[Interview] Nikhil Pereira, CEO, Africa Healthcare Network, East Africa
Africa Healthcare Network has over the years worked to change the landscape of renal care and education in Sub-Saharan Africa through the provision of dialysis services, education of clinicians and patients across the region and by working with governments to build standards of care to ensure that a patient in Africa receives the same, if not better, quality of care that they would receive in the Western world.
Nikhil Pereira, the founder and CEO of the organization talked to Africa Business Communities about the interventions, the milestones, hiccups and expansion plans
Tell us a bit about Africa Healthcare Network and your role in it?
Africa Healthcare Network (“AHN”) has established the first dialysis chain across East Africa, providing high-quality, life-saving dialysis at an affordable cost.
AHN brings world-class technical expertise combined with developing world practical operating experience to a region in dire need of quality dialysis treatment. The net result is increased access, higher quality and lower cost to patients, payors, and governments, delivered through a sustainable and scalable business model.
AHN entered Rwanda as Africa Healthcare Network Rwanda Limited on June 30th, 2015, Tanzania as Africa Healthcare Network Tanzania Limited on March 3rd, 2017 and Kenya as AHN Kenya Limited on October 24, 2018.
In addition to currently holding the role of Chief Executive Officer and Director, I have had the pleasure of being part of the founding three members of Africa Healthcare Network which includes Dr. Lloyd Vincent, a leading nephrologist from India who previously held the role of Senior Consultant Nephrology and Clinical Director for Dialysis Services at Narayana Hrudayalaya Hospitals and Satellite Centres, and Dr. Brian J. G. Pereira, one of the World Experts in the field of Nephrology currently sitting on the Board of Kidney Disease Improving Global Outcomes (KDIGO), the international standards organization, and NephroPlus, India’s largest dialysis provider, and CEO of Visterra Inc., a biotechnology company based in the Boston Area.
Why was it formed and to what extent is it achieving its purpose?
Africa Healthcare Network was established to change the way healthcare, specifically kidney care, was provided to patients.
Historically, there has been no focus or regulations in sub-Saharan Africa on ensuring patients suffering from Chronic Kidney Disease and/or requiring dialysis receive high quality care. AHN entered the region committed to providing best in class dialysis care in Africa, using state of the art dialysis technology, an experienced clinical and non-clinical team and all within an affordable costing structure to improve critical healthcare access in frontier African markets.
Since its establishment in 2015, AHN currenltly opreates the largest and most disperse network of dialysis centers in East Africa and has consistenly been rated as the leading provider of dialysis in the region.
Additionally, AHN has stayed true to its mission of providing affordable quality care with the Company currently offering dialysis at a 20-30% discount relative to Government Hospitals in Rwanda and 10-20% discount to Private Hospitals in East Africa.
Who are your clients?
AHN’s clients are directly the insurance providers / hospitals that partner with the Company to ensure we can provide high quality care to their covered / captive patient population.
Ultimately though, being a patient centric organization, our highest priority are the end customers or patients who are currently suffering from kidney related issues and may require Renal Replacement Therapy (RRT).
What trends have you noticed among those seeking dialysis services? Is there an upsurge? What in your opinion is driving this?
The incidence and prevalence of Chronic Kidney Disease (CKD) is growing globally, fuelled by diseases associated with an aging population, high blood pressure, and increasing rates of diabetes and obesity.
As the prevalence of contributing diseases grows, the rates of CKD and ESRD are expected to follow suit. By 2030, more than 70% of patients with ESRD are estimated to be living in low-income countries. Additionally, high rates of communicable diseases in the region that are risk factors for CKD, such as HIV infection, have increased the incidence rates of ESRD. With over 22 million people in Sub-Saharan Africa testing HIV positive, the burden of CKD is overwhelming relative to the rest of the world.
Likewise, sub-par standards of care, high rates of diarrheal disease, malaria, various nephrotoxins, and surgical complications have also lead to significantly higher rates of AKI than in the developed world. Conservative estimates put the annual incidence of ESRD in East Africa at 1,000 per million population (PMP) or over 200,000 patients needing dialysis treatment.
Unfortunately, limited dissemination of health information, late presentation of patients to health care facilities, lack of access to life-saving dialysis and high costs of care has led to an extremely high kidney failure mortality rate across Africa.
For expensive, chronic therapies like dialysis, there is a stark divide between wealthy nations and the rest of the world. While wealthy nations enjoy widespread access to care, in most developing countries, the vast majority of patients with kidney failure don’t have access to dialysis.
This lack of access is due to a combination of factors, most importantly price, distance to/availability of dialysis centers, and limited insurance reimbursement or government coverage.
In most sub-Saharan countries, dialysis services only commenced in the past one to two decades with less than 1% of the addressable patient population receiving treatment; this is expected to increase as universal healthcare and universal health insurance schemes such as National Health Insurance Funds gain traction and enrollment in individual countires and regionally.
For those receiving care, the decision on the frequency of dialysis depends on patient symptoms and financial considerations. It is not uncommon for patients to reduce their frequency of dialysis as financial resources dwindle leading ultimately to discontinuation of dialysis or death.
With the projected growth of ESRD patients, these problems will only worsen. The dialysis units and the number of nephrologists (kidney specialist doctors) in Africa is insufficient for the number of patients requiring treatment.
Despite 40%+ of the population living in rural areas in most African countries, current dialysis centers are located in a few large metropolitan cities. Patients have to travel large distances to seek treatment (as far as 1,000 kilometers). In many instances, families need to be temporarily relocated, with consequent loss of livelihood of family members.
How crucial is public private partnership in ensuring affordable healthcare in the region and what has your experience been in this regard?
Whether it is a public private partnership or a private private partnership, partnership is going to be key in aligning stakeholders across the healthcare ecosystem, including DFIs, state sponsored organizations, aid organizations, NGOs, Private Hospitals, investors and advisors and, most importantly, Governments.
We pioneered the first true Public Private Partnership in Rwanda with the Ministry of Health of Rwanda in both the District Hospital of Gisenyi and District Hospital of Gihundwe.
We believe this was a good first step in working with the Government and we soon followed with an MOU signed with the Ministry of Health of Tanzania to establish dialysis centers across all regional hospitals of size in the nine health zones in Tanzania.
We continue to look to partner with Governments and their relevant institutions so long as these partnerships are true to their name. The key is alignment amongst stakeholders on the objectives and ensuring that all parties are walking in the same direction.
What is Africa Healthcare Network bringing to the region’s healthcare sector that isn’t present at the moment?
Quality of Care, Professionalism and Honesty.
Quality of Care: Unfortunately, the sub-Saharan African sub-continent is behind other emerging markets on access to dialysis, but most importantly quality of care.
We hold this to be of the highest importance for our organization – building the right foundation of high quality care in a country will lead to huge benefits to overall patient outcomes and will also set the entire health system on the right path.
Professionalism: Our organization brings a level of professionalism and transparency to the healthcare sector that has enabled us to build long-lasting and trusting relationships with our partner organizations, whether it be the Governments (Ministries of Health and Government Health Insurance), Partner Hospitals or Medical Professionals.
This has allowed us to rapidly and successfully partner with the various stakeholders in the healthcare ecosystem to strive for a mutually beneficial outcome for all parties.
Honesty: We hold ourselves to the highest ethical standards when it comes to both operations and clinical care. As the Former First Lady of the US, Michelle Obama, said, “We learned about honest and integrity – that the truth matters… that you don’t take shortcuts or play by your own set of rules… and success doesn’t count unless you earn it fair and square.”
We preach these three pillars every day to our team with the view that if you want to be part of the AHN family, you must live by these principals.
What kind of collaboration do you expect and need for AHN to succeed?
We are constantly looking for partners that align with our organization’s ethos of highest quality care in-line with global standards at an affordable cost. In order for us to succeed we must continuously work to align all the stakeholders within the healthcare ecosystem to ensure broad engagement and agreement.
This includes DFIs, Government Insurance, Private Insurance, Public and Private Hospitals, and most importantly, the Government’s and their Regulatory Bodies.
What are the growth and expansion prospects of your company?
AHN is already the first scale dialysis provider in East Africa and we have grand ambitions to continue this growth in existing markets, Kenya, Tanaznia and Rwanda, including adjacent markets, and also both the Western Africa and Southern Africa regions.
We are actively pursuing our expansion and welcome a conversation with any organization interested in partnering with us.
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