Read the Conversation

EF: What is the strategic importance of Siemens Healthineers footprint in South Africa? 

MF: We have had a presence in South Africa for over 100 years in healthcare, and as Healthineers since the IPO. We have a large installed base, and are market leaders in imaging, whereas Laboratory Diagnostics (LD) is a growing space for us. We engage with both the public and private sectors, and we are highly recognized within the industry. 

EF: What is the allocation of resources to the private and public sectors? 

MF: In South Africa, we have specialists that address both the private and the public sector with specialized sales teams, one of which solely approaches state or government institutions. South Africa is large; thus, there are challenges to having a commercial team to cover all the government institutions at all times. For instance, in Japan, we were around 2000 employees, which allowed us to have teams dedicated to public and private sectors separately. However, in South Africa, we are a tenth of that and need to be flexible. To rectify this, we leverage the various sales teams distributors to address areas where additional coverage is required.

A typical example is in provinces where the business volume is low, and here our private sector sales person appraises the government business as well. We do the same with our services as the customers invariably keep the equipment for ten (10) years, and the equipment needs to work for that period. This is why we are a very dynamic and flexible organization.  That is a common issue here, and there is an Afrikaans saying that a farmer always makes a plan, that is exactly what we need to do. 

EF: Siemens portfolio includes Imaging, Diagnostics, and other services. How does that translate into South Africa?

MF: The portfolio of products we have is the same as in Europe. We are strong in Advance Therapies and have supply agreements with private institutions. In the diagnostic imaging space, we have Computed Tomography (CT), Ultrasound, MRI’s, X-ray systems, and others. On the LD side, we are engaging with the large players. The National Health Laboratory Service (NHLS) is our biggest client and then three (3) private institutions with which we work together. 

EF: Medical technologies and a preventive approach to health help detect and diagnose more accurately and faster. If prevention is the backbone of health economics, what initiatives of this nature work in South Africa? 

MF: We have to look at the challenges first from the customer’s perspective, and one of the challenges in the public sector is that there is no central database. When a person goes to a public hospital and is attended to, they are registered, tests are conducted, potentially imaging like a CT is performed, prescriptions are provided, and medication is dispensed. If a month later the patient has to do a follow up at a different hospital, he/she will have to be re-registered, get another CT scan, and receive another prescription for drugs, the same routine. Not only is this costly, but it opens the system to abuse, especially in the drug space. 

We need to have a system where the patient data can be viewed at all the state hospitals throughout South Africa. The medical history of a patient that lives in Cape Town should be instantly accessible in hospitals in Pretoria or Johannesburg, should that patient have an incident there. This concept is highly technological and innovative and is an area of opportunity within the government. With a linked and accessible database, there will be a foundation for all primary health care and preventative healthcare measures to be recorded and analyzed and will bring the overall healthcare cost down as well as increasing the quality of care. 

EF: Who do you think should own the data on the patients? 

MF: The data belongs to the patient. However, it also needs to be accessible to physicians and hospitals. This involves a particular responsibility as well as an investment. There are models where the government could outsource certain services and come to a company like Siemens to manage the data. We could put the infrastructure into place with servers and excellent connectivity, provide statistics and reports. The data needs to be managed to gain leverage for the future in the healthcare cycle. Although the data belongs to the patients, the information needs to be stored and be made accessible to those with the correct permissions. Some countries have an e-health record that is managed by the patient. Regardless of everyone having a mobile phone, our market may not be ready for this. There has to be some guidance and guidelines coming from industry or government, preferably both, together with looking for the best management solution. We have to take the technologies we have and apply it to the market and the situation we have. 

It is critical to understand what is going on locally and how technology can fit in. For example, in another Southern African country, there was a large equipment tender involving CTs, but placing a 64 Slice CT in a small clinic in the middle of nowhere might not be the best idea, as it has high-cost maintenance and won’t be utilised to its full advantage. Placing a more straightforward system that covers the local needs and then use the balance of the funding to invest in digitization and the transfer of the data to a tertiary institution would be a smarter approach. In the end, it’s applying innovative technologies specifically to the situation in question. 

EF: What do you think of the idea of having a Chief Technology Health Officer in hospitals to decide from an infrastructure and human resources perspective, how to integrate technology? 

MF: That would be a very tough job and depends on whether the approach is proactive or reactive. With a proactive approach, one has to plan strategically using technology to help this or that disease, and having such a person in each healthcare institution may not be needed. Vendors can play a role as we have the experience and can help in a consultative role; it could even be a multi-party affair where all the vendors get together to improve the healthcare institutions. On the reactive side, it’s about reviewing the current solutions and trying to leverage these further. Here too, the responsibility could lie with the vendors. In Africa, the demand from our clients is heavily weighted around training. We provide CPD points on our courses, we conduct workshops with clients and have collaboration agreements with different universities and hospitals to give clients training and certification. We also have an online training tool that is free and provides courses on many aspects of our solutions. These, too, are CPD accredited. It is critical that with proper training, the leveraging of technology and the innovations are in the best benefit for the patient and minimizing cost. 

EF: What does access mean to you? 

MF: It is people having access to care. In South Africa, there is low access to the availability of equipment, doctors, data, whether the equipment is running or not. The National Health Insurance (NHI) is going to happen because today, there are over 40 million people without access to care, and this is a considerable challenge. In rural areas, accessibility is a big problem. In Limpopo, there is no state mammography machine in the entire province, and the mortality rate for breast cancer is high. Patients that do experience an abnormality need to travel to Pretoria for diagnosis, which incurs costs for travel, accommodation as well as drop-in productivity of that individual. Innovative solutions can be created. On the private side, there are mobile breast screening clinics that drive from one village to the next, and the processing is done on-site by transmitting the data using 4G over a phone network or satellite to a data storage center. A pool of doctors will have access to the data and compile a PDF document report that can be sent to various locations. The productivity that comes out of this is enormous, saving people’s time and resources. 

To increase access, South Africa could adapt to a model used in Japan. Most people travel to work by train and at the major train station, in addition to a 7/11, a Lawson and a dry cleaner, there is a small clinic. If they have an ailment, they pop into the clinic and can have a checkup. It is quick, easy, and on the way home. The doctor can tell them if they need a follow-up exam, and if required, it gets scheduled and shifted to a larger institution. The first benefit is that the person is productive because the clinic is accessible. The second benefit is that non-urgent problems are kept out of the big hospitals.  South Africa can apply this model by having containerized clinics that are mobile, quick, and easy to set up, and put them at transportation hubs. It would be easy to deploy, and it would keep people out of the large institutions and yet supply primary care. 

EF: The concept of the triple bottom line (people/planet/profit) works very well in the healthcare industry. What advice would you give to CEOs of other sectors of the economy on managing a triple bottom line? 

MF: We have a solid Corporate Social Responsibility (CSR) policy built on four pillars; one of the pillars is conservation, driven by myself. In my spare time, I volunteer as an honorary ranger and spend time doing conservation activities. When we receive used ultrasound machines, we donate them to NGOs in conservation to help them to do a better job. Recently, we donated an ultrasound machine to Vulpro, a vulture organization that works at ensuring their survival. As far as our employees are concerned, we look for resourcefulness, the will to better themselves, and for certain flexibility. We invest in our people from a training perspective but also from a life skills perspective. 

We don’t look at every one of our projects as a profit maker; we look at the bigger picture. If we can make a difference in people’s health and it takes off, even if it is not profitable in the short term, the volumes will increase, and there is a long term opportunity. Return in healthcare is not immediate, it could take from 10 to 15 years, but the return will come if we keep on investing in people. 

EF: You will be celebrating your 35th anniversary in Siemens Healthineers soon. What would you like to raise a glass of sake to? 

MF: I believe in people, in making a difference in people’s lives, to enable and energize them to do things they never even realized they could. Within Siemens, we have great products and solutions, we have the experience, and we know how things work in healthcare. With exceptional people that are willing to go that extra mile, the whole delivery changes and becomes much more powerful. My most significant success in the different countries I have been comes down to the people. People are the biggest asset, especially when they find their potential and make a difference. I have spoken with doctors at academic institutions who want to push the boundaries on what can be done with treatments and medication. We must address primary care, but we cannot ignore the tertiary institutions which need help. We also must help build a syllabus for the universities, including technology, and revise the current programs.

December 2019
South Africa