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.
South Africa: Better Education & Spatial Integration Crucial for Reduced Inequality, Job Creation
In an environment of accelerating but still modest growth, government policies that stimulate competition and create the fiscal space needed to build a skilled labor force from the poor population of South Africa, would create jobs and help reduce inequality, according to the South Africa Economic Update released by the World Bank today.
The World Bank expects real growth in gross domestic product (GD) to accelerate from 1.3 percent in 2017 to 1.4 percent in 2018, supported by a rise in confidence, global growth and benign inflation. For 2019, the forecast is 1.8 percent and 1.9 percent in 2020. But despite this modest rebound, growth in South Africa remains constrained and continues to lag behind its peers. Overall, South Africa is projected to remain largely below the average growth rate of 4.5 percent in 2018 and 4.7 percent in 2019 in emerging markets and developing economies.
“This outlook calls for fundamental policy action to turn the economy around through policies that can foster inclusive growth and reduce inequality,” said Paul Noumba Um, World Bank Country Director for South Africa. “Creating labor demand and fiscal space to finance improved education as well as reinforcing spatial integration will enhance the ability of the poor people of South Africa to participate meaningfully in the economy”.
The special focus section of this 11th edition of the South Africa Economic reviews the evolution and nature of South Africa’s inequality – among the highest in the world– arguing that it has increasingly been driven by labor market developments that demand skills the country’s poor currently lack. It suggests that significantly raising South Africa’s economic potential will require breaking away from the equilibrium of low growth and high inequality in which the country has been trapped for decades, discouraging the investment needed to create jobs.
Simulations assessing the potential impact of a combination of various policy interventions on jobs, poverty, and inequality suggest a scenario in which the number of poor people could be brought down to 4.1 million by 2030, down from 10.5 million in 2017. This would be driven by increasing the skilled labor supply among poor households through improved education and spatial integration as well as increasing labor demand through strengthened competition.
In this scenario, the Gini index of inequality would be reduced from 63 today to 56 in 2030. An additional 800,000 jobs would be created with higher wages for workers from poor households, and cheaper goods and services contributing to these outcomes, according to the report.
“In the short term, these policy interventions would include, getting the implementation of the recently granted free higher education right, continuing to address corruption, improving the competitiveness of strategic state-owned enterprises, restoring policy certainty in mining, further exposing South Africa’s large conglomerates to foreign competition and facilitating skilled immigration,” said Sebastien Dessus, World Bank Program Leader.
In the longer term, the report suggests that improving the quality of basic education delivered to students from poor backgrounds and reinforcing the spatial integration between economic hubs, where jobs are located, and underserviced informal settlements, would reduce poverty and inequality and support job creation.
Can Insurance Help Low-Income Ethiopians Cope With Risk?
The loss of crop or livestock as well as concerns about illness and accidents are key financial expenses on the minds of low-income Ethiopians.
Unexpected expenses associated with these issues are relatively common. A third of low-income Ethiopian households experienced at least one major health issue in the previous year, often paying for it out-of-pocket.
In rural areas, almost 50% of households experienced some agricultural loss in the previous year. For three-quarters of these households, these financial losses accounted for more than half of their income in a typical year.
Yet even though these crises affect a large number of the population, Ethiopians don’t have adequate mechanisms in place to cope with the financial hardship they bring.
“People don’t put money aside to deal with risk. Instead, they rely on cash and savings, if they have them, borrow money from family, if possible, or as a last resort, sell livestock to cope with these unexpected shocks,” said Craig Thorburn, a Lead Financial Sector Specialist with the Finance, Competitiveness and Innovation Global Practice of the World Bank Group, and the technical lead for a FIRST Initiative funded project that produced the new report What People Want: Investigating Inclusive Insurance Demand in Ethiopia.
Informally borrowing money is a common coping strategy as loans from formal financial institutions are expensive and hard to get. However, when a crisis, such as drought, affects an entire community, informally borrowing money from relatives isn’t a viable option. And selling livestock may inject rural households with quick access to cash, but this approach ultimately leaves families poorer and less resilient.
Last year, the World Bank Group conducted a demand-research study in Ethiopia to examine risks low-income households face and see whether insurance could be a tool that Ethiopians could tap into to reduce and better manage these financial burdens.
This country-wide survey reached close to 3000 households, totaling 13,000 people, from both rural and urban areas.
“Understanding the needs of underserved populations, including low-income households, is key to developing quality insurance products and expanding insurance markets,” Thorburn said. “Without this knowledge, potential insurers wouldn’t understand the real and perceived risk of this unserved market segment.”
The survey found that people had little knowledge or experience with insurance, and that 50% of surveyed households never heard of insurance. However, people expressed interest in it if insurance products were devised as accessible and inexpensive.
Ethiopians have unserved needs that could be met with affordable products they actually want.
For example, 97% of focus group participants indicated they would buy a proposed prototype crop insurance product if it were available to them, as it would allow them to replace lost income and buy inputs for the next crop cycle.
And for health-related issues, the survey found that while many people fear a high-cost illness, they could manage many basic expenses with their existing resources, with 75% reporting that they were able to fully recover from financial hardship. This indicated that a well-designed insurance product could leverage existing strategies such as savings, and provide peace of mind. Interest in a hospital cash prototype was high, with close to half of participants willing to pay an actuarially sound premium.
This openness to insurance could provide a great opportunity for insurers, particularly if they can customize and tailor their products to suit customers’ needs.
While this initial research indicates that low-income households are interested in insurance, it would require insurers, the government and other stakeholders to work together to develop insurance products that are accessible, affordable and appropriately designed for people’s needs. Other aspects related to extending the insurance market would need to be considered as well. These include adapting the regulatory framework to motivate insurers to enter this market and devise financial education programs to educate people on insurance.
“Ethiopia provides a significant opportunity for insurers to expand their businesses, the government to improve the overall stability of the low-income population, and low-income people to stabilize their economic status,” said Thorburn.
Focus group participants indicated they would be most likely to purchase insurance from formal financial institutions, such as banks or microfinance institutions, which would bring stability and financial capacity. They indicated that they would be less likely to purchase insurance through informal formal groups, such as savings and credit cooperatives or Edirs, which are well-ingrained local community-based organizations created to help cover funeral expenses.
The World Bank is working in Ethiopia to create an enabling environment for inclusive insurance.
These survey findings are part of a broader World Bank study that that looked at supporting more inclusive insurance markets in Ethiopia.
Catholic Church under attack in the DRC
In a country increasingly wracked by armed conflict, nothing is sacred anymore. The kidnapping of a Catholic priest in the Democratic Republic of Congo, and the subsequent demand for a ludicrous Sh50 million ($500,000) ransom, is just the latest instance of turbulence in this violence-ridden nation.
The abduction is concerning not only as the latest instance of the encroaching lawlessness that plagues the land, but also because it represents an openly hostile attack on the Catholic Church of Congo itself. With a corrupt president clinging onto power, the Church has become one of the DRC’s main sources of moral authority and resistance to tyranny. As a result, such a brazen assault on this influential institution only further undermines the country’s chances for a stable future.
Anarchy in the DRC
Despite its incredible natural wealth (it has vast resources of cobalt and copper, among other precious minerals), entrenched corruption in the DRC has kept the vast majority of the populace locked in entrenched poverty. With over 13 million people in need of humanitarian aid and 7.7 million of those facing “severe food insecurity”, the situation is comparable to the crisis in Syria. To add to the humanitarian emergency, armed rebel groups have been engaging in increasingly frequent attacks, especially in the DRC’s eastern provinces, prompting the UN to deploy over 16,000 peacekeepers in the country. That’s the largest peacekeeping operation anywhere on the planet.
15 of those peacekeepers were targeted by rebels in December last year in what has been described as one of the worst attacks on UN personnel in living memory, and the violence has recently spilled over into the religious community as well. The abduction of Father Celestin Ngango on Easter Sunday is just the latest attempt to extort money from the Church, as there have been several others in recent years. In October 2012, three priests were abducted from the Betumbo-Beni diocese, while two more were kidnapped in July 2016. None of the abductees have been seen since. Although a prominent bishop has admitted that kidnappings are virtually a daily occurrence in the DRC, the extortionate ransom demanded for Father Ngango represents a serious escalation vis-à-vis previous sums.
Church as a figurehead of freedom
The stakes have not only been heightened in monetary terms. By targeting clergymen, the rebels are destabilising the DRC further by victimising the very body which is fighting most to save it. The Church has long been an outspoken proponent of democracy and freedom, stretching back to the days of dictator Mobutu Sese Seko. After Mobutu attempted to quash the Church in the 1970s – seeing it as an obstacle to his attempts to consolidate absolute power – the institution enjoyed renewed popularity among the common people, aided by its role as provider of educational and welfare services.
Indeed, in a country where the authorities often fail to supply even the most basic public services to their citizens, the Church has filled a critical vacuum, resulting in enduring popularity even among non-believers. 35 million of 84 million Congolese call themselves Catholics, but many of those who do not identify with the Church still appreciate their support for democracy and social justice. The de-facto leader, Cardinal Laurent Monsengwo, enjoys wide popularity; perhaps more tellingly, he has also been a constant thorn in the side of the country’s dictators. Indeed, current leader Joseph Kabila himself once confided to a European diplomat that he viewed Monsengwo as his “main opponent”.
Striving for justice
It’s easy to see why Kabila is so wary of Monsengwo and his order. The Church fielded 30,000 observers in the 2011 elections and were the first party to cry foul play. When Kabila promised to step down at the end of his mandate in 2016, the Church acquiesced, only to step in as mediators and broker the Saint Sylvester agreement (which called for elections by December 2017) after he refused to keep up his end of the bargain. However, the failure of those elections to materialise has now shifted their position from mediators to mobilisers. Since the end of 2017, the Church has organized 149 peaceful protests, only 16 of which have been allowed to take place unchallenged. With the political opposition typically fractious in nature, the Church has provided a rare and crucial voice of unity against Kabila.
That fractiousness, however, may now be coming to an end with the rise of presidential candidate Moïse Katumbi. Championed by the Church and by dozens of opposition leaders, Katumbi announced his candidacy with the launch of a new “Together for Change” party earlier this year. Katumbi has the financial credentials and the widespread popularity to topple Kabila, prompting the latter to hinder the former’s campaign in any way he can. Kabila has levelled charges of real estate fraud and mercenary recruitment at Katumbi’s door and charged him with three years in prison, though Katumbi (and the Church) maintain his innocence. Additionally, Congolese authorities have blocked his passport application and raised his former Italian citizenship as problematic in blatant attempts to discredit his candidacy. Nonetheless, Katumbi has promised to return to the DRC by June at the latest and lead the charge against his old foe.
If elections are allowed to proceed as planned on December 23rd and Katumbi given the opportunity to stake his claim to the presidency, there is a real hope that the DRC can dig itself out of the corruption, conflict and poverty that has taken hold of the country. The support of the Church will be instrumental in giving that hope credibility.
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