Read the Conversation

EF: You have been Roche’s regional Latin-American leader for nearly 2 years now, what was your given mission when appointed? 

RH: My mission was to make our products and drugs accessible to the largest number of patients in Latin America and my biggest interest was to bring innovation to Latin America for the highest possible number of patients. 

Latin America is a region with a lot of ups and downs but it has enormous potential. Many patients are not covered, which means that if we do our job right, we will ensure access to our innovations for more patients, which will also mean growth opportunities for the company, even in the middle of the crisis. The region has its challenges but with a portfolio like ours, based on a lot of innovation, will mean a process of continual growth as we bring more value to the table. Working in a challenging environment is also part of what makes my work in the region so valuable and exciting.

EF: Which are the countries that are performing the best in Latin America?

Regarding performance, if we look at it from the size and working environment, the answer is Brazil. The Mexican affiliate is performing really well, and despite the present circumstances, even our operations in Argentina are doing well. We are in the middle of a portfolio shift, and each country is in a different stage of this process. It will be interesting to see how we progress, but I don’t foresee us having serious problems next year. 

EF: How have you been managing 2020, and your non-communicable portfolio within a communicable disease scenario? 

RH: I never thought back in March that we would be in lockdown for over five months. During the transition, our mission has been twofold: addressing the sanitary emergency and sustainability. At the beginning of the pandemic, we gave our people the mission of doing something unique, of making a difference in the healthcare system and we had a lot of government collaboration in the first impact of the crisis. The next task was dealing with all the usual patients, the ones with chronic diseases that are out there, some who had their treatment interrupted and others who must be diagnosed to be able to receive treatment. When the Covid-19 crisis will have been solved we will have another huge crisis on our hands of patients that have died or had complications for other reasons or even from lack of access to care. So we have worked on empowering our employees from very early on to make a difference even in times of distress and uncertainty because this not only helps people become more resilient at an emotional level but also gives them a sense of purpose. I feel very proud of the willingness and ingenuity of my team to support patients and health systems in this time of great need. In some countries, we have worked with call centres to give answers and dissipate fear, in other countries we have done it through a chat-box or doing blood donations as a result of looking for solutions that would help. We created internally a repository of ideas called the “caring initiative” to share best practices of initiatives that could be replicated worldwide. Here, we have examples covering telehealth, treatments at home, or home infusions all in aid of helping with the world healthcare crisis. This is what leadership means in times of crisis. 

EF: What are the lessons learned?

RH: An important lesson is that there are almost no limits to what can be done.  There are partnerships with governments or institutions where it is harder to make a significant impact as they are the ones that manage the projects but the more open and the clearer we are in offering collaboration, even in the short term, giving assistance getting the healthcare system running is very important and the lesson learned is that with the correct focus there is no limit to what can be done, and that is the beauty of my job. The current context has truly shown me that when everyone works together, we can achieve great things, important advances that can make a difference for patients, and we have to continue looking for ways to collaborate.  

EF: Could you elaborate on examples of collaboration in the region to address local needs?

RH: In the face of the pandemic, the Roche  Pharma and Diagnostics Divisions in Latin America joined forces to find and deliver the best solutions to the challenges presented by this crisis. We had a case in Ecuador, for example, where we were able to learn from each of our experiences to identify synergies and work efficiently to get approval 48 hours after submitting the documentation for the testing system – this is a clear result of working together with a focus on solving an urgent need. The spirit of collaboration is fundamental, and we have quite a few examples of working together with external partners. In Uruguay, which was in a relatively good situation, health workers and patients were afraid of going to the hospitals and of taking public transport so, in the beginning, we organized their safe transport in collaboration with a local provider and this could be done because the hospitals in Uruguay had segregated areas for COVID patients. After analyzing how things work locally country to country, we find the issues, adopt certain actions, and collaborate in the areas we can. If the medical personnel of a hospital doesn’t have the protective equipment, that would be our first priority. Argentina is a good example of blood donations and in Chile, it was a collaboration of treating certain patients from home. This last one was a pilot of a worldwide initiative that trigged ideas of working further in this area although it does depend on the countries legislation. In all these cases, this is the spirit we want and look for, we look for entrepreneurship within the company to find solutions. We look to co-create something with the clients that solve the issue helps all sides. 

Peru had a very difficult situation at the beginning of the pandemic especially with protective equipment so that was one focus, but a big change was to get the electronic prescriptions accepted as it avoided extra contact between patients and doctors. In Peru, we also collaborated in the production of ventilator connections to ventilate two patients instead of one. It boils down to what we find locally, finding the collaborations, and acting on them.

A positive coming out of this crisis is that collaborations work in the healthcare environment so governments will perhaps be more prepared to work with industries and private partners to resolve certain issues.

EF: The pandemic has caused organizations to make shifts within their structures on a global level, so in terms of the ‘company of the future’ what skill sets do you think will be needed?

RH: I think we are transforming having already moved into more self-organized teams focused on looking for sustainable solutions and going ahead with them. In Latin America, there is a big difference between healthcare systems, where private institutions have stronger infrastructure while some public hospitals may not even have computers or internet connection, but regardless we need better use of the existing tools. We must listen to our clients, the physicians, and the institutions, understand what they need, and adapt, a difficult task as we have our own needs but we must listen to add value to the discussion and to be able to treat patients in the different disease areas in times of COVID. Roche LATAM has a long history of addressing patients’ needs and we are valued by our clients for this reason. Nowadays it is easier to bring together the international world virtually and it is no longer necessary to have to travel and this is a positive shift for us today. It is no longer a matter of where one is physical, the barrier is connectivity and the rest is all a matter of organization. It is down to time zones and case studies which with a good organization is feasible. Most countries struggle to get statistics together and without electronic medical health records system implemented throughout the health system there is a lot of information which is at best delayed; any data shown is always at least 4 to 6 days old because that is how they manage to connect the information. Testing is done first, taking a couple of days to get the results and then the reporting takes another couple of days so decisions are taken on data that is old, not to mention what happens in some countries’ rural areas health systems, where testing is scarce and data is often inconsistent, so there is no way we have accurate information. In fact, we make a lot of decisions on unreliable data, COVID and the pandemic make the system’s failings all the more obvious and visible but in fact, this should be a lesson on the importance of making changes. In rural areas of Peru or Mexico they are no knowledge of recent data or what little there is, is all handwritten reports which needs to be typed into the system. A result of this pandemic will be a big call into action on healthcare systems which won’t be sustainable, the population will demand it and the awareness on the subject will make it easier to get budgets for healthcare in these countries, and this won’t last for long so we should take advantage of the opportunity now.  

EF: After 27 years of working in Roche, what is your personal definition of access? 

RH: I have focused on emerging markets in my career because I think it is where we can make the biggest impact, for example, if you think that 1000 patients would be the patient population of a certain disease in a particular country but have probably only 20% of that number some or most in the private system. Bear with me; I will get to the point.  We have to consider how to break the barriers between the 1000 and the 200 patients that are probably being treated. Any systemic change has to be done from the health system and we need to have a long-term vision -looking ahead at least to 2030 - if we continue to work within the same health systems that exist today we will improve in access discussions to go from maybe 200 to 300 patients. Access is to work with persistence and that’s why my definition of access is working within the existing system to generate better results. But the real changes come through correct policies, where we work on how to change health, and the way we operate health so instead of expanding the range from 200 to 300 we should discuss finding the other 700 patients, and this is the most useful discussion and a long term horizon. Roche is supporting the initiative “Movimiento Salud 2020”, of which I am a board member – which actually looks at systemic issues, not so much at what we call access issues. There is a huge difference between access issues and health issues. 

EF: What are “Movimiento 2030” initiatives and decisions for this year?

RH: Movimiento Salud 2030 is a collaborative platform that brings together stakeholders with different backgrounds and areas of expertise and young leaders to find solutions to the pressing health problems of the future. It’s focused on innovation and collaboration and taking feasible short-term actions. As a result of a board decision at the moment, we are working on the continuation of therapy as a short-term goal -which makes a lot of sense. We are concentrating on three countries to see results, on Brazil specifically and in Peru as well we are helping by way of collaborative groups. Our current work looks promising and we will continue to build on these and future initiatives. 

EF: Do you think we are now at a unique moment where public policy could be changed? 

RH: I think so; as you probably know Peru went into lockdown very early and this was because they have very few emergency units, ventilators, so it is a simple calculation. The lockdown allowed them more time to build up capacity and infrastructure which is a health system issue, something which was never before prioritized. This is a country which has had a wonderful growth of the economy for 20 years but the investment in health in terms of percentages has been much lower than it should have been. Peru is just one example as there are many others. In Chile, people have just recently started demanding a health system at the level of the capital rate the Chilean population has. Public hospitals in Chile are no different from public hospitals in other countries in Latin America; sometimes they are even worse whereas the private sector works much better. Today it would be possible to have a more rational discussion to reduce the inequalities without getting into short term politics. The discussion should be about the future, about 2030 and beyond, and work backwards from there, avoiding discussions with politicians and what they have or haven’t done in the last three years because it is not useful. What is useful is to know if there are enough physicians or introducing telehealth as a realistic option. 

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

RH: I would like to get the collaboration started to transform health systems in Latin America. Nobody can solve this issue on their own but collaborating and with a long-term vision, we can change the health systems of the region. Our industry has a long-term focus and things cannot be changed from one day to the next but investing people and resources to fertilize the ground for future growth would be so much better than short term fixes. 

August 2020
Latin America