threecorners

Firstly, I have come because like most consultants, I’m a travel whore, and the opportunity to work globally has always been a huge selling point of the job. Africa is a vast region of the world to see - the whole of Europe, China, and the U.S. could fit into its landmass with room to spare, per TED talks referenced below -and I am lucky enough to have a chance to see it now. What I’ve encountered so far are incredibly hospitable hosts, beautiful landscapes, and a decent dose of adventure with relatively few kinks along the way, so I suspect I will want to return for more after my current time is done.

I am here on assignment with Accenture Development Partnerships, which is a part of my consulting firm that operates on a not-for-profit basis to deliver business and technology solutions in the effort for international development, primarily working with NGOs. ADP was one of the main reasons I joined Accenture and has done kickass work like helping AMREF virtually train nurses to help meet East Africa’s healthcare professional shortage and designing the strategic blueprint for Oxfam’s Global Agricultural Scale-Up Initiative, among other projects. Being staffed to an ADP role has more or less been my dream since starting with the firm two years ago, and I finally became eligible this year, around the time I was promoted to consultant.

Caveat: I am in no way being sacrificial in coming here. Unlike the above projects, my project is not a typical ADP engagement in that it is to help one of our commercial clients (call them “PharmaCo”) design an access-to-medicines project for breast cancer in Kenya and Ghana. What this frankly means in English is that my team is tasked with helping a Big Pharma company effectively sell more drugs in sub-Saharan Africa. While I am optimistic that this project will be a succesful case study in the convergence of the private sector with emerging markets development, I think I would have preferred to work with an NGO on infectious diseases or public health infrastructure. Moreover, I have a furnished, electrified apartment with housekeeping service - the latter not my choice - in Nairobi and the use of a standard corporate expense budget for hotels and travel. This is generous given the day-to-day experience of most people anywhere in the world, much less this region. There are valid critiques to be made here although I think a development-sector-as-neocolonial-elitism argument is simplistic. Give me a little bit of time to marinate on my current situation and I’ll tell you what my ambivalence has become.

Nonethless, let me be clear that my primary chagrin is at the financing technicalities of our project within our firm’s accounting, and not about the work in and of itself. I am convinced of the need for economic sustainability in development and the role for free and fair markets in moving toward global social justice. This is not an endorsement of neo-Ricardian economics or even what is called neoliberalism. I am trying to come in with good faith and be thoughtful with the little experience that I have. I’m not always for trade over aid per se, but if anything, I think the convergence of these two areas in public-private partnerships for development is really exciting and will mean better results for both parties. My team has made some slide sets around this that I might sanitize and eventually share, but in the meantime Ngozi Okonjo-Iweala and Euvin Naidoo speak to this much more eloquently than I can when it comes to Africa. 

So, the reality is that our client expects to earn more revenues from their Sub-Saharan Africa (SSA) unit as a result of this project. The reality is also that three out of every five dollars spent on healthcare in SSA come from private household funds, with over 50% going to private providers (1). The reality is that although AIDS/ TB/ malaria and clean water deservingly have the bulk of immediate world attention, 70% of the world’s cancer burden will be in developing countries by 2010 and more than 70% of the world’s cancer deaths already occur in low- and middle-income countries (2). The reality is that the breast cancer incidence in Kenya and Ghana is lower than in the US and EU, but that each woman who gets breast cancer in these countries has a 60-150% greater likelihood of dying from it than her American or European counterpart, in addition to twice the likelihood of being struck with this devastating turn of events before the age of 50 (3). The reality is that 50 Kenyan women are on PharmaCo’s breast cancer medicines, out of the 2,000 - 5,000 patients out there that should be able to see their tumors shrink and their lives probably extended, with relatively minimal side effects in the world of oncology medications (4).

More opportunistically, the reality is also that Africa’s middle class is rapidly rising, with area-wide GDP growing at a clip that is just below Asia and exceeds Latin America (5). The reality is that in addition to being passively racist, it is intellectually lazy to a profound degree for a global business to ignore this (6), particularly in Kenya and Ghana where the healthcare markets are forecast to almost triple in size (17-24% CAGR) by 2014 (7). The reality is that PharmaCo sees this situation and instead of walking away from SSA or trying to push more product with US sales tactics, they have approached us to consider what it is in the basic healthcare environments that is keeping them and their customers to ~1% of total treatment potential, and what barriers they can and should bring down for their patients. The reality is that this is maybe actually a Real! Live! case where a corporation can do good by doing well, if we can make it happen.

My team is currently researching and creating ways for PharmaCo to serve patients across the healthcare “life cycle”. Some of our early ideas for this particular engagement include the following:

• Adding capacity to the healthcare system through investments like basic biomarker screening equipment and protocols for pathology labs, training doctors and nurses to take tissue biopsies outside the oncology specialist bottleneck in the capital city, and improving public health surveillance and treatment guidelines in cooperation with ministries of health
• Addressing treatment gaps by setting up multi-functional satellite teams of nurses/ oncologists/ pharmacists/ GPs/ radiologists/ pathologists across underserved areas, partnering with NGOs to help change the cultural disparity for spending on women’s healthcare, and working constructively with traditional healers to ensure safe, effective treatment is offered
• Making medications more affordable by offering adherence-oriented discounts, tailoring the product offering to local needs, tapping the power of microinsurance, and partnering with microfinance or other entities to make credit facilities/ remittances more accessible
• Growing education and awareness of breast cancer by developing curricula, contributing multi-channel SMS/radio education campaigns, setting up events for survivor support groups, and assisting volunteer-based NGOs to educate women at schools and churches
• Securing the drug supply chain in Africa by ensuring medicines are stored and transported in a proper cold chain, leveraging technology to address distribution delays and stock-outs, and developing solutions to prevent the very real and very deadly prevalence of counterfeit drugs

Most importantly, if our framework and recommendations work, this project should become a replicable model for the client to use across their therapeutic portfolio. PharmaCo also expect to spin it out across SSA and potentially all of their emerging markets around the world. I’m hoping that they actually see that there are valuable lessons for contributing social utility in their established markets (US/ EU/ JP), and that this project can help build a best practice for expanding global access that will resonate throughout the industry*. In my own self-interest, I also expect to build real-life skills and networks while I’m here so that someone will maybe one day hire me to do this sort of thing forever.

This should give you a sense of why I’ve been working 80-hour weeks and it’s taken a while to put this all together. Now off to (mostly) lighter fare…

1. WHO Fact Sheet: “Spending on health. A global overview”
2. WHO Fact Sheet: “Cancer”
3. Crude year-against-year mortality index according to my own epidemiology model, based on raw data from GloboCAN/ IARC/ WHO. Do not interpret this as overall mortality or disease prevalence, although I’m in the process of validating a natural log-model of survival and some other (missing) data points with our WHO, Ministry, and medical contacts. This is probably proprietary.
4. Super-proprietary; thanks.
5. World Bank Indicators, 2008-2009.
6. Accenture: “Africa - The New Frontier for Growth”. See also Reuters special report from Davos, January 2010: “Not investing in Africa is like missing out on Japan and Germany in the 1950s, Southeast Asia in the 1980s, and emerging markets in the 1990s.”
7. Business Monitor International, Africa Database 2010 (proprietary)
*Generics are hugely important and I’m happy to discuss this with any of you separately, but I hope you will also see that generics cannot sustain a R&D operation, particularly in areas of genuine unmet need like oncology.