Many African countries are still consistently looking forward to improve healthcare delivery to millions of people living in rural communities with little success. In this interview, Professor Mikhail Y. Natenzon, chairman of board of the “National Telemedicine Agency” Research-and-Production Union and also deputy head of the Regional Working Group for Telemedicine of the Regional Commonwealth for Communication of the CIS countries, tells Kester Kenn Klomegah, an independent researcher and policy consultant on African affairs in Russia and Eurasian region that the establishment of compatible national telemedicine systems, which has many advantages, can suitably be adapted to the local conditions of any particular African country.
How important is modern telemedicine technology for African countries? And the reasons why you are passionately exploring Africa?
Economic development of African countries reached the level where the government can begin a strategic reform of health systems to create a modern, meeting the world standards of health care. The implementation of these programmes will solve health problems and give African countries the opportunity to take the next leap forward in economic and social development.
African governments and international specialized organizations have now developed and are implementing various programmes to improve the quality of life of African populations. The most advanced project is the elimination of the epidemic of socially dangerous diseases such as HIV/AIDS, tuberculosis and malaria and allocate significant funds for it. Indeed, one of the problems of the slow development of African economies is the fact that people suffering from malaria are unable to work effectively and vigorously. Another important international project is the maternal and child mortality reduction programme.
Significant, multi-billion dollar funds have been allocated by governments and international organizations to these projects, and the results are clearly not in line with the efforts made. The efficiency of investments is not large enough.
The reasons for this are, inter alia, the inadequate health infrastructure in Africa, its concentration in major cities and the almost total absence in rural, remote and hard-to-reach areas, where about 60 per cent of the population-600 million people-live. It is obvious that the traditional methods of providing medical care can not work in the current situation.
Therefore, we have developed new methods to ensure accessibility and a single high standard of quality medical care for the population, especially in rural areas and remote areas. These system solutions, technologies and equipment are based on the widespread use of Russian information and telemedicine technologies. These proposals are now practically non-alternative, as confirmed by the documents of the UN, the world Health Organization, the International Telecommunication Union, the African Development Bank and other international organizations.
As it’s already known, many African rural communities are very limited or disadvantaged with sources of energy (electricity), but how could telemedicine be useful for these remote areas of the continent?
The problem of all rural areas in Africa is the underdeveloped social and health infrastructure. Its creation with the traditional approach is a long and very expensive project. Moreover, such infrastructure will always experience a shortage of qualified medical and technical staff. But most importantly, its exploitation will require large funds that are not available to either rural communities or the state. The only solution for the cost effective implementation of social development goals in Africa so far is the establishment of an integrated telemedicine system.
It consists of two parts: network of telemedicine consulting-diagnostic centers, established in stationary medical institutions of different levels, and communication associated with them system of the mobile telemedicine laboratory diagnostic facilities (the ITC) in various fields. The ITC is designed to address a wide range of health challenges and provide social services to people in rural, remote and remote areas. Built on international standards, it integrates with similar systems in other African countries and Russia, interacting with telemedicine systems in other countries.
A key element of the mobile telemedicine complex and mobile hospitals can provide medical care to the population in remote and inaccessible areas in a completely autonomous manner. They have their own power supply system, communication system, up to the satellite, life support systems, crew systems cleaning air and water and many other optional installed systems required for successful operation. Most importantly, the personnel of the ITC may not be a doctor, but an average medical worker. Use MTK allows radically solving the problem of comprehensive medical services to the rural communities. Their residents will not have to get to the city hospitals. The hospital will come to them.
At the same time, qualified doctors working in provincial hospitals, to which the ITC is assigned, can provide advice through telemedicine equipment to personnel of several ITC operating in different parts of the province. This solves the problem of shortage of qualified doctors and reduces the cost of operation of MTC.
Can you discuss innovative tools available in the plant and key competitive advantages? Do you have all the equipment and / or components manufactured in Russia?
The main goal and the main competitive advantages of the medical complex are the solution of four socially important tasks: ensuring accessibility of medical and social services to the population; providing a unified high quality medical and social services for citizens regardless of their place of residence and social status.
It helps optimization of the cost of healthcare while improving its quality and coverage and creation of permanent jobs for highly qualified technical and medical personnel, ensuring the creation and operation of complex.
Other important competitive advantages of the systems offered by us are: High capacity of MTC – up to 20,000 people per year, and therefore, almost 100% coverage of health care for the entire population.
Low cost of rendering medical services to the population due to use of the average medical personnel and absence of need to build stationary medical institutions and to spend means for their operation.
Possibility of step-by-step realization of the project, the complex telemedicine system. At the same time, the system itself begins to function fully from the start of its first segment. Connecting the following segments extends the functionality of the system and without requiring structural adjustment.
There is high investment attractiveness. The expected return on investment in the project is 5-6 years. The functioning of the system is an important contribution to the stable development of the state, providing an increase in the human capital development index. There is also professional development of medical personnel and the use of international standards and the possibility of organizing cross-border telemedicine consultations.
All equipment which is a part of complex telemedicine systems: stationary telemedicine consulting and diagnostic centers for stationary medical institutions of all levels (from the Central hospitals in the capital, to the para-medicine point in the small village), mobile telemedicine laboratory and diagnostic complexes of various medical appointment with all equipment, communication equipment, satellite communication systems, guarantee maintenance of system, preparation of medical and technical personnel for system functioning is the Russian know-how, certified and manufactured in Russia.
At the request of the customer, the system offered by us can be connected with the existing telemedicine systems in the country. The system can begin to operate immediately after the installation of equipment in the country and completion of training. The system is delivered on the principle of “turned on and work” without any complications.
What will be the main direction in terms of implementation of this medical technology projects in Africa? And what are your expectations from African governments?
The main direction of our project for Africa is the gradual creation of compatible national telemedicine systems that can interact with each other and in the long term to create a pan-African telemedicine system. The telemedicine system becomes economically and socially effective when it is a queueing system. This is exactly how the proposed system is designed.
Health systems in almost all countries of Africa basically are state-owned. Therefore, the establishment of compatible national telemedicine systems is possible only in close cooperation with the regional Ministries of health, so that the project can be adapted to the conditions of a particular country and at the same time maintain the universality of national telemedicine systems, so that they can interact with each other. We know the serious efforts that African Governments are making to promote health, and we hope that our cooperation in implementing telemedicine systems will yield significant, qualitatively better results.
Mozambique’s Crisis and its Humanitarian Aid
Escalating conflict and a deteriorating humanitarian situation in Cabo Delgado has left communities completely reliant on humanitarian assistance. According to the Government, attacks by non-state groups have forced more than 565,000 people to flee their homes and villages, abandoning their crops and livelihoods.
Last December, the United Nations Regional Directors for Eastern and Southern Africa visited Mozambique to assess the plight and needs of displaced populations as well as of host communities in northern Cabo Delgado province, and met government officials in Maputo.
They expressed their deep concerns about the unfolding humanitarian situation in Cabo Delgado where violence has exposed people to human rights violations and left people with very limited access to food and livelihoods. The growing insecurity and poor infrastructure have meant that reaching out to people in need has become harder and coupled with the fallout of the COVID-19 pandemic, the crisis has become even more complex.
“We need to urgently increase our presence in Cabo Delgado in order to help those in need, especially women and children,” said Lola Castro, WFP Regional Director for southern Africa.
The joint mission with Regional Directors of FAO, IFAD, IOM, UNFPA, UNHCR and WFP, as well as by the UNDP Resilience Hub Manager and members of the UN Country Team, allowed participants to witness firsthand the impact of continuing violence in Cabo Delgado and to show support for affected communities and the Mozambican people.
They heard extremely moving accounts from displaced men, women and children in the city of Pemba, the capital of Cabo Delgado, and in the districts of Ancuabe and Chiúre, whose lives have been upended by conflict and insecurity. They also met communities accommodating the displaced, visited planned resettlement areas and held discussions with the provincial governor and Secretary of State, as well as with religious leaders and representatives of civic organisations.
The crisis in the north of the country is a complex security, human rights, humanitarian and development emergency, underscoring the imperative of continuing to provide life-saving assistance while collectively supporting government-led long-term resilience building.
While acknowledging that much has been done to help victims of the crisis, the Regional Directors stressed that with displacement increasing daily, the lack of adequate food, water, sanitation, shelter, health, protection and education was exacerbating an already dire situation – one set to be further compounded by the imminent rainy season in a country particularly prone to climate extremes, as cyclones Idai and Kenneth devastatingly illustrated in 2019.
Most recently, tropical storm Chalane, which hit the same populations last December, as cyclone Idai did less than two years ago, was a harsh reminder of the climate threat Mozambicans are facing and of the urgency to massively scale up investments in recovery and resilience
With COVID-19 keeping most schools closed, the importance of robust investment in education to build Mozambique’s social and human capital is a growing concern.
There is an urgent need to expand protection, health, food and nutrition programmes for vulnerable children and women, and vaccination and immunisation interventions and psycho-social counselling, and of working to enable displaced farming and fishing families re-establish sustainable livelihoods.
The Regional Directors urged support for the adequate resettlement of uprooted families straining the already limited resources of impoverished host communities and slowing government efforts to effectively register and assist the displaced.
They noted that urgent investments in development and resilience-building are required to not only promote human rights and social justice, but also to limit the impact of current crises and help prevent future ones.
To curb violent extremism, they called for development initiatives to be transnational in approach and to prioritise the economic empowerment and social and political inclusion of women and young people.
They urged the Government of Mozambique and the international community to step up efforts to end all forms of violence in the country, including gender-based violence and child marriage, and to invest more in women and girls as agents of progress and change.
The Regional Directors expressed gratitude to the government for its role in helping to meet the humanitarian needs of people in the north of the country and re-affirmed the commitment of the United Nations to upholding human rights and promoting peace and sustainable development for all Mozambicans.
What Social Movements Mean for African Politics
Africa’s transition from a continent of colonial protectorates to independent states has been met with developmental and political challenges. From the 1960s, the political trajectory of Africa witnessed many regimes, regimes that have made their mark on the continent. The struggle for the legitimacy of state power between the African people and the regimes whose policies have shaped the political history of the continent oscillated between nationalistic interest and arbitrariness, at a time when the newly independent states needed a definite political direction.
For instance by 2002, the nationalistic government of Robert Mugabe had left Zimbabwe groveling in the drought stricken velds from bad economic policies. Today, Uganda is still reeling from the administrative recklessness of the Idi Amin regime. Considering the dark regimes that have been etched into the history of some states in Africa, democracy was a light that was to lead into a new dawn.
With democracy, came promises that would ensure the emancipation of dissident voices. The promises that democracy bore for African states were the development of state institutions and the improvement of state responses to the general will. For the people of Africa, the advent of democracy signified that a leader had to prove themselves, while for the leaders, it proved a paradigm shift in the management of power; a loss of the insularity of state politics. It meant that leaders had to show accountability, not only to their people, but also to external powers that existed as international institutions and hegemonic states with pro-democratic foreign policies.
Many issues with the African conception of democracy remain unresolved even despite many years of political transitioning for Africa’s largest economies. One of the issues that have remained unresolved in the African democracy is the perception of institutions by the individuals occupying them, another of these issues is the sensitivity of the African democracy to vibrant social movements where the protection of human rights is concerned.
In contemporary African democracies, there exists a new democratic space where social movements have engaged the political realities. One of the most empowering facts for social movements in Africa is the globalized effect of the social media and its pivotal role in ensuring government accountability.
In safe-guarding human rights and ensuring the protection of the rule of law in Africa, social movements have a huge role to play, as they are essential to achieving governmental accountability through a sustained engagement and with the power of collective insistence. In African states where the government is autocratic, social movements are a threat to state power and are thus met with violent resistance.
According to a study by Guillermo A O’Donnell, state repression have proven to be the constant response to social movements. This is because the greatest strategy of autocratic governments in stifling resistance that could lead to an explosive demonstration of popular discontent, is in the use of threats, intimidation and persecution. According to Human Rights Watch, in 2016, there was a violent suppression of peaceful protests in East Africa. In Uganda, Ethiopia and Kenya, the governments responded to peaceful protesters with deadly force which led to the death and the injury of many protesters. In 2020, the Nigerian government engaged protesters and activists during the EndSARS protests with the state security forces, which led to the deaths of unarmed protesters at the Lekki Toll Gate in Lagos. The aftermath of the protests saw the Nigerian government intimidating activists that were thought to have been at the forefront of the End SARS protests and attempting to muzzle the media.
One of the greatest challenges of democracy in Africa is the imbalance of power in the governmental structure. The imbalance in the allocation of power between arms of government or in the monolithic representation of power has resulted in the overexploitation of power. This has made it difficult for the African states that are yet to transit to democratic status to do so, and for those that have transited, to perfect their democratic act.
The power imbalance which could be attributed in some African countries like Nigeria to constitutional deficiencies was demonstrated when Obasanjo who became Nigeria’s president in 1999, tried to adjust constitutional term limits so that he could contest elections for a third term. Social movements in Africa have toppled regimes in Africa and they have tremendous capacity to change the political course of a state.
This could be achieved when social movements are popular and when they represent a general interest, then the interest which a government might claim it represents become invalidated by the shift in the alliance of the people. This is usually the case when there is a common agreement that the government in power no longer serves the interest of the people who elected such government.
The fear that spurs an autocratic government into attempting to repress social movement is that it might become popular. Social movements are powerful and could be harnessed for political change since they signal the activation of the collective power. At the level of the social movement, it is not a call to negotiation, but a call to swift action which both the government and the people recognize as it becomes insistent.
With its large population and fragile health systems, Africa has recorded more than three million Covid-19 cases, still less deadly as compared to other regions in the world, according to the Africa Centers for Disease Control and Prevention (Africa CDC). According to Africa CDC, Africa’s coronavirus tally was 3,021,769 as of January 10. The death toll was 72,121 and the number of recoveries was 2,450,492. The biggest number of coronavirus cases were reported from South Africa, Morocco, Egypt, Tunisia, and Ethiopia.
South Africa, with more than 1.2 million reported cases, including 32,824 deaths, accounts for more than 30% of the total for the continent of 54 countries and 1.3 billion people. The high proportion of cases identified in South Africa, were attributed to more tests carried out than many other African countries.
African countries are expecting to get medical equipment, most especially vaccine, to help them out of the pandemic. These they expect from external sources. During January 4-9, Chinese State Councilor and Foreign Minister Wang Yi paid official visits to Nigeria, the Democratic Republic of Congo (DRC), Tanzania, Botswana and Seychelles. Wang Yi emphasized that China is willing to deepen mutually beneficial cooperation in diverse spheres with Africa. For example, China’s efforts to create a new image in Africa through China-European Union Cooperation in vaccine.
Both China and the EU vow to work as a global collaboration under the World Health Organization in terms of accelerating the development and manufacture of Covid-19 vaccines, and assuring fair and equitable access for every country in the world. It’s about making the vaccine a global public good.
Last December, during his annual media conference, President Vladimir Putin made it known that Russia’s readiness to help foreign countries including Africa. With regard to cooperation with other countries, it would boost the technological capabilities, enterprises to produce the vaccine, foreign countries would invest their own money into expanding their production capacities and purchasing the corresponding equipment, he explained.
Foreign countries would be investing in these projects: the enlargement of production facilities and the purchase of equipment. “As for cooperation with foreign countries: nothing is stopping us from manufacturing vaccine components at facilities in other countries precisely because we need time to enhance technological capacities of our vaccine manufacturing enterprises. This does not hinder vaccination in the Russian Federation in any way,” Putin said.
According to January report from the Tass News Agency, the Russian Direct Investment Fund has only registered the first Russian vaccine Sputnik V in Africa. “Russian Direct Investment Fund announces the first registration of Sputnik V in Africa. Ministry of Pharmaceutical Industry of Algeria registered Sputnik V on January 10th,” as follows from a post on their official Twitter account.
According to the Russian Direct Investment Fund, the registration was done under the accelerated Emergency Use Authorization procedure. This procedure was also used to register this vaccine in Argentina, Bolivia, and Serbia. The Fund said that supplies to Algeria would be possible thanks to its international partners in India, China, South Korea and other countries.
Writing under the headline “Africa’s Road to Recovery in 2021 Is a Fresh Start” published originally by Chatham House, Dr Alex Vines, the Director for the Africa Program at Chatham House, said many African countries would be much more seriously affected by the socioeconomic consequences of the global economic slowdown triggered by the pandemic. Even before Covid-19 hit, an increasing number of African countries were indebted and financially stressed.
He wrote that African debt would become a greater global concern in 2021 as many African states remain the world’s poorest and most fragile and have been hard hit by the economic and financial costs imposed by the pandemic.
In his analysis, Dr Vines further pointed out that 2021 will also see increased geopolitical rivalry for influence in Africa. This will include competition over generosity, ranging from positioning over debt cancellation to providing Covid-19 vaccines. China has its Sinopharm vaccine and has already signed up to Covax, the international initiative aimed at ensuring equitable global access. The Russians have their Sputnik V vaccine, the UK has its AstraZeneca and University of Oxford vaccine, and the US the Moderna and Pfizer-BioNTech (with Germany) vaccines.
Since the beginning of the pandemic, several countries around the world have been making efforts to facilitate local vaccine development, clinical trials, and some had made upfront payments for vaccines to encourage early production. Outside of South Africa, most African economies have played too little or no role at all in the development of Covid-19 vaccines and had likewise made little or effort to secure vaccines while other economies around the world were doing so.
For instance, a globally respected genomic and infectious disease laboratory in Nigeria announced the development of a Covid-19 vaccine in September that is 90% effective against the virus in the preclinical trial but it has not been able to carry out clinical trials due to lack of support and funding.
While Kenya recently announced that through the COVAX facility, it ordered 24 million doses of the AstraZeneca vaccine, with supply expected to start arriving in the second week of next month, several African countries are opting for vaccines from India, Russia, and China. This is despite skepticism about the vaccines from Russia and China in particular. Both countries rolled out their vaccines without phase 3 clinical trial results that confirm the vaccine effectiveness.
South Africa said it made a deal with Serum Institute India and will be getting 1.5 million doses of AstraZeneca vaccine for its health workers starting this month. The country, which is going is also in talks with Russia and China to procure vaccines. Currently, Guinea is testing the Russian vaccine, Sputnik V and has ordered 2 million doses.
Morocco has ordered 65 million doses of the Sinopharm vaccine from China, and AstraZeneca vaccine from Serum Institute India. Egypt plans to buy 40 million doses of the Sinopharm vaccine, has already received 50,000 doses of the vaccine in December, and expecting another 50,000 in the second or third week of this month when vaccination will commence. Nigeria says vaccine access was in its discussions this week with the Chinese foreign minister during his visit to the county, according to the report from Quartz.
Besides the fact that Africa has registered its three million cases, Africa still behind the United States and European countries, and Asian countries such as China and India when it comes to the Covid-19 outbreak. For many African countries, it is still the time to reflect on African countries’ responses to Covid-19. Although it has abundant resources, Africa remains the world’s poorest and least developed continent, and worse with poor development policies. It is time to prioritize and focus on sustainable development.
Significantly, the global pandemic has exposed the weaknesses in Africa’s health system, adversely affected its economic sectors, it is therefore necessary for African leaders, the African Union (AU), regional organizations and African partners be reminded of issues relating to sustainable development and integration. It sets as a reminder to highlight and prioritize the significant tasks set out by the UN 2030 Agenda for Sustainable Development and the African Union’s Agenda 2063.