Second opinion

Clockwise from above: Xu Ming, vice-president of China Chamber of Commerce for Import and Export of Medicines and Health Products; Teguest Guerma, director-general of the African Medical and Research Foundation; Mustapha Sidiki Kaloko, commissioner for social affairs of the African Union. Photos by Li Lianxing / China Daily

Fifty years after the first Chinese medics traveled to Africa to offer aid, the nature of healthcare collaboration is being re-examined

Tens of thousands of tourists make Zanzibar their holiday destination each year, drawn among other things by the Tanzanian islands' blessed seclusion. However, that seclusion, despite the millions of dollars it brings to the community each year, has long been a curse for its people, cut off from some of the things that make life livable. Not the least of these is medicine and healthcare to ward off and treat malaria, cholera, AIDS and other infectious diseases, constants of life there.

Shortly after Zanzibar gained independence from Britain 50 years ago, China has played a key role in helping Zanzibar grapple with such problems, sending medical staff to local hospitals. More than 24 Chinese medical teams have worked there since.

Malik Juma, director-general of Zanzibar's Ministry of Health and Social Welfare, received a loud round of applause recently when he said that over the years most residents of his community had had contact with, and benefited, from Chinese medical workers, who had soldiered on in tough living and working conditions without complaint.

He was speaking at the 4th International Roundtable on China-Africa Health Cooperation, in Gaborone, capital of Botswana, in May.

Since 1963, when China sent its first medical team to Africa, to Algeria, it has been unstinting in its efforts to improve healthcare in the continent, improving and saving the lives of millions of people.

Over that time, China and Africa have transformed themselves economically and politically, and the way China delivers its healthcare to the continent has greatly changed. Its role in helping Africa has gone well beyond sending medical teams, extending to helping with building infrastructure and with research. China has helped African countries build more than 100 hospitals and clinics and set up malaria control and prevention centers that have provided anti-malaria drugs worth more than $150 million, China's National Health and Family Planning Commission says.

It has also provided AIDS treatment based on traditional Chinese medicine. The flow of human resources has not been in one direction, with many African medical staff having been sent to China to be trained in infectious disease control, traditional Chinese medicine, nursing, hospital management and rural health.

While China's collaboration with Africa in health has remained consistent over the years, its character has changed depending on the needs of the time, says Cheng Feng, vice-president of Global Health Strategies Initiatives, an international nonprofit organization that works to improve health in developing countries.

"Before reform and opening-up began in the late 1970s, China's help to Africa, including expertise, medicines and other medical products, was given gratis, because China was in the frontline with Africa fighting for independence. But after the reform policy came in, China needed to shift its attention back to its own development and domestic issues in a time of dramatic transition."

With globalization and the establishment of a new international order, the two sides were given the chance to diversify their partnership in various areas, Cheng says.

"The change in the macro environment and changing conditions in China and Africa introduced more diversity and more opportunities."

Previously in China's dealings with African governments on health, organizations such as the United Nations and its agencies and the African Union were close at hand. The Chinese government was keen to ensure that its collaboration with Africa was not seen as commercial, says Ren Minghui, director-general for International Cooperation of China's National Health and Family Planning Commission.

"It was shy about commodities issues and didn't want to be seen as promoting commodities for commercial interests."

However, UN agencies, African countries and other international organizations urged the Chinese government to look at commodities, including vaccine, Chinese medical devices, medicines and even Chinese herbal medicines as critical ingredients in helping Africa, and in a highly efficient way, Ren says.

In recent years the interest in Africa by the Chinese private sector and individuals has grown greatly, because they have sensed great business opportunities through strengthened cooperation between China and Africa in health, says Xu Ming, vice-president of China Chamber of Commerce for Import and Export of Medicines and Health Products, part of the Ministry of Commerce.

"They think they can lift their products' international competitiveness, because to enter Africa their products need to be approved by the World Health Organization, and of course they also want a share of the African market in a broader sense."

The priority for the chamber is to provide more detailed and tailored information to enterprises interested in investing in Africa, because of the widely varying conditions in the continent's 54 countries, he says.

"We give them critical information regarding the investment environment in different countries, such as economic and political stability, social security, professional standards and other risks that members would need to evaluate given their own circumstances."

The chamber's knowledge of African markets is still incomplete, he says, but it is gathering experience along the way.

"We can provide vital guidance on market demand and marketing methods in different countries. For example, some companies that make chronic-disease medicines are extremely keen on investing in Africa, but we tell them Africa is not suitable for them, because right now the demand is for treating epidemics."

Xu says that before Chinese companies enter a market such as Africa it is crucial for them to familiarize themselves with local culture, legal systems and medicine policy, among other things.

"The challenge for Chinese companies is a lack of information because of the limited access or even unfinished policy structure in some countries. It's not like in the West, where you can get details such as how to register a product or how to open a factory from the Internet. In that regard, Africa's information is not well balanced and developed."

This is partly because although Africa has made conspicuous progress in health over the past few decades, its investment is well short of what is required, says Teguest Guerma, director-general of the African Medical and Research Foundation.

Africa is giving priority to industrialization and economic growth ahead of health, she says. "But you need to invest in health for economic growth and eventually African governments should allocate more resources to health if they want to develop their economies."

At present there are not enough incentives for Chinese companies to invest in health in Africa, and they remain skeptical about the investment environment, Xu says.

"The value of medicines and medical products made in China is more than 1.8 trillion yuan ($293.4 billion), but only 20 percent of them are exported. China has more than 20,000 companies in this field, but most still concentrate on the domestic market, even if they are aware of the opportunities overseas."

They should be properly guided and led to the international market, especially emerging markets including Africa, by working with the World Health Organization and other international organizations, Xu says.

Regulations need to be harmonized throughout Africa to encourage foreign healthcare investment, a daunting task given the number of countries and the issues involved, and it will take a lot of time to complete such a task, says Mustapha Sidiki Kaloko, commissioner for social affairs of the African Union.

"It is nearly impossible to give a timetable on a very detailed plan about the collaboration among member states regarding this issue. We want to create circumstances whereby we start something and provide something. Then we may ask for help from partners."

All member states need to work together to create a benign environment for foreign healthcare investment, he says, and the idea that "you put something in a bowl" to attract more investment needs to be dispelled.

Establishing more coordinated, business-oriented collaboration between China and Africa on health would benefit both sides, says Kolaatamo Malefho, permanent secretary in Botswana's Ministry of Health.

"We have agreed on the collaboration models. China supports Africa, and Africa in turn could come up with proposals that may enhance development in China in terms of meeting each other's internal demand for services and products. This is a building block for both.

"But collaboration on the transfer of know-how must ensure it is sustainable and that countries benefit. That transfer is a gradual process. It is still a challenge because we need to create the capacity to absorb the technology first. That is where the gap is, and it needs to be bridged."

Ren of China's National Health and Family Planning Commission, says the Chinese government is willing to support any technology transfer from China to Africa in medicine and health.

"We do have policies, and even subsidies, to encourage Chinese companies to work on this issue. Sometimes there are property rights issues, and reaching agreement may not be easy, but dealing with clinical services technology and skills is quite easy. You can't focus just on commodities when talking about technology transfer. Plenty of Chinese medical teams are working in Africa, and they have introduced a lot of new clinical technology to local staff."

Lucy Chen, executive deputy director of the Institute for Global Health at Peking University, says there are many opportunities for technology transfer from China to Africa in healthcare.

"In China we used to rely heavily on imported pharmaceuticals. Many of the world's biggest brands had joint ventures in the country over about 20 years, and some have left because the domestic pharmaceuticals industry has become very strong. It's a rare thing, moving from heavy dependence to essentially being independent in such a short time."

Embarking on joint ventures, particularly involving technology transfer, collaboration between China and Africa, Chen says, and China stands to benefit greatly because of the great number of partners available in Africa.

"Health is a distinct service industry. Health commodities are distinctly different, too, and you can't rely solely on government or the market. China has made painstaking efforts to develop its health industry from being labor intensive to being technology intensive, so it has something to offer Africa."

Any Chinese company wishing to become involved in healthcare in Africa has to be aware that there is no quick money to be made, as partnerships take time to build and mature, Chen says. Just as the Chinese companies reap the rewards of a long-term investment, Africa would then be a capable partner promoting Chinese medical specialties and expertise.

"Market principles have usually failed in Africa as the mechanisms have been unable to operate properly and people have not had the money to buy things. But when a market matures, everything follows market mechanisms, government intervention decreases and companies have to rely on their own performance for survival."

Now is a good time for Chinese companies to become involved in African healthcare, she says.

"The Chinese government should create and encourage the conditions that will allow more NGOs and private companies to join this partnership to refresh this 50-year-old relationship. China's method of medical collaboration with Africa has not made a huge difference compared with that of other international players because it has stuck to an approach dominated by medical teams."

This approach has been decentralized, being carried out as a political mission by the provinces, which now, with their medical teams, are trying to diversify their involvement in Africa and make it more professional.

"Some of them have sent out a highly coordinated specialized team and also short-term expert teams to Africa, which has made the assistance more effective and efficient. In this change, intellectuals play a vital role."

Ren of the National Health and Family Planning Commission says there is strong impetus from Chinese research institutes and think tanks to improve the China-Africa healthcare relationship. The institutions believe that if they worked together they could often play a more effective role than the government because bureaucracy in various bodies hampers programs.

Chen says the role of think tanks and research institutes in healthcare collaboration is irreplaceable.

"Some government officials have little knowledge about the overseas situation so it's quite difficult for them to make decisions. But think tanks and research institutes offer a way of doing research and working with international players.

"If we want to change the way we go about collaboration from being government-led to business-led, we need think tanks, because by their very nature private-sector interests are in conflict with government interests. Intellectual entities, on the other hand, don't have a self interest."

lilianxing@chinadaily.com.cn

(China Daily Africa 07/05/2013 page1)