Abdel Agadazi Archives - Camber Collective

Emissions, Climate Change, and Health

Rozella Kennedy — Thu, 07 Sep 2023 23:30:10 +0000

As we reduce emissions, let’s not forget about the impact of climate change on health

Climate change is affecting the air we breathe, the water we drink, and the quality of food we eat. Over the past decades, it contributed to a rapid increase in asthma cases and allergies and the spread of mosquitoes to higher hemisphere regions, with the US seeing the first cases of local malaria transmission in two decades [1]. The WHO (World Health Organization) projects that, all else equal, between 2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths per year from heat stress, malnutrition, malaria, diarrhea, and heat stress [2].

Extreme climate events have significantly increased over the past 50 years

Over the recent decades, extreme climate events have significantly increased, primarily floods, storms, and wildfires. This affects millions through population displacement, socioeconomic shocks, direct mortality, and health impact (Figure 1).

Figure 1. Number of extreme weather events and people affected [4].

Note: Each dot represents an event; the circle size represents the number of affected persons.

According to IPCC (Intergovernmental Panel on Climate Change) scenarios, global temperatures will continue to rise, causing more adverse effects on human health. The burden of many climate-sensitive health risks is projected to be greater at an increase of 2 ◦C above pre-industrial temperatures than at 1.5 ◦C., highlighting the sensitivity of health conditions to minor changes in global temperatures [3]. We outline examples of crucial health conditions expected to exacerbate if we continue our current trajectory in Figure 2.

Figure 2. Illustrative health effects of climate change [5]

Global warming with unequal local impacts

While global warming is measured against the global average target of 1.5◦C, the local impact varies significantly, with some regions bearing a significant burden. More countries are undertaking better vulnerability and adaptation assessments to understand the health risks they will face as temperatures rise. These analyses have highlighted the most vulnerable populations, often the elders, children, and people living in remote areas [7].

We have highlighted below in Figure 3 the projected temperature increase in select countries, highlighting the global disparities. Even the national average hides vast differences in the sub-national regions, with some areas extremely vulnerable to changing conditions. Rapid projected population growth in most countries will also contribute substantially to the number of people affected by temperature rises and extreme weather events.

Figure 3. Projected temperature changes under different climate-change scenarios and population growth between current and 2050. [8] [9]

What are we doing about it: Current funding trails projected need

While the scientific community and country priorities emphasize the growing challenge that the globe faces related to climate and health, funding commitments at the intersection of these sectors have continued to trail behind the projected need.

Development finance institutions (DFIs) have increased their commitments to climate in recent years and, on average, committed to nearly doubling their spending on climate from 2020 to 2025 [11]. Certain DFIs have even made ambitious commitments until 2030, including the Asian Development Bank (ADB) and the World Bank (WBG), which have committed to dedicating 75 percent of commitments to climate finance by then. While spending on climate has been increasing, the share of spending to mitigate health impact remains very low at under 6% of climate adaptation funding [10].

Figure 4. Breakdown of Adaptation spending by major MDBs in 2020/2021 [10][11].

Despite the recent push by some major development finance institutions to increase overall climate spending and adaptation spending as a percentage of this amount, total mitigation spending by multilateral development banks (MDBs) was still over three times that of adaptation spending in 2021[11].

The focus of development finance institutions on mitigation activity (vis-a-vis adaptation) or the importance of CO2 reduction as the defining metric to measure the impact of climate projects may explain their hesitation to shift funding into the climate-health nexus.

On the health side, DFIs bolstered their spending during the COVID-19 pandemic. Across four major MDB (WB, IDB, AfDB, ADB), health funding rose 3-fold from $3.8 billion in 2018 to $12.1B in 2021 [12]. Despite this pandemic-driven increase, the overall health sector constitutes a small portion of total funding and trends between 5% and 15% for most bilateral and multilateral institutions [13].

Despite the recent momentum in the climate and health sectors individually, funding at the intersection of climate and health has remained stagnant. It is not yet a stated focus of most funders.

The philanthropic sector has followed a similar trend as development finance institutions. While many philanthropies dedicate energy and funds to the climate and health sectors individually, few of these institutions have declared a focus at the nexus of the two. Wellcome Trust is one of few large foundations with an expressed focus on funding climate-health interventions, communicating the intersection as one of their three focus areas related to health [13]. This presents an opportunity for other foundations to direct capital to an underfunded sector to catalyze additional investments.

What’s holding us back: Key challenges to increase capital commitments

Funders face several challenges when deciding to invest in projects at the intersection of climate and health; if addressed, there is potential to vitalize commitments in the space [13]. These challenges range from a need for a shared definition and impact metrics for climate-health investments to a lack of robust evidence across these interventions.

Thoughts on a way forward

Considering the challenges depicted above, a range of actions can be undertaken to address the key issues hindering further commitments to climate-health initiatives.

Here are three recommendations to address the challenges outlined [13]:

The upcoming COP28 is a promising opportunity to delve deeper into this topic as it is the first COP conference that includes an entire day dedicated to the health sector. This global convening presents a unique occasion to gather key stakeholders to identify solutions to these challenges, garner momentum, and solidify commitments at the climate-health nexus.

Citations

[1] https://www.nytimes.com/2023/06/27/health/us-malaria-mosquitoes.html

[2] Climate change and health (who.int)

[3] Health risks of warming of 1.5″00B0`0C, 2″00B0`0C, and higher, above pre-industrial temperatures (iop.org)

[4] Data from EM-DAT. The International Disaster Database; Graphic produced with RAW Graphics.

[6] Data from https://www.ipcc.ch/report/ar6/wg2/chapter/chapter-7/; graphic produced in Microsoft PowerPoint.

[7] Climate change and health: vulnerability and adaptation assessment (who.int)

[8] Climate Risk Country Profiles | Climate Change Knowledge Portal (worldbank.org)

[9] World Population Dashboard (unfpa.org)

[10] How much bilateral and multilateral climate adaptation finance is targeting the health sector? A scoping review of official development assistance data between 2009–2019 – PMC (nih.gov) citing Lancet Countdown data.

[11] 2021 Joint report on multilateral development banks’ Climate finance (eib.org)

[12] Microsoft Word – 2023-04 Making it work – role of MDBs – final.docx (actionsantemondiale.fr)

Melissa Flores leverages her background in quantitative analysis and research to support clients’ strategic decision-making centered around social impact. Prior to Camber, Melissa worked as consultant at the UN World Food Programme, providing operational and programmatic support to the organization’s global food security monitoring initiative. Melissa began her career as a financial consultant, working on risk mitigation strategies for Consumer and Healthcare clients in the United States. She holds an M.A. in International Development from Sciences Po’s Paris School of International Affairs and a B.A. in Applied Mathematics from Harvard University.

Abdel Agadazi is a Camber Collective alum. While with the firm, he worked with clients on their strategy and investment planning via data-driven decision-making and market analysis. Prior to Camber, Abdel led consulting engagements at Accenture, supporting global clients on their digital transformation journey. He began his career building technology systems for optometrists and healthcare clients in the United States. Abdel is also involved in supporting entrepreneurs in Europe and Africa through growth and operational advice. He holds an MBA from INSEAD and a Master’s in advanced analytics from IMT Atlantique, a top-tier French engineering school. Abdel grew up in Lomé, and he enjoys cooking and playing basketball. Our Paris office mates look forward to seeing him strolling the streets as an amateur photographer.

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A Patient-Centered Health Model for Sub-Saharan Africa

NiiAmah Stephens — Fri, 02 Sep 2022 21:06:00 +0000

In most African countries, access to primary health has improved over the last 20 years, with 87% of people living less than one hour away from a health center in 2020[1]. Further, the current health system is designed around facilities where most patients seek primary health services. There are still, however, many barriers to quality health care access, such as high costs and crowded, understaffed, and under-resourced facilities.

Digital technologies can bridge the gap between the current health care offering and the increased demand driven by population growth and urbanization. Combined with human-centered design techniques, digital tech can help center the patient experience decreasing the pressure on health care systems while improving both patients’ and providers’ experience. By prioritizing prevention over treatment, healthcare systems can also save more lives, leveraging digital tech’s ability to help patients to track their health, eat better, and check in more regularly with doctors through remote care when a trip to a facility is inconvenient or inaccessible. Furthermore, a human-centered design approach would enable policymakers to understand which services are the most needed and learn the realities and constraints of their patients.

The Covid-19 pandemic, recent rises in inflation, and the economic downturn have all increased pressure on healthcare systems. More than ever, every dollar matters. We believe that countries wishing to invest in tailored and intelligent health services, and who focus on increased productivity (and efficiency) will be more resilient to these and future challenges.

Centering the Patient Journey in Healthcare Design
Countries will achieve higher positive health care outcomes if they put the context-specific needs, challenges, and beliefs of their patients at the center of future investments. Groups such as pregnant women, youth, or patients with chronic disease, for example, all have specific needs and encounter distinct friction points with the health care system.

In sub-Saharan Africa, pregnant women are particularly at risk. Indeed, 94% of all maternal deaths occur in the Global South.[2] Pregnancy necessitates many lifestyle changes and health care modifications; women must attend several ANC (ante-natal care) sessions to mitigate those pregnancy risks, and they must undergo regular health checks, comply with preventative medicine schedules, and adapt their nutrition habits. One study we analyzed across three sub-Saharan African countries revealed that only 44% of women attended regular antenatal checkups[3], with some women not seeing antenatal clinics early enough and others struggling to adhere to preventive treatment schedules. A deeper analysis showed that fear of being turned away, the constraints of social norms, and partner pressure are all factors which limit pregnant women’s engagement with ante-natal care services.

In order to design cost-effective solutions to increase the wellbeing of the mother and newborn, along with the efficiency of the entire health system, it’s necessary to deeply understanding what are the motivations and barriers specific patient groups experience. Below are examples of potential digital solutions that are simple to prototype and pilot and which demonstrate value-add and cost-effectiveness to global funders and private investors.

Mobile phones and internet access can be a game-changer in sub-Saharan Africa. The continent, on aggregate, enjoyed a mobile connectivity coverage rate of 81% in 2021.[4] With increased affordability of mobile phones, there already exists a sufficiently large base of patients to pilot these initiatives. Furthermore, as the share of adults accessing financial services in the Global South [5] it has become easier to build sustainable business models and monetize patient-centered health services. Once tested and scaled, such approaches could engender a virtuous cycle for the health systems of many countries in the Global South.

Enhance the Patient-Provider Relationship
While promising, digital tools aren’t meant to replace human interaction entirely; many patients want and need personal connectivity and a tactile experience in their heath care visit. Patient-centered solutions that engage and inform patients outside the facility can empower them to better understand and adopt providers’ counsel and also diminish the risks associated with unnecessary and/or harmful self-medication. At the same time, person-to-person contact enables providers to access individualized data, refine diagnoses, and increase empathy with patients. Face-to-face health care visits also provide a quicker feedback loop regarding the patient experience and the quality of care.

Prioritize Familiar Use-Cases for Vulnerable Groups
We believe policymakers should begin with several small experiments in order to test and better understand the needs of different patient groups. Combining qualitative human-centered approaches such as in-depth interviews, focus groups, and patient observation with quantitative methods including latent-class segmentation, discrete choice modeling, and patient data mining will provide comprehensive insights into patient preferences. Further, patient insights should be contextualized within the existing health infrastructure, so that care givers can obtain a comprehensive view of the opportunities and needs across the current infrastructure.

Organize for Scale
Countries face numerous challenges, from siloed initiatives that only partially scope the landscape and its opportunities, to the barriers of limited resources and buy-in. Therefore, delivering the expected results can be a challenge. Pulling all the innovation initiatives under the autonomous and lean oversight of a single organization is one way to increase efficiency and generate synergistic benefits. For example, a digital health ‘factory’ made of multi-sectoral expertise in health, public policy, design, and technology would enable countries to rapidly develop and test new prototypes and approaches. Once the business case is established, promising use-cases could scale to broader implementation with local and international partners.

Strengthen Local Partners
Trusting and empowering the local talent pool and working with local startups and service providers is a critical component of innovation acceleration. The “digital health factory” would be essential in building market-relevant business models that appeal to the private sector. At the same time, the public sector needs to de-risk its mechanisms in order to incentivize entrepreneurship into the sector. Ultimately, each country’s health system model will scale in its own specific context, taking into consideration the existing model, policies in place, and the maturity of the tech ecosystem. This said, the time for countries to experiment with innovation in the sector is now: doing so will leverage data and empathy alike to build resilient health systems that improve patient journeys throughout the continent.

[1] (PDF) Planning universal accessibility to public health care in sub-Saharan Africa (researchgate.net)
[2] Maternal mortality (who.int)
[3] Camber ANC analysis of recently pregnant women in Côte d’Ivoire, Cameroon and Malawi. 44% attending more than 4 ANC visits.
[4] The-State-of-Mobile-Internet-Connectivity-2021-Sub-Saharan-Africa.pdf (gsma.com)
[5] The Global Findex 2021: Interactive Executive Summary Visualization (worldbank.org)

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Sub-Saharan Africa: the Digital Health Imperative

Abdel Agadazi — Fri, 12 Nov 2021 23:22:25 +0000

The authors wish to thank Patrick Russel and Natacha Mugeni for their contributions to this article.

Public healthcare spending has doubled in sub-Saharan Africa over the last two decades, with the per capita going from $100 in 2000 to $205 in 2018^[1]. But, despite this progress, access to primary care remains a challenge for many people. In remote areas, it’s still difficult and costly to access a doctor, a nurse, or the appropriate treatment. Six out of ten people^[2] are not covered by Universal health coverage schemes, and for those covered, the out-of-pocket expense is significant and can be as high as 76% in Nigeria^[3]. Moreover, going to the hospital is associated with bad personal experiences for many people discouraged from seeking preventative care. The challenge is even daunting when we factor in the population growth on the continent. By 2050, the continent’s population is projected to double to 2.5 billion people, with one in four people in the world living in Africa. The healthcare sector needs a massive increase in productivity to address this challenge, and we cannot see it happening without bringing in new innovative approaches and leveraging digital technologies.

Provide better health through digital

With the recent uptake in smartphone and internet usage, there is an opportunity to take a different approach to quality and cost-effective primary health. Digital health services could transform people’s experience with healthcare. Even in rural areas, internet uptake has increased to 60% in some countries such as Senegal and Zimbabwe^[4]. Seeking a doctor consultation could be as simple as pulling out a phone to book a virtual appointment. The patient could order her medication through an e-commerce health platform doing last-mile delivery in rural areas. This scenario is already a reality in Kenya, but most people in sub-Saharan Africa are not yet benefiting from this opportunity. Given population growth projection for the next decades, this opportunity is one that stands to grow exponentially.

GSMA_ME_SSA_2021_Infographic_Spreads.pdf and State of the Industry Report on Mobile Money 2021 (gsma.com)

The good news is that Africa is only at the onset of its digital health journey, and we are seeing the rapid growth of highly scalable innovations that have the potential to disrupt global health. Startups like Kasha and Totohealth are bringing concrete and fast-to-market digital health and self-care solutions for women with novel business models that benefit both patients and providers in urban and last-mile environments. Focusing on the customer experience helps these businesses to improve patients’ interaction with primary health and enhances spaces such as self-care. Other players such as Crib MD are building on-demand preventive care platforms. Beyond primary care, BIMA seizes the opportunity to safeguard people from economic shocks by providing cost-effective health insurance.

Unfortunately, too few of these solutions are available at scale and customers without access to smartphones are not often prioritized. Entrepreneurs face multiple challenges to bring their products to the masses and reach those still using a basic mobile phone. It is important that whilst we acknowledge the power of digital health care and the benefits it provides, we do not forget those who do not have easy and affordable access to digital solutions. We believe there are complementary opportunities between these private initiatives and the public health systems to build affordable, cost-effective, and sustainable primary care services to the hard-to-reach.

Seizing the digital health opportunity

Our experience suggests that building platforms that bring together startups, public health systems, and regulators will enable countries to take advantage of the digital health opportunity fully. Similar approaches have yielded benefits in other countries. For example, Doctolib, a French startup offering online doctor-appointment services, has increased access to providers with a user-friendly experience, an area in which the public health offering was lagging. During the Covid-19 pandemic, public bodies, startups, and regulators collaborated closely to make PCR-tests and vaccine appointments widely available, leading to other innovations such as ChronoDose or ViteMaDose^[5], built as soon as the vaccines were available.

Empathize with patients

Getting a deep understanding of patient needs and behaviors is the best place to start for all ecosystem actors, that way platforms are built with a customer first approach. Patients need a space to share their pains and aspirations, which are necessary to build sustainable digital health products and services. Additionally, each country is different, and understanding people’s cultural norms, behaviors, and specific digital profiles will increase digital health adoption and utilization.

Create space for entrepreneurs to grow

Enabling the new digital health startups to emerge should be a priority for countries. It starts with standard innovation building blocks such as dedicated support, mentoring programs, coupled with eased access to financing to demonstrate product-market fit. For digital health, it also requires evolving the regulatory framework to enable use cases such as remote consultations and task shifting while protecting patients’ data and privacy.

Experiment boldly within the public health systems

Too few health systems are digitalized today, data is not collected, and most investments provide basic needs. While this remains critical, bringing technology could bring massive operational efficiencies within the current healthcare systems and improve patients’ experience. But it requires a bold vision to bring the technology within the public health system. Starting with patient-facing services could be an excellent place to begin building a digital and data-driven culture within public health agencies. The future of public healthcare relies on engaging new models alongside the traditional public health models and leading with successful public-private partnerships or success.

Share and collaborate

Public health systems have an established distribution system across countries, and startups have innovation and the ability to deliver market-ready products with a novel business model as well provide traceability back to the provider. Learning platforms where people will learn from each other through local organizations are critical. These platforms will help entrepreneurs understand the challenges in the healthcare systems while exposing public health bodies to the innovation mindset that startups bring. Finally, collecting and sharing data through open data platforms will be critical to foster concrete solutions that will ultimately benefit the patients wherever they are.

[1] Current health expenditure per capita, PPP (current international $) – Sub-Saharan Africa, European Union | Data (worldbank.org)

[2] UHC service coverage index – Sub-Saharan Africa | Data (worldbank.org)

[3] Out-of-pocket expenditure (% of current health expenditure) – Sub-Saharan Africa | Data (worldbank.org)

[4] DHS Survey : Usage of internet, ownership of a mobile phone

[5] Vite Ma Dose : trouvez un créneau de vaccination COVID-19 (covidtracker.fr)

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