Since diseases do not respect national boundaries we have no choice but to adopt a multilateral approach to preparing and responding to epidemics like HIV or Ebola. It requires the buy-in of key stakeholders across the world – at national, private and public levels. Communication is key.


May 2014

EXCLUSIVE: When it comes to finding innovative solutions to health care issues in Africa, a unique set of challenges—from misaligned funds to archaic technologies and inaccessibility to health clinics in truly life-or-death scenario—represent some of the high stakes. The need to find innovative solutions that not only lower costs but increase quality and improve patients’ outcomes has never been greater than now as the continent deals with recent Ebola outbreak in West African countries.

So how do health services providers, both private and public sectors working on the continent, find solutions to these challenges and provide better health services?

As it turns out, many of the innovative solutions may already exist in unlikely sources. For example, some of the most exciting ideas are not just the treatments coming from research labs. Instead, they are a combination of multi-sectors such as medicine, business, NGOs and technology companies working together to boost efficiency of service and turning health care services into a real, functioning marketplace. The results appear to be what the doctors recommended. THE AFRICA BAZAAR spoke with Lambert van der Bruggen, chief executive officer of Netherlands-based supply chain software and management solutions firm ORTEC consulting group and North Star Alliance’s Executive Director, Luke Disney about their partnership and how they leveraged logistics technology to help deliver better health care management system in Africa.

Q: Ortec and North Star Alliance won the 2013 award for [xxx] their collaboration on COMETS. What does winning the award mean for each company and the partnership as whole?

van der Bruggen: ORTEC and North Star have developed a strong partnership that truly leverages both organizations’ strengths and capacities to address a pressing global health issue. It’s a partnership that both organizations are proud of, and the impact on the ground along Africa’s transport corridors is for [ORTEC] the most important thing. This award, however, has been a wonderful validation for two teams of people who have worked hard together to achieve these results. Further, the award has helped draw attention to the very important role that the private sector can play in supporting innovative not-for-profit organizations, not only through the provision of funds, but through leveraging staff expertise and human resources generally.

Disney: For North Star, winning this award underlines the importance of public-private partnerships. Without this partnership, we would not have been able to approach the challenging situation with such innovation. While we have the on-the-ground knowledge and a concept of what we need – what we hope is possible – Ortec has the technological know-how, experience and ability to bring that idea to life.

Let’s talk about the partnership. How did it come about?

Disney: Our relationship with ORTEC developed from a public-private partnership. We were introduced to ORTEC through TNT, a customer of ORTEC, during our initial stages as a TNT project, who saw the potential synergies, and so history was written.

van der Bruggen: Prior to becoming involved with North Star Alliance, ORTEC was working on projects with the United Nations World Food Programme (WFP), who was also a founding partner of North Star Alliance. Because we specialize in supply chain optimization, and one of North Star’s key populations is truck drivers, the partnership seemed like a natural fit.
North Star grew out of the public-private partnership between the United Nations World Food Program and TNT.

While the primary focus of the partnership was hunger, the issue of health and mobility came to their attention during the 2003-2005 Southern Africa food crisis when WFP struggled to find sufficient numbers of truck drivers to deliver relief food to hungry communities.

At the same time, TNT had committed itself to responsibly address the negative impact of AIDS-related diseases within the transport sector. Similarly, research by WFP indicated that some transport companies had already lost over 50 percent of their drivers and that an entire generation of truck drivers was at risk.

Although HIV/AIDS fell outside the scope of their partnership, WFP and TNT realized that both organizations’ core activities relied on a healthy and vibrant transport sector. To address this, they decided to set up a separate pilot program involving the establishment of a roadside drop-in clinic at the Mwanza border crossing in Malawi.

While both partners were inspired by the success of this project, it was clear that this was not an isolated issue. The transport links in the supply chains of private and humanitarian organizations across the continent were at risk and similar clinics would have to be located along major transport corridors across Africa to have significant impact on public health. With this ambitious goal in mind, North Star was founded in September 2006 as a non-profit organization with the purpose of establishing a network of clinics that cover and connect the continent. ORTEC began working with North Star Alliance in 2008 to design COMETS.

Tell me about COMETS. What is it and how does it work?

Disney: COMETS, or Corridor Medical Transfer System, is the home-grown (proprietary) Electronic Medical Record Software developed in partnership with ORTEC. It has been developed to assist the clinicians at North Star Alliance’s RWCs along major transport corridors in East and South Africa, networking patient’s data across borders.

van der Bruggen: In short, COMETS is a system that safely stores a patient’s medical records and make it accessible at all North Star Alliance clinics across Africa. This means that medical personnel can treat mobile patients and store their medical records so that nurses and doctors in other locations can continue to provide consistent, high-quality treatment.

Disney: COMETS consists of various modules, including a treatment module for diseases like TB, malaria and a range of STIs, as well as utility modules for stock keeping, patient history and a reporting dashboard. The clinicians at the centers enter the patient data into COMETS during their treatment, and a synchronization service transfers all the data from the local machines to our central database. Thus, a truck driver’s medical information is available to all the centers across the network, which they can in turn use to treat [the patient]. In this way, COMETS plays a central part in our mission of providing continued care to the hard to reach populations.

Technology and data have become increasingly important in our society and how systems run, what role did data play in the success of your project and in developing future effective healthcare system?

van der Bruggen: Public health experts have long identified mobile populations as highly vulnerable to infectious diseases. Data was without a doubt one of the most important elements of designing a health intervention that would address the impact of communicable diseases on mobile populations like truck drivers, and the communities with which they interact. The very mobility and behavior of these groups have led to higher prevalence along busy transport routes and make it difficult for them to receive healthcare. Mobile populations also play a role as ‘vectors’ in the spread of these diseases between high-risk key-populations (e.g., sex workers) and lower-risk groups (e.g., general community members, long term partners). This becomes most visible along transport corridors where large numbers of truck drivers interact with the communities that live and work along the corridors.

Disney: In order for [North Star] to successfully develop our healthcare infrastructure, innovative technology, data collection and analysis is critical. We use technology in finding out the optimum locations for positioning our RWCs in order to reach maximum patients, while also ensuring longest continuity of care to the truck drivers.

van der Bruggen: By coupling a robust data collection and storage network with a physical network of strategically located clinics, we’ve been able to ensure that mobile populations are able to access their medical records (and therefore consistent high quality healthcare) across borders. This data has also enabled North Star to gain increasing insight into important health trends and disease patterns at the local, national, and regional levels which can be valuable with regard to both monitoring the project’s impact, as well as providing early warning signs of disease outbreaks.

Disney: We routinely use our patient data to generate reports presenting the exact scenario on the ground, assisting governments and other agencies with the facts required to take necessary steps. Our next plan is to use big data analytics in partnership with ORTEC, to provide an anticipatory and preventive service to the communities.

What is humanitarian logistics and how did Ortec segue into humanitarian logistics?

van der Bruggen: Logistics is a main element of the supply chain. Humanitarian logistics involves taking the techniques and knowledge of supply chain optimization to the field of delivering aid and food. With our techniques you can work more efficient, reach your destination earlier and build better truckloads. This simply means more aid, faster and cheaper at its destination.

Could humanitarian logistics help solve some of the challenges facing Africa’s healthcare system? Can it be replicated in other projects?

Disney: A major challenge faced by governments in Africa today is the delivery of health care to hard-to-reach communities – an area in which humanitarian logistics can help. The expertise in supply chain management can be utilized to deliver medicines and health care infrastructure to remote locations, while related technology can be leveraged to capture, process and deliver relevant information to all the stake holders.

van der Bruggen: Humanitarian logistics have already had a tremendous impact on both improving the delivery of food aid across the developing world and of health services to some of the communities in Africa that are most disproportionately affected by communicable diseases like HIV, tuberculosis, and malaria. The same principles can and should be applied to developing a better response to other humanitarian, health, and development issues globally.

Disney: At North Star Alliance, we have applied our logistical know-how to bring health-care to places and communities who are isolated from mainstream by time and distance.
Another good example of humanitarian logistics improving lives of people is the Dutch Agricultural Development and Trading Company which, through its miniaturized Cassava processing plants in shipping containers, is bringing economic independence to distant farmers in Ghana, Mozambique and Nigeria who are not able to take their produce to big processing facilities.

The success of the project depended on gaining access to a key segment, the mobile population. How and who came up with the concept to convert and use shipping containers as roadside drop-in clinics that are strategically located in key areas access by targeted population?

van der Bruggen: The idea to use shipping containers to house roadside clinics (or Roadside Wellness Centers) was originally conceived by North Star’s Regional Director for Southern Africa, Paul Matthew. Paul initially became aware of the alarming impact of HIV/AIDS on mobile workers in the 1990s through his work with The Learning Clinic, an agency that provides commercial training programs for the road transport industry. It was clear to him that a generation of truck drivers was at risk and he came up with the idea to bring health services to the truck stops and borders where drivers convened, and informal trades like sex work flourished. Paul was recognized as a 2012 Social Entrepreneur of the Year for Africa at the World Economic Forum on Africa for this concept and the impact it’s had on regional health.

What other projects are you involved in or working on in Africa, health-related or otherwise?

van der Bruggen: [For ORTEC] we [are] working for some programs of the WFP through our office in Ethiopia. Also, [we are working on] a second project with NSA: POLARIS, a tool that uses quantitative methods to determine the optimal locations for new clinics.

Disney: In line with [North Star] focus to bring high quality health services to hard-to-reach populations, we are involved in a large number of projects across the continent of Africa. We are continuously looking at ways we can bring innovative solutions to provide best practice health services, developing processes so we can further develop these to suit the needs of our clients. We want to ultimately map communicable diseases from their sources – monitor trends, prepare our staff, and educate our clients.

Currently we are about to launch a series of clinics in West Africa, with another partner, that are focusing on educating young girls on reproductive health and we’re piloting the provision of ARV Treatment at our RWCs in South Africa, Zimbabwe and Zambia, with the plans to roll this out throughout our whole network.

We are working with a transport leader to provide a health solution that both services their employees, as well as the local community. We’re also currently piloting an innovative truck driver health program developed specifically to meet their needs and interests. This program brings health and recognition together, acknowledging the important work that is done by truck drivers, motivating them to alter their health seeking behavior.

Throughout all of our projects, we are implementing COMETS, further driving the reach of the data capabilities, amplifying the data-reading and interpreting possibilities.

Now, let’s talk about the recent Ebola outbreak in West Africa. Unlike previous diseases and outbreaks, the recent Ebola outbreak seems to have taken the international community by surprise with its rapid contagion. Do you see any similarities between Ebola and HIV spread?

Disney: Obviously HIV and Ebola are two very different diseases with different etiologies and different approaches to dealing with them. However, both have highlighted weaknesses in many sub-Saharan African health systems, and the need to build capacity before outbreaks occur and not while they are occurring. This is not the first nor the last outbreak we will see in the region.

The outbreak is also drawing attention to emergency preparedness and response, and long-term plans for health systems strengthening in Africa and other developing countries. Based on your company’s work in the field, what would you suggest to the international community and what should be the short-term and long-term solutions for developing effective healthcare and health systems in Africa?

Disney: A lot of people wiser than us have made recommendations on how to strengthen health systems in sub-Saharan Africa. And there are a lot of dedicated people working incredibly hard across the region to bring about change. However, as the WHO has pointed out in their recent report on the progress towards the Millennium Development Goals and achieving universal access to essential health services; if national governments and the international community were to uphold the commitments they made in terms of health spending and health development assistance it would be sufficient to reach both in 49 of the world’s lowest income countries.

Is multilateral approach one of the solutions?

Disney: Since diseases do not respect national boundaries we have no choice but to adopt a multilateral approach to preparing and responding to epidemics like HIV or Ebola. It requires the buy-in of key stakeholders across the world – at national, private and public levels. Communication is key.

If you were part of the international teams working to find solutions to the outbreak, how would you approach containing the disease and what programmatic solutions should be used now and put in place for future outbreak of any disease in Africa?

Disney: We are not experts in the field of emergency response, [however] for our part, we are doing what we can to inform our clients about Ebola and to make sure that all our staff are adequately trained and equipped to respond to any suspected cases they may encounter.

Interview conducted and Edited by Kemi Osukoya

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