At the recent International Finance Corporation (IFC) conference on “Developing Resilient Health Systems in Emerging Markets,” Kenyan Professor Khama Rogo urged South Africa to join the Colleges of Medicine for Central and East Africa, to improve specialist training and set joint standards. This article by health journalist Chris Bateman describe how Rogo, part of an African think tank that developed a joint African training platform, emphasised the need for collaboration between African countries and said cross-border regulation and setting up universal standards was essential to enable healthcare professionals to work everywhere. Rogo also noted that while countries like the UK and Canada have recruited Kenyan nurses in large numbers, South Africa has not collaborated with other African countries in the same way. Sadly, he said his repeated appeals to South Africa had fallen on deaf ears. This article first appeared on Med Brief Africa. – Nadya Swart
SA’s ‘health Ubuntu’ wake-up call
Repeated appeals to SA to join the Colleges of Medicine for Central and East Africa, enabling crucial collaboration on specialist training and crafting joint standards, have “fallen on deaf ears.”
This was claimed by Kenyan Professor Khama Rogo, a global consultant and keynote speaker at the International Finance Corporation (IFC) conference on “Developing resilient health systems in emerging markets,” held in Cape Town on Wednesday last week (Feb 14th).
Rogo, part of an African think tank that developed a joint African training platform, was speaking to Medbrief Africa shortly before taking the podium for his keynote address.
“Most African, including Swaziland, Zambia, Malawi, and Tanzania, belonged to this body – but not SA. We want to bring training together, using all our hospitals and expanding the scope and area of training. The number of people training registrars is finite, and we have to share them. I think your SAMA, HPCSA and the bureaucratic system don’t allow things to happen quickly. We last approached them just before COVID when I gave two keynote speeches to a conference of one of your regulatory bodies,” he said.
With Kenya and South Africa having the strongest regulatory frameworks in Africa, there was a crying need to work together across borders, Rogo said.
“The best thing we can have is cross-border regulations and set up universal standards so our healthcare professionals can work everywhere. It’s a myth that SA is ahead of the rest of Africa. We all need to get all our standards up. You speak Ubuntu, but you don’t live it,” he charged.
How Kenya helps its jobless nurses.
He illustrated this during his keynote address, citing a treaty signed last year between Kenya and the United Kingdom, enabling 9,000 surplus Kenyan nurse graduates to work in the UK.
“The UK and Canada have been recruiting them in hordes. It’s now easy passage. Southern Africa has some of the most robust nursing schools in Africa. Kenya can only afford one thousand nursing posts annually, so we help the others advance in this way. The private sector wasn’t absorbing them, and they were being forced to get jobs outside nursing. You know, the problem is not just the production of human resources – the question is how do we pay them?” he added.
Rogo said a recent Kenyan study showed that to improve healthcare services, the most productive approach was to produce and recruit skilled healthcare workers.
“Increasingly, the private sector is taking over the training of human skills, but the cost of training eludes the poor, so there’s a challenge on sustainability. We need to produce, use and retain staff,” he added.
An obstetrician-gynaecologist and holder of Kenya’s first Lifetime Achievement Award in Healthcare (2019), plus the coveted Zenith Lifetime Achievement Award for Excellence in Health (2021), Rogo, 64, has been an advocate for reproductive health and human rights for three decades.
A consultant to several international development agencies, he knows Kenya’s hospital system intimately.
He said a recent meeting of the Deans of Kenya’s Schools of Health Sciences agreed on three priority health challenges.
These were: teaching faculties plus the creation of teachers, library services and the procurement of “just about everything.”
“A lot of equipment is state-procured – it takes a very long time, and you end up not being able to deliver the best healthcare. One example is the tech you need for teaching.”
Global funders and philanthropic agencies needed to appreciate and learn from the critical role of impoverished parents when it came to resilience.
Impoverished people model resilience.
He put up a slide of a father, his wife and child on a motorbike, with a heavy suitcase and mattress on the wife’s head, en route to their child’s boarding school.
“We are nations of resilience. If only the healthcare sector were like that father or the early missionary hospitals that were set up with literally nothing but faith to sustain them,” he added.
He said the problem was not confined to LMI countries.
“You can define resilience as the capacity to withstand shock and recover quickly. If you look at your own country, do you really believe it’s resilient?” he asked his global audience.
“In New York, they had to call in the army to help during COVID. That means the health system is not doing too well. We forget about our own inbuilt resilience,” Rogo added.
Tripartite partnerships between governments, investors and communities were needed – one of the main problems being constantly changing political officials, creating a lack of continuity.
One example was the IFC recently invested in a critically needed hospital in Lesotho.
“When the politicians changed, and a new group came on board, everybody denied that they knew what the contract said,” he said.
Country-specific solutions were also “essential.” He cited the differences in societal attitudes to reproductive health in Ghana and Bangladesh.
Global agency’s Fool’s Errand.
“USAid put contraceptives in the hands of shopkeepers in Bangladesh where they are trusted by women in the community. In Africa, however, women deeply mistrust shopkeepers, so community healthcare workers are far easier to create access. But they repeated the shopkeeper gambit in Ghana – it has never recovered,” he said.
Rogo said international agencies had to become better listeners than they had been “and for far longer.”
Many agencies set up in a country for two or three years and then moved on.
“You must be able to continue. In Ghana, one year, they had three health ministers. Every time you had to explain to the new incumbent what’s happening.”
He said that when COVID arrived, instead of a coordinated global response, nationalism emerged.
“For the first time since Jesus died, we started changing the reference to the BC of our time (Before COVID). And AD is not after the death of one person but after the deaths of millions. The vision of BC and AD, with COVID in between, is unbelievable. It challenges us to plan and budget and procure differently.”
He said universal health care and sustainable health systems were not achievable without honest and effective participation by non-state actors.
“No government can exist with the levels of corruption we see in the health sector in every country – developed and underdeveloped. Until we get honest people in this sector, resilience is but a dream,” he added.
Lease, don’t buy!
Rogo strongly punted lease agreements as a cheap and effective way of deploying medical equipment, with maintenance and repair clauses avoiding “the graveyard of equipment you see behind every State hospital.”
“Buying equipment in emerging countries is madness. Things last two years if you’re lucky. The private sector should be part of this discussion. Part of the reason it doesn’t work in Kenya is that the middlemen in the production pipeline whisper in the ears of the politicians, saying they can get this or that cheaper for them. This is the very enemy of resilience.”
Earlier, Farid Fezoua, the IFC’s Global Director for Health and Education, told the estimated 500 delegates that COVID had turbo-boosted digitisation and telehealth.
“The (global) digital health market is being estimated to grow by at least 19% (2023 growth level) from its’ $200 billion levels in 2022. But we need a separate digital initiative for education. Without the right healthcare workforce, the health system will collapse. You need strong ecosystems on a continuous basis, so any pandemic can be negotiated better,” he concluded.
Fezoua said that with the global population ageing by a factor of three, healthcare provision would have to grow by a factor of five to cope.
“The shift of the disease burden to non-communicable diseases (NCDs) was at 60% (NCDs) in 2015. It will grow to 70% more by 2030,” he said.
Emerging markets needed access to reliable sources of supplies of medical equipment, technology and pharmaceutical products, plus a trained workforce.
“We must help countries to be more self-reliant on production and create a trained workforce for decent outcomes. The public sector cannot do it alone. COVID prompted great innovation from the private sector, which was a major provider across low and medium-income countries, weighing in at 60% in India and Pakistan and 30% in Ghana. The IFC can serve as a public/private bridge in emerging countries,” he said.
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