Logistic Challenges in Sub-Saharan Africa

Africa is the second largest of the earth’s seven continents and makes up approximately 22% of the earth’s total land area. In 1974, the skeleton of “Lucy”, a hominid who lived approximately 3.2 million years ago, was discovered in Hadar, Ethiopia. In 1979, a 165-foot trail of the earliest hominid footprints was discovered in the Kibish region of Tanzania. Africa was the birthplace of humanity.

The population in around 50 countries (the number changes depending on who is defining it) covers all extremes: nomadic herders, village dwellers, city folk, well educated business professionals, subsistence farmers, miners, oil workers, fishermen – a whole diversity of communities and people. The population are generally young due to rapid population growth in the last few decades, and because of the effect of AIDS on recent generations.

Sub-Saharan Africa displays the most linguistic diversity of any region in the world. This is apparent from the number of languages spoken. There are several European languages – English, French, German, Portuguese, and Afrikaans, which is derived from Dutch – but whilst these are spoken and are often still the official languages of countries, the region contains over 1000 languages, which is around 1/6 of the world’s total.

In the last decade private capital flow to Sub-Saharan Africa has begun to exceed official development assistance. Six of the world’s ten fastest-growing economies over the previous decade were situated below the Sahara, with the remaining four in East and Central Asia. Economies are thriving; political stability is at an unprecedented level.

However it is not all rosy. There are still significant problems getting healthcare out to everyone, due to lack of infrastructure in rural areas, despite the efforts of governments and NGOs like the Gates Foundation. Ebola has highlighted some of the problems in delivering healthcare both in big cities and out in the bush, whilst balancing responses from the WHO, MSF etc. with government policies and actions. Many governments have been guilty in the past of trying to downplay disease situations in order not to scare off foreign investment and to maintain order.

There are some amazing initiatives to deliver vaccines, including drones which can travel 100K into the bush and parachute them in. Energize the Chain is an initiative between the University of Pennsylvania’s Wharton School and Econet Wireless, a global telecoms leader. Together they have started a programme in Zimbabwe to place vaccine fridges into mobile phone tower compounds, which are in place all over Africa. The electricity grid in rural Zimbabwe might not be able to ensure continuous, reliable power supply, especially in remote parts of the country. In such regions, vaccines may be stored at a central point and moved over large distances by road for each vaccination session, greatly increasing transportation time, logistical hurdles, and operational costs. Their solution shifts the last point of storage significantly closer to the point of vaccine delivery by deploying highly energy-efficient vaccine-storage refrigerators to rural clinics and/or co-locating such refrigerators with Econet’s tower sites. This simple but revolutionary approach reduces vaccine transportation time and increases health system efficiency. It’s a fantastic solution to a continent-wide problem.

The regulations vary across such a wide region for import and export, but universally we should expect clearances to take days rather than hours, and so packaging should be chosen with that in mind. Some of the best examples can be found in the chart below.

Clinical sites are available mainly in the larger cities, and really the next big area for clinical studies has to be Sub-Saharan Africa. There’s actually nowhere else left to go. There are already about 4500 studies underway, but it should be borne in mind that almost half of those are in South Africa. There are currently at least 905 million people in the region and the UN predicts this will rise to around 1.5 billion by 2050. That will create a potentially huge market for commercial drug, which is very hard to ignore. There are many countries with less than a hundred studies underway and we need to work together with governments and NGOs to deal with the logistical issues and make the most of this region.