DRAFT Ethiopia country report Pharmaceutical production & technology transfer - a private sector perspective - CAPE TOWN DECEMBER 2009 STRICTLY CONFIDENTIAL
Contents � IFHA � Health systems in Africa � Ethiopia country report � Scope of IFHA research � Economic landscape � Competitiveness � Protection of local industry � Technology transfer � PIC/S GMP � Joint ventures: � Sinio-Ethiop � East African Pharmaceuticals & Cadila � Conclusion 2 STRICTLY CONFIDENTIAL
Contents � IFHA IFHA IFHA � Health systems in Africa � Ethiopia country report � Scope of IFHA research � Economic landscape � Competitiveness � Protection of local industry � Technology transfer: � PIC/S GMP � Joint ventures: � Sinio-Ethiop � East AfricanPharmaceuticals&Cadila � Conclusion 3 STRICTLY CONFIDENTIAL
Anchor Investors in IFHA Size of Investment Investors 1st Closing Investors: SIFA 1 st Closing Investors • IFC • African Development Bank 2 nd Closing Investors • Pfizer • APG 4 STRICTLY CONFIDENTIAL
Contents � IFHA � Health systems in Africa Health systems in Africa Health systems in Africa � Ethiopia country report � Scope of IFHA research � Economic landscape � Competitiveness � Protection of local industry � Technology transfer: � PIC/S GMP � Joint ventures: � Sinio-Ethiop � East African Pharmaceuticals & Cadila 5 � Conclusion STRICTLY CONFIDENTIAL
Health systems in Africa Africa spends very little on health care Population Burden of communicable Total health expenditure diseases X mio x $ mio DALYS ����� Africa Africa ��� Rest of the Rest of the ��� world world ��� ����� ��������� Source, WHO 2008 Health in Africa is underfunded 6 STRICTLY CONFIDENTIAL
Health systems in Africa Traditional approach Traditional approach Aid US$ Top-down (trickle down) Supply/input driven Patient is passive receiver 7 STRICTLY CONFIDENTIAL
Health systems in Africa Public services benefit the rich most Percentage of lowest and highest quintile using public health services ��� ��� ��� ��� ���������������� ��������������� ��� ��� ��� ��� ������������� ���������� ��������� ����� Source: Preker AS, Langenbrunner JC et al (2005) ������������������������������ 8 STRICTLY CONFIDENTIAL
Health systems in Africa The private for-profit health sector is an important provider for the poor Percentage of lowest and highest quintile receiving care from private providers ��� ��� ��� ��� ��� ��� ��� ��� ����������������������� ���������������������� ������� ������ ����� �������� Data based on usage, not expenditure (most recent survey year available between 1995-2006; data not available for all countries Source: Africa Development Indicators, World Bank 2006 > 40% in lowest income quintile receive health care from private providers 9 STRICTLY CONFIDENTIAL
Health systems in Africa Public systems are very inefficient Value received Value received by customer by customer ���� ��� ��� 88% of every dollar of public expenditure on medication is ��� lost to inefficiencies �� ���������� ������������� ����������� ����������� ���������� ��� ������ �������� ����������� ������������ ������������ ������������� ��������� �������� Source: The World Bank 1994 Much money is lost STRICTLY CONFIDENTIAL
Health systems in Africa Social security and private prepaid health care spending Only 4% of total health Only 4% of total health ����������������������������������� ��� expenditure in Africa is expenditure in Africa is financed through financed through ��� health insurance health insurance ��� ��� ��� �� ���� �������� ������� ��������� ���������� ����� ������ ������������ ���������� ������� �������� ������ ����� ���� ����� ����� �������� ������������� ������ �������� ���������� ���� ������ �������� ����� ������������� ��������� ������� ������������ ���������� Source: WHO 2008 Africans lack protection against medical costs; solidarity is limited STRICTLY CONFIDENTIAL
Health systems in Africa Private out-of-pocket expenses are 50% of total health expenditure ���� �������������������������������� ���������������������������������� ��� ��� ��� �� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Source: WHO 2008 Many fall in a poverty trap 12 STRICTLY CONFIDENTIAL
Health systems in Africa African health systems are stuck in a vicious circle ��������� ������ ������ ������� ������� ���������� ������ �������� ���� The bill is paid by the poor 13 STRICTLY CONFIDENTIAL
Health systems in Africa Investments in the private health sector in Africa are non- existent Amount of IFC’s private investments in health (loans and equity 1997-2007) ��� �������������������������������� ��� �� �� � ���� ������ ��� �������� �������� Source: Improving effectiveness and outcomes for the poor in health, nutrition & population, World Bank 2009 STRICTLY CONFIDENTIAL
Health systems in Africa Donor funding for health to Africa has increased rapidly ��� ��� ��� ��� ��� ��������������������� ��� ��� ��� ���� ���� ���� ���� ���� ���� ���� ���� Source: Financing of global health: tracking development assistance for health from 1997 to 2007, Lancet 2009 ......to large extent due to the rise of vertical funding Bulk donor funding is channelled to the public system 15 STRICTLY CONFIDENTIAL
Development and health policy Tight relationship between income and health expenditure leaves little room for impact of policy variables 9 8 Log Health Expenditures/capita 7 6 5 4 3 2 1 4 5 6 7 8 9 10 11 12 Log GDP/capita 16 STRICTLY CONFIDENTIAL
Development and health policy The second law of health economics; out-of-pocket expenses % Out of Pocket Expenses of Total Health Expenditure versus GDP per capita 0% ��� ��� ��� ��� ��� ��� ��� ��� 20% � �� % Out of Pocket ��� ��� ��� ��� ��� ��� 40% � �� �� � 60% ��� ��� ��� 80% ��� 100% 100 1.000 10.000 100.000 GDP/ Capita (log scale) A Africa versus developped countries (GDP/Capita>$15000) Logaritmisch (Africa versus developped countries (GDP/Capita>$15000)) Rich countries have lower out-of-pocket expenses than poor countries 17 STRICTLY CONFIDENTIAL
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