NEW YORK — How do you make sure that the quality of what you deliver is consistent? How do you make sure that 50 years from now you've managed to build the right capabilities yet you remain a partner in the delivery of health services? How do you effectively contribute to achieving universal health coverage?
These are questions Farid Fezoua, CEO of GE Africa and GE Healthcare in Africa said companies should be considering as they look to contribute to the UHC challenge. Investing in primary health care, he said, is the way to go.
“It's not charity, it's not corporate social responsibility. We want to make it economically viable.”— Farid Fezoua, CEO, GE Africa
According to the World Health Organization, only eight out of 30 countries for which data is available, spend above $40 annually per person on primary health care and at least half of the world’s people lack access to all essential health services.
“Being able to strengthen the primary care level has the virtuous effect of recreating a healthier referral system in the continuum of care,” Fezoua said.
Speaking from the sidelines of the 74th session of the United Nations General Assembly, he explained why working to improve primary health care is critical, the challenges GE has experienced in creating sustainable health care delivery models, and lessons learned.
This conversation has been edited for length and clarity.
How important is the role of primary health care in advancing the universal health coverage agenda?
This is a topic that is quite timely because if you look at the evolution of health care in Africa — particularly the way the ministries of health and the governments have been managing health care — primary health care has typically, over the past few decades, not been a priority.
The issue of corruption in frontline health care service and delivery is often neglected by stakeholders. For universal health coverage to be achieved, stakeholders need to be open to having frank discussions about the drivers and potential solutions to corruption.
It's been a concern because obviously the delivery of health care services at the level of primary care clinics has not been optimum, but we haven't really seen that being prioritized. I think that's changing within the framework of the attainment of UHC that is now a top priority — or there is a realization by the governments and ministries of health, in particular that the foundation of any health care system is really at the primary level that then creates a sound referral system.
And it's not just in Africa. In a lot of emerging markets, but even in the more mature markets, the primary care level is underutilized and does not play that triage role where patients come to that level of care and are referred in the right way.
Can you describe the sustainable PHC delivery models GE has developed?
When we started five years ago building or realizing the importance of primary care linked to what we do — technology, early diagnostics, or very critical diagnostics, and also addressing maternal and infant mortality — we realized that the primary care level was not efficient.
With 65% of the population being in rural areas in Africa, women, and particularly pregnant women, would not come to a primary care clinic, which means they could not be screened at the right time to identify potential risks in pregnancy and they would typically die in childbirth. This is where we started looking at the primary care level and particularly around one of our technologies, which is ultrasound.
In several countries — starting in Tanzania — we put in the hands of midwives and community health workers, a portable ultrasound. You can hold it in your hand and do an ultrasound exam in any setting. It has a battery so you can go to the village and be able to screen pregnant women without those pregnant women having to go to a primary health clinic.
The dimension of trust in being able to do that primary care or rural point of care is essential. Combining this technology with continuous training and the ability to make sure that these primary care centers are well-maintained and-well equipped so that you can sustain the delivery and quality of service is really where we're going. We've been able to replicate that now in 18 countries today across Africa including Nigeria, Ethiopia, and South Africa.
It's not charity, it's not corporate social responsibility. We want to make it economically viable, creating this service over time at a price level that could enable the ministries of health to budget against a service delivery and not against the infrastructure.
It's not about building a primary care center, it's making sure that that primary care center delivers service over time at a cost that is affordable to newly created national health systems, thereby making services sustainable over time.
“I don't believe that without localization of capabilities, of your talents, of your ability to understand the risks locally, to understand the culture — you're able to address any challenges.”—
What are the biggest challenges in strengthening primary health systems?
Human resources. Particularly when you work with ministries of health, being able to get the right personnel, the health workers to stay in rural areas. What we've seen as a major challenge is you train people and then these health workers move from this primary care clinic because it's easier to find a job in an urban area where they would get better paid. When a nurse or a midwife has been trained extensively, they do find better opportunities outside of the country.
The second one is the environment and the infrastructure outside of the primary care clinic. You still need a minimum of electrification to be able to run a primary care center efficiently. You need water and infrastructure, which can be challenging.
Thirdly, typically in Africa, as a technology company, we see there is one standard way of procuring equipment and service. We still don't have the necessary skills in these ministries to really be able to assess and design these new required procurement models for sustainable long term lifecycle management of technology, skills development, and quality of service delivery.
What are the biggest lessons GE has learned so far in rolling out these models?
Particularly when you get into a partnership or private sector engagement model alongside the public sector, it is key to engage with the different ministries of the different authorities within the government at the same time. The mistake we made in the past was to say “Okay, we're going to discuss that with the ministries of health and we're going to work with them and once we have the ministries of health on board things are going to move on.” But once you have a ministry of health on board, you need to get the ministry of finance, the treasury, the parliament. It's key to engage the stakeholders very early.
In health care today it's really about co-creation. It's really about working locally through a workforce that we've developed over time. I don't believe that without localization of capabilities, of your talents, of your ability to understand the risks locally, to understand the culture — you're able to address any challenges.
I meet a lot of big U.S. and European companies that have not made that choice to devolve the decision-making and build leadership in-country, and they are struggling with the ability to assess risk and to execute on big projects. Localization is key.