THIS week we celebrated World AIDS day. Though celebration is hardly the right word for such an occasion, it was an opportunity to highlight the fact that AIDS is still with us and take stock of the progress which has been made in combating this epidemic. In Uganda, the picture regarding AIDS is mixed — we have taken some steps forward and also gone backwards. The overall rate of HIV is now lower than it was 10 years ago, so that is progress. But more new cases are arising, so we are going backwards in that area. Surprisingly many of these new cases are in married couples or people in stable relationships and the risk of infection within a married couple is now twice the risk of infection through a prostitute!

The reason for this is that there are so many discordant couples — where one partner is positive, but the other is negative. This may be because one of the partners has another relationship, or that they were already positive when they commenced the relationship. Either way, as long as the couple are having sex, they are sitting on a time bomb. There are all sorts of possible combinations and permutations in sexual relationships and the permutations don’t get much more complicated than in Uganda. In this country, we have people with wives, co-wives, side-wives and girlfriends. Relationships may be described in terms of monogamous, serially monogamous, polygamous, informally or serially polygamous.

With all these different types and combinations, it is no wonder that AIDS is still an issue and in the face of discordancy within such networks the old message of Abstain, Be faithful or Use a condom is inadequate. The International Agencies have been looking for new ways to communicate the issue and someone came up with the message — Get off the sexual network, which for ordinary Ugandans must be one of the most obscure messages about AIDS they could have dreamed up. The message is a bit too subtle for most Ugandans — it sounds like getting off the London underground or Facebook and how does one apply it to real life? If people are already in complex relationships, they are either in that situation unwittingly because they do not know what their partner is doing, or they are aware that they have more than one partner but continue because they enjoy that lifestyle. Either way, telling them to get off the sexual network is meaningless and the simple message is — don’t have sex with anyone unless you know their HIV status, even if you have been married for many years. This means that you not only need to test yourself, you need to take your partner with you, and if they refuse, then stop having sex, or protect yourself by using a condom. This is an issue which you cannot leave to trust, it is a matter of life and death and if you don’t take the decision the death will be yours. If you are the person in the relationship who is positive, you must also ensure that your partner is protected, which you can do by using a condom.

For this World AIDS Day, the message should be straight to the point — don’t have sex with anyone, even your husband or wife, unless you know their status. It is your life and it is your responsibility to protect it. Don’t put your life in the hands of your partner, because all too often, if you happen to get infected, they will deny that it was from them and then blame you for bringing HIV into the relationship.

Do a test with your partner and know their status.

What was just an empty field now contains a 110 bed hospital, many out-patient departments, a large pharmacy and 3 labs, serving more than 75,000 patient visits each year and of course the university.

Well done Dr. Ian.

In an earlier posting I mentioned that for a hospital to operate well we need, in addition to Doctors and other Clinical staff, a wide range of non-clinical expertise.

Much of my time over the last few months, and indeed during my time over the last 2-3 years as a non-exec Director, has been spent reviewing the numbers. IMG is a relatively large organisation and managing the financials (Management Accounts, Finance Accounts, Billing, Credit Control, Central Purchasing and Audit) and improving upon the associated processes is quite a task. We need more help with this and would welcome contact from any suitably experienced individuals who might consider giving some of their time and sharing their expertise.

Here are some of the numbers:

• International Medical Group employs just over 550 staff.
• Our monthly payroll totals more than 400 million Ugandan Shillings.
• The Outpatients department (OPD) at International Hospital Kampala receives more than 6,000 patient visits every month, 72,000 in a year. That’s a lot of patient records to be updated, bills to be generated and collected. OPD numbers in Q1 showed a 10% increase over those for Q4 ‘08.
• We have 8 standalone health centres and a further 5 within schools and factories; these clinics provide care to more than 2,500 patients every week, almost 130,000 patient visits every year. Even more records to be updated, bills to be generated and monies collected. Monthly totals for these clinics have increased by 20% since the start of this year.
• 425 women were admitted onto the Maternity ward in Q1.
• 648 diagnostic tests were performed in Q1, mainly for Cardiology plus 1,525 Ultrasound Scans, 1,122 X-Rays and 6,679 Lab Tests.
• In the same period there were 550 surgical operations.

• Of special note, 62 patients were admitted onto Hope Ward (Charity)during Q1 compared to 58 patients in the last quarter of 2008.
• IMG has a Central Purchasing Department which manages the purchasing, storage and provision of the drugs, treatments and medical supplies necessary for all of the above; a significant undertaking and an essential management control.

If you are interested in helping and up for a fresh challenge, then please do get in touch. You can contact me by clicking here.

In the last year more than 4,750 people have received counselling and testing. Of those, 514 have tested positive; 43 are receiving Anti-Retroviral Therapy and 291 are being given other treatments and are continually monitored for any change in their condition that might trigger the need for ART.

More than 130,000 Ugandans are enrolled on the government’s free antiretroviral programme, but more than 250,000 people are estimated to need treatment.

Touch Namuwongo is supported by funds managed by the Civil Society, from sources such as the Irish Government.

Suubi Trust helped to get this programme started by meeting the initial project costs and by providing assistance in the creation of the proposal for funding.

1. IAA Health Care provides Health Schemes to employers for their employees and families and also some personal schemes. These schemes meet the costs of any treatments required. Members can get treatment from IMG, or from a number of other partner health service providers.

2. International Hospital Kampala, the largest private hospital in Uganda, provides care for IAA members, for those with other health insurance and for cash and invoiced patients. IHK has 100 beds for in-patients, plus general outpatient and specialist clinics. It is the country’s first ISO certified hospital.

3. International Medical Centres has 13 community based Health Clinics throughout the country. These provide primary health care and refer patients to IHK as needed. Some of these are stand alone clinics and others are in large Factories and Schools.

IMG employs about 530 people and has more than 100,000 clients.

In recent months we have started to shape our plans for the next 5 years. We want to add to the specialist services available at IHK creating a hospital capable of being a Regional Referral Centre for East Africa. In May we heard that IMG had been awarded a very significant grant to implement a fully fledged Cardio Vascular Centre, which will be the first of its kind in Uganda.

We have a number of strategic discussions underway with other potential investors and business partners. With one of these we are exploring how best to extend the reach of our community based primary care.

Dr. Ian and I are looking for a few good people to join our management team to help develop and implement these new ventures. Ideally we would like those who can work as volunteers or interns or at the very most be content to receive a local wage (for now).

Ideal candidates will be those with a number of years business management experience, perhaps working with or at Board level, now looking for a sabbatical and a new experience to add to their portfolio.

Alternatively you may have just completed a Business related degree and looking for an early opportunity to start building your CV. If that’s you and you have no job to go to yet then get in touch.

Others might have been considering doing an MBA and could see this as a very viable and less expensive alternative.

You must have great communications skills, both verbal and written and also be able to work with numbers, spreadsheets and lots of data.

You must be very driven, ambitious and the type that won’t stop until all objectives are achieved and issues overcome. If, when thrown in the deep-end, you think this is okay, I can do this, I can cope on my own, then this may just be the opportunity you’ve been looking for.

To find out more you can contact me by clicking here.

We’ll pick up our discussions with them again in July.

Kevin.

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New Private Equity Fund Launched to Strengthen Health Care in Africa

London/Washington, D.C., June 4, 2009—IFC, a member of the World Bank Group, the African Development Bank, the Bill & Melinda Gates Foundation, and the German development finance institution DEG – Deutsche Investitions- und Entwicklungsgesellschaft mbH announced today that they have created a new private equity fund that will invest in Africa’s health sector.

The Health in Africa Fund, managed by Aureos Capital, will invest in small- and medium-sized companies in sub-Saharan Africa, such as health clinics and diagnostic centers, with the goal of helping low-income Africans gain access to affordable, high-quality health services. The fund will be measured not only by fiscal performance but also by its ability to cultivate businesses serving the poor.

The Health in Africa Fund will help implement key recommendations of IFC’s landmark report, The Business of Health in Africa: Partnering with the Private Sector to Improve People’s Lives, which found that the private sector already delivers about half of all health-related goods and services in Africa, and that greater investment in private health companies could have major health and economic benefits for low-income Africans.

The fund will target commitments between $100 to 120 million over two closings. Today’s first closing of $57 million includes investments from IFC ($20 million), the African Development Bank ($20 million), the Gates Foundation ($7 million), and DEG ($10 million). The final closing will take place within a year.

“This is a great opportunity to provide health services where it’s needed most,” said Lars Thunell, IFC Executive Vice President and CEO. “The Health in Africa fund is a key component of IFC’s $1 billion Africa health strategy, which includes improving the operating environment for companies in addition to providing financing.”

Donald Kaberuka, President, African Development Bank, noted: “The Health in Africa Fund is likely to have considerable growth potential despite the global economic slowdown and we are committed to supporting this landmark initiative.”

The fund will make long-term equity and quasi-equity investments in socially responsible and financially sustainable private health companies with the aim of scaling up successful businesses, taking proven business models into new regions, and identifying and investing in areas where there are critical gaps.  It will invest in a wide range of companies that deliver health services (clinics, hospitals, diagnostic centers, labs); risk pooling and financing vehicles (health management organizations, insurance companies); distribution and retail organizations (eye clinics, pharmaceutical chains, logistics companies); pharmaceutical and medical-related manufacturing companies; medical education; and providers of medical education.

“To fight disease and save lives in sub-Saharan Africa, it is important to improve both public and private health care options for the poor,” said Tachi Yamada, president of the Bill & Melinda Gates Foundation’s Global Health Program. “With so many low-income Africans already accessing care through the private sector, this fund will help enhance the quality and quantity of that care, while also directly supporting local economies.”

Dr. Winfried Polte, chairman of DEG’s Board of Management, said: “We are proud to support an initiative that is introducing innovative approaches to meet Africa’s health challenges and could help in reducing poverty.”

The fund plans to make about 30 investments, ranging from $250,000 to $5 million. Although viable investment opportunities from all parts of Africa will be considered, priority countries include Côte d’Ivoire, Ghana, Kenya, Nigeria, Senegal, Tanzania, and Uganda.  Angola, Burundi, Democratic Republic of Congo, Ethiopia, Mozambique, Rwanda, South Africa, and Zambia are expected to follow.

“Aureos is delighted to manage a private equity fund focused on bringing capital and business services to SMEs in Africa’s health sector,” noted Sev Vettivetpillai, CEO, Aureos Advisers Limited. He added that the fund manager will provide value-added services to investee companies, including HIV/AIDS management support, business development, quality control, marketing, corporate governance, and operational assistance.

The Health in Africa Fund is part of IFC’s Health in Africa Initiative (http://www.ifc.org/healthinafrica) under which IFC intends to mobilize up to $1 billion in investment and advisory services over five years, following publication of its 2007 Business of Health in Africa report, which focuses on how to improve people’s lives by partnering with the private sector. Besides the equity vehicle, IFC is improving access to long-term financing for smaller companies involved in health care through local financial intermediaries. Together with the World Bank and other partners, IFC is working with governments to help them better harness the private sector to achieve national health goals and is producing the first biennial report on Africa’s health care investment climate.