Demonstrating impact to drive sustainable change
Supported by evidence-building and research, the advocacy we do aims to set the agenda of digitalizing health financing and delivery and showcase successful approaches that can eventually lead to the fundamental transformation of health systems. Through advocacy and effective partnerships, we can scale solutions that contribute to a health system where trust prevails.
Providing a strong evidence base
Before suggesting a new approach, we first build a strong evidence base. Evidence is built through research and pilots, both our own and those of others. We published 15 research papers in 2022, most of which are done in cooperation with international and African research institutes. Collectively, this evidence demonstrates our paradigm and gives governments the evidence and business case they need to develop and implement a transformative policy. Although our biggest reward is impacting the lives of patients, awards help highlight the results of our efforts and provide recognition for PharmAccess to better engage governments and key stakeholders. In 2022, we received six global awards that garnered appropriate media coverage. One of the highlights this year was the recognition of MomCare as a Global Innovation Hub by the Global Coalition for Value in Healthcare at the World Economic Forum. We supported various countries in their work, in line with the Dutch development agenda. We helped organize a trade mission of Dutch companies, including those working in healthcare, to Kenya. In Nigeria, we facilitated the work towards the Health Sector Market Study, commissioned by the Dutch Embassy, to foster collaboration and investments between Dutch and Nigerian businesses. We equally participate in the Ghana-Netherlands Business and Culture Council. These are important steps towards ensuring aid is seen for its role in economic development, not just as donations. Lastly, we contributed to the development of the Dutch global health strategy as part of the Dutch Global Health Alliance. In the strategy, PharmAccess (including SafeCare, Medical Credit Fund and spin-off company CarePay) is highlighted as a good example of private-sector collaboration.
Long-term commitment to drive change in health systems
Advocacy is a continuous process: digital technology, data, and innovation have not yet fully delivered on their huge promise for healthcare in Africa, but we firmly believe in their potential to change the healthcare paradigm. Ongoing initiatives show us the contribution that digital technology can make to ensuring quality healthcare is accessible and inclusive, including new models for remote care and value-based financing, but we have seen too little scaling of these approaches. We continue to advocate for these approaches through policy dialogue and capacity building, bringing these innovative approaches to life at scale for the benefit of especially vulnerable and poor populations.
Our advocacy work centers around four main areas:
Increasing local financing for health
Low investments and inefficient spending on primary healthcare are two of the main challenges when it comes to ensuring continuity in health financing and delivery of care. Our advocacy in this area aims to encourage the government to increase and use its funding for healthcare efficiently and develop a sustainable approach to financing care, for example through health insurance schemes and value-based care models. This requires a long-term collaborative approach with the country to help provide evidence for the change, and encourage the development of better policies for health financing and use of digital technology.
Achievements in 2022
In 2022, we saw some success with our advocacy for innovative approaches to increased government spending on health. In Zanzibar, we suggested to the government a levy paid by tourists that would contribute towards financing healthcare insurance. In Ghana, our evidence fed into a policy to use some of the tax from goods and services (2.5%) to finance care for vulnerable populations. And at the Tanzania Health Summit, which PharmAccess helped to organize, our advocacy on maternal health led to more discussions with the Ministry of Health about potentially shifting funding towards maternal care. The new Health Insurance bill in Nigeria makes health insurance mandatory for all citizens. PharmAccess supported the review and alignment of the bill and advocated for using digital technology to administer the scheme and to pool funds, combining donor and governmental funding to support the lowest income groups that cannot pay the premium. These elements are present in the final Act.
In 2022, we published several studies that highlight the impact of health insurance. (+) Patient’s perceptions of quality of care and commitment to health insurance (+) Effects of temporary suspension of financing of the health insurance scheme in Kwara, Nigeria (+) Short and long term effects of health insurance on catastrophic health expenditures, Kwara, Nigeria
Driving public-private engagements in the healthcare sector
In sub-Saharan Africa, we see the private health sector filling critical gaps where public services are insufficient, of very poor quality, or absent. PharmAccess strongly believes in and advocates for including the private sector in the process of strengthening and reforming healthcare systems. Many of our innovations for the health sector started in – and with – the private sector and then scaled up to the public sector. Our advocacy also focuses on promoting better policies for innovations and enhancing the capacity of the private sector, including ways to ensure the poor can access those services without huge out of pocket expenditures. In Zanzibar, the government stimulates public-private partnerships to increase availability of services. For example, 12 government hospitals outsourced radiology to a private sector hospital, which received a loan from MCF to grow its capacity. We have also supported the setting up of Zanzibar Private Hospitals Owners Association (ZAPHOA) to stimulate policy dialogue and promote investments and better care delivery in the private health sector.
Achievements in 2022
In the Access to Finance program, the Nigerian government partnered with the private sector to take over malfunctioning and abandoned healthcare facilities and expand quality service delivery to rural communities, aiming to serve the Delta State health insurance scheme. PharmAccess conducted a study in 2022 showing how this approach provided care for over 30,000 people who previously had no access and demonstrating that it could be a scalable model. The facilities in the program also performed well: findings reveal that the under-five mortality rate for facilities that took part in this program stood at 0.7 per 1,000 live births, compared to 53 per 1,000 live births for other healthcare facilities in the Delta State. No maternal deaths have been recorded at any of the facilities taking part in the program since its inception. (+) Read more in this article on Devex.
Using digitalization to drive transformation in healthcare systems
Digitalization is a key topic throughout our discussions and advocacy work. We believe technology and data have the potential to transform healthcare, and we facilitate countries in driving and adopting digital innovation as well as scaling examples of successful digital interventions. Our ambition is to develop models that create value from personal health data, ensuring that the data is used for the public good rather than benefiting large private technology companies. At PharmAccess, we gather evidence of the impact that digital models – such as for non-communicable diseases (NCDs) and maternal care – have on the delivery and outcomes of care, and that evidence forms the basis of our advocacy discussions. Digitalization is also instrumental in addressing the fragmentation in funding, which is a major challenge to achieving UHC. Under traditional funding models, a patient may only be able to access care for a single issue, such as malaria. Digitalization can place the patient at the center of their care and provides opportunities to finance care that meet all their overall health needs.
Achievements in 2022
PharmAccess and the Norwegian government advocated for NCD models in Ghana, Tanzania mainland and Zanzibar where we looked at the financing and delivery of care through digitalized care models that can drastically bring down the costs of treatment of chronic diseases. We also worked with donors to encourage a less siloed, defragmented approach, moving from disease-specific funding to health system strengthening. In 2022, we held discussions on defragmenting funding with the Global Fund – a key global health actor. We are continuing our advocacy here and look forward to working together to improve the delivery of primary care. Ghana’s country director was appointed as civil society representative in the WHO’s Health Data Collaborative, a community of over 220 partner organizations. The aim of this community is to align technical, advocacy, and financial resources with government priorities for data and digital development. PharmAccess is also participating in technical advisory groups of the Ministries of Health and national health insurance schemes in our core countries, supporting policy dialogue and capacity building on digital health innovations.
Institutionalizing quality healthcare
Quality of care is a fundamental part of universal health coverage (UHC), and at PharmAccess, we advocate for improved quality and greater attention to quality throughout the healthcare system. In this context we have increased our focus on leading quality improvement through license partners and capacity building of public institutes. We advocate for institutionalizing quality healthcare, encourage governments to embrace constant quality improvement, and offer SafeCare as a methodology. SafeCare is a proven framework already making an impact, and we share the evidence as part of our advocacy work.
Achievements in 2022
In Nigeria, the Lagos State Health Management Agency (LASHMA), a governmental entity, signed an agreement with PharmAccess to adopt SafeCare standards for quality improvement in public as well as private health facilities under the Lagos State Health Scheme. This was the result of a much longer partnership and continued advocacy for quality in healthcare delivery. The commitment and investment of LASHMA’s leadership in the implementation of quality care in private and public hospitals is unprecedented.
“While we are working hard to ensure more Lagosians are enrolled in the scheme and more healthcare providers empaneled, we want to reinforce our achievements so far by ensuring that every resident of this great State enrolled on the health insurance scheme, irrespective of their location and status, can enjoy the highest attainable standard of health.” – Dr. Emmanuella Zamba, General Manager of LASHMA