From Chicago Tribune (June 9)
Ernest Darkoh
A physician with an MBA, the 35-year-old melds business practicality and public health idealism in effort to revolutionize Africa's fight against AIDS
By Laurie Goering
Tribune foreign correspondent
Published June 9, 2005
JOHANNESBURG -- Ernest Darkoh saw early what was wrong with Africa.
In Kenya, where he spent his teenage years, he watched as government mismanagement and corruption sometimes left his parents, both university professors, without paychecks for a month or more. Neighbors lived in abject poverty, and crime was a constant worry. When Darkoh was 19, a friend his age died at a local hospital because doctors were worried the young man might have AIDS and refused to treat him.
"That was the environment I grew up in--seeing a lot of poverty, poor services, even my parents struggling to make a living," remembers the strapping young doctor. "I decided I wanted to really do something about these things."
Today, at just 35, Darkoh is on his way to reshaping the way Africa solves its health problems. Armed with two medical degrees from Harvard University and an MBA from Oxford, he has already launched Africa's most successful public HIV treatment program, in Botswana, has laid the groundwork for mass-scale private treatment of AIDS patients in South Africa and helped create a revolutionary health-care model that might one day extend effective medical treatment--and solutions to many other African crises--throughout the continent.
"For so long Africa has been locked into inappropriate models. Now it needs to step back, have a new kind of thought process and not just keep on optimizing things that are not working," said Darkoh, who is trying to combine business practicality and public health idealism to create new delivery systems that work in Africa.
Colleagues think he might pull it off.
"He's not typical," said Joy Phumaphi, Botswana's former health minister and now a World Health Organization official in Geneva. "The typical person has a generic model they try to force down your throat and they assume solutions apply in every environment. He's not like that."
In an environment where "the work is all uphill and a daunting challenge," she said, Darkoh is remarkably open-minded, optimistic and determined.
"Here it's easy to give up hope," she said. "He's not that type."
Africa's problems have long defied simple solutions. The continent is home to the world's poorest people--nearly a quarter survives on less than 50 cents a day--and the world's worst AIDS epidemic. Millions have no access to clean water, electricity or other basic services, and diseases like diarrhea, malaria and pneumonia are rife. The continent's governments are burdened by huge debt, a major subject of talks Tuesday in Washington between President Bush and British Prime Minister Tony Blair.
Darkoh sees Africa's problems from a unique background and has an unusual set of qualifications to help solve them.
Born at the University of Wisconsin-Madison to Ghanian graduate students, he moved to East Africa as a child. Pushed by his parents to explore a career in medicine, he returned to the University of Wisconsin to triple-major in chemistry, biochemistry and molecular biology before going on to Harvard for medical school.
Early educational frustrations
Studying medicine, however, turned out to be frustrating. The focus was on older patients, chronic diseases and problems like obesity--"things I felt wouldn't apply in my lifetime in the developing world," Darkoh remembers.
He took time out for a master's in public health, and there found "lots of nice sentiments about health care for all but very little about how you get things done," he said.
So, he finished off his training with a master's in business administration, and a first job at McKinsey & Co., a leading New York management consulting firm.
Working with utility companies, high-tech firms and even snack manufacturers, he learned "how to make processes short and cost-efficient," he said. "In business you succeed or go out of business. There's no fluffy `I help humanity' in the middle. Business forces you to do things well and show results."
The pivotal opportunity
Darkoh got a first chance to combine all his training when in 2001 the government of Botswana hired McKinsey to develop a strategy for Africa's first large-scale public rollout of antiretroviral AIDS treatment drugs. Soon Darkoh was on a plane back to Africa.
"It became clear this project was going to redefine HIV issues on the continent," he said. "If we could pull this off and create a successful treatment model, it would change things for Africa. And if we failed it was fuel for all the naysayers who to this point had said there should be no treatment for Africa."
"We knew it had to work," he said. "It completely changed my life."
Impressed with the plan and with McKinsey's enthusiastic young doctor, Botswana ultimately hired Darkoh to implement it. Within three years, the fledgling civil servant had 38,000 HIV-positive people--a third of those in need of treatment--on lifesaving drugs in a country where few people had even known their HIV status before his arrival. The program was underwritten by donor and government funds and used a mix of public and private doctors,
With his phone ringing with calls from other African nations asking for advice on HIV treatment models, Darkoh called an old friend from Harvard, who works in health-care management in the U.S., and formed Broadreach Healthcare, a private company "dedicated to expanding access to health care services across the globe."
The company, which does consulting as far afield as China, is focusing on a new African challenge: expanding antiretroviral drug access in South Africa, a nation with the highest number of HIV-positive citizens in the world but with a government that has long dragged its heels on implementing large-scale public antiretroviral treatment.
South Africa, interestingly, has one of the developing world's biggest antiretroviral programs, but nearly all of it is private companies offering their workers drugs through private doctors. Working with AIDS activist groups, Darkoh is trying to harness that system to treat public patients.
In cooperation with private treatment partners such as South African-based Aid for AIDS, Darkoh has built a network of underused private physicians willing to take on public patients. AIDS activists seek uninsured HIV-positive people in need of treatment, many in remote rural communities, and Darkoh's group arranges visits from front-line health-care workers, usually local nurses or community health workers.
Summary of program
Those workers then ask the patients a short list of questions designed to determine their health status. If the patients answer yes to certain red-flag questions, indicating they are ill enough to need immediate medical treatment or drugs, private doctors are called in to develop and monitor a treatment program, which is administered by local health-care workers. Funds provided through the United Nations Global Fund and the U.S. President's Emergency Plan for AIDS Relief pay the doctors and nurses and buy the drugs.
In a country where antiretroviral drugs are given to only 26,000 people while more than 610,000 are anxiously waiting, Darkoh's program has the capacity to bring 100,000 to 300,000 people onto treatment within a couple of years.
The effort is just getting under way as the first donor funding arrives. It already is drawing support from South African provincial authorities.
What the plan does
The plan addresses many problems slowing AIDS treatment efforts in Africa: How to successfully treat patients in remote areas beyond the reach of trained AIDS specialists, how to make the best use of a limited number of trained doctors, how to hold down costs, spend donor money effectively and quickly begin treating large numbers of patients, particularly in rural areas where highly trained doctors are reluctant to set up practice.
"The reality is, you don't need a doctor to regularly see every single person who's HIV-positive," Darkoh said. Using less-trained local health-care workers consulting with urban specialists is cheaper and creates jobs in rural areas. The model brings expertise where it's needed and raises the possibility of quickly putting thousands or even millions of HIV-positive Africans in treatment, something critical in a region where more than 2 million people die of the disease yearly.
Ernest Darkoh
A physician with an MBA, the 35-year-old melds business practicality and public health idealism in effort to revolutionize Africa's fight against AIDS
By Laurie Goering
Tribune foreign correspondent
Published June 9, 2005
JOHANNESBURG -- Ernest Darkoh saw early what was wrong with Africa.
In Kenya, where he spent his teenage years, he watched as government mismanagement and corruption sometimes left his parents, both university professors, without paychecks for a month or more. Neighbors lived in abject poverty, and crime was a constant worry. When Darkoh was 19, a friend his age died at a local hospital because doctors were worried the young man might have AIDS and refused to treat him.
"That was the environment I grew up in--seeing a lot of poverty, poor services, even my parents struggling to make a living," remembers the strapping young doctor. "I decided I wanted to really do something about these things."
Today, at just 35, Darkoh is on his way to reshaping the way Africa solves its health problems. Armed with two medical degrees from Harvard University and an MBA from Oxford, he has already launched Africa's most successful public HIV treatment program, in Botswana, has laid the groundwork for mass-scale private treatment of AIDS patients in South Africa and helped create a revolutionary health-care model that might one day extend effective medical treatment--and solutions to many other African crises--throughout the continent.
"For so long Africa has been locked into inappropriate models. Now it needs to step back, have a new kind of thought process and not just keep on optimizing things that are not working," said Darkoh, who is trying to combine business practicality and public health idealism to create new delivery systems that work in Africa.
Colleagues think he might pull it off.
"He's not typical," said Joy Phumaphi, Botswana's former health minister and now a World Health Organization official in Geneva. "The typical person has a generic model they try to force down your throat and they assume solutions apply in every environment. He's not like that."
In an environment where "the work is all uphill and a daunting challenge," she said, Darkoh is remarkably open-minded, optimistic and determined.
"Here it's easy to give up hope," she said. "He's not that type."
Africa's problems have long defied simple solutions. The continent is home to the world's poorest people--nearly a quarter survives on less than 50 cents a day--and the world's worst AIDS epidemic. Millions have no access to clean water, electricity or other basic services, and diseases like diarrhea, malaria and pneumonia are rife. The continent's governments are burdened by huge debt, a major subject of talks Tuesday in Washington between President Bush and British Prime Minister Tony Blair.
Darkoh sees Africa's problems from a unique background and has an unusual set of qualifications to help solve them.
Born at the University of Wisconsin-Madison to Ghanian graduate students, he moved to East Africa as a child. Pushed by his parents to explore a career in medicine, he returned to the University of Wisconsin to triple-major in chemistry, biochemistry and molecular biology before going on to Harvard for medical school.
Early educational frustrations
Studying medicine, however, turned out to be frustrating. The focus was on older patients, chronic diseases and problems like obesity--"things I felt wouldn't apply in my lifetime in the developing world," Darkoh remembers.
He took time out for a master's in public health, and there found "lots of nice sentiments about health care for all but very little about how you get things done," he said.
So, he finished off his training with a master's in business administration, and a first job at McKinsey & Co., a leading New York management consulting firm.
Working with utility companies, high-tech firms and even snack manufacturers, he learned "how to make processes short and cost-efficient," he said. "In business you succeed or go out of business. There's no fluffy `I help humanity' in the middle. Business forces you to do things well and show results."
The pivotal opportunity
Darkoh got a first chance to combine all his training when in 2001 the government of Botswana hired McKinsey to develop a strategy for Africa's first large-scale public rollout of antiretroviral AIDS treatment drugs. Soon Darkoh was on a plane back to Africa.
"It became clear this project was going to redefine HIV issues on the continent," he said. "If we could pull this off and create a successful treatment model, it would change things for Africa. And if we failed it was fuel for all the naysayers who to this point had said there should be no treatment for Africa."
"We knew it had to work," he said. "It completely changed my life."
Impressed with the plan and with McKinsey's enthusiastic young doctor, Botswana ultimately hired Darkoh to implement it. Within three years, the fledgling civil servant had 38,000 HIV-positive people--a third of those in need of treatment--on lifesaving drugs in a country where few people had even known their HIV status before his arrival. The program was underwritten by donor and government funds and used a mix of public and private doctors,
With his phone ringing with calls from other African nations asking for advice on HIV treatment models, Darkoh called an old friend from Harvard, who works in health-care management in the U.S., and formed Broadreach Healthcare, a private company "dedicated to expanding access to health care services across the globe."
The company, which does consulting as far afield as China, is focusing on a new African challenge: expanding antiretroviral drug access in South Africa, a nation with the highest number of HIV-positive citizens in the world but with a government that has long dragged its heels on implementing large-scale public antiretroviral treatment.
South Africa, interestingly, has one of the developing world's biggest antiretroviral programs, but nearly all of it is private companies offering their workers drugs through private doctors. Working with AIDS activist groups, Darkoh is trying to harness that system to treat public patients.
In cooperation with private treatment partners such as South African-based Aid for AIDS, Darkoh has built a network of underused private physicians willing to take on public patients. AIDS activists seek uninsured HIV-positive people in need of treatment, many in remote rural communities, and Darkoh's group arranges visits from front-line health-care workers, usually local nurses or community health workers.
Summary of program
Those workers then ask the patients a short list of questions designed to determine their health status. If the patients answer yes to certain red-flag questions, indicating they are ill enough to need immediate medical treatment or drugs, private doctors are called in to develop and monitor a treatment program, which is administered by local health-care workers. Funds provided through the United Nations Global Fund and the U.S. President's Emergency Plan for AIDS Relief pay the doctors and nurses and buy the drugs.
In a country where antiretroviral drugs are given to only 26,000 people while more than 610,000 are anxiously waiting, Darkoh's program has the capacity to bring 100,000 to 300,000 people onto treatment within a couple of years.
The effort is just getting under way as the first donor funding arrives. It already is drawing support from South African provincial authorities.
What the plan does
The plan addresses many problems slowing AIDS treatment efforts in Africa: How to successfully treat patients in remote areas beyond the reach of trained AIDS specialists, how to make the best use of a limited number of trained doctors, how to hold down costs, spend donor money effectively and quickly begin treating large numbers of patients, particularly in rural areas where highly trained doctors are reluctant to set up practice.
"The reality is, you don't need a doctor to regularly see every single person who's HIV-positive," Darkoh said. Using less-trained local health-care workers consulting with urban specialists is cheaper and creates jobs in rural areas. The model brings expertise where it's needed and raises the possibility of quickly putting thousands or even millions of HIV-positive Africans in treatment, something critical in a region where more than 2 million people die of the disease yearly.
