60 minutes

This morning, Olwethu, Cecil and I met with Dr Meba Kagone, a medical doctor and a senior programme director for the DELIVER project. This project deals with supply chain management of public health in a range of issues: malaria, HIV and AIDS, family planning, pandemic threats, etc. Dr Kagone is originally from Burkina Faso and manages projects for 13 countries. He is an inspiring individual. We had an interesting discussion about Africa and public health.

The challenge of getting public health products to patients on time is huge. These can be either preventative or curative. Many barriers exist. JSI and the DELIVER project works to assist governments and ministries of health across the world to streamline supply chain management and build capacity to manage these systems sustainably and self-sufficiently in future. A key area that is being developed is quantification of needs. Knowing how much product is necessary is just as important as managing the infrastructure to supply product in country.

Dr Kagone’s opinion is that governance is the biggest limiting factor to self-sufficiency in Africa. His mantra was “governance governance governance” throughout our discussion. When I posed a question about population growth, he acknowledged that contraceptives are a means to curb growth rates, but the complex nature of adequately curbing the projected rates means that without good governance, efforts will not be successful. Africa (and other developing regions) is faced with high infant and maternal mortality rates. This is in part due to a short period between pregnancies for mothers. My own interest in nutrition of course also speaks to infant and maternal health and longevity, and this was another perspective that adds levels of complexity.

Bringing change to the population growth rates in Africa cannot be successful without women’s education and economic empowerment. The prevalence of contraceptive use (and the implications of that to population growth and maternal health) is significantly higher in countries with a higher rate of female education. Projects should therefore be focusing on all women: young girls to grandmothers. Each age group can be part of the change. What is of importance is commitment from governments in terms of policies and legislation, and then, crucially, the implementation of the commitments made. Although, according to Dr. Kagone, there is a theoretical buy-in from governments, this lack of resource and implementation commitment creates real challenges.

To sustain Africa we need the brilliant minds to stay on the continent, good governance and the determination to make the right decisions, Dr. Kagone said. You can be poor and live within your means, and this mind set should be pervasive on the continent. This means managing resources well and equitable distribution. He said to us: “go and fight” (for what’s right). His advice was to go back home, reflect and think critically about what you can do for your country. Ask a question like what is the situation right now; how can I contribute? This can be by running for public office, creating your own business, given that there is a system of good governance and democracy. Furthermore, it is important to have a good idea and then to garner the support of a critical mass of people who share it. Then, take control of that destiny.

Cecil asked him why he decided to study medicine originally. His response was that in medical school in Senegal, a survey was done with the same question. His response then was that he wants to help people who are sick, to be involved in curative health. Others responded that they want to be rich. Dr. Kagone still feels the same; he said clinical practice was very rewarding. As his career progressed, he realized that treating individual cases of malaria was not making the problem go away, and therefore answering the question “is this enough” of himself no longer was affirmative. He then moved to public health, where his work helps 1000s or even millions of people. And to that he says, yes, it is enough, because to him, that is the only way. With good governance, it will be enough.

Dr. Kagone thinks that the best way to make a difference is to be in Africa. He said that devising solutions in situ will yield the best results. Even though he may live here in the US, his heart and mind is still very much in Africa. He is working in a field that he is very passionate about, has no regrets and is still taking care of people. For me, the challenge in his great story was to make a difference where my passion lies. Delving into that statement is a topic for another blog post.