Dr. Amit N. Thakker is a synonymous with the growth of the private healthcare sector in Kenya, Eastern Africa and Africa at large. From co-founding Avenue Healthcare in 1996, to becoming the first Chairman of the Kenya Healthcare Federation in 2015 and later helping set up the East Africa Healthcare Federation and lastly, the Africa Healthcare Federation, Dr. Amit’s influence and impact on the healthcare industry in Africa is immense. In this interview, HealthCare Africa magazine discusses with him some of the opportunities, challenges and trends in the industry, as Africa continues to face challenges brought by the Covid-19 pandemic. Below are excerpts of the interview.

HCA: Tell us about yourself, for those who may not know you.

AMIT: I am the Executive Chairman of Africa Health Business and the current President of the Africa Healthcare Federation whose interest is to promote the role of the private sector to strengthen health systems across Africa. I have been doing this for the last 26 years.

My early days in the private healthcare sector began when I founded Avenue Healthcare, which is well known for their clinics and hospitals across Kenya. I worked across about 14 countries in Africa in the healthcare space, before founding Africa Health Business in 2015.

HCA: Let’s focus on Covid-19 first, because I think that’s what everyone would want to hear about now. What is the opportunity around the pandemic in Africa, for the private sector, governments and other players in the healthcare sector in Africa?

AMIT: In the short term, the pandemic has affected the economies in Africa quite badly, with tourism, accommodation and hospitality the worst hit, not only in Africa but globally. In the medium and long-term, we see opportunities in manufacturing, we see the opportunities in improved healthcare services, and we see opportunities in digital health systems.

Immediately, as Covid hit Africa, supply chains were shut down and all those imports that we relied upon in the healthcare sector became very difficult to acquire. For example, in Kenya and the broader region, we needed PPEs, but the PPEs supply was constrained as they were all coming from outside the region.

We therefore needed our governments and manufacturers to reposition themselves to manufacture the PPEs – and the result is that we are now making all the PPEs we use in both the public and private sectors! Before the pandemic hit, we had only one manufacturer that was making masks in Kenya and now we have over 35 factories making masks. When it comes to medications and pharmaceutical supplies, we have realized again that the more we make these ourselves, the less we shall rely on outside imports. Out of this crisis, all the countries in Africa are trying to find how they can be more self-sufficient.

Countries such as Kenya, Rwanda, South Africa, Egypt, Senegal and Morocco are at the forefront of soon getting into vaccine manufacturing, even if it means bringing the vaccines for finishing and bottling in the country. The next step will be how to handle intellectual property (IP) issues to start making the vaccines locally, for example the deal between Johnson & Johnson that is making the vaccines in South Africa currently.     

HCA: How does Africa get to manufacturing vaccines in the continent soon?

AMIT: Vaccine manufacturing is very complex – it’s so complex that the entire production system needs to be very intensely managed, it takes a lot of intellectual property, the mechanism of putting it together is complex and the need for extreme sterility plus all the systems – it is not easy, like manufacturing tablets. Therefore, we can’t just say ‘why can’t you make the vaccines?’

The gap is the the kind of conditions you need for a factory that makes vaccines to be extremely high level and the kind of skills and the technical production aspects we need are very high level – none of the pharmaceutical factories here in Kenya right now can take the task, without significant investment.

HCA: How can Africa take advantage of the opportunities brought by Covid-19 to improve investments in the healthcare and pharmaceutical sector?

AMIT: You have raised a good question and that question supports the plans by the Africa Union (AU), which is in the process of establishing the Africa Medicine Agency (AMA).

AMA aims to harmonize all the medications across the continent so that if you register a product in one country, it can be used in another country. This will reduce the cost of doing business in the region – a huge opportunity for many distributors and manufacturers. Secondly, it will allow the free movement of medical goods across borders without irregular taxes.

This agency will allow for greater investments in manufacturing of medications and distribution of medications in Africa – the kind of initiatives we need to put in place so there is policy harmonization and standardization of charges when you are moving goods across borders to improve local manufacturing.  

HCA: When do you think this initiative could be achieved?

AMIT: The Treaty for the Establishment of the AMA entered into force as of the 5th of November 2021, thirty days after the deposit of the 15th instrument of ratification, on the 5th of October 2021, by the Republic of Cameroon at the African Union Commission. The African Union Commission continues to encourage all its member states to sign and ratify the treaty, in the interest of public health, safety and security. The Commission shall proceed towards the establishment and full operationalization of the AMA at the earliest.

Passing the AMA treaty will have a multiplier effect – then Africa will become the continent of hope for investors. Many investors think that the economy in each country in Africa is too small while they have other bigger markets to place their investments. Initiatives such as AMA treaty and the African Free Continental Free Trade Agreement (AfCFTA) will strengthen regional economic communities like EAC, ECOWAS and SADC, giving investors the platform to invest larger funds in the healthcare sector and other sectors.

HCA: Which African countries appear to you as exciting new frontiers for investors in the healthcare sector?

AMIT: There are lots of hotspots for investments in the healthcare space across the continent. In west Africa, we know that Ivory Coast is leading, so is Nigeria and Ghana. If you look at southern Africa, we have seen the rise of Mauritius; we have seen also good attraction to Botswana.

Countries such as Kenya, Rwanda, South Africa, Egypt, Senegal and Morocco are at the forefront of soon getting into vaccine manufacturing, even if it means bringing the vaccines for finishing and bottling in the country

In East Africa, the two leading countries are Kenya and Rwanda – Rwanda really shines because they have reduced the cost of doing business. In the northern Africa region, Morocco really shines; it has opened interesting public-private partnership models that can be replicated to increase healthcare investments in Africa.    

HCA: What is the opportunity for PPP models in Africa?

AMIT: The PPP model has been trialed across Africa in the last 10 years but there has been a trust barrier between public and private sectors in healthcare – they thought they were opposing forces. Before, the private sector was seen very suspiciously; that they were profit oriented while the public sector was thought of as corrupt and ineffective.

However, through public private dialogue, we have managed to bring leaders together from the public and private sector with the aim of improving healthcare on the continent. Over the last 10 to 15 years, I think the trust between the private and public health sector players has increased – becoming the bedrock on which we must build PPP initiatives – without that trust, any PPP initiatives in healthcare will crumble.

That lack of trust previously, means we don’t have many examples of PPPs on the continent – the public sector has done what it best can with government and donor money, while the private sector has done what it best can through market approach.

The way PPPs can work is, for example, the government can have equity together with private sector players to establish a plant that produces vaccines locally. The government can also provide free land or come up with taxation incentives that will make the venture much more attractive to provide jobs and boost local manufacturing and economies.

My rule of thumb is that: if it’s economically viable and socially necessary, let the private sector do it on its own; if it’s economically unviable but socially necessary, let the public sector deal with it; and if there is a mix in between, that’s where PPPs come in. 

HCA: We see more private sector investments in healthcare in Africa. What is the opportunity for further investments in the region?

AMIT: The latest statistics show that there has been a year-on-year increase of close to 60-70% more funding in the private healthcare sector in Africa through private equity. I therefore see more funding, more players in the market, more transactions in hospitals, digital and the manufacturing space.

Leading private equity players have seen good opportunities in the same countries that I mentioned earlier, so they are scouting for either start-up businesses, greenfield or brownfield opportunities. There is a lot of funding available; I have also seen many pharmaceutical chains coming into Africa. We have also seen groups being formed, hospitals merging etc. I believe the next decade will be the decade for private equity growth in the healthcare sector in Africa.

HCA: The urge to have an affordable and effective universal healthcare (UHC) is getting louder by the day across many countries in Africa. What are your comments?

AMIT: UHC is an aspiration that we all think is great; it is to ensure that everyone has access to healthcare without any financial barriers, but to attain UHC is a journey – it is not one policy or an event, it takes many years, for example, in Japan it took 10 years to implement!

For UHC to be effective, you need to fix your health systems, you need to have the right number of health care workers, and you must have a solid base for healthcare provision and then you bring in the financing; it’s not an easy process but it requires both the private and public sector to be aligned to enable everyone to access decent, quality healthcare services, be it public or private facilities.

I think UHC is a great policy, and it is a multi-stake holder partnership that is necessary, and I think Kenya, Rwanda, Ghana, South Africa and Zambia are some of the countries that are on the path to implementing UHC soon.

In Kenya, the National Hospital Insurance Fund (NHIF) is one of the institutions that is at the foundation on which UHC can be built. The main point to global health leaders is to avoid mistakes that other countries may have made, as they seek to implement UHC.      

HCA: What opportunities for digital technologies have been brought by the pandemic in Africa?

AMIT: Covid-19 has made us realize that digital health is very vital and necessary to strengthen health systems in Africa.

Before the pandemic, Kenya had never issued any telemedicine licenses – we now have over 75 companies that have been issued with telemedicine service licenses in the past year. This shows that a new crop of companies is rising in the healthcare scene that are going to create employment through digital health!

During this crisis, we have already seen digital laboratory services and digital pharmacies being looked at very favorably – you have seen medicines being delivered to homes and offices bringing service provision closer to the people. Beyond these areas we also have analytics:  the amount of data we are receiving because of the vaccinations and the Covid situation if well analyzed can give a snapshot into what is going on in any country. Finally, I also think that artificial intelligence will make reading of CT and radiology scans easier, better and quicker – without the specialist travelling to where the patient is. Digital health is going to bridge the geographical barriers that we have had in healthcare before the pandemic in Africa.         

HCA: How can regulations be used by authorities to facilitate innovation and growth in digital technologies in the healthcare space in Africa?

AMIT: Good regulations foster responsible private sector growth; bad regulations will kill innovations. To have good results, you need to let the innovation space thrive, but you need to guide the process by drawing a path on which it can thrive. On the other hand, when there are no regulations then the sector will be scopeless, where people take advantage of the market and innovation will be killed.

Even in medical supplies, we want regulations, but some people are unscrupulous and bring counterfeit and fake drugs to an extent that some people don’t have faith in medications anymore. We don’t want to follow that path; there is a need for regulations – sound regulations will promote good care, good practice and great innovations.

HCA: What is the opportunity around the workforce of the future in Africa, especially considering that we have been hit by the pandemic, while we still have gaps in getting adequate healthcare professionals in the Continent?

AMIT: 3% of the world’s health workforce is in Africa, yet we have 17% of the global population; you can imagine the disparity that we have! The shortage of health workers in Africa is obviously seen in the weakness of the health systems, there is no doubt we must train more health workers in Africa post the pandemic – that is not negotiable.

We also need to strengthen the community health workforce so that we can increase our primary healthcare services at the community level, and we also need to boost public health education to all households; remember, healthcare starts not at the hospital doorstep but at your home. Prevention plays an important role – it’s cheaper than cure.

Having that all done, we still need to work on building our healthcare workforce and we need to use our technology effectively so that we can use the specialist in say, Nairobi to treat a patient in Lodwar. Why does a person in Lodwar who has a skin problem need to travel all the way to Nairobi for treatment? Because of the high cost of transport, you find that person coming in at very late stage in the diagnosis – telehealth will bridge the need for specialists across the entire country. We also need to start thinking of how to attract skills back home.

HCA: Do you think Africa is better prepared to handle the next pandemic?

AMIT: This pandemic is the loudest wake-up call for Africa; we have never had a louder sound than this. We cannot afford to be lazy; this is the wake-up call to become more sufficient; we have learnt that if we are reliant on others, we will be left behind.

We have learnt that if we don’t invest in research and development we will be left behind. We have also learnt that manufacturing is key to success and growth of achieving health coverage in Africa and finally, Africa must speak as one voice – we must be our brother’s keeper. We must be one continent, one people – because together we are stronger.

HCA: What is the opportunity around setting up hubs in Africa to enhance manufacturing in Africa?

AMIT: There is a great potential of the hub-and-spoke model in Africa. For example, could we make Kenya the cardiology hub, so that everything around cardiology issues could be treated in Kenya? Can Rwanda be the nephrology hub? Can Uganda be the orthopedics hub?

There have been such discussions – if we could set up regional centers of excellence, so as not to duplicate some of these investments in the region.

HCA: What is the importance of the federations like the KHF, EAHF and the African Healthcare Federation?

AMIT: The biggest advantage of such federations and associations is that the private sector gets to speak with one voice.

Before the establishment of these bodies, the government found it very difficult to bring non-state actors on the table to discuss how to improve health systems. It was important for us to have one voice as the private sector to enable us to engage with ministries of health and other stakeholders.

At Kenya Healthcare Federation, for example, we have been able to table our concerns on mandatory contributions to NHIF and we also tabled our concerns on VAT on pharmaceutical raw materials that was later waivered. Further, we wanted doctors and nurses to move freely within East Africa; it used to cost US$ 4000 dollars for a permit fee for 2 years and after we negotiated and discussed it with our regulatory agencies and the Ministry of Health, that permit fee was waived, reducing the cost of employment.

HCA: As the President of the African Healthcare Federation, what is the future of the pan-African federation?

AMIT: AHF is in its early days: we just had the inauguration of the first board of the federation last year. I am really delighted to chair the Board; I have very able directors on the Board.

At the moment, we are learning, we are having cross-country learning platforms – we are all sharing knowledge between each other. We are trying to pick up what really works, what has the best impact, so that we can share that in other countries – during the pandemic, we have already shared many ideas and initiatives. During the first 3 years, we shall be learning and sharing, together with the African union, the Africa CDC and other African agencies.

HCA: Thank you Dr. Amit. Maybe you can make your last statement while also addressing the issue of vaccine hesitancy.

AMIT: I do believe that the vaccines are working. When Covid-19 first broke out, the number of health workers that were admitted in hospitals were so many; right now, most of our health workers are vaccinated, thankfully, and the number of admissions for health workers is minimum. The good news is that we are not losing doctors or nurses currently. If you look at the current ICU and HDU statistics, over 95% of the beds being occupied by Covid-19 positive patients is by unvaccinated people and a handful who are already vaccinated.

I am trying to say that vaccination works, and the best vaccine is the one you have in your arm. Do not compare the Moderna vaccine to Johnson & Johnson or AstraZeneca vaccines, with regards to which one is better – the best is the one that you can get in your arm right now. It helps you, your family, the people you work with. Do not take a chance to be admitted to a hospital and don’t take a chance to spread the virus.

I think vaccine hesitancy is not a major issue in Africa currently because our supply is smaller than the demand; maybe in a few months, we will come to it, but for those who are living in Africa who are hesitant to get the vaccine, I would urge them to consider taking the vaccine as soon as they can to save themselves, their families, colleagues and to save the economy of Africa. It’s only then we will reach hard immunity; remember we are not safe until everyone is safe. Please take the vaccine.

HCA: Do you think the pandemic has improved government-private sector relations and dialogue in the healthcare sector in Africa?

AMIT: In many countries, yes and in some countries, no. The countries which had already started discussing public and private sector engagements – had trust already developed which enabled them to build better systems during the pandemic, but in countries that has a gap, the pandemic has made a bigger wedge – it has created a bigger distance between the public and private sectors.

In Kenya, relations between the public and private sector have tremendously increased during this crisis, thanks to the leaders in government and leaders in the private sector.

This feature appeared in the February 2022 issue of HealthCare Africa. You can read this and the entire magazine HERE