Healthcare systems need to deeply understand the contexts in which they work to improve healthcare outcomes.
In this episode of Bite the Orange, we feature the incredible healthcare thought leader and CEO of the Fondation Botnar, Stefan Germann! His experience in healthcare technology worldwide gives him a unique perspective on how the system should work to improve young people’s lives and the democratization of this industry. Stefan breaks down the needs healthcare must consider regarding data security and governance and how to solve this issue. Stefan also dives into his experience working in African countries and what they’ve been doing to implement technology in healthcare.
Tune in to this episode to turn the traditional mindset into thinking about health in the digital age!
FULL EPISODE
BTO_Stefan Germann: Audio automatically transcribed by Sonix
BTO_Stefan Germann: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Emmanuel Fombu:
Welcome to Bite the Orange. Through our conversations, we create a roadmap for the future of health with the most impactful leaders in the space. This is your host, Dr. Manny Fombu. Let's make the future of healthcare a reality together.
Emmanuel Fombu:
Good morning. Good afternoon. Good evening, ladies and gentlemen. Welcome to another episode of Bite the Orange. And today we have a very special guest all the way from Basel, Switzerland, with a great organization and someone that I've known for some time, and we wrote a paper together, Universal Health Coverage several months ago, someone that's very passionate about where we're going as a future in healthcare, but not from a country perspective, but from a global perspective and have a lot of experience on it. If you know him, it's fantastic you know him, but if you don't know him, you're going to be him today. And I think the best for the conversation. Welcome to the show, Stefan Germann, did I pronounce that right, Stefan?
Stefan Germann:
Yeah, almost. I hear all versions, but nice to meet you online again, Manny. It's Germann, but it's.
Emmanuel Fombu:
Germann.
Stefan Germann:
It's another one.
Emmanuel Fombu:
German.
Stefan Germann:
But it's great to be here and really excellent podcast that you have been producing. It's fantastic, the themes you choose and the flow you create so looking forward for the chat.
Emmanuel Fombu:
Thank you. I appreciate that. So tell us about yourself. You are Stefan, right? So a lot of people might say, you know.
Stefan Germann:
Well, first.
Emmanuel Fombu:
I know you spent a lot of time in Asia as well. You have an interesting background from a research perspective. But why do you never talk about your organization?
Stefan Germann:
Too am I, do you want a philosophical answer or do you want the more practical answer?
Emmanuel Fombu:
Well, the philosophical answer, I'd expect the practical one from you.
Stefan Germann:
Okay so the, probably I start with what guides me in my life and was just reflecting actually last weekend on this, I was talking about leadership within disturbing complex environments and times. And it's good to think for all of us to have some guiding, some they have lighthouses, some they have North Stars. But for me it's more like the system I'm embedding myself. And for me it's like have a commitment in my life to, to bring with joy, but as well with ease, courageous kindness to my loved ones, myself, all people in the planet Earth, and like to bring that courageous kindness as well into all that I do. And so don't really separate in terms of like work or private. It's purpose. So bringing purpose forward in terms of bringing courageous kindness shapes us in our thinking, in our day to day doings. And so as a foundation that has been going for the last six years with a strong focus on bringing well-being in the understanding of well-being as not being something that you reach one day and then you have it, it's constantly emerging property if we talk systems language, that is linked to how I feel within myself, but how I feel with you, with others in terms of our people and with the environment. And it's that interaction, that interface of constantly changing dynamics between myself, others and the environment that I'm living in, that well-being can continuously emerge. And now bringing that to health and digital, it is really putting us as humans within the center. And I think one of them we're probably going straight into the topic now here, one of the big challenges of digital health and I've been involved, started off as an engineer, I was leading a hospital, building up a clinic in a hospital in rural Zimbabwe at the border to Botswana and South Africa, almost Kalahari Desert for a couple of years, and then got involved in the whole Aids pandemic across Africa in the field of children and Aids then got involved first time actually in digital on that time it was called Mobile Health. In 2005, after the Asian tsunami hit Indonesia, north, North Sumatra and Sri Lanka, India and Thailand, when almost half of all the midwives died in that disaster and there was need to get new midwives quickly upskilled and trained and be used rudimentary mobile technologies to support them in that. And since then I've been involved in digital health and coming back, now there is a challenge that too much of the deployments are driven by technologists or even by, by professionals who are in the medical field but are not really having it around the person, you and me. And so we really need to challenge a lot of these uptakes. And if you really see where digital health has come to scale, it's when we start in terms of seeing a person in her or his ecosystem really deeply understood and being cared for by caring help environment and then the technologies working closely within that ecosystems and embed the digital solution within that. If we think that we can disrupt health all but disrupted logistics and taxi services, we are doomed to fail because health systems are deeply rooted within local contexts they are deeply rooted in cultural contexts. And if we don't understand these things, we might create bullet points and magic silver points that we think should solve all our health problems now and immediately, but it's not happening. It requires, as well, strong country leadership. And so if we go into which countries really have advanced incredibly well, I had the privilege of going to 27 countries in Africa, worked in most of them, but this year was the first time, no, sorry, time moves so fast. It was last year, I was the first time in Rwanda and I was actually impressed in Rwanda how they have embraced digital technologies end to end. And when I've reflected in which countries the digital uptake is high, it's where the health system is not shying away from transparency end to end. And I've reflected on, in a number of countries like we've worked in Eastern Europe in 1 or 2 countries, we, even look here at Switzerland, there is really not a good uptake in terms of digital health, and it's partly because they are actors within the systems who are not interested in transparency end to end and are not interested in what I would call the democratization of health, of putting you and me as the people at the center of a health system in terms of really having our well-being really at the core of us. And I think if we take these things, we then start to appreciate how better could we actually scale. My particular interest in focus is on Africa, how we can scale through enabling environments, digital health. So one of the coalitions we've been actively involved from the beginning is to Transform Health Coalition, and they launched last year the Health Data Governance Principles. And that's for me a very good example how quite a number of African countries, their policymakers have embraced that framework because it was collectively developed and it gives really good guidance around the core elements of an ecosystem where we actually put people, citizens at the center of a digital transformation in health.
Emmanuel Fombu:
It's quite fascinating. And last time we had a conversation was ..., Stefan, what I really liked about interviews, you said ... digital health, right? And you said it's about technology in healthcare as opposed to using this term digital health. And you have a pretty interesting mandate and the areas that you guys focus on. So tell us in general as an average listener listening to what you are doing, because right now a lot of people that would say, hey, how do I partner with on the show or even try to raise capital, have an idea of where I'm in a third world country, I would say Eastern Europe and where we're trying to go. Your experience in it the way healthcare is, tell me why you use that term, that, not the digital health, but technology in healthcare as a way to transform? I remember that was very.
Stefan Germann:
Yeah.
Emmanuel Fombu:
And I thought you said I can't say.
Stefan Germann:
Yeah, that's a, as a foundation we look at a systems lens and we have a strong interest on the well-being of young people in urban and digital spaces. And I think today we have to acknowledge that the digital space is as prevalent as wherever we live. It's this virtual reality that we all live in, at least those who have access. I think there's another issue in some settings they'll, just access to digital to start with. But I think a different challenge that we need to resolve. Now, and if we look at health, talking about digital health is thinking that this is like a small, a slice and then we have non digital health. This is just not the reality anymore, I think. And so I encouraged us to think not about digital health, but really about health in a digital age. And that gives a different design perspective because then you start to look end to end. And that goes back to the what I would call democratization of health. If we take, in Switzerland I still was part of the Transform Health Coalition. They had this campaign that was focusing on going to ask your local health provider to get all your health data. I tried here in Switzerland. I wrote an email to my healthcare providers, I still don't have all my health data, it's here and there and everywhere a little bit. Whereas in Estonia with the health data exchange, I've got it here on my phone, I can know what's the medical bills was, how much the last blood test cost and what its results was. They have got access to the X-rays. I have everything on my phone and it's secure, it's safe. That means it puts me into the owner of health. But they are dynamics that is not really conducive for us as citizens to have more ownership of our own health, including the health data and the kind of going back to this health data governance principles that Transform Health Coalition that we have been involved from the beginning as one of the co-organizers, we are funding some of their work. They look at protecting people. It's about building trust within data systems that citizens can trust, it's protecting citizens. That means as well ensuring data security. And we therefore need to protect not only individuals, but as well communities that we don't start to use data then to disaggregate the data and then start to discriminate against certain population groups, as we see now in some political debates where certain segments of the community are starting to be discriminated for whatever reasons that they might have. We need as well to prioritize equity in terms of health data governance. We need to ensure that the, we establish the rights and ownership. Who owns that data? Is it, if I'm involved in a clinical trial and data is getting extracted and that leads us to, to I think the question of data colonialization specifically related to Africa where people either through through research for commercial or academic purposes or whatever reasons are extracting data, they are using data to, to train large, large machine learning and whatever models. But the benefit is not getting back to the communities that actually have given up. So this is critical in terms of data prioritization and equity, and it's therefore that we have the promotion of equitable benefits from this health data. And the last bit is really to promote health values in terms of that, we facilitate innovations using health data. We have three M's and that's not myself, that's a Dip Gill Singh, who is the current special Envoy of the Secretary-General on Digital Transformation in the UN, and he talks about these three, yeah. We have missing data. That's a big issue across Africa and others that we have really a lot of missing data. So that means we can't really use that data for innovation because data is just not there. Then there is missed data. So there is data there, but we are not using it. And that's where we should start with the mistake. And then the third is misuse of data. You know, we are being manipulated, extracted and that's misuse of data. And I think when we talk about promoting equitable benefit and established data rights and ownership, we need to think about these three M's and critical that is the last two elements within these health data governance principles is to really we want through digital transformation. That's why really it's helped in a digital age. We want to enhance health systems and services and that requires that we have really sharing and interoperationability of data. And if we really get that together, it's not so difficult. And if we take Covid now, why didn't we get it that we could have had and WHO had all done? We know all these yellow vaccination card, which is actually a W.H.O. on the International Health Regulation, there were attempts to have an international ... digital yellow card that we all would have had. I don't know how where you were during that time, but when I tried to go to France, I needed to download a different app and somehow tried to convert the certificate. They're a total mess, a total mess.
Emmanuel Fombu:
You're right.
Stefan Germann:
It's not because the technological solutions wouldn't be there. It's because we don't have the political will to put citizens of this world into the center of the digital health data transformation.
Emmanuel Fombu:
Like you said, Stefan, it's about perspective. It's not about the technology, it's about this political kind of mindset piece. And I think you also see it in a very, very good cheer to actually see this at the forefront of things. How do we solve this problem? We think that the UN, for example, has a role they could play, like the WHO has digital health organization and advisors and communities. What is that central way? What how do we go about solving this global perspective?
Stefan Germann:
I see there are three pathways and I think in complex problems we have to be careful not to go into linear solutions and think that's because complex problems requires, I think, more pathways. And so I would name three pathways. The first one is really ensuring, especially young people, I mean, you take across Africa, maturity, I think it's now depending on what demographic data you look at, but it's around 60% of all the people in Africa are under 30, some countries even higher than that. And these are the young people who really have grown up with digital. So I would call them the digital experts as lived experience of young people. So we need to have policy makers, ministers of health, permanent secretaries, people in the technical teams, corporates who develop technologies, we need to bring young people around the table and listen to them as experts. So that's one pathway, very meaningful participation of young people around these finding solutions. That's something we has found as important, are really investing a lot increasingly to help young people to convene. We are going to be in Kigali at the Women Deliver conference, where we actually support the youth networking. So we need to have young people as the experts within a lot of this, that's the first. The second one you asked about WHO, yes. The World Health Organization under international law has a normative role and very strongly think that a health data governance framework should be adopted by all the member states as that really deals with data sharing, interoperationability, the equity aspect, the issue of data rights and ownership as laid out in this health data governance principles that transform health data is a building block that the WTO can use, and they actually are looking at this. The number of member states at the last World Health Organization, Transform Health Coalition had a panel where they were, I think 4 or 5 ministers really coming forward and encouraging the WHO to really look at the World Health Assembly level to get some agreement. So talked about the two pathways. The third pathway is really much more collaboration between the private sector and health systems. Specifically in Africa, I'm leading a working group under the UAE government's Global Council on SDG three and the working group I'm leading is looking at structural barriers of scaling health innovations. A large part of them are digital innovations, and we really struggle. We have really good digital innovations and then they are not being scaled through public financing. And so we are really looking at what are some of the reasons and the reasons that emerging are A, some of these innovations that are developed by civil society together with private sector, they are interesting, but they're not addressing a government priority and the government needs. So it's innovations that's at the fringes, that's maybe sexy, exciting, but it's not addressing the key issues that a government has in terms of its public health systems. So first of all, we need to make sure this. Secondly, that on issues around procurement challenges. But that's the third point I want to get deeper. It's a lot of these solutions are driven by US European innovators or companies then are not embedded deeply within the local ecosystem of entrepreneurs, of African entrepreneurs, and they're really good solutions. So as a foundation, we have a venture philanthropy where we actually invest in Africa, in Asia and in Latin America, in start up companies, including some. And we have one in Nigeria, a startup company in the health field that we have invested. And only when there is these solutions have a good, strong local ownership. That's when it gets interesting for the Ministry of Finance and Economic Development because that creates jobs in the local ecosystem. This idea to parachute in the best digital health solutions into a country and suddenly the country should pay for it through it's very limited financial resources, it's just not happening. So if we really want digital transformation in Africa to take place, we need to create the enabling environment for African digital entrepreneurs to give them a chance, win, win their markets to develop solutions that they can create jobs for young people in the digital economy. And health then is one of the key sectors that has a dual win. On one hand, it improves health, as we all know, that improves a country's kind of health in terms of well-being of its citizens, which is a core mandate for a government. And secondly, it creates actually economic growth and prosperity and employment within the digital health economy.
Emmanuel Fombu:
And what, is very interesting piece, because I've been a wonder myself for smart conference down there and being African, from Cameroon, I would say I hold .... on high esteem as a great African leader. ... I've admired what he has done in Rwanda and personally from Cameroon. And I've been to the country and I've seen, it reminds me of kind of like Switzerland or I call, I call Rwanda like the Switzerland of Africa ..., and I say be one of the top countries to do business in Africa, I've seen young ministers or young leaders, organizations, I've talked to people that had fellowships to come to America and study in healthcare sponsored by the Rwandan government. The many companies that have come out of Rwanda to go there, it's like a great kind of foundation piece. But when I went to the conference in, Smart Africa conference that was there, and then the president of Kenya, the president of Rwanda, president of Mali, ... Keita, was passed away, rest in peace. But they were all there. But everyone was talking about fintech, Stefan. The healthcare became so secondary to package that they didn't care if I was adopted or not, being African too, as the point at which is a mentality to get governments in these kind of countries to actually look at healthcare as a place to invest and not just from a fintech perspective, but something that we can actually focus on?
Stefan Germann:
That's one of the challenges. And there was actually within the African Union, there was a couple of years in effort and there was a whole movement in terms of really helping ministers of finance, particularly to really understand that invest, a lot of ministers or senior policymakers on the finance side they look at the Ministry of Health as an expense, rather than an investment that generates a return. And I do think that's where we are in the digital health space needs to become, how, I don't know whether smarter is the right word, but we need to start to shift the narratives like we have seen with fintech. We need to see health tech in terms of local job creation. And it can be, they are, there's so much potential in Africa in terms of frugal innovations within the health space linked to digital, like this Nigerian company that we invest in in terms of equity or ... old, but as identified a device that looks at quantified drugs. And then when they find drugs that are not genuine, which can cause tremendous damage to human health, they can be placed it within stock really good, and they have a really clever business model. There are countries around the world outside of Africa started to look at this company for growth. We should have the belief that some of the next unicorns are coming out of Africa in the digital health space. If we see the same kind of like the ministers and presidents are excited about fintech and there are good examples and I think your show is healthy actually because don't know, don't you have the statistics in terms of your listenership, but I would hope that there are quite a number of senior African policymakers within the health space are listening to your podcasts that if they frame it in terms of actually digital health as a growth path that can create revenue outside even of their own countries, then you start to shift that investments into digital health ecosystems and start ups is actually creating a pathway to prosperity with a dual outcome. You know, you have an economic outcome for the economic activities these companies do as they grow, employment creation, tax, tax revenue increases, etcetera, external revenue, even foreign currency revenue if they start to export their digital solutions. At the same time, you have enhanced the health of people in your own country. So it's a, it's a double win.
Emmanuel Fombu:
And I think that because you look at the digital age, healthy Africa is actually benefiting from it. I think if you look at it from the council, like the bigger concept of the future of the digital societies and universal basic income as a foundation, because even though I know in Switzerland you guys rejected that idea, which is great, that means everyone in Switzerland is quite rich because you guys rejected the idea of piece of it, which is quite interesting. But the idea is people could donate data sets, right? In Africa in general, just donating data in exchange for healthcare coverage for them because that's something that, the donated data anyways, in, thanks, I think having that foundation could foster growth and employment in people, educate people how to sector companies and grow and become better I think is the best way to go. Hopefully I could join you in Rwanda. Stefan but what is the, I know we're over time a little bit here, I don't want to take all the time and it's very important. But what is the what parting words would you share with our audience today to hear what you think things should go or where you're trying to fight for accomplish the next six months or next year that people should take from you? What's your wisdom? Give us a words of wisdom.
Stefan Germann:
But words of wisdom would be that we all should reflect on courageous kindness. I think we're living in a world where we don't live sufficient kindness with each other. And this is not about the fuzzy kindness. That's why it's courageous kindness. We should really challenge each other. We should continuously be curious and question the status quo and move to what I would call consciousness that really understands that we all interact and we all belong together. Because in the end of the day, whatever views we have of the world, we all breathe the same. Even to some extent, I'm breathing out and in, you're somewhere else, but somehow these molecules that I was breathing, one day you will breathe one of these molecules from the into. So we are all connected regardless of where we are. And if we apply that thinking of being so deeply interconnected just by breathing. And that's the only thing we cannot control. We can control saying I don't eat anymore and then I'll probably die. I can say I don't drink anymore than I die quicker. I cannot say I don't breathe anymore unless I do something, the body will continue breathing. I have no control over my breathing. So this is for me a deep and interesting is the word spirit in the languages of Latin, etcetera is the same, like breathing. And so it's that interconnectedness is in that breathing. And if we live then courageous kindness with the understanding that we are actually all interconnected and we are all one human family, then these barriers that we create that are impacted on how we live, health and well-being will fall apart and then digital can just be part of this transformation. But the mindset needs to change above.
Emmanuel Fombu:
And that's what it's about. And it goes to the point where Chinua Achebe's things fall apart, where things fall apart, the centre cannot hold, correct. And so we're all connected. Our DNA is all connected. There's nothing special about each one of us. We're all one human family. If we're about the borders and the barriers and things that happen, we can come together. And to do that will make the future healthcare a reality. So I'm honoured, Stefan, thank you for this particular episode and thank you for coming and taking time to do this. Much better voice today. We're honored. Thank you, listeners. We have Stefan's contact information, policies, public permissions to find out how to get in contact with. But, but, but it's so important. Now, read about our organization. Read about the great things they're doing. And let's together, let's support, not just listen to what Stefan says, but take what we listen and spread it in your own locations. Spread the word and spread about the philosophy. Thank you, Stefan. And I'm honored to have you on the show.
Stefan Germann:
Thank you, Manny. Let's be great. Take care. Have a good day.
Emmanuel Fombu:
Thank you for listening to Bite the Orange. If you want to change healthcare with us, please contact us at info@EmmanuelFombu.com or you can visit us at EmmanuelFombu.com or BiteTheOrange.com. If you liked this episode and want more information about us, you can also visit us at EmmanuelFombu.com.
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About Stefan Germann:
Stefan Germann is the CEO at Fondation Botnar, a Swiss philanthropic foundation working to improve the health and wellbeing of young people living in cities around the world. Since setting up the management office in 2017, Stefan has been honored to be leading the foundation in the next stage of its development.
Prior to joining Fondation Botnar, he spent over 25 years working in leadership roles in Africa and Asia, focusing on health-related development for children, relief, and advocacy work.
Stefan previously held several board and advisory board memberships. These include the Partnership for Maternal, Newborn, and Child Health (PMNCH), the UBS Optimus Foundation, REPSSI in Africa, the Global Health Program, and The Graduate Institute in Geneva, where he focused on the role of NGOs in global health diplomacy.
He strongly believes that compassionate leadership is key to creating long-lasting change. By nurturing leaders in the younger generation and allowing them the space to operate according to their purpose, we can find new, fairer ways of approaching problems, set clear goals, and work together to create a brighter future.
Things You’ll Learn:
Digital Health is putting human beings more at the center of their actions.
Health systems require a deep understanding of the context in which they will be working.
We are now in the “healthcare in the digital age” era.
Missing, missed, and misused data are the Three M’s that can facilitate the use of innovations in healthcare.
Complex problems require more than one linear solution pathway.