When The South ‘Swings’ Together On Health Equity New Possibilities Emerge

Satellite technology for telehealth consultations in a rural Guyana community; one of a number of health innovations the small Caribbean nation has spearheaded recently.

While this week’s CARICOM summit in Grenada has been postponed due to Hurricane Beryl, a key item on the agenda was a new initiative to deepen South-South partnerships to meet shared global health challenges – including climate change.

In remote communities of Guyana, the introduction of new satellite technology is enabling freshly trained community health workers to get patients an accurate diagnosis and rapid, appropriate treatment in ways unimaginable only a few years ago.  

In Rwanda, meanwhile, the government’s achievement in getting the COVID-19 vaccine innovator, BioNTech, to set up its first mRNA manufacturing facility in Kigali is a success story that small island states in the Caribbean would love to emulate. 

At a high-powered dinner on the sidelines of the recent World Health Assembly, health ministers and high level officials from Africa and the Americas, set out a shared vision for a way forward on closer collaboration between the two regions under the umbrella of a new South-South partnership initiative, known as HeDPAC

The initiative grew out of an initial set of pandemic-era collaborations between Africa and the Caribbean and was incubated at WHO  until its launch as an independent non-profit in December 2023

“HeDPAC offers a model for self-service cooperation. And for sharing knowledge, expertise and resources,” said WHO Director General Dr Tedros Adhanom Ghebreyesus, at the event, noting that the aim is to enhance health infrastructure, improve access to essential medicines, and strengthen health systems.” 

WHO Director General Dr Tedros Adhanom Ghebreyesus

Partnership building self-sufficiency  

The overarching aim, says HeDPAC CEO Haileysus Getahun, is to foster a partnership  between countries in the global south around key objectives critical to handling future pandemics, as well as creating more robust health systems today. 

The peak of the COVID-19 pandemic exposed the flaws in models of North-South cooperation that have come to dominate the global health landscape – when countries in the Global North hoarded the vaccines, medicines and medical products, he observed. The lack of equity and global solidarity were glaringly absent. 

South-south collaboration is one important antidote; a way to foster more self-sufficiency among countries and stakeholders on a more even playing field with a vision of universal health coverage. 

Three concrete priorities   

Jarbas Barbosa, WHO Regional Director of the Americas/PAHO.

The issues HeDPAC is targeting are not new, but they are perhaps the most critical building blocks to change. They include: 

  • More local R&D, manufacturing of drugs, vaccines and other medical products; 
  • Health workforce strengthening, particularly at primacy health care levels; 
  • Building health system resilience to shocks ranging from climate to supply chain breaks. 

“These are completely aligned with our regional priorities,” declared Jarbas Barbosa, WHO Regional Director of the Americas/PAHO, at the WHA conversation.  

Along with the dependency on outside sources for vital medical supplies laid bare during COVID,  Latin American and Caribbean countries currently are facing a shortage of some 600,000 health care workers, Barbosa observed. 

In Africa, the shortages are even more glaring, according to WHO. A 2023 report showed 37 African nations ranked below the global recommended minimum of 4-5 health workers per 1,000 population.

When the South swings together ….

Alison Drayton, Assistant Secretary-General for Human and Social Development at CARICOM

Registered in Rwanda and Barbados, the initiative aims to work with heads of state and political leaders but without the bureaucratic handcuffs of a formal intergovernmental organization, Getahun said. 

Early champions included the President of Rwanda, Paul Kagame,  Prime Minister of Barbados Mia Mottley and President Irfaan Ali of Guyana. Mottley gained international recognition for her Bridgetown initiative for international debt reform aimed at reducing the crippling burden of low- and middle-income countries to free up more funds for investments in solutions for climate, health and other vital development priorities. 

“My experience has been when the South swings together, we achieve far beyond our wildest dreams,” said Alison Drayton, Assistant Secretary-General for Human and Social Development at CARICOM, the intergovernmental organization of 20 Caribbean states, at the WHA event.

She noted that CARICOM and HeDPAC are currently engaged in the development an MOU to address the three priority areas of: health workforce, health system resilience and local manufacturing of medical products. 

The discussions on collaboration will continue at the 47th CARICOM Conference of Heads of Government. The meeting, planned this week in Grenada, has been postponed because of the effects of Hurricane Beryl.

Moving beyond pandemic poverty 

Barbados received its first shipment of 33,600 doses of COVID-19 vaccines, through the WHO co-sponsored COVAX facility, in April 2021. But after an initial spurt, COVAX deliveries faltered, leaving many low- and middle-income countries scrambling.

On the other side of the ocean, the African Union is a key partner with bonds forged in the early days of the COVID pandemic, when both African and Caribbean countries found themselves struggling desperately to obtain the most basic medical products like protective masks and gloves, and later vaccines.  

“When the world wouldn’t give us vaccines and the world wouldn’t sell us vaccines, and we pulled together an important procurement initiative, to my amazement, it was not just Africa but our brothers and our sisters from the Caribbean who supported this,” declared Dr. Ayoade Alakija, who had, at the time, been asked to lead the Africa Union’s Vaccine Delivery Alliance (AVDA)

Thanks to those relationships, Caribbean countries like Jamaica, ultimately secured significant  vaccine supplies from African partners at a time when rich nation hoarding and the rise of India’s SARS-CoV2 Delta variant made vaccines almost impossible to secure.  

“And so we have done this before, this South-South collaboration… because we are the same people,” she said.

It was in that period that the initial framework for HeDPAC was laid, recounted Getahun, in an interview with Health Policy Watch

HeDPAC CEO Haileysus Getahun

“At the time, Prime Minister Mia Mottley of Barbados was the head of the CARICOM. She reached out to African Union president Uhuru Kenyatta (president of Kenya until 2022). She asked for collaboration between Africa and the Caribbean,” said Getahun.

“After that discussion, the first meeting of the heads of government of CARICOM and the AU was held in September 2021, which laid out clear steps for the two regions to collaborate.”

In November 2022, Mottley, Kagame [then AU champion for Institutional Reform],  and Guyana’s President Irgaan Ali met in Sharm el-Sheikh in November 2022 on the margins of COP27. 

Together with European Commissioner Ursula von der Leyen, Africa CDC and WHO’s DG, the African and Caribbean Heads of State etched the outlines for a new ‘transatlantic alliance for health and vaccine equity.’ 

The initiative quickly won  support in other quarters, including the International Finance Corporation, the World Bank’s investment arm, and several major philanthropies.    

“After observing the inequities and inequalities of COVID, we have to take the valuable lessons  and if a pandemic happens again, the valuable lessons will not be forgotten,” Getahun remarked.

Paul Kagame, Mia Mottley and Ursula von der Leyen at a meeting on the margins of COP27 in Sharm el Sheikh,  November 2022.

“What makes us unique is that we work with heads of government, ministers and political leaders at the highest level to advance a common vision of health development. We utilize political clout but without the handcuffs of a formal intergovernmental organization,” Getahun said. 

HeDPAC’s priorities emerged from a series of consultations of Ministers of Health from the two regions, he said, pointing out that all three pillars – manufacturing, health workforce and resilience – are all critical to greater pandemic preparedness as well as vibrant health systems more broadly. 

“These are the most pressing challenges, on which we will focus. The rationale is not to try to be everywhere.”

And while the first priority is fostering cooperation between like-minded African nations and the Caribbean, that mandate could eventually extend to promoting South-South collaborations more broadly, Getahun suggests.  

“We believe Africa-Caribbean partnership is the starting point, but we are also drawing interest from countries in other regions.’’

Learning from Rwanda’s experience with BioNTech  

International political leaders at the launch of BioNTech’s new facility in Kigali in December 2023.

As just one example of learning from others’ experience, Caribbean nations like Guyana are keen to see how they could duplicate Rwanda’s success in bringing a major pharma experience to their region.

In December 2023, BioNTech launched its first ‘BioNTainer’ in Kigali. The 35,000 m2 modular manufacturing facility is set to produce new mRNA vaccine candidates for malaria, tuberculosis and HIV for use firstly in clinical trials – followed by mass rollout if they are demonstrated to be efficacious.   

“There are many things that are happening in Africa. There are many things that are happening in South America, but very often the good things that happen on one side [of the ocean] are not shared with the other side,” said Guyana’s Minister of Health Frank Anthony at the WHA side event.

 “This will be a platform by which we can share what is happening between the two regions – and HeDPAC can be the bridge that allows us to do that.”

“From the pandemic we could see the needs and the inequities that exist because of lack of medicines or vaccines, and we don’t want that to be repeated. In some cases we had monies available, but we could not get the things that we needed.  

“And therefore, we thought that if we can fix this by locating manufacturing in our regions, so that when these things occur we can easily be able to access it, that this is going to be an important way to prepare for future pandemics.

“What Rwanda has done is major….  Using the mRNA vaccine platform can be a good way to produce other types of vaccines. And I think this is going to be the future. So if we can borrow what they have done, if they can assist us with accelerating [the process], that would be extremely positive. 

Using technology – hybrid courses and satellite health consultations 

At the same time, Caribbean nations also have valuable lessons to share.  

The Guyana Health Minister described how his country, with a widely dispersed population of just 800,000 people, has initiated a new hybrid programme of nurses training to rapidly expand the workforce. 

Guyana’s innovative nurses training initiative grabbed headlines in local media.

The online programme, developed through a collaboration with the University of Sao Paulo’s College of Nursing, enrolled nearly 1200 nurse trainees in 2023 its first year and plans to scale up further over the next several years.  

Simulation centres are being established in core health care facilities along the coast and in more remote regions, to allow students to participate in practicals that are essential for the Registered Nurses (RN) degree.     

“We can easily share that with other countries that are interested in using the courses that we have,” said Anthony. “You don’t have to move from Africa. You don’t have to move from the Caribbean. You will be able to go online and get these courses. That’s how we can share trying to find solutions to the problems that are facing us.”

Courses for community health workers also are being revamped, with health workers taught to use telecom and satellite technology to diagnose serious diseases in remote locations with the support of experts elsewhere. 

Satellite technology in rural Guyana enables high-quality telehealth consultations

“We call it ‘’tele-pathology’,” said Anthony, describing how high-resolution slides of suspect tissue can be quickly relayed to a partner hospital, Mount Sinai in New York City, to diagnose dangerous malignancies. 

Some two dozen clinics in remote regions of the country have been equipped with satellite technologies that allow doctors to “examine” patients remotely together with a local health worker to obtain a fast diagnosis in an emergency. .  

He shared the recent story of one patient whose life was saved through the quick action of a community health worker whose remote consultation led to the rapid diagnosis of life-threatening sepsis. 

“They called a medivac and he was airlifted to a hospital and operated on right away. Otherwise, he probably would have died by the time they figured out what’s wrong and got him to the hospital.”  

Elevating the status of community health workers  

Translating such stories of success into more systematic approaches is one of the big challenges that HeDPAC wants to facilitate, said Getahun. 

He notes that while community health workers are the foundations of primary health care, many  countries still treat them as quasi-volunteers, working for stipends and funded by donor grants – rather than as civil servants in the public health system. 

Catalyzing government moves to advance their status as regular civil servants is one important  HeDPAC target, he says. “This creates employment opportunities for women with far-reaching societal impacts’’.     

Mapping of Community Health Worker accreditation and salary status in Africa, Latin America and the Caribbean.

Throughout much of central and southern Africa, CHWs lack either regular salaries or accreditation.

In Rwanda, a PHC success story, CHWs are accredited but not salaried. But a major 4×4 reform of the health workforce launched in 2023 by the national government could lead to changes for that workforce as well. The 4×4 initiative is part of a broader Rwandan aspiration to quadruple the healthcare workforce and meet the WHO recommended goal of at least 4 health care professionals per 1000 people. 

And as an outgrowth of the new Africa-Caribbean links, doctors and nurses from Cuba are supporting Rwanda with training for its health workforce, said Rwanda’s Minister of Health, Dr. Sabin Nsanzimana.

“As we speak, a group of Cuban doctors has landed in Rwanda to support our 4×4 initiative,” he said. 

It takes guts…   

Ethiopian Minister of Health, Dr Mekdes Daba.

Regional collaborations in manufacturing and procurement will become all the more critical as countries seek to realize the promise and potential of the new African Vaccine Manufacturing Alliance (AVMA), experts also note. 

Only last week, AVMA secured commitments of more than $1 billion in finance at the kickoff at  the Gavi, the vaccine alliance replenishment drive co-hosted by France and the African Centres for Disease Control. The new initiative aims to facilitate the production of 60% of the continents’ vaccine needs with local supplies by 2040.  

Collective manufacturing and procurement arrangements are just as vital to small Caribbean nations that can’t possibly compete alone in global markets.  

“It’s so important to take a regional and cross regional approach, with south south solutions because it offers the possibility of creating economies of scale, and more sustainable production, and building thus a diversified production capacity,” said Johanna Hill, World Trade Organization Deputy Director. 

“Initiatives like this take guts and that’s where HeDPAC has been born – from that guts of taking into consideration South- South collaboration,” added Ethiopia’s Minister of Health, Dr Mekdes Daba.  

“I lost my grandma from COVID, a very dear, very dear person to me,” she added.  “We’ve [all] lost parents, family members, and it was very late for us to get the vaccine. So when things like a pandemic happen, we see how interconnected we are. 

“Now, it’s time to use this connectedness to realize our potential for South-South Collaboration.” 

This story was updated to note the postponement of the CARICOM meeting.

Image Credits: @DPA, HeDPAC, Caricom.org, PMO Barbados, Guyana Standard , Community Health Impact Coalition @Mapbox @OpenStreetMap.

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