The healthcare investment space is starting to hit its stride in Africa. Two decades ago, the healthcare sector found its greatest asset and growth through the arrival of foreign doctors and missionaries.
But the sector today is finding significant partnership in private investors. The opportunity is vast, with many estimates placing the capital need for the sector beyond $25 billion.
The continent accounts for 25 percent of the world disease burden, according to the World Bank.
Countering this reality is also accompanied with growing challenges often associated with increasing incomes, as well as changing consumer preferences for better food and service options.
The healthcare space therefore requires holistic approaches across multiple verticals, including insurance, primary care, and medicine/foods.
Private investors able to step into these verticals and provide global as well as localized solutions are poised to change healthcare in sub-Saharan Africa while finding strong financial returns.
This piece looks at the top five sub-Saharan African countries for tapping into this expanding healthcare investment opportunity in 2018:
A settling of the election process will open the market up for investment in 2018. One of the biggest opportunities for this country will be healthcare.
First, more than 30 million Kenyans lack any form of basic insurance and are generally served by low quality healthcare facilities. Many Kenyans, including the middle class, cover healthcare emergencies through pooling of money from family and/or coworkers, leaving them financially vulnerable to each health concern, whether small or large.
Financial institutions able to tap into this space can change lives, particularly through mobile technology that can engage a large bandwidth of potential insurance purchasers.
Secondly, Kenya has north of 5,000 pharmacies, most of which do not possess a license nor uphold quality controls to meet international standards.
Other opportunities also include medical device investment—both therapeutic and diagnostic—as well as ICT solutions for reaching rural populations. Establishing a training facility for nurses and doctors to build Kenyan and the larger East African region would be beneficial too.
Why group these two countries together? Kenya wants to be a healthcare hub and example for the region, but it needs another partner in this regional space. Investors actively discuss Tanzania as that country for partnership because it possesses a population north of 55 million and a common language bond (even if the Kenyans and Tanzanians swear the other knows Swahili better).
Yet the debate is ongoing among investors. Both Tanzania and Uganda require better training facilities for nurses and doctors but Uganda is currently doing a better job to address this challenge.
Pharmaceuticals and medical devices are lacking in both countries, but Tanzania is seeing a greater investment and growth in this space. Insurance is lacking in both markets but with Tanzania having a stronger financial market to support insurance. Tanzania is home to more than 3,000 – 4,000 pharmacies, depending on the source of information, most of which are also unlicensed and lacking in quality control.
Many investors ponder whether investments into these two countries possess the cross-border scaling opportunity ideal for financial gains and returns. Answering that question in conjunction with the opportunity in the Kenyan market will be a priority for 2018.
The Nigerian healthcare sector is estimated to be worth north of $20 billion in 2018. The number is large but so are the remaining challenges.
Good private healthcare in this country of nearly 190 million people is expensive. The country requires a low-cost, high-volume solution that can tie into the Nigerian government’s long term commitments and expectations.
The Nigerian government committed one percent of the annual federal revenues towards boosting basic healthcare services through the National Health Bill in 2014. The financial commitment has been hurt by decreased government revenue due to lower oil prices, and even at a $100-plus oil price, the money would not be sufficient to confront the Nigerian challenges.
Financial institutions could do more to strengthen risk-pooling and lower insurance costs in conjunction with government efforts. With everything else in the Nigerian market, quality is the opportunity for investors. A perceived lack of quality in medicine, devices and facilities has largely undercut the sector’s growth in-country.
Nigerians, including President Muhammadu Buhari, spend to receive healthcare abroad. Local, high quality offerings will find consumers with money to pay. Those offering the high quality solutions hope they will find investors ready to invest.
French Africa requires a couple of champion countries in the healthcare space. The francophone healthcare space is large, with the pharmaceutical market approaching $3 billion, for example. Annual growth is projected between 8 and 10 percent through the next five years.
Production in these markets is lacking, with many private investors slowly entering the space. Pharmacies, hospitals, and related facilities are also insufficient in the local markets and furthermore lack qualified staff to serve growing populations.
Senegal is a major focus for some investors, illustrated by the public success of Winthrop Pharma Senegal, purchased by Actis—via its portfolio company MédiS—from Sanofi.
Government commitment to changing the space, as well as partnering with international NGOs within its borders, has also encouraged investors to come to Senegal.
That said, Cote d’Ivoire is doing more to strengthen physical infrastructure for manufacturing pharmaceuticals as well as building social infrastructure, including hospitals and training facilities.
It is not a competition per se between the two countries, but their combined efforts are attracting the most interest and excitement from investors looking to penetrate the francophone African healthcare space.
Kurt Davis Jr. is an investment banker focusing on the natural resources and energy sectors, with private equity experience in emerging economies. He earned a law degree in tax and commercial law at the University of Virginia’s School of Law and a master’s of business administration in finance, entrepreneurship and operations from the University of Chicago. He can be reached at kurt.davis.jr@gmail.com.
