We believe it is possible to create a health system where trust prevails, and where data and connectivity are catalysts for change. Our advocacy supports this vision and sets out to demonstrate the role of digitalization and to help create the enabling environment needed for scaling impactful solutions. Amid increased healthcare challenges and shrinking budgets, we are collaborating with governments, private sector organizations and other stakeholders to innovate and deliver more value from existing resources.
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 inspire change and engage stakeholders to scale successful solutions that contribute to a health system where trust prevails.
Our advocacy work is catalyzing change across the region, including in Ghana and Tanzania, where PharmAccess and partners hosted the first national symposium on research and policymaking in 2023. The conference, which welcomed ministers of health among its participants, aimed to strengthen capacity for innovation adoption and drive evidence-based policymaking in healthcare. Engagements like these are already having a tangible impact: Ghana’s Finance Minister acknowledges the key role of quality of care in ensuring efficient use of financing for health, and the Ministry of Finance intends to include SafeCare scores in its budget statements.
Providing a strong evidence base
Before suggesting a new approach, we first build a strong evidence base. Evidence is built through research and programs, both our own and those of others. Most of the research papers we submitted for publication in 2023 were done in cooperation with international and African research institutions. Collectively, this evidence demonstrates our paradigm and gives governments and the private sector the evidence and business cases they need to develop and implement transformative policies and scale interventions.
Although our biggest reward is impacting patients' lives, awards help highlight the results of our efforts and provide recognition for PharmAccess as a thought leader, allowing us to better engage governments and key stakeholders. In the past year, we received seven global awards that illustrate the recognition of the efforts of PharmAccess and our partners towards innovating healthcare access. One of these awards was the Nigeria Governors Forum’s Primary Healthcare Leadership Challenge award, sponsored by the Gates Foundation and UNICEF, which was awarded to Kwara State, recognizing the partnership between Kwara Government and PharmAccess on improving the performance of primary healthcare.
Findings from research resulted in 21 publications submitted to peer-reviewed journals in 2023; most of these were accepted and published, and we anticipate that the remainder will be accepted for publication in 2024. Our research was recognized with the Frontiers in Health Services Paper of the Year Award 2023 for our paper “Digital health systems strengthening in Africa for rapid response to COVID-19".
Driving change in health systems
Advocacy is a long-term endeavor: 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.
This is not without its challenges: significant economic and political obstacles in the region have slowed progress in providing underserved populations with high-quality healthcare. Despite this, there have been notable improvements in life expectancy and child mortality in recent years. Globally, the under-five mortality rate has fallen by 51% since 2000. Universal healthcare coverage (UHC) remains high on the political agenda thanks to coordinated advocacy efforts by diverse stakeholders toward a common goal; the task is to show governments why and how they can fund quality healthcare more efficiently and effectively.
We are contributing to advancing this agenda, including by participating in various working groups, advising public and private institutions and governments, and advocating for innovative care models with proven impact. Transformation takes time. We will continue to work patiently, persistently, and strategically across our focus areas to bring our vision of healthcare for all to life.
Using digitalization to drive transformation in healthcare systems
Digitalization is a key topic throughout our discussions and advocacy work. 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.
We facilitate countries in driving and adopting and scaling digital innovation, with the aim of uniting fragmented funding sources through technology to increase efficiency and advance UHC. For example, incorporating NCD care into health insurance is critical for moving from a fragmented to an integrated approach for UHC. Our advocacy work in collaboration with the Norwegian government (Norad) has led to Tanzania passing a Universal Health Care Bill that includes NCDs, and to Zanzibar agreeing to set up a Health Equity Fund (HEF) to subsidize primary care, including NCD care. These developments are inspiring changes elsewhere, extending our impact.
Our ambition is to apply digital technologies to put patients at the center of their care journeys and develop models that ensure health data is used for the public good. We work to mobilize patient groups at the country level to ensure that patients' voicesare truly reflected in the design and implementation of digital and data-driven solutions. Collaboration is key to our work here. PharmAccess is a member of the WHO Health Data Collaborative. We have engaged with the Africa CDC digital flagship initiatives, including Health Data Governance and the forthcoming Africa Digital Health Network.
We are also using health data to inform policy decisions. For example, Zanzibar’s Social Health Insurance has issued Matibabu Cards to 85% of Zanzibar's population, thereby digitally connecting citizens and producing actionable data that can help design effective insurance schemes. In Ghana, the NHIA is the first African health insurer to establish a Data Analytics Unit, producing data that informs decision-making. And in Nigeria, we supported Lagos state in setting up a digital platform to register and track data and performance of health insurers and health management organizations.
Increasing local financing and resources for health
To ensure that millions of poor and vulnerable populations who cannot pay will obtain access to quality healthcare, African governments must mobilize more financing and spend it efficiently. Our advocacy engages governments to increase and use budgets efficiently for health, for example, through health insurance and value-based care models. This ensures the sustainability of financing and the continuity of care for people who depend on government subsidies. It requires a sustained collaborative effort with the country, generating evidence to stimulate improved policies and the use of digital technology to support the desired change.
Our advocacy efforts have helped ensure governments continue to fund insurance schemes during the economic downturn. PharmAccess collaborated with Ghana's National Health Insurance Authority (NHIA) in 2023 to ensure that government reimbursements for health insurance were prioritized despite the economic challenges that Ghana faced when inflation hit 50% . In Nigeria, the State and Federal Governments continued to pay for insurance for 35,000 people in Kwara through the Basic Healthcare Provision Fund (BHCPF). Zanzibar is set to launch and contribute resources to the Health Equity Fund, which PharmAccess supported during development.
We also provide expert advice and support for policies and legislation across the region. In 2023, Tanzania Mainland passed the Universal Health Insurance Bill into law. PharmAccess has advocated for this Bill and played a key role by providing technical advice on the benefits package and financing. PharmAccess also participated in drafting policies in Kenya, where four pieces of legislation were passed, aimed at extending healthcare coverage.
Read our opinion piece in Dutch newspaper NRC on why development cooperation is more important than ever.
Driving public-private engagements in the health sector
The private health sector fills critical gaps where government services are insufficient in sub-Saharan Africa. We see the power of including the private sector to drive trust in the transformation of healthcare systems. Our advocacy 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.
PharmAccess plays an important role in agenda-setting and capacity-building to strengthen partnerships. We facilitated a partnership between the Christian Health Association of Ghana (CHAG) and the national insurer (NHIA-Ghana) in a public-private partnership (PPP) on value-based care models. Based on experiences in Nigeria and Ghana, we facilitated sharing learnings and capacity building among private health sector actors, leading to the first meeting of the West Africa Private Health Care Federation.
We also continued building capacity for the Zanzibar Private Hospitals Owners Association (ZAPHOA) in 2023, to stimulate policy dialogue and promote investments and better care delivery in the private health sector. The Zanzibar Ministry of Health has contracted the private sector to manage all public hospitals, to stimulate efficiency and innovations.
With digital health technologies being developed increasingly by private technology companies, we will continue to advocate for African governments to create the enabling policy environment for digital innovations to thrive while advocating for governments and Big Tech to work together to sustainably advance the UHC agenda. PharmAccess hosts the secretariat of the Digital Connected Care Coalition (DCCC), which advances partnerships for digital transformation and UHC.
Institutionalizing quality improvement in healthcare
At PharmAccess we believe that quality of care is critical for building trust, and both are vital components of universal healthcare coverage (UHC). At PharmAccess, we advocate for improved quality and greater attention to quality throughout the healthcare system. We focus on leading quality improvement through license partners and capacity building of public institutes, offering SafeCare as a methodology.
Delivering value for healthcare is critical given the limited budgets that countries face, and SafeCare’s adoption is a testament to the role of quality in providing value. Ghana's Finance Minister cited the CHAG SafeCare program in his 2024 annual budget speech in 2023, and the Ministry of Finance would like to include SafeCare scores in budget statements. The Ghana Health Service has also agreed to implement SafeCare in public facilities and took positive steps towards this in 2023, including through a pilot.
In Nigeria, the Lagos State Health Insurance Scheme (LASHMA) is the first public health insurer to incentivize better quality of care for providers by paying them based on their quality improvement and SafeCare score. NHIA-Nigeria has agreed to a phased deployment of SafeCare digital tools for quality assurance and accreditation across 18 States.
Leveraging development cooperation for enhancing investment
Consolidating the progress made in Africa through robust investments and long-term economic relationships is critical to ensuring that Africa becomes less dependent on development aid. The Aid and Trade approach reflects the Netherlands' policy to promote inclusive and sustainable development through a combination of development assistance, trade promotion, and public-private partnerships. By integrating aid and trade policies, the Netherlands aims to create mutually beneficial partnerships that contribute to poverty reduction and economic growth in partner countries.
Our advocacy in this area is geared towards shaping the opinions of the Dutch public and politicians on the effectiveness of development cooperation for promoting sustainable development and global prosperity.
PharmAccess is a member of the Dutch Global Health Alliance, through which we advocated for continued development cooperation through engagements with members of Parliament. We also signed the Global Health Pact, which aims to strengthen the implementation of the Dutch Global Health Strategy and act as a co-chair on health systems strengthening working group.
At the international level, our advocacy is connected with the United Nations (UN). In 2023, PharmAccess Kenya participated alongside the vice-president of Kenya in the UN Hearing on Scaling UHC. The Netherlands Ministry of Foreign Affairs requested, and we provided input and feedback on the UN Commitments for UHC. And the UN selected PharmAccess, with special accreditation, to attend the High-Level Meeting on Universal Health Coverage in New York.