Read the Conversation

EF:  2020 was the year of diagnostics, and 2021 was the year of vaccines; what will 2022 be the year of?

RN: 2022 will be a year of recovery. As utilization recovers, there will be a change in how care is delivered. Instead of going back to conventional ways of delivering care, we hope for new ways of delivering care, digitally and efficiently reaching more places.  

EF: Will the ecosystem expand due to this change in homecare delivery and access?  

RN: I believe it is a reliable trend. We could care for people responsibly during COVID-19. with an acute illness at home, monitoring them adequately and with the right resources to ensure home care is safe. We are now applying this to many other conditions, continuing a global pre-Covid trend. In South Africa, the trend was to move out of acute hospitals into less critical, less infectious, and less costly care sites. This trend has dramatically accelerated. The change of management will take some time but this is the year it starts, and in the medium term, we will see the trend accelerate, and I hope it will end up with a significant amount of care done at home. Our data estimates say that 8-10% of hospital admissions could potentially be looked after at home. Patient selection is key, and there should be an eligibility check to select the patients properly. An ecosystem must be created around a platform with healthcare professionals to monitor whilst using artificial intelligence to help predict issues ahead of time along with a fleet of nurses and homecare practitioners to deliver the care at home.  

EF: How do you see the private sector and insurance providers adapting to these changes in healthcare delivery?

RN: Another trend that emerged during COVID-19 was blurring margins between healthcare companies and providers. Our analysis says that across the world, during the late COVID-19 and post-pandemic period, a large number of mergers and acquisitions happened among non-healthcare companies, and non-traditional players, entering the healthcare domain. There are distinct healthcare opportunities in the supply chain that can make these companies' products, footprint, and distribution even more relevant. It is also to do with the consumer interface, particularly from a big-tech and retail perspective, it is a change for healthcare players and companies like ourselves who innovate and provide care. We do not believe competing with incumbents doing a great job providing care is appropriate. We pick up where the market is failing or not delivering care and are opportunistic in those areas. There are no at-scale homecare players in South Africa, and this is an opportunity for us to stimulate the market. We don't have the aspiration of being the only hospital-at-home, but we would love to be the catalyst that formally starts this categorization in South Africa and see it become a crowded and competitive space.  

EF: Solidarity fund is a perfect example of coming together in unity. With Discovery as a catalyst, what challenges does South Africa face to achieve unity between the private and public sectors?

South Africa is a country with strong social inequality. On an economic level, we measure as one of the highest globally on the GINI coefficient, and our healthcare system is no different. There is a very big gap in the equality of access in the public and private sectors. As a healthcare professional, it is discomforting that patients do not have equal access to care, and as a company, we feel strongly about contributing constructively and favourably to that narrative. As a result of COVID-19, and credit to BUSA, with whom we worked very closely, solidarity was created between the public and private sectors in South Africa. In vaccine distribution, for example, we truly partnered in a joint venture to get vaccines to as many South Africans as possible, irrespective of which sector of the health market they typically accessed. We provided vaccines to hundreds of thousands of uninsured people, and the public sector vaccinated some insured people and jointly cut through the inequality. Lessons and outcomes were forced upon us during COVID-19; we must now apply them to new healthcare models to move forward. We can leverage the expertise in both sectors, collaborate and attain sustainability for both and ultimately deliver great patient care. The Solidarity Fund was a unique and successful South African vehicle. I know no other country to develop a model where a non-governmental organization participated meaningfully and played a significant role in driving collaboration between sectors, contributing financially to a well-governed, high fiduciary system ensuring good care for all. I am very proud of what was achieved, and credit goes to many people who were instrumental in the venture's success. I would like to mention two, Stavros and his massive contribution and my colleague Johnny Broomberg, who had recently vacated his role at Discovery Health and assisted and rallied support for the Solidarity Fund.  

EF: What can other countries' health systems learn from South Africa's original response to the pandemic?

RN: There is a lot to be learned from how we currently train doctors; we produce some of the best healthcare professionals in the world. There is a lot of innovation in our healthcare system directly relevant to other parts of the world. The value for money we deliver in the South African private healthcare sector is superb. Based on key data points, we benchmark value for money. The best way to measure value for money in a health context is to look at how much quality is delivered at what cost –cost per quality in health economic terms- and South Africa purports brilliantly. I hope we can learn from other markets to close the gap, using universal healthcare solutions we can apply locally.

EF: From the perspective of private insurance, how do you see healthcare's role in closing those gaps and advancing the economy?  

RN: There are a number of lenses we should use to analyze the situation:  

  1. The foreign direct investment and confidence lens: the absence of a highly competent healthcare offering in the country poses a significant threat to sustained foreign direct investment and confidence. As investors, we must maintain foreign confidence in the country and ensure our employees and stakeholders access excellent healthcare in South Africa.
  2. South Africa's private healthcare sector contributes hugely to the tax authority, the National Treasury, and we are a significant employer. Using existing private sector capacity, we must collaborate with the public sector to drive returns in taxes and broaden employment and fiscal returns.
  3. Human rights and access to excellent healthcare are enshrined in our constitution and at the base of Maslow's pyramid of needs. We must stand together to deliver a societal dividend of better care for all South Africans. We live in a country with an unusual quadruple burden of healthcare disease, and we need to stand together to face the challenges.

EF: What would be your advice to investors looking to put a stake in South Africa?  

RN: I would welcome them to the party and encourage them because we are very optimistic about South Africa's prospects; despite the challenges we face, which we are very aware of and understand, the fundamentals are good. In our developing economy, the opportunities for investors are enormous; the headroom in developing economies is much greater than in developed economies. Finally, we have a very stable financial system; our banks navigated the 2008 and Covid crises better than most other financial systems worldwide. We have very solid governance principles and a well-regulated financial sector that mitigates risk. Investors need to know their money is safe in South Africa.  

EF: 90% of multinational pharmaceutical companies choose South Africa as their regional headquarters. What sort of an example does South Africa set to the rest of the world as a healthcare hub?

RN: There have been some superb developments lately, such as South Africa's vaccine manufacturing capabilities. African countries and the world have recognized the importance of access to healthcare and vaccination. If we have a strong variant in an African country, it will be inevitable that it will get to countries with developed economies. It is in the global interest to ensure it does not happen and the South African economy poses certain attractions. South Africa has stood with world leaders on COVID-19 research, genotyping the variants of Covid-19 and its early identification. It has great local engineering capabilities, sound financial regulatory and government principles, a proven manufacturing record, and a brilliant local scientific community. With all that, South Africa emerges as a natural hub for healthcare investment and growth, not only for the African continent but for developing markets.  

EF: What achievement would you like to celebrate by the end of 2022?  

RN: We have a very clear vision at Discovery of the legacy we want to leave behind as a leadership team:  

  1. We want a motivated, aligned and adjusted workforce in a post-COVID-19 world. The world faces a new work mode, where flexibility and opportunity and the ability to work virtually have become important. As a large employer, we have key priorities. I want to celebrate doing right by the workforce, that they have felt protected as we have adjusted to the modern ways of working. We are an employer sensitive to the changing workplace, and we have given our employees the flexibility and opportunity they require to make the best of their work lives. The employees, in turn, give their best to Discovery, creating engagement and retention of personnel.
  2. We would like to leave a legacy of availing access to excellent high-quality private healthcare to a new market in South Africa that traditionally has not been able to afford it. We want to broaden access to people in the lower-income markets, who are not traditional customers of Discovery Health, with products and opportunities that meet their needs. We want to use our scale, data, and understanding of the health system to design products and provide services to a lower-income market.
  3. Sustain the digital momentum accelerated during the pandemic and sustain it in a post-COVID-19 world. Sustain the trajectory of the digital conversion, which means we need to build assets and offer meaningful and digitally engaging service, -user-friendly assets. There will, of course, be some reversion to the main, people who prefer to see their doctors face-to-face over virtual consults.
  4. Make good inroads with physicians into the change management of delivering care at home or other care sites. I am under no illusion that we will be providing massive care at home by the end of the year, but if the change management progresses, giving safety and quality, it will be a success.
  5. Finally, I hope to sustain a close working relationship with the National Department of Health and the public sector. Through COVID-19, we have worked more closely than ever before, and I have enjoyed it. If COVID-19 continues to become endemic and less topical, I hope we can sustain the ongoing conversation and cooperation with the Department of Health.

May 2022
South Africa