OPINION

Outwards to Africa

Shahid Jameel  

New Delhi’s Vigyan Bhavan will host leading health researchers and policymakers from Africa and India on September 1-3. This India-Africa Health Sciences Meet (IAHSM) is a follow-up of the India-Africa Summit in October 2015, at which Prime Minister Narendra Modi announced India’s intent to partner Africa. To accomplish this, he proposed a $100-million India-Africa Development Fund, a $10-million Health Fund and 50,000 scholarships for African students to study in India.

Shared assets and challenges

Africa and India together cover about a quarter of the world’s land area, support over a third of its population and harbour about half of its disease burden. Infectious diseases such as tuberculosis, malaria, HIV/AIDS, childhood diarrhoea and respiratory infections remain big challenges. However, both regions are witnessing a shift towards non-communicable diseases such as diabetes, cardiovascular disease, mental illness, etc.

Africa and India also share an important asset in their young populations, about half of which is below 25 years of age and aspires to have the knowledge and technical skills to participate in their economic growth. Science and technology is increasingly seen as the centrepiece of development and should provide these young people the tools to tackle not just health and well-being, but other important challenges such as energy, climate change, food, water and sanitation as well.

Despite significant challenges, both regions spend less than 1 per cent of their GDP on S&T and are home to low numbers of researchers. Against the U.S. and Europe, which have 2,640 and 1,990 researchers per million of the population, respectively, India and Africa have only 137 and 70. Not surprisingly, each contributes only about 2 per cent to the global knowledge pool.

While Africa is quite diverse, the numbers show poor capacity in the health sector, especially human resource. It has a very low density of physicians and nurses, which stand at 2.7 and 12.4 per 10,000 people, respectively, against a world average of 13.9 and 28.6. This is also reflected in hospital beds and specialised medical equipment. Even though its own health indices are nothing to be proud of, India’s engagement with Africa is growing at a rapid pace in the sunrise sector of health care. Besides the private sector, Government of India initiatives such as ‘Focus Africa’, ‘Team-9 Initiative’ and ‘Pan-African e-Network Project’ have a significant investment on health care. The telemedicine initiative has enabled a number of super-specialty hospitals in India to be connected with physicians in Africa, impacting not just health tourism in India, but also capacity building in Africa through continuing medical education (CME) credits.

In 2014 India exported medicines worth $3.5 billion to Africa and the foreign direct investment (FDI) by Indian pharmaceutical companies in Africa was $67.4 million. Affordable anti-retroviral drugs from India have been instrumental in containing Africa’s HIV/AIDS epidemic. India is also a frequent destination for Africans seeking specialised treatment for cancer and other ailments. In 2013 about 14 per cent of African visitors arriving in India came for medical treatment.

Health research, partnerships and innovation

With India aspiring to be a ‘knowledge economy’ and a global power, it must also use health research and innovation to improve people’s lives at home and overseas. Some key partnerships to build capacity, support health research and promote innovation have developed between international funders and either Africa or India. These African and Indian programmes should learn from each other and together build sustainable science-based partnerships. A useful trend with international funders now is to recognise the value of local decision-making and management. This will positively impact the partnerships.

Why is there a special case for India and Africa to collaborate in health? Both face similar challenges and India has sufficient and contemporary experience in tackling health-care issues in the context of a developing country. India has clear strengths in its generic pharmaceuticals industry, and due to early development of its higher education sector, it has a large human resource in the health sector as well. These can be leveraged for capacity building in Africa. The health challenges facing Africa, India and other developing countries are not attractive for big pharmaceutical companies due to low profit margins. As a result, the pipeline for medicines and vaccines against many of these neglected diseases remains sparse. Both Africa and India have a rich heritage of traditional medicine and will have to develop their own low-cost approaches. India has developed not just high quality institutions in basic, clinical and public health research, its alternative models of drug discovery, such as the Open Source Drug Discovery (OSDD), can provide interesting options. The Council of Scientific and Industrial Research (CSIR, India) is already championing the OSDD model for TB and malaria, both highly relevant for Africa as well.

An agenda for India-Africa cooperation

The Indian pharmaceutical industry’s outward FDI to trade ratio for Africa being low, there is ample scope for this sector to invest in Africa. For an aspiring global power, the India story will mean more if “Make in India” is extended to “Make with Africa”. The Health Science Meet this week should discuss the challenges and partnerships for Africa-based manufacturing, investment mechanisms, alignment of the regulatory frameworks and how best to leverage the funds announced by Mr. Modi last year.

The meet should also discuss research capacity in the two regions and identify strengths, weaknesses and potential partnerships. Disease priorities and areas of research focus should be outlined for future collaboration.

India’s ‘Look Africa’ policy can be a game changer if it also becomes an engine for knowledge generation and innovation. The India-Africa Health Fund should be used to build capacity by training African health-care workers and researchers in Indian hospitals and research laboratories. Some of the 50,000 scholarships over the next five years should also be used to train African students in basic, clinical and public health research at Indian universities and institutes. Capacity building, biomedical research and innovation should become central themes for discussion at the IAHSM. This will make the partnership sustainable and valuable.

Shahid Jameel is CEO, The Wellcome Trust/DBT India Alliance, New Delhi.



The Health Fund should be used to train African healthcare workers

in India