PHARMACCESS GROUPWorking towards inclusive quality health care in Africa

Corporate presentation11 February 2014

2011

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2001 2013

A PROMISING LAST DECADE…

“More people have died of Aids in the past year in Africa than in all the wars on the continent.” UN Secretary General, Kofi Annan

“Africa is the world’s fastest-growing continent. Pride in Africa’s achievements should be coupled with the determination to make even faster progress.” The Economist

“Africa could be on the brink of an economic take-off, much like China was 30 years ago and India 20 years ago.” World Bank

…WITH ROOM FOR IMPROVEMENT IN HEALTH CARE

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ACTUAL DESIRED

• Facility before start community insurance program• Total lack of basic services• Still now too often the state of health care in Africa

• Facility after 5 years in community insurance program• Basic quality services provided• Increase of patient visits and revenues

More than 10% of the world population 25% of global health burden 47% of communicable diseases Less than 1% of global health expenditure

In one decade, IFC invested USD 12M in sub-Saharan Africa out of USD 12.8B World Bank Group spending on health

Donors mainly fund through public sector with insufficient outcome

50% of all care is provided through the private sector > 40% in lowest income quintile receive healthcare from

private for-profit providers

FACTS ON HEALTH IN AFRICA

Mismatch of needed vs available funds

Mismatch in public vs private

UNDERLYING PROBLEMS: MACRO ECONOMIC VIEW

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First law of health economics: Poor countries spend little on healthcare When GDP per capita is known, health expenditures

per capita can be predicted with more than 95% accuracy

Donor intervention (aid & debt relief) make almost no difference!

Increased government/donor spending is offset by crowding out private investments

Problem

Increase healthcare spending&

Stimulate economic development

In general, economic development is the only way to increase healthcare spending. This takes too long!

Therefore, we must actively and specifically enable both private investment as well as government spending to increase healthcare spending

Source:A new paradigm for increased access to healthcare in Africa, 2007

Solution

UNDERLYING PROBLEMS: MACRO ECONOMIC VIEW

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Second law of health economics:

Poor countries have a high share of out-of-pocket costs Only as countries grow richer, health insurance

coverage increases Results in catastrophically high out-of-pocket expenses

when poor people fall ill

Decrease out-of-pocket costs&

Stimulate risk pooling

In general, economic development is the only way to increase insurance coverage. This takes too long!

Therefore, we must actively and specifically reduce individual risk for consumers through risk pooling in insurance schemes

Source:A new paradigm for increased access to healthcare in Africa, 2007

Problem Solution

UNDERLYING PROBLEM: INSTITUTIONAL ECONOMIC VIEW

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Douglass North (Nobel Prize 1993):

“Institutions affect the performance of the economy by their effect on the costs of exchange and production”

President Obama on his first trip to Africa, in 2009:

“In the 21st century, reliable, transparent institutions are the key to success.”

President Obama awarding PharmAccess the 2010 G20 award for our innovative healthcare financing model

Banerjee & Duflo, 2011:“[Being poor] means living in a world whose institutions are not built for someone like you.”

OUR APPROACH

Our focus is therefore to help build trust and

reduce risk to increase investments in private

sector and stimulate risk pooling. We work at

system level, the full value chain.

THE PHARMACCESS GROUP – OUR ALTERNATIVE APPROACH

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Founded in 2000 to make HIV/AIDS treatment accessible in Africa:

• no public money for treatment started with uniformed forces in Tanzania

• Private sector workplace programs: Heineken, Shell, Celtel, Diageo, Unilever, Coca Cola

From 2004 broadened scope to integral approach:

• 2005 - Health Insurance Fund - public grants from the Dutch Government and World Bank to

finance health plans and related initiatives

• 2008 - Investment Fund for Health in Africa - private equity fund investing in healthcare

companies

• 2009 - Medical Credit Fund - loans and technical assistance for clinics at the bottom of the

pyramid

• 2010 - Amsterdam Institute of Global Health and Development - independent research and

impact study institute

• 2011 – SafeCare - internationally recognized clinical quality standards for resource-limited settings

• 2013 - mHealth Initiative - mobile solutions to improve access and financing of health care

INTRODUCING THE PHARMACCESS GROUP

Affiliates

INTRODUCING THE PHARMACCESS GROUP II

Staff 150 FTE, of which 60% in Africa 6 offices:

− Netherlands (Amsterdam)− Nigeria (Lagos)− Kenya (Nairobi)− Tanzania (Dar es Salaam, Moshi)− Namibia (Windhoek)− Ghana (Accra)

Annual budget EUR20M

Raising capital for health in Africa:

• Health Insurance Fund - EUR150M • Equity Investment Fund for Health in Africa

- EUR50M • Medical Credit Fund – USD30M

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RESULTS

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Increasing resources:Our public funds have leveraged 8x its amount of international and local private capitalToday 2.5 times more capital invested than the IFC in 10 years in the whole of Africa 12 million Euro loan portfolio will result in loans to 2,000 clinics and

revolving portfolio of 47 million Euro Total loan amount disbursed is USD 3 million. Repayment

performance is over 95%

Improving healthcare delivery & access:All 500 clinics that received a loan to improve their business and services have shown progressClinics are visited by 800,000 patients per month120,000 people who live on <USD 1.5 a day are now insuredLargest private health insurance scheme for bottom of the pyramid in Africa implemented by largest private health insurers in Africa

Improved health outcomes:5-year impact research shows that out-of pocket healthcare expenditures decreased 40%And that people with health insurance are living healthier lives

1. WORKING WITH DONOR MONEY

2. WORKING IN AFRICA

STRICT / TOUGH ON OURSELVES, NO PERSONAL ENRICHMENT, BUT………….

Affiliates

ETHICS & VALUES

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Thank You