Read the Conversation
EF: What are your priorities for 2024 in the region?
RM: We focus on reaching as many patients as possible while running our business sustainably. We are reinforcing our commitment to patients in SSA by driving access to innovation and supporting the growth of the healthcare systems. We must continue to expand our reach to those who need our medicine, all while maintaining a sustainable approach.
Having been born in a rural Kenyan community and later relocating to an urban setting, where I now hold my current position, I've developed a profound comprehension of the healthcare landscape from diverse viewpoints. I've seen firsthand what healthcare looks like for those in rural areas, those who can afford care within Kenya, and those who can't, both within and outside of Kenya. I've also observed the different healthcare systems across various countries, where, in some, over 90% of costs are paid out-of-pocket. This highlights the need for more collaboration in those regions to make healthcare more affordable for patients. In contrast, in countries like Botswana, where over 80% of the population is covered by the government, patients generally receive the care they need without significant out-of-pocket expenses unless the treatment falls outside what the government provides. My experience in these varied settings gives me a unique advantage in understanding the challenges on the ground and what needs to be done. I highly support Novartis's appointment of someone indigenous to manage its operations in Sub-Saharan Africa. This decision addresses a common mistake multinational companies make when entering the African market—assuming it can be handled the same way as in Europe. Often, they bring in someone without the necessary experience, leading to misunderstandings and ineffective changes. Novartis, however, has ensured that from an access perspective, there's buy-in from stakeholders. People are more likely to trust and embrace solutions tailored to their specific circumstances and presented by someone who shares their background. This can be a substantial advantage in effectively addressing patient needs.
When we shift our focus from internal matters to external collaboration, healthcare is the government's responsibility. The private sector is a critical partner because we understand governments cannot do it alone. We must define where and how we want to operate, leveraging our strengths to ensure we excel in our contributions. My approach to collaboration emphasizes understanding the entire patient journey, which many overlook. Often, people think the patient journey begins when they visit a doctor or pharmacy, but in Africa, it starts from the moment they leave their house and continues until they return. This is especially true for cancer patients who often must travel long distances due to the limited doctor-to-patient ratio, which is particularly concentrated in cities. For instance, a cancer patient might leave home to travel to a town, hoping to see a doctor.
EF: Could you elaborate on Novartis's role in enhancing the patient journey?
RM: When addressing the patient journey, we need to consider several critical stages: disease awareness, screening, diagnosis, and the patient's experience when they see the doctor. We must analyze these important aspects to determine where to partner effectively.
At Novartis, we've partnered across multiple areas—diagnosis, screening, and building doctors' capacity and capabilities. Since we aren't a screening or medical device company, we sought partners specializing in these areas to support screening and diagnosis. We've also collaborated with patient associations for disease awareness and with community health NGOs and companies that work with community health workers to extend this awareness to households. Our goal is to ensure that every part of this journey is covered. Since we provide medicine, we also had to focus on ensuring that patients have access to the right medication when they need it, in the correct form. From a payment perspective, we've engaged with various governments to develop systems that ensure patients can afford their medications. For example, we've explored reimbursement options for conditions like cholesterol and sickle cell disease, even in cases where other diseases like malaria might not be reimbursed. This involves working with governments to support patients sustainably.
I'm cautious about heavy reliance on donations because it could potentially do more harm than good for Africa if there isn't a sustainable plan to ensure patients can continue their medication. Donations can be useful in the short run, but what happens to those patients if the support is withdrawn? We must carefully consider the ethical implications - are we acting ethically if we start a program that we know we won't be able to maintain or will inevitably end? We must ask these critical questions when engaging in this type of work.
An example that underscores the importance of understanding the full patient journey, from when they leave home to when they return. During a visit to Ethiopia's Black Lion Hospital, I encountered a cancer survivor who had identified a crucial need. He collaborated with organizations from Norway to set up free hostels for cancer patients traveling long distances to receive treatment. This is essential because the doctor-to-patient ratio in certain regions is severely disproportionate. For example, the WHO recommends one doctor for every 1,000 patients, but in some Sub-Saharan African countries, the ratio is as low as one doctor for 15,000 patients. This is an immense challenge, and at Novartis, we strive to partner with academic institutions to train more doctors and nurses, working to improve this imbalance. Collaboration is vital. We can't simply offer medicine without ensuring there are trained doctors to prescribe it. The medicine will go to waste without a supporting system, supply chain management, or cold chain infrastructure. This is why we need each other and why partnerships are crucial to achieving the health outcomes we all strive for.
EF: How are you localizing Novartis's global innovative portfolio in sub-Saharan Africa, and what are some of the unmet needs in terms of the burden of diseases that you are getting ahead in addressing?
RM: At Novartis, we strongly focus on non-communicable diseases (NCDs), particularly in cardiovascular health, covering areas like heart failure, hypertension, and diabetes. We're also heavily involved in neuroscience, addressing many patients' neurological challenges. In Africa, ophthalmology is a key area for us. We also engage in oncology and transplant care, though our approach in these areas is more about centres of excellence. We believe in recognizing our strengths while also building on the strengths of others.
Sickle cell disease is another major area of focus for us, and you've probably noticed significant attention from our global health team and Novartis on this issue. Our strategy is to operate in therapeutic areas where we are competitive while also addressing neglected tropical diseases unique to Africa. We aim to collaborate closely with governments to work towards eradication where possible. When it comes to sickle cell disease, the question of eradication is complex. It's a genetic disease, and while countries like India have implemented measures to address it, in Africa, we are still in the early stages of ensuring early diagnosis and treatment for children despite the stigma that surrounds it. This stigma is a significant barrier, particularly in regions where cultural or traditional beliefs often overshadow scientific perspectives.
Leprosy, a disease with biblical roots, is another area where Novartis is making a significant impact, especially in Sub-Saharan Africa. We've been actively involved in this space, particularly in Africa and India, through our contributions and donations of leprosy medicine via WHO for the past five years. We renewed our commitment last year, and we hope to continue this support to ensure leprosy patients are cared for and that we can work towards eradicating the disease. We focus on these core therapeutic areas, striving to eliminate diseases where possible and doing it to the best of our ability. From a gene therapy perspective, we're actively exploring this area, along with radioligand therapy. However, in Africa, these therapies may take some time to be widely accessible, mainly due to the high costs. Since these treatments aren't covered by government reimbursement, patients must pay out of pocket. This raises concerns about sustainability and ties back to the ethical question I mentioned earlier. Many patients and caregivers, especially mothers, face tough decisions. They must prioritize providing their children with food, clothing, and shelter. Health often takes a backseat, leading to late diagnoses of chronic diseases because people manage their conditions as best they can but not in the way they should.
Each African market has its peculiarities; understanding these is key to our approach. How we operate in Botswana differs from how we approach Kenya or Ghana. In Ghana, where the government plays a significant supportive role, we might see better sales and reach more patients with our medicines compared to Nigeria, despite Nigeria's much larger population of over 230 million people. At Novartis, we focus on areas where we have competence, ensuring we perform well in those spaces. We also constantly consider the ethical implications of introducing new medicines.
EF: What is your pitch to attract investment from headquarters into Sub-Saharan Africa?
RM: The idea that health should be viewed as an investment rather than just a cost is a powerful conversation that needs to be consistently reinforced. Once policymakers and governments adopt this perspective, they will allocate resources accordingly. While the goal is for at least 15% of the fiscal budget to be directed towards healthcare, the reality is that many countries fall far short of this target, with some dedicating as little as 1-2%. This disparity often results in funds being diverted to non-health-related expenditures, leaving the healthcare sector underfunded and unable to address the population's growing needs. We must shift the mindset to understand that a healthy nation is the foundation for economic growth. A robust healthcare system enables a productive workforce, which drives economic prosperity. Countries that have recognized this have taken steps to prioritize prevention over cure, acknowledging that early intervention not only saves lives but also reduces long-term healthcare costs. For example, Rwanda promotes physical activity among its citizens, even having national exercise days led by the president. At the same time, Senegal offers public outdoor gyms to encourage people to stay active without the financial burden of a gym membership.
By investing in prevention, these countries create a healthier population requiring less intensive and expensive medical care. This approach also highlights the importance of an ecosystem approach to health, where all stakeholders, including doctors, patients, caregivers, and financial backers, play a role in maintaining and improving health outcomes. However, achieving this balance requires starting with the basics and building from there. Unfortunately, the tendency to seek medical attention late in the progression of diseases often results in a focus on curative care, which is far more costly. The saying that prevention is better than cure is especially true in healthcare, and we must start investing in preventive measures today so that future generations can reap the benefits of a healthier society. Education is also key; even with free screening and diagnosis services, many people delay seeking care until it's too late, and we need to change this behaviour through comprehensive education and awareness campaigns.
Ultimately, when governments and policymakers begin to view health as a critical investment in the nation's future, we will see the kind of sustainable, efficient health systems that improve individual lives and bolster national economies. Investing wisely in health today will reduce costs in the long run, creating a cycle of prosperity that benefits everyone.
EF: Looking back, what are the things you are most proud of that you have accomplished in Sub-Saharan Africa and with your patients and team from a leadership position?
RM: I have been working on four focus areas. First, a health policy emphasizes that health is an investment, not a cost. The second is regulatory harmonization. Africa's 54 different regulatory frameworks are a major barrier. Moving medicine across countries can be incredibly complicated and costly. We need to streamline these regulations. Third, local manufacturing is crucial. While everyone talks about it, having 54 countries manufacturing separately might not be practical. We need a framework that supports centres of excellence to ensure efficiency. The fourth area I'm passionate about is women in health and leadership. Growing up, I saw how patriarchal norms often disproportionally disadvantaged women. Sometimes, women feel they can't make decisions without approval from male relatives or society. Women should be empowered to make decisions related to their health or other matters, consult where necessary, and feel confident in their choices. Listening to and supporting women as they navigate these challenges is important.
I occasionally experience imposter syndrome, questioning my abilities before starting a new role. However, I've understood that it's all about how we communicate with ourselves. During leadership training, we received a toy monkey as a metaphor for self-doubt. The idea was to 'hide the monkey' when those thoughts arise, which has been valuable in maintaining focus and confidence.
I am also passionate about addressing period poverty, particularly in Kenya and Africa. Many girls lack access to sanitary pads, leading to dire consequences, including early pregnancies to avoid the stigma of menstruation. It's crucial to provide education and resources so that women can manage their periods with dignity and continue their education without fear.
In leadership, I have successfully increased the gender balance on my team from 30% to 50% female leaders. This achievement is not about excluding men but ensuring that women are included based on merit. Men are valuable allies in this effort, and supporting women to qualify for leadership roles is vital.
