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  • South Africa Innovates Healthcare with Prepay Phone Vouchers

    South Africa Innovates Healthcare with Prepay Phone Vouchers

    By David South, Development Challenges, South-South Solutions

    SOUTH-SOUTH CASE STUDY

    Pioneers in Africa are experimenting with new ways to fund the delivery of healthcare that is affordable and sustainable and not dependent on foreign aid and donations. A South African company is prototyping the selling of pre-payment healthcare services through mobile phones with a range of vouchers that can be bought and downloaded at the tap of a keypad. They are priced at between US $12 and US $49 and cover medical and dental check-ups, tests, treatments, chronic care and medicines. They are flexible and can also be sent to friends and family who need help.

    In South Africa, poverty is still widespread. The majority black population has a median income of US $2,000 a year (New Internationalist) and many still live in crowded townships and poor rural communities. Poverty has also increased for many white Afrikaner South Africans (http://en.wikipedia.org/wiki/Afrikaner). A study by the Standard Bank of South Africa found the number of whites earning less than US $80 a month grew from 2000 to 2004 by more than 50 per cent. In the government capital of Pretoria, 50 Afrikaner squatter camps have emerged in recent years. For many, affordable healthcare is a critical issue.

    The story of healthcare in Africa is not a linear one of constant progress. The continent as whole achieved its lowest child mortality rates in the 1970s. But after that, the quality of healthcare declined as a result of various factors including economic crises and the HIV/AIDS crisis – both of which overwhelmed public systems. In sub-Saharan Africa, health systems reached rock bottom in the late 1990s.

    “Few people could afford annual check-ups, medicines or user fees at hospitals,” wrote Dr. Ebrahim Malick Samba in the paper “African health care systems: what went wrong?” for News Medical (www.news-medical.net). “One result was the resurgence of infectious diseases such as malaria, tuberculosis and cholera.

    “Prior to the 1980s, the district hospitals, community health centres and other outreach health posts provided medical services and essential drugs free of charge. With reforms, user fees and cost recovery were introduced, and the sale of drugs was liberalized.

    “Many governments discontinued budget support to the health sector which paralysed the public health system. There was no money for medical equipment and maintenance; salaries and working conditions declined.”

    Things have been steadily improving from this low base through the 2000s, the result of increased aid funding for public health systems and greater national investments in staff, facilities and equipment. There is still a long way to go, but Africa is becoming a world leader in developing and deploying mobile phone applications for health and healthcare.

    Despite dramatic improvements to the quality of hospitals and the number of qualified doctors, the continent’s healthcare services are still a patchwork, with rural and slum dwellers poorly served and the stresses of treating patients with contagious diseases like HIV/AIDS and malaria pushing resources to the limit.

    Research has shown it is better and fairer to develop pre-payment mechanisms for healthcare than to just hit patients with fees when they are ill. With pre-payment, a person can buy care services when they are financially able to and bank up care for when they become ill and not able to work and save.

    This is a crucial issue for people with low incomes who can quickly be devastated by their illness or that of loved one or family member.

    The World Health Organization (WHO) has taken a firm stand against so-called out-of-pocket payments and encourages the growth in pre-payment methods. The World Health Report 2000 found that “Fairness of financial risk protection requires the highest possible degree of separation between contributions and utilization.”

    South Africa’s Yarona Care (www.yaronacare.co.za/prepaid.html) – a health insurance provider network – is rolling out prepaid mobile phone vouchers, allowing patients to see doctors or dentists and even traditional healers for treatment. When a patient visits, the healthcare worker redeems the mobile phone voucher to get paid. One product, Impilo Go, allows people to pay for one visit to a doctor and seven days of medicine for R230 (US $34). For people on a tighter budget, there is Impilo Care for R80 (US$12). A patient can visit a nurse practitioner for a medical check-up and receive tests.

    Impilo One offers medicines alone for R100, while Impilo Plus for R195 (US $29) is aimed at people with chronic conditions. They can get a prescription from the doctor and then go to a pharmacy participating in the scheme to receive medicines.

    Dental work is also covered by the vouchers.

    An online demonstration shows how the mobile phone process works (www.yaronacare.co.za/cellphonedemo.html).

    The service is marketed at a mix of customers, from individuals to corporate clients looking to cover large numbers of people to government and NGOs. They can purchase services by voucher, payroll schemes or mobile phones.

    Prepaid by mobile phone as a concept is already well established across Africa. It is a simple way to make payments and sell services. In the case of Yarona’s offering, the customer or patient uses their mobile phone to dial a code to pay for a service. When at the doctor or dentist’s office, he or she spends the voucher for the service by giving a unique code to the healthcare professional. Once this is done, Yarona Care pays the healthcare provider for the service.

    The voucher approach allows customers to buy health services for family members for a defined period of time. Vouchers can also be sent to family members for emergencies.

    Published: April 2011

    Resources

    1) South Africa’s Afridoctor mobile phone application claims to be Africa’s first personal mobile health clinic. It lets patients use its “SnapDiagnosis” system to submit photos of their ailments and in turn receive advice from a panel of medical professionals, or use the mapping feature to find doctors, clinics and health industry-related services nearby. Website: http://twitter.com/afridoctor

    2) Ghana’s mPedigree uses cell phones to build networks to tackle and identify counterfeit drugs. Website: http://mpedigree.net

    Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP’s South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South’s innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator. 

    Creative Commons License

    This work is licensed under a
    Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

    ORCID iD: https://orcid.org/0000-0001-5311-1052.

    © David South Consulting 2023

  • Safe Healthcare is Good Business and Good Health

    Safe Healthcare is Good Business and Good Health

    By David South, Development Challenges, South-South Solutions

    SOUTH-SOUTH CASE STUDY

    Many people have been shocked by recent stories about the proliferation of counterfeit drugs and the rate at which they are killing and harming people in Nigeria. The International Narcotics Control Board found that up to 50 percent of medicines in developing countries are counterfeit. This has driven home the point that without the presence of legitimate players in the African drug market, the illegal sharks will step in to make large profits – and a literal killing.

    To counter this negative trend, what is most needed is support for reliable Africa-based companies: businesses that are long-term, sustainable and not living from one grant to the next. But as experience has shown around the world, nurturing businesses requires certain fundamentals: they must work to be profitable, they must find a market and exploit it, and they need cash infusions that are timed to the company’s growth, not to the cycle of international donors. This role, often served in developed countries by venture capitalists, who want a fast return of 35 percent – is too onerous a burden for most African businesses. What African companies need is a more conservative, long-term approach; one that expects returns of between five and 10 percent.

    Kenyan company Advanced Bio-Extracts (ABE) is one good example. Only 18 months old and based in Nairobi, the company produces one of a new generation of low-cost anti-malarials known as artemisinin-based combination therapies (ACTs). The drug is produced from the green leafy plant Artemisia, or sweet wormwood. The company is the first in Africa to make this drug, and employs 7,000 local farmers in Kenya, Tanzania and Uganda, as well as scientists.

    ABE has received two infusions of cash from non-profit social venture capitalists Acumen, as well as investment from Swiss drug giant Novartis. Acumen has so far invested US $9.6 million in 11 active investments focused on a diverse set of health challenges, including basic healthcare access in rural areas and treatment for malaria and HIV/AIDS.

    “We are commercializing a product that had never been commercialized,” said ABE’s owner, Doug Henfrey, to the New York Times. “Those little windows of support make these things happen. We could not have done it otherwise.”

    Acumen’s Kenya country director, Nthenya Mule, said “there are positive things happening in Africa, but they are not happening overnight, and some are happening quietly. ABE is exemplary. You will not see it as front-page news, but in 18 months they set up a factory with 160 people interfacing with 7,000 farmers and supplying one of the major pharma companies in the world.”

    Stimulating private sector solutions to African healthcare problems is receiving an additional boost from a new fund established by the World Bank’s private sector arm, the International Finance Corporation. To be launched later in 2007, it will offer cash and loans totaling US $500 million to commercial healthcare projects in Africa. According to its own statistics, 60 percent of health expenditure in sub-Saharan Africa is privately funded, and the market, excluding South Africa, is worth US $19 billion.

    Published: May 2007

    Resources

    • Roll Back Malaria Partnership: Launched in 1998 by the World Health Organization. UNICEF, UNDP and the World Bank to coordinate the global campaign, to fight malaria.
    • Malaria Atlas Project (MAP): An online map showing up-to-date information on high-risk areas for malaria.
    • A paper on the global threat of counterfeit drugs: Click here

    Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP’s South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South’s innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator. 

    Creative Commons License

    This work is licensed under a
    Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

    ORCID iD: https://orcid.org/0000-0001-5311-1052.

    © David South Consulting 2023

  • Woman Wants African Farming to be Cool

    Woman Wants African Farming to be Cool

    By David South, Development Challenges, South-South Solutions

    SOUTH-SOUTH CASE STUDY

    Can farming be cool? Especially on a continent where it has long been associated with hardship and poverty, can agriculture be attractive to a young generation looking for big opportunities? A young woman in Nigeria thinks so and is on a mission to show farming is a great way to get ahead in modern Africa. And she hopes more people attracted to farming will boost the continent’s food security and reduce costly imports.

    Cynthia Mosunmola Umoru’s company, Honeysuckle PTL Ventures (http://www.tootoo.com/d-c3015227-Honeysuckles_Ptl_Ventures/), is based in Lagos , the business capital of Nigeria. The West African country has become dependent on food imports, despite many attempts to modernise its agricultural sector.

    The country’s heavy dependence on oil exports for its income has led to poor investment in its domestic economy. Over 80 percent of Nigeria’s university graduates struggle to find work. And it is these two problems – food security and high unemployment among the country’s young, educated and ambitious – that Umoru wants to change.

    Leading by example, Umoru has set up a successful and modern agribusiness focusing on high-quality food products using modern packaging and fast delivery. She produces meat products, from seafood like shrimps and prawns to snails, beef, chicken, and birds. Her niche is to deliver the product however the customer wishes: fresh, frozen or processed. Her business has its own farms and ponds but also has developed a sophisticated network with other farmers, providing them with standard contracts and benefits. This extra capacity means she can meet the demand and handle large volume orders.

    She is proudly self-taught. “I didn’t have a mentor in farming! Though I have other mentors,” Umoru told the Guardian Life Magazine. “My knowledge of agribusiness has been largely from personal education and research. The Internet has served greatly as my resource bank.”

    Umoru was initially on the path to study medicine, but had that dream upset by riots in the late 1990s. She then moved on to study zoology at Lagos State University. In her final year, she became interested in agribusiness. Her company was officially registered in 2004, but she had already begun at university providing meat products to fast-food outlets in Lagos.

    “It took five years to gain relevance,” she said. “My involvement in the agribusiness sector is really impacting people, particularly young people like me, who I always hear say ‘If you are involved with farming then it is probably not as bad as it seems’. Farming, before now in Nigeria, was termed business of low-lives and with the barrier to entry being so high for young people to actively participate.”

    “I have successfully, in my little way, impressed on my generation that farming could be glamorous and cool enough for us to trade places with the business executive in the large conglomerate and also the bank’s middle management cadre, which is the initial attraction for most young graduate(s) in Nigeria.”

    She is not shy talking about how rough it was in the beginning: “As a young entrepreneur, in my very early days, I lost a lot of the seed capital I got from financial mentors to poor and bad business decisions I took because there was no one to talk to.”

    Overall in sub-Saharan Africa, the long-term prospects for agriculture are good. The Food and Agricultural Organization (FAO) found in a 2009 paper that “the sub-Saharan agricultural sector — 80 percent of which consists of smallholder farmers — grew more than 3.5 percent in 2008, well above the 2 percent rate of population growth.”

    Sub-Saharan Africa’s population is predicted to grow from 770 million in 2005 to 1.5 to 2 billion in 2050 (FAO). Despite rapid migration from the countryside to cities and the growth in urban population, the absolute number of rural people is also likely to continue to increase.

    Agriculture is the motor for rural development, poverty and hunger reduction in sub-Saharan Africa. The FAO paper said that agricultural growth in sub-Saharan Africa is likely to be led by domestic and intra-African demand for food commodities due to urbanization and the growing population.

    African farming has been able to benefit from rising global food prices and demand. The policy environment has also become more favourable, according to the FAO. The paper found “There is a particular need for programmes and policies to increase the capacity of smallholder farmers to enter dynamic sectors of national, regional and international markets.”

    African farming can see serious productivity gains if it changes and it takes on new techniques. At the moment only 3 percent of the region’s food crops are produced using irrigation, compared to more than 20 percent globally.

    The irony is that Nigeria has already hatched one of the world’s most successful food companies, Olam (www.olamonline.com). A global food supply company in ‘agri-products’ that got its start in Nigeria, it shows Umoru is on to something – a Southern brand can grow and go global, and overcome the difficulties of cross-border trade in Africa.

    Olam currently supplies well-known global food brands including Cadbury (chocolate), Nestle, Lavazza (coffee), Mars (chocolate), Tchibo and Planters (peanuts).

    With some 218 million people in Africa — around 30 percent of the total population — estimated to be suffering from chronic hunger and malnutrition, a thriving local food sector would bring many gains.

    Turning to more sophisticated business models offers solutions to chronic problems. With 80 percent of Africa’s farms less than two hectares in size – and there are 33 million of them – cereal yields have grown little and are still around 1.2 tonnes per hectare in the region, compared to an average of some 3 tonnes per hectare in the developing world as a whole. Fertilizer consumption was only 13 kg per hectare in sub-Saharan Africa in 2002, compared to 73 kg in the Middle East and North Africa and 190 kg in East Asia and the Pacific. The FAO has estimated that the potential additional land area available for cultivation in sub-Saharan Africa amounts to more than 700 million hectares – a boon to the continent’s and the world’s food needs in coming years if handled well.

    And the demand is there: Between 2001 and 2007, annual increases in the global consumption of agricultural commodities were larger than during the 1980s and 1990s. The quantity of agri-products harvested in the world is 5.2 billion metric tonnes a year.

    “I have been able to reach out to so many people across the nation, preaching the agribusiness development and adoption gospel,” said Umoru. “I have also worked closely with other youth agencies to empower many more young people to aspire in Nigeria.”

    One such agency is the Harambe Nigeria Endeavour. Harambe Nigeria (http://www.hendeavor.org/content/bgroups/nigeria.php) is a programme designed to stimulate growth in the agricultural sector and open up opportunities for youth to become leaders and entrepreneurs in this area. And this means future young entrepreneurs going into the agricultural sector will not feel as alone as Umoru once did.

    As Obinna Ukwuani, creative director of Harambe Nigeria says: “We wish to rectify the tarnished image of agriculture in Nigeria, making it a viable investment for Nigerian youth from all walks of life.”

    Published: May 2010

    Resources

    1) World Vegetable Center: The World Vegetable Center is the world’s leading international non-profit research and development institute committed to alleviating poverty and malnutrition in developing countries through vegetable research and development. Website: http://www.avrdc.org

    2) Marketing African Leafy Vegetables: Challenges and Opportunities in the Kenyan Context by Kennedy M. Shiundu and Ruth. K. Oniang. Website: http://www.ajfand.net/Issue15/PDFs/8%20Shiundu-IPGR2_8.pdf

    3) 2050: Africa’s Food Challenge: Prospects good, resources abundant, policy must improve: A discussion paper from the Food and Agricultural Organization (FAO). Website: http://www.fao.org/wsfs/forum2050/wsfs-background-documents/issues-briefs/en/

    4) African Alliance for Capital Expansion: A management consultancy focused on private sector development and agribusiness in West Africa. Website: http://www.africanace.com/v3

    5) Branding Strategy Insider: This blog provides advice and case studies on how to build trust for your brand. Website: www.brandingstrategyinsider.com

    6) Growing Inclusive Markets, a web portal from UNDP packed with case studies, heat maps and strategies on how to use markets to help the poor. Website: www.growinginclusivemarkets.org

    7) Starting a SME (small, medium enterprise): This website is packed with advice and tips for starting a small business and how to grow it with limited resources. Website: http://www.smallbusiness.co.uk

    8) World Business Fair: The World Business Fair is an international trade platform for global entrepreneurs and professionals. Website: http://www.worldbusinessfair.com

    Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP’s South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South’s innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator. 

    Creative Commons License

    This work is licensed under a
    Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

    ORCID iD: https://orcid.org/0000-0001-5311-1052.

    © David South Consulting 2023

  • Small-scale Farmers Can Fight Malaria Battle

    Small-scale Farmers Can Fight Malaria Battle

    By David South, Development Challenges, South-South Solutions

    SOUTH-SOUTH CASE STUDY

    Malaria is one of Africa’s biggest killers. Each year globally 300 to 500 million people are infected, and around 1 million die from the disease (theglobalfund). Ninety percent of malaria deaths occur in sub-Saharan Africa – mostly to children under the age of five. The disease costs African countries US$12 billion a year in lost gross domestic product.

    Malaria is a parasitic disease – the parasite plasmodium – transmitted by mosquito bites. Symptoms include fever, headache and vomiting. Internal bleeding, kidney and liver failure may follow and can result in coma and death.

    The most common and effective treatment, recommended by the World Health Organization, is artemisinin-based combination therapies, known as ACTs. ACTs have low toxicity, few side effects and act rapidly against the parasite. Research shows that artemisinin remedies cure 90 percent of patients within three days.

    But there are far fewer doses available than people who need them. WHO has claimed the quantity made available by pharmaceutical companies falls far short of the more than 130 million doses required to combat malaria throughout the world.

    And ACTs are very expensive to deliver: in just one country, Tanzania, providing such therapy for three years would cost US $48.3 million. Every year, this would account for 9.5 percent of Tanzania’s health budget, and 28.7 percent of yearly spending on medical supplies: a six-fold increase in budget for malaria treatment (Malaria Journal 2008, 7:4).

    But a cheap alternative to the expensive pill form of the treatment is being piloted across Africa. It involves the drinking of a tea made from the bushes of the artemisia plant. Artemisia annua is an annual shrub and the active ingredient in the pills (artemisinin). It is native to China and Vietnam and has been used for 2,000 years to treat fevers.

    Bushes cultivated by farmers in Kenya, Malawi, Tanzania, Zambia, Zimbabwe and Mozambique under the supervision of the World Agroforestry Centre in Nairobi, Kenya, are helping to bring down malaria rates without the long wait for the pills to arrive.

    The leaves are boiled and made into a tea. Drinking the tea gives a high enough dose of artemisinin in the blood to cure malaria. Helen Meyer, a nurse operating nine mobile health clinics in rural Mozambique, is using the bitter tea made from the dried leaves. Even in treating drug resistant malaria, she has found the artemisia tea effective: “If you drink the tea, you feel better after the first day. Other medicines take a few days.”

    A special hybrid of artemisia, A-3, is used because it is adapted for warmer climates. The wild variety grows to only five centimetres in the tropics, but A-3 grows to three metres and packs 20 times more artemisinin. It is also highly economical: thousands of plants can come from a single stem.

    The daily adult dose of anti-malaria tea just needs five grams of dried A-3 leaves in one litre of water. The tea is drunk every six hours for seven days. Each plant produces 200 grams of dried leaves, and a thousand shrubs can cure 5,700 people. Since it is a cheap cure, money can be spent instead on other things. Farmers are also able to supplement their income by growing the bushes. And the dried leaves have long-lasting power: even after three years the leaves retain close to a 100 percent of their artemisinin.

    Access to authentic artemisinin is critical: it is estimated 16 percent of malaria medicines in Kenya are counterfeit. Elsewhere, the proliferation of counterfeit anti-malarials substantially raises the risk of the emergence of resistance to artemesinin combination therapy, the last truly effective treatment against malaria. Past misuse of other malaria drugs, such as chloroquine in the 1980s and sulphadoxine/pyrimethamine in the 1990s, resulted in the malaria parasite becoming resistant. Hundreds of thousands of people in malaria-prone areas may have died as a result.

    The World Agroforestry Centre, recognizing potential problems with artemesinin monotherapies, is working to combine it with indigenous herbal remedies made from other anti-malarial trees, producing a herbal combination therapy (HCT).

    “I used to grow fruits and beans here,” said Charles Kiruthi, a Kenyan farmer, to the IRIN news service. “but I will get a better return from this plant. No pests attack it, and until harvesting time it requires very little labour.”

    “I expect to get a good return, and I am also very happy to be helping fight malaria,” continued Kiruthi. “I recently lost two friends to the disease, and my child gets sick with malaria sometimes.”

    Published: July 2008

    Resources

    Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP’s South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South’s innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator. 

    Creative Commons License

    This work is licensed under a
    Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

    ORCID iD: https://orcid.org/0000-0001-5311-1052.

    © David South Consulting 2023