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1、Inclusive Health Systems:Innovations towards Health Equity in AfricaW H I T E P A P E RJ A N U A R Y 2 0 2 3In collaboration with Bayer FoundationContentsImages:Getty Images,Unsplash 2023 World Economic Forum.All rights reserved.No part of this publication may be reproduced or transmitted in any for
2、m or by any means,including photocopying and recording,or by any information storage and retrieval system.Disclaimer This document is published by the World Economic Forum as a contribution to a project,insight area or interaction.The findings,interpretations and conclusions expressed herein are a r
3、esult of a collaborative process facilitated and endorsed by the World Economic Forum but whose results do not necessarily represent the views of the World Economic Forum,nor the entirety of its Members,Partners or other stakeholders.ForewordExecutive summaryIntroduction1 Barriers and actionable sol
4、utions for stakeholders2 Four principles to advance social innovation and entrepreneurship3 Practical pathways forward ConclusionContributorsEndnotes34592730323335Inclusive Health Systems:Innovations towards Health Equity in Africa2ForewordThis white paper showcases actionable ways in which social e
5、ntrepreneurs and innovators in health tackle key issues related to closing the health equity gap.It examines the work and actions of social entrepreneurs across Sub-Saharan Africa through the COVID-19 pandemic and draws from rich meta-research and artificial intelligence-data analytics that have eme
6、rged over the COVID-19 pandemic life cycle and beyond.Notably,the actionable insights offer substantive evidence of the distinct ability of social entrepreneurs and innovators in health to react to systemic health shocks,bolster government responses,develop inclusive solutions to health system barri
7、ers,create socioeconomic systems that prove resilient during crises and tackle the root causes of health inequity,by embracing local contexts.It is important to recognize that this ability to react is partly due to the actions of private and public partners that help create an environment where soci
8、al entrepreneurs can act in catalytic ways.This paper is a result of the collaborative and multistakeholder approach driven by the World Economic Forums Global Alliance for Social Entrepreneurship,the Schwab Foundation for Social Entrepreneurship and the Bayer Foundation,bringing together academic l
9、eaders from the University of Cape Town Bertha Centre for Social Innovation and Entrepreneurship,and Impact Hub Africa,in consultation with data research providers,health practitioners from the private and public sectors and experts on social innovation across Sub-Saharan Africa.Through this researc
10、h,we suggest that a holistic and inclusive attitude to social entrepreneurship and innovation in health is necessary and will be vital in moving the social system closer to achieving true health equity.Social entrepreneurs are one of the key actors that can drive the needed systems change.By drawing
11、 on their understanding of the landscape and context in which they operate,social entrepreneurs co-create and pioneer solutions and business models that help to reimagine and rebuild our healthcare,education,environmental and urban planning systems,among many others to be more just,sustainable and e
12、quitable.Crises that come on the heels of complex health challenges such as HIV/AIDS and the increased prevalence of chronic non-communicable diseases occurring across Sub-Saharan Africa will only accelerate as the continent and the world prepares to confront climate change,access to water,migration
13、 and conflict,looming recession and food insecurity.There is thus a need to re-examine the concept of health equity as a part of a much wider social justice goal that cannot be achieved without addressing structural inequities in societies.Emphasizing health equity as everyones business and partneri
14、ng with social innovators who lead the way in developing practical and scalable solution to address systems barriers provides an actionable pathway for different stakeholders,including corporate and philanthropic leaders,alongside the public sector to follow through on their equity commitments.Frano
15、is Bonnici Director,Schwab Foundation for Social Entrepreneurship and Head of Social Innovation,World Economic ForumMonika Lessl Executive Director,Bayer FoundationInclusive Health Systems:Innovations towards Health Equity in AfricaJanuary 2023Inclusive Health Systems:Innovations towards Health Equi
16、ty in Africa3Executive summaryThe COVID-19 pandemic and response measures presented many hardships to people living in Sub-Saharan Africa.Coordination was initially a challenge among governments in the region,as public health policies,lockdowns,the economic measures taken were not always designed wi
17、th vulnerable populations in mind.This meant that the response to the virus was slow and fragmented,which lead to an erosion of social trust and a proliferation of misinformation.The COVID-19 pandemic was also a time of triumph in the face of adversity.In addition to better coordination by regional
18、bodies such as the African Union(AU)and Africa CDC,on the front lines,social innovators across Africa organized online and digital technologies to respond to the COVID-19 pandemic in their local communities,such as developing asset-lite models of social enterprises,which were well-timed during the C
19、OVID-19 pandemic.There was also a strong sense of community-centred approaches,with growing notions of reciprocating,sharing solidarity and providing care for more vulnerable segments of the population.Over the years,social innovation and entrepreneurship in health across Africa have shown enormous
20、value in addressing healthcare delivery gaps and in contributing to universal health coverage and patient-centred health systems.Arguably,social entrepreneurship provides an inclusive platform for people from different disciplines and sectors to contribute collectively to their local health system.S
21、ocial innovation and entrepreneurship in health may also be understood to be a mechanism through which societal goals can be achieved.The insights contained in this paper helped to surface ten barriers of inclusive health systems as well as associated solutions and gaps.The COVID-19 crisis demonstra
22、ted that social innovators could be critical actors in addressing such barriers by harnessing a sense of community-centred approaches with strong notions of reciprocating,sharing solidarity and providing care for more vulnerable segments of the population.Insight 1:Cultivating enabling environments(
23、both public and private sector)activates solutions to systemic and protracted health systems barriers Amplified by the COVID-19 pandemic,barriers concerning the logistics and transport of medication,received the lions share of attention from international and local actors.Here,social entrepreneurs w
24、ere given the opportunity to leapfrog their solutions,specifically in scaling digital technologies.However,other logistical and supply chain challenges,specifically with regards to access to rural populations encompassing roads quality,internet access and the supply of essential goods,among others,g
25、ained less of a spotlight with community-centred solutions still to be scaled.Insight 2:Many solutions remain underused across barriers The research has shown that two types of solutions innovations in diagnostic technologies and digital health accounted for 25%of the total share of innovations and
26、have been effectively used to address barriers such as lack of access and affordability of quality healthcare and medicine,economic impacts,as well as challenges in digitalization and data.However,these innovations had not emerged in addressing gender equality,access to basic needs,stigmatization or
27、 persistent challenges in capacity or infrastructure.Insight 3:To activate social innovations,stakeholders will need to undergo a fundamental shift in alignment towards a broader health equity agenda while embracing strategic systemic focus The barriers identified demonstrate that a systemic shock t
28、ends to expose existing societal weaknesses and worsen broad health inequalities.By accepting that health equity is a societal goal,there needs to be a recognition that social factors are integral to developing fairer health systems.To collaborate for inclusive health systems through social innovati
29、on and entrepreneurship,four principles are recommended:actively build for the long haul,acknowledge that progress is not linear,commit to actively building resilience and embrace radical partnerships and opportunities for collaboration.This paper is a step towards raising awareness and initiating a
30、ctions,especially within the Global South,intending to reduce barriers to health equity while also understanding that there is great variance across geographies and contexts.An effort to continue driving this forward must include wider exploration and comparison of the barriers and solutions identif
31、ied on a global,regional and cross-thematic scale.Doing so will bring in additional partners and actors and stimulate the public sector engagement necessary to ensure the continual testing and iteration of the insights generated.Inclusive Health Systems:Innovations towards Health Equity in Africa4In
32、troductionAfrica continues to face sustainable development challenges,and the effects of global climate change and the COVID-19 pandemic have only exacerbated these conditions.In response to the challenges,many countries and cities on the continent have,over the years,become vibrant hubs for social
33、innovation and entrepreneurship.1 Promoting innovation and social economy,which comprises multiple models with a common goal of creating a more inclusive and sustainable economic paradigm,is seen as a contributor to inclusive and sustainable development and demonstrates who the key actors in the env
34、ironment are,what types of partnerships and cross-collaborations are integral to success and how governments in African countries can contribute to creating enabling environments for social innovators and entrepreneurs.The objective of this white paper is to demonstrate how social innovation can off
35、er actionable solutions in addressing systemic barriers while building health equity across Sub-Saharan Africa.Examining the catalytic impact that the COVID-19 pandemic had on social entrepreneurs and innovators in health uncovered the lessons and actionable insights gleaned from these important sta
36、keholders and change agents within the inclusive health system.This paper is an analysis that employs a mixed-method approach,entailing:An artificial intelligence-(AI)driven data and analytic approach that initially collected more than 1.9 million articles and posts(news reporting,online discussions
37、 and academic publishing),which were then distilled to approximately 450,000 sources that were used for analysis.The scope of the analysis was 48 countries in Sub-Saharan Africa and languages included English,French,Portuguese,Spanish,Arabic,Swahili,Amharic and Yoruba.35 hour-long semi-structured in
38、terviews with health experts,including representatives from governments,international organizations,social enterprises,private businesses,non-governmental organizations and academia(most of which are based in African universities).Three consultation workshops,with local stakeholders and partners wit
39、h the support of the 2022 Sankalp Africa Summit,and Impact Hub Africa for Harare and Accra validation sessions workshop,which convened key stakeholders and helped to frame the research goals.The barriers to creating inclusive health systems in Africa are widespread and challenging to overcome.Defini
40、tions of terminology used in this paperTABLE 1TerminologyDefinitionBarriersObstacles or factors that hinder progress towards inclusive health systems.Sub-barriersA deeper dive into the granular barriers that hinder progress towards inclusive health systems.SolutionsInnovations that target the barrie
41、rs to creating inclusive health systems that come from social innovators,entrepreneurs and actors at the ground level.Types of solutionsBroad categories of solutions that were developed to strengthen the health system.Enabling environmentFactors that promote the creation of solutions to tackle barri
42、ers.These factors stem from the collaborative action by ecosystem actors such as governments,regulatory bodies,funders,global and local stakeholders.GapsThe divide between barriers and solutions.Inclusive Health Systems:Innovations towards Health Equity in Africa5Summary of SANKALP Africa Summit,Acc
43、ra and Harare workshopsBOX 1The SANKALP Africa conference was held on 2 March 2022.This session initiated the discussion on actionable insights for inclusive health systems and created the foundations for research as well as the design of the study.The Harare validation workshop was hosted by Impact
44、 Hub Zimbabwe on the 16 September 2022.The workshop included around 20 guests consisting of social innovators and entrepreneurs.A second validation workshop was hosted by the Impact Hub Ghana team in Accra on the 22 September 2022 and included around 20 participants,again from social innovators and
45、entrepreneurs in the region.Barriers to inclusive health systems and innovative solutions The systemic barriers highlighted in this paper were identified through AI analysis and in-depth interviews and span different areas of the healthcare system as well as the policy and regulatory environment in
46、which health and social innovators and entrepreneurs try to work within.It is unsurprising that in an assessment of the data examined,the most prominent barriers being reported were the lack of screening and documentation on disease control and public health,lack of tech-forward healthcare systems,a
47、dapting to digitalization and mitigating the impact of the COVID-19 pandemic on micro,small and medium enterprises(MSMEs)through the digitization of services,and the lack of accessibility of medical data.The lack of technological innovations and infrastructure in the healthcare system is another fre
48、quently mentioned barrier,mostly in Rwanda,Kenya and Nigeria.Ten barriers to creating inclusive health systems and their respective share(%)FIGURE 1Weak healthcare capacityand infrastructure24.7%Lack of access and affordability of quality healthcare and medicine16%Economic impactof COVID-1913.5%Gend
49、er inequality5.8%Challenges tothe access tobasic needs2.7%Supply chain distruptions andlogistic challenges1.7%Malnutrition and food insecurity5.3%Stigmatization andinsufficient health literacy9.4%Digitalization andinaccessibilityof data7%Inequality related to COVID-1914%Source:Impact IntelligenceInc
50、lusive Health Systems:Innovations towards Health Equity in Africa6Share of reporting around solution typesFIGURE 2Telemedicine anddigital health solutions12%Diagnostic technologiesand health data13%Development andproduction of medicines,medical equipmentand vaccines17%Support systemsfor entrepreneur
51、s9%Paymentsolutions7%Agritech solutions andsupport systems for farmers6%Provision ofsanitation and utilitiesKnowledge and awareness building2%2%1%1%1%Mobility and homecare solutionsValidation of authenticity of medications,medical equipment and vaccinesProvision of nutritious and affordable foodMana
52、gement and recycling ofwaste for medical purposes4%Other7%Transport and storage of medications,medical equipment and vaccines25%The COVID-19 pandemic catalysed innovation and adoption of digital technologies in African countries,which resulted in some well-being tech start-ups thriving.Additionally,
53、several digital health solutions have been reported that address different barriers to inclusive health.These include interventions such as the Ugandan company Teheca where parents and nurses are connected for postnatal at-home care,and Sila Health in Zimbabwe,which provides access to basic healthca
54、re through chat platforms.The period following the pandemic has been a great accelerator of digital transformation for Africa,as organizations increased their investment in digital technologies to attain greater agility and improve their response to the disruption caused by the pandemic.2 Throughout
55、 the pandemic,fintech solutions have been helping the continents small-and medium-sized enterprises(SMEs)and MSMEs overcome these and other challenges by enabling digital transactions and facilitating fast and convenient access to credits.3Examining regional data trends has revealed valuable geograp
56、hic insights.For example,the lack of on-demand emergency deliveries of vaccines,medical supplies and life-saving medications was a major barrier reported in Ghana,Rwanda,the Democratic Republic of Congo,Malawi and Mozambique.This barrier is mostly reported in relation to access in rural areas,as one
57、 of the drivers of this barrier is the lack of physical and digital infrastructure.Innovative approaches and solutions were considered to overcome this issue,the most prominent instance being drone delivery services.South Africa,Zimbabwe and Botswana reported a strong focus on health inequity and CO
58、VID-19 apartheid,while reporting in Nigeria,Cameroon,Uganda and Tanzania was characterized by a strong focus on healthcare infrastructure.Source:Impact IntelligenceNot all the solutions that unfolded through the research are novel;some emerged due to scaling and adapting existing interventions and b
59、usiness models.Still,others developed from collaborations and partnerships that capitalized on the unique context of the pandemic.Inclusive Health Systems:Innovations towards Health Equity in Africa7Central African RepublicGambiaGuinea-BissauStronger reporting about public enablersStronger reporting
60、about privateenablersNigeriaMauritaniaEquatorialGuineaGhanaBeninLiberiaRwandaMalawiCongoLesothoGuineaEswatiniMauritiusSomaliaZambiaSudanZimbabweSenegalSierra LeoneBotswanaMozambiqueKenyaEthiopiaSouthSudanSouthAfricaDemocratic Republicof the CongoEnabling environment In the context of this paper,a su
61、pportive enabling environment is essential for health innovation.Enabling environments can include formal elements,such as public policies,governance structures,regulatory frameworks and investment programmes,and informal elements,such as cultural,social and economic norms and practices that influen
62、ce innovation actors,networks and systems.Developing the capacity for innovation and entrepreneurship is challenging but doing so helps to drive systemic change and sustainable impact.Public enablers refer to governments,regulators,policy-makers or public sector organizations that actively promote t
63、he creation of environments conducive to developing solutions.Private enablers refer to actors,funders,incubators and accelerators,among others,within the private sector that contribute to cultivating the enabling environment.Figure 3 shows where countries are placed along a spectrum of public and p
64、rivate enablers.Four principles to advance social innovation and entrepreneurshipThe insights identified within this paper are further grounded in four key principles for stakeholders that emerged when examining the patterns that surfaced during the AI scan and interviews with innovators and entrepr
65、eneurs.These principles speak specifically to the mindset and attitude embodied by social entrepreneurs and innovators that enabled them to respond to the challenges of COVID-19.They might not be applicable in every context,but they help to frame a holistic,systems-focused approach.List of African c
66、ountries on a spectrum of strong public and private enabling environmentsFIGURE 3Source:Impact IntelligenceInclusive Health Systems:Innovations towards Health Equity in Africa8Barriers and actionable solutions for stakeholdersThe pandemic exacerbated the barriers to inclusive health by challenging i
67、nfrastructure capabilities,broadening inequities and disrupting the established way of life and work.The following insights and strategies are particularly helpful in conceptualizing how stakeholders and partners can develop strategies that promote inclusive health locally and within broader Sub-Sah
68、aran African development issues.Ten key challenges present opportunities for building inclusive health systems in Africa.1According to the analysis,weak healthcare capacity and infrastructure had the greatest gap for solutions and enablers.This implies that the healthcare system continuously faces c
69、hronic issues for which few solutions and enabling factors encourage innovation.There is a clear dearth of medical and protective personal equipment as well as a scarcity of clinics and qualified healthcare personnel,which social innovators are trying to solve.Still,the enabling environment is not c
70、onducive to these measures.Poor health infrastructure presented challenges in relation to screening mechanisms,early warning measures and the ability to produce and transfer vaccines;solutions were developed to address these issues,but here a strong enabling environment would be able to cultivate mo
71、re solutions.This is a priority area and requires the commitment and willingness of stakeholders to bridge the gap and create conducive environments for solutions.Weak healthcare capacity and infrastructure1Breakdown of sub-barriers with solution and enabler scores for barrier 1:weak capacity and in
72、frastructureFIGURE 405040Share of sub-barrier(%)Sub-barriersSolution scoreEnabler scorePoor working conditionsfor health workers11Lack of medical equipmentand protective equipments22Lack of infrastructure toproduce and transfervaccines33Lack of clinics and qualified healthcare personnel13
73、Poor management ofmedical waste14Weak screening,preventionand early warning measuresfor diseases24Source:Impact IntelligenceInclusive Health Systems:Innovations towards Health Equity in Africa91.Insight 1:Cultivating enabling environments(both public and private sector)pays off,it activates solution
74、s to systemic and protracted health systems barriers.Collaboration between the World Health Organization(WHO),Medicines Patent Pool,the Access to COVID-19 Tools(ATC)Accelerator and COVAX were actors that enabled,supported and fast-tracked vaccine technology transfer.This resulted in companies such a
75、s Afrigen in South Africa producing vaccines locally.Recommendations for insight 1:Global and local actors play important roles in creating enabling environments to reduce weak healthcare capacity and infrastructure.The momentum of removing global and local policy barriers should be sustained in ord
76、er to promote inclusive innovation.2.Insight 2:Many solutions remain underused across barriers Several of the solutions developed were in the areas of mobility and homecare solutions,as well as telemedicine and digital health solutions.Additionally,many organizations took the opportunity to develop
77、training opportunities for healthcare workers,thereby increasing health force capacity on the continent.However,many other types of solutions remain underused across these crucial sub-barriers.Examples illustrating weak capacity and infrastructure and the low spread of solutionsTABLE 3Sub-barrierSoc
78、ial innovation solution examplesSolution typeEnabling environmentWeak screening,prevention and early warning measures for diseasesKenyas Tibu Health provides medical services,testing and vaccine services at home.Mobility and homecare solutionsGovernments,including in South Africa and Nigeria,have re
79、iterated the important role of public-private partnerships(PPP)in improving the efficiency,quality,innovation and health impact of both private and public healthcare systems.Redbird in Ghana,provides pharmacies with rapid tests for diseases and blood values.Telemedicine and digital health solutionsV
80、ive Teens in South Africa provides mental health services to teenagers through an app.Any warning signs of depression,anxiety or suicidal ideation trigger a call for help from family and mental health professionalsTelemedicine and digital health solutionsLast Mile Health provides healthcare workers
81、and healthcare services to rural and remote areas.Mobility and homecare solutionsNorth Star Alliance provides clinic services to truck drivers travelling along borders and highways who may not have access to healthcare services.Mobility and homecare solutionsRecommendations for insight 2:Create a wi
82、der spread of solutions across the barrier to target different aspects of the healthcare system.This includes knowledge and awareness building,support systems for community innovators,mobility and homecare solutions for patients and provision of sanitation and utilities.Examples illustrating weak ca
83、pacity and infrastructureTABLE 2Sub-barrierSocial innovation solution examplesSolution typeEnabling environmentLack of infrastructure to produce and transfer vaccinesCompanies such as Afrigen,in South Africa,manufacture vaccines and adjuvants locally.Development and production of medications,medical
84、 equipment and vaccinesWHO,Medicines Patent Pool,and the ATC Accelerator/COVAX were actors who supported the transfers of vaccine technology for vulnerable countries and populations.Inclusive Health Systems:Innovations towards Health Equity in Africa10Breakdown of sub-barriers with solution and enab
85、ler scores for barrier 2:lack of accessFIGURE 5006070Share of sub-barrier(%)Sub-barriersSolution scoreEnabler scoreCoverage and insurance costsCounterfit drugsAccess to affordable,high-quality,basic andspecialized healthcareAccess to affordablemedicine and contraception12344413Source:Impa
86、ct Intelligence1.Insight 1:Cultivating enabling environments(both public and private sector)pays off,it activates solutions to systemic and protracted health systems barriers.Strong enabling environments helped to address some of the sub-barriers identified,such as access to affordable medicine and
87、contraceptives.Insights into coverage and insurance also surfaced as an example of how the public sector can contribute to creating strong enabling environments.Strong themes emerged regarding issues around the access,affordability and quality of both basic and specialized healthcare.There were few
88、enabling factors that encouraged social innovation and entrepreneurship to overcome the sub-barriers,while some enabling factors were weak.This contributes to the persistence of the barrier.Similarly,problems relating to the access and affordability of medicine and contraception constitute another l
89、arge theme.However,the sub-barrier ranked lower on the solution gap rank,which implies that solutions were more easily created in this priority area.Lack of access and affordability of quality healthcare and medicine211Inclusive Health Systems:Innovations towards Health Equity in AfricaRecommendatio
90、n for insight 1:Despite the success in creating enabling environments for access to medicines,contraception,costs and coverage for healthcare,other solutions struggle with poor enabling environments.Access to affordable,high-quality,basic and specialized healthcare requires stronger enabling environ
91、ments and efforts from both private and public actors for solutions that will contribute to inclusivity.2.Insight 2:Many solutions remain underused across barriers As shown above,for the“access to affordable medicine and contraception”sub-barrier,there is a concentration of solutions in the transpor
92、t and storage of medications,medical equipment and vaccines,followed by telemedicine and digital health solutions,diagnostic technologies and health data and payment solutions.Examples of solutions to this barrier include the Whispa Health and MyMedicines apps in Nigeria and the Medikea health app i
93、n Tanzania.Recommendation for insight 2:There is a general spread across the types of solutions for this barrier,however,there is also room for improvement:In telemedicine and digital health solutions,measures can be adaptive to reduce the volume and burden on the public health sector;scale online p
94、harmacies,decentralize chronic medication distribution and strengthen primary care through community health workers.All components in the healthcare system play an important role here.In terms of communication,there should be a redesign of communication outreach efforts to ensure that general health
95、 communication does not falter in the face of a crisis.Interruptions to testing and treatment(HIV/AIDS,malaria,tuberculosis,etc.)will only serve to exacerbate the general health burden once pandemics have abated.Efforts should go towards creating support systems for entrepreneurs who want to enter t
96、his specific area of innovation,as well as entrepreneurs already working in this area to scale and grow their innovations.Examples illustrating lack of accessTABLE 4Sub-barrierSocial innovation solution examplesSolution typeEnabling environmentAccess to affordable medicine and contraceptionTelemedic
97、ine solutions provide online doctor-patient calls and emergency online pharmacy services through companies such as Nigerias CribMD and Doctoora.Telemedicine and digital health solutionsBiocon Biologics,Indias largest biopharmaceutical company and an insulin manufacturer,unlocks universal access to q
98、uality insulins in low-and middle-income countries(LMICs)by making recombinant insulin available for less than 10 US cents per day.The Boehringer Ingelheim Making More Health global initiative provides support to social entrepreneurs to create social impact.The Making More Health Initiative also wor
99、ks towards increasing access to healthcare for people,animals and their communities.Whispa Health in Nigeria offers young girls and women access to contraception and sexual and reproductive health services.Telemedicine and digital health solutionsMyMedicines Nigeria partners with the National Postal
100、 Service to distribute medicines.Telemedicine and digital health solutionsMedikea Health is an app that provides primary care to patients in Tanzania.Telemedicine and digital health solutionsCoverage and insurance costsSOSO Care provides micro-insurance services in Nigeria via facilitated payment op
101、tions,including payment with recyclables.Payment solutionsSenegals welfare system is described as innovative,accessible and striving towards universal health coverage.The Strategic Plan for Developing Universal Health Coverage in Senegal 2013-2017 was designed to help achieve this goal.Inclusive Hea
102、lth Systems:Innovations towards Health Equity in Africa12The COVID-19 pandemic brought a renewed focus to health inequity across the continent.The low COVID-19 vaccination rate in Sub-Saharan Africa has been described as partly a result of vaccine hoarding by rich countries.Unequal vaccine distribut
103、ion and the solidarity or lack thereof of the international community has been a frequent topic in online conversations.Inequity related to COVID-193Breakdown of sub-barriers with solution and enabler scores for barrier 3:inequality related to COVID-19FIGURE 6006080Share of sub-barrier(%)
104、Sub-barriersSolution scoreEnabler scoreUnequal vaccinedistribution and lowvaccination rateLack of equipment andsupplies to fight COVID-192334Source:Impact Intelligence1.Insight 1:Cultivating enabling environments(both public and private sector)pays off,it activates solutions to systemic and protract
105、ed health systems barriers.There are moderate enabling environments for the barrier of inequality related to COVID-19.It demonstrated that both global and local level actors could collaborate and create access to medical equipment and supplies for more vulnerable countries.Recommendation for insight
106、 1:The lessons learnt from the COVID-19 pandemic can be applied and carried forward for future pandemic preparedness to prevent the same inequity from continuing.Policies,plans and roadmaps should be created by global and local actors to navigate future pandemics and avert inequality.2.Insight 2:Man
107、y solutions remain underused across barriers Most of the solutions were concentrated in the development and production of medications,medical equipment and vaccines.These examples illustrate how the COVID-19 pandemic catalysed innovative solutions.Examples illustrating inequality related to COVID-19
108、TABLE 5Sub-barrierSocial innovation solution examplesSolution typeEnabling environmentUnequal vaccine distribution and low vaccination rateAmref Health Africa focuses on creating access to healthcare through human resources for health,health service delivery and investments in health,as well as addr
109、essing vaccine inequity across the continent.Development and production of medications,medical equipment and vaccinesThe WHO is working with the ministries of health in African countries to design oxygen plants for sustainable and self-sufficient local oxygen supply.The COVAX initiative,and the Afri
110、can Export-Import Bank,guaranteed the procurement and distribution of$400 million Johnson&Johnson vaccine doses to African countries.Prior to June 2021,South Africa did not have the capacity to manufacture vaccines from scratch.The South African technology transfer hub,facilitated by the WHO,will en
111、sure that South African companies BioVac Institute and the Afrigen Biologics will be equipped with the technology,skills and licensing required to manufacture vaccines at an industrial scale locally.Development and production of medications,medical equipment and vaccinesInclusive Health Systems:Inno
112、vations towards Health Equity in Africa13Recommendations for insight 2:There can be more efforts invested in focusing efforts in other solution areas.For example,knowledge and awareness building to counter stigma and false information should be strengthened as a solution.There is also a need to stre
113、ngthen solutions that create support systems for entrepreneurs,especially those whose innovations emerged as a direct response to the COVID-19 pandemic.The economic impact of COVID-19 includes disruption of business continuity as the transition to remote work within low-and middle-income countries(L
114、MICs)was challenging due to infrastructure and socioeconomic realities.Restrictive local policies and a lack of government support made it difficult for social entrepreneurs to fill gaps in the healthcare system.Additionally,unlike their peers in areas such as fintech,health entrepreneurs have found
115、 it difficult to raise funds during the COVID-19 pandemic amid a deteriorating economic environment.Economic impact of COVID-194Breakdown of sub-barriers with solution and enabler scores for barrier 4:economic impact of COVID-19FIGURE 700Share of sub-barrier(%)Sub-barriersSolution scoreEn
116、abler scoreBusiness continuitychallenged by infrastructureand social problemsLack of governmentsupport and restrictivelocal policies forentrepreneursDeteriorating economicenvironmentDifficulties accessingfunding and support22334335Source:Impact Intelligence1.Insight 1:Cultivating enabling environmen
117、ts(both public and private sector)pays off,it activates solutions to systemic and protracted health systems barriers.The enabling environments during the COVID-19 pandemic were extremely strong.Many barriers were removed,and processes were fast-tracked to mobilize additional funding used in response
118、 to the COVID-19 pandemic,specifically by private sector actors and investors.Inclusive Health Systems:Innovations towards Health Equity in Africa14Examples illustrating economic impact of COVID-19TABLE 6Sub-barrierSocial innovation solution examplesSolution typeEnabling environmentDifficulties acce
119、ssing funding and supportBridge for Billions is an entrepreneurship programme that supports organizations with training entrepreneurs.Support systems for entrepreneursCross Border Impact Ventures is an enabling actor in the ecosystem that provides capital for devices to benefit women,children and ad
120、olescents.Impact Hub branches in Accra and Harare supports entrepreneurs by running programmes,facilitating networks and communities.The South African Breweries(SAB)Foundation is a trust that invests funds towards developing entrepreneurship in South Africa.The Unknown Group provides early-stage fin
121、ancing for founders with promising solutions that can be scaled and provide a conducive environment for founders to thrive.We Share Forward is a non-profit that promotes and supports social entrepreneurs and changemakers in communities while using a pay it forward principle to recycle capital.The As
122、hoka East Africa branch supports social entrepreneurs or fellows by providing assistance with their social innovations and enterprises.Support systems for entrepreneursHealth Tech Hub Africa supports digital innovators in Africa with education,training and access to funding opportunities.Support sys
123、tems for entrepreneursRecommendations for insight 1:Despite enabling environments for accessing funding and support,there is still room for the various governments and local policy-makers to create more enabling policy environments to support innovators and social entrepreneurs as policies remain re
124、strictive.2.Insight 2:Many solutions remain underused across barriers There was a general spread of solutions for this specific barrier,with many solutions falling into the category of support systems for entrepreneurs,followed by transport and storage of medications,medical equipment and vaccines,a
125、nd telemedicine and digital health solutions.Recommendations for insight 2:Unlocking financing has,in turn,highlighted a pathway to unlock support systems for entrepreneurs,innovators and youth.There should be continuing investment in support systems to strengthen their efficiency and effectiveness,
126、as well as extra effort that can be directed towards mobilizing additional capital and providing a cushion against macroeconomic events that will strengthen the development of solutions for this barrier.Inclusive Health Systems:Innovations towards Health Equity in Africa15Stigmatization and insuffic
127、ient health literacy presented a considerable gap in designing solutions during the COVID-19 pandemic.This was evident in the literature as well as interviews with social innovators working in the field.Relatedly,discrimination towards various groups,such as sex workers,disabled people and religious
128、 minorities,has been reported.Stigmatization and insufficient health literacy5Breakdown of sub-barriers with solution and enabler scores for barrier 5:stigmatization and insufficient health literacyFIGURE 805040Share of sub-barrier(%)Sub-barriersSolution scoreEnabler scoreLack of knowledg
129、e andhealth literacy ofeducators and parentsStigmatizationDiscriminaiton towardscertain groups/minoritiesLack of knowledgeand awarenessVaccine hesitancyand misinformation1112233344Source:Impact Intelligence1.Insight 1:Cultivating enabling environments(both public and private sector)pays off,it activ
130、ates solutions to systemic and protracted health systems barriers.There were strong enabling environments and efforts to address the lack of knowledge on COVID-19 and vaccination awareness during the COVID-19 pandemic.However,misinformation and misconceptions emerged as obstacles to immunization cam
131、paigns for COVID-19.This was reinforced by poor health literacy among educators,parents and informal influencers.Furthermore,there were and are considerable barriers to further strengthening the enabling environments to address issues such as mental health and sexually transmitted diseases,as there
132、is a deep mistrust of governments across the continent that heightened during the COVID-19 pandemic.Inclusive Health Systems:Innovations towards Health Equity in Africa16Sub-barrierSocial innovation solution examplesSolution typeEnabling environmentLack of knowledge and awarenessHopeful Nkomo provid
133、es mental health education and awareness services in Ghana.Knowledge and awareness buildingA former Namibian Minister of Health organized information sessions together with companies to inform employees and combat myths associated with vaccination.Governments enlisted celebrities,influencers,officia
134、ls,assemblymen and chiefs in vaccination programmes.The engagement of all trusted stakeholders was more likely to increase vaccine uptake than government institutions alone.Geedka Mooska is an educational programme for Somali speaking children that uses“edu-tainment”to make learning fun.As the COVID
135、-19 pandemic began,Poet Nation Media modified several public health videos and created a set of superhero puppet characters called Hiddo&Hirsi who seek to protect their neighbourhood from various types of dangers,including COVID-19.These educational videos are the first of their kind for Somali-spea
136、king children.All these videos were approved by the Ministry of Health in Somalia.Knowledge and awareness buildingBrandMed in South Africa provides digital health solutions focused on lifestyle changes and awareness of disease prevention.Telemedicine and digital health solutionsDigital Medic provide
137、s education and awareness content to patients and the public using digital health technologies.Telemedicine and digital health solutionsVaccine hesitancy and misinformationPulse Africa in Ghana provided information and awareness throughout their platforms to prevent misinformation and fake news.Know
138、ledge and awareness buildingResolve to Save Lives,which works globally,creates a collaboration between journalists and doctors,using media to enlighten audiences and decrease vaccine hesitancy.Examples illustrating stigmatization and insufficient health literacyTABLE 7Recommendation for insight 1:Th
139、ere was still plenty of stigmatization and discrimination towards certain groups and minorities during the COVID-19 pandemic.Authorities and different actors in the environment can strengthen their efforts to create more enabling environments to mitigate these negative occurrences by encouraging mor
140、e education and easing digitalization and access to data.2.Insight 2:Many solutions remain underused across barriers There were numerous solutions to tackle this barrier with knowledge and awareness building.Recommendation for insight 2:Analysis revealed that there are weak and fragmented solutions
141、to address this barrier,which reflects deeper structural and systemic barriers.Knowledge and awareness building can be better structured to be the most useful tool in combating stigma,averting misinformation and decreasing discrimination towards vulnerable groups.There are also digital solutions tha
142、t have been developed to provide information and education related to health and raise awareness among patients.However,this barrier requires long-term,systems-thinking solutions to cultivate streamlined solutions and create inclusive health systems.Inclusive Health Systems:Innovations towards Healt
143、h Equity in Africa17During the COVID-19 pandemic,the digitalization and inaccessibility of data presented a small gap in solutions,which,when coupled with strong enabling environments,contributed to digitally focused social innovators and social enterprises thriving.Insufficient digitalization and d
144、igital infrastructure in healthcare,including the limited use of digital tools and data to fight the COVID-19 pandemic,remain important obstacles to inclusive health.Systems for storage,analysis and sharing of medical records and patient histories are described as lagging behind the Global North,alo
145、ng with digital solutions to better serve patients,such as online appointment booking and referral systems.Digitalization and inaccessibility of data6Breakdown of sub-barriers with solution and enabler scores for barrier 6:digitalization and inaccessibility of dataFIGURE 90504540Share of
146、sub-barrier(%)Sub-barriersSolution scoreEnabler scoreNeed for digital solutionsto serve patientsInaccessibility of medicalrecords and patienthistoriesNeed for agriculturaldigitalizationLack of data forgenomic data onAfrican ancestoryLack of digitalinfrastructureInsufficient use ofdigitalization to f
147、ightthe pandemic5Source:Impact IntelligenceInclusive Health Systems:Innovations towards Health Equity in Africa18Examples illustrating digitalization and inaccessibility of dataTABLE 8Sub-barrierSocial innovation solution examplesSolution typeEnabling environmentInsufficient use of digita
148、lization to fight the COVID-19 pandemicGeoEpid and Prundge make use of digital technologies to fight COVID-19 through contact tracing,resource management,self-assessment and reporting.Diagnostic technologies and health data Through a project financed by the European Union,the Belgian development age
149、ncy aims to strengthen the Rwanda Food and Drug Authority through the provision of key laboratory software(laboratory information management system).Lack of digital infrastructureDigitalized diagnostics technologies are created to improve access in rural areas.The Ubenwa start-up,based in Nigeria ma
150、kes use of AI powered software to analyse crying sounds of infants to detect medical anomalies.Diagnostic technologies and health data The Ghanaian Nursing and Midwifery Council began online licensing examinations for registered mental health nurse candidates which has since progressed to a stage wh
151、ere the online licensing examination system has been rolled out for all the nursing and midwifery programmes in Ghana.Liberia followed suit as the second country in Africa.Need for digital solutions to serve patientsCompanies such as Helium Health(Nigeria),Eyone(Senegal),OGow Health(Somalia)and Afya
152、 Rekod(Kenya)help healthcare institutions and patients to digitize,store and access medical records.Diagnostic technologies and health data The Agency for Universal Health Coverage in Senegal has launched a new digital platform,leading the way alongside Ghana and Rwanda in the advancement of univers
153、al health coverage.Recommendations for insight 1:Despite creating enabling environments for digitalization and the accessibility of data,one key area where no enablers were present was in the lack of data for genomic data on African ancestry.As knowledge and evidence is sparse and healthcare is bias
154、ed towards other population groups,there is a need to create more inclusivity for all patients accessing healthcare systems and tailoring treatment plans accordingly.2.Insight 2:Many solutions remain underused across barriers There was a general spread of solutions across the different types,but mor
155、e so in diagnostic technologies and health data.There is also a potential to address solutions that fall under the categories of payment solutions,support systems for entrepreneurs,transport and storage of medications,medical equipment and vaccines and telemedicine and digital health solutions.Recom
156、mendations for insight 2:Although there is a wide range of solutions spread across different areas,some areas may provide an opportunity for strengthening.For example,strengthening knowledge and awareness-building solutions,management and recycling of waste for medical purposes and provision of nutr
157、itious and affordable food for vulnerable populations.1.Insight 1:Cultivating enabling environments(both public and private sector)pays off,it activates solutions to systemic and protracted health systems barriers.There were strong enabling environments created both by public and private sector acto
158、rs to encourage the proliferation of digital technologies in response to the COVID-19 pandemic.Inclusive Health Systems:Innovations towards Health Equity in Africa55030453540Share of sub-barrier(%)Sub-barriersSolution scoreEnabler scorePandemics disproportionateeffect on womenLack of supp
159、ort forfemale entrepreneursMaternal and reporductivehealth and awarenessGender inequalityaffecting health12233344Women face unique challenges that make their access to quality health harder.Issues in healthcare infrastructure,as well as social norms that alter care-seeking behaviours,create gaps in
160、access to maternal healthcare,sexual and reproductive health,and menstrual health.It is also visible in the data that the economic challenges faced by entrepreneurs due to COVID-19 constitute an even greater issue for female-led enterprises and female entrepreneurs.Gender inequality7Breakdown of sub
161、-barriers with solution and enabler scores for barrier 7:gender inequalityFIGURE 10Source:Impact Intelligence1.Insight 1:Cultivating enabling environments(both public and private sector)pays off,it activates solutions to systemic and protracted health systems barriers.As shown by the data analysis,t
162、here are instances of both local and global enablers rising to the occasion by assisting and supporting women in their business development.On a local level,the support is frequently in the form of creating job opportunities for women such as the Lemlem Foundation,which was created to support impove
163、rished women artisans in Africa with programmes that offer training and job opportunities in the textile and fashion sector.On a global level,examples of support mainly consist of providing women with the relative tools and funding to build greater impact businesses such as the Women Entrepreneurshi
164、p for Africa(WE4A)project.20Inclusive Health Systems:Innovations towards Health Equity in AfricaExamples illustrating gender inequalityTABLE 9Sub-barrierSocial innovation solution examplesSolution typeEnabling environmentLack of support for female entrepreneursThe FemBioBiz Accelerator Programme,imp
165、lemented across southern Africa,builds and supports the growth of women-owned and led businesses in the health and agricultural biotech field among other technologies,with an impact on health,nutrition and food security.Support systems for entrepreneurs There was a widespread foundation of global co
166、mmunities,such as Reunity that built a network of female entrepreneurs,granting access to venture capital for social impact projects led by women,aimed to improve the health and lives of women.Maternal and reproductive health and awarenessThe Perinatal Mental Health Project in South Africa provides
167、mental health support to mothers through social workers and training healthcare workers to be more sensitive to the needs of girls and women in labour.Knowledge and awareness building The Nigerian government pledged to deconstruct gender and social norms that hinder the agency,autonomy and access to
168、 rights-based family planning for women and girls.mothers2mothers provides maternal health services to women using a mentor mothers initiative that provides maternal health services to women.Knowledge and awareness buildingThe Cup Foundation empowers underprivileged girls by providing them with sust
169、ainable menstrual cups and comprehensive education on sexuality and reproductive rights.Knowledge and awareness buildingRecommendations for insight 1:Despite the enabling factors implemented by actors,the COVID-19 pandemic still elicited a disproportionate impact on women and gender inequality in he
170、alth persists.These present long-term,complex systemic issues that need to be worked on and which require the collaboration of all actors in the environment.Better alignment between philanthropic actors,investors and corporates could also directly strengthen the enabling environment to reach more fe
171、male innovators.2.Insight 2:Many solutions remain underused across barriers There are a few solutions targeting womens sexual and reproductive health and awareness through knowledge and awareness building.Recommendations for insight 2:More action is required to invest in diagnostic technologies and
172、health data.Considering the negative impact of the COVID-19 pandemic and the caregiver roles that women play,there need to be more solutions targeting the provision of nutritious and affordable food,mobility and homecare solutions for women.Inclusive Health Systems:Innovations towards Health Equity
173、in Africa21According to reporting and online discussions,a general lack of access to nutritious food has become exacerbated by a lack of public awareness and information about healthy nutrition.The problem is especially severe among vulnerable groups such as refugees and the urban poor.Malnutrition
174、and food insecurity8Breakdown of sub-barriers with solution and enabler scores for barrier 8:malnutrition and food insecurityFIGURE 545303540Share of sub-barrier(%)Sub-barriersSolution scoreEnabler scoreLack of accessto nutritious foodFood insecurityLack of informationand awareness onheal
175、thy nutritionMalnutrition ofvulnerable groups23232434Source:Impact IntelligenceExamples illustrating malnutrition and food insecurityTABLE 10Sub-barrierSocial innovation solution examplesSolution typeEnabling environmentLack of access to nutritious foodCompanies such as Keki-Mawe(Malawi),BabyGrubz(N
176、igeria),TIP Global Health(Rwanda)and BeNu Foods(Ethiopia)work on mitigating the malnutrition issue by producing nutritional food.Provision of nutritious and affordable food The SUN Pitch Competition awards cash prizes and technical assistance to the winning SMEs with the most innovative nutrition so
177、lutions.Food insecurityFarmers Pride is an online-to-offline marketplace that connects farmers with everything they need to succeed by using technology to improve the capacity of women-owned agro-dealer stores to ensure increased farm production and improved family income and food security.Agritech
178、solutions and support systems for farmers The Cost of Hunger study,an African Union-led study that has been conducted in 21 African countries,seeks to estimate the social and economic impacts of child undernutrition in Africa and spur action.1.Insight 1:Cultivating enabling environments(both public
179、and private sector)pays off,it activates solutions to systemic and protracted health systems barriers.Actors in the environment recognize the need to create more enabling environments for solutions.So far,enabling environments only favour lack of access to nutritious food and food insecurity.Inclusi
180、ve Health Systems:Innovations towards Health Equity in Africa22Recommendations for insight 1:While a lot of efforts from the international multilateral organization are focusing on nutrition,the enabling environments to promote and educate the public on nutrition remain poor.It is critical that the
181、private sector helps to support these efforts,as there is a real opportunity for cross-sectoral collaboration with partners focussing on agriculture,climate and land rights issues.2.Insight 2:Many solutions remain underused across barriers Solutions spanned a variety of different types;however,new s
182、olutions are in Agritech solutions and support systems for farmers.There are also many solutions to create awareness and knowledge around nutrition,but this does not correspond with adequate nutrition practices.Recommendations for insight 2:Although there is a spread of the different types of soluti
183、ons,there is an opportunity to create more solutions across the different types,especially in the provision of nutritious and affordable food and to prevent food insecurity.This barrier focuses on access to water,sanitation,electricity,education and food,the lack of which can further increase the bu
184、rden of diseases on various regions of Africa.Similarly to the barrier of weak capacity and infrastructure,accessing basic needs presented significant challenges to social innovators and entrepreneurs.However,during the COVID-19 pandemic response,enabling environments were more conducive for social
185、innovators to develop and scale solutions.Challenges to access to basic needs9Breakdown of sub-barriers with solution and enabler scores for barrier 9:challenges to access to basic needsFIGURE 5070609080Share of sub-barrier(%)Sub-barriersSolution scoreEnabler scoreUnfulfilled basic needsM
186、ultidimensionalpovertyVulnerability to disastersand extreme weatherevents121334Source:Impact Intelligence1.Insight 1:Cultivating enabling environments(both public and private sector)pays off,it activates solutions to systemic and protracted health systems barriers.There are large enabling environmen
187、ts for basic unfulfilled needs,specifically created by public sector and multilateral organizations and coalitions.For example,the United Nations Development Programmes(UNDP)Solar for Health project supports Liberia and other countries to power public health facilities through solar power.Inclusive
188、Health Systems:Innovations towards Health Equity in Africa23Examples illustrating challenges to access to basic needsTABLE 11Sub-barrierSocial innovation solution examplesSolution typeEnabling environmentUnfulfilled basic needsAsili is a social enterprise supported by Eastern Congo Initiative,United
189、 States Agency for International Development(USAID),and other organizations.Their model focuses on creating businesses that improve clean water and healthcare access,creating sustainable and self-sufficient systems that do not depend on constant humanitarian aid.Provision of sanitation and utilities
190、European Investment Bank investments have helped to connect rural Senegalese communities to the electricity network and increased access to finance by smallholders.The UNDPs Solar for Health project supports Liberia and other countries to power public health facilities through solar power.In Tanzani
191、a,the construction of 22 solar-hybrid mini-grids is in progress.The government of Sierra Leone is running the Rural Renewable Energy Project(RREP),aiming to provide power to rural communities through small grid-connected solar power plants.Lack of sanitation services is addressed by companies such a
192、s Sanergy,that provide clean,affordable toilets and waste management services to low-cost areas.Provision of sanitation and utilitiesWater Access Rwanda and Joelex Uganda are examples of social enterprises that focus on clean water access and sanitation issues.They offer affordable and simple soluti
193、ons in different regions of Africa.Provision of sanitation and utilitiesRecommendations for insight 1:The enabling environments for addressing multidimensional poverty still require work to address systemic issues.All actors,across global and local levels need to work on long-term enabling environme
194、nts to increase inclusivity and affordability.2.Insight 2:Many solutions remain underused across barriers The development of solutions to address the barriers is concerning.Only one type of solution,namely the provision of sanitation and utilities was offered.However,this is still insufficient and l
195、eaves many vulnerable populations behind.Recommendations for insight 2:Access to basic needs presents a considerable challenge to overcome.If basic needs are not met,then the vulnerable population segments will not be able to thrive.More innovative solutions at the ground level need to be created.In
196、clusive Health Systems:Innovations towards Health Equity in Africa24The negative impact of COVID-19 on the supply chains of different vital items is the biggest focus of this barrier.These items include farm products and other food items,as well as pharmaceuticals and vaccines,all of which may need
197、cold chain storage technologies to be working properly and in integration with the supply chain.The disruptions in supply chains tend to affect rural areas and mountainous areas more severely.The supply chain disruptions and logistic challenges was a barrier that had a small gap to solutions as well
198、 as a small enabler gap,which in turn meant that social innovators and entrepreneurs were able to thrive despite this barrier.Supply chain disruptions and logistic challenges10Breakdown of sub-barriers with solution and enabler scores for barrier 10:supply chain disruptions and logistic challengesFI
199、GURE 50706080Share of sub-barrier(%)Sub-barriersSolution scoreEnabler scoreLogistics and transportissues of pharmaceuticalsSupply chain disruptionUnderserving ofrural populations233445Source:Impact Intelligence1.Insight 1:Cultivating enabling environments(both public and private sector)pa
200、ys off,it activates solutions to systemic and protracted health systems barriers.There are strong enabling environments for this barrier from both private and public sectors.These are namely in the logistics and transport of pharmaceuticals and disruption in the supply chain,both indicating the will
201、ingness of the industry to support these types of solutions.25Inclusive Health Systems:Innovations towards Health Equity in AfricaExamples illustrating supply chain disruptions and logistic challengesTABLE 12Sub-barrierSocial innovation solution examplesSolution typeEnabling environmentSupply chain
202、disruptionProblems with access and cold chain requirements of COVID-19 vaccines are addressed by companies including Zipline Ghana.Transport and storage of medications,medical equipment and vaccinesWorld Banks support for Burundis response to COVID-19 included strengthening cold chain storage,includ
203、ing refrigerators and cold rooms.Rwandas Kapsule uses market intelligence to digitalize processes,identify bottlenecks and track key performance metrics.Pharmaceutical manufacturers can monitor their supply chains,identifying bottlenecks.Pharmacies and warehouses can accurately manage inventory and
204、arrange logistics.Government bodies are given birds eye and granular insights to the progress of health programmes.Transport and storage of medications,medical equipment and vaccinesLogistics and transport issues of pharmaceuticalsArone Delivery addresses the issues in logistics and transport of pha
205、rmaceuticals by using autonomous drones powered by solar energy to deliver medical supplies.Transport and storage of medications,medical equipment and vaccinesThe government of Ghana established the Coronavirus Supply Chain and Trade Disruption Team in view of the COVID-19 impact on Ghanaian busines
206、ses,especially SMEs,to urgently mobilize teams to assist in addressing specific supply chain issues and challenges affecting businesses.Recommendations for insight 1:Despite the strong enabling factors for some sub-barriers,there is still some effort required to address rural populations and ensure
207、inclusivity in the health system.2.Insight 2:Many solutions remain underused across barriersIn line with the identified enabling environments,solutions were concentrated in the transport and storage of medications,medical equipment and vaccines.Recommendations for insight 2:Solutions are spread in o
208、ther areas but have the potential to be strengthened,especially in the provision of nutritious and affordable food,sanitation and utilities and validation of the authenticity of medications and medical equipment.Inclusive Health Systems:Innovations towards Health Equity in Africa26Four principles to
209、 advance social innovation and entrepreneurshipThe insights identified through intensive inteviews and workshops are further grounded in four key principles that speak to the teachings of Margaret Wheatley,the systems theorist,who wrote that“we live in a world of complex systems whose very existence
210、 means they are inherently uncontrollable”;thus,to effectuate change requires patience,commitment,resilience and collaboration.4 To cultivate inclusive health systems,actors should look to foundational principles to anchor their work.Inclusive innovation means to involve those affected by the soluti
211、on in the planning,implementation,and assessment thereof.Solutions based on personal experience of a crisis or challenge on the ground,have greater traction and validity.They are more likely to be embraced by those they are intended for,more likely to galvanise local action,and more likely to be sus
212、tainable.Inclusive innovation reaffirms the importance of narrowing the gaps between planners,activists,and beneficiaries.This is a key social innovation principle that holds in and outside times of crisis.Solange Rosa,Director,UCT Bertha Centre for Social Innovation and EntrepreneurshipFour key pri
213、nciples for partnersFIGURE 14Source:Bertha Centre for Social Innovation and Entrepreneurship,University of Cape Town Graduate School of Business1 Actively build for the long haul2Acknowledge that progress is not linear4Embrace radical partnerships and opportunities for collaboration3Commit to active
214、ly building resilience2Inclusive Health Systems:Innovations towards Health Equity in Africa27For many of the subjects interviewed,their focus pre-COVID-19 was already on survival versus rapid growth through short-term market share gain.This meant that they were largely better able to weather the lon
215、g period of instability that COVID-19 represented.Additionally,they were able to view the COVID-19 pandemic as an opportunity to re-examine their organizational purpose,their relationships with funders and other stakeholders,and how they interacted with their customers and ultimate beneficiaries.Thi
216、s comfort with uncertainty,and the ability to act with agility,are key characteristics of a systems change agent.By deliberately creating for the long haul,social entrepreneurs in health can avoid the trap of allowing competition to dictate their pace.Instead,by taking the time to build their busine
217、ss model,by expecting that breakthroughs will emerge against a longer timeline,and by authentically engaging with their customers and partners to create an interconnecting web of reciprocal relationships,these entrepreneurs have shown themselves able to thrive through adversity.In actively building
218、for the long haul,it is necessary for all actors within the system to:Innovate through employing participatory approaches that respect the rights of all stakeholders,particularly the most vulnerable and neglected,to ensure fair participation in social and health system decision-making.Innovate throu
219、gh engaging community and stakeholder buy-in by building mutual trust,thereby ensuring long-term support,engagement and goodwill.Innovate through building business models and opportunities that prioritise organizational strengths,continuous learning and teaching,and flexibility.Innovate through inst
220、itutionalizing an iterative mindset;this requires laying a stable foundation for an organizational culture that empowers experimentation,allows for collaborative testing and rewards both success and failure.Innovate through de-prioritizing short-term,output-centred metrics and prioritizing informed
221、risk-taking and strategic pacesetting.Creating national and regional environments that support entrepreneurship requires inclusive strategies that are adequately resourced,supported and committed to.After all,entrepreneurship does not occur in a vacuum.However,the limited resources and infrastructur
222、e within Sub-Saharan Africa mean that countries are not able to comprehensively provide the necessary stable foundation from which to create value and drive development.Despite this,Africa has a rich entrepreneurial landscape,and this robust entrepreneurship culture has contributed to a growing numb
223、er of African incubators and accelerators,to the promulgation of government policies and standards,and to a societal push that encourages new business and innovation activities.For many,the COVID-19 pandemic was an opportunity to reflect on what progress meant within the system that they were operat
224、ing in or changed their conception of that system.It allowed for an expansion from a purely health or biomedically focused agenda to a more societally focused one that allowed for an interpretation that included the web of interconnected touchpoints and activities that the COVID-19 pandemic highligh
225、ted,where health intersected with gender rights,youth development,education and economic development.In acknowledging that progress is not linear,it is necessary to:Innovate by taking advantage of open-access information.This type of knowledge-sharing reduces barriers,encourages stakeholder transpar
226、ency,facilitates sharing of technical and financing support,and boosts collaborative efforts.Innovate through inclusive digitalization by developing digital tools,technologies and infrastructure ensuring equitable access,supportive regulatory framework,user and beneficiary privacy,regional coherence
227、,and robust data collection and sharing.Innovate through developing collaborative environments that allow innovators and entrepreneurs to draw on collective wisdom,mentorship and skills development.Innovate through co-learning and capability building by promoting inclusive multistakeholder coalition
228、s,networks and partnerships,ensuring a common language and systems-centric methodology.Principle 1:Actively build for the long haulPrinciple 2:Acknowledge that progress is not linearInclusive Health Systems:Innovations towards Health Equity in Africa28Building for the long haul and being clear-eyed
229、about the nature of progress and success are key traits that encourage entrepreneurial resilience.In this context,the traditional definition of resilience is the ability to withstand and overcome adversity.The COVID-19 pandemic has,therefore,arguably been a once-in-a-lifetime test of resilience for
230、the stakeholders interviewed during this research.For the entrepreneurs and stakeholders interviewed,the COVID-19 pandemic demonstrated that resilience is not necessarily an inherent trait but a muscle that must be exercised as individuals,teams,and organizations.Having the ability to recognize a ne
231、ed is one way in which social entrepreneurs were able to demonstrate their ability to learn from and respond to their environments.It demonstrates that they continually learn and adapt their approaches key factors in building resilience.One such instance of responding to a need has been the recognit
232、ion that accessible mental health services were necessary during the COVID-19 pandemic,which providers highlighted as one of the crucial needs of communities during the time.In committing to actively building resilience,it is necessary to:Innovate through developing a shared understanding that socia
233、l systems are complex,ever-changing and experiential.Conventional solutions do not solve wicked problems.Innovate through creating advocacy platforms that are inclusive and adaptable and which address power imbalances,mitigate inherent biases and promote equitable participation.Innovate through deve
234、loping robust feedback loops that allow for open communication,real-time change and strong bonds between stakeholders.Innovate by creating mutual trust and long-term commitment by building bridges between stakeholders.Social innovators and entrepreneurs focused on health services do not conduct thei
235、r activities in isolation.Rather,these actors work within complex systems that expand outwards from the local level to the regional,the national and ultimately to the global level.It is important to understand how these actors work within the systems in which they operate since this informs how they
236、 partner with one another,how programmes and services are integrated with government health systems,and how these actions impact and influence service delivery at the front lines of healthcare.Enabling cooperation and collective social innovation alongside other systems change actors often results i
237、n co-developed and locally anchored solutions.Unlocking these partnerships full potential requires a greater level of trust,mutual understanding and collaboration between government,business and societal actors.Such collaboration across sectors can create and enhance a mutual understanding that is v
238、ital to addressing societal challenges.In embracing radical partnerships and opportunities for collaboration,it is necessary to:Innovate by actively seeking out partners and collaborators from different disciplines,institutions,businesses,multilaterals and government departments.Crossing boundaries
239、can accelerate change.Innovate by unlocking multi-sector participation and developing a collaboration framework that can support social entrepreneurs working with complex social issues.Innovate through strategic convenings that engage a wide variety of stakeholders and drive solidarity,engaged probl
240、em-solving,confidence building and shared value creation.Principle 3:Commit to actively building resiliencePrinciple 4:Embrace radical partnerships and opportunities for collaborationInclusive Health Systems:Innovations towards Health Equity in Africa29Medical waste management(recycling solutions)Sc
241、reening,prevention and early warning(diagnostic technologies for health data)Agricultural digitalization(agritech solutions and support systems)Genomic data on African ancestry(diagnostic technologies for health data)Lack of health knowledge and awareness(knowledge building solutions)Maternal and re
242、productive health awareness(knowledge building solutions)Logistics and transport of pharmaceuticals(transport and storage solutions)Clinics and qualified healthcare personnel(mobility and homecare)Access to affordable,high-quality basic and specialised healthcare(telemedicine and digital health solu
243、tions)Knowledge and health literacy among educators and parents(knowledge building solutions)Stigmatization(knowledge building solutions)Gender inequality affecting health(support systems)Underserved rural populations(transport and storage solutions)Lack of infrastructure to produce vaccines(develop
244、ment and production of medications)Unequal vaccination distribution(knowledge building solutions)A challenging economic environment(support systems)Low government support and policies for entrepreneurs(support systems)Lack of nutritious food(provision of food)Access to affordable contraception(devel
245、opment and production of medications)Insufficient use of digitalization(telemedicine and digital health solutions)Support of female entrepreneurs(support systems)Unfulfilled basic needs(provision of utilities)Supply chain disruptions(transport and storage)Lack of digital infrastructure(digital techn
246、ologies for health)Poor working environments for health workers Lack of medical and personal protective equipment Discrimination towards minorities and groups The disproportionate effect of COVID-19 on women Multidimensional poverty Infrastructure and social problems Lack of equipment and supplies t
247、o fight COVID-19 Vaccine hesitancy and misinformation Food insecurity,malnutrition and vulnerable groups Vulnerability to climate disasters and extreme weather events Coverage and insurance costsPractical pathways forwardWhen examining the barriers,solutions,enabling environments and insights gleane
248、d from the participant interviews,there are several key areas where it is possible for stakeholders to play an important role in accelerating the impact of social entrepreneurs in health across Sub-Saharan Africa.Conversely,stakeholders including private sector actors,corporate entities,investors an
249、d philanthropists can rely on social entrepreneurs to scale and embed their solutions to propel health equity and address systemic barriers.To create inclusive health systems,there are some actions that can be taken according to the strength of the enabling environments as well as the maturity of th
250、e solution.The following matrix describes solution areas according to enabling environments,and where investments with higher and quicker returns can be made.Matrix of sub-barriers regarding enabling environments and solution typesFIGURE 15Advancing health equity requires commitment to addressing st
251、ructural inequities and strengthening enabling environments.Figure 15 shows how different solutions can be created along with the strength of the enabling environments.When both the solutions and enabling environments are weak,it points out deeper structural issues that need to be addressed.On the o
252、ther hand,it can be seen that there was a group of solutions from social innovators that thrived when there was a supportive enabling environment.LowHighMediumEnabling environmentMost complex and highest effortsSub-barriers and solutions types proved successfulHighly scalableSolution scoreMediumHigh
253、Low3Inclusive Health Systems:Innovations towards Health Equity in Africa30Solution types by the number of addressed barriers versus the strength of enabling environment FIGURE 16Transport and storage of medications,medical equipment and vaccinesDevelopment and production of medications,medical equip
254、ment and vaccinesDiagnostic technologies for health dataTelemedicine and digital healthsolutionsPayment solutionsAgritech solutions and support systems for farmersSupport systems for entrepreneursKnowledge and awareness buildingProvision of sanitation and utilitiesMobility and homecareValidation of
255、authenticity of medications,medical equipmentand vaccinesProvision of nutritious and affordable foodManagement and recycling of waste for medical purposes0LowEnabling envionmentQuick wins with more supportive enabling environmentProven and scaled solution typesNumber of barriers addressed
256、MediumHigh1%1%1%9%2%6%7%1%4%13%25%17%12%Figure 16 illustrates the types of solutions versus the number of barriers addressed.This again highlights successful and proven solution types and those that require more supportive enabling environments from the public and private sectors to be applied for w
257、ider and more structural barriers.This research suggests that curated and cultivated public-private efforts could propel support environments for social entrepreneurs,payment solutions,agritech and knowledge and awareness types of solutions,expanding the number of innovations and addressing critical
258、 gaps.Source:The Schwab Foundation;the Bertha Centre for Social Innovation and Entrepreneurship,University of Cape Town Graduate School of Business Inclusive Health Systems:Innovations towards Health Equity in Africa31ConclusionThis actionable white paper,and its key findings,shed light on where ena
259、bling environment actors across private and public sectors,philanthropic and social enterprise support organizations,as well as local and global networks,could direct their interventions and align their efforts to increase impact and benefit from the lessons and the sense of urgency imposed by the C
260、OVID-19 crisis.Social entrepreneurs and innovators offer practical solutions to some of the worlds most intractable problems,but to fully realize this potential,an important shift needs to take place to better tackle the inequities in health that exist across the African continent.The barriers highl
261、ighted in the report are not unexpected;this fact only demonstrates that a health agenda that focuses solely on healthcare delivery is not adequate to meet the needs of African communities.Instead,it is necessary to build an inclusive health system that is positioned as a social fairness goal and is
262、 designed to address the structural inequalities political,social and economic that continue to sustain health inequities on the African continent.Central to advancing action on health equity is the ability of decision-makers to understand where their greatest opportunities for impact exist.The find
263、ings in this report offer a number of interventions and partnership models for various stakeholders that could inform the areas of greatest health equity return,thus,reducing barriers to health equity through a systemic approach.It is also setting the scene and encourages continued research efforts
264、across geographies and different contexts evaluating the potential and avenues for social innovators in tandem with private and public actors to impact health outcomes and social fairness.Inclusive Health Systems:Innovations towards Health Equity in Africa32Impact IntelligenceSeyfettin BaranAnalystG
265、uliz Koldas Programme ManagerTomas LarssonSenior Adviser Nikolaj MoesgaardCo-Founder and Partner Impact Hub Africa Hope MuchanyukaManager,Impact Hub HarareKelechi OfoegbuChief Operations Officer,Impact Hub Accra Tapiwa NyandoroAfrica Development Lead Tadzoka PswarayiDirector,Impact Hub HarareAuxicil
266、lia RabwiBusiness Development Associate,Impact Hub Harare ContributorsAcknowledgementsBayer Foundation Peng ZhongDirector,Social InnovationUniversity of Cape Town Bertha Centre for Social Innovation and EntrepreneurshipGillian MoodleySenior Project ManagerKatusha de VilliersHealth Systems Innovation
267、 LeadWorld Economic ForumEkaterina DemushkinaCommunity and Initiatives Lead,Global Alliance for Social Entrepreneurship Partners for the actionable insights:Inclusive Health Systems:Innovations towards Health Equity in Africa33We would also like to extend our thanks to the following organizations fo
268、r their contributions to the report.African Health Innovation CentreAfrican Paediatric Fellowship Programme Amref Health AfricaAMP HealthAshoka East AfricaBoehringer Ingelheim Making More Health Bridge for BillionsBroadreach Health Cross Border Impact VenturesThe Cup Foundation DigitalMedicHealthEdu
269、HealthTech Hub AfricaHopeful NkomoKapsule Tech Last Mile HealthLGT Venture PhilanthropyMedikea Health MobiKlinikmothers2mothersMotsepe Foundation MyMedicines North Star AllianceOpen Road Alliance Perinatal Mental Health Project Pulse Media Redbird Remote Doctors for AllSAB FoundationShonaquip Social
270、 Enterprise SIHI GhanaSIHI Malawi SIHI UgandaSomalia Response LabSpark Health AfricaTebita AmbulanceTIP Global Health Unknown Group Vitol Foundation Vive TeensWe Share Forward Whispa Health WHO Afro Innovation Office WHO Innovation HubZipline International Editing and designLaurence DenmarkDesigner,
271、Studio Miko Martha HowlettEditor,Studio Miko George MesserDesigner,Studio MikoInclusive Health Systems:Innovations towards Health Equity in Africa34Endnotes1.Littlewood,David,Giacomo Ciambotti,Diane Holt and Laurel Steinfield,“Special issue editorial:social innovation and entrepreneurship in Africa”
272、,Africa Journal of Management,vol.8,no.3,pp.259-270.2.“African enterprise excellence in digital transformation celebrated at SAP quality awards for customer success”,Pan African Visions,16 September 2021,https:/ fintech the key to African SMEs Covid-19 recovery?”,African Leadership Magazine,12 June
273、2020,https:/www.africanleadershipmagazine.co.uk/is-%EF%AC%81ntech-the-key-to-african-smes-covid-19-recovery/.4.Wheatley,Margaret and Debbie Frieze,“Leadership in the Age of Complexity:From Hero to Host”,Resurgence Magazine,2011,https:/ Health Systems:Innovations towards Health Equity in Africa35Worl
274、d Economic Forum9193 route de la CapiteCH-1223 Cologny/GenevaSwitzerland Tel.:+41(0)22 869 1212Fax:+41(0)22 786 2744contactweforum.orgwww.weforum.orgThe World Economic Forum,committed to improving the state of the world,is the International Organization for Public-Private Cooperation.The Forum engages the foremost political,business and other leaders of society to shape global,regional and industry agendas.