How Government and Healthtech Partnerships Are Digitally Transforming Healthcare Supply Chains in Africa With Yomi Kazeem and Jessica Vernon

[00:00:00] You're listening to the Unlocking Africa podcast. I'm a medical doctor by training and first started working in East Africa about 13 years ago in a small part of Western Kenya. Over the past few years, we've produced comprehensive reports

[00:00:14] taking deeper looks at the ecosystem of supply chain innovations that aren't technology enabled. In many of these health systems, the same pharmacist is actually working in the public and private sector and so they are using tools and resources in the private sector that

[00:00:29] they also want to be able to adopt in the public health system. What we predict over the next few years will be increased collaboration really as companies look to work with each other better and measure with others as well.

[00:00:41] Stay tuned as we bring you inspiring people who are unlocking Africa's economic potential. You're listening to the Unlocking Africa podcast with your host Tessa Adamu. Welcome to the Unlocking Africa podcast where we find inspirational people who are doing inspirational things to unlock Africa's economic potential.

[00:01:06] Today, we have Yomi Kazim from Salient Advisory which is a healthcare consulting company that tracks innovations in African health tech and we also have Jessica Vernon, CEO and founder of MyShamed which is a company that has created the first and largest network of private pharmacies

[00:01:28] and clinics in East Africa. Welcome, welcome, welcome to the podcast, Yomi and Jessica, how are you? Doing good. Thank you very much for having us. Yeah, yeah, just wanted to echo that. Thanks for having us.

[00:01:40] It's a pleasure. I usually like to start from the beginning so I'll go with you first, Jessica and tell us a bit more about Jessica Vernon. Sure, yeah. Thanks so much for having me. It's very exciting to speak with you.

[00:01:52] My background is medicine and economics. I'm a medical doctor by training and first started working in East Africa about 13 years ago at this point. And in a small part of Western Kenya, started seeing how pharmacies supported

[00:02:06] the public health system by supporting patients to access care when there were stockouts in the public health system and became really interested in that problem. And we spent about the past six years building a company to solve that. So I'm very excited to share more. Fantastic and Yomi?

[00:02:23] So I'm Yomi Kazim. I'm an engagement manager, a selling advisory and essentially sitting as a healthcare consultant for when we focus on helping global stakeholders and change makers better understand the biggest trends in African health technology systems by producing intelligence and then also

[00:02:39] convening partnerships. And so my work essentially lies in the segment of producing intelligence. I lead our work to produce and deliver marketing intelligence on an ongoing annual basis. And over the past few years, we've produced comprehensive reports essentially taking deeper looks at the ecosystem of supply chain innovations

[00:02:59] that are technology enabled and are supporting both private of course and more importantly public health supply chains as well. Essentially to deliver a future, both the present and future should say where medicines and health products are more easily accessible or more safely

[00:03:18] accessible and also more conveniently accessible. The ultimate bottom line here essentially is that these innovations like Jessica's Mashemet are creating a present and future where regular Africans, our family members, our friends, our loved ones have safer

[00:03:34] access to health products and it's hard to overstate the impact of what that means. Thank you for that, Yomi. So Jessica, in your introduction, you gave us a brief background into your medical background and also an overview of Mashemet. So I was hoping you could

[00:03:51] go into a bit more detail regarding Mashemet in terms of the company, the work that you're currently doing in East Africa? Sure. And we work in East Africa, but we also have expanded

[00:04:03] to both Nigerian and Zambia in recent years. So we started out with this question around how to best support private pharmacies and clinics to help them build their business. So we started off with business management tools based on the feedback from pharmacies

[00:04:18] to say, you know, how can we help them better understand their sales profitability, manage their inventory better and do this in an offline digital first way that would help them meet them where they were at that last mile. A few years ago then, we started thinking about

[00:04:35] what we actually wanted to do to support patient care. And as we were digging in on the data on how pharmacies were supporting patients, we're finding that there were very clear instances where patients were accessing care based on what they could afford rather than what they needed.

[00:04:52] They were paying almost entirely out of pocket for their primary health care and as a result, they weren't purchasing things like malaria rapid tests, longer acting emergency contraceptives, the right sort of non-communicable disease care. And so we started thinking about

[00:05:06] how we could kind of do small financial nudges to help them access the care they actually needed. So started with malaria testing before treatment. If you bring the cost of the test down, you can actually make sure that patients are accessing testing before treatment on a much

[00:05:25] more significant scale. So about 300% increase in uptake and this has proven true for other disease areas as well. So over the last couple of years, we've received scale funding to support currently we're at 2800 pharmacies and clinics across the region. The goal next year is to

[00:05:41] support about 5000 and in the next several years go to about 10,000 pharmacies and clinics. We have funding to support over a million patients with this way of accessing care. And the goal is to make this just standard of care across the region.

[00:05:54] Fantastic. So you kind of detailed the work that you do in terms of supporting private pharmacies and clinics, are we know that salient advisory works consulting and tracking innovations in African health tech. So people might be wondering what is the link between the two companies?

[00:06:14] So can you elaborate in terms of how the two organizations have come together and all work them together? Sure. Essentially, as I said earlier, our focus is on tracking leading innovators in this space that are leveraging technology to ensure that supply chains of

[00:06:31] health products are more efficient and consistently over the past few years. My shaman has featured strongly in that work because as Jessica says, there's such a strong point at space 2800 pharmacies already. It's one of the largest networks that we

[00:06:44] are aware of, if not the largest. And so our work really is first presenting intelligence that highlights the broad work that's ongoing and then going further to spotlight some of the standout leading innovators to ensure that they essentially get access to a network of

[00:07:02] donors, of investors, of stakeholders that essentially have the power to make the decisions that could empower their skill. So essentially think of us as producers of intelligence at the first level and then at a secondary level, advocates of innovators in this

[00:07:18] space. Looking beyond my shabeds, our work in the most recent report highlighted the fact that on the pan-African basis or the pan-African level, there are at least 350 innovators that are digitizing health supply chains across the continent, spread across 27 countries in

[00:07:35] Africa. Of course, there's a high concentration in key markets like Nigeria, Kenya, each of us South Africa. And that essentially mirrors what you see when you do rather micro-analysis of health technology ecosystems or other technology ecosystems across the continent. So it's not

[00:07:51] that much of a surprise, but it's super interesting to see that there's nearly 350 companies out there doing great work to ensure that health supply chains eventually become safer, more efficient and faster. And Mashin-Bets stand out strongly as one of the leading ones.

[00:08:07] Really quickly, the one thing I would add on that is when we first started out, private sector was not seen as an area that public health could invest in and focus on. And I think salient has done an incredible job of building private sector healthcare as a category

[00:08:19] that is of interest to governments, global health funders and others as a way to reach patients where they are and to ensure that there's kind of interesting debates about how to improve access and funding through private sector. So I've just been incredibly impressed with

[00:08:33] salient's work over the last few years. Brilliant. So Yami, you've mentioned that your work is presenting intelligence. So what is the motivation to focus on the innovations in health product distribution in Africa, particularly concerning governments?

[00:08:50] Well, as Jessica just said, the reality is a few years ago, the private sector wasn't seen as a potential everyone strong enough partner. And so our work focused on in this segment of health technologies, ecosystems was essentially to do two things. First, to meet the demand

[00:09:06] from stakeholders out there who saw the need rightfully to understand this space much better than they already did. And then this was initially triggered about five years ago when we did the first exploration of this work. And then we slowly built on that,

[00:09:19] producing about four reports in the past five to six years, all focused in different ways on this space and incrementally building on the awareness and advancing understanding of these stakeholders outlook of the space. And on the other hand, it also gives you a strong passion

[00:09:38] to meet this demand wherever it is, but also build on that to essentially advance global conversations about leading health innovators on the continent. The hypothesis is that there are so many exciting new models that are out there that are looking to do things

[00:09:53] in a much different way that has been done across the continent historically. The private sector as far as health is concerned has typically been, I want to say overlooked or seen as more directional. But as we see this exciting wave of technology startups across the

[00:10:09] continent, across various sectors, there isn't as much as a focus on health as there should be. Of course, a lot of great amazing things that happen in these sectors like financial services, I mean sectors like education, but also in health, we see new models springing up and

[00:10:26] it's our job to ensure that the intelligence that helps to understand these new models are out there and also it's our job to continue to advocate for these new models as well.

[00:10:36] And one of the ways to highlight how we go one step further in our focus is two years ago, we produced the third iteration of this work. One of our recommendations was essentially to say that we see gaps in funding African led innovators and then also as well,

[00:10:52] woman led innovators seem to be on the lowest spectrum as far as funding is concerned, as far as the flow of venture capital equity grants and deaf funding is concerned. And if that reality was allowed to possess then we could have a situation where these innovators are

[00:11:08] essentially not as funded as they should be resulting in a widening chasm in these ecosystems. And so building on that recommendation, we advocated to global donors, a global industry essentially to design a program that allows them to create targeted grants that provide these

[00:11:27] innovations with the funding that they require, but then one step further to attempt to catalyze their skill by looking to accelerate partnerships between them and governments between them and key industry players between them and donors. And that recommendation and that

[00:11:42] program design eventually evolved into what is today known as the investing in innovation program, which is essentially a program that over the past two years has invested in 60 outstanding supply chain startups across the continent all doing great work, providing them with

[00:11:58] risk tolerant grant funding on one hand. But then more importantly also facilitating access to markets for them by convening donors at the highest of levels regional national and also of course global leadership players at the highest of levels and also government actors

[00:12:13] as well, bringing them in the same way with these innovators, having partnerships meeting with them over an accelerated period of two to three days in select countries and essentially just having them speak with each other, engage with each other and proverbially saw the seeds

[00:12:28] of potential partnerships. It's a work that we're really, really excited about and it's just that highlights the link that exists between our work to produce intelligence and our work to advocate for the largest companies in this space.

[00:12:39] Fantastic. So you shared a specific example with regards to or highlights the successful impact of government partnerships with health tech platforms in Africa. With regard to that, in terms of this partnership, there are some challenges that might be faced.

[00:12:56] One of the challenges is the supply chain. So if it could be more specific with regards to what challenges do you think are faced by African health supply chains prior to the advent of these digital solutions and partnerships? Well, the challenges are pretty well documented

[00:13:15] actually. So essentially it's been an ongoing reality where public health supply chains are typically overburden and we saw that most recently and most significantly during the pandemic where essentially there were gaps and there were lags in getting important PPE materials,

[00:13:34] important health products across to points of need. And so historically public health supply chains across the continent have to be really been overburdened, essentially not being able to serve the entire capacity of demand that exists as it were. Now, private health supply chains

[00:13:50] have also long existed in parallel with public health supply chains. The problem, however, is that those have also been fragmented. And so essentially what exists is you have this multiple layers across the supply chain to the point where medicines are imported or manufactured

[00:14:07] and then the point where they are dispensed to the end consumer. The network effect of having so many layers in the supply chain is that as products pass through these several layers, first it drives an increasing price. There's research out there to suggest that you can drive

[00:14:23] prices up by as much as 60%. That of course has an impact on equity and affordability. These prices are recently added on to with markups at ETC as products pass across the supply chain.

[00:14:34] It means that at the end of the day, a low income earner in the setting part of Nigeria or Kenya, for example, is likely unable to afford that medicine as they typically should. Another effect of course is the impact it has on availability. Again, so much fragmentation

[00:14:49] across the supply chain means that at a retail pharmacy where a drug should be available and where somebody has got a critical need and needs to access that medicine or health product,

[00:14:58] it probably might not be available. And then the third is that it also has an impact on quality as well. One of the well documented problems with African health supply chains is the fact that

[00:15:10] there is I don't want to say influx but the stark reality is there's quite an abundance of fake and substandard medicines. According to WHO across the continent, I believe the average is way above the 10% global average in terms of the availability of fake and substandard health products.

[00:15:27] And so what we are saying is this emerging crop essentially of tech and involved innovations like my show beds, like the nearly 350 innovations that we also referenced in our reports that are leveraging technology to do a bunch of things essentially ensure that there's more

[00:15:43] direct access to health products by the end user via pharmacies, via clinics, via hospitals as it were, ensuring that there's more convenient access as well by I say online pharmacies that allow individuals to simply go on their mobile phones or their computers or

[00:15:59] internet connection devices, find an order of medicines that they need at critical points of need and receive them at a more accelerated pace than compared to previous years. And there are also technologies out there that are essentially building solutions to protect

[00:16:15] and track movement of products across supply chains. And when you put all of this together, you know, as I said earlier on, we then have a reality where these innovations are working hand in hand, sometimes in collaboration, you know, other times in isolation, but collectively

[00:16:29] working hand in hand to build both the present and the future where these supply chains that have typically been overburdened that have typically been fragmented, essentially become better optimized, become more efficient, result in a reality where

[00:16:42] that Louisville, Knoerner in Kenya or Nigeria or Uganda has faster access to the chase medicines when they need them. A greater level of availability of medicines at their local pharmacies, at local hospitals or clinics and also unknown to those residents also a greater assurance

[00:17:01] of the quality of those medicines because what you have digital infrastructure that connects a pharmacy, for example, directly to a manufacturer of a medicine or an accurate distribution of that medicine, essentially reduces the chances of, you know, fake and

[00:17:17] substandard products making their way into health supply chains on the floor of products across those supply chains. It's an amazing reality to be on the front foot of observing and on the front foot of building research and sharing with the world.

[00:17:30] Yeah. So maybe we can take this in a different direction. So you mentioned direct and faster access. I know the report mentions that government partnerships have led to the democratization of digital orders. So how is this democratization positively influenced healthcare access specifically

[00:17:48] in rural areas? I can speak to this. So we actually work with governments in several countries and in Kenya in particular, we spend a lot of time with the county government. So in Kenya, because of devolution and how healthcare is financed, the counties are actually the

[00:18:03] primary entity that is thinking about healthcare and budgeting for healthcare. And then they're working with the central government to then be doing some of their procurement and planning. So we work with several counties at this point that use our platform for managing all their

[00:18:17] stock at the last mile in their health centers and dispensaries. So they are able to log in at a central level and be able to see in every facility that they have, how much they have in

[00:18:28] stock, what is expiring, what is low in stock, what do they need to reorder. And one of the things that we found really interesting as we've been starting to expand this further is that the

[00:18:38] groups that are interested in this are actually the governors and the politicians within each county, not necessarily like it's also of interest to the to the groups that are within the ministry of health. But the groups really advocating for it are the governor's groups because they keep

[00:18:52] hearing from their constituents that there's no medicine in stock. And so if they're able to add that layer of accountability and understanding about, you know, when is that happening and why is it happening, they're able to then help influence and change those systems. So it's

[00:19:06] been a really powerful learning for us. And then I think the second learning is that in many of these health systems, the same pharmacist is actually working in the public and private sector. And so they're usually using tools and resources in the private sector

[00:19:19] that they also want to be able to adopt in the public health system. And so being able to give them those same tools and ways of being more efficient is actually a huge opportunity and a

[00:19:29] huge way of kind of introducing innovation within the health system. Thank you for that, Jessica. So if we go back to you, Yomi, I know from reading the report, there's a section in it that discusses

[00:19:40] a decline in terms of new entrance from 2021 through to 2022. From your perspective, what factors do you think contributed to this decline? And how do you think it would kind of impact or change a future landscape of healthcare, supply chain innovation in Africa? Right. So I think the

[00:20:01] important context to say here before talking about the decline is the boom that we first saw. You know, that boom came across 2020. In my research on my research that happened post 2020, we've consistently seen that there was a spike in 2020 driven by the pandemic. That's

[00:20:20] the big obvious reason, a spike in terms of the number of digital health innovations that essentially were founded or came into the market, you know, in that year. And so 2020 has constantly stood out as the year in which the highest number of new innovations enter

[00:20:37] the market. Right? So if you look at the line chart, for example, what you should envision is essentially a line that's close to the bottom of the lower axis that's almost flat with it from

[00:20:46] the 90s, starts to pick up in the mid-2010s, super high spike in 2020 and then sort of a deeper afterwards. And so, you know, that context, that background for why that spike happens, which is the pandemic is really useful information because essentially what they'd

[00:21:02] highlight and what it suggests is the reality is that after the pandemic, what we're seeing is this decline and the number of new market entrants that are coming into space. And I think that,

[00:21:13] you know, it follows logic really to start with that during the pandemic. A lot of innovations were inspired to launch these solutions seem very clearly and starkly the crisis of need that existed, not just with supply chain innovations, I should say with,

[00:21:28] you know, also innovations that enable greater access to consultations, for example, greater access to diagnostics, possibly even remotely at home beyond supply chains. So this spike was also noted across all the sectors as well. And so post the pandemic,

[00:21:42] what we're seeing could be due to a lot of different reasons. First, it could be the fact that there is a saturation of companies providing similar solutions, giving the fact that a significant number of them came into the market around the same time. And now,

[00:21:53] while the market is broad as it is, there's still a saturation of companies that are similarly looking to do the same things. The second could be the fact that during the pandemic, sort of super high demand for digital first products, that is, you know,

[00:22:06] products that enabled remote access. But after the pandemic, that has likely declined as well as far as that need for digital first products goes. There's sort of like a reversion to the mean where it's not to say that there's no longer my first products is that, you know,

[00:22:22] people can leave their houses now. And so that need that stock needs for digital only products are sort of reduced and in most cases is now a balance. And then also as well, another

[00:22:31] fact that we're seeing is that in some cases, incubants in this space are now adapted to provide consumers with services that are essentially similar to what the startups offer. A great example here

[00:22:45] are traditional pharmacies and online pharmacies. And so in 2020, we saw a spike in the number of online pharmacies that came into the market. And all I'm saying is to define it very simply essentially is a digital tunnel on online tunnel that allows individuals to purchase

[00:22:58] medicines online, right? Order it online and have it delivered right to your doorstep. Versus a traditional pharmacy, which is a physical outlet where you have to walk to look through the shelves, pick up a medicine and then take that home and use it.

[00:23:10] What we're saying is that a number of the major traditional detail chain pharmacies that are based on the continent some for multiple decades and now adapting to new market realities of building digital channels on top of course of their traditional retail chains,

[00:23:26] essentially to offer services that are similar to what an online pharmacy would provide. And so it's possible that a player who's considering getting into the space with an online pharmacy, so for example, that isn't that much different from what Craig did.

[00:23:40] It's this first sees the fact that there's a saturation of several other online pharmacies and then more importantly sees as well these larger cubans that are pretty likely much better capitalized also have greater brand name and brand recall

[00:23:52] adapting to provide a similar service and that could be seen now as a deterrent or a deterring factor. And this is applied just on the continent. In our report we cited that this is a trend or phenomenon that we're seeing in other markets as well. In the US,

[00:24:05] companies like CVS and Walgreens, the looking to replicate features offered by digital first and the invaders as well. So it's a combination of several of these factors. Now what we predict over the next few years could be increased collaboration really

[00:24:19] as companies essentially look to work with each other better, partner with each other. In some cases, some better funded companies or better great companies could look to acquire and measure with others as well. So it's an interesting time to look to what the effects

[00:24:35] really of this slowdown could be. The slowdown itself isn't necessarily a bad thing. It doesn't mean that we're not seeing innovation still happening in space. There's still a lot of innovation happening in space. It's just one of the characteristics really

[00:24:49] of the evolution of an ecosystem that's still in its early days. The more interesting periods definitely still lie ahead of us. Yes. So rightly so, you mentioned there was a boom in 2020 due to the pandemic decline 2021 to 2022. We're coming to the end of 2023. So what does

[00:25:07] 2023 look like from your perspective with regards to the number of new entrants in the space? So as far as numbers go, since 2021 to 2022 we've seen nearly a 90% drop as far as new innovations that come into the space have concerned. This year, as far as our research

[00:25:27] goes, so we completed our research towards the first quarter or early seventh quarter of the year. So we're inaccurate to speak to the entirety of the whole year. As we continue to do this research

[00:25:38] in coming years, perhaps you can be better positioned to reflect on 2020 as a whole and provide an information. I just want to say to anybody who's out there listening to this, don't take the wrong message from this. It's not to say that you shouldn't relaunch your innovation

[00:25:52] because we've seen these slowdowns. If anything, now is probably the time to launch your innovation, especially if you can differentiate yourself appropriately in the market space. Yeah, I think the one thing that I would add on that is the macroeconomic environment, the increase

[00:26:05] in interest rates has just affected the startup ecosystem globally in many, many ways. And I think this is just also a reflection of that. I think that many of the larger groups that have raised

[00:26:16] quite a bit of money at very high valuations are having trouble exiting now. We're thinking through what the next step is for them. And I think that there is going to be adjustment as a

[00:26:24] result of that. I think the next phase of people entering the market in 2024 and beyond, everybody from investors down to the innovators themselves are going to be much more careful with how to think about fundraising to make sure they're not pricing themselves out of a potential

[00:26:38] exit for this. And so hopefully there's going to be more partnership on how to do that thoughtfully. Thank you for that, Jessica. So if we stick on the theme of the innovators that are in the

[00:26:48] space, we know from the report that many innovators are focused on data analytics within the healthcare supply chain. So from your perspective and from the work that you're doing, Jessica, how do you feel these analytics contribute to improving the efficiency and effectiveness

[00:27:05] of supply chain processes? Yeah, great question. And we've been very lucky within our team to have the person building our healthcare analytics work be the person who built IQVIA's business in East Africa. So he has years of experience building healthcare. IQVIA is one of the largest

[00:27:22] healthcare analytics companies globally. And so he's kind of taken some of that knowledge and then applied it to how we are providing our offerings and thinking about building them. I mean, there's just a dearth of supply chain analytics and understanding more generally. And so

[00:27:36] I think a lot of the work that we're seeing now is just learning more about the sector, learning what products are actually selling, what the price points are, what the margins are, and being able to have that very detailed information to help do planning for the future.

[00:27:49] There is definitely an interest in forecasting, but I think the forecasting is still very focused on public sector and using those public sector supply chains. I think the stronger interest right now is actually in thinking about new product launches and thinking through what

[00:28:01] products should be introduced and registered in individual countries based on what else is doing well in those countries. And so a great example is our analytics team has just finished some work looking at emergency contraceptives and actually showing the kind of a global

[00:28:15] group of people focused on emergency contraceptives that they had underestimated the total market size across Africa by, I forget the number, it's like 100x or 1000x, something just kind of absurdly large. And so as a result, it's changed their strategy in terms of

[00:28:29] how they're thinking about re-registering emergency contraceptives as a periquital method. So before or after sex and thinking through kind of guidelines changes within the WHO. So I think those are the highest yield instances we've seen, but I think there's also

[00:28:45] the ability to have that visibility at the last mile unlocks all sorts of decision making power throughout the supply chain. Thank you for that Jessica. So if we stick on the theme of the

[00:28:54] data and the analytics, I know there is generally a challenge in terms of collecting reliable, usable timely data on the continent. So how have you guys gone about navigating that challenge of collecting the data, ensuring that it is usable and to enable with your processes

[00:29:14] as an organization? Yes, we've built it into every part of our operation. The point of sale platform that we've developed that's in 2800 pharmacies and clinics currently captures information on every single sale in terms of including the pricing, the brand, how much is

[00:29:31] in stock and who the supplier was. And we're able to use that to provide really interesting specific trends on the last mile. We've found that it's most powerful when it's paired with additional information on market level intelligence. So you need to also,

[00:29:45] in order to understand what's happening in a particular town, and in order to make it especially useful, you have to understand how much that particular town or that particular pharmacy's information is representative of something happening at a

[00:29:59] larger scale. So we've needed to also build capabilities and data sets around market level information, and it's by pairing those two that we find the most value. So I'm assuming to enable you to do your work, partnerships and networks are key. So are there any notable partnerships

[00:30:14] that you have engaged in that have enabled you to do some of the great work that you're currently doing? Yeah, wonderful question. I would say governments are the first one. We've been just so impressed by partnerships we built with the National Lariat Control Programmes

[00:30:28] in several countries by the HIV and AIDS programs in those countries as well. And how thoughtful many people within the Ministry of Health are and how to engage private sector and how much that's becoming a core part of what they're thinking about. We have really incredible

[00:30:43] partners within the global health space, so working with the Gates Foundation, USA Development Innovation Ventures and others to think about how to scale these technologies. And there's a lot of things that are operating at a very early stage, but they've helped us think

[00:30:57] through what national level scale looks like and helped us to have that ambition, which has been really neat to see. And then finally, as we think about scaling, the goal is to work through partners that already have networks. So wholesalers,

[00:31:10] pharmaceutical associations, governments and others to NGOs sometimes also have very strong networks. So leverage their capabilities to both be able to expand our data capabilities network, but then feed that data back to them to help them be better at what they do

[00:31:28] has been a really important learning as well. Brilliant. So you mentioned that governments are key partners. So I guess with governments leading the way in partnerships, do you think are there any notable hurdles that might be faced trying to scale these public sectoral government

[00:31:44] type partnerships? The main one we're encountering all the time right now is just the fiscal position of many of these governments. It's been an especially hard couple of years with currency depreciations and a lot of them are just working with a lot less money than they had

[00:31:58] a couple of years ago. And so they're trying to figure out how to do more with less. And oftentimes the things that get cut first or the things that don't get budget first are the

[00:32:07] ones that are newer novel and haven't been proven yet. And so I think they're struggling to figure out how to amply resource these sorts of things and make sure that they're thinking for the future as well. So yeah, so that's been the primary one for us.

[00:32:20] Earlier on, Jessica, you mentioned that you have a presence in quite a number of African countries or markets. So are there any specific countries where you've seen government partnerships have had significant effect in terms of transforming health supply chains?

[00:32:40] Yes. So we have core operations in Kenya, Tanzania, Uganda and Nigeria. And in three of those countries, we have actually started working directly with the government on their malaria programs and have been really impressed by how data driven and thoughtful they all are

[00:32:56] in how to build these programs for private sector. But I think the stand out for me is Uganda, the National Lariat Control Program there is starting to face resistance to many of its anti-malarials or the primary anti-malarial that's used across the region

[00:33:11] to the rapid tests that's commonly available and then also to the bed nets. So it's a tough time and tough set of problems to be thinking about. And they've just been doing it with this very thoughtful, very data driven way of targeting specific interventions to certain regions,

[00:33:26] doing a lot of experimentation and kind of meeting the partners where they are in terms of what they're able to offer for some of these solutions. So I've learned an incredible amount just watching them in action. I've been very impressed.

[00:33:38] So from the Uganda example, which is a great example, what lessons do you think over African governments can learn from this positive example? I think the first one is many governments try to always resource public sector first because there is a shortage of resources and generally

[00:33:56] there's not enough to go around. And so they try to put the funds and put the focus on the things that they're most able to control. But I think that by being able to use a small

[00:34:06] amount of additional funding that is effectively just leveraged to run experimental programs and think about how to influence private sector, you have the ability to actually, instead of incremental improvements in health systems, like exponential at that stage, they're just at a

[00:34:21] different point in their investment life cycle. And so things like capturing data and then influencing behavior in private sector, many of these groups are actually paying for anti-malarial to be distributed via private sector, but focusing in on resistance. I think that,

[00:34:38] yeah, that's been one of the biggest learnings that I think can be applied elsewhere is that willingness to engage with areas where there might be more impact to be had with smaller amounts

[00:34:47] of money. Fantastic. Thank you for that, Jessica. So Yomi, I guess back to you in terms of the insight that you gather and collect in the reports that you generate. If we look at the innovation within Africa, we know that there are some key markets where we are

[00:35:05] seeing huge numbers of innovators in, say, tech startups, primarily Nigeria, Kenya, South Africa and Egypt. Are you seeing a high concentration of innovation in the healthcare supply chain space in those markets? Or is the decentralization we're seeing innovation spread across the continent?

[00:35:26] Right now it's more of the forward. So it's a concentration in key markets. Nigeria, South Africa, Kenya, Egypt, and Cal 4, about 60% of all of the innovations that we tracked across the continent. In total, we're at inside innovations in about 27 African countries in total, but

[00:35:44] 60% of them, as I say, are concentrated in justice for markets. One of the segments that often tends to get overlooked or perhaps under discussed is Francophone Africa. We also have some data and insights on that as well. So 12% of the companies that we tracked are headquartered

[00:35:59] in Francophone African markets. So think markets like Cote d'Ivoire, Cameroon, Democratic Republic of Congo, and Seneca as well. About 90% in total of all these companies that we tracked are headquartered on the continent. But then we've got about 10%

[00:36:14] that are headquartered outside of the continent, but of course, maintain operations within Africa. So these companies are headquartered around North America, around Europe and around Asia. One thing that's interesting to note and mention though is what we're seeing in terms of companies

[00:36:30] operating in more than one country. So Maestro Mace is a fantastic example of a company that's been able to start from one market, test that model, so you find that model and then expand to other markets. As Jessica said, they're not just in Kenya

[00:36:43] but also in Nigeria and Uganda as well. But that's just not yet commonplace, which is something to expect with an ecosystem that still needs NACS. So around 80% of all the companies that we tracked

[00:36:54] essentially still operates in a single country. And as I said, operating in more than one country essentially is currently limited by the fact that the ecosystem is still NACS. I love the companies that we track in this ecosystem are still NACS. But another key thing to add as

[00:37:07] well is a limitation as far as multi-country regulatory environments are. In some cases, these environments are uncertain for some of these models. Regulatory timelines don't yet exist, so it makes expansion somewhat of a tricky subject. So the reality is the majority of

[00:37:24] these companies are probably not in a position to expand. But as they increasingly grow and get ready to be useful governments, they'll also start to think in advance about updating or adapting their regulatory environment to essentially foster more innovation that allows

[00:37:37] some of these companies grow within their countries or come into their countries with expansion from other markets where they already operate. Thank you for that. So Jessica, you mentioned the challenges faced by startups or innovators in terms of expanding to new African markets. So

[00:37:53] from your experience, you operated a number of African markets. What have been the challenges that you faced trying to expand into new markets? So first of all, I think for many

[00:38:04] companies it's wise to be fully focused on one market. I think the thing that has enabled us or pushed us to be expanding to many is that much of our core business is data analytics focused.

[00:38:14] And until we are building reimbursement programs for patients, it's actually very light touch and just tech enabled. And so we have the ability to adapt a tech to many different contexts without having to support warehouses or other things that many of these other innovators are

[00:38:30] focused on. So wanting to have information about as many markets as possible at as large of a scale as possible, and then wanting to think through what are the common pieces of functionality has been the reason that we've pushed into many of these different markets.

[00:38:43] In terms of challenges, it's many. I think the biggest learning is just when you add a country, each time it's going to get easier and it almost feels like it gets harder or it's equally hard each time because there's just many compliance regulatory finance

[00:38:57] related things that are just challenging to do. And the costs don't necessarily scale in the way that you think they will. So oftentimes you have to build the same components in new markets. I would say the second piece is just making sure we're really

[00:39:12] understanding each local market. You kind of assume that they're similar, but actually they're quite different in their needs and in the competitive landscape in many places. And so there's been a lot of product changes that are needed when we enter particular new countries.

[00:39:27] And then I think the other challenge is just thinking through what the right kind of regional approaches and how to build a team that feels integrated across these countries instead of feeling like they're silos and that each individual team is building their own culture.

[00:39:42] Thank you for that. So what role do you say government policy plays in terms of encouraging innovation and also expansion? I mean it can play both sides. It's sometimes it encourages and sometimes it discourages. I think in terms of encouragement, the more

[00:39:59] there are streamlined policies around how innovators can expand and there's encouragement from individuals within governments that are inviting people are enthusiastic about particular things that are what really drives that push forward in terms of expansion. In order to start in a

[00:40:13] new region or a new country, there's often just this very long checklist of things that must be complied with. And so I think being able to streamline some of that and maybe make

[00:40:22] it easier for innovators to kind of move through those processes would be an important step towards encouraging further expansion. Thank you for that, Jessica. So Yomi, in light of your findings in terms of your report, what policy recommendations would you make to governments to fair to

[00:40:38] promote and sustain these digital innovations and health supply chains? That's a great question and also asked very recently. It was at the Global Health Supply Chain Conference under the future of global donors, also government officials from the host country of Kenya.

[00:40:55] And I said at the time, which is an asset I'll share again that I really do think it's a simple equation as far as a policy recommendation for countries as goes. For countries that want to see more innovation in not just health product distribution but also health innovation

[00:41:10] quality. For countries that want to see more innovation, one simple but big step they've got to take is creating a regulatory environment that allows those innovations to thrive. First to emerge and then second to thrive. So to my mind, it's a pretty simple equation.

[00:41:25] For countries that are intentional about creating these regulatory environments over the next decades to come, there will be significant benefits because the reality is while of course, taking care of health is one of the government's key jobs as far as creating infrastructure is

[00:41:42] concerned, there's a thriving private sector as well as far as providing health care is concerned. And the abundance of innovators that are doing the work to create the solutions that ensure that healthcare access is more reliable, it's safer, that access to health products is more

[00:41:58] efficient, more reliable, it's also safer as well. The abundance of those invisions that exist can only ever be a good thing. And one example that I shared is a few years ago when on-mand aerial vehicles essentially were first prototyped as potential tool to distribute medicines on the

[00:42:14] continent, there was some pushback from some quarters while in other quarters there was a bit of an embrace of this new technology. And so in certain countries on the continent, these innovations were allowed to essentially test their models, allowed to

[00:42:29] fine-tune these models and then allowed to launch these models on a larger scale. And in markets where these innovations were first accepted, we now see that there's a much larger uptake as far as leveraging drones to deliver medicines is concerned. Whereas in markets

[00:42:45] where there wasn't that initial embrace, where there was perhaps a bit of trepidation, those markets essentially are now playing catch up. And so that dynamic is essentially the question that exists to my mind. Countries that want to see more innovation first have to create

[00:42:59] the regulatory environment that allow these innovations to emerge and then to thrive. The more innovations emerge and thrive, the more access people in those countries are likely to have and most significantly, the more innovations that emerge and thrive, the more potential

[00:43:13] partners the government has to work with to optimize public health systems, to optimize public health supply chains and ultimately to advance public health outcomes. Fantastic, I like that. So creating an environment to allow innovators to emerge and thrive also creates

[00:43:32] resilience. Could you share some best practices or trends that you're potentially seeing? Absolutely. So one of the best examples really is to think about online pharmacies as a market segment. In our work, we identify online pharmacies as one of the most common types of models

[00:43:51] out there in operation. In the market segment that would classify as direct distribution to consumers, there are nearly 200 innovators in there with the majority of them essentially, that individuals can essentially purchase medicines directly from them. So that's

[00:44:04] essentially an online pharmacy model in a snapshot. The reality is even though these are the most common types of models out there across the continent, the majority of countries do not yet have regulatory guidelines or even establish regulations to guide online pharmacy

[00:44:21] operations. What we currently have is a reality where a lot of these online pharmacies operate across markets on the continent are essentially operating in this weird gray area where there's no regulatory guideline to guide how they operate yet. In several countries,

[00:44:36] this discussion is ongoing in terms of creating this guideline in the handful of countries guidelines already exist. But the reality, as I say, is that irony where this is the most common model we're saying across the continent, across the majority of countries, guidelines to regulate how this model

[00:44:52] operate don't currently exist. It's that classic case of regulation, catch up to innovation. And so think of it as a low hanging fruit really. Of course, there are multiple ways to uncreate what you know of any literally change environments. But just looking at that segment

[00:45:06] of online pharmacies, it's urgent really for governments across the continent to think deeply and also to think more nimbly about approaching creating guidelines that allow online pharmacies or that to guide the operations of online pharmacies. The argument for us is not

[00:45:23] allow every single online pharmacy that exists to operate. The argument is creates the guidelines that essentially guide how the operates to ensure that good faith actors can thrive and ensure that bad faith actors do not. A great example of a best practice is what we're saying in Ghana

[00:45:40] where there's a national electronic e-pharmacy platform, essentially what they're doing or what they're looking to do, since this is fairly new and was launched earlier this year, is aim to centralize in one key national hub the operations of online pharmacies. And so

[00:45:54] the idea is, does this central hub that's operated by the government that allows them to have both sides as far as transactions with online pharmacies, between online pharmacies and the general public goes. And so they've got this high level bird's eye view of all that's happening

[00:46:07] in there, online pharmacies have to register with the government that can transact through this platform. And that just two things. It creates this safe medium through which members of the public can access health products and health services provided by

[00:46:19] these online pharmacies. And it also allows the government to maintain a keen eye on ensuring that these transactions essentially are fostering and advancing safety of the public and that bad faith actors will potentially sell in fake medicines cannot operate at all in this

[00:46:35] space. It might not be an example that translates to every single country, but that's one approach that they're testing and taking right now. And we're super interested in seeing how that evolves in the coming years. Thank you. So you've highlighted some key trends that

[00:46:47] you're seeing. So if we move from the current trends to the future, how would you foresee the future of healthcare supply chain innovation in Africa evolving over the coming years?

[00:47:00] Well, I'm going to share a hopeful picture. The hope is if we look to do this work in another decade, the hope is that first for starters, we see a more path African spread. I'll work this

[00:47:10] year. We saw positively, you know, innovations across seven countries will like to see that reflect a bit more the reality that there are 54 countries across the continent in swaths of the continent. So as we just are concerned, where there are noticeably white spots as far as

[00:47:27] I would say missing innovation is concerned because it could be that even without research in our landscaping, we miss some of these innovations. But I'll say we see more prominence in those regions. So Franco for in Africa, Northern Africa, for example, another thing

[00:47:41] we'd like to see as well is more equity in bees in this ecosystem. Jessica is such a voice in this space. And she's a model of a company or innovation that led by a couple of

[00:47:52] men founder. The reality though is across this ecosystem, we don't see yet enough equity as far as supporting the founders is concerned. Right now, as far as the landscape goes, what our data reflects is that women founders seemingly have a greater reliance on grants and debt compared

[00:48:09] to equity. So just think that there's still a measure of bias or gaps in terms of how equity flows into the space. We'd love to see more equity along those lines. Another hopeful high

[00:48:23] point as well is seeing a lot more, not just a lot more partnerships between governments, but deeper partnerships with governments right now of the realities of other partnerships that exist. Very exciting, very promising, but are still in the early days. I would like to see,

[00:48:39] you know, in the decade, for example, where these partnerships are ingrained to serve two purposes. The first is to ensure that on the one hand for the innovators that have these partnerships, they constantly have a significant large public portrayal in the government. Having, you know,

[00:48:55] being able to serve large public portrayals is one path with a skill for these innovators. And of course, the second is that governments can then translate the benefits of the models of these innovators to a wider and broader public to ensure that, you know,

[00:49:09] the public benefits from positive, you know, impact and benefits that these, that the models of these innovators have to offer. So yeah, I'm one of the African spread seeing a vision of what countries more like to the ecosystem, more so for women founders

[00:49:23] and more and people government partnerships. That's my hopeful picture of the future. Fantastic. That's a great picture and something I look forward to seeing happening. So Jessica, if we go back to yourself, where do you see my shimmy and yourself in five years time?

[00:49:41] What impact or work will you be doing in Africa's healthcare space? Great question. So the name of the game for us right now is scale. So in five years, I would hope to see us in 10 to 20,000 health facilities across five to six countries in Africa and be

[00:49:57] supporting millions of patients every year to access like all of the areas of primary care that are most needed and least accessible right now. So the focus is on continuing to expand our product base with our reimbursement program, things through new health financing areas to help support

[00:50:12] that and then to continue to scale the platform more generally. Fantastic. Fantastic. As we're coming towards the end of today's conversation, there's a question that I ask each and every guest that's a bit different to the rest of the questions. Quote of the week. As people,

[00:50:28] we often have quotes, mantras, proverbs or affirmations that keep us going when times are challenging or when times are good. Yomi, do you have one that you can share with us today? Wow. Okay. This is a good chance to pretend to be deep. Okay. I'll take it.

[00:50:43] Now I'll be honest. So I don't know that I have one single mantra. My mantras change over time. But one that has been on my mind about the past mother so essentially is life

[00:50:53] is what you make of it. And it applies both at a personal level but also of course, on a broader philosophical level as well. Essentially we're seeing innovators across the continent that are operating sometimes in research constraints, circumstances in markets where data

[00:51:09] isn't exactly as available as they would like. In realities where funding as well is not as available as they would like but yet they're pushing on, they're powering on. They're creating these models that could well define a future generation for and for Africans,

[00:51:24] especially that they're making the most of the circumstances that they have. And so yeah, it really strongly reflects the mantra that has been played over my mind over the past few weeks which is life is exactly what you make of it. These innovators are inspiring.

[00:51:38] Jessica is one of the leading forces of course in this space and it's great to be on the sidelines and also on the front lines helping people understand better what you're doing and then also of course advocating for them to continue doing their amazing work.

[00:51:51] Very true. Jessica, do you have one that you can share with us today? Yes. So the short answer is from Angela Duckworth who's the writer on grits, is enthusiasm is common, endurance is rare. But I think the takeaway for me is a lot of

[00:52:09] our biggest insights and greatest strengths in organization now have come from some of the hardest times that we've had. And in many of those times it's been this question of like, should we keep doing this? Because it is quite hard and especially early on,

[00:52:23] you know, I'm so glad we're through that period but I understand there are so many innovators out there who are wondering whether this is how they're going to spend the next five years, 10 years of their time. And I think it's in those moments when you're asking those

[00:52:34] questions and really drilling down to what's most important that you get the greatest insights that you can then turn into the next phase of the business if you look deep within yourself and kind of have that reflection. I like that. A very fitting quote for a startup founder,

[00:52:48] it is about obviously the early enthusiasm and also the endurance. So yeah, thank you for sharing that. I think we can all agree that Jessica's is much deeper than mine. But I also googled it just now so I just found one. Brilliant. I like that.

[00:53:05] Brilliant. So as we're coming to the closer today's conversation, I was wondering if you had any closing remarks from the course of action for people who are interested in health supply chains in Africa and the great work that you're actually doing

[00:53:19] on the continent as well. What we like to do is spotlight innovators. So I do think strongly that, you know, Jessica was writing the front lines doing this amazing work should have the

[00:53:29] last words. Thank you, Yomi. And I guess the first thank you is just to Yomi and to you, Tercer, for giving us this opportunity to chattel it on the supply chain work. I think it's really important that groups that are interested in healthcare in Africa

[00:53:42] first be thinking about how to do it more efficiently and thoughtfully. Get in touch with innovators, maybe us, maybe others that are highlighted in the report, but just, you know, start to

[00:53:51] reach out and build that conversation and learn how to work together on it. And then I think the space just needs more people as well that have the talent and technology and product and operations to keep expanding. I think the next phase is going to be incredibly exciting

[00:54:05] and excited to find people to head in that direction with us. So thank you. Thank you for that, Jessica. And thank you, Yomi. It's clear that you're both doing great work and this collaborative effort highlights the importance of the health supply chain aspect

[00:54:20] within Africa. And I'm looking forward to reading some more in depth and detailed and valuable reports that come out from salient and also keeping a close eye on the progress and the great impact that you're making on the continent via my share meds, Jessica. So yeah,

[00:54:39] thank you for joining me on the podcast today. It's been an absolute pleasure. Thank you for having us. Thank you so much. We really appreciate it. Bye. Bye-bye. Thank you to everyone who has listened and stayed tuned to the podcast. If you've enjoyed

[00:54:52] this episode, please subscribe, share or tell a friend about it. You can also rate reviewers in Apple Podcast or wherever you download your podcast. Thank you and see you next week for the Unlocking Africa podcast.