Infectious diseases are devastatingly egalitarian and the global scope of the pandemic has forged a shared vulnerability that is driving intense efforts to combat Covid-19. In global health, the dual burden of disease refers to health systems dealing with infectious and chronic diseases simultaneously. There is also a dual window of opportunity: to fortify health infrastructure, and to take a systemic approach to investing in healthcare innovation, particularly initiatives led by women.
According to a McKinsey survey, 90 percent of executives believe the Covid-19 pandemic will fundamentally change their businesses, and 85 percent predict lasting changes in customers’ preferences. But openness to change cannot be capitalized upon when a significant pool of innovators and entrepreneurs – women – are not enabled or supported to innovate and scale up ventures.
In October 2020, nearly eight months after the start of the pandemic, a World Health Organization (WHO) study looked at more than 1,000 new or modifications of existing technologies that were developed worldwide to respond to Covid-19. The analysis identified over 120 examples, or about 12.8 percent of the total, that were piloted or adopted in Africa. The response areas included surveillance, contact tracing, community engagement, treatment, laboratory systems, and infection prevention and control.
In 2020, the World Bank Group, the International Monetary Fund (IMF) and their partners mobilized more than US$55 billion in Covid-19 funding to bolster front-line health services, support vulnerable populations and boost deteriorating economies in Africa. Improving global health and gender equality are integral components of the 2030 Agenda for Sustainable Development of the United Nations, or the Sustainable Development Goals (SDGs). Sizeable programs directed at Covid-19 present an unprecedented opportunity to address the gender imbalance of access to opportunity, development and support.
It’s the women in the economy, stupid
Consider the work of the PharmAccess Foundation, an NGO headquartered in Amsterdam, Netherlands, with four country offices across Africa. PharmAccess is led by a female chief executive, and across the organization, half of the global management team are women. PharmAccess’s entrepreneurial approach to address vexing problems in health has resulted in mobile payments platforms such as M-TIBA and CarePay that have reshaped how financial inclusion can be expanded to the unbanked and vulnerable. At the small-and-medium-enterprise level, its Medical Credit Fund provides working capital to growing health businesses.
In Africa, women represent about 70 percent of the health workforce but only 30 percent of science professionals. Meanwhile, the continent has the highest rates of female entrepreneurship, yet according to the African Development Bank, there is a US$42 billion funding disparity between men and women entrepreneurs. (A similar landscape exists in the Asia Pacific. In ASEAN economies, for example, women-owned micro enterprises with adequate financing accounted for just 5-6 percent of the total. For small and medium-sized enterprises, the figures are 12-15 percent and 17-21 percent, respectively.)
In trying to make sense of this inequity, Nicole Spieker, East Africa director and director of quality at PharmAccess, overseeing its innovation agenda, points out that historical and cultural precedence are often antithetical to the needs of identifying and cultivating female innovators. “We know from our work that Kenya has great women leaders, with a rising generation of women leaders. The pandemic has been devastating. There is, however, excitement for the opportunities borne out of great need. Clearly, what the pandemic shows is the irrefutable link between healthcare and economics and economies.”
Initiatives such as the Medical Credit Fund play a critical role for entrepreneurs, providing working capital and bridge financing for African micro, small and medium-sized enterprises (MSMEs). With less access to financing, women entrepreneurs globally, not only Africa and Asia, are more likely to face a liquidity squeeze where they are not able to collect earnings quickly enough to pay expenses. This cash-cycle debt problem can topple “successful” businesses, which might have substantial earnings activity but actually have little cash on hand.
Across the board, a gender lens
Weaknesses in health systems are not uniform across regions and countries or within countries. For example, the United Nations Population Fund (UNFPA) reports that in the Asia-Pacific region, in 2010, for every 100,000 births, 150 women died from complications related to pregnancy and childbirth. Subregional differences were significant: In South Asia, the figure was 220, compared to 150 in Southeast Asia and just 37 in East Asia.
In Africa, the UNFPA reports that only about half of the 123 million women who give birth each year receive antenatal, delivery and newborn care. In developing countries, there are too few properly equipped health facilities for women, and those that do exist rarely provide all of the care that women and babies need.
At ReaMedica Healthcare Kenya, which I founded in 2018, a value-based healthcare approach to innovation is predicated on a nurse-midwife-centric services model. The evolution of point-of-care-ultrasound (POCUS) limited obstetric scanning is focused on process improvement based on our mission to address the challenge of equitable access to ultrasound imaging in prenatal care that has proven clinical efficacy.