A WHITAKER GROUP PUBLICATION
AFRICA HEALTH NEWS
59TH SESSION OF THE WHO REGIONAL COMMITTEE FOR AFRICA
PRESIDENT KAGAME CALLS FOR
STRONG HEALTH LEADERSHIP
President Paul Kagame of Rwanda called for a renewed commitment
to leadership and accountability at the opening of the 59th Session
of the World Health Organization (WHO) Regional Committee for
Africa held in Kigali, Rwanda, from August 31 to September 4.
“Money is essential for achieving development objectives, but greater
challenges lie elsewhere - including strong and multi-level leadership,
robust policy ownership, appropriate strategy, commitment, hard work,
being innovative and accountability,” President Kagame told the gath-
ering of African health ministers and other delegates. “No amount of
material or financial resources can transform a nation without a clear
political and policy purpose.”
He pointed to Rwanda’s success in expanding universal health cover-
age from 7% in 2003 to 85% in 2008, and the implementation of Per-
formance-based Financing as evidence of what can be achieved when a
nation takes ownership of its health challenges.
Rwanda’s increased health coverage is largely due to the creation of
mutuelles de santé or community prepayment health insurance schemes,
which pool the resources of all mutuelle members who then receive ser-
vices at designated health centers. Under Performance-based Financ-
ing, the Government of Rwanda and its partners tie the provision of aid
and government support to health outcomes at facilities. By improving
outcomes, health care providers can earn bonuses, thereby providing
LEADERS DISCUSS SECURE SUPPLY CHAINS
Over 100 African health leaders, including Ministers of
Health and senior delegates from 19 African countries at-
tended a dinner on the margins of the WHO Africa region
session in Kigali to discuss strategies to secure patient health
by ensuring the safety of supply chains in Africa.
Dr. Richard Sezibera, Rwanda’s Minister of Health, called on
countries and the industry to work closely together to ensure
that supply chains remain safe. Speakers also gave examples
of best practices in the Ghanaian and Rwandan procurement
systems.
The dinner was hosted by Global Health Progress (GHP), an
initiative that brings research-based biopharmaceutical com-
panies and global health leaders together to improve health in
the developing world, Eli Lilly & Company and the Interna-
tional Federation of Pharmaceutical Manufacturers and As-
sociations (IFPMA). Other speakers included Dr. Benjamin
Kumbour, Deputy Minister of Health, Ghana (now serving as
the Minister of Health); Ambassador Zephyr Mutanguha, Di-
rector General, CAMERWA; Ms. Suvi Rautio, Regional Chief
of Supply, UNICEF; Mr. David Talbot, Director, International
Government Affairs, Eli Lilly and Company; and Dr. Ryoko
Krause, Director, Biologicals and Vaccines, IFPMA.
SEPTEMBER/OCTOBER 2009
incentives and increasing ac-
countability.
“Citizens develop a direct
stake in health, and can no lon-
ger afford to stand on the side-
lines precisely because they now
realize they can contribute con-
siderably to the improvement
of the lives of their children,
siblings, parents, or their very
own,” the President added.
President Kagame also cred-
ited this approach for Rwanda’s
dramatic reduction in malaria
cases in recent years. “We had
to have an effective preventa- A Rwandan mother holds up her
tive and curative strategy that mutuelles de santé card
emphasized public and private partnerships, assertive community mo-
bilization and a consistent focus on strengthening our national health
system, particularly at the district and local levels.”
The President thanked Rwanda’s development partners for their as-
sistance in supporting the government’s health goals. He outlined sev-
eral key features that maximize the impact of aid:
■ National policy ownership with a clearly defined purposed for aid,
understood and shared by the provider and receiver;
■ Shared oversight and accountability mechanisms with well-de-
fined indicators to systematically monitor the impact;
■ Embedding aid into the execution of national development strate-
gies and policy priorities; and
■ Built-in human and institutional reinforcement to build and sus-
tain capacity and competence beyond aid.
Improved Health Capacity
WHO Director-General Dr. Margaret Chan, who also spoke at the
opening of the regional session, reported that recent WHO data showed
large reductions in child mortality and mortality from malaria as Afri-
can countries approach universal coverage with recommended malaria
interventions. The dramatic improvements, she said, were the result of
excellence in research and institutional capacities in Africa, where 11
centers are now conducting phase three trials of a potentially revolu-
tionary malaria vaccine.
In addition, Dr. Chan pointed to the “add-on benefits” of malaria
control in reducing child mortality, which include quicker identifica-
tion and management of childhood pneumonia, real-time disease sur-
veillance, and the use of mobile telephony to manage health care.
“I believe it is time to stop talking about Africa in terms of sweep-
ing generalizations,” Dr. Chan said. “The region as a whole may not
reach the Millennium Development Goals, but there are bright sparks
of success, in many areas of health in many countries, that tell a differ-
ent story. Success builds the momentum for transformational change.
Success gives all those same old problems a different perspective. They
can be overcome.”
PAGE TWO
NEW EFFORT ON MALARIA
AFRICAN LEADERS LAUNCH ALLIANCE
TO ELIMINATE DEATHS
African leaders, gathered at the United Na-
tions General Assembly, launched an ambi-
tious program in September to eliminate ma-
laria deaths in Africa by 2015.
The African Leaders Malaria Alliance, made
up of the Heads of State of 20 African nations,
aims to streamline procurement and distribu-
tion of control and treatment methods while
advocating keeping malaria high on the inter-
national development agenda.
The alliance’s first goal is to provide univer-
sal access to malaria control methods - insec-
ticide-treated bed nets and indoor residential
spraying - to all at-risk Africans by the end of
2010 in the hopes of eliminating all prevent-
able malaria deaths by 2015.
Ninety percent of the more than one million
deaths from malaria annually occur in Africa,
the vast majority of which are children un-
der five and pregnant women. It is estimated
that the economic costs of malaria in Africa
amount to about $12 billion each year.
“We are now creating a critical forum and
mechanism for advocacy, action, and follow-
up on the implementation of these noble goals.
The goals are ambitious, but I am confident
they are achievable,” said Tanzanian President
Jakaya Kikwete.
The alliance will complement the ambitious
plan to combat malaria unveiled in 2008 by
the Roll Back Malaria Partnership. The inter-
national community has committed $3 billion
in support of the plan, which includes the dis-
tribution of more than 240 million bed nets
by the end of 2010. With bed net distribution
tripling over the past five years, malaria deaths
PHARMACEUTICAL INNOVATION
NEW DRUG TARGETS SLEEPING SICKNESS
A new combination drug therapy is now
available for trypanosomiasis, or sleeping
sickness, the Drugs for Neglected Diseases
initiative (DNDi) announced in September.
The new treatment, Nifurtimox-Eflorni-
thine Combination Therapy (NECT), is the
first advance in 25 years, and will be half the
cost of previous treatments and much easier
to transport to remote locations. The World
Health Organization (WHO) is preparing to
send free kits to endemic regions and train
health workers on how to administer the new
treatment. The drugs were donated by bio-
More than 300 million Africans are now
covered by insecticide-treated bed nets. The
goal of the African Leaders Malaria Alliance is
to extend coverage to 700 million Africans by
the end of 2010.
have declined by up to 60% in some malaria-
endemic countries.
President Kikwete said that the alliance must
address critical issues such advocating for in-
creased spending for national malaria pro-
grams to establishing comprehensive national
prevention and therapy policies. “In scaling up
use of insecticide-treated mosquito nets and
indoor residence spraying, we need to remind
ourselves of the importance of maintaining in-
ternationally-agreed standards. In our national
malaria control programs, due regard must be
given to solving the problems of a shortage of
health workers at all levels and ensuring effi-
cient utilization of available resources for scal-
ing-up interventions,” he said.
pharmaceutical companies sanofi-aventis and
Bayer Schering Pharma AG. Sleeping sickness
threatens 60 million people in 36 countries
across sub-Saharan Africa, with about 48,000
people dying from it each year.
The development of the NECT kit is the
result of a partnership made up of Médecins
Sans Frontières; Epicentre; HAT Platform,
a network of researchers from five African
countries; the Swiss Tropical Institute and the
national control programs from the Demo-
cratic Republic of the Congo (DRC) and the
Republic of the Congo.
HEALTH & FINANCE
KENYA TO BENEFIT
FROM PRIVATE EQUITY
HEALTH INVESTMENTS
Kenya is one of the first countries in Africa to
access private equity funds, established spe-
cifically for health care investments in Africa,
to finance broad-based improvements to its
health system.
In August, the Government of Kenya an-
nounced the country would benefit from capi-
tal, made available through the Health in Af-
rica Fund and the Investment Fund for Health
in Africa, to improve Kenyatta National Hos-
pital as well as other health services.
In 2008, the Government of Kenya’s health
financing taskforce developed a public-pri-
vate partnership financing model to sell to the
country’s development partners as the pre-
ferred long-term means to improve Kenya’s
health system.
The taskforce concluded that selling equ-
ity in health institutions would inject private
sector discipline into their management, and
would provide needed capital to increase the
training of health care workers and to procure
equipment and drugs.
“Financing the subsidy gap is a good invest-
ment that will unlock the demand side obsta-
cles to health care services in Africa,” Professor
Eyitayo Lambo, CEO of International Man-
agement and Health Consultants, told Kenya’s
Business Daily.
The Health in Africa Fund was established
in June with the backing of the World Bank’s
International Finance Corporation (IFC), the
African Development Bank (AfDB), the Ger-
man development finance agency DEB, and
the Bill & Melinda Gates Foundation. The
fund plans to make about 30 investments,
ranging from $250,000 to $5 million, in health
care ventures throughout Africa.
The Investment Fund for Health in Africa
(IFHA) is a Dutch-led private equity fund ded-
icated to small and medium size investments
in private health care companies in Africa. Its
investors include FMO, the entrepreneurial
development bank of the Netherlands; Gold-
man-Sachs investment bank; and the Social
Investor Foundation for Africa, which is sup-
ported by the private sector.
When private equity partners are given a
stake in management control, they are likely to
exert a positive influence on efficiency, policy
and corporate governance of private health
services.

PROTECTING HEALTH WORKERS
NEW PUBLIC-PRIVATE PARTNERSHIP TO
IMPROVE BLOOD COLLECTION SAFETY
BD (Becton, Dickinson and Company), a
leading global medical technology company,
and the US President’s Emergency Plan for
AIDS Relief (PEPFAR) announced a joint ini-
tiative in August to help protect health work-
ers and patients in Africa by improving blood
collection safety in clinics and hospitals.
The program, to be implemented in partner-
ship with Ministries of Health in the partici-
pating countries, will help health care workers
improve their blood-drawing procedures and
specimen handling, and will also work to con-
trol health workers’ exposure to HIV by pro-
viding post-exposure prophylaxis.
The three-year initiative - which may be
extended by up to two additional years - is
scheduled to begin in October in Kenya, and
will be expanded to up to four additional PEP-
FAR focus countries where the Ministries of
Health will take the lead in developing indi-
vidualized policies, guidelines and standard
operating procedures for blood drawing and
specimen handling.
It will ultimately support in-service training
for as many as 10,000 health care workers and,
when fully implemented, will track as many as
two million blood draws within each partici-
pating country.
“A critical role of international development
partners such as PEPFAR is to develop and
support national leadership,” said Ambassador
Eric Goosby, the US Global AIDS Coordina-
EXPANDING ACCESS
GSK TO MAKE LARGE INVESTMENT IN
AIDS DRUGS FOR AFRICA
GlaxoSmithKline (GSK), the United King-
dom-based biopharmaceutical research com-
pany, has announced it will invest up to ₤60
million ($97.6 million) over 10 years to im-
prove research and development and access
to HIV/AIDS drugs in Africa.
GSK will create a pediatric treatment pro-
gram - Positive Action for Children - and has
granted South African generic drug maker
Aspen Pharmacare a royalty-free license to de-
velop a cheaper, generic version of the antiret-
roviral (ARV) abacavir. GSK acquired a 16%
stake in Aspen Pharmacare in May 2009.
According to GSK CEO Mr. Andrew Wit-
ty, the company is considering making more
Safer blood collection has become critical in
Africa since HIV testing and treatment has
dramatically increased.
tor. “PEPFAR is proud to partner with BD to
invest in health systems strengthening and
health work capacity-building for safe blood
collection. Efforts like these build the capacity
of partner countries, support the scale up of
proven HIV interventions, and ultimately help
create a sustainable response to HIV/AIDS.”
This is the third time that BD has partnered
with PEPFAR in a joint initiative. In 2007, BD
and PEPFAR launched a five-year program
to improve the quality of laboratories in sub-
Saharan Africa, and, in 2008, BD, PEPFAR
and the International Council of Nurses an-
nounced a three-year, public-private partner-
ship to establish a new Wellness Center for
Healthcare Workers in Kampala, Uganda.
drugs “appropriate for use in an African set-
ting” available for license.
Of the total investment, ₤50 million ($81.3
million) will go to a fund to support non-gov-
ernmental organizations working with preg-
nant women to prevent mother-to-child trans-
mission of HIV. The remaining ₤10 million
($16.3 million) will be seed money to support
public-private partnerships to develop AIDS
medicines specifically for children.
“Our objective for Africa is clear - to make
existing medicines as widely available as pos-
sible while at the same time ensuring sustained
investment into R&D for a new generation of
medicines,” said Mr. Witty.
PAGE THREE
BUILDING CAPACITY
AFRICAN NATIONS
SEEK ACCREDITATION
Government health officials from 13 African
countries launched the first ever push for ac-
creditation of the continent’s medical labo-
ratories in July, starting a process that many
believe will be an historic step in strengthen-
ing health systems and providing better care
for patients.
The five-step accreditation process, de-
veloped by the World Health Organization
(WHO) Regional Office for Africa, will allow
labs to gradually receive credit for improve-
ments with the goal of eventually attaining
full international accreditation. The initiative
will be supported by the WHO and the US
President’s Emergency Plan for AIDS Relief
(PEPFAR), with funding from the Clinton
Foundation.
The 13 countries pursuing accreditation are
Botswana, Cameroon, Côte d’Ivoire, Ethiopia,
Ghana, Kenya, Malawi, Nigeria, Rwanda, Sen-
egal, Tanzania, Uganda and Zambia.
“It’s time for Africa to go in this direction.
Accreditation is the only way to be sure a lab-
oratory is a good laboratory,” said Dr. Agnes
Binagwaho, Rwanda’s Permanent Secretary of
the Ministry of Health. “We cannot provide
high quality care, no matter what type of dis-
ease we’re fighting, without strong laboratories.
This will greatly strengthen our health systems
in the short term and the long term. This is all
about building sustainable health systems.”
The accreditation process will be carried out
by the American Society for Clinical Pathol-
ogy (ASCP) with the assistance of volunteer
laboratory professionals who will carry out
training programs and standardize the quality
of African laboratories.
Laboratories are considered the backbone
of a well-functioning health system, support-
ing correct diagnosis and speedy and effective
treatment. There are only 28 internationally
accredited labs in sub-Saharan Africa, exclud-
ing South Africa, all of them belonging to the
private sector or international research orga-
nizations.
“Supporting governments’ efforts to
strengthen national health care systems, in-
cluding laboratory quality management, is
essential to ensuring sustainability of country-
driven HIV/AIDS interventions,” said Ambas-
sador Eric Goosby, the US Global AIDS Coor-
dinator. “Efforts like this new lab accreditation
process are essential to equipping countries
and communities with the tools necessary for
progress on health.”
PAGE FOUR
STRENGTHENING PANDEMIC RESPONSE
WHO PROPOSES PREPAREDNESS
RESPONSE TO H1N1 FLU PANDEMIC
World Health Organization (WHO) Regional
Director for Africa Dr. Luis Sambo has pro-
posed a series of measures for strengthening
Africa’s response to the current global H1N1
influenza pandemic.
In a report to the WHO Regional Commit-
tee for Africa session in September, Dr. Sam-
bo proposed raising awareness of the disease
through improved communications, updating
existing epidemic and pandemic preparedness
and response plans, and scaling up surveillance
and assessment of the status of the disease.
In addition, Dr. Sambo called for an in-
creased capacity for influenza diagnosis, en-
suring effective coordination of infection con-
trol in health care settings and communities as
well as intensified resource mobilization.
The WHO Regional Office for Africa has
dispatched over a million doses of the antivi-
ral drug oseltamivir and protective equipment
to all countries in the Africa region, and has
established crisis management teams at the
WHO Regional Office in Brazzaville, the Re-
public of the Congo, and at country base loca-
tions in Harare, Zimbabwe; Libreville, Gabon;
and Ouagadougou, Burkina Faso.
PREVENTION
TANZANIAN ANTI-MALARIAL BED NET PLANT
TO EXPAND PRODUCTION
Vector Health International, a joint venture
in Tanzania with Japan-based Sumitomo
Chemical and A to Z Textile Mills, announced
in August that it was expanding production
of anti-malarial, insecticide-treated bed nets
from 9.9 million annually to 16.6 million.
The capacity expansion will bring the total
annual number of Olyset® Nets made in Tan-
zania to 29 million, and is expected to increase
the number employed at the plant from an es-
timated 4,000 people to 6,000.
While the majority of bed nets distributed in
Africa are manufactured in Asia, an increasing
number are now being made in Africa. Cur-
rently, there are six African manufacturers - in
Tanzania, Kenya, Nigeria and Uganda - reach-
ing over 6,000 retail outlets in seven African
countries.
The predecessor program for this commer-
cial bed net industry in Africa began in 1999
with the creation of the $67 million NetMark
In addition, the WHO has dispatched a mil-
lion doses of oseltamivir (an anti-viral medi-
cine) and personal protective equipment to all
countries in the African region.
In her remarks at the session’s opening, Dr.
Chan announced that the WHO had secured
pledges totaling 150 million doses of vaccine
for the developing world and thanked the
pharmaceutical industry, in particular Glaxo-
SmithKline and sanofi-aventis, for their con-
tributions, adding that she appreciated work-
ing in partnership with them.
“Last week, WHO and its international
humanitarian partners issued a call to action
aimed at mobilizing resources and supplies
to support developing countries during the
pandemic,” Dr. Chan said. “Apart from facili-
tating the management of acute respiratory
illness and pneumonia, actions include build-
ing stockpiles of essential medicines to ensure
continuity of services for priority conditions
such as diarrhoea, malaria, HIV and TB.”
As of September 10, the WHO reported that
there had been 8,125 confirmed cases of H1N1
in Africa.
project, funded by the US Agency for Interna-
tional Development (USAID).
“The US government, through USAID, pro-
vided the funding to develop a program to
create a public-private partnership in malaria
prevention by developing retail markets in se-
lected African countries for insecticide-treated
nets,” said Mr. Juan Manuel Urrutia, the Johan-
nesburg-based Deputy Director of NetMark.
African manufacturers are expected to sell
21 million nets in 2009, he said, adding that
the NetMark project has been so successful it
can now sustain itself, even if no more donor
funding were available.
Insecticide-treated bed nets have proven ef-
fective in dramatically lowering the number
of malaria cases. Sumitomo provides its Oly-
set technology free of charge to A to Z Textile
Mills, Sumitomo’s partner in Vector Health In-
ternational. More than half of global produc-
tion capacity for Olyset Net is in Africa.
PREPARED AND DISTRIBUTED BY THE WHITAKER GROUP
LEADERS IN HEALTH
DR. GUNTHER FABER
CEO, THE HEALTHSTORE
FOUNDATION
When Dr. Gun-
ther Faber retired
in 2008 as Vice
President, Sub-Sa-
haran Africa, for
bio-pharmaceutical
research company
GlaxoSmithKline
(GSK), he did not
Dr. Gunther Faber
leave the field of
health care.
Instead, as the new CEO of The Health-
Store Foundation, he took up the chal-
lenge of expanding access to affordable
and safe medicines and primary health
care to East Africans. It was a natural
progression for Dr. Faber who through-
out his career has been active in efforts to
improve access to essential medicines’
The HealthStore Foundation’s Child
and Family Wellness (CFW) franchises
include micro pharmacies and clinics
that provide access to essential medicines
and target the most common causes of
childhood mortality in Africa. Each fran-
chisee must adhere to uniform systems
and training, as well as strict controls on
quality backed up by regular inspections.
In less than two years on the job, Dr.
Faber has brought his management ex-
pertise - gained from managing pharma-
ceutical businesses for GSK in 45 sub-Sa-
haran African countries - to HealthStore
franchises in Kenya and Rwanda where
he has significantly improved the perfor-
mance of those franchises.
The most valuable aspect of the CFW
model, Dr. Faber said, is that nurses own
the clinics. This not only makes the clinics
sustainable, but ensures that they deliver
quality service at least 12 hours a day for
six days a week. “An added bonus is that
we are creating employment for women
in the developing world,” he said.
The Foundation’s immediate goal is to
expand the model to include 14 African
countries with at least 1,200 clinics, pro-
viding quality basic health care to about
15.5 million people at a cost of $1.50 to
$2.00 a person per year. It hopes to even-
tually export its innovative micro-fran-
chising model to East Asia and South
American.