Open letter to The Bill and Melinda Gates Foundation.
Dear Melinda and Bill,
First, happy holidays ! I hope this has been a good year for the both of you , in all your endeavours.
I wanted to applaud for the foundation’s work, as you have decided to deploy immense amounts of capital to tackle the world most pressing problems, with such a huge dedication over the years. I have personally seen an exemple of that when I met a data scientist of a project developed by the Foundation in collab with the Senegalese Health Minister to address problems regarding malaria. Specifically, data collection and feedback by nurses on the cases, the occurrences, …. So much work to do in order the cleanly gather then, analyse then and try to derive concrete and actionable insights from them … as a digital entrepreneur/ data scientist myself, this is a huge work to do !! Especially with the most critical part : the data collection, as you have to spend time training the medical personnel to correct use the tools at their disposal in order to deliver the service.
Have been looking on your website, and there are so much project launched in so many countries. This is quite staggering, and confirms the magnitude of the work to do in the trenches, and there is a very very long way to go. I do also applaud the efforts you do in policy evaluation, as this part is also quite neglected in some countries in which you are operating, regarding public policies.
There is a clear strategy defined on your wenbsite, corresponding to the vision of the foundation : XXX.
However, using some exemples which maybe could be non representative of what I am about to suggest, I would like you to consider integrate other elements in this strategy as well.
My sister is a medical doctor by trade. She works in Douala, Cameroon, in a military hospital. Right now, she is looking to to a hepato gastro entomology specialization abroad, maybe in Ivory Coast, or in Canada. When I asked her where she will try to settle as she end up the specialization, she says that she will not come back to Cameroon. This is a huge loss for the country, as it has spend quite some time and money to train her. Even for her, being apart from our family can be a big strain to have.
When asking why she doesn’t want to stay, she tells me about a situation where her boss hasn’t paid her for almost six months, and she is obligated as a contractor to work for the hospital although not paid, despite all the fees she has spent for her private studies (almost 5000 dollars per year for 7 years, which is a huge investment in Cameroon).
This short story, with variations I heard three or four times, displays one big problem in health in our countries : the doctor working conditions. I believe that improving them willl decrease significantly the number of doctors staying abroad after their studies and their specialization.
How is this your problem, you will tell me : first, just wanted to add my 2 cents regarding your strategy, thus this open letter. Then, I think you have the resources, although with a thoroughly thought strategy, to also add this problem to your plate, as it will help you further down the line think.
How could this be actionnable ? I think of building for profit (capped profits) big and specialized hospitals, in all the main health fields in our countries. For example, diabetes is a huge health problem in Senegal for exemple. And so is hearth problems, with people being more and more sedentary. Building for example , not in Dakar as it’s too dense, ia highly specialized hospital in these problems , with well trained and competent doctors, with the necessary authorizations , and a good family and social life for them could help improve the image and the attractiveness of the healthcare in our countries. You could also build a hospital specialized in ophthalmology for example, but not in the countries capital, as they are already huge and well equipped with those means.
Another thing you could do is putting out a budget on communications regarding basic health problems and child care. I think of cartoons sanctioned by the health ministries of the concerned states about them. There is a huge information access problem everywhere, but especially in Africa, where I think regarding health problems people, especially young moms, gather sometimes incorrect informations from social networks. Just a very sad but true anecdote about this. A Ivorian woman read on Facebook that she should purge her kid with pepper diluted in some water. She did it several times, and you could imagine what that can do to an infant. He died. Cartoons seems to me to be content viral enough that the foundation, in partnership with the health authorities could not spend too much resources (some influencers, little advertising…) to give accurate and credible information to people.
An up to date list of all the influencers and content creators on health problems could also be compiled and distributed, as their help is also needed to prevent problems and they could benefit from the additional audience.
Then, I would like you to consider to develop medical devices adapted to our African exosystem (the problems mentioned are , for the two most important ones), the billing problems and the energy problems, as in some establishments the current is not stable enough to use some heavy machinery. There is a huge shortage in for example in dialysis machines, as it can be costly to operate. You can thinks also if …
Finally, regarding the shortage of medical doctors, in some countries people are willing to train themselves, but the cost of training remains very high ; to that you have to add the cost of living expenses and the fact as you are focused, you risk not graduating if you do too much work outside your studies.
So I would propose to finance universities of their extensions in willing countries, with subsidized of even free housing / other perks for some students, regarding their grades. So that as Europe takes up troves of them, there are still students who decided to stay in our counties who are able to form these doctors. In some countries, maybe the hospitals mentioned above could be chus … there just need to be very careful as that the incentives to go to your hospitals (who will be awesome I believe) are not depriving existing hospitals of personal …
SO that’s it. Having these in my mind for quite some time, I wanted to offer them to you as food for thought … I know you are quite busy, so I will throw this bottle at the sea and hope for the best ….
Keep pushing guys,
Insatiable curions, interested even in how to tackle health problems.