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Meeting highlights:
- Discussing evolving market dynamics: Donor support vs Self-funded and its impact. Ways to address changes in donor support.
- There is a need for a complete overhaul of current market dynamics.
- Emphasis on low-cost healthcare solutions for positive market dynamics, underscoring the need to support vulnerable groups.
- The importance of supporting local manufacturing as a strategic priority.
- Highlighting key H4D recent focus:
Localizing manufacturing capacity for pharmaceuticals.
Developing low-cost, community-based care options, such as nurse-led clinics.
Establishing service and supply models that reinforce localized manufacturing and community care.
EF: In light of the evolving landscape of donor support in healthcare, how do you assess the current and future sustainability of healthcare systems in African countries?
IB: Over the past 20-25 years, particularly with initiatives such as the US President’s Emergency Plan for AIDS Relief ( PEPFAR), we have witnessed significant shifts. Initially, donor funding constituted the majority of healthcare budgets, but over time, governments have gradually increased their contributions. Today, in many African countries, individuals now account for over half of healthcare spending through out-of-pocket payments. Therefore, although a withdrawal of donor funding would not cause the health system to collapse, it would certainly create substantial challenges in critical areas such as HIV, family planning, tuberculosis, and malaria, with HIV and family planning being most vulnerable.
South Africa has made remarkable progress in family planning coverage, while HIV remains a greater challenge. Since 2000, life expectancy in Africa has increased by 12 years, largely due to access to antiretroviral drugs. HIV has become a manageable chronic illness, enabling many affected individuals to remain productive members of the economy. Losing access to treatment would have a significant negative economic impact. Importantly, donor funding has not been limited to direct patient care; much has supported systems, administration, and monitoring. In reality, only about a third of donor funding has gone directly to treating patients, meaning the actual funding gap may be smaller than expected, and reducing bureaucracy could potentially improve efficiency.
An additional challenge arising from donor funding has been its narrow focus on HIV, sometimes to the detriment of other aspects of healthcare. To address these issues, we must acknowledge that heavy reliance on foreign governments for core health services is unsustainable. Sustainable progress depends on identifying domestic funding sources and developing more efficient models of care. A fundamental step is making healthcare both affordable and accessible. Currently, in South Africa, the government secures HIV drugs for approximately US$50, while private market prices can be six to ten times higher. This disparity must be addressed to allow individuals broader access to essential medicines. The government should not only deliver services but also act as a strategic purchaser to secure better prices and larger volumes.
This discussion connects closely to the ongoing debate around National Health Insurance (NHI). At the same time, some advocate for a state-only system, but true universal health coverage will only be achieved through integration of both public and private sectors. Private providers require capital to expand, which is facilitated by a market that allows for a return on investment. Rather than adversarial relations, collaboration between government and private providers is essential. Despite political challenges, many people are already opting to pay for private healthcare when it is accessible and affordable, as evidenced by the growth of self-care and nurse-led clinics – an increasingly important component of the health system.
The guiding principle must be to increase the funding available to the health sector, whether through taxes or organized out-of-pocket payments. If tax funding is insufficient, the government should create frameworks that enable individuals to pay for care directly. Enabling more people to self-fund their healthcare, through insurance or direct payment, will accelerate movement toward universal access. It is crucial for leadership to recognize and embrace this opportunity. The inequality seen in healthcare reflects broader societal inequality. While some will always need government assistance, many others are able and willing to pay when systems make it possible, whether through public hospitals or private providers.
An estimated 20 million people in South Africa could self-fund healthcare through insurance or direct payments. However, insurance growth is hampered by high costs and political resistance. There are also entrenched interests, with some funds and providers resisting more affordable options. Nevertheless, innovation is possible, with certain companies open to new models. Furthermore, outdated practices such as unnecessary consultation with specialists persist, partly due to financial incentives. Greater civil society engagement is needed to address these systemic barriers. Although the government advocates for universal healthcare, progress will remain limited without a willingness to reform the entrenched systems that currently impede this goal.
EF: How can we build a long-term, sustainable, and self-reliant system beyond donor support?
IB: To build a long-term, sustainable, and self-reliant system beyond donor support, it is essential to move beyond outdated assumptions. The perception that HIV primarily affects poor, rural communities is no longer accurate. While this may have been the case decades ago, today the epidemic is largely driven by economically empowered individuals, particularly well-off working men with mobile lifestyles. Data indicate that the highest rates of infection are now found among young women aged 15 to 25, often connected to relationships with older, wealthier men.
HIV is no longer solely a disease of poverty; many people living with HIV today belong to higher-income groups. Consequently, the financially stable segment of the population should take greater responsibility for their own treatment, rather than depending on government programs or international aid. Empowering these individuals with affordable treatment options and diverse access to care is essential for fostering self-reliance. By redirecting existing personal income toward healthcare solutions, rather than relying exclusively on public funding, we can lay the foundation for a more resilient and independent health system.
There is also a critical need to foster a new generation of leadership within the sector, bringing fresh ideas and renewed energy. This new perspective is vital to addressing present challenges more effectively and driving innovation. By encouraging collaboration between public and private stakeholders, this leadership can unlock new opportunities and strategies, ultimately strengthen the system, and accelerate progress toward sustainable solutions.
EF: Why do you think there is not yet a clear path for the next generation of leaders to step in and drive progress?
IB: There are two aspects to consider regarding young professionals in healthcare leadership. First, whether they are avoiding leadership roles, and second, whether they are simply absent from more “old-school” leadership settings. Young people continue to join the healthcare industry, but many choose to distance themselves from the noise and politics often associated with established leadership. Instead, they dedicate their efforts to their work, entrepreneurship, innovation, and building purposeful careers.
I see numerous young, driven individuals making meaningful contributions by launching companies, developing new solutions, and driving impact. However, they often do not participate in formal leadership forums or high-profile healthcare meetings, which tend to be dominated by longstanding figures. Some young professionals intentionally avoid these settings, preferring to focus on tangible results rather than engaging in repetitive debates. The issue is not a lack of youthful energy but rather a generational shift in how leadership and meaningful work are pursued.
EF: Could you share the key initiatives and priorities of Health 4 Development?
IB: Our primary focus centers on three key areas. First, we are dedicated to advancing local pharmaceutical manufacturing in Africa. Over the past four years, local drug production has experienced remarkable growth. What began as an initiative supported by organizations such as USAID and the Global Fund, and quickly adopted by the Africa CDC, has now matured into a commercially driven movement. The pandemic underscored the risks of relying on external sources for medicine, and today, even as donor funding declines, commercial interest continues to rise. Significant investments are now originating from Indian, Chinese, European, and American companies. For example, there are major partnerships underway to build Africa’s largest API manufacturing plant in Nigeria and expand manufacturing capabilities in Kenya, Egypt, Morocco, and Algeria. Momentum is now fueled by commercial opportunity rather than aid dollars. Additionally, efforts to unify and streamline regulatory processes are accelerating market access and fostering continental cooperation.
Second is our commitment to the development of affordable, community-based healthcare services, specifically through nurse-led clinics. I believe strongly in this model and have personally invested in its growth, with the aim of establishing the largest nurse-led network in the country. By combining accessible clinics with health education and digital tools that guide patients through care, we can empower individuals to take greater responsibility for their health, ultimately reducing system-wide costs and improving outcomes.
Third, we are building the supply and support systems underpinning these initiatives. Demand aggregation stands out as a particularly effective approach – by enabling smaller healthcare providers to pool resources, we can secure better pricing and drive efficiency. This model, exemplified through pooled procurement strategies, extends beyond pharmaceuticals to encompass a broad range of medical products and services. In addition to reducing costs, aggregation has the power to attract investment and stimulate infrastructure development, further strengthening the healthcare ecosystem.
EF: What final message would you like to share with Forbes Africa this year?
IB: Right now, we have a critical moment of opportunity, with significant buy-in and political will from African leaders to develop local pharmaceutical manufacturing. This includes their support for increasing and incentivizing investment in local production. What concerns me most is the risk of losing this engagement because a new political trend or distraction emerges prematurely. Any shift in political attention could undermine the progress made and stall these vital initiatives. We must remember that there are vested interests opposed to this progress in localisation, and they may simply wait for the opportunity to divert decision-makers’ focus. Therefore, unwavering political commitment to these goals is crucial for continued advancement.
