The Structural Changes Required To Build Resilient Diagnostics and Healthcare Systems in Africa with Dr Allan Pamba

[00:00:00] You're listening to the Unlocking Africa podcast. I qualified as a physician at the peak of the HIV-AIDS pandemic in Africa, and that was very career-defining for me. If we could work towards creating health insurance, then this will provide quality care if they want me to come back. I think there's an opportunity here to create more health insurance and pool our risks as population through insurance, both public and private.

[00:00:25] We estimated that in 2021, we were reaching 50 million Africans. We think for a company of our size, we should reach no less than 500 million Africans with quality diagnostics. 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, Terser Adamu.

[00:00:56] To unlock Africa's economic potential. Today, we have Dr Allan Pamba, who is an Executive Vice President at Roche Diagnostics. Roche is a global pioneer in pharmaceuticals and diagnostics focused on advancing science to improve people's lives. Welcome, welcome, welcome to the podcast, Dr Allan. How are you? I'm very well, Terser. It's such a pleasure to be at the podcast.

[00:01:24] It's a pleasure to have you and welcome to the show. As always, I like to just get going. So I was hoping you could start by first telling us a bit about your journey from your roots in Kenya to your senior role at one of the world's leading diagnostics companies. Oh, it's been a crazy journey, Terser. My goodness, where to start? So I'm a physician by background. Grew up in Kenya in a typical African family. We were nine kids. Eight boys, one girl.

[00:01:54] Oh, wow. I know. And I was bang in the middle of fifth born, you know, so you completely feel ignored. But that worked in my favor. I believe I worked really hard in my early life. And with some good luck, support, some good Samaritans along my journey, got scholarships and went on to medical school, which was my dream. I qualified as a physician at the peak of the HIV AIDS epidemic in Kenya, in Africa. And that was very career defining for me.

[00:02:24] I always say one of the best things I ever did. I was a young doctor working in a research facility in the coast of Kenya, an organization called Kemri Welcome Trust. And I was supposed to be doing malaria research in children. And I did that as well. But I couldn't ignore the HIV burden around me. So I set up what was one of the first HIV care clinics in Kenya at the peak of the epidemic. And I took it to about 150 patients.

[00:02:53] They were all very young, average age, you know, 19, 20 years. They would come to the clinic with a diagnosis of AIDS, but they looked normal. And the sad thing is many of them had no understanding what that meant. They thought I'd give them a pill to go home and they're better. I did not have that pill. And I spent the next many months building these clinics, this clinic talking to these kids and listening to their stories and just managing them with simple antibiotics. In the end, of course, they started dying.

[00:03:22] And that was very defining in terms of my career. I joined the pharmaceutical industry, not because I liked it, because I hated it. At that point, I thought they were the problem. And long story short, I left the clinic, went to London, studied public health in developing countries as my master's degree. And at the end of my studies, there was one job that nobody would touch.

[00:03:48] It was a job with GlaxoSmithKline, which is, of course, a pharmaceutical company. Yes. And they were looking for an African physician who had experience working with HIV AIDS. There was only one in the class. I tried to run away from that job. I did everything I could. But my best friend told me he knew the hiring manager. So I interviewed just to please him and jumped on a plane and went back to Kenya. Three days later, they called me and they said to me I had the job. And I had the biggest dilemma in my life. Do I take it? Do I not?

[00:04:18] I jumped back on a plane, went to London, joined GSK, thinking I'm going to go in and shout like crazy and then run out. But I found normal people like you and me that just didn't have these 150 stories that I had. So I dedicated my life to telling the stories of my patients from Africa. To cut a long story short, I have been in industry now for over 20 years. I now work for Roche.

[00:04:43] And what I've seen is the power of industry or the potential power of industry to work as a credible partner for Africa to deliver healthcare for our people. Today, as you said, I lead Roche Diagnostics in Africa and we continue that battle. Wow. It shows that you can't escape your destiny. I guess so. I tried to. But it kept pulling you back in. Exactly. Wow. Fantastic. Thank you for sharing that, Dr. Allen.

[00:05:13] So as you mentioned, you're a physician by background, had a very decorated career within the industry, worked in pharmaceuticals, which has led you to what you're doing at Roche. I know that Roche has a dual focus on pharmaceuticals and diagnostics. That is correct. How do you see this dual approach shaping global health and what does it mean specifically for Africa?

[00:05:40] It's a strong advantage in our industry. So we are able to provide end-to-end solutions. So, for example, take cancer. We can provide diagnostics to diagnose cancer, ALU. And historically, we have been very strong in cancer medication. So we can provide, you know, end-to-end patient care.

[00:06:04] And as a company, we try and leverage that in our approach to governments and other stakeholders where we are present. In Africa, we are looking at a dual burden of disease today. We have grappled with non-infectious diseases, particularly malaria, TB, and HIV. And now as our middle class is growing, we're seeing a rise of non-communicable diseases. And don't get me wrong.

[00:06:34] We still have a big infectious disease problem. We have 25 million people living with HIV in Africa. We have 95% of all cases and deaths of malaria in the world here in Africa. We have 25% of all TB cases in the world here in Africa. While we're seeing at least 25 million people with diabetes, we are seeing more and more people with cardiovascular disease, strokes, heart attacks, more and more people being diagnosed with cancer.

[00:07:03] And the health system and the health model still remains what we had around independence in the 60s. Sadly, also, the health budgets haven't changed that much. So Africa is sitting on a potential time bomb here, which, if not addressed urgently, could be catastrophic, both from a human perspective and, of course, from an economics perspective.

[00:07:32] We saw recently what happened with the U.S. Very consequential election. Stop orders on many areas of collaboration that were supported by USAID. And suddenly our eyes are open to the fact that Africa is hugely dependent on aid to deliver healthcare for its populations. Very defining.

[00:07:54] So the conversation we're having today, in my view, is a critical conversation at this point in time for Africa. As an industry, how do we come in? As governments, how do they come in? What needs to change? How do we move this forward together? You touched on a key point in terms of what needs to change. I know that last year, who adopted a resolution of strengthening diagnostics capacity.

[00:08:21] Since then, have you seen much significant progress on the continent? There has been progress, Tursa. But let me take 300 feet helicopter view of health in Africa fast. And I'll come down to your question and be relevant in a second. When I look at our continent, the positive is many countries have adopted a universal health coverage goal of vision. It's a great positive. It's a great start.

[00:08:51] When a country says, by 2030, we want to deliver healthcare with a minimum basic package for our entire population. It's a bold political statement. And I applaud Africa and the many countries that have jumped on that ship. That is step one. Now, step two is let's put our money where our mouth is. It's very important. Budget that will deliver that universal health coverage.

[00:09:18] The history of budget of healthcare in Africa, I anchor it to 2021 to a city in Nigeria called Abuja. In 2021, African heads of states met in Abuja and resoundly declared and signed that they will put 15% of their budgets to health. 15%.

[00:09:44] Today, 24 years later, I can count with the fingers on one hand how many countries have honored their budget declaration. We have Kabul Varder in there. We have South Africa in there. We have Rwanda in there. And I don't think it goes much further than that. Not even Nigeria is on that list. I think Nigeria is doing around 5%. Yeah.

[00:10:17] Health is not seen as an investment. It's not seen as a priority. This is the next level of argument, which I think Africa needs to have. Africa has a lot of mineral wealth. People focus on the mineral wealth. And what drives investment in Africa is where the minerals are. So you see a lot of money going into infrastructure. Roads, railways, bridges, those are all very important. But let me tell you our biggest open secret.

[00:10:47] Africa's best assets are its people. Yes. One billion, average age 20 years. Very, very youthful. The envy of Europe, the envy of the aging parts of the world. Now, how do we make this demographic dividend come alive for Africa? I personally believe that three key areas of investment that speak directly to investing in the human capital. Agriculture, health and education.

[00:11:17] To prioritize budgets towards these three. One less short, one less reach. But make sure that these three are done properly. Africa's human capital will emancipate us from the levels of poverty that many countries have suffered for many years. So what stops Africa from delivering on the budget declaration is the lack of realization that there's a big ROI if you invest in your human capital.

[00:11:44] Go be patient when you do it because you need an educated, healthy population that is youthful in a world where the Internet is an equalizer. And you're right at the cutting edge of global economies with the innovations that, you know, could potentially come from the continent. Our governments need to understand that and reprioritize our budgets. This is the first point.

[00:12:09] Now, having said that, even looking at the budgets that we put into health, I personally feel we have got the equation wrong. We prioritize treatment way above diagnostics. And that makes for inefficient use of our budgets. And let me explain myself.

[00:12:32] If you have a budget of $100 and you had to diagnose and treat your patients, take one disease, malaria, which presents with a high fever. You could decide, I'm going to wait until people have malaria. And then I'm going to have lots and lots of medicines to treat them. Or you could decide, I'm going to try and diagnose early people with suspected malaria. Only treat those who have malaria.

[00:13:02] And then continue making sure that I diagnose the disease early. With the second approach, you will save on your treatments and you'll save on your hospitalizations. Why? Because, first of all, you will only treat malaria and not anything else. In the first approach where you put all the money on treatment, as a physician, when a patient came to me with a fever and I didn't know the diagnosis because I didn't have a lab that could diagnose the disease, I gave them medicine for malaria.

[00:13:32] I gave them medicine for meningitis. I may have even, so you get polypharmacy for a patient who only needs one treatment if only you could diagnose it. So your treatment costs are higher. And then, of course, also because you're diagnosing it late, they're already presenting with symptoms like coma, like convulsions. It's dramatic. They need to be hospitalized. So now you're paying for a hospital bed. Now you're paying for longer physician nursing care. Those costs are higher.

[00:14:01] So even with existing health budgets, if we allocate appropriately, focus on primary health care, prevention, early diagnosis, then our treatment budget will be less and we will be able to deliver more health care. This is a summary of where we are. So you've touched on the economic case for investing in diagnostics up front rather than focusing spending on treatment alone.

[00:14:26] Would you say that diagnostics should be seen almost as an economic lever? Absolutely, Tarsa. Diagnostics are an economic lever, especially in this critical juncture where we find ourselves today with donor aid fast disappearing from our continent. You talked about the World Health Assembly that passed a resolution on diagnostics.

[00:14:52] That was a watershed moment for healthcare delivery, not just in Africa, but globally. And the background to achieving that vote at the World Health Assembly to put diagnostics up there on the agenda was COVID. During COVID, we suddenly appreciated the value of a diagnostic. It made the difference between you being in an isolated room and being with everyone else.

[00:15:16] It made the difference between you catching that flight and being in the aeroplane or being bad at all, you know, from it at all, you know. And suddenly people realize, OK, I invested a bit of money. I get a test. I get a decision. It helps to make a decision that actually is critical. Long story short, we end up with the vote and the resolution. We have seen progress.

[00:15:39] Many countries in Africa never had a diagnostics policy within their health systems, never had an essential diagnostic list. Here is this list of diseases we must be able to diagnose as a country. HIV, malaria, tuberculosis, diabetes, cancer, etc., etc. They never had a list. But now with the passing of that diagnostics resolution, we are seeing countries writing diagnostic policies.

[00:16:05] We're seeing countries creating an essential diagnostic list, happily to say driving more towards primary health care. So diagnosing in the sort of primary health care space, the early entry level health facilities, and therefore driving more towards early disease detection, whether it is cheaper to treat and cheaper to intervene and probably ability to intervene for cure. So there is some progress. Thank you.

[00:16:35] I was thinking if countries are facing constraints to efficiently allocate budgets to diagnostics, how can they collaborate regionally, you know, through say pool procurement or shared labs to drive economies of scale in diagnostics? Yeah, that's a great point. You know, it's a great point on many levels.

[00:17:00] There is underlying that point is a fact that, you know, Africa is divided into numerous boundaries that don't make any sense if you're to ask me, you know, when you look at the populations across those boundaries today. Thankfully, and even from an economic sense, thankfully, Africa is realizing this and increasingly moving in the direction of creating collaborative blocks.

[00:17:27] And here I'm referring to the emerging regional economic blocks. The East African community, ECOWAS in West Africa, SADAC in Southern Africa, you know, looking to make our borders borders for goods and people and drive increasing collaboration to make us more and more competitive. And of course, therein more and more efficient. Same applies to diagnostics. Two points. Two points.

[00:17:55] The first point is we've donor funded programs. Yes, we have built some diagnostic infrastructure in Africa, but these are built off the back of what we call vertical disease programs. This is a HIV program funded by PEPFAR, US money. We have put this machine in the lab. You can only use it to test HIV AIDS. It's Rosh makes the machine.

[00:18:21] That same machine can test multiple diseases over and above HIV AIDS. It can test for TB. It can test for human papillomavirus, hepatitis B and C, et cetera. But because it's a HIV program, you only use it for HIV. We're missing out. That is a huge capital investment sitting in that lab. Can we integrate testing? Can we open the channels so that that one machine can test across those diseases?

[00:18:48] With the disappearance of aid funded programs and domestic financing taking over delivery of health in Africa, governments should be able to say that one machine will test across panels. We're not going to buy one machine for HIV, another one for TB, another one for HPV, cluttering the lab. This is what you get when you have donor funded programs that are vertical with programs that are vertical in nature. There is an opportunity to integrate.

[00:19:17] Second point, diseases do not know boundaries, especially if you look at the area of surveillance for, you know, your Ebola's, your COVID's, even cholera and so on.

[00:19:29] Countries need to think about not just economic integration, but also integration in the healthcare space where you invest into strategic surveillance points with data shared and therefore are able to pick up signals and share the data and help populations across borders. Yeah.

[00:19:52] And the last dimension, third dimension that I'll talk about here is when we move into a future where Africa has to pay for its healthcare, then pooled procurement begins to make a lot of sense. We've seen this during COVID when, you know, vaccines were scarce and Africa CDC showed very strong leadership, driving pooled procurement of vaccines for Africa.

[00:20:19] Now, this, I believe, will also apply in the future that we're looking at, where countries coordinate their purchasing, when they have, you know, pooled volumes and therefore through economies of scale, industries also able to offer better prices and it's a win-win for everyone. You nicely highlighted the challenges of donor funded programs.

[00:20:43] With what we've seen recently, the shrinking in foreign aid allocations, how can African countries optimize current health budgets before seeking new funding streams? It's a great question, Tasa. And African countries will have to optimize current existing health budgets before ministers of finance release additional budget.

[00:21:11] And one, you know, there's a couple of opportunities for optimization of those budgets. One, I addressed with respect to allocation of budgets between diagnosis and treatment. If you get the right allocation, the right proportionality, you can work out a formula where you deliver more healthcare. Because if you diagnose diseases early, you save on treatment costs and you save on hospitalization.

[00:21:41] The second is pooled procurement that you referred to. If countries can gang together, as it were, and pool their volumes, then, you know, their purchasing power becomes stronger, their gaining power becomes stronger, and you get better prices when you do that. That is an opportunity that they have, you know. Thirdly, I would say it is time for Africa to revisit its health delivery model.

[00:22:11] We've used the same health delivery model since, you know, independence years in the 60s, where health delivery is dominated by government. Now, apart from churches, believe you me, there is no bigger white elephants in Africa than health facilities. Many hospitals, many dispensaries, many health centers, but not functional. You just see the building there.

[00:22:37] Either the physician is not accessible or not there at all, or there's no medication, or there are no supplies, you know, to keep the facility functional. What I believe is governments need to review their role in healthcare delivery, cede a lot more of that operationalization of healthcare delivery to private sector entities, operating at different levels, you know, from your five-star private hospitals to a simple,

[00:23:07] you know, village cottage hospital, you know, run by a retired nurse or even a nurse in active, you know, career, but running it as their own entity where they will show up for work every day, where they will make sure that, you know, the drugstore is supplied, etc.

[00:23:27] And so the role of government kind of like moves back, is clawed back to be more of the strategy owner and, you know, more of ensuring that, you know, the environment is compliant with, you know, a set regulation. So, you know, key regulatory role there. Yeah. I think we have a chance with that.

[00:23:56] And then, you know, coupled with that, if we could, again, as governments, work towards creating health insurance, both public and private, so that you and me work with our health budget in our back pocket and we choose where we get our healthcare, then this private outlets I'm talking about will provide quality care if they want me to come back. I think there's an opportunity here to rethink how we deliver health.

[00:24:24] There's an opportunity here to create more health insurance and pull our risks as populations, you know, through insurance, both public and private. And in that, be able to tide the storm of disappearing foreign aid and pay away for people's health. It's a dignified thing to do. You pointed out that governments should review their role in healthcare.

[00:24:50] With that in mind, how do you think African governments should think differently about value for money in healthcare? It's important. Every dollar counts and counts for a lot. And the model I'm describing treats the leakages that we have in the public sector that then dilute the value that you get for every dollar that you invest in healthcare.

[00:25:19] So to make the value of every dollar powerful, I think rethink your health delivery model. Government play a regulatory role, a steward role, and let private sector players deliver it at different levels and regulate them. Government could keep a section of delivery with the most vulnerable parts of the population, you know, but it's scaled back.

[00:25:46] And that, I think, will make every dollar that goes into health more powerful in terms of what it eventually delivers. The other strategies around old procurement also could help, you know, through economies of scale and so on, you know. So the role of government then radically shifts from what we have already known.

[00:26:10] But I think this is the kind of radical shift that's needed if UHC is to become a realistic target. You've touched on something quite key in terms of private sector playing a bigger role, but how can African governments create more attractive environments for private sector investments in diagnostics and healthcare infrastructure?

[00:26:33] You know, you know, attracting capital, whether it's in health and diagnostics or in any other sector, requires certain very standard principles. And I just call them out. And African needs to really, you know, look into how we achieve some of this.

[00:26:56] Rule of law, if you're going to invest your money in any country, you want to understand, is there a robust judicial system in this country where I can get redress when I'm faulted? And investing in a strong judicial system may look very peripheral, but it attracts capital because it gives a sense of security.

[00:27:23] The infrastructure that is required, you know, for delivery of whatever business it may be, be it health, diagnostics specifically, or anything else. And here now you're looking at how do governments invest in roads, railways, ports, et cetera, where we can move in and out, you know, move goods in and out. That becomes important as well.

[00:27:49] Specifically for health and for diagnostics, creation of a health market. One strategy I talked about was health insurance. When a government drives the development of public and private health insurance, there is a health market there. And also, especially if the government is not the dominant provider of health, and that is space that private sector can come and fill and hopefully deliver more efficiently

[00:28:16] than we have seen in the past with less pilferage. So that, you know, every dollar, as we say it, is as powerful as it can be. And then the government, as we say, playing the role of a steward can have a clear vision for health and clear strategies to achieve it. What do I mean by that? Vision, adopt a UHC target and declare that's where your country is going. Strategies to get there.

[00:28:45] You have data on disease patterns in your country. We have a dual epidemic of malaria, of infectious diseases, the non-infectious diseases. We would like to make sure that we have investments that treat HIV, investments that treat malaria, investments that speak to or prevent non-communicable diseases, diabetes, cardiovascular cancer, et cetera. And therefore, investors coming in can understand

[00:29:11] where do their investments land on that master plan. Now, I tell you what, there's a country that does this, Rwanda. That was the first country I ever went in with an investment proposition when I worked for a company. And the minister of health showed me her plan. And she said, show me on my plan where your investment lands. And I call it. And she said, thank you very much. It's a lot of money you're bringing, but thank you. We don't need it. It's a distraction. We have a plan and we follow the plan. Strong, clear stewardship.

[00:29:39] You know, I think those are sorts of the elements that make a country attractive for investors. And, you know, land more capital. Interesting, interesting. Thank you for sharing that. I know we're talking about African very general terms and both you and I probably don't like doing that. But for the sake of this next question in terms of what are some of the key policies governments must prioritize

[00:30:06] now to achieve what you've just mentioned? Absolutely important. I think policies around health insurance will be very important because health financing is a huge topic when you have a universal health coverage target as a country. So what are your policies around health insurance, both public and private? Because you've got to create the financing to get us to UHC.

[00:30:36] If I step a little bit lower, treatment policies on critical disease areas, the highest part in disease areas, you know, what's your policy on HIV management? What's your policy on malaria? What's your policy on TB? What's your policy on cancer, you know? So that there are clear guidelines and policies that will land investments but also guide interventions that then will result in control or even eradication of these diseases. Policy on diagnostics. We talked about it.

[00:31:06] This focus on primary health care, this focus on identifying diseases early or even risk factors early so that you don't even get disease at all, you know, at population level. Do you have a diagnostics policy? Do you have an essential diagnostics list that define what you should diagnose in a level five facility, a level four facility, a level three facility, et cetera, you know?

[00:31:34] I'm just mentioning a few of them. There may be others, but certainly policies around health financing and policies around diagnostics are gaps today that will help Africa move faster in the direction of universal coverage. How can companies such as Roche and other industry leaders from the private sector work more collaboratively with African governments as not just vendors,

[00:32:02] but also long-term partners? That's an important question, Tarsa. In particular for me, because when I joined Roche three years ago, the company decided to have a bold ambition in Africa. And my task was to work with our team to create that vision and ambition. And the vision we're working towards is to increase the number of quality diagnostic tests that we bring to Africa tenfold over a 10-year period.

[00:32:29] We estimated that in 2021, we were reaching 50 million Africans, drop in the ocean for a population of a billion. We think for a company of our size, we should reach no less than 500 million Africans with quality diagnostics. That's the vision. That's our UHC. That's the vision we're working towards. And we have, over the last three years, made investments, be it in people,

[00:32:55] in setting up legal footprint, in supply chain, you know, in the direction of that vision. Now, we want to be a strategic, not a transactional partner for governments. It's a massive difference. Many governments will look at industry as a supermarket. I go, I pick what I want, I bargain on the price, and I get what I want, and I'm gone. No, that's not what I want.

[00:33:20] I want to go to Nigeria and discuss either with the federal government or even with the state governments what the health vision is and understand what solutions can I bring to help you contain your HIV challenge, your malaria challenge, your TB challenge, your diabetes challenge. How can we, what are your goals for those disease areas?

[00:33:46] How can we create end-to-end solutions where my solutions and the solutions of others deliver on the result that you want, the patient outcome, the patient result? That is a strategic relationship. It's not a vendor, you know, sort of simple relationship. That's what I'm hoping to get from African governments. Let's trust each other. Let's sit down together. Let's focus on the patient.

[00:34:16] Let's focus on the outcome you want and work our way backwards and say, what can I bring on the table? Now, in that conversation, I'm not just placing that piece of equipment that will test HIV, malaria, TB, et cetera, or diabetes in your facility. No. I'm actually talking to you. We're having a conversation on how do we create awareness in populations about these diseases? How do we co-invest, you know, to do that?

[00:34:42] How do we, if we need to, you know, understand how we speak with one voice to get financing for treating cancer once you've diagnosed it? So that we're not just diagnosing and then leaving patients there with a diagnosis and nothing happening. I care that every patient diagnosed with a cancer or with HIV or with malaria with our platforms actually do have a solution. And that is a strategic relationship.

[00:35:12] So in a nutshell, my hope is that we move our relationships from being transactional to being strategic. We care about our people and we want solutions for them. It's not just another sale. It's a life saved. Fantastic. Thank you for sharing that. So you talked about your vision, but if we look at what is currently happening now,

[00:35:37] are there any new trends that you're seeing in terms of how diagnostics is being successfully deployed or implemented on the continent? Yeah, there have been many success stories, Tarsa, you know, that I am proud to tell. So I could talk about what Roche has done. I talked about the HIV epidemic in Africa, which defined my career.

[00:36:01] Roche's response over the last 10 years has been setting up what we call the Global Access Program for HIV. In this program, Roche put in place diagnostic platforms for HIV viral load testing across, I think it's about 40 countries across Africa. That's a lot of countries. So today we have platforms that sustain 8 million people living with HIV in Africa.

[00:36:27] And what happens in these HIV clinics is that patients are put on treatment once they're diagnosed. But twice a year, we check their viral load, the number, the level of virus in their blood, which if your own treatment should be fully suppressed with the treatments that we have today. So twice a year, that is checked. And if you remain suppressed, then your treatment is working. If your treatment stops working, the viral levels go up and we pick it up very early and revise your treatment.

[00:36:56] And this is sustaining many moms, many dads, many kids in school, you know, living their normal lives. And that has been possible through a partnership with African governments, ourselves. And, you know, it has largely been funded by U.S., you know, U.S. funding. But hopefully there's a future where, you know, Africa can take over programs like this that struggle multiple countries.

[00:37:23] But because it's multiple countries, there's economies of scale and, you know, we're able to deliver it with a lot more efficiency. This is one area. And, you know, again, I tell people, you know, both from a diagnostic and a treatment perspective, you do not see clinical AIDS anymore in Africa. I am of the generation where when I was a young physician, as I described it, I saw AIDS everywhere in the bus stop.

[00:37:47] As I'm going to school, you could see in a restaurant, in church, in the streets, there was clinical AIDS. And they had these billboards that were very scary that you don't see anymore. So there's a generation now that's never seen that. And there's a lot of work that's happened in the background, you know, to bring us to where we are, which is a very happy place where a diagnosis of HIV-AIDS is no longer a death sentence.

[00:38:15] And you can live your entire life as it was meant to be, thanks to the diagnostic platforms and the treatments that we have. So that's one example, you know, of great success. Time permitting, I'll give another example of Egypt. Egypt had a big problem with liver cancer. Now, liver cancer is associated with an infection with hepatitis C. Now, hepatitis C is bloodborne. You know, you can get it through needle pricks and so on.

[00:38:44] Now, how did Egypt end up having a huge proportion of the population infected with hepatitis C? And subsequently, one of the highest rates of liver cancers in the world. The story goes that back in, I believe it was the 60s earlier, there was a government program to vaccinate people against another disease, bilharzia, which is also common there. And back then, needle practice was not as sterile as it is today.

[00:39:12] So many people ended up getting infected with hepatitis C and it's spreading the population. And subsequently, this became a huge problem in the country many years later. Now, the government decided we're going to eliminate hepatitis C from our country. And they created a consortium of many partners. Thankfully, Roche was one of the diagnostic partners at the table. This initiative was called the 100 Healthy Lives Initiatives.

[00:39:40] And through this initiative, testing programs were built across the country to pick up all the cases of people who were infected with hepatitis C, treatment was provided, and literally we mobbed the lot. Ten years later, Egypt was declared hepatitis C by the WHO, the first ever country to eliminate a disease. Within 10 years, it's an amazing story of partnership with the government,

[00:40:10] an amazing story of a commitment by a government to its people. Today, they're seeing rapidly declining cases of liver cancer because they did their job. And, you know, we did it together as partners. Wow. Wow. So if we move from current successes and look at the future or look to the future, if we revisit this conversation and say five to 10 years from now, what do you hope would have been achieved?

[00:40:38] I hope a child born five to 10 years from now, Tersa, anywhere in Africa, will look back at you and me, all of us, of this time and say, thank you guys, you did your job. I can now live 70, 80 years, as does the child born in Europe, as does the child born in Japan, because you guys did your job. That's what I hope. Universal health coverage for Africa.

[00:41:06] Brilliant. So if we look closer to home, where do you see yourself and Roche Diagnostics in five to 10 years time? I believe we will have achieved our 10x ambition. We will have played our role as a good partner for government and other stakeholders and help to strengthen Africa's health system by building or contributing to the building of a strong diagnostics backbone for Africa.

[00:41:35] If it happens to you, we will diagnose it here. We're not going to send any support anywhere else. We will be able to tell you what it is right here in Africa. And then we deal with it right here in Africa. Quote of the week. As people, we often have quotes, mantras, African proverbs, or affirmations that keep us going when times are challenging or when times are good. Do you have one that you can share with us today? Yes. Oh, in quotes.

[00:42:04] That was a bit too quick, Taz. You're very prepared. You know, I'm going to use this one because I think Africa needs it. And it basically says that the leader brings the weather. You can have very tough times, very tough moments. If you have been blessed to be in a leadership position, people look up to you and you bring the weather. You have to bring that hope.

[00:42:34] Not just bring the hope, but actually guide to deliver the hope. Africa needs this. We talked about some of the governance challenges that bedevil many countries in the continent and slow down progress, be it economic, human, etc. Just a reminder to African leaders. It doesn't matter. Politics, business, it doesn't matter that you bring the weather. Brilliant.

[00:43:04] What a fantastic way to end today's conversation. Dr. Alan Pamba, thank you for sharing such powerful insights with us today. You've highlighted how diagnostics aren't just a medical tool. They can act as a economic catalyst, lever, a policy priority, a moral imperative for the continent.

[00:43:27] I hope today's conversation has made people think or sparked some kind of action among policymakers, investors, innovators. So, yeah, thank you for joining us today and sharing your knowledge and experience with us. Delsa, thank you very much for having me. It's been a pleasure. Bye for now. Thank you to everyone who has listened and stayed tuned to the podcast.

[00:43:55] If you've enjoyed this episode, please subscribe, share or tell a friend about it. You can also rate, review us in Apple Podcasts or wherever you download your podcast. Thank you and see you next week. for the Unlocking Africa podcast.