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PEI Spotlight Seminar: The Future of Public Health in Africa

Africa faces the world’s most dramatic health crisis. Accounting for 24% of the global disease burden, the challenges the continent faces are many and complex, with growing inequities in access to health services and health outcomes across the region. Furthermore, the WHO estimates that NCDs are likely to surpass the toll of sickness and death from infectious disease by 2030, with cancer, type-2 diabetes and heart disease the biggest killers.

Yesterday, the PEI hosted our second-ever Spotlight Seminar, which explored the public health challenges Africa faces today, as well as the scientific and technological innovations that will come to shape the area. PEI Chairman, the Rt Hon Lord Paul Boateng, opened the event with a warm welcome to our guests and a special thank you to our PEI Partners whose support makes these initiatives possible.

Challenges and Opportunities: Defining the State of Public Health in Africa Today

Our first speaker, Professor Charlotte Watts, gave an informative overview of trends and issues in global health in Africa. While there has been incredible progress on global poverty reduction in the past 30 years, Professor Watts pointed out the world’s poorest are increasingly concentrated in sub-Saharan Africa. Nevertheless, African countries have seen significant progress on health indicators such as child mortality and maternal mortality, with a country such as Mali seeing a 31% reduction in child mortality between 1955-2015. Professor Watts also stated that gains in life expectancy and contextual changes such as rapid urbanisation have contributed to a rise in non-communicable diseases such as cardiovascular diseases.

Our next speaker was Dr. Diana Marshall, Editor of the BMC Series Journals, discussed the importance of open access to research knowledge for public health development. She pointed out that open access to research knowledge doesn’t simply refer to the ability to read a research article that has been published, but also involves the ability to use and reuse the aspects of that research with appropriate citation. As such, open access journals allow researchers and medical practitioners in low-income countries, including the African continent, to learn about the latest research trends and novel experimental approaches. Dr. Marshall also noted that BMC Series Journals were among some of the first open-access research journals launched, and bring into the light pieces of research that might have gone unpublished or remain hidden behind a pay wall. A great example is a recent article published by Kwaku Poku Asante et al, which examined knowledge of antibiotic resistance and prescription practices in the Brong Ahafo region of Ghana.

Samy Ahmar, Acting Head of Health for Save the Children, discussed his organisation’s work on the continent. First, he argued that reaching the poorest and most marginalised communities with basic healthcare will be one of the defining challenges of public health in Africa during the Sustainable Development Goals era, as hundreds of millions of people still lack this basic access and nearly 6 million children keep dying from completely preventable, infectious causes, mostly in Sub-Saharan Africa. There are known approaches such as community case management which can support this agenda. Mr. Ahmar also noted that strengthening health systems is the only way to expand coverage in a sustainable way and that this area of work represents a “sweet spot” that can bring together governments, NGOs, communities and the private sector, as they have shown through their global partnership with GSK. He argued that aid alone cannot solve Africa’s health problems, and that raising much greater domestic resources for health through fair, progressive and transparent taxation was the only way to achieve Universal Health Coverage and support the notion that basic services should be free at the point of use. Finally, he affirmed that, while Save the Children is a vocal supporter of UHC, he recognises that it is an empty promise if not associated with improvements in the quality of care. Examples abound in Africa where very poor families and communities will spend significant sums on private providers, for example traditional birth attendants, rather than using the public services available because the latter are poorly perceived.

Next we heard from Dr. Manjinder Sandhu, Co-Director of the African Partnership for Chronic Diseases (APCDR) and the Ugandan Medical Information Centre. In a thought-provoking presentation, he noted that there is a clear need to build large-scale data resources that provide reliable information on the burden and causes of non-communicable diseases across sub-Saharan Africa. He also noted that, traditionally, the task of handling this information has moved to the global North where it is analysed, interpreted, and presented. In 2013, APCDR decided to disrupt this model by developing the Ugandan Medical Information Centre, which will enable the integration, curation and analyses of large-scale data resources in Africa. In this way, the centre aims to support human research capacity in medical informatics and computational genomics within the continent.

Our final speaker in the morning, Max Mallas Secrett, Somaliland Programme, Manager of Kings College, London, gave an overview of the university’s Somaliland Partnership, one of the UK’s longest running health partnerships. He noted that Somaliland has a serious shortage of health workers, estimated at approximately 200 doctors, 1000 nurses, and 1500 midwives serving a population of 4 million people. Furthermore, academic institutions are overstretched and there is a distinct lack of postgraduate training opportunities. In 2000, Kings College partnered with several international actors to embark on the Kings Somali Partnership (KSP), which has a collaborative approach to health system strengthening, with a focus on higher education and training. The KSP’s major achievements include examining every doctor and most nurses that have graduated since the country’s creation and co-publishing 12 academic titles with Somaliland authors, representing 35% of the country’s entire research output.

From there, Lord Boateng invited our audience to participate in a Q&A session with our speakers. We were delighted to see the high levels of engagement from our guests, and listen to the wide-ranging discussion. Issues raised included epigenetic research, debates around Universal Health Coverage, and incorporating traditional knowledge into healthcare.

Innovation from Africa: The Future of Public Health on the Continent

Our afternoon panel opened with a presentation from Dame Sally Davies, Chief Medical Officer for England and Chief Medical Advisor, UK Government. Dame Sally pointed out that that we need to build on the classic cornerstones of public health in Africa, from sanitation and hygiene to adequate housing and education. She also highlighted the contextually relevant technological and scientific innovations on the continent, which include motorcycle ambulances attending complicated births in Sierra Leone, and the increasing use of mobile technologies. Finally, Dame Sally noted, given the rise of non-communicable diseases, greater emphasis needs to be placed on healthy diets and physical activity.

We then heard from Frances Longley, Chief Executive of Amref Health Africa, who spoke about the Innovative Partnership for Universal Sustainable Healthcare (i-PUSH). Funded by the Dutch Postcode Lottery’s Dream Fund, i-PUSH is a pilot project that aims to increase both demand and supply for quality healthcare in some of the poorest and most marginalised communities in Kenya. i-PUSH harnesses three mobile tech innovations to achieve its aims: M-TIBA, a health wallet connected to a mobile money wallet; Leap, Amref’s mobile phone platform providing community health workers with training and communication tools; and m-Jali, Amref’s mobile application enabling community health workers to collect health data effectively at a household level. At the end of the first quarter, i-PUSH had signed up 1,188 women signed up and 47% were already using M-TIBA to save for healthcare.

Professor David Ingram, Emeritus Professor of Health Informatics at UCL, President and Chair of the openEHR Foundation, and Trustee of the OpenEyes Charity, was our next speaker. He noted that healthcare IT is a $134 billion global industry per annum, and is projected to reach $280 billion by 2021. Professor Ingram also gave an overview of OpenEHR, an emerging social enterprise that develops and sustain open specifications and software for electronic healthcare records, freely available under open license.

Following this, Dr. Kunal Patel, physician and Medical Director at iHeed, spoke about innovation, health education and universal health coverage. Dr. Patel began by outlining some stark facts regarding global health. For example, there is a shortage of 7.2 million health workers worldwide, and there is only 38% of nurses in the areas where healthcare is needed the most. Furthermore, apart from South Africa and Nigeria, he observed that there are no other countries that have more than 100 doctors trained to postgraduate level in family medicine or primary care. As a result, iHeed’s report on achieving universal primary healthcare recommended strengthening primary healthcare systems across the continent by securing political and financial support. The organisation also advised on adopting a collaborative interprofessional approach to training for these healthcare workers.

Our final speaker was Dr. Aisha Walcott-Bryant, Research Scientist and Cognitive Healthcare Manager, Kenya Research Lab, at IBM Research-Africa. First of all, Dr. Walcott Bryant noted that Africa’s population growth rate is double that of European countries. At the same time, the continent is facing colliding epidemics of non-communicable diseases and infectious diseases.

Dr. Walcott-Bryant then discussed IBM Research-Africa’s Epidemic Preparedness System and the Chronic Illness Management Systems, solutions that work horizontally across the healthcare space. During the 2014 Ebola outbreak, Dr. Walcott-Bryant noted that there were a huge number of organisations operating in the response, but a lack of coordination in data collection and poor data sharing infrastructure and agreements. What’s more, there was a lack of specialised data analysis skills in the response, which led to delays in data for decision-making, and lost lives. As a result, IBM Research-Africa created the Epidemic Preparedness System, a data management platform that integrates community and health system data, allows quick data analysis for improved decision-making, and provides evidence-based decision support for resource allocation. The system has two main streams of work: disease surveillance, through reporting, resources, and citizen engagement through multimodal platforms.

The rise of non-communicable diseases across the continent prompted IBM Research-Africa to work on the development of the Chronic Illness Management System. Last year, IBM Research-Africa worked with the Kenya Health Federation to conduct a study on the treatment of hypertension in the country. One of the study’s key findings was that pharmacists and traditional practitioners are a major source of healthcare for many households and that there is limited outgoing support for patients to manage these conditions at home. In addition, treatment of non-communicable diseases is compounded by challenges including health literacy and education and adverse drug reactions. In response, IBM Research-Africa developed the Chronic Illness Management Platform, a health analytics engine that provides cognitive support for healthcare providers to address medication challenges, support for regular measurements on IoT and medical devices, and patient outreach.

Our guests then embarked on another spirited discussion with our panellists, which explored issues such as air pollution on the continent, empowering community health workers and fostering global health leadership. PEI trustee, Sir Christopher Edwards, then closed the event by stressing the importance of addressing basic health challenges as well as creating innovations.

Thanks go to our distinguished speakers for their illuminating presentations, as well as our attendees for their active participation! We are especially grateful for our PEI Partners whose assistance makes these events a reality.

Here are our speakers’ presentations:

Professor Charlotte Watts’ presentation

Dr. Diana Marshall’s presentation

Dr. Manjinder Sandhu’s presentation

Max Mallas-Secrett’s presentation

Dame Sally Davies’ presentation

Frances Longley’s presentation

Professor David Ingram’s presentation

Dr. Kunal Patel’s presentation

Dr. Aisha Walcott-Bryant’s presentation

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