Read the Conversation

EF: You have been with BD for 7 years. How has the general healthcare landscape evolved in your tenure? What was your mission coming in and how have you adapted?

IW: The South African market is very different to the rest of Africa. The distribution of funds in healthcare has changed significantly over the last few years. When I became GM seven years ago, there was more certainty in the funding of healthcare in markets outside of South Africa. This has changed. External funding has become more selective and focused, with a growing need for Ministries of Health to self-fund healthcare needs in-country. Whilst there is an expectation to self-fund, they have tighter constraints than ever before. Countries like Mozambique are applying for HIV funding, but they are only getting 50% of required funding for specific programmes. All of this impacts the patient through a decreased level of access. This has been a critical change within healthcare which has made the healthcare environment much more complex. Ministries of Health are increasingly having to balance access and the quality of services provided and this has sometimes resulted in a compromise in the quality of goods procured.

Across Africa, access is becoming more difficult due to the current funding environment. In South Africa, the government is juggling the need to implement universal health care while dealing with stagnant GDP growth. As corporate players, we need to be adaptive to these changing environments by leveraging different partnerships and business models.

EF: Could you elaborate on your adaptations to those new challenges?

IW: Across Africa today, there is a will to provide patient care but there are drastic skills and technology shortages. Africa has less than 10% of healthcare professionals compared to that of a developed country. In South Africa, we have less than 1 doctor per 1000 population compared to European countries such as Greece, which has 6.1 doctors per 1000 population or Sweden which has 4.1 doctors per 1000 population. Given these statistics it is clear to see that Africa is far below meeting global standards with respect to the number of healthcare workers required to service the population and for this reason, we have invested into partnerships which focus on assisting and building capacity for healthcare systems. While we have innovative technologies that provide fantastic outcomes, in the light of a healthcare worker shortage, we need to focus on improving the delivery of healthcare. In 2018 alone we trained nearly 15 000 healthcare professionals in Africa with over 30 000 healthcare professionals trained in the last 3 years.

Through our non-commercial arm, called Global Health, we have rolled out Labs for Life which supports labs in Africa to become accredited through a quality standards programme. This is done in partnership with the Centre for Disease Control (CDC) and PEPFAR. Our volunteers in BD have spent time in different African countries, particularly in the laboratories in the rural setting, supporting lab accreditation. We run programs on infection protection, prevention and control like the infusion practice we have in Kenya. Additionally, in the anti-microbial resistance (AMR) space we look to improve lab quality testing in countries like Kenya, Uganda, Tanzania, Ghana, Zambia and Nigeria.

 In South Africa specifically, we have a public-private partnership with University of Cape Town Medical School.  In collaboration with the University of Cape Town’s Clinical Skills Centre, we have converted a ward in Groote Schuur Hospital to a Safety in Health Simulation Centre, a training facility for medical and paramedical students and other healthcare staff such as nurses. 

 We believe that the more skilled healthcare professionals are, the better the care that will be delivered. Ministries of Health do not always have the necessary capacity to provide ongoing training programs, especially in more specialized areas. Therefore, we roll out these programs consistently on an annual basis. This differentiates us beyond a commercial partner, as a partner devoted to delivering sustainable healthcare across Africa. We work with the Ministries of Health to target priority areas, focusing on HIV, TB, AMR, Surgical Interventions and Oncology. All this makes a difference beyond the products we sell in that space.  

EF: What is the importance of BD SA for Africa? What comparisons can be made to South Africa’s healthcare environment and the rest of Africa’s?

IW: South Africa has one of the more developed healthcare systems in Africa. Our operations in South Africa differ from our approach to the rest of Africa; with South Africa having a  well-funded private healthcare sector, whilst in the rest of Africa healthcare is largely self-funded or state funded e.g. in Nigeria 95% of healthcare funding is out of pocket. Based on the nature of the South African healthcare market, innovative technology is more easily adopted. This allows us to showcase leading innovative solutions that BD provides in healthcare. When we engage with other African customers, such as laboratories in Africa who may want to implement new technology, we are able to leverage existing skills and technology in South Africa in order to transfer these newer technologies into African laboratories and hospitals. This culture of openness and inter-country sharing also helps to position South Africa as a learning ground across Africa. One of the challenges is that our markets may not yet be ready for some of the technological innovations that are available in the US and Europe, so we’d like to practically show what innovations are appropriate and implementable in an African setting. In South Africa, we can showcase the more accessible innovations here, in order to present what is possible in healthcare. Currently, BD is a leader in laboratory automation and microbiology. We’ve used automation to help with the shortage of skills, upskill healthcare workers and laboratory employees, and provide better care. 

However, at the same time, there are some major healthcare differences between South Africa and the rest of the continent. The South African hospital network is large and centralized, whereas for the rest of Africa, we have to take healthcare closer to the patient. For a patient to get to a healthcare center, they may have to travel for half a day to get to a large urban centre. Therefore, we have introduced innovative diagnostic technologies that may be less relevant in South Africa. For example, BD provides a small and portable system for CD4 testing in HIV patients, which is ideal for settings in Africa. 

In Kumasi, Ghana, in a rural area where you have to drive for hours, BD was present at the opening of the HopeXchange Medical Centre, which is a new, high-tech hospital that has access to an MRI and CT scanners etc. There is an X-ray machine on the ground floor that can remotely send the results to the clinician upstairs for viewing. You would think that this kind of high-tech equipment would only be found in South Africa. It is an eye-opening experience to see a hospital deliver such a high standard of care with such unexpected technology in extremely, unexpected surroundings. This is a true example of taking healthcare to where the patient need is. 

With regards to technology, Africa is exciting because there is an opportunity to leapfrog to the latest technology available, instead of going through all the developmental stages of technology, and that is what we are able to offer as an organization. One of the strengths of our “Go to Market” model is that we also provide the necessary engineering support to wherever our products are located. It’s critical to our rollout that we have trained engineers, organizational reach and capacity, and distributional partners with the ability to support our technology. When we go into a new space, we invest in having the right partners or resources to provide on-the-ground support for our products.

EF: How does BD headquarters see Africa? How are you able to encourage BD global to invest in Africa? 

 IW: BD is quite different in this regard. For example, BD became so prevalent in the early days of HIV diagnosis in Africa because a BD senior business leader, Gary Cohen, traveled through Africa, saw the need, and communicated it to headquarters back in the US. That was how our Global Health organization got funded. Even today, he and other senior leaders of BD still visit Africa frequently. Making a difference in emerging markets aligns with BD’s values. We’ve been expanding into the rest of Africa where, for example, we have recently invested in additional resources in West Africa for the last 18 months. We want to be relevant wherever there is a healthcare need and we do so through the different programs we have like Global Health.

EF: How could you convince other multinationals to take the same approach to Africa that BD currently has? 

IW: Different companies have different approaches, but at the end of the day, what is vital for the company is that they are sustainable. However, we know that our approach works. While we have invested in different programs and capacity building, we know that those investments have added to our commercial value and growth. We have not become less profitable because we are doing healthcare capacity building. In fact, it has elevated our position and opened doors for us. The shared value approach has been successful. “Doing well by doing good” is something we acknowledge and is in our DNA. I’ve been with BD for 7 years, so it also aligns perfectly with my own values: to impact society on a personal level. BD allows me to express myself personally in advancing the world of healthcare.  

EF: What would be your advice to CEOs in Africa on managing a triple bottom line (people, profit, planet)?

IW: In order to lead a business in Africa, you must be committed to your team on the ground and you must be visible. I don’t think it can be done from a desktop perspective. Unless you go out and see for yourself, you cannot impactfully make a change. There are many nuances at the country level. For example, Nigeria and Ghana are close to each other but are radically different. If your only perspective is from the desktop in Johannesburg, it’s much more difficult to be successful. As a CEO you must be in the countries to experience their healthcare systems in order to make a difference. It is easier to share the Kumasi experience with others having visited the site.  To understand the opportunities and challenges in a country, you need to talk to the Ministries of Health and clinicians in that country. Building capacity helps one to be seen as more credible and that credibility allows for more access and realization of access. Managing the triple bottom line successfully in Africa cannot be achieved from a desk. My team, myself, and global visitors are on the ground to support the local teams, to ensure that they are not alone in this challenging environment.

EF: What are the key drivers for performance in your business units or portfolios? 

IW: The African business has been very different to BD’s other markets. BD has a wide footprint across Africa; we have legal entities in Zambia, Kenya and Ghana. We have had significant revenue through our HIV business, in terms of CD4 testing, and with TB; there’s a large focus on infectious diseases. Our revenue contribution in markets outside of Africa is very different. BD’s recent acquisitions of Bard and CareFusion have allowed us to take an expanded portfolio to new markets and new segments. Historically these companies were largely South African focused. With BD’s established footprint across Africa, we have been able to leverage these acquisitions to accelerate our growth

When I became GM, I had to oversee the integration of these companies into the BD. My key role was to assimilate and incorporate them into the BD Africa organisation. These acquisitions have allowed us to offer more complete solutions.  Adding to our existing solutions in cervical cancer and lymphocyte & leukemia cancers, we now also have technologies for breast and prostate cancer. In the drug delivery space, we only had partial solutions in the past, whereas now we have a more complete solution for end to end drug delivery. These complete offerings have fostered new discussions with Ministries of Health, hospitals and labs. With our integrated portfolios, we have been able to position ourselves in new ways where historically we did not have the capacity to do so. 

We used to be largely focused on infectious diseases, whereas now we have a growing focus on non-communicable diseases especially in the oncology space, where we have technologies which address the big 3 oncology focus areas in Africa being cervical, breast and prostate cancer. Additionally, we have a growing suite of diagnostic solutions which are much more suitable to the bench-top and smaller instrument footprint requirements of African labs. Our portfolio offering complements our capacity building initiatives in the healthcare space.

EF: What is your personal definition of access?

IW: Access means different things to different people in different countries. From an African perspective, it is about basic healthcare needs at a primary care setting that will impact patients’ lives in the long term. Many Africans don’t have access to that right now. If we could provide access to as many patients as possible, we will change the lives of Africans, thereby impacting productivity and quality of life. It’s great to have innovative technology to provide a solution for a sophisticated disease area, but Africa’s needs are much more basic for example, there is need for preventative interventions such as cervical cancer screening and for the delivery of basic healthcare services such as providing education and treatment to diabetic patients. If that level of care is provided, we could truly elevate the lives of Africans.

EF: In three more years, it will be your 10th anniversary with BD. What would you like to celebrate on that anniversary?

IW: I would like to see a measurable impact on patients’ lives in Africa. If I’ve seen that BD has impacted more people, in more spaces, that’s something I’d be very proud of. Africa has a deficit of care in the healthcare space. There are capacity and technological constraints, but behind that, there are real patients with very real needs. I would raise a champagne glass to being part of an organization that has made a difference to more of those patients.

February 2020
South Africa