Africa-India Health Partnerships

Professor T. C. James ANALYSIS Healthcare

The Third India-Africa Forum Summit, held in New Delhi in October 2015, announced ambitious programmes for development of cooperation between Africa and India. Health is a major sector for such a partnership. The Indian Prime Minister, in his final statement at the Summit, declared that “India’s expertise in healthcare and affordable medicines can offer new hope in the fight against many diseases; and give a newborn a better chance to survive”.

Africa and India have much in common in developmental aspirations, particularly in social sectors like health and education. India and many countries of Africa have shared certain parts of colonial history and inherited common institutional architecture in those sectors. They also have comparable problems having traversed similar paths. This makes them empathic partners in the process of development of the healthcare sector. They also have common goals of progress towards Sustainable Development Goals (SDGs) including the one on ensuring healthy lives and promoting well being for all at all ages (SDG3).
Realising this, both Africa and India had engaged in building on their healthcare sectors in a partnership model in the past. India had shared its experience, institutional and human resource capabilities and technical expertise with countries of the African continent. In the process, it also gained valuable insights useful for its own developmental needs. The experience of the cooperation during the last two decades in shaping healthcare in Africa brings out the potential that such cooperation has for the future.

The role of cheap Indian generics in combating HIV in the African continent is well recognised. According to Janice Lee (2010), a pharmacist who worked with medical teams in Médecins Sans Frontières (MSF) projects in Liberia and Zimbabwe, 80% of the AIDS medicine that MSF Access Campaign uses in Africa are made by Indian companies (www.doctorswithoutborders.org/news-stories). This reliance is not restricted to AIDS alone but extends to TB, malaria and many other infectious diseases. Affordability being the toughest hurdle in the provision of healthcare anywhere, the availability of generally affordable Indian generics has significantly contributed to Africa’s and India’s achievements in health-related Millennium Development Goals. No wonder India’s pharmaceutical exports to Africa, especially in the formulations sector, had grown from less than US$250 million in 2000 to almost US$3.5 billion by 2014. India accounted for 17.7% of the total pharmaceutical imports in Africa in 2011 (Pharmabiz, 2012).

But the relationship in the health sector between Africa and India is not one of mere trade relations in drugs and pharmaceuticals. It has gone much beyond that into a real partnership in capacity development. India is one of the few developing countries that acquired all-round manufacturing capability in the pharmaceutical industry to such an extent that Indian firms felt confident in investing in the pharmaceutical sector in other countries. India’s investment (FDI) in Africa in the pharmaceutical sector during 2008 to 2014 was to the tune of US$245.56 million (source: Reserve Bank of India monthly data). Major Indian firms which have been active in the field of pharmaceutical trade and manufacturing in Africa are Cipla Ltd., Ranbaxy Laboratories, Dr. Reddy’s Laboratories, Glenmark Pharmaceuticals, IPCA Laboratories, Parenteral Drugs, Emcure Pharmaceutical Ltd., Aurobindo Pharms Ltd., JB Chemicals, Cadila Healthcare, Lupin Ltd. and Intas Pharmaceutical Ltd. Some of those companies have made huge investments and set up distribution networks across the continent. Having already made a beginning, this activity can make much progress in the years to come since Africa is in need of drugs and medicines in large quantities, preferably locally manufactured.

Indian firms have introduced certain innovative schemes and programmes in the health sector in Africa. In the case of HIV/AIDS therapy, the lead taken by Indian companies has really paid off. Cipla’s Dollar a Day Treatment Programme for HIV/AIDS was one such scheme which brought affordable medicines to needy patients in Africa. That company also introduced the innovative ‘Mother-Baby Pack’ for preventing mother-to-child transmission of HIV/AIDS. This was done in collaboration with the United Nation’s Children Emergency Fund (UNICEF) and other partners. The pack contains a range of anti-retroviral drugs and antibiotics required by an HIV-infected mother.

Two notable features of the Indian presence noted by commentators is the integration of local talent in their operations, along with the quality and cost of the medicines (Aparajita Biswas, “Indian Investors Seeking Markets and Business Prospects” in India and Africa’s Partnership: A Vision for a New Future, edited by Ajay Kumar Dubey, Aparajita Biswas, 2016). Indian firms have also taken the lead in introducing new drugs, such as Synriam for the treatment of malaria, to the African market. Ranbaxy have introduced nine new products, including Valaciclovir, Imipenem and Cilastatin, in one year alone (African Business Magazine, 2012).

Domestic capabilities in the pharmaceutical sector need to be built up in every country in order to ensure that its healthcare needs are met without hitches and independent of the ups and downs in international relations. Many Indian pharmaceutical companies, such as Cadila Healthcare, Lupin Laboratories and J B Chemicals and Pharmaceuticals Ltd., have invested in the sector in Africa by setting up subsidiaries or joint ventures, some of them with the national governments. Their experience in developing the industry in a country like India can contribute to the development of manufacturing capability in this vital sector in African countries.

Along with the private sector, the government of India also took steps to further the cooperation between Africa and India in the healthcare sector. Some of the notable initiatives are Focus Africa programme, Team-9 Initiative, Pan Africa e-Network and Telemedicine. Under the Focus Africa Programme, lines of credit were opened up for trade with Africa and the pharmaceutical sector benefitted from this one. The Techno-Economic Approach for Africa-India Movement (TEAM) initiative contributed to technology transfers in the field of pharmaceuticals (RIS 2015).

The Pan-Africa e-Network, launched in 2009, includes telemedicine as one of the major elements. It envisages setting up an e-network connecting the entire continent of Africa. Under this telemedicine project, medical practitioners at the patient-end locations in Africa can consult online an Indian medical specialist in various disciplines/specialities. Patient Consultation Centres have been set up in 12 super speciality hospitals in India including the All India Institute of Medical Sciences, New Delhi, Apollo Hospitals, Chennai, Escorts Heart Institute and Research Centre, New Delhi, Narayana Hridayala, Bengaluru and Fortis Hospital, NOIDA (RIS 2015).
The network also provides continuing medical education services through interactive sessions in select disciplines and subjects, thereby contributing to human resource development in this vital sector in a cost-effective manner.

Because of the cost factor, large numbers of African nationals come to India for medical treatment. In 2013 alone about 20,000 people from Africa visited India for medical treatment, thus highlighting the potential of this important field.
The India-Africa cooperation extended to setting up healthcare infrastructure facilities in Africa, with the Apollo hospitals taking a lead in the matter in 2003. Vision Care Appasamy Eye Hospital in Lusaka is another such venture.

Considering the similarities of the issues and problems which Africa and India face in the health sector and their commitment to achieve the SDGs, there is ample scope for continued cooperation between the two partners, building on each other’s strengths. For one, India has its strength in the manufacture of generic drugs. It currently produces over 400 bulk drugs and 10,000 formulations. Most countries in Africa are in need of developing manufacturing capability in the pharmaceutical sector. India should offer generous term partnerships with its technical and financial resources in this area, nurturing the African pharma industry.

Setting up healthcare infrastructure, such as hospitals and dispensaries, poses a major problem in many low-income countries. While a developing country, India has a large healthcare infrastructure, including tertiary level super speciality hospitals. This is an experience which can contribute to Africa’s efforts to establish widespread and comprehensive healthcare facilities throughout the continent.

The growth of India’s generic pharma industry was consequent on certain changes introduced in the overall government policy and laws, particularly patents laws, in the 1970s. While every country has to have its own policies which suit its local conditions, learning from each other is the way forward. India’s experience in this sector can profitably be shared.

Research and development (R&D) is an area much neglected in most developing countries for various reasons. One reason for this is that the current model available is highly resource intensive and institution based. Overall the approach of countries of Africa, Asia and South America needs to be towards cost-effective solutions to the health needs of the people, instead of merely copying the models available in high-income countries. In this regard, the open model developed by India in the form of Open Source Drug Discovery (OSDD) is one which raises hopes. This is a model which, appropriately adapted to local conditions, may suit many of the low-income countries as it is less costly and attracts participation by large numbers of institutions and scientists.

The African continent and India have rich heritages of traditional medicine. India and some countries in Africa have already taken steps to integrate the traditional systems with the modern system in their healthcare programmes. The two partners can and should cooperate much more in this matter and ensure that traditional medicine and knowledge systems get their due place. R&D based on traditional knowledge can bring out sustainable medical solutions which meet with local cultural and social ethos.

In the light of the Third India-Africa Forum Summit, both sides need to push forward for deeper partnerships in healthcare, with a view to reaching the goal of providing affordable and quality healthcare to their populations. In view of the present state of the world’s economies, governments will have to be facilitators of such efforts rather than the actual players. They will have to create a congenial environment through policy interventions and providing financial incentives and support wherever needed, such as through the India-Africa Health Fund announced at the summit.

Written by

Professor T. C. James is a Visiting Fellow at Research and Information System for Developing Countries, New Delhi, India. The views expressed in the paper are personal and do not reflect the views of the organisation. The paper is based on India-Africa Partnership in Health Care: Accomplishments and Prospects by T. C. James et. al, RIS, 2015)