PharmAccess

1. PHARMACCESS GROUP
Working towards inclusive quality health
care in Africa
Corporate presentation
11 February 2014

2. A PROMISING LAST DECADE…
2001
“More people have died of Aids in the
past year in Africa than in all the wars on
the continent.” UN Secretary General,
Kofi Annan
2011
“Africa could be on the brink of an
economic take-off, much like China was
30 years ago and India 20 years ago.”
World Bank
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2013
“Africa is the world’s fastest-growing
continent. Pride in Africa’s achievements
should be coupled with the determination
to make even faster progress.” The
Economist

3. …WITH ROOM FOR IMPROVEMENT IN HEALTH CARE
DESIRED
ACTUAL
• Facility before start community insurance program
• Total lack of basic services
• Still now too often the state of health care in Africa
• Facility after 5 years in community insurance program
• Basic quality services provided
• Increase of patient visits and revenues
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4. FACTS ON HEALTH IN AFRICA




More than 10% of the world population
25% of global health burden
47% of communicable diseases
Less than 1% of global health expenditure
Mismatch of needed
vs available funds
 In one decade, IFC invested USD 12M in sub-Saharan Africa
out of USD 12.8B World Bank Group spending on health
 Donors mainly fund through public sector with insufficient
outcome
 50% of all care is provided through the private sector
 > 40% in lowest income quintile receive healthcare from
private for-profit providers
Mismatch in
public vs
private

5. UNDERLYING PROBLEMS: MACRO ECONOMIC VIEW
Solution
Problem
First law of health economics:
Increase healthcare spending
&
Stimulate economic development
 Poor countries spend little on healthcare
 When GDP per capita is known, health expenditures
per capita can be predicted with more than 95%
accuracy
 Donor intervention (aid & debt relief) make almost no
difference!
 Increased government/donor spending is offset by
crowding out private investments
 In general, economic development is the only way to
increase healthcare spending. This takes too long!
 Therefore, we must actively and specifically
enable both private investment as well as
government spending to increase healthcare
spending
Source:A new paradigm for increased access to healthcare in Africa, 2007
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6. UNDERLYING PROBLEMS: MACRO ECONOMIC VIEW
Solution
Problem
Second law of health economics:
Decrease out-of-pocket costs
&
Stimulate risk pooling
 Poor countries have a high share of out-of-pocket costs
 Only as countries grow richer, health insurance
coverage increases
 Results in catastrophically high out-of-pocket expenses
when poor people fall ill
 In general, economic development is the only way to
increase insurance coverage. This takes too long!
 Therefore, we must actively and specifically
reduce individual risk for consumers through
risk pooling in insurance schemes
Source:A new paradigm for increased access to healthcare in Africa, 2007
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7. UNDERLYING PROBLEM: INSTITUTIONAL ECONOMIC
VIEW
Douglass North (Nobel Prize 1993):
“Institutions affect the performance of
the economy by their effect on the
costs of exchange and production”
President Obama on his first trip to
Africa, in 2009:
“In the 21st century, reliable, transparent
institutions are the key to success.”
President Obama awarding PharmAccess the
2010 G20 award for our innovative healthcare
financing model
Banerjee & Duflo, 2011:
“[Being poor] means living in a world whose
institutions are not built for someone like you.”
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8. OUR APPROACH
Our focus is therefore to help build trust and
reduce risk to increase investments in private
sector and stimulate risk pooling. We work at
system level, the full value chain.

9. THE PHARMACCESS GROUP – OUR ALTERNATIVE
APPROACH
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10. INTRODUCING THE PHARMACCESS
GROUP
Founded in 2000 to make HIV/AIDS treatment accessible in Africa:
•
•
no public money for treatment  started with uniformed forces in Tanzania
Private sector workplace programs: Heineken, Shell, Celtel, Diageo, Unilever, Coca Cola
From 2004 broadened scope to integral approach:
•
2005 - Health Insurance Fund - public grants from the Dutch Government and World Bank to
finance health plans and related initiatives
•
2008 - Investment Fund for Health in Africa - private equity fund investing in healthcare
companies
Affiliates
•
2009 - Medical Credit Fund - loans and technical assistance for clinics at the bottom of the
pyramid
•
2010 - Amsterdam Institute of Global Health and Development - independent research and
impact study institute
•
•
2011 – SafeCare - internationally recognized clinical quality standards for resource-limited settings
2013 - mHealth Initiative - mobile solutions to improve access and financing of health care

11. INTRODUCING THE PHARMACCESS GROUP II
 Staff 150 FTE, of which 60% in Africa
 6 offices:
− Netherlands (Amsterdam)
− Nigeria (Lagos)
− Kenya (Nairobi)
− Tanzania (Dar es Salaam, Moshi)
− Namibia (Windhoek)
− Ghana (Accra)

Annual budget EUR20M
 Raising capital for health in Africa:
•
•
•
Health Insurance Fund - EUR150M
Equity Investment Fund for Health in Africa
- EUR50M
Medical Credit Fund – USD30M
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12. RESULTS
Increasing resources:
Our public funds have leveraged 8x its amount of international and local
private capital
Today 2.5 times more capital invested than the IFC in 10 years in the
whole of Africa
 12 million Euro loan portfolio will result in loans to 2,000 clinics and
revolving portfolio of 47 million Euro
 Total loan amount disbursed is USD 3 million. Repayment
performance is over 95%
Improving healthcare delivery & access:
All 500 clinics that received a loan to improve their business and services
have shown progress
Clinics are visited by 800,000 patients per month
120,000 people who live on <USD 1.5 a day are now insured
Largest private health insurance scheme for bottom of the pyramid in
Africa implemented by largest private health insurers in Africa
Improved health outcomes:
5-year impact research shows that out-of pocket healthcare
expenditures decreased 40%
And that people with health insurance are living healthier lives
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13. ETHICS & VALUES
1. WORKING WITH DONOR MONEY
2. WORKING IN AFRICA
Affiliates
STRICT / TOUGH ON OURSELVES, NO
PERSONAL ENRICHMENT, BUT………….

14. Thank You
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