Having enjoyed a measure of success in emerging markets across the Middle East including Egypt, Saudi Arabia, Lebanon and Jordan, Dubai-based digital healthcare booking platform Vezeeta, founded in 2012, is now looking to scale up operations and activities at a pivotal time for telemedicine.

Nana Frimpong, the startup’s Vice President for Africa, explained more to Omnia Health Insights on Vezeeta’s ambitions in sub-Saharan Africa.  

Related: Breaking down barriers in telehealth in Africa

Earlier in 2020, the company soft-launched in Kenya and Nigeria, with initially varying results. It was a strategic move, allowing it to understand better the similarities and differences of both sides of the continent, with the two markets possessing unique characteristics and strengths.

Vezeeta will evaluate how to scale its numbers in the “coming months”, ahead of any planned further expansion into sub-Saharan Africa. It’s also evaluating how to deliver services without establishing a physical footprint or presence in a target market, since its technology can be accessed anywhere.

Tech-savvy Kenya, populous Nigeria

Kenya, a nation of 50 million people, stands out as one of the most tech-forward countries in sub-Saharan Africa today, and especially dominant in the fintech space (Frimpong cited mobile money transfer service M-Pesa as an example).

As such it was favoured by Vezeeta from the outset for factors that included internet availability and smartphone penetration. But it also appealed for its accessibility to doctors and, relatedly, affordability of doctors, and doctor patient ratio.

These conditions presented the startup with the ideal opportunity to identify how to augment or enhance existing processes through technology that is using the phone to find and book a physician without having first to drive to the clinic in the hope of meeting the doctor.

Frimpong added another benefit: innovations that begin in Kenya proliferate throughout the East Africa region.

Nigeria was a decision based on commercial considerations. “One of the most important countries on the continent,” Frimpong explained, owing to the sheer size of the market and population, Nigeria offered an unique opportunity: how to use technology to leapfrog infrastructural challenges that come with such a large territory.

Integrated model succeeds in COVID-hit Kenya

In Kenya a proliferation of telehealth services emerged during the COVID-19 crisis. Yet Vezeeta stood out in the market. Rather than offering technology alone it provided an integrated service including in-person consultations as well as telehealth.

In other words, technology is used to support the continuum of care, rather than supplanting it altogether.

This was ideally suited to Kenya, as while the nation’s doctors are tech-savvy and tech-ready, they also have reservations about prescribing drugs via a teleconsultation and would therefore expect the patient to physically come into the clinic.

If it’s a simple follow-up conversation or an initial consultation to determine what happens next, then the telehealth format “makes a lot of sense,” Frimpong explained.

In Nigeria the nation’s relatively severe lockdown impeded Vezeeta’s ability to get into the market quickly, get its physicians on board and bring them together with patients.

Since the country eased lockdown measures, however, Vezeeta has seen adoption pick up – both of its platform and suggestions.

Young patients seek mental care - and care for parents

In terms of how patients have been using Vezeeta’s platform to date, Frimpong revealed that “psychiatry”, while not a mainstream subject in Africa, is a popular category of teleconsultation as patients seek mental health support.

Medical specialities too, that include gynaecology and dermatology - demand is seen coming in from patients in the East Africa region for teleconsultations with Kenyan doctors on skin issues that they are facing.

In Nigeria, where there remains a disposition towards in-person consultations still, patients are recognising that they can see a doctor in Lagos from Abuja without having to travel (a distance of approximately 700km), or alternatively they can book ahead of their visit, as opposed to turning up and hoping for the best.

Most teleconsultation patients are young, in the 24-35 bracket (Gen-Z and young Millennials). Surprisingly, many are booking appointments on behalf of their parents - the analytics show that people are booking from Australia, Florida, Canada and the UK, for example, for a parent or loved one living in Nigeria or Kenya.

A telehealth policy framework could unleash a healthcare revolution

Highlighting that many doctors in both markets are raising questions around legal issues, data security and protection, Frimpong said that for Vezeeta is was “incredibly important” that patients are given the security they need, as well as the company adhering to general ethical practices around data management.

But there remain important questions – for instance what happens in the event of medical malpractice lawsuit. This underlines the need for a clear and robust policy framework to guide how telehealth interactions take place moving forward.

This is especially pertinent, Frimpong believes, in consideration of how telehealth appears to be accelerating more quickly than anticipated.

A well-designed framework would see greater and faster adoption of telehealth solutions - so long as policies and legislation are in favour of expanding access.

He noted how Australia developed a framework bringing together payers, patients and providers in a way that everyone benefits, while the US lifted restrictions during COVID-19 that allowed people to access care across state lines.

A similar framework that allows patients to safely access doctors across Africa, provided they are licensed and held to the same standards, could prove “revolutionary” for healthcare in sub-Saharan Africa, where there remains a shortage of doctors.

In some rural areas there are few specialists for certain diseases compared to North Africa, where there are physicians across multiple specialties.

A new model could therefore emerge that, through telehealth, integrates local doctors with physicians in other countries who have particular expertise in a given area. Under such a scenario, Frimpong said, patients are able to select medical care that suits themselves and their families in accordance with their needs and price point – rather like consumers.

On this last point, he elaborated further by saying that uptake surges when patients feel the price point is right, and that it was important to understand how patients price the value proposition of teleconsultations versus in-person consultations.

But physicians too have a different perspective on this, in how they get compensated.

How the two may be reconciled was an area of discussion at Omnia Health Live Africa that Frimpong looked forward to. The Vezeeta executive spoke at a session on Policies and regulations shaping telemedicine in Africa: Challenges and opportunities in COVID times when he was joined by panelists from Lagoon Hospitals; Board of Healthcare Funders of Southern Africa; Discovery; and Homeplus Medical Care Services.

Honeywell and Influence Healthcare International (IHI) are collaborating to advance the quality of healthcare through the deployment of cutting-edge technologies and next-generation end-to-end connected solutions.

The collaboration will combine Honeywell Safety and Productivity Solutions’ (SPS) global expertise in automation, mobile communication, productivity products and solutions, and cloud-enabled predictive analytics with IHI’s industry-leading healthcare transformation capabilities to create ultra-safe healthcare solutions.

Digital transformation

Under the collaboration, IHI will be able to leverage Honeywell’s technology expertise for healthcare environments, including nurse call systems, RFID solutions, remote patient monitoring and mobile barcode scanners among others. IHI will provide its advisory services, operation transformation solutions and training, coaching and leadership consultancy.

Speaking to Omnia Health Insights, Miroslav Kafedzhiev, vice president and general manager for Honeywell SPS, High-Growth Regions, explains: “We are continuously exploring new opportunities to provide high-quality healthcare solutions and support healthcare sector participants by reducing costs, optimising hospital operations, and enhancing the overall patient experience in the region. The safe handling and monitoring of patients and healthcare staff are at the core of our operations.”

Honeywell’s solutions help keep clinicians, patients, general consumers and industrial workers safe, and address current as well as future challenges for Personal Protective Equipment (PPE), among others.

“From check-in to discharge, our technologies equip healthcare providers to be more effective and efficient with the right mobile solution for patient data and communication. For example, Honeywell’s 2D imager quickly and accurately reads 1D and 2D barcodes on virtually any medium – vials, syringes, IV bags, patient wristbands and more,” says Kafedzhiev.

Healthcare Mobility

Honeywell is also advancing the mobility of nursing workflow processes with Healthcare Mobility, which has been designed specifically for the demanding healthcare environment. The solution connects healthcare professionals to all critical information, applications, and interfaces, when they need it, where they need it. It enables accurate, coordinated procedures such as vital sign parameters and medication control, eliminating inefficient work processes and reducing common errors.

“With simple reliable workflow steps, patient information and alarms are intelligently forwarded to the correct individual, helping to reduce alarm fatigue. Additionally, Healthcare Mobility offers integration with several safety applications and systems such as patient and asset monitoring, medical supervision, fire alarm and hazard management, and enables care facilities to define individual escalation procedures,” Kafedzhiev adds.

“It makes everyday patient care safe, more productive and efficient, by empowering nurses to spend less time on routine tasks and more time providing exceptional patient care.”

Ethics, human rights & medico-legal issues regarding the COVID-19 pandemic: African cross-national perspectives

The ethical issues of COVID-19 range from depriving people of their personal liberty, their right of movement, as well as putting measures that limit access to healthcare, stressed panellist Prof Felix Nzube Chukwuneke, Chair, UNESCO Bioethics Unit; Chair - College of Medicine Research Ethics Committee (COMREC), Chair - Eastern Nigeria Research Ethics Forum.

Related: How open data platforms for polio were leveraged to fight COVID-19 in Africa

He said: “In Nigeria, for instance, some people who were really unwell were not able to see their doctors because they couldn’t go out during lockdown. The law enforcement agencies were also brutal in their approach in some instances which raised serious ethical issues.”

Another example, he shared, was of women who couldn’t continue the vaccination of their children. The governments were concentrating on CVOID-19, but leaders were not thinking of the routine immunisation of children that needed to be done and it was completely stopped.

Related: Pandemic impact on women 'devastating' in Africa

Panellist Prof Julius Kipkemboi, Member, National Bioethics Committee; Associate Professor of Aquatic Sciences, Department of Biological sciences - Egerton University, said that COVID-19 has presented several ethical dilemmas such as balancing between the interest of the society and that of the individual. These include issues of quarantine for people coming from abroad, the matter of lockdown versus livelihoods, issues of contract tracing and surveillance versus privacy and rights of individuals.

“In Kenya, we are just finalising ethical guidelines for public health emergencies in response to COVID-19. If there are any clinical trials, this will provide guidelines on how we can participate and comes with ethical principles such as sharing of benefits,” he explained.

Transforming health through AI - challenges and opportunities?

Omnia Health Live Africa concluded with a session looking at AI’s role in healthcare. Speakers from IBM Research, Africa; Facebook; Novartis Foundation; Moxit; and Pan African Women in Health (PAWH) discussed what low- and middle income countries have to gain from the radical potential of AI to transform health systems and they have to lose.

The panelilsts were invited by moderator Lucy Setian, Digital & AI Stakeholder Engagement Lead at Novartis Foundation, to share updates how on their organisations were leveraging AI, before and during the pandemic. 

Charles Wachira, Software Developer at IBM Research, commented on a similar system powered by AI. IBM Research is building a system to support intervention planning in Africa. Machine intelligence was originally used to explore more effective malaria policy interventions. The primary goal of the system was to allow insights to be generated: decision-makers use AI to interrogate a high-dimensional model. It's powered by AI, he explained, because it's "hard to determine what to do" otherwise.

Laura McGorman, Policy Lead, Data for Good at Facebook commented that the Data for Good team sits within data and privacy policy at Facebook, and that there was a deliberate decision to generate social impact through a "privacy by design" framework. Three pillars of trust are followed: 

1. user consent, with surveys (they’re doing global symptom survey in 200 countries, for example) and location history requiring opt in;
2. the second pillar concerns access control, through open source data sets and making them publicly available; and
3. techniques are deployed to preserve user privacy - Facebook uses a technique called "differential privacy" to add noise to make re-identification impossible.

She revealed that it was important to prioritise in that one product is built well that may be used by a wide variety of non-profits and academics. Good products must cure a migraine (in the decision-making process), rather than fix a headache.

McGorman offered an example of such a solution from Facebook, which were population density maps, resulting in more detailed census data (where are there people/not people, which would inform spraying or vaccination decisions). While this may not sound "Facebooky", she explained, it was one of the tech giant's most impactful projects. 

Ramatoulie Jallow, Public Health Consultant and Health Communications Specialist; Stigma Index Researcher - Global Network for People living with HIV (GNP+), provided a different perspective, in that it was important to keep community in mind.

She highlighted that sometimes in tech or AI "we don't see women" for instance, and that it was important to bring everyone to the table. In this regard, neighbouring countries can also learn from one another - Ethiopia and Gambia for example.

How digital health and technology can strengthen healthcare around the African continent 

In a discussion moderated by Manish Kohli MD, Senior Advisor - Albright Stonebridge Group, Sanjana Bhardwaj, MD, Chief of Health and HIV - UNICEF Nigeria, and Prof. S. Yunkap Kwankam, Ph.D., CEO of Global eHealth Consultants looked at how technology and digital health is changing the course of healthcare in Africa. 

Prof Yunkap shared three innovative projects that he was working on in healthcare. The first, a telemedicine platform, is in the process of running through a joint venture in South Africa (with an investor company). 

The second is supporting Zimbabwe's Ministry of Health and UNDP in the development of a national digital health strategy, while the third through the International Society for Telemedicine and eHealth, aims to bring a global knowledge commons to fruition.

Dr Sanjana Bhardwaj revealed that while UNICEF has access to considerable health data, “everything under the sun”, including where facilities are located, performance and indicators, it’s not possible to change the trajectory of results for women, children and communities without other sectors playing a role.   

To enable more efficient resourcing planning and prioritisation, UNICEF is currently working with Nigeria state governments and state department for planning and research and statistics is to develop a portal that has health data with schools and water points plotted in too.  

Dr Bhardwaj added that the GIP mapping and data collection systems from community level upwards, that had been originally developed to fight polio, were quickly and easily leveraged in Nigeria’s COVID-19 response.  
 
She explained that through the data sample a better understanding was developed around transportation systems and mechanisms – where the bottlenecks are for example – and preparedness by facility, for example checklists completed for oxygen and commodities. Efforts are ongoing to see how this platform can be made more sustainable, not only for a further national outbreak response, but beyond.  

On examples of innovation cases studies that can provide lessons for the rest of the continent, Prof Yunkap referred to a startup hub in Cameroon named Silicon Mountain (referring to a physical mountain in the area), that began around the University of Buea and that now attracts innovators. To nurture technology and innovation, he added, "we're looking for movements that lift the entire economy."

Dr Bhardwaj, in agreement, named the need for an enabling environment to “think differently”. In South Africa she was part of an initiative, MomConnect Programme, started by UNICEF in two facilities.

Major potential across Africa had been identified early on. The system and lessons from the pilot were adapted to a bigger scale, and it became one of the largest programmes for reaching pregnant women all over the country. 

As a further example of its impact, MomConnect was adapted in Uganda to become FamilyConnect - the same concept but expanded to include family. 

She also highlighted the enormous impact of the phone in empowering people across the continent. UNICEF’s U-Report is actioned through text messaging; people sign up and polls are sent out, and through responses it's possible to obtain the pulse on the ground (and tailor messaging accordingly). 

Workshop: Key role of a “healthy” health sector in sustainable economic development

This engaging session was led by Hon. Dr Osagie Ehanire MD, Minister of Health - Federal Ministry of Health, Nigeria, who said that COVID-19 has had a far-reaching economic impact on the normal life in the country. But it has also given the nation the opportunity to improve its healthcare system. “COVID-19 showed us that a country is socially and economically healthy only if its citizens are healthy. The relationship between growth on one hand in investment on the other will boost the economy. Our mission is to ensure the availability of affordable and quality healthcare for all citizens,” he said.

While Dr Olusoji O. Adeyi, Senior Advisor for Human Development, World Bank Group, shed light on the role of health in the West African economic growth agenda. He said that the region faces a combined burden of maternal-child health, infectious diseases and non-communicable diseases.

“The economic impacts of COVID-19 in Africa have led to growth in sub-Saharan Africa to fall to -3.3 per cent in 2020,” he highlighted. “There is an increasing need to manage chaos, increase practical local production of critical equipment and supplies by expanding supply capacity, understand supply constraints and incentivize suppliers.”

The need for collaboration during the pandemic has uncovered the power of partnership that will change the demographics and life expectancy, according to panellist Dr Amit Thakker, Chairman, Africa Healthcare Federation. It’s only those countries, he said, that had institutional partnerships were able to save more of their citizens through e-learning, supply chain, telemedicine etc.

“We stand proud as a continent in front of the globe since we started early. We must learn and share with each in order to build a robust healthcare sector. Africans can learn from Africa, and this is the time for us to make an investment into a trusted partnership between the public and private sector,” he added.

Ensuring safety in the CSSD, no matter if it’s in a resource-restricted environment or a fancy hospital, apply the principles

At the panel, Dr Georgia Alevizopoulou, Senior Manager, Clinical & Education - STERIS Infection Prevention Technologies, stressed that “One can clean without sterilising, but one cannot sterilise without cleaning.”

She explained that cleaning in CSSD is the process of removing contamination from an item or surgical instrument to the extent necessary for its further processing and intended subsequent use. Contamination is also referred to as soil, which includes organic and inorganic materials such as blood, tissue, saliva, salts, gels etc. The presence of soil can lead to an adverse event such as toxicity in patients. This cleaning can be done manually, semi-manually or as a combination of both.

Stephen M Kovach, Educator, Healthmark Industries, explained that there are two important things in this process of manual cleaning – friction and fluid. Friction involves rubbing and scrubbing the soiled area with a brush and is an old and dependable method. But you also need the fluids to remove the debris.

While cleaning of instruments is important, it is essential for healthcare workers to do it while ensuring their safety, said Adele Colyn, Regional Infection Prevention and Control Manager – Netcare. Therefore, they must be provided with protective attire (PPE) for the tasks being performed.

Women driving clinical innovation during a crisis

An all-female roundtable moderated by Gillian Stewart, Industry Strategist - Life Sciences & Healthcare - Deloitte, discussed how female healthcare organisations can emerge stronger post-COVID-19.

Related: Africa CDC: COVID-19 recovery rate across Africa now 83 percent

The panel included speakers from Aga Khan Foundation, Ghana Health Service HQ, Pharmacess Foundation and University of Cape Town.

When prompted, all had a different idea of what female leadership entailed.

Prof Maswime, Head of Global Surgery at University of Cape Town, shared her perspective on leadership, in that it was about "getting things done" using skill, expertise and social intelligence. Women are furthermore "more collaborative", among other special skills, as leaders. 

Dr Mary Eyram Ashinyo, Deputy Director - Quality Assurance - Ghana Health Service HQ, measures leadership in the form of "contribution to humanity", influencing and nurturing others and the ability to surmount obstacles.

Dr Elizabeth Wala, Global Advisor, Health and Nutrition at Aga Khan Foundation, believes that everyone has the capacity to give guidance, and looks forward to the time when women leaders are spoken of as "leaders". 

Njide Nidili, Country Director - Pharmacess Foundation commented that it takes a special type of skill to secure buy-in, and that humility and passion are important to the leadership role ("everyone supports one another").

On specific challenges facing female leaders within the past six months, Nidili began by saying that the majority of people accessing healthcare are women and children. Women were dying from all ailments during COVID-19, because they were afraid to access hospitals. Her organisation, Pharmacess Foundation, made a concerted effort to support state government in putting out correct information.

Pharmacess Foundation supplied PPE (almost 65,000) to hospitals, as women were being sent away by hospitals - there were fewer people, and less money to buy PPE. The effect of the pandemic was "devastating".

Nidili added that compounding this is the fact that a large percentage of doctors are women, but not all are decision-makers. The issue of access and how to level the playing field needs to be addressed, and that's why innovation in Africa is critical.

Dr Ashinyo's observation was that in Ghana the pandemic has heightened existing mindsets. Most women needed to create space for themselves, as the pandemic "pushed them further into the background" because of perceptions that the crisis required strengths (associated by men with men). They had to do their own situation analysis, and provide solutions to gaps, which was how they entered into the limelight. Much work remains however, conceded Dr Ashinyo.

The moderator introduced the fact that in South Africa the ceasarian rate has dropped because of COVID-19 because women are not going to hospital. Neo-natal care has dropped to virtually nothing.

Prof Maswime in reply indicated the disparity between public and private care; in South Africa only 20 percent can afford private. A lot of the issues go back to disparities. Furthermore, pregnant women in South Africa are anxious at this time, owing to the pandemic, and they require more support. Some are having to give birth alone.

Dr Wala highlighted a considerable reduction in funding for shelters, meaning some shut down; and the issue of job losses in an economic downturn. Teenage pregnancies because of school closures was another challenge, as was a reduction in access to care. Many community workers (majority women) were fearing going into houses as they didn't have PPE.

Some policies were not gender-specific, Dr Wala added. Women were reduced to taking minutes in meetings, rather than making decisions and having a proper place at the table.

The impact of COVID-19 on breast cancer management

Breast cancer patients and care providers have found themselves in a difficult and uncertain position since the pandemic began. COVID-19 has affected the screening, diagnosis, treatment and follow-up of breast cancer patients. The outcomes of women with breast cancer are dependent on timely and high-quality interventions. And any delay in timely management will impact both the physical and psychological state of these women.

One of the challenges that breast cancer providers had to address was the fact that many patients did not seek care out of fear. Even patients with diagnosed breast cancer were hesitant to come into a healthcare facility to receive further management knowing that they are immune-compromised.

“As a result of this, we are now seeing many breast cancer patients with advanced disease,” said panellist Prof Dr Rasha Kamal. “As breast health care providers, it is our duty to tell patients to not fear the Coronavirus because you might not get it, but you do have breast cancer and that needs to be treated.”

Dr Kamal emphasised that hospitals need to re-evaluate the flow of patient care to minimise personal interactions in order to prevent the transmission of the virus while keeping both patients and breast care providers as safe as possible.

SMEs in the healthcare supply chain

Supreet Singh Manchanda, Managing General Partner at Raiven Capital, moderated a panel comprising speakers from Stanford Seed, Kizo Ventures and iJenga, who discussed how to increase the performance of SMEs in the healthcare supply chain and the competitive advantage of SMEs in the healthcare supply chain ecosystem.

The panel was asked for perspectives on healthcare in the current pandemic context.

Soravar Singh, Managing Director: Real Estate Development & Investments - iJenga, compared his experiences in Kenya with Canada, where he'd spent the early part of the COVID-19 pandemic.

There were similarities in both countries where there was mobilisation of health researches, from communications to how healthcare was administered (in Nairobi he witnessed some differences in how communication was conducted). In Canada there was heavy reliance upon community, with community participation working across economic statuses.

Laurie Fuller, Executive Coach, Strategic Advisor - Stanford Seed highlighted how, from her perspective, the pandemic has shown inequalities in access to healthcare. COVID-19 aside, natural disasters have accelerated in frequency around the world, presenting a challenge to keep people safe in the "new normal". 

Regina Njima, Co-Founder & Managing Partner - Kizo Ventures, commented on the need to wait for N95 masks from China, requiring the use of surgical masks in the interim. She added that mental issues and anxiety have emerged through the pandemic alongside other challenges. 

The talk quickly turned to innovation emerging in the healthcare supply chain.

Fuller highlighted two innovations: a company using the opportunity to go straight to the manufacturer and disintermediate the supply chain, reducing the price significantly and giving quality feedback; and the other being a digitalisation of services.

On this last point, she explained this as teleconsultations, and used the example of a hospital that recouped revenues through digital services that would have been lost otherwise. This is now an established vertical of the business - a standalone business, as well as complementary. 

She that it was interesting to see Africa transfer technologies to the US, for example Zipline matching blood with hospitals in Africa through use of a "high-tech" drone and who are now doing this in the US.

However, what is especially empowering is the relationship between low tech and high tech in Africa. She gave the example of LifeBank, who also match blood with hospitals but use the more low tech method of motorcycles, or "blood riders". 

Singh commented on the building of robust cold chains so that vaccines may be accessed by rural settlements. He referred to a "Melinda Gate-ism" in that people may receive a cold coke, but not a vaccine at the right temperature, and that people were trying to understand the economic and social viability of that. 

On her part, Njima offered the example of fintech empowering the pandemic response, with Kenya at the forefront of this. M-Pesa [mobile money service in Kenya] was extremely instrumental in cashless transactions between vendors and suppliers of goods and services, and Safaricom [Kenyan mobile network operator] allowed transactions under 10 dollars to be free of charge.

This aside, in West Africa, Senegal experienced Ebola in 2014, and based on set up a system for communicable diseases. Under this system they were able to launch test kits for one dollar when the country was struck by the pandemic and provide results within 24 hours.

Workshop: Focusing on the communicable diseases’ agenda in Nigeria

Communicable diseases remain the top cause of deaths in Nigeria and don't look like they are going to be eradicated soon. The workshop brought together eminent personalities from Nigeria’s healthcare industry, who spoke at length about the need to change the narrative through partnerships between the public and private sector.

Dr Chibuzo Opara, MD/Chief Executive Officer, DrugStoc, said: “There is consensus that there will be another pandemic. We have understood the importance of needing to strengthen the healthcare infrastructure. It is essential to realise that we need to go beyond the front-line of defence."

One of the major lessons, said Mories Atoki, Chief Executive Officer - African Business Coalition for Health (ABC Health), is that COVID-19 happened without preparedness and readiness and that other countries did not come to support as everybody was fighting this battle. Therefore, it is crucial to ensure that the next time a need for crisis management comes around, countries need to be better prepared.

“What I saw in the private sector was that the element of competitiveness was replaced by the need to come together and bond. They are demonstrating an appetite to the region that they can’t thrive on an economy that doesn’t exist. The healthcare industry should work along with the private sector to ensure the possibility of another pandemic ends,” she emphasised.

Another issue that has come to the forefront is that people are not wearing masks, and this is a sign of the lack of personal recognition of risk, explained Dr Caroline Jehu Appiah, Director, Nigeria Country Office, Bill & Melinda Gates Foundation.

She said: “The issue around enforcement and education is that the government doesn’t have enough resources for it, and, therefore, the responsibility falls on each of us. A kind of fatigue has set in because people are not seeing the gravity of the pandemic. If people begin to understand the epidemiology, they would begin to wear masks.

“Also, at the national and state levels, budgets need to be reprioritised towards COVID-19 response. However, in the medium-term, it would be better to use the funds to strengthen the health systems, so that it can be used in fighting other diseases as well. In the long-term, it should be about revenue generation and to maximise on efficiency gains.”

Other priority areas the workshop highlighted included vaccine-preventable diseases, maternal-child health, malaria, tuberculosis, scaling up digital services, building a resilient supply chain, behavioural change communication, increasing research and development, and showing the close link between economics and health – staying true to the adage health is wealth.

In May 2020, the WHO warned of 190,000 people in Africa dying in the event of COVID-19 pandemic containment measures failing. Five months later, experts are stunned by the continent’s low fatality count, along with hospital admissions that continue to fall.

Africa has “really, really responded to this quite well,” said Estelle Mbadiwe, pharmacist and founding partner of Abuja healthcare consultancy Ducit Blue Solutions to Omnia Health Insights, an achievement she attributed to effective coordination between the Africa Centres for Disease Control and Prevention (Africa CDC) and African Union. 

In her native Nigeria in particular, she highlighted the efforts of the Nigeria Centre for Disease Control (NCDC) and its director general Dr Chikwe Ihekweazu, who began a preparedness approach before the pandemic that encompassed public health emergency operations centres (PHEOCs) and other strategies. 

However, this approach alone was not enough, and Nigeria – like other countries – had to pivot to effectively respond to the crisis. In this regard the leadership of the coordinating body NCDC and the Minister of Health, with the launch of a presidential taskforce proved critical (Mbadiwe indicated that some things could have been handled better, for example the delayed closure of entry points into the country).

These successful partnerships and collaborations across African nations leave Mbadiwe highly optimistic in terms of building the Africa of the future, not only in the healthcare space, but beyond. 

The qualities are there: the leadership strengths (she highlighted the example of Uganda for its pandemic response), a large young population, and innovation. The challenge is galvanising all moving parts at once. 

She believes that data is the missing ingredient to making this happen – data that can help cement any current understanding of the health situation. Yet presently only a small amount of information is analysed, the tip of a big iceberg, but the data under this remains overlooked.

Through pulling the data and using it to assess where the gaps are and points of strength in different countries, healthcare officials will be able to make better informed decisions beyond public health emergencies that include developing other healthcare strategies and building a health system.

It’s a challenge that Mbadiwe’s company Ducit Blue Solutions is excited about the opportunity to support: identifying weaknesses in the healthcare system and building capacity holistically to address our unique challenges.

Of course, any capacity building exercise also requires political will, to address issues like financing, accountability and governance for example. 

Yet Mbadiwe believes that the opportunity to rebuild healthcare and indeed strengthen the nation is a timely one, in part because Nigeria has just passed a symbolic milestone - 60 years of independence - and is now looking ahead to the future with increased confidence. 

Yet whatever the vision, she conceded, it must last longer than Nigeria’s four year election cycle, and ensure that all stakeholders and people are aligned – no easy feat.

In the short term there is still the matter of a pandemic to deal with. In response to reports that African scientists are concerned that vaccines developed in the West aren’t taking into account the Africa context, Mbadiwe agreed that it was important that the continent was “at the table” to assert what was best for its citizens in terms of protecting its systems and populations while in line with the global strategy. 

As a pharmacist, it was a problem she was familiar with. She explained that when post marketing surveillance is carried out for medication, it doesn’t always translate well into the Africa context. Climate, environment, population, food and a variety of other nuances would affect what and how people could respond  to vaccines and treatment.

In the even shorter term, Mbadiwe is looking forward to listening to as many sessions as possible during Omnia Health Live Africa to develop an understanding of what others are doing in their sphere of influence, from leaders to specialists, and the challenges they are currently facing. She added that she hopes for opportunities to collaborate after the virtual event to learn more. 

Mbadiwe will be moderating an Omnia Health Live Africa session on Bridging the gap in communicable diseases: The Future of Infection Prevention & Control (IPC), joined by Dr Tochi Okwor and Dr Abiodun Egwuenu of the Nigeria Centre for Disease Control; and Prof Folasade Ogunsola of Lagos University Teaching Hospital.

Dr Iman Eweis, a radiologist specialising in breast imaging at a women and foetal imaging clinic in Cairo, has observed that many women at a younger age are prone to breast cancer and that Egypt has a lower age threshold compared to other countries in the world.

“Breast cancer is a public health problem in Egypt,” she highlights. “October being Breast Cancer Awareness Month, I want to request the government to work hard towards this issue and design solutions and better pathways for women for breast cancer.”

A speaker at Omnia Health Live Africa, Dr Eweis is part of the national women's health outreach programme in Egypt and has graduated from Mansoura University Medical School in 2009. The doctor shares that during her first year of service in primary healthcare, she received many women with breast complaints who didn't know where to go or what examination was suitable for them.

“I didn't have any directory of where to refer them to and noticed the huge gap women had to face to access breast healthcare. So, I decided to address this problem, and continued my postgraduate studies in radiology and breast imaging to be a part of better breast healthcare in Egypt and give the women the care they deserve,” she says.

Enhanced breast care

The doctor emphasises that the role of imaging is based on detecting and diagnosing different breast diseases not only cancer. But when it comes to breast cancer, more sensitive modalities in the pre-operative assessment are needed especially when a multi-focal disease or bilateral disease is suspected. “We need imaging for patient follow up in neu-adjuvant therapy, and for patients follow up after surgery. And we need it again when patients survive and are back to their routine annual screening,” she adds.

When asked about how to ensure consistency in image interpretation, she advises and follows BI-RADS, which stands for Breast Imaging Reporting and Database System. It is a scoring system like tool for the abnormalities found in the breast in daily practice. It is a helpful and evidence-based method that helps monitor performance and improve the quality of reporting and communication with clinicians. It is a tool provided by the American College of Radiology and is being used worldwide.

Moreover, technology has also enhanced the field of imaging and is improving the quality of examinations such as breast density. In breast imaging, she explains, every woman has her own breast texture and many women present with dense breasts, which lowers the 2D mammography sensitivity and hides small masses. But digital breast tomosynthesis, which is performed through the same mammography machine, helps a lot more in detecting invasive disease in the dense breast at an earlier stage, as this could have been missed out with conventional 2D images.

Dealing with radiation exposure

Dr Eweis says that she often receives questions from patients about radiation exposure. “We need to agree on something here – mammography saves lives,” she stresses. “The radiation dose that women get exposed to in a full examination is quite low, even lower than the natural radiation that we get exposed to in our daily life. It is almost equal to radiation received in a four-hour round-trip flight. Till today, there is no scientific evidence of breast cancer-associated risk with mammography radiation following the guidelines of annual screening even in high-risk women. We need to end the confusion around this issue and help women get screened annually starting at the age of 40 because saving a woman's life is what really matters!”

When it comes to other examinations besides mammography, the doctor highlights that guidelines are in place and all examinations are not requested in one go and distance is maintained between keeping each course into consideration.

She concludes: “I wish one day women in the Arab countries would have access to breast care that addresses their need, and that they can receive an annual screening without worrying about the cost or the distance. I wish we could all work together for better healthcare for all women in our region.”

Omnia Health Live Africa

Dr Eweis will be a panellist at ‘The impact of COVID-19 on breast cancer management’ on Wednesday, October 14, 14:00 CAT at Omnia Health Live Africa.

The presentation will feature members from The Egyptian Society of Radiology and Nuclear Medicine and The Egyptian Society of Breast Imaging on how the pandemic has affected breast imaging practice and the management of breast cancer patients.

“It is a very important topic, as breast cancer radiology services were held back during the pandemic outbreak in Egypt,” says Dr Eweis. “We experienced fewer working hours and limited personnel at the clinic. We could only deal with one case at a time. Also, the patients didn’t want to leave the house due to the fear of contracting the virus. This reflected in some of the patients' results when they came in later for their routine screening. In some cases, this delayed intervention for a palpable abnormality, and we found many patients with a later stage of the disease at presentation, so COVID-19 has had a significant impact on our practice and patient outcomes.”

The COVD-19 pandemic presents the perfect opportunity to introduce universal healthcare to South Africa, believes Prof Morgan Chetty, Chairperson of KwaZulu-Natal Doctors Healthcare Coalition.

The crisis has “opened up a lot of cracks” and deficiencies in healthcare systems worldwide, pointing towards the need to place greater emphasis on public health actions.

He cited historic examples of similar systems launching during economically challenging times – Germany and the UK, whose successes he attributed to the visionary foresight of Bismarck and Beveridge, respectively.

In South Africa, he continued, healthcare is presently not delivered to the people who need it most. A nation of 60 million, only one in six have access to private health insurance, while half the national healthcare budget is spent on 10-15 percent of the population.

He added that healthcare spend amounts to 8.5 percent of South Africa’s GDP, despite high mortality rates, when it should be closer to 6 percent (for a developing economy). He explained that while the funding is available, resources are used inefficiently, and urged better spending on healthcare.

At fault are a “very high level” of corruption, inefficient provincial healthcare delivery systems; and a large amount of fraud in the healthcare system.

These inefficiencies are the result in part of silos: community health workers, nurses, specialists and doctors are not all on the same page, and they need to be brought together through an interconnected and integrated platform.

But patients too need to join this shared platform. Prof Chetty said the focus is too much on physicians and investors in South Africa, while the patients themselves are overlooked as passive recipients of care.

Putting greater emphasis on patients and securing their participation is conducive to making universal healthcare work in South Africa, he argued, rather than continuing along the lines of a paternalistic, top-down approach.

He identified two additional requirements. The first was to have a form of visionary leadership.

Second, he advocated implementing universal healthcare is by rolling it out in iterative phases (“let’s do it in small chunks”) with a target completion date of 2030. Initially this would focus on people with disabilities and the unemployed, while reforms and legislative changes are implemented in parallel.

Any sooner, such as 2021 or 2022, is simply not realistic, owing to resources, facilities and equipment not being available. Furthermore, all this must come under the stewardship of government.

Prof Chetty was similarly optimistic about the prospects of technology in healthcare in South Africa. “Virtual healthcare” was the future and there was little point in fighting it. The challenge was how to get the average doctor better acquainted with the nuances of it.

He offered the example of telemedicine and telehealth which have taken off in South Africa as a result of COVID-19 (the Health Professions Council of South Africa had been against telehealth).

Telehealth is a good opportunity to collect good data, in order to make changes in the healthcare system. But it’s good for the patient too: within the past two weeks in South Africa, patients are beginning to be monitored from the comfort of their own home via a Bluetooth monitor, that has the added benefit of a reduced cost for hospitalisation.

Doctors may remotely collect data and make whatever changes are required based on this information. Medical schemes in the private sector were already using such platforms to treat chronic illness, Prof Chetty added.

Prof Chetty spoke at Omnia Health Live Africa in his role of moderator for the discussion “UHC plans ‘pie in the sky’? – How the COVID-19 pandemic is shedding light on the best strategy for NHI”. The panel, comprising speakers from Deloitte; Gauteng Department of Health; previous Statistician-General of South Africa; and National Department of Health, looked at the best way to build NHI in South Africa, highlighting challenges and opportunities and what the new strategy can look like.

Policies and regulations shaping telemedicine in Africa: Challenges and opportunities in COVID times

Some estimates suggest that currently the telehealth market in Sub-Saharan Africa is around a US$4 billion market and there are some projections that it is going to grow to be over US$5 billion in 2025, highlighted Nana Frimpong (pictured above), Vice President – Africa, Vezeeta, a digital healthcare booking platform and practice management software in MENA.

Related: Africa CDC: COVID-19 recovery rate across Africa now 83 percent

Frimpong said that due to COVID-19, Vezeeta had to fast-track its roadmap for launching its telehealth products. “We saw a 50 to 60 per cent drop in March in face-to-face consultations. However, we were still receiving calls and requests through our call centre for ways to interact with doctors, which meant that we had to launch our telehealth services immediately,” he shared.

Vezeeta launched its telehealth services in Egypt in collaboration with the government and launched it in Saudi Arabia for free. Through the service, people were able to access doctors if they were having issues or symptoms related to COVID-19 and could get a quick triage, and were referred to a hospital for physical consultation if needed. “We saw around 1,500 consultations each day via the platform,” said Frimpong. “We continued to see this uptake in Egypt and Saudi Arabia for a while until things stabilised, and we introduced a paid service as a way to expand the service to other hospitals and clinics who wanted to use our technology.”

One of the challenges that were seen was on the payer side, as they were not necessarily set up to pay for these consultations via telehealth early on. Therefore, Frimpong said, patients had to pay out of pocket, which led to a dramatic dip in the numbers. “That was when the conversation around regulatory challenges in the long-term surfaced.”

On the other hand, Akinoso Olujimi Coker, Chief Executive Officer - Lagoon Hospitals, Nigeria, highlighted two challenges. The first was that at the start of the pandemic, platforms such as Zoom and WhatsApp were used for teleconsultations, but these platforms had their shortcomings, related to the privacy of medical records, data and cybersecurity breaches and particularly continuity of care. The second issue is the credentials of practising doctors to ensure patient safety. He said: “When there are cross border teleconsultations happening, one can easily foresee a scenario where an Egyptian doctor is looking after a Nigerian patient. So, what regulations would be applicable here? Teleconsultation and the scope of accreditation don’t concern healthcare alone. There is also the issue of information technology and data protection.”

While Katlego Mothudi, Managing Director - Board of Healthcare Funders of Southern Africa, stressed: “When you talk about telehealth, be it for diagnostics or procedural support, you have to make sure that all the laws that are in place to support it. For example, if we talk about electronic health records, protection of personal information, quality measures, accreditation, etc., all these should start talking about the facilitation of telehealth.”

Covid-19 lessons learned so far: Embracing crisis as an opportunity

A panel talk moderated by Dr Hala Daggash looked at how COVID-19’s disruption of the healthcare industry has created opportunities for innovative organisations and leaders.

Joining the panel were Dr Adebajo Adewole, Managing Director/CEO - Alimosho General Hospital; Irene Atuhairwe Duhaga, Technical Advisor – Nursing and Midwifery - Seed Global Health; and Karen A.S Hendrickson, CEO of Rabito Clinic.

Both Dr Adewole and Karen Hendrickson began pandemic preparations in Nigeria and Ghana, respectively, with the emergence of news of an outbreak in China. "It was only a matter of time," they both agreed. Dr Adewole explained that Lagos was a hub of international air travel. Meetings were commenced from January, and the behaviour of the virus was learned based on information received from across the world.

For Dr Adewole it was an opportunity to see how different healthcare systems responded worldwide, and how they affected communities. He recognised it as being "completely different from Ebola" and they "knew what to do". This included training, face masks and hand washing, and doctors were put in a state of constant readiness.

Similarly, Hendrickson and her leadership team considered "what if", despite that many people in Ghana assuming it wouldn't affect them for they would be protected by the heat or "God". As part of their initial preparations, they bought sanitiser for branches, in institutional size, though they did not think the nation would go into lockdown. 

When the first case had become known, the country entered into a "panic" and Rabito Clinic saw almost zero clients as a private facility. The financial impact was described as shocking.

Despite this, with the prices of PPE escalating (quadrupling) and significant price gouging, the business did what it could to support, through ordering 10,000 PPE for government nurses and doctors, and 5,000 individual hand sanitisers were given for free to police officers. 

Technical Advisor Irene Atuhairwe Duhaga said Seed Global Health (non profit providing medical training) had to refocus with the pandemic forcing closure of universities and students out of six months, and support the government in responding to the pandemic. This refocusing involved the harnessing of technology, though online training that included videos, while it was a challenge in part because of inaccessible areas. 

Post-COVID, what have we learned about the supply chain, capacity and demand for African medical devices manufactured products?

A panel comprising speakers from Handel Street Automotive, Africa Investor, Afrisky Holdings and Guidehouse discussed supply chain issues affecting medical devices in Africa during the pandemic.

Rob Botha, Chief of Party: Global Health Supply Chain Technical Assistance (GH-SCTA) - Guidehouse, highlighted the regulatory environment as a challenge "for some", while acknowledging it was good in areas, explaining that it was not easy to understand.

As such he suggested that there was much education that needed to take place. For instance, while there are excellent manufacturers, they might not necessarily be familiar with medical. He added that the harmonisation of standards and specifications across the continent would help in supporting manufacturers, making compliance much easier. 

Ashraf Ismail, Marketing Director at Handel Street Automotive, agreed that one of the biggest challenges was understanding regulations. It took a long time for the local regulatory body in South Africa to understand standards, he said, and this "decimated" local manufacturing to a certain extent. He suggested the need to harmonise standards in line with the EU or US, and working with manufacturers towards getting there. This will help South Africa and the general economy of African countries, and foster collaboration.

Hubert Danso, CEO of Africa Investor, went further, describing issues relating to logistics, trade facilitation and regulation, and the lack of preparedness overall. He identified five key challenges and recommendations.

The first challenge was around bans on the export of PPE - notices were published in local languages, presenting difficulties in translating into a universal language. The second concerned changes in controls and in regulation of borders.

Third, there was a lack of internal coordination among some agencies, in some cases within regions and countries, and this created confusion.

Fourth, inspections of PPE; and finally, there was a lack of international cooperation, meaning that some measures were more stringent than others.

Danso suggested that harmonising standards across the African Continental Free Trade Area (AfCFTA) was a crucial first step in facilitating local production and trade across the healthcare industry. This meant deepening pan-African networks on both commercial and policy levels. He recognised that the AfCFTA was already prioritising regional harmonisation for 2021, announced last month, and that the private sector was behind the curve on this.

Bridging the gap in communicable diseases: The Future of Infection Prevention & Control (IPC)

The current training provided by African CDC for Infection Prevention & Control (IPC) is targeted at frontline workers. However, to bridge the gap, it is important to go back to the fundamentals and understand what IPC is, said Prof Folasade Ogunsola, Honorary Consultant Microbiologist & Infectious Disease Specialist, Chairman - Infection Control Committee - Lagos University Teaching Hospital.

“We have to institutionalise the routine part of IPC and have a solid foundation,” she said. “We need to train healthcare workers and set up programmes at the national and facility levels, and ensure these are running on a day-to-day basis, so when another epidemic comes around, we are used to IPC and can avoid the short-term training frenzy.”

Ogunsola explained that for a sustained IPC effort, there is a need to develop another cadre of staff that includes practitioners and experts who can drive the process daily. "We need to develop, what I like to call, the ‘institutional muscle’ for IPC,” she added.

According to panellist Dr Abiodun Egwuenu, AMR Programme Manager - Nigeria Centre for Disease Control, the pandemic has brought a lot of innovations in IPC. “There are now trials on how to decontaminate or recycle some of the PPEs that are crucial such as the N95 masks. Countries are also providing grants to produce PPEs in a self-sustaining manner.”

However, she stressed that IPC for patient safety goes beyond PPE and involves having clear policies or guidance in the facility and community on how to implement the procedures. It is also important to focus on data that is needed to drive improvement and see where there are gaps.

Panellist Dr Tochi Okwor, Antimicrobial Resistance and Infection Prevention and Control Programme Coordinator - Nigeria Centre for Disease Control, concluded; “Effective IPC doesn’t require expensive resources and can be implemented with minimal cost. What is required is a strategic approach.”

In his keynote on day 1 of virtual event Omnia Health Live Africa virtual, African Centres for Disease Control and Prevention (Africa CDC) Director Dr John Nkemgasong highlighted research into any COVID-19 vaccine developments in Africa and what a return to normal looks like for the continent.

Presenting from Addis Ababa, his epidemiological update included the following: 

• 38,000 deaths from 1.5 million cases across Africa, representing a recovery rate of 83 percent. 35 countries are reporting fewer than 10,000 cases (65 percent)
• It took the continent 123 days from when the first case was reported in Egypt to reach 500,000 cases. Then it accelerated, taking 30 days to reach 1 million cases. Thereafter it took 58 days to reach 1.5 million cases
• The pandemic peaked in July 2020. Key public health measures helped to reduce the number of new cases
• The rate of new cases have greatly differed across Africa: for example a 12% decrease in cases in Central Region of Africa and a 10% increase in the Northern Region

On public health measures, Dr John Nkemgasong explained as follows:

• a joint continental strategy was agreed to ensure better cooordination and promote evidence-based practices, underpinned by the need to limit COVID-19 transmission on the continent. More than 30 policy guidelines were distributed to member states
• a PACT strategy originally targeted 10 million tests to be completed by October. It was surpassed two months ahead of the target date
• an African Medical Supplies Platform online marketplace was launched to enable critical COVID-19 equipment in Africa
• member states were brought into Senegal to train on diagnostics (in January there was no diagnostic capability)

The search for a vaccine meanwhile has involved a “whole of Africa” approach to saving lives, economies and livelihoods that included a stakeholder roadmap. He pointed to the example of AIDS deaths in US versus Africa during the 1980s, where in the latter case deaths continued to increase relative to the US (totalling 12 million deaths), and that history shouldn’t repeat itself. Vaccinating 60% of the African population is expected to cost USD 10-15 billion. 

Despite Africa's success, there have been major lessons learned. Challenges included access to diagnostics, medicines and vaccines; underfunding; inadequate human resources; a need for improved leadership in the health sector; a need for strong political commitment; and weak health infrastructure. 

These present opportunities to systematically strengthen Africa's health systems to promote sustainabilty and increase resilience against future emergencies, Dr Nkemgasong concluded.

Quality and safety lessons learned from COVID in the African context

At this session, panellist Irene Ogongo, Founder and Lead Mentor, Nurses in Africa, Nairobi, Kenya, shared that when COVID-19 took centre stage, safety took over quality.

“One of the lessons I quickly learned was that quality is being viewed as something to do after everything else is said and done, which should not be the case,” she said. “Often the quality part comes in as an afterthought. Another thing COVID-19 taught us is that remote mentoring and coaching is possible in resource-restricted settings. We were able to hold virtual classes with good uptake.”

While Dr Edgar Kalimba, Deputy CEO, King Faisal Hospital, Kigali, Rwanda, highlighted that healthcare workers in his hospital were becoming COVID-19 positive from the community as well as within the hospital and that required the need to change the approach. “Before we were testing only those who showed symptoms, but we quickly changed that to testing every elective admission patient. Based on this we were admitting patients who were asymptomatic or had mild symptoms and this helped in stopping the spread to the healthcare staff,” he said.

Dr Kalimba added that his hospital also realised that there was a need to allocate teams differently. “We put the doctors and nurses into different groups and teams, and they stick to that group when they do their shifts. So, for instance, if a member of the staff becomes COVID-19 positive it will be only within that team instead of different groups. All these measures have helped reduce exposure to staff and helped to control spread within the hospital. One thing that we are looking to do is significantly step up our remote consultations.”

“We need to have strong leadership, teamwork and coordination starting from the national level but also trickling down to regional district levels,” stressed Dr Apollo Basenero, Chief Medical Officer, Namibia Ministry of Health and Social Services, Windhoek, Namibia.

Immunological response in COVID-19

Dr Mervat El Ensary, Chair - Clinical & Chemical, Pathology Department, Cairo University, Cairo, Egypt, the moderator of the session, explained that the immune response to SARS-CoV-2 infection has two phases.

Phase 1 – moderate symptoms where the cytokine response used to eliminate the virus causes inflammation.

Phase 2 – severe symptoms that cause hyper inflammation and destruction of lung tissue. This uncontrolled inflammation is called “Cytokine Storm” that can result in severe tissue damage and acute respiratory distress and death. The cause of the large-scale release of cytokines is still unknown.

Current observations indicate that coronaviruses are particularly adapted to evade immune detection and dampen human immune responses. She highlighted that this partly explains why they tend to have a longer incubation period 2-11 days on average compared to influenza, 1-4 days. The longer incubation period is probably due to their immune evasion properties, efficiently escaping host immune detection at the early stage of infection.

Panellist Prof Rudo Mutasa, Professor of Pathology, University of Zimbabwe, Harare, Zimbabwe, added: “COVID-19 has had a smaller sample of autopsies due to the fact that it is a new disease and there is the fear of catching the virus. However, the samples have shown that COVID-19 is not just pneumonia, it is a multi-system inflammatory disease. The main findings are in the lungs and the consistent finding is diffused alveolar damage, which correlates to respiratory disease.”

Going viral: How COVID-19 could transform hospital planning and design

Healthcare infrastructure experts shared their thoughts on the role healthcare planning and hospital design have in helping to prevent pandemics in the future.

Moderated by Abbott's Judy Varndell, Commercial Excellence Director, Africa, the discussion involved speakers from Western Cape Government Health; Health Access International; Deloitte; and Africa Institute of Healthcare Quality Safety & Accreditation (AfIHQSA).

• Elom Otchi from AfIHQSA commented that there were instances of PPE shortages which were partly addressed within the facility, for example the sewing of face masks. The development of an app also helped with contract tracing and testing.
• Speaking from Utretch, Health Access International consultant Dirk Joubert said of the pandemic that no one had effectively planned for it, in terms of resources, buildings and materials.
• Duncan Rendell (Western Cape Government Health) agreed that no one in South Africa was used to the scale of disaster management that the pandemic presented, and "off the shelf responses" weren't ready. He added thtat they pivoted to solutions such as shipping containers.
• Deloitte's Marco Macagnano stated "the future is now" and that the move to digital enabled capabilites wasn't as difficult as had been anticipated. Healthcare will permeate so that it forms part of other environments, such as retail and commercial.

Healthcare worker safety – In collaboration with Infection Control Africa Network (ICAN)

As of September 3, more than 7,000 health workers have died around the world by contracting COVID-19. The pandemic has exerted unprecedented pressure on healthcare systems worldwide. Dr Adebola Olayinka, National Lassa Fever Research Coordinator, Nigeria Centre for Disease Control, Abuja, Nigeria, highlighted the below factors impacting healthcare worker safety:

Psychological effects

• Fear of being infected at work and then passing on the disease to families
• Working in inadequate environments with low capacity to apply optimal safety measures
• Lack of access to PPE
• Mental stress from watching people die
• Increased workload
• Reduced rest periods
• Increased violence and harassment from patients or colleagues
• Increased social stigma and discrimination

Dr Olayinka shared a few guidelines for administrative precautions for COVID-19:

• Establishing new healthcare facility policies on the management of COVID-19 suspects and confirmed cases.
• Development of training packages to instruct healthcare workers on how to effectively adhere to standards while caring for COVID-19 patients
• Establishment of isolation spaces