Barriers to inclusive health are spurring African innovators into action. But to build an inclusive health system the continent needs to address structural inequalities – political, social and economic – and this will require that private and public partners alike embrace radical collaboration to support inclusive innovation.

When public health graduate student, Jason Carmichael, arrived in Kenya in 2013, he noticed numerous gaps in the healthcare system that troubled him. There were not enough hospitals. Doctors were not always working full-time or at full capacity, and patients were not getting the care they needed. Then he met Kenyan tech whizzkid, Peter Gicharu. They pooled their expertise and started testing models aimed at connecting the dots between healthcare providers and patients.

Fast forward to 2018, and the launch of TibuHealth, a social enterprise that delivers health services directly to those who need them. Born of the curiosity of two people about how to do things better, the system allows patients to request medical consultations, sample collections and vaccinations in their home or other chosen location using an app, website, customer support line or email.

This kind of scheduling capacity means that there is burden-shifting from the public sector to the private sector, lightening the load felt by public sector institutions. Tibu’s services cost Ksh 1,850 (US$15.80) while a typical GP charges Ksh 1,800 – 3,000. 

TibuHealth is one of the hundreds of social enterprises in sub-Saharan Africa doing extraordinary work solving healthcare challenges in innovative and often very practical ways. 

Innovating to overcome barriers 

Social enterprises are emerging as critical actors in African healthcare systems, rising to prominence during the COVID-19 pandemic where they played a key role in bolstering government responses across the region.

Where others see challenges, social innovators like Gicharu and Carmichael see opportunities. Typically, these innovative actors harness community-centred approaches and inclusive solutions to close the gaps in healthcare delivery. By their nature, they are willing to take risks to create change. They also have the local insight and business sense to turn their ideas into reality.

 According to a new White Paper published by the World Economic Forum on Innovation towards health equity in Africa, there are 10 common barriers to inclusive healthcare that social innovators across the continent are working to dismantle. The analysis included an AI scan of 450,000 pieces of content across 48 African countries and eight languages, in addition to 35 interviews and three verification workshops in 2022. 

It found that the majority of healthcare innovations (about 65%) were seeking to address issues such as weak healthcare capacity and infrastructure, the lack of access and affordability of quality healthcare and medicine, the economic impact of COVID-19, and inequality related to COVID-19 – particularly the low COVID-19 vaccination rate, due, partly to vaccine hoarding by wealthier countries. 

Other major themes included stigmatization, health literacy, digitalization and the inaccessibility of data, gender inequality, malnutrition and food insecurity, access to basic needs, and supply chain disruptions and logistic challenges.

Fundamental shift needed

But while the solutions these innovators are coming up with are ingenious and many of them are making a huge impact, on their own they won’t be enough to build a more equitable health system in Africa. As health inequality is a systems problem, it will require a systemic response.

The WEF White Paper makes the point that, to fully realise the potential of social health entrepreneurs, a fundamental shift needs to take place towards a broader health equity agenda. There needs to be a recognition that social, political and economic factors are all integral to developing fairer health systems and this will require an all-out collaboration across all sectors to create an environment that enables innovation for equity.

To build such an enabling ecosystem, attention would need to be paid to formal elements, such as public policies, governance structures, regulatory frameworks and investment programmes, and informal elements such as cultural, social and economic norms and practices.

Key principles to build equity

We believe that four key principles are necessary to underpin this work.

First, social innovators and their corporate and government partners need to build for the long haul. This means that, rather than rushing to develop a competitive solution, they need to take the time to develop their business model and authentically engage with their customers and partners to create an interconnecting web of reciprocal relationships which will help to lay solid foundations for the enterprise.

Second, they would need to be prepared for the reality that in complex systems progress is not linear. As Margaret Wheatley, the systems theorist, wrote: “We live in a world of complex systems whose very existence means they are inherently uncontrollable”. To put this another way, we need to make friends with the reality that setbacks in this line of work are common.

Building for the long haul and being clear-eyed about the nature of progress and success are key traits that encourage entrepreneurial resilience, the third key principle of an inclusive health system. If the COVID-19 pandemic showed us one thing it was that resilience – the ability to withstand and overcome adversity – is not necessarily an inherent trait but a muscle that must be exercised as individuals, teams, and organisations. 

Healthcare innovators and their partners then must take care to put in place practices to build their resilience muscle. This could include developing robust feedback loops that allow for open communication, real-time change and strong bonds between stakeholders. The ability to learn and adapt is a key factor in resilience.

Lastly, to build inclusive healthcare systems it will be necessary to embrace radical partnerships and opportunities for collaboration between different disciplines, institutions, businesses, multilaterals and government departments. 

Health equity is everyone’s business. Every actor in the ecosystem needs to do what they can to support the innovation and resilience of social entrepreneurs and innovators at ground level and they need to work together to go further.

Unlocking such partnerships will require greater levels of trust and mutual understanding between government business and societal actors, and this will take hard work to build. But build it we must because, without it, it is unlikely that we will get close to achieving true health equity in Africa. And sick and vulnerable people across the continent will continue to be excluded from life-saving care.

Katusha de Villiers is Health Systems Innovation Lead for the Bertha Centre for Social Innovation and Entrepreneurship at the University of Cape Town.

Gillian Moodley is a Project Manager at the Bertha Centre for Social Innovation and Entrepreneurship at the University of Cape Town. 

Both contributed to the new white paper on Innovation towards health equity in Africa, published by the World Economic Forum.