Many African countries are still consistently looking forward to improve healthcare delivery to millions of people living in rural communities with little success. In this interview, Professor Mikhail Y. Natenzon, chairman of board of the “National Telemedicine Agency” Research-and-Production Union and also deputy head of the Regional Working Group for Telemedicine of the Regional Commonwealth for Communication of the CIS countries, tells Kester Kenn Klomegah, an independent researcher and policy consultant on African affairs in Russia and Eurasian region that the establishment of compatible national telemedicine systems, which has many advantages, can suitably be adapted to the local conditions of any particular African country.
How important is modern telemedicine technology for African countries? And the reasons why you are passionately exploring Africa?
Economic development of African countries reached the level where the government can begin a strategic reform of health systems to create a modern, meeting the world standards of health care. The implementation of these programmes will solve health problems and give African countries the opportunity to take the next leap forward in economic and social development.
African governments and international specialized organizations have now developed and are implementing various programmes to improve the quality of life of African populations. The most advanced project is the elimination of the epidemic of socially dangerous diseases such as HIV/AIDS, tuberculosis and malaria and allocate significant funds for it. Indeed, one of the problems of the slow development of African economies is the fact that people suffering from malaria are unable to work effectively and vigorously. Another important international project is the maternal and child mortality reduction programme.
Significant, multi-billion dollar funds have been allocated by governments and international organizations to these projects, and the results are clearly not in line with the efforts made. The efficiency of investments is not large enough.
The reasons for this are, inter alia, the inadequate health infrastructure in Africa, its concentration in major cities and the almost total absence in rural, remote and hard-to-reach areas, where about 60 per cent of the population-600 million people-live. It is obvious that the traditional methods of providing medical care can not work in the current situation.
Therefore, we have developed new methods to ensure accessibility and a single high standard of quality medical care for the population, especially in rural areas and remote areas. These system solutions, technologies and equipment are based on the widespread use of Russian information and telemedicine technologies. These proposals are now practically non-alternative, as confirmed by the documents of the UN, the world Health Organization, the International Telecommunication Union, the African Development Bank and other international organizations.
As it’s already known, many African rural communities are very limited or disadvantaged with sources of energy (electricity), but how could telemedicine be useful for these remote areas of the continent?
The problem of all rural areas in Africa is the underdeveloped social and health infrastructure. Its creation with the traditional approach is a long and very expensive project. Moreover, such infrastructure will always experience a shortage of qualified medical and technical staff. But most importantly, its exploitation will require large funds that are not available to either rural communities or the state. The only solution for the cost effective implementation of social development goals in Africa so far is the establishment of an integrated telemedicine system.
It consists of two parts: network of telemedicine consulting-diagnostic centers, established in stationary medical institutions of different levels, and communication associated with them system of the mobile telemedicine laboratory diagnostic facilities (the ITC) in various fields. The ITC is designed to address a wide range of health challenges and provide social services to people in rural, remote and remote areas. Built on international standards, it integrates with similar systems in other African countries and Russia, interacting with telemedicine systems in other countries.
A key element of the mobile telemedicine complex and mobile hospitals can provide medical care to the population in remote and inaccessible areas in a completely autonomous manner. They have their own power supply system, communication system, up to the satellite, life support systems, crew systems cleaning air and water and many other optional installed systems required for successful operation. Most importantly, the personnel of the ITC may not be a doctor, but an average medical worker. Use MTK allows radically solving the problem of comprehensive medical services to the rural communities. Their residents will not have to get to the city hospitals. The hospital will come to them.
At the same time, qualified doctors working in provincial hospitals, to which the ITC is assigned, can provide advice through telemedicine equipment to personnel of several ITC operating in different parts of the province. This solves the problem of shortage of qualified doctors and reduces the cost of operation of MTC.
Can you discuss innovative tools available in the plant and key competitive advantages? Do you have all the equipment and / or components manufactured in Russia?
The main goal and the main competitive advantages of the medical complex are the solution of four socially important tasks: ensuring accessibility of medical and social services to the population; providing a unified high quality medical and social services for citizens regardless of their place of residence and social status.
It helps optimization of the cost of healthcare while improving its quality and coverage and creation of permanent jobs for highly qualified technical and medical personnel, ensuring the creation and operation of complex.
Other important competitive advantages of the systems offered by us are: High capacity of MTC – up to 20,000 people per year, and therefore, almost 100% coverage of health care for the entire population.
Low cost of rendering medical services to the population due to use of the average medical personnel and absence of need to build stationary medical institutions and to spend means for their operation.
Possibility of step-by-step realization of the project, the complex telemedicine system. At the same time, the system itself begins to function fully from the start of its first segment. Connecting the following segments extends the functionality of the system and without requiring structural adjustment.
There is high investment attractiveness. The expected return on investment in the project is 5-6 years. The functioning of the system is an important contribution to the stable development of the state, providing an increase in the human capital development index. There is also professional development of medical personnel and the use of international standards and the possibility of organizing cross-border telemedicine consultations.
All equipment which is a part of complex telemedicine systems: stationary telemedicine consulting and diagnostic centers for stationary medical institutions of all levels (from the Central hospitals in the capital, to the para-medicine point in the small village), mobile telemedicine laboratory and diagnostic complexes of various medical appointment with all equipment, communication equipment, satellite communication systems, guarantee maintenance of system, preparation of medical and technical personnel for system functioning is the Russian know-how, certified and manufactured in Russia.
At the request of the customer, the system offered by us can be connected with the existing telemedicine systems in the country. The system can begin to operate immediately after the installation of equipment in the country and completion of training. The system is delivered on the principle of “turned on and work” without any complications.
What will be the main direction in terms of implementation of this medical technology projects in Africa? And what are your expectations from African governments?
The main direction of our project for Africa is the gradual creation of compatible national telemedicine systems that can interact with each other and in the long term to create a pan-African telemedicine system. The telemedicine system becomes economically and socially effective when it is a queueing system. This is exactly how the proposed system is designed.
Health systems in almost all countries of Africa basically are state-owned. Therefore, the establishment of compatible national telemedicine systems is possible only in close cooperation with the regional Ministries of health, so that the project can be adapted to the conditions of a particular country and at the same time maintain the universality of national telemedicine systems, so that they can interact with each other. We know the serious efforts that African Governments are making to promote health, and we hope that our cooperation in implementing telemedicine systems will yield significant, qualitatively better results.
Mali’s withdrawal from G5 Sahel, Joint Force ‘a setback’ for the region
Mali’s decision on 15 May to withdraw from the G5-Sahel group and its Joint Force is “unfortunate” and “regrettable”, a senior United Nations official told the Security Council on Wednesday, as she urged countries in the region to redouble efforts to protect human rights, amid protracted political and security crises.
Martha Ama Akyaa Pobee, Assistant Secretary-General for Africa in the Departments of Political and Peacebuilding Affairs and Peace Operations, said the Joint Force was created in 2017 by the “G5” Heads of State – Burkina Faso, Chad, Mali, Mauritania and Niger – to counter terrorism in the Sahel “head on”.
However, the challenging political and security dynamics in the Sahel – and uncertain outcomes of transitions in Mali and Burkina Faso, in particular – has already slowed Joint Force operations. The G5 Sahel, meanwhile, has not convened a high-level political meeting since November 2021, while its Defence and Security Committee has not met in over six months.
Thanks to Commander General Oumar Bikimo, she said, the Joint Force has been able to carry out operations in all three of its sectors since the Council last met in November, despite the absence of Malian battalions.
How Mali’s decision to leave the G5 and the Joint Force will impact the dynamics in the region remains to be seen. “It is most certainly a step back for the Sahel,” she said.
MINUSMA on hand
For its part, the United Nations Multidimensional Integrated Stabilization Mission in Mali (MINUSMA) will continue to provide support to the Joint Force long as it is mandated to do so by the Council. It has been working with contractors to deliver life support consumables to the contingents and will honour requests received by the other four contingents outside of Mali.
Cycle of radicalization
“Protecting the most vulnerable has become ever more important,” she stressed.
She cited reports of serious violations committed against civilians – by terrorist armed groups, as well as reportedly by armed and security forces.
To be sure, uprooting terrorist groups deeply enmeshed or embedded within communities is “uniquely challenging” in the Sahel, she said, making counter terrorism operations immensely difficult to carry out.
But if civilians fall victim to these groups, “those very efforts are going to be pointless”. Terrorist operations cause immeasurable human suffering, seriously undermine trust in the State and fuel radicalization.
Time for a re-think
“It is perhaps time to rethink our approaches and change the way we do our work” she added. “We need innovative approaches in the face of the constantly evolving tactics of terrorist groups, whose influence keeps expanding”.
She noted that for the last five years, the international community, donors and partners have struggled to reach a consensus on the most effective support mechanism for a collective security response in the Sahel.
And the lack of consensus persists – despite the recognition by all, that the terrorist onslaught in the Sahel constitutes a slow-burning, mortal threat to international peace and security.
Holistic approach needed more than ever
“It is now more urgent than ever to act,” she said.
She called for a holistic approach that honours “the primacy of politics”, addresses the causes of poverty and exclusion, and provides opportunities and fulfilled lives for the many young people in the region.
The African Union Commission and the United Nations Secretariat will jointly carry out a strategic assessment of security and governance initiatives in the Sahel, she said, with the goal of strengthening support to the G5-Sahel, its Joint Force and other security and governance initiatives in the region.
African Development Bank Seeks U.S. Support to Alleviate Africa’s Food Crisis
With Russia’s “special military operation” still continuing in the former Soviet republic of Ukraine and its impact especially on Africa’s economy, the President of the African Development Bank Group, Dr. Akinwumi Adesina, made a compelling case for the United States to back the institution’s $1.5 billion emergency food production plan. The comprehensive urgent plan seeks to avert a looming food crisis in Africa caused primarily by Russia-Ukraine crisis that started late February.
The African Development Bank is prepared to meet this new challenge and has developed an Africa Emergency Food Production Plan. Within this plan, $1.5 billion will be used to support African countries to produce food rapidly – produce 38 million metric tons of food. The Russia-Ukraine conflict is a huge factor in fertilizer prices hiking upwards of 300%. Analysis has shown that Africa faces a fertilizer shortage of 2 million metric tons this year. It is estimated will cost about $2 billion dollars – at current market prices – to source new fertilizer to cover the gap.
The total value of the additional food production is $12 billion. The Africa Emergency Food Production Plan will deliver climate-resilient agricultural technologies to 20 million farmers. The $1.5 billion plan intends to source $1.3 billion of its own resources. With U.S. support to reduce the $200 million financing gap – this can ensure the Africa Emergency Food Production Plan’s success.
Chairman Senator Chris Coons, Ranking Member, Senator Lindsey Graham, and distinguished Members of the U.S Senate Appropriations Subcommittee on State and Foreign Operations, appreciated the opportunity to testify about the U.S. response and policy options for global food security crises.
The AfDB chief, and a panel of witnesses, testified about global food insecurity and persisting impacts of the Covid-19 pandemic before the US Senate subcommittee on State, Foreign Operations and Related Programs. Among others, senators Chris Coons (Delaware), Lyndsey Graham (South Carolina), Dick Durbin (Illinois), Chris Van Hollen (Maryland) and Roy Blunt (Missouri) participated in the hearing.
Distinguished members of the Subcommittee are spearheading efforts for African solutions to Africa’s immediate, medium, and long-term challenges. US has a strong support for the Africa Emergency Food Production Plan, and will allow Africa to avert a looming food crisis and use the opportunity to drive structural changes in agriculture, to unleash the full potential of Africa to become a breadbasket to the world.
Ukraine exports 40% of its wheat and corn to Africa. According to the United Nations, 15 African counties import more than half of their wheat, and much of their fertilizers and oil from Ukraine and Russia. As the Russia-Ukraine conflict rages, Africa is also dealing with a 30-million metric ton loss of wheat and corn that won’t be coming from Russia. The cost of bread is now beyond the reach of many Africans.
Senator Coons, Chair of the Senate subcommittee, stressed that the US should move fast and provide sufficient funding. “We should be concerned and even alarmed about the widening food security crisis that this war is causing for hundreds of millions far beyond Eastern Europe,” he said. Senator Graham expressed support for the establishment of a global fund for food security.
Speaking live via videoconference from Accra, Ghana, Adesina said the proposed Africa Emergency Food Production Plan would result in the rapid production of 38 million tons of food across Africa over the next two years. “The African Development Bank, with your support, is prepared to meet this new challenge and others head-on,” he said.
The plan is anchored on the provision of certified seeds of climate-adapted varieties to 20 million African farmers. With the disruption of food supplies arising from the Russia-Ukraine war, Africa faces a shortage of at least 30 million metric tons of food, especially wheat, maize, and soybeans imported from the two countries.
Adesina said the African Development Bank would invest $1.3 billion in the plan’s implementation. He called on the US to make up the funding balance. “With US support to reduce the $200 million financing gap – we can ensure the Africa Emergency Food Production Plan’s success,” he said.
The Africa Emergency Food Production Plan is currently before the African Development Bank’s Board of Directors for approval. Also providing testimony were David Beasley, Executive Director of the World Food Programme and Ms. Tjada D’Oyen McKenna, Chief Executive Officer of non-governmental organization Mercy Corps.
McKenna said, “A perfect storm is leading to heightened global food insecurity, worse, much worse than the previous food crises over the past decade.” She cited the Covid-19 pandemic and climate change as factors sharpening the current food insecurity.
Beasley said food insecurity had already begun to rise sharply before the war. He said 135 million people were acutely food-insecure before the onset of the pandemic. “Covid comes along and that number went from 135 million to 276 million people marching toward starvation.”
Adesina emphasized that the bank’s food production plan would foster the production of nutritious food rather than simply calories. “One of the things we will be supporting through this emergency food production plan is bio-fortified foods. Sorghum fortified with iron. Nutritional supplementation is important,” he said.
The president said the AfDB was setting up meetings with international fertilizer companies to discuss ways to ensure that African farmers continued to have access to such inputs. “If we don’t solve the fertilizer problem, we cannot solve the food problem,” he said. According to Adesina, the Africa Emergency Food Production Plan would have a long-term impact on Africa’s food productivity. The initiative will “drive the structural changes in agriculture, to unleash the full potential of Africa to become a breadbasket to the world.”
Furthermore, the fact is that the AfDB is helping to fend off a food crisis. On the other side, Africa must rapidly expand its food production. The AfDB has taken a few measures including mitigating the effects of a food crisis through the African Food Crisis Response and Emergency Facility – a dedicated facility being considered by the AfDB to provide African countries with the resources needed to raise local food production and procure fertilizers.
According to Adesina, the continent’s most vulnerable countries have been hit hardest by conflict, climate change and the Covid-19 pandemic, which had upended economic and development progress in Africa. He warned that Africa, with the lowest GDP growth rates, has lost as many as 30 million jobs on account of the pandemic. Now the impact of the Russia-Ukraine crisis has brought an unimaginable suffering and extra hardships around the world.
Russia-Ukraine crisis has severe impact on Africa, only half the continent voted agaisnt Russia at the United Nations. Today, its focus is on feeding Africa and is doing a lot to address the global food crisis. Africa has an estimated 33 million smallholder farms. They are key to food production and the livelihoods of millions of Africans whose work and lives are linked to the agricultural sector. The African Development Bank’s strategic priorities are to light up and power Africa, feed Africa, industrialize Africa, integrate Africa, as well as improve the quality of life for the people of Africa.
Will Southern Africa be the next Sahel?
The Russian invasion of Ukraine and the shift in the geopolitical world order that followed is undoubtedly at the epicenter of the global focus at the moment and with a reason. Nonetheless, there are copious other issues of political instability that have been causing civil unrest, with the majority of them happening in Sub-Saharan Africa. The most prevalent example is the insurgency wave in the Sahel, which started with the coup in Mali on 2020 that quickly created spillover effects in Guinea and Chad. Burkina Faso has been the latest victim of the military takeovers trend, where Lieutenant Colonel Paul Henri Damiba took and his military junta ousted President Roch Kabore. These disruptive events stem from the broader distress that exists in the local communities to the point that there is no opposition to the violent transition of power within their own country. Similar patterns within the society are expanding across the continent, nonetheless, with Southern Africa in particular facing several destabilization efforts within the last years. Hence, questions ought to be answered. What are the reasons behind this instability wave in the Sahel? Can they be found elsewhere in the continent? Will Southern Africa be the next Sahel?
Reasons for the instability
Understanding the magnitude of the strain the society in the Sahel is facing is paramount to be able to anticipate a potential replication in this insurgency in the rest of Africa. A factor of uttermost importance is the surge in extreme hunger and poverty, the biggest one in the world, at a regional level. Only in 2021 the Sahel saw a spike of 67%, while Burkina Faso alone was the champion in this category, with a staggering 200% rise in extreme hunger. And while hunger has been deemed a key driver of hunger, it is not the only one. Climate change also has a strong reinforcing effect on that regard. It has been gauged that the region faces a 50% more severe stress from climate change than the global average. Lake Chad alone has seen a 90% decline of its surface, which has been the main source of fresh water for nearly 40 million people around the region.
To add to that, over the past 5 years the Sahel has become a place for action for several jihadist groups. Boko Haram has been expanding its hits to Chad after Nigeria, whereas in 2017 JNIM emerged as a serious jihadist threat to the region. Only in the first half of 2021, 420 civilians lost their lives during massacres and raids from violent extremist groups, most of which in motorbikes.
The three foregoing factors resulted in a perfect storm in this part of Africa, that was devilishly challenging to tackle from the regional leaders. The common theme of these three issues was insecurity, on one hand in the traditional manner of lack of safety and security, and on the other hand on the insecurity in the food-water-energy nexus. This was, thus, seen as a vacuum of power that ought to be filled by military leaders and resulted in a reverse trend to the previous one of democratization that existed in the region.
One of the same in Southern Africa?
The economic state of affairs presents numerous similarities in the southern tip of the continent, as a side effect of the pandemic. During the previous two years, Zimbabwe saw a 23.9% of the poorest people losing their jobs and increased the tally of the people who lived in extreme poverty by 1.3 million. This formulated a migration crisis, as many Zimbabweans attempted to find better conditions in neighboring South Africa, that increased tensions and took them from a national to an international level.
A similar situation is observed in the two small landlocked states of Lesotho and Eswatini as well. Endeavors to reduce poverty have blatantly failed and this has resulted in desperation among the masses. Here the civil unrest was expressed rather internally, where clashes in both countries with the local authorities throughout 2021 were audibly violent and resulted in many deaths in addition to the existing clashes between the different political entities. The energy stemming from the clear dissatisfaction of the population over the political status quo can easily be harvested by the military elites who, especially in Maseru, have portrayed their appetite before.
Complementary to the struggle with poverty, the region is recently facing terrorism from jihadist groups. More precisely, Mozambique has been dealing with insurgencies in Cabo Delgado, caused by Islamist militants, since 2017. The increasing violent attacks by the local Al-Shabab militia, which is deemed to be connected to the Islamist State(IS) peaked in 2020, when almost 1800 people lost their lives. Connecting these disruptive actions with the expansion of terrorism from the North to the South of the continent, it would be safe to infer that such groups would be eager to spread to South Africa on the long-term.
Climate change is also present as one of the myriad issues that have been a burden on the local communities. Temperatures are rising at double the global rate in the region and this is having a detrimental effect on food security, as droughts are becoming substantially more severe effect, devastating crops and livestock. Out of the few “survivors” in this category, the majority is then damaged by the intensified insect infections.
The landscape looks alarmingly similar to the one is Sahel, as several common patterns can be identified. However, there are also some points of incongruity. A main difference exists in the structure of the regional blocs, as ECOWAS in West Africa comprises of two zones , which is not the case for SADC in Southern Africa. Furthermore, the leading country in ECOWAS, due to its GDP share and power, is Nigeria, which is already dealing with extremist insurgencies and hence it becomes increasingly challenging to aid other member states, either diplomatically or militarily. This does not apply to South Africa, which, despite its struggles in various aspect of its society, is managing to maintain relative stability internally and has a strong military presence which allows the country to also aid peacekeeping processes in the neighborhood. In addition, DRC, lying at the north end of the SADC, has had some successful efforts of deterrence against extremist violence and this can function as a roadmap, provided there is enough regional collaboration on security.
One final pattern that has been observed in one region and is not yet that evident on the other, despite signs that we should worry, is the presence of Russian PMC’s. Wagner Group, being the prevalent example, has had major impact in the North of the continent, in particular in the Sahel, Sudan and throughout the Central African Republic. However, this should not be grounds for relief in Southern Africa, since CSIS has reported that the Russian private military has been deployed in Botswana, Zimbabwe and DRC, among others. The isolation of Moscow following the invasion of Ukraine is only going to make its approach to foreign affairs more aggressive and militarized, so it is paramount to monitor the Russian PMC’s movements in Southern Africa
In a nutshell
The African continent is facing severe hits to its societal cohesion, security and democratization efforts, with Sahel being the region that faces mayhem, which caused a wave of coups. The patterns that cause this major upheaval are being replicated at a worryingly accelerating pace and are gradually reaching the southern tip of the continent. There lies one of the continent’s two largest economies, namely South Africa, but also resource-rich countries of uttermost importance for the global energy landscape, such as DRC and Mozambique. Comparing to the situation in Western Africa, there might be some common points, but there are also some points of divergence that might prove to be critical for the successful deterrence of the extremist threat and the avoidance of a series of military takeovers. It is paramount that the following recommendations are taken into consideration for that to happen:
-The SADC sets up a special security task force mainly responsible organized by the respective Organ on Politics, Defense and Security (OPDS). An increase on funding to this organ ought to be allocated, but at the same time it should be ensured that these expenditures do not create unwanted imbalances within the respective militaries.
-Special attention ought to be paid towards Russian PMC’s. Amidst the Russian invasion of Ukraine and the isolation of Moscow, aggression efforts from the Kremlin are only projected to rise and actors like the Wagner Group are expected to geographically broaden their sphere of action.
-Hitherto, it would be helpful that other international security institutions are involved. NATO reaching out to Mauritania to assist the Sahel in fighting extremism was a good step forward and a similar approach could be taken with South Africa as an example, with the objective of signing an agreement on collaboration. Another institution that could be involved, in a diplomatic manner, could be the EU, predominantly for intraregional conflicts, such as the looming one between South Africa and Zimbabwe.
-In terms of food security and climate change, the SADC needs to reach out to the global community and the international institutions for further financial support packages after raising the issue in the UN World Food Program.
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