How Germany’s bilateral health programmes forge public-private cooperation for more resilient health systems
The coronavirus pandemic highlights the critical importance of resilient health systems for the management of outbreaks and efficient healthcare provision for all. To strengthen them, the public health sector and private healthcare industries need to work together. GIZ’s extensive in-country experience and contacts can act as a catalyst for such collaboration.
Change happens fast – and in the case of the coronavirus pandemic so fast there has hardly been time to blink or think. ‘Six months ago it was a different world,’ says Dr Axel Klaphake, Director of Economic and Social Development for Deutsche Gesellschaft für Internationale Zusammenarbeit GmbH (GIZ). Coronavirus, he says, has changed everything and underlined the importance of health to every sector of society and the economy, as well as the linkages to the environment and climate change: ‘The health sector should be at the heart and focus of every development organisation.’
The German Health Alliance (GHA) is a firm supporter of this position. Founded in 2010 (originally as ‘German Healthcare Partnership’) by the German government and the Federation of German Industries (BDI) the initiative represents German organisations active in international health, including healthcare industries, consulting firms, non-governmental organisations, GIZ and KfW Entwicklungsbank. According to GHA Chairman Roland Göhde, ‘We all know the collateral damage caused by COVID-19. Its impact will lead to millions of deaths, economic suffering and hunger. Coronavirus has shown that health is one of the most important development topics of our time.’
This article considers why German health industries value Germany’s technical development cooperation so highly, and how the challenges of the COVID-19 crisis are also an opportunity for stronger collaboration between these two.
The COVID crisis calls for intensified collaboration with the private sector
Over the past two decades it has become increasingly apparent that the private sector has an important contribution to make to global development, specifically in infrastructure- and technology-intensive fields, if meaningful progress is to be made towards the Sustainable Development Goals (SDGs) by 2030. As a result, GIZ has involved the private sector in many development cooperation projects it implements for the German Federal Ministry for Economic Cooperation and Development (BMZ).
Around the world, the current crisis has highlighted the dual need for strong and resilient health systems – a longstanding focus of German technical cooperation in health – as well as for innovative technology, testing kits and PPE produced by private sector companies. Many of these companies, however, are hesitant to enter unfamiliar markets and invest in countries whose health systems, decision makers and political framework conditions are unfamiliar or where existing health systems do not have the capacity to use their technologies, equipment or medicines to best effect.
A catalyst for collaborations between the public and private sectors
In this situation, German Development Cooperation and specifically GIZ can play a critical role as a catalyst for collaborations between the public and private healthcare sectors. With experienced staff in many of the countries where healthcare companies may like to invest, existing bilateral health programmes implemented on behalf of BMZ can facilitate fruitful new partnerships between partner countries’ government agencies and private sector companies. Such partnerships can help to both mitigate the immediate crisis of the pandemic and serve the longer-term development goal of affordable quality healthcare for all.
‘The COVID crisis has intensified our collaboration with the private sector,’ says GIZ’s Dr Axel Klaphake. Now, in response to the coronavirus crisis, BMZ has accelerated that process by setting up a corona task force and adding additional funding for development partnerships that involve German and European private sector companies in projects GIZ implements on its behalf. However, there is still huge potential for further cooperation between the public and private sectors, and the urgency of the pandemic response illustrates the political, economic and social imperative of driving this momentum forward.
Building on established strengths
Roland Göhde of GHA says Germany’s long and respected expertise of supporting health programmes in partner countries and their in-country structures are really useful for German companies developing and producing innovative healthcare products and medicines: ‘When German companies embark on new ventures and cooperation initiatives in developing countries, being able to build on Germany’s established bilateral cooperation structures makes all the difference for them. The direct relationships BMZ-supported bilateral health programmes have with the relevant institutions and with all health system stakeholders cannot be replaced.’
Dr Susanne Grimm, senior health expert and focal point for Global Health/pandemic preparedness including cooperation with the private health sector at GIZ head office, confirms that GIZ’s health programme experts are well integrated and trusted advisors to partner countries’ governments. They know the country context and the health systems’ strengths and weaknesses and are experts in capacity development for health system strengthening, including the effective use of new technologies and products that only private sector companies can provide.
German pharmaceutical and health technology companies are keen to contribute
Many of German development cooperation’s partner countries would like to strengthen their health systems to deal more effectively not only with emergencies such as COVID-19, but also to manage the growing burden of non-communicable diseases. At the same time, Germany has large and innovative pharmaceutical and health technology sectors keen to expand into new markets in low- and lower-middle income countries.
However, market access alone is not enough says Frank Strelow, Vice President of Bayer’s Global Healthcare Programme: ‘It’s not just bringing our medicines at a lower price to sub-Saharan African markets that will do the trick. Our products have to be introduced, they require a certain infrastructure and there has to be sufficient knowledge amongst doctors and health workers to ensure their safe use.’
‘German pharmaceutical and health technology companies and our partner countries’ governments have a common goal: They need health system strengthening to attain their objectives,’ says Wolfgang Jessen, in-charge of the GIZ business development project `Cooperation with the healthcare industry‘. ‘Without functioning health systems there are no opportunities for German companies.’ Conversely there is a growing demand from partner countries for access to high quality technology, state-of-the-art pharmaceutical products and expertise. ‘Both sides have realised that they need each other – and that’s where we come in: as German Development Cooperation, we can help them unlock their synergies.’
An inspiring example: The Ghana Heart Initiative
‘Only if the health system works, can you then treat specifics,’ says Bayer’s Frank Strelow, That’s why in 2018 the company decided to ‘commission GIZ to help contribute to strengthening Ghana’s health system through the Ghana Heart Initiative (GHI) a two-year project training health workers and doctors to recognise and treat the growing burden of cardiovascular diseases.
‘It’s a change process,’ says Strelow. ‘You have to develop health workers’ diagnostic capacities, provide relevant reference materials, build referral networks and create new routines in the hospitals.’ As a first step the Initiative has supported the development of clear, specific and implementable guidelines for the management of cardiovascular diseases. The Initiative is now scaling up for a second phase with enlarged technical and geographical scope.
Implementing the GHI with support from GIZ’s Ghana programme has been an invaluable experience, says Frank Strelow: ‘It is fun working with them. You don’t need to worry about the details like compliance, stakeholder management and transparency because the local GIZ team is professional, well-connected and well-managed.’
In the past few months, however, the COVID-19 pandemic has had a huge and disruptive impact on development programmes around the world – including the Ghana Health Initiative. By 30th June, Ghana had 17,357 confirmed cases and 112 deaths. GHI is no longer able to conduct face-to-face training due to partial lockdown, and although the project’s focus are non-communicable heart diseases, rather than infectious diseases per se, the project is now donating personal protective equipment (PPE) to protect Ghana’s frontline healthcare workers. In spite of this immediate disruption, the Initiative’s long-term aim of strengthening diagnostic capacities and creating reliable routines in hospitals for cardiovascular diseases will also help to cope with diseases like COVID-19 in the future, says Frank Strelow, especially given the growing evidence of and understanding about the links between underlying conditions such as heart disease, diabetes and obesity and COVID-19 outcomes.
New partnerships against COVID-19
‘I have worked a long time in Africa and I see collaboration between the private sector and GIZ health programmes as highly efficient in catalysing development,’ says Dr Holger Till, GIZ Team Leader for Development Partnerships (develoPPP.de) in health in Ghana. He says the coronavirus emergency, whilst presenting a plethora of challenges, is also an opportunity to develop further partnerships between Ghana’s health system and German and Ghanaian private sector companies.
In one such partnership GIZ linked up six Ghanaian hospitals with a Berlin-based hospital engineering company. The company will support the installation and maintenance of BMZ-funded equipment for intensive care units (ICUs), including 14 ventilators, and train Ghanaian teams in what they need to know to maintain them in good condition. The partnership will enable hospitals to treat critically ill COVID-19 patients. In addition, it reassures hospital staff to know that, should they get infected and fall ill, the ICUs will be there for them too. According to Dr Holger Till, keeping staff healthy and motivated keeps the health care system functional in times of crisis.
Another private sector partner GIZ brought on board to work with the Ghana Health Service for the coronavirus response is a small Ghanaian company called Oasis which included COVID-19 in their existing health information app called BISA (which means ‘to ask’ in the local Twi language). With BMZ funding, the BISA team and the Ghanaian Health Services disease surveillance and health promotion departments train final-year medical students in telemedicine. The telemedicine team will be available to discuss caller’s symptoms, refer patients for either treatment or self-isolation and then follow up with people who are self-isolating with a daily call for two weeks. The app should be up and running by July and that with adequate data protection, the information generated will be available for research purposes.
Dr Till believes that many of these new partnerships will become the handmaiden to more sustainable, longer-term and systematic partnerships between partner countries’ health systems and the private sector.
‘Now is the time to act’
Like many other international development organisations, BMZ has been assessing how best to prioritise development resources in the coming years. The growing global focus on climate change, the environment and other issues, has led to competing claims on financial and human resources and a considerable debate about future priorities. Now, coronavirus is forcing further reassessment, reorientation and transition as the world struggles to come to terms with the new reality and how to pick up the post-pandemic pieces.
The GHA strongly believes that Germany’s bilateral health programmes should continue to be a priority, arguing that in-country expertise has an important role to play in health system strengthening. In two open letters to BMZ, Chairman Roland Göhde made a case for BOTH bilateral programmes and a mixture of increasing multilateral relationships to meet the complex challenges of containing coronavirus, as well as health system strengthening and implementing the SDGs.
At the GHA Annual General Assembly, held on 24th June 2020, Dr Maria Flachsbarth, BMZ’s Parliamentary State Secretary, pointed out that BMZ has decided to set up a new department ‘Global health; economics and trade; rural development’ with a subdepartment focusing on global health, pandemic prevention and One Health. In conjunction with a recent parliamentary initiative on health in Africa and German industries’ expressed interest to contribute, BMZ’s internal restructuring can be seen as encouraging sign that health continues to be high on Germany’s development agenda.
Roland Göhde, the GHA’s Chairman strongly believes ‘health must be a core priority.’ Spending on health is certain to be a worthwhile investment, he argues. ‘It would be a global disaster if the coronavirus wake-up call was not taken seriously. Now is the time to act.’
Ruth Evans, July 2020