market Intelligence study but others on blended financing that still had that common thread of the need for early-growth stage innovators to have risk-tolerant funding that allows them to scale and contribute to the achievement of important public health goals, of improved access to affordable and good quality medicines.

So this is what the I3 Program is designed to start, and it kicked off as a $7 million investment. It’s Pan-African in nature, so four regions North Africa, Southern Africa, and then East and West Africa. There are 30 innovators who receive a grant of $50,000 and will be supported by accelerator and commercialization partners, one for each region, helping to oversee the access to market, access to training, access to all those key success factors for these innovators who are lucky to get through. There were about 400 applications, out of which 30 were successful, so you can see that it was very competitive. And in each region, you have, on the average, about seven to eight innovators. So they’re going to be receiving not just the funding but also investment readiness training.

We had our first Access to Market event in Lagos in December. Access to Market is the title of the flagship program of the Investing in Innovation program of the Bill and Melinda Gates-sponsored initiative that has amongst its co-sponsors quite some significant industry players. You have the likes of MSD and AmerisourceBergen from the pharma industry, and you also have industry tech giants like Microsoft and a host of others who have really come on to take full part of this. So what that Access to Market event proved was the interest on the public sector side in actually getting to meet innovators that can improve the access to affordable and good quality products in Africa. So we had over 115 participants cut across sponsors to the donors to government, and the government’s presence was very interesting. We had, from the national government, from the Federal Ministry of Health to all its implementing programs, the National Supply Chain Program, and the individual TB, Malaria, and HIV programs.

So if you match that with the donors and like the Chemonics and all the rest of them, we had a situation that we match made about over 200 one-on-one meetings between these innovators and those key partners across government, and they’re now starting to see partnerships. Just in less than a month, at least about nine partnerships have been signed, and the interest is just blowing up. So the partners led with Salient Advisory and other partners, the Southbridge Investment and Southbridge A&I and the SCIDaR, Solina Center for International Development and Research, really put the show together. The next edition of it will be in November 2023, and this time it will be in Nairobi.

Tiwonge Mkandawire: I am super excited about that, and I was trying to think of a clever way to wrangle an invitation to that Lagos party, but we can talk about that in a minute. Any last burning thoughts that you wanted to share that maybe we didn’t get a chance to go to?

Remi Adeseun: I’ll just say that a systems approach is very important in driving forward this concept of using technology, health technology, to improve access to good quality and affordable products. And two things that I would like us to keep in mind and advocate for is that pharmaceutical data platform is something that should be driven into existence at both the national level and the regional level, and the global level. The second thing in terms of systems thinking is that there are some precursors to the success of the electronic disintermediation of the supply chain. Right? And those are things like e-prescriptions. If there’s no e-prescription and you’re still relying on paper-based prescriptions, yes, in the short time, that can still be digitized and incorporated. But we need to consciously move to a system that has e-prescription built into it over time so that a unique identifier is there for both the prescriber as well as unique identifiers for the patient, in addition to unique identifiers for the places that are credited for accessing these services and health products. So overall, I think that systems thinking to bring more people than would ordinarily be reached through traditional legacy systems.

Tiwonge Mkandawire: That is fantastic. Thank you so much, Remi. We need systems thinking, government at the lead, an innovation-friendly regulation environment, and basically doing everything we can to work with public purchases and government to get over this space of unclear demand to a point where they are designing and being intentional about it so that we can actually leverage private sector capacity in this space. Thank you, and looking forward to more conversation.

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