21st Century Healthcare Across Africa

Russell Duke

Russell Duke

Sponsored by the Catholic Church Health System (The Vatican, Roma, Italy) and underwritten by National Standard Finance, LLC and Healthby

The Catholic Church or commonly known as The Vatican in Roma, Italy manages the world’s largest network of global hospitals and medical clinics spanning all continents with hundreds of years of history operating global healthcare.

The church’s network includes thousands of non-profit healthcare facilities and hospital unmatched by any other health system in the world. National Standard, Italian healthcare pioneer Healthby, led by word famous Dr. Ilja Gardi, believes that to design, finance and build a new generation of global health care, should be considered a partnership of the Vatican institution with its powerful story in the field of healthcare management worldwide. In particular, this should be considered for the frontier and emerging markets including Africa, in partnership with health agencies and local government ministries.

Non-communicable diseases (NCDs) are the world’s largest killers, according the World Health Organization’s (WHO) Global Burden of Disease (GBD) data. While the world has focused on the traditional causes of premature death in Africa – communicable diseases such as HIV, malaria and tuberculosis, malnutrition, road and other accidents and political conflicts – a column of other types of killers has been gaining ground such as cancer, heart disease, diabetes, sickle-cell disease and kidney disease, whose collective toll is rising rapidly.

WHO predicts that by 2030, such deaths will account for 42% of those in SSA (Sub Saharan Africa) from current 25%, surpassing the figure for infectious diseases. Worldwide, between now and 2020, the largest increase in NCD deaths will occur in Africa. Sub-Saharan Africans are developing many NCDs at younger ages than people and nowadays they are too dying younger than in other parts of the world. If the continent does not come to terms with the challenge that these illnesses represent, millions more will do so unnecessarily.

A recent analysis estimated that 49 low-income countries should, on average, need to spend about US$60 per capita in 2015 to reach populations with a basic package of health services. This estimate included only medicine costs for some NCD, a full assessment of the resources needed to deal with NCD is not available. However expensive it is, NCD care is often of poor quality. Only 24% of NCD patients in SSA reported their care is managed well or very well, for cancer the figure drops to 5%. These figures reflect a variety of widespread deficiencies in health care in the region, including: very poor staffing of systems in general (SSA 0.2 physicians and 1.1 nurse *1000 inhabitants) ; few specialists or often none, lack of access to specialists or to clinicians with the necessary equipment. A further constrain to patient access to health care is lack infrastructure and outdated facilities in SSA. For example, the number of hospital beds per 1,000 population varies from country to country — ranging between 0.5 in Uganda to 1.8 in Botswana.

In summary NCD control requires prevention programs, early diagnosis, proper follow up and treatment, in other words structures, infrastructures, technologies, personnel and organizational method, all lacking in SSA. To extend access to the Healthcare System to a broader range of citizens would involve sticking a compromise between: the necessary concentration of expertise and technology to forestall the squandering of available resources and to ensure the system functions more efficiently and effectively. The necessary distribution of widespread access, based upon territorial and social criteria of equality and justice for the entire population .

Both these condition, apparently irreconcilable, may in fact be satisfied by an organizational and technological solution: the Hub & Spoke type network system, bolstered by road infrastructure and with informatics and telecommunications structure.

Once the criteria set forth in the proposed organizational model are agreed upon, the method of approach must be defined in order to upgrade existing healthcare systems in the areas under consideration and to set clearly defined targets for their expansion. However the healthcare structural, infrastructural and organizational planning must provide indications of the service offering to be achieved and be strictly related to the epidemiological data together with the analysis of potential demand. This service offering will then be spread throughout the Hub & Spoke network towards the gradual identification of a specific method.

Hub and Spoke model foresees and the decision criteria for the design of a health care system, leading to a system developed on three levels:
Primary Healthcare (primary care and preventive – PHC)
Secondary Healthcare (general hospitals)
Tertiary Healthcare (highly specialized, research and teaching)

closely related each other and organized according to the plan of care of the patient.

The interconnection between the system nodes must be done through:

The organizational integration of health activities organized throughout the course of patient care
The integration of data relating to patient information, through the use of infrastructure ICT (Information & Communication Technologies)

The logistic support for the handling of the patient and for the movement of services and principals
In the proposed vision is therefore possible to use the existing care centers to achieve functionally the first level (PHC) and, where the infrastructural and structural conditions permit, a portion of the second level. Obviously, this functional assignment of the existing will be gradually accompanied by measures to improve the organization and technologies through: organizational procedures for governance of patient care; smart phone apps for patients remote control; shared and standardized protocols and procedures; ICT connection applications. The PHC, health care entry point, may be provided with basic diagnosis facilities (radiology, ECG, laboratory support for most common analysis).

Should therefore be developed during final design of the network, a plan for improvement of existing centers, from the technological to the network interconnection system giving then gradually technological resources and professional skills as a function of the overall development of the local, regional, national health system. The enhancement of the existing is necessarily accompanied by a structural reinforcement that effect the completion of the three levels indicated in the vision, bringing the system up to international standards.
Is therefore essential to proceed with the construction of an adequate number of health care centers of the second and third level, to be distributed on the basis of the hub and spoke model presented above

The sizing and placement of these hospitals (and their specialties) must take into account the need to avoid duplication of services and technologies, and not to waste the human resources available, qualified and gradually formed during the appropriate transfer of know-how, in cooperation with the network of developed word hospitals.

Russell Duke is Chairman and Managing Principal of National Standard Finance, LLC headquartered in the United States. National Standard Finance Africa is managed from Johannesburg, South Africa with representatives throughout Africa. Mr. Duke may be reached at RDuke@NatStandard.com. For more information about National Standard please visit www.NatStandard.com.