The Second Japan-Africa Business Forum

Session 6

Health and Sanitation: For a Healthier African Population
Moderator

Jennifer Blanke
Vice President, Agriculture, Human and Social Development
African Development Bank

Ms. Jennifer outlined the session, which included a panel discussion on
how African public sector, Japanese development agencies and the private
sector are thinking about the African health sector, followed by Q&A
session.
It is well recognized that Africa faces daunting challenges with populations’
health and rising population. Addressing the health and water challenges
and sanitation issues in Africa is a big priority for the African Development
Bank and the World Bank. The High-Fives is part of improving African
people’s lives. Without health, it is hard to think about anything else.
Much remains to be done in order to make this a reality.
The African Development Bank addresses the challenges in the healthsector by improving the provision of health services by helping countries
to get more value for every dollar spent.
The healthcare costs inadvanced and developing countries are exploding.
It is important to look at how Universal Health Coverage ensures thateverybody is covered. Importantly, improving public health security is
being worked on with a number of partners in establishing African Centers
for Disease Control to deal with rapidly rising diseases, like the new Ebola
that Africans can quickly address.
Studies show that to meet the healthcare demands of African countries,
an estimated $25 to $30 billion are needed annually which is verysignificant. The public sector has an important role to play to do this andraise funding. This has to be set aside in public budgets in Africa andelsewhere to ensure that the public is covered.
The private sector also has a major role to play because the public sector
and development funding will never be enough to ensure that Africans
have the healthcare that they need. Importantly, health represents amajor business opportunity around the world. The panelists from theprivate sector can reflect on how this can be a win-win situation when it isdone right. The perspective of the Japanese development representatives
and the private sector is also important.
Kwaku Agyeman-Manu
Minister of Health, Republic of Ghana

Mr. Kwaku reflected on how the Japanese private sector can help Africa’s
health sector to provide healthier lives for African people throughtechnology and finance, where both technology and finance are importantin addition to several other things.

Ghana, and Africa, lacks critical technology in terms of practicaltechniques, devices, IT solutions, and all other technologies. Funding andfinance is the other critical area. The public sector would not be able tofund everything that is needed from infrastructure, equipment, tools,
replacement and maintenance, reagents, medicines, training, thenecessary skills and knowledge. It is a challenge to fund all of these.
Ghana has moved to a level where a health insurance scheme has been
established. Since it is very distressed, things like the Health Sector Bondare being looked at to get immediate funds and leverage on the futurelevel of inflows to package this for Africa. Almost everything that isneeded is in there. The presence of technology and skills is very crucial.
There is a huge cost burden on healthcare. Africans, who can afford, havestarted travelling to other countries for healthcare, leaving behind those
who cannot access advanced technology and skill-driven care.
Therefore, Japanese presence and the works of a good country that can
support Africa through the private sector are welcome. Establishingtechnology and skills that are absent will probably cut down the
expenditure of healthcare that traveling and accommodation raise. If the
facilities and services exist, it is not much of a challenge. These things
are needed for technology.
The partnerships between private sector in sponsoring trained Africans in
the healthcare delivery to specialize and acquire knowledge are also
necessary and important. Sponsoring excellent programs, younger people,
doctors and nurses to come and work in facilities with a view of acquiring
training, skills and knowledge are being looked at.
The private sector can drive a young African doctor to go to Japan to
specialize in oncology for 3 years and return and utilize the knowledge at
home. Nurses can be trained to specialize in different disease burdens
and the private sector companies and corporates that make devices,
medicines and practice health can support this.
Private sector
involvement in this direction would not cost much.
On its part, Ghana has the responsibility of building infrastructure that
attracts private sector investment into the country.
The oligarchic
regimes need to be looked at and the old laws need to be amended tomake them private sector friendly so that investors can come, do theirbusiness and make some margins to take good returns back home on
their investments.
Ghana needs to be disciplined enough and responsible to manage themacro-environment so that the investors can come into an environment
without any erratic fluctuations and changes in macro-indicators and haveconfidence that their investments will be protected. Ghana needs tostrengthen the private sector by making policies more business friendly to
attract investors.

These things need to be looked at besides technology and funding.
Training and managing things in an efficient manner can stabilize themacro-environment, so when growth comes it is okay.
Ms. Blanke stated that there is a give and take and a certain level ofgovernment support is needed by creating a business-friendly
environment.
Although finance and technology is needed, Japanesebusiness sector’s knowhow and expertise is also important.
Takao Toda
Vice President, JICA

Mr. Toda talked about JICA’s activities in the private sector collaboration
to promote health service in Africa and how that complements what
Ghana is doing.
The most important job for JICA vis-à-vis private sector is to attract theJapanese private sector towards Africa. The MMR, Mortality Rate ofMothers, is 100 times more in Africa than in the other regions of the world.
Despite a remarkable improvement, the number of children and the rateof under-5 malnutrition stunting is still increasing in Africa. The stance ofthe holistic approach starting from infectious diseases, beefing up Noguchi
Research Institute, health system strengthening, the MCH handbook, noncommunicable disease control, and food security is being taken.
In August 2016, JICA established UHC in Africa in collaboration with World
Bank, African Development Bank and the WHO, and some other importantfactors such as Financing, Services, Equity, Preparedness, andGovernance. JICA expects all private sector stakeholders to be interested
in these comprehensive approaches.
JICA has lots of wings like money, technology and volunteers. JICA is also
keen to strengthen their relationship for private sector and utilize their
wisdom, experience, experience of failures included, for the betterment ofAfrica. JICA does not want to limit their activities to target countries.
JICA expects 55 countries in Africa to be benefitted, be active, and be
empowered by their own willingness.
In Kenya’s case, in addition to ¥4 billion concessional loan, JICA continues
lots of technical cooperation, volunteer and research work by paying due
respect to Kenyan government and people. The same thing is being
repeated in Ghana.
Ghana gained independence in 1957.
JICA immediately sent theirtechnical cooperation mission and established the Noguchi ResearchInstitute. JICA is spending much of its energy, passion and affection on
quality service coverage, sustainable financing, and strength in having
IMR, the main platform.

As Prime Minister Abe mentioned, Ajinomoto Company is enthusiastic
about nutrition issues in Ghana using KOKO Plus. In addition to KOKO
Plus, they are now using MAMA Plus.
In Uganda, Saraya’s powerful activities improve the sanitation issues insync with the kaizen and the gradual improvement spirit that originatedfrom the United States but was brought up in Japan.
Cancer Scan, Dynamic Company, makes free use of healthy kiosks which
benefits around 1000 people. Thousand such kiosks would change theattitude of one million people. Such innovative activities have beenbrought by a Japanese company.
Grain was exported to Bangladesh, where it was grown locally to
drastically improve Africa’s nutrition situation where one-third of children
are still malnourished.
JICA has a triangular collaboration with universities, private and public
sector. Kenya utilized cell phone to make it more resilient. This systemshould be prevalent in all the continents.
TB package, TB-LAMP and delamanid, Genoscholar is based on the Prime
Minister Office’s initiative to be expanded in the Philippines, Indonesia andAfghanistan, and Africa in the future.
In brief, JICA’s activities support the private sector’s strengths in terms ofinnovation, technology, sustainability as ODA is not sustainable andscaling up. JICA is not satisfied with a small success story in some part ofAfrican country but wants to go to all the continents to be dynamic,
sustainable and successful.
Plentiful opportunities exist in new issues of non-communicable disease
prevention, health promotion, and digital MCH handbook. At the end of
the century, one out of four people in the world will be African. Africa is
not a regional but a global issue. Africa is a Japanese issue. People
should work for Africa, not only for their own sake but for the sake ofJapan as well as the world.
Jennifer Blanke stated that it is true that Africa is a regional and a Japanissue. It also covers a lot of the key issues in terms of the importance ofa holistic approach. When it comes to nutrition, it is not just how much is
being produced but what actually is being eaten and the nutritional valueof what is being produced.
The rise of non-communicable diseases is becoming increasingly
important in Africa and other parts of the world and requires a different
approach than the traditional one to communicable diseases.
The
importance of Universal Health Coverage is something that more andmore governments around the world want to provide and that people
expect.
Yasusuke Tsukagoshi

Special Representative, Japan, World Bank GroupMr. Yasusuke reflected on what the World Bank could do to strengthen the
African health sector in achieving Universal Health Coverage as it has
been working on this not only in Africa but also worldwide.
The UHC is such that medical services are available to people whenneeded and avoids people experiencing poverty because of health issues.
The overall objective of the African Development Bank and the WorldBank is to eliminate poverty, which is a basic issue. In explaining UHC,
people often talk about UHC cube.
Population coverage means that everyone must be specifically covered
under the UHC, without leaving anybody out. What kind of medical
services must be provided is not an easy topic. Depending on eachcountry’s priorities, appropriate and efficient services must be provided.
In many countries, the service coverage relates to the quality and thenecessary medical services being provided by the private sector.
What is relevant from the financial institutions development standpoint isthat when all people and services are covered, what financial projections
are being done. In many developing countries, poor people cover theirown medical costs. Out-of-pocket medical costs are becoming large, sowhen people fall ill or get injured, they become poorer as they are notable to afford the medical services. Something needs to be done about
this.
At the TICAD-VI in Nairobi, last year, the World Bank, Japanese
government, JICA, WHO, African Development Bank, and the Global Fund
got together to talk about the global health coverage in Africa andannounced the Action Framework number one, two and three covered
under the UHC cube.
Additionally, the fourth point is preparedness or health security. The
Ebola experience would provide the leverage to deal with communicablediseases. The Universal Health Coverage point out that preparedness isimportant.
The fifth point is that in order to achieve SDG or similar goals, there has
to be governance, which in the world of Universal Health Coverage, isparticularly important.
The World Bank and the Global Fund deal with these issues together. The
World Bank will fund up to $24 billion over the next several years. An
important approach in this connection is the Global Financing Facility, GFF.
The target is to basically protect the health of women and children.
Realizing Universal Health Coverage would go a long way towards
achieving this goal. The GFF is being implemented in 16 countries
worldwide and 12 African countries. The World Bank wants to expand thisin support with the JICA and the Japanese government. GFF is aboutownership of the countries themselves.
The overseas aid agencies,

governments and private sector will be involved in creating a country
platform.
Based on this platform, the concerned entities will formulate the mosteffective investment plan. The financing also needs to be examined tomake these investments sustainable.
For the health sector to end its reliance on overseas aid, the domestic,
public and private finance, tax reforms, and financial sources need to bestudied, prioritized and leveraged. Health financing strategy is being
contemplated. The financing plan is such that the GFL set up a fund. In
Africa’s case, highly concessional IDA funds will be used to support.
Additionally, similar to the Universal Health Coverage in Africa, thePandemic Emergency Financing Facility, PEF, was introduced. The global
private sector needs to be involved to quickly deal with the pandemics andadhere to the international health rules. When possible, innovative healthmechanism should be used to deal with the financing needs. The global
private sector reinsurance or catastrophic bonds, already being used fornatural disasters, should be applied to pandemics along with the private
sector. This is a major innovation.
Jennifer Blanke stated that this goes back to some of the key issues,
which are the importance of having the right kind of governance structure
to allow this to work, the importance also of national ownership but of
scale, because if it cannot be scaled then it is not possible to deal withissues Africa-wide.
She changed the focus a little bit to the other side of the win-win equation
due to the fact that this is a business and there is market share to begained.
Tetsu Kawamura
President, Lequio Power Technology Corporation

Mr. Tetsu talked about how a Japanese SME can position itself to gain
market share in the African health sector.
He stated that Lequio Power Technology Corporation is a very small
company with a few employees. It provides affordable medical devices to
30 countries around the world. Being an SME they cannot localize theirbusiness as there are too many competitors.
A lot of cost and labor is necessary to advertise the company in Africa.
Incidentally, Lequio was supporting JICA and that is how it got involved
with Africa. By going to Africa, Lequio found that their position in Japan,
US or Europe is entirely different compared to their position in Africa. This
is why they started this business.
If Japanese SMEs or small venture companies in the healthcare sector
limit their business to Japan or western countries, there are too many
regulations that make it difficult to even start a business. Investors

should try Africa, and JICA will provide support for an interesting business
opportunity.
Lequio developed the ultrasound diagnosis device in 2015 as per the
Sudanese government’s request. Lequio could develop this device as thistechnology is 40 years old in Japan and there is no patent anymore, so
people can develop this device.
It is possible to manufacture this product as there are many people whoare able to provide support.
The assumption is that Africa needs
something that requires technology, not necessarily latest, that would bevery helpful. In Japan, this technology may be old and obsolete but by
combining it with IT, it is possible to make it affordable and easy to use.
This is where SMEs could play a role in this sector.
Lequio is supported by JICA. In Sudan, Lequio started training midwives
to use echo and now 50 midwives are able to use this device to do thescreening for maternal health. Lequio believes in not only selling products
but also imparting training and education. To combine training with thedevice is extremely important. The usual ultrasound provides an image,but Lequio is using cameras that capture from outside, so the camera isshooting externally and the internal image can be viewed on the video
screen. This whole process is very easy.
Textbooks can be made using this image. It is very difficult to use thisdevice, so training and knowhow is important.
This is the Egg ofColumbus. This something usual as no one has ever tried if before.
Images are uploaded to the cloud, where one can freely access it andlearn. Advice is provided based on this image. Lequio provides thisdevice and service and improvises it in a way that would suit the local
community. It also provides training support.
Lequio not only sells the devices but also the diversified business model.
Although Lequio wants to sell a lot of devices, being a small company ittakes time to be able to sell large volumes. The business model isimportant. Lequio used IT like Google. With Google, one does use
Encyclopedia anymore. The same can be done with Lequio. Lequio, beinga small company, is trying to do the same by involving large companies towork together to realize the business model.
Certification of medical devices from each country is very important andLequio needs cooperation on this front. In Japan, US, or Europe, devices
are expensive. Interestingly, in Africa the price is same for the samedevice but the amount that one can afford is different.
If there are only expensive devices, that raises the cost. To make itcheaper, the cost of certification and approval needs to be minimized asmuch as possible. If the African countries can come up with a rule toshow that this device is safe and if the certification process can be
simplified, it would be easier to introduce Lequio’s device. If such amechanism is introduced, it would be very helpful for Lequio.

Jennifer Blanke stated that the above talk gives some clear food forthought on a few things. The idea takes a holistic perspective thatdevices need to have a well-functioning IT infrastructure to work. The
other big story is leapfrogging the intermediary stuff to get to the newest
and make sure that it is adapted in the African context.
Finally, she invited Mr. Tsubaki to talk about the finance side of things.
She added that everybody would be interested to hear Mr. Tsubaki’s
perspective on opening a private equity fund in the health sector in Africa.
What are the business opportunities in this sector and are there more
benefits than risks?
Susumu Tsubaki
Representative Partner, Asia Africa Investment and Consulting

Mr. Tsubaki stated that Asia Africa Investment and Consulting, AAIC, isthe first private equity Japanese fund focused on Africa.
AAIC has invested in several businesses. The first one is in Uganda whichis agriculture and processing for Macadamia nuts. AAIC has funds in 300
hectares of land right now.
The second one is the Toyota Tsusho SV Fund, which is a Kenyan
company focused on medical and ITC. This is an investment through thefunds.
The third one is Katonga Farm Limited, which is going to invest in Zambia,
in the field of sago farming on a big scale in an agricultural area totaling
2700 hectares.
The last one is invested in the garment industry in Ethiopia and is aJapanese subsidiary company from the fund investment.
AICC introduced their next fund, which is Africa Healthcare Fund, whichjust started this week. This fund focuses on private sector investment in
African healthcare issues and business. AICC’s target is not big and is
only US $100 million base for 7 years.
AICC is basically focused in four areas. One area is advanced medicalcare. Even though it says advanced, it is basically very primitive. One isin oncology in areas such as cancer and the other one is in the area ofheart attack or stroke. Third area is in the area of diabetes. There is ahuge opportunity in these areas as recently the number of patients withsuch types of diseases has increased.
The second area of focus is healthcare tech. This is very important for
AICC because in the countryside, people do not have access to the AI
diagnosis or tele-diagnosis or telemedicine. In Japan, it is basically very
difficult because of the many barriers. In Africa, the AICC is looking toinvest in the very big Greenfield area of technology, which is coming
faster in the African continent. M-PESA is one such service from Kenyan

Safaricom in Africa. In Japan, it is very difficult to do this.
thing has happened in the medical healthcare tech areas.

The same

Third is the medical service area, which has a very wide variety and is not
only service but also human development or healthcare insurance or
distribution. There is a huge opportunity in distribution, which means
drug or pharmaceutical distribution. This area has quite rapidly increasing
business opportunity.
The last one is the public health. Basically, there are already manylaboratory systems or healthcare, public healthcare, and these are also
very interesting. AICC is a private company and not a development donor,
as they look for return on investment. There is a huge opportunity in the
African healthcare market in the long run, say 10 years from now.
In many countries, there are foreign pharmaceuticals such as Novartis,
Pfizer and Gilead. Japanese pharmaceuticals or medical companies have ahuge opportunity to invest in private sector areas, if possible with JICA.
One surprising example is that of investment in Luanda Medical Center inAngola. The total investment is US $80 million base, half is private funds,
half is OPIC, the US bank. This hospital annually receives 450,000
patients. There are 1500 patients coming in and per year there are 5000
operations and surgeries being done in the hospital. The amazing thing is
its internal rate of return is 20% annually. It is a huge opportunity with
200 doctors and a very good hospital.
AICC can possibly do this business, but need to collaborate with thegovernment for support in the areas of healthcare insurance or the manytariff or education issues. AICC would like to utilize this huge opportunity
to make country-specific investments.
Jennifer Blanke summed up the talk by saying that exciting opportunities
exist out there. The importance of blended finance can be seen more andmore in the health sector. The investments also need to be de-risked to acertain extent. For people, who are interested in that, it would be
replicable in other funds. If someone is interested and has not beenclosed on yet, they can come make that particular investment or invest
more in healthcare in Africa.
The first round of discussion was very interesting.
would get into more details.

The second round

Addressing Mr. Kwaku, she stated that the governments in Africa havetraditionally been receiving overseas development assistance, ODA, fromadvanced economies or international organizations to support the healthsector. Are there any changes in that role over recent years given theinterests of the private companies in getting involved and doing businessin the health sector?
Kwaku Agyeman-Manu stated that ODA is a reality that nobody can run
away from. One can continue to benefit from it sitting at the recipient end

forever. JICA is supporting Ghana right from the basic primary care.
Ghana has been doing a lot of prevention. Ghana has a policy of taking
healthcare to the doorsteps of the rural people. JICA is supporting theCommunity Health Services Program in some of the displaced regions of
Ghana. GAVI or the Global Alliance for Vaccines and Immunization is theirown program, but they are exiting aid to Ghana by 2021.
Global Fund, which helps in identifying disease burdens such as Malaria,
HIV/AIDS and tuberculosis is also exiting. The President of the new
Ghanaian government that won in January has declared Ghana beyond
Aid. In this regards, Ghana has some medium-term strategy and plans inplace to try to wean them off of aid. Ghana needs to look at new sourcesof funding. Ghana can definitely not continue to increase taxes. Ghana
cannot continue spending all government money into health. There areseveral obligations for the state and so private sector funding has become
the new model.
Presently, Ghana has started talking about outsourcing some high levelgovernment facilities, where they play the rule of public-private
partnership in some facilities like management and procuring
infrastructure to learn to deliver healthcare. This is a reality that nobody
can run away from disasters again. Sooner or later, everybody will haveto set up and look for their own private sector funding source. Ghana is
attracting and getting more foreign direct investments into the country.
People are coming from India and China and setting up facilities andsubspecialties. Some companies are setting up medicine manufacturing
plants without government money. Ghana has an obligation to ensurethat their investments are protected and they get good returns on theseinvestments. Ghana is at the center of a lot of countries, who have
patients who travel far away for healthcare. Ghana can get markets toinvest into their healthcare systems that yield results.
Jennifer Blanke stated that it is that positive feedback loop that has thedomestic resource mobilization through taxation. But for that to happen,a thriving private sector is needed to attract private sector investment,
thus ending up with a healthier population. It would be interesting towatch that continuous story unfold in Ghana.
She asked about Mr. Toda’s perspective on how can a win-win situation
between JICA and the Japanese private sector in health be insured. Has it
been easy to find Japanese companies to do this or is it difficult to reallygo out, grab them and get them interested?
Takao Toda stated that that is the human bridge which is ongoing. In thename of ABE Initiative, Africa Business Education Initiative, and with someother brilliant initiatives, the best and the brightest, who are willing to be
the new group of human bridges from Africa, are being sent to Japan.
The triangular win-win structures including the public, private andacademia sectors can be realized by making full use of these excellent
human bridges. The best and the brightest who are in Africa and who arein the excellent universities in Japan can be the bridges between the twonations and be the symbol of the win-win strategy.
Jennifer Blanke stated that the positive feedback loop is important.
She turned to Mr. Tsukagoshi to get World Bank’s perspective in universal
healthcare.
How can the World Bank work with the private sector
encourage universal healthcare, which is not under the purview of thegovernment?
Does the Universal Health Coverage require moreprivatization of medical facilities, greater private sector participation
supplying medical equipment, pharmaceuticals or a combination of allthese to roll out its services?
Yasusuke Tsukagoshi talked about the UHC cube.
There are twodimensions for the involvement of the private sector. The first is financial
protection. To prevent people from falling into poverty as a result ofreceiving medical services, social protection and social health insurance isneeded. These are important and are provided by the government. In
many countries, the private health insurance is complementing or
replacing government support.
In India, health insurance is being
outsourced to the private sector. In Ghana, a community level insurance
mechanism exists.
The people in the community have an increased awareness of how risk
should be covered. This has been combined with the national level
insurance. In the world of financial protection, there is a complementary
relationship between the government and the private sector insurance.
One sector cannot be expected to do everything. The government has alarge role. The informal sector should be covered by the government. In
order to do this, the pie becomes bigger by teaming up with the private
sector. This is very important in financial protection.
On the service delivery side, the private sector is involved in various forms.
By engaging the private sector, the service becomes more efficient,particularly in areas like pharmaceutical distribution. The private sector
brings in the innovative products. Furthermore, the private sector financeis introduced as a business, but the quality is not necessarily acceptable
and may not cover all people. Appropriate government supervision andregulation is important. By doing this, higher quality can be provided forexisting services.
A unified standard criterion is important and insures existing higher
quality. The public sector plays a large role in this. The GFF provides acountrywide platform. The private sector is involved from the upstream.
The investment that is important is prioritized, with the financing toenable private sector service delivery. The government is involved inthinking about this and formulating funds from the initial stages. That iswhat is ongoing under GFF. The results are being eagerly awaited.
Jennifer Blanke stated that the dance between the public and private
sector will be critical here. The private sector is going to be providing ahuge amount of the services both on financing and provision of health side
directly.
Turning back to private sector perspective, Mr. Tetsu, what are thestrategies that the private sector should take in order to make healthcare
more affordable. Also, what are the learnings from Africa in terms of thefamous idea of reverse engineering?
Tetsu Kawamura stated that the term generic medical device is often used
for reverse engineering. Technology itself is generalized, but it tends tobecome expensive in case of medical devices. It would be very simple ifmany such devices are treated as usual household electric appliance, with
50% of a profit and sell. But if expensive medical devices are sold in thatmanner, there will be a lot of friction, which is not necessary. People, who
need high level advanced functions, can sell expensive products.
The first step is important for places that cannot access expensive devices
and a way must be thought to realize that. Advanced devices mean thatthe doctor or the hospital wants a customized device. Customized devices
are more expensive. The first step should be something that everyone
can use in the same manner. Having one design that everyone can use
and how to use that device is very simple.
The first step to make something affordable is to take advice and enhance
the functions. It is important to improve the level of skills by adding IT
and basic training. In rural area, sometimes there is only one doctor, so it
is very difficult to acquire and learn new technology. It is possible todevice a method using remote technology and database through which thedoctor can learn new skills that would be cost effective and raise the levelof service. This mechanism can be realized if the device can be easily
used and is easily available at an affordable price.
Jennifer Blanke stated that in terms of the private sector on the financing
side, what role private equity funds can play in accompanying the local
private companies in the health sector.
Susumu Tsubaki stated that at the moment a reform or a revolution was
taking place in the medical world. ICT is being applied and countries like
India and other mid-emerging and mid-income countries are offering
things that are extremely affordable. This kind of idea is applicable in
Africa and there are some interesting examples. Ethiopia has a service
called the Hello Doctor service, which uses a smartphone to make adiagnosis. Japan has a telephone treatment or advice where diagnosis is
made without any charge.
Ethiopia has a framework that enables physicians to officially hand down
the diagnosis and offer prescription because of the low number ofphysicians and patients. Mexico has a huge player that already has 5
million users. This is business viable and the same concept applies inAfrica. Africans with visual impairments are charged ¥100,000 per eye for
IOL lens, whereas the same costs $100 in India. If IOL operations areoffered at $100, then the number of patients would increase.

Africa has 6 million people, who remain blind as they cannot afford
surgery. Doctors are performing 20 operations per day on a daily basis,so they can gain income level similar to that in advanced countries. If thedoctor can see many patients and reduce the surgery cost, more patientswould come. There are doctors, who are doing the same in gynecology
and cardiology.
The business model where reduced cost increases the number of patientsa physician can see in unit time can be transplanted in Africa as well. The
private equity wants such endeavors to become business viable for themto make investments.
Jennifer Blanke talked about the importance of frugal innovations, not toforget that at stake is the human rights issue of blind people, who areblind because they simply cannot afford the operation.
With this, Ms. Blanke opened the floor for questions.
Q&A

Gabriel, from a Japanese NGO Ashinaga supporting orphan students inJapan and worldwide, asked about the shortage of medical doctors.
Considering the fast-growing population of Sub-Saharan Africa, thenumber of doctors needs to increase at the same demographic speed.
Another important actor of the healthcare system is the healthcare
workers, like nurses, who need lower skills, but are important forcommunities in order to reduce waiting lines, and who can work directlywith NCDs and in the lifestyles of people, and also can bridge the gap
between doctors and patients. How important are they and how can the
problem of healthcare workers’ shortage be approached.
Kwaku Agyeman-Manu mentioned that within the last 5 months, Ghana’s
Ministry of Health has alone recruited close to 17,000 nurses and allied
health workers that were a backlog of the IMF-government arrangementthat were not employed. The Ministry is looking at offloading some ofthese health workers into other places. These workers are very importantas they are part of the equation that looks at how best the health services
can be delivered.
Ghana is looking up to countries like Japan to train them for 3 years in a
Japanese facility. After acquiring advanced skills, they can be recycled
into other parts of Africa and Ghana as well. Ghana has the capacity to
train them for African countries and the developed world, provided theprivate sector supports and provides investments for them to work in anadvanced environment, where they can learn new skills and specialize sothat the whole world can utilize them.
Jennifer Blanke stated that globally healthcare workers at all levels aregoing to be important in the coming years, particularly given the ageingsocieties in some parts of the world and the need for healthcare in places
like Africa.
With this, Ms. Blanke invited the panelists to comment on one wish thatwould improve the healthcare sector in Africa.
Takao Toda stated that it would be the belief, trust and wisdom to achieve
UHC by believing in future and in each other. Wisdom can be sharedbased on the trust.
Yasusuke Tsukagoshi emphasized that the private sector is very important.
In order to realize UHC, the government has a very large role to play insecuring the financial resources.
To secure the domestic financial
resources will be a large problem and a large issue going forward. The
position of the private sector in UHC is that the government and theprivate sector must grow together.
Tetsu Kawamura stated that the private sector cannot depend on funding
from others and must be able to make their own profit. To be able to dothat in an affordable manner, medical devices certification should be
simplified as much as possible through a common platform established in
Africa.
Susumu Tsubaki stated that good investment and good partner would be
important in these areas.
Kwaku Agyeman-Manu stated that the health sector delivery should not
be considered as a special service any longer but a complete business
entity. The multilaterals should work towards funding private sector to
make interventions affordable. Procedures like renal dialysis are quite
expensive. If private sector can be supported to deliver these services
cheaply, then the states can institute health insurance schemes that the
Ministry can pay for and they can be built in the scheme of thegovernments. Having Universal Health Coverage for that will do.
Jennifer Blanke thanked the panelists and concluded by saying that
healthcare is a win-win situation for Africa, the world, for businesses andgovernments, and especially for the people of Africa.