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EF: What are the lessons learnt from this very atypical year navigating a pandemic? 

BN: First and foremost it has been to lead with empathy. At the same time, it has been critical during this atypical year to secure continuity of supply, especially with airspace closing down across Africa. We focused our teams on innovation, accelerating digitalization and embracing disruption. When I walked out of the office on March 18th, 2020, I had my heart in my hands, but from day one we worked together as one team, across our markets to ensure the continuum of care to patients in Africa. This is what we kept at the centre of our solutions, keeping our focus on what we could control and make a difference in and letting go of those things beyond our control.  We connected on our virtual platforms every week, to check in with our teams across geographies, to find out how they were doing, what they needed.  As a senior leadership team we met daily to ensure that all facets of the business were able to continue delivering their valuable service, whether this be internally or to our customers. Within the first week we had pivoted to digital, with our medical representatives trained on our new virtual engagement platforms. Whilst our internal teams pivoted to digital we immediately started to challenge ourselves as a leadership team to consider how patient behaviour may change to access healthcare.   We also looked at opportunities to facilitate crucial knowledge sharing amongst Healthcare Professionals and delivered a series of  “By Africa, For Africa” webcasts, in partnership with key healthcare societies in Africa, across therapeutic areas. The webcasts enabled key experts to share locally relevant content, within each therapeutic area, in response to the pandemic. We provided the platform and the various partner healthcare societies provided the content. I think we were one of the first movers on the African continent to embrace the easy and obvious digital solutions, going from face to face to remote engagements, and later a mix of the two to allow for HCP preference. 

EF: What has been AstraZeneca’s participation in the Covid- 19 fight?

BN: The extraordinary circumstances of the COVID-19 pandemic calls for extraordinary measures. AstraZeneca has risen to the challenge of creating a not-for-profit vaccine that is widely available around the world and we are proud that our COVID-19 vaccine accounts for over 90% of COVAX supply to date, with more than 77 million doses delivered to 127 countries, including more than 38 African countries. No one is safe until we are all safe, together we can bring an end to this pandemic. We are committed to playing our part in achieving this goal, here in Africa and around the world.

EF: How are you managing the chronic diseases portfolio in a communicable disease scenario such as Covid-19?

BN: Our focus remains on the patient and their journey through the health care system. The pandemic has influenced patient behaviour, with patients looking to minimize the time spent in large hospitals or clinics. We have seen a significant reduction in breast cancer diagnoses and mammograms performed over the last months, this statistic lies at the heart of our New Normal Same Cancer Campaign, which urges patients to contact their doctor and return to treatment following the disruption to their care due to COVID-19.  Our eSihle programme in South Africa offers prostate cancer patients home-based care and support. Our response to these changes in patient needs has been focused on three aspects: 1. A low touch patient journey: introducing an integrated holistic ecosystem that minimizes the time the patient spends at a healthcare facility. 2. Home-based care: where the patient is diagnosed by their doctor and is then able to receive treatment at home. 3. Access to medication and solving the issues around economic turmoil. We have worked internally and externally with customer groups to understand the requirements for these ecosystems,  both in the public and private sectors. We have been able to do a few things in the short term, others will take longer, but we must support the patient flow, the clinicians, nurses and all involved in the patient's journey. 

In South Africa, we have partnered with BrandMed a leading South African connected healthcare company that integrates medical and lifestyle expertise and science with ground-breaking technologies. As part of this collaboration, AstraZeneca has provided sponsorship towards the establishment of fifteen BrandMed Syntro-P Health Centres of Excellence offering patients access to a more proactive, patient-centric, integrated risk-reduction and treatment approach to chronic conditions. 

Similarly, our  Kamba Ya Shanga initiative, in partnership with the Independent Community Pharmacy Association (ICPA), provides an end-to-end digitally integrated patient solution. Kamba Ya Shanga is a Swahili term that means ‘a a beautiful string of beads, the beads represent the link between the patient, the pharmacist, and the doctor. Through the initiative, we have changed the ecosystem for patients, as well as enabled pharmacies to direct patients to a relevant healthcare professional and track their progress and response to medication, in so doing ensuring a continuum of care.

EF: How do we keep momentum on the importance of health in the future? 

BN: Considering all the hardship that Covid-19 has caused to so many people in terms of losing loved ones, losing jobs, etc., if anything, it has helped us to focus on health, we have all learned that there are things to be thankful for so we can take positives from this situation by taking what we can control and use it as a platform to build awareness. We are using social media to raise awareness around cardiovascular and respiratory health, through platforms such as Yes2Life and Yes2Breathe, this ensures it is sustainable over time with people becoming aware of the importance of looking after themselves. A 70-year-old cancer patient’s behaviour is often driven by fear, worried about going to the hospital, and the possibility of getting Covid. We are creating awareness amongst those patients that homecare could change that fear to comfort by seeing their doctor every quarter and then be treated at home with the help of a nurse. All these negative emotions such as worry, frustration or fear can be turned into really positive actions, of benefit to the patient because it is convenient and controlled and good for the healthcare system as it won’t be overloaded. The distribution of services will be a long-term benefit for the healthcare system. For the private patient -usually, the more affluent patient- homecare will happen, they will be at home and the nurse will go there. But we don’t just work for high-end solutions, for the public sector patient the solution will be cheaper and closer to home, instead of getting on a bus and going to a big hospital they will go to the local clinic and be treated there, this is linked to the low-touch patient journey solution.  We also are working with partners to build the capabilities of our nurses at smaller clinics and our community health workers. In South Africa, we are working closely with the National Department of Health to shape the new and innovative National NCD screening programme. As part of the partnership, AstraZeneca donated 10,000 electronic blood pressure (BP) machines, which will be used by healthcare workers in under-resourced communities.  The programme supports the vision of taking healthcare to the communities; utilising community healthcare workers to bring primary care closer to patients, enabling earlier access to screening and diagnosis.      

EF: What are the different healthcare system scenarios, does anything stand out?

BN: If we compare French Speaking Africa and sub-Sahara, I think the sub-Saharan countries are probably further along the journey of national health insurance but from a public health perspective the issues and challenges in Kenya, Ethiopia or Ghana are the same and it all boils down to access, to the ability to pay the value, to what the government is able to do although in South Africa we have a clearer set up in terms of private health. Regardless of where an asthma patient is, be it UK, South Africa or Nigeria the basic challenges and issues remain the same, the scale and level of education might be different, the accessibility to digital platforms may differ but the fundamental needs of an asthma patient are the same as is our need to reach them.

EF: What examples of decisions taken this year that you believe will have an impact on the future?

BN: As far as internal changes are concerned the obvious one is adopting a hybrid working model balancing working from the office and working from home, I have seen an increased cross-functional collaboration which was already important for us, but it has grown even more so. We have a very clear approach and structure within the company in terms of how the engagement happens and how we work in our enterprise teams, not working across brands but across disease areas putting the patient in the centre to see things from that perspective. If we consider the people that are consuming medicine, the ones that have easy access from a digital perspective will definitely become more educated and own more of their health themselves. I think there will be a fundamental shift in terms of patients owning their diseases but on the other hand, the public sector will have less funding due to the expenditure governments will have in terms Covid and the economy. For the patients to flow through the system and still be identified early the main challenge will be enabling the lower levels of care to deliver the needed healthcare. To achieve this there must be changes. 

Our Africa PUMUA Initiative, launched in 2021 looks to address some of these challenges. Through partnerships with Governments, Healthcare Professionals and Societies PUMUA (a Swahili word that means ‘breathe’) aim to improve paediatric and adult asthma management across both the public and private sectors with a focus on local health system strengthening,  health worker capacity building, awareness and education, and equitable access to AstraZeneca’s respiratory medicines.

Similarly, our Healthy Heart Africa Programme focuses on hypertension and the increasing burden of cardiovascular disease (CVD).  It is currently active in Kenya, Ethiopia, Uganda, Tanzania and Ghana. We work with local governments and partners to increase access to hypertension services and strengthen health systems, including capacity building of healthcare workers. HHA also contributes to data collection mechanisms that can help inform decisions in policymaking and their implementation. At the moment, lack of data is one of the major challenges facing access to hypertension care in Africa. Since its launch conducted over 16.6 million blood pressure screenings in the community and in healthcare facilities. 

EF: What would you like your 2020- 2021 tenure to be remembered for?

BN: I think it is about caring, really caring first and foremost about our teams and our empathy for what they are experiencing. Our organization is 60% female, and we know for a fact, and indeed the data also reflects, that female staff are dealing with a lot at the moment in terms of balancing work and being at home looking after children, so empathy within the organization is important to overcome this disruption together. Secondly, it is health access, AstraZeneca will do everything within its power to help and assist equitable access to medicine. In addition to our Africa PUMUA initiative and our Healthy Heart Africa Programme, we have our Phakamisa programme in South Africa which takes a collaborative approach between community, civil society, government and private entities to improve breast and prostate cancer management in the public sector.  Phakamisa which means ‘uplift’ in Zulu addresses early detection of the diseases while promoting primary prevention and access to care. According to the cancer registry, breast cancer is the most common cancer in women while prostate cancer is the most common cancer in men.  A lack of awareness often leads to delayed treatment for symptoms, especially among marginalised communities and this has hindered efforts to combat the disease. An example of the type of events we host is the recent successful community Prostate Cancer Awareness and Screening day, in Vilakazi Street, Soweto. In addition to the Prostate Specific Antigen (PSA) screening offered at the event, the agenda also included insightful talks by prostate cancer survivors and presentations on the prevalence, risk and treatment of prostate cancer.      

We are committed to bringing forth profound changes in healthcare by empowering patients, community healthcare outreach workers, and healthcare professionals.

EF: Do you have any final message you would like to share with us? 

BN: As in any situation we live through, there are always positives to be found and we are actively engaging in new ideas that will make a difference, seeking answers to health challenges, taking some risks and adapting our strategy to make a difference to patients, and doing it now when it matters the most and when it can be a game-changer for the patient. We wish to be part of shaping healthcare in Africa, standing with clinicians and patients to deliver sustainable solutions to impact lives across both the private and public sectors.

October 2020
South Africa