BRIDGING THE HEALTH FINANCING GAP IN AFRICA

Michelle Akande, Vice President of Global Access Financing at Pfizer outlines why building connections across the global health community and developing new solutions has never been more important, especially for Africa. 

We are living in an era of unacceptable juxtapositions. In 2015, a report about the frontiers of longevity postulated that a child born then could live to 142 years. On the other hand, life expectancy in the lowest ranked 10 countries in the world ranges only between 55 and 60 years. Even where life expectancy is getting longer, people aren’t necessarily getting healthier, which means facing many years lived in poor health. 

Scientific breakthroughs, an important part of closing this gap, are accelerating at an unprecedented rate. However, access remains a challenge to some of the most underserved populations globally. Access is being compounded by several immediate and longer-term mega trends including the economic consequences of COVID-19, the food crisis caused by the ongoing war with Russia and Ukraine, and the triple burden of disease–often referred to as the culmination of communicable diseases, the growing epidemic of non-communicable diseases, and emerging globalization related conditions like pandemics and the impact of climate change on health.

The pharmaceutical industry will continue to be a key player in advancing scientific discoveries whilst also helping to equalize access to quality healthcare. At this inflection point in human history, that responsibility has never been more critical. According to the Institute for Health Metrics and Evaluation, there is an estimated gap of $370 billion annually on health spending in frontier countries, which includes African countries, if the Sustainable Development Goal target is to be met by 2030. The Global Impact Investment Network (GIIN) tells us that, of the estimated $500 billion annual global social-impact investment, Africa receives only 1.6% yet it has 23% of the global disease burden and is home to 16% of the world’s population.

Equalizing access and accelerating health equity in our changing global context requires new thinking. It requires seizing this pivotal moment and leveraging the increasing democratization and decentralization of health with those who shape it and those who fund it. It is no longer feasible just to think about interventions from the perspective of big philanthropy or government financing–even though these remain critically important.

During the World Economic Forum’s Annual Meeting at Davos this year, Pfizer announced ‘An Accord for a Healthier World’, a transformative initiative focused on providing our current and future patent-protected medicines and vaccines available in the US and EU to 45 low-income and lower-middle-income countries on a not-for-profit basis. The Accord is also an invitation to collaborative action with other access and health equity focused health actors. It is the first step of a long-term commitment to close the time it takes to access scientific breakthroughs in these countries, and an opportunity to leverage earlier access to innovations to support health system strengthening. 

Under the leadership of their governments and the support of global health partners, work is already underway in the first countries to implement the Accord. Taking a patient centric approach and led by governments and with other stakeholders, the Accord is working at select facilities to identify healthcare gaps and optimize the patient journey, leading to improved health outcomes across rare diseases, cancers and rheumatic conditions. Although needs will vary across facilities and health systems, this will likely involve leveraging appropriate innovative service delivery tools, and leapfrogging approaches to close demand and supply side gaps, including the availability of efficient referral and patient navigation networks, strategically positioned diagnostic and laboratory infrastructure, treatment access and patient adherence, as well as counselling and other support services where needed. Making this transition will take resources meaning we also need to challenge ourselves in creating new, commercially viable and sustainable models for identifying and securing financial support.  

As interest rates rise globally, currencies are devalued, and liquidity becomes more challenged, new financing will be required to close health system gaps. With over 50% of low-income countries facing the possibility of debt distress, that financing will need to be patient and transformational. 

Such transformation is already emerging from collaborative efforts. During the United Nations 77^th General Assembly, Pfizer and partners hosted the Accord House, an opportunity for government, the private sector and the global health community to discuss how best to address the health equity gap and enable greater well-being in lower-income countries. During a discussion on Health Systems Financing which was moderated by Prof. Prashant Yadav, Academic Director of the INSEAD Africa Initiative, we heard the Minister of Health for Ghana, Mr. Kwaku Agyemang-Manu, Zeynep Kantur Ozenci, Global Sector Manager for Health and Education at the International Finance Corporation (IFC), Sebastian Ashong-Katai, Group Head of Financial Institutions and International Organisations at the EcoBank Group and Michael Anderson, CEO of MedAccess talk about agreements between Governments, Multilateral Organisations and the Private Sector that are unlocking concessionary financing for health. Likewise, partnerships between development finance institutions and commercial banks are resulting in new products with longer payback periods and lower interest rates. Health-focused funds by influential investors are also playing a critical role in catalyzing and encouraging diverse participation, whilst de-risking health investments. While smart finance solutions like volume and procurement guarantees are part of a proven solution for addressing systemic market failures. 

This is the type of transformation that will contribute to sustainable health system improvements and improved patient outcomes–from results-based financing to repurposing sovereign debt; from decentralized finance to blended finance solutions; from risk sharing arrangements to the use of credit enhancements; and, from the organizing of remittances going back to developing markets to donor-assisted funds. The range of actors, trends and financing pathways present a unique and urgent opportunity to close the equity gap in financing healthcare and addressing the social determinants of disease. Emboldened by our purpose to bring breakthroughs that change patients’ lives, we are collaborating across these actors, leveraging these trends and instruments to enable the shared vision for a healthier world. Not only do these approaches provide an opportunity to redefine financial pathways globally, if organized optimally, they can revolutionize how healthcare is financed.

As we build on Pfizer’s presence in Africa, which dates back more than 70 years, building connections across the global health community and developing new solutions has never been more important. Health care financing has been decentralized, which means that private and public money, capital markets, corporations, individuals and more have a role to play in building sustainable equitable healthcare solutions and reorganizing funding. We must all work together to help close the health equity gap, strengthen health systems and enable better patient outcomes.