‘What are the responsibilities of the private sector in health care?’
International visions on the future of health care in resource-poor settings

Dr Henk Rijckborst

Dr Henk Rijckborst opened the symposium by indicating the goal of this symposium. He emphasized that regarding public-private partnerships, an inadequate understanding of each other among the various parties can result in widely divergent expectations. According to Rijckborst: “The business sector, encompassing a wide variety of cultures and backgrounds, primarily sees its own staff as target group, along with their dependents, if necessary. In recent years, it has also started accepting responsibilities outside this circle. This can contribute greatly to external appreciation and can increasingly be included in investment considerations by fund managers.”

Dr Rijckborst said that, following an extensive study, the Heineken Executive Board had decided to include highly active anti-retroviral therapy in the medical care package. Providing HIV/AIDS medication in rural Sub Saharan Africa was made possible, financially, organisationally and medico-technically, on account of the absence of the required high-tech medical infrastructure.”

Rijckborst explained that we have now entered an era in which other organisations such as the Global Fund, the USA PEPFAR programme, private foundations such as the B&M Gates Foundation and others, have created a flow of aid dedicated to treating HIV/AIDS and TB and to preventing malaria. The private sector is increasingly being called upon to play a role in providing help to communities and – by the Global Fund – to make significant financial contributions. However, serious limitations remain.

Rijckborst supported this by giving a striking example: “We advised concerned parties not to send a months-old baby from Central Africa to Europe for open heart surgery, after children’s cardiac surgeons had advised us not to on account of the lack of adequate aftercare facilities in the home country. As we knew all too well, the negative advice could have fatal consequences for the baby. Discussing such matters with external organisations and experts (Amnesty International, public authorities, local population, ethicists, physicians and so on) will not discharge companies from their responsibilities, but it does help them to properly appraise similar cases in the future. “

It is important to work on developing health insurance policies that provide a solid health care package and that assure groups of people of access to health facilities of adequate medical care. The establishment of the Health Insurance Fund in the Netherlands is an important and innovative initiative: it subsidises the provision of health care, creates awareness, and allows more people to benefit from medical services through the increase in financing capacity.

He concluded his introduction by expressing the wish that the symposium may contribute to a clearer perception of the responsibilities and the limitations thereof in the field of health care.

‘Business is increasingly playing a major role in international health’

Dr Peter Piot

Over the past 25 years, the AIDS epidemic has become one of the world’s most significant global challenges and health burdens. In 2006 alone there were 10,000 new HIV infections and 7,000 deaths every day. In spite of some real results in the global response to AIDS in recent years, the number of people living with HIV continues to grow.

“The AIDS pandemic affects the private sector both directly and indirectly,” said Dr Peter Piot, UNAIDS Executive Director and Under Secretary-General of the United Nations during his video address at the Heineken Health Symposium in Amsterdam yesterday afternoon. “The needs are enormous.”

Dr Piot went on to describe what he believes to be two key challenges facing businesses considering health care issues; making money directed towards health care work for those on the ground, and developing and maintaining long-term responses. Piot argued that companies are fully equipped to surmount both of these challenges, as the private sector possesses the skills, the resources and the know-how to successfully establish long-term investments.

Dr Piot concluded his address by urging the private health insurance sector to step up its role in contributing to AIDS programmes and commented: “It is critical that we look way beyond the health systems and health care when dealing with AIDS, as most HIV prevention activities are not of a medical nature and are happening outside health services. Indeed the multi-sectoral realm of AIDS presents enormous opportunities for further contributions of the business sector—in terms of resources, reaching people, expertise and long-term planning.”

‘Disease burden in resource-poor settings and the contribution of the private sector’

Professor Joep Lange

Roughly 14 per cent of the world’s population can be found in sub-Saharan Africa. And yet, 60 per cent of malaria cases, 30 per cent of tuberculosis cases and around 66 per cent of the world’s AIDS cases can be found in countries in this region. This creates a disproportionate burden for the provision of adequate health care services.

During his address at the Heineken Health Symposium, professor Joep Lange, Executive Director at the Center for Poverty-related Communicable Diseases, Academic Medical Center, University of Amsterdam, said there was a role to be played by the private sector in creating a more even playing field. Lange highlighted the positive steps forward achieved by pharmaceutical companies in developing appropriate medicines to help treat a range of diseases as a typical example.

However, professor Lange admitted that the provision and administration of adequate health care services presents unique difficulties in sub-Saharan Africa, due to poorly trained medical practitioners, brain drain and an inadequate infrastructure. Initiatives such as the Health Insurance Fund (to which Heineken contributes) are positive examples of private sector businesses committing to providing proper health care in poor countries. Lange praised Heineken as ‘a shining light’ that has encouraged other companies to redefine the limits of their own responsibilities.

‘The challenge of Global Governance and the role of businesses’

Mr Peter Lacy

Placing the involvement of the private sector in the provision of and contribution to health care services in a broader context, Professor Peter Lacy, Executive Director of European Academy of Business in Society (EABIS), discussed the impact of globalisation at the Heineken Health Care Symposium.

The world’s population is rapidly growing and aging, and the economic performance of global regions are changing. These trends have had an impact upon the role of companies in contributing to sustainability issues such as health care.

As a result, professor Lacy argued that global governance (specifically in relation to health care) is becoming increasingly blurred, with the roles of both the private and public sector less clearly defined. Businesses are more and more being asked to take responsibility, with 95 per cent of international CEOs believing that social expectations are increasing, according to a recent UN survey. And despite the limitations presented, Lacy argues there is a role to be played by businesses. They can use a range of strategies to provide products and services that tackle these global challenges, to form strong relationships with governments to help progressively shape and inform policy and regulation, and to engage in new partnerships and collaborative forms of governance that create a level playing field for companies and society.

Lacy highlighted the importance of involving business schools and academics, but also educating managers and business leaders to start thinking about their potential role and responsibility in contributing to sustainability issues such as human rights, climate change and sharing the global health burden.

‘Public-private partnerships’

Mr Bert Koenders

Following a recent trip to the Democratic Republic of Congo and Rwanda, Bert Koenders, Minister for Development and Cooperation in the Netherlands, yesterday addressed the Heineken Health Symposium in Amsterdam. The Minister expressed his deep distress at the social plight facing the African nation’s population. And yet in stark contrast, Koenders added that during his visit to the Bralirwa brewery – Heineken’s operating company in Rwanda – he was greatly encouraged, praising the company and applauding Bralirwa’s General Manager Door Plantenga for her tireless efforts in the area of health care provision.

“Heineken is one of the pioneers of developing partnerships,” Mr Koenders said, specifically referring to Heineken’s contribution to the Health Insurance Fund (HIF) in Rwanda. The HIF is a groundbreaking initiative for African countries enabling low-income groups to receive collective health insurance through a premium subsidy. The Public-Private-Partnership Forum laid the basis for the HIF, which included parties such as Heineken, the Dutch government, Pharm Access International and a range of multinational companies including Unilever, Celtel and Shell.

His Excellency went on to explain how Heineken has been setting the standard when it comes to health care provision and praised Henk Rijckborst for his vision and contribution to this during his career with the company.

The Minister made specific reference to the company’s development and implementation of the Economic Impact Model, an innovative tool, which was developed and used in Sierra Leone for the first time. The Minister emphasized that it clearly quantifies the direct and indirect impact of Heineken’s presence in the economies where it operates.

The Minister underlined the importance of the business sector for governments, especially in Sub-Saharan Africa. However, he also mentioned the need for clearly defined roles and responsibilities as companies should not take over the role over governments.

‘What are the limits of health care responsibilities?’

Jean-François van Boxmeer

Having spent much of his early career working in sub-Saharan Africa, Heineken CEO Jean-François van Boxmeer has a wealth of first-hand experience dealing with the intense challenges relating to business and its support of health care services. During managerial positions in Rwanda and the Democratic Republic of Congo, Van Boxmeer developed a deep understanding of medical ethical dilemmas and yesterday shared his vision of an international company and the future of health care at the Heineken Health Symposium in Amsterdam.

Since the early 1980s, Heineken has been working to provide health care services to its employees and their families. Van Boxmeer explained that this is of particular importance in poverty-stricken nations, where governments are not in a position to provide adequate social support.

“A healthy business needs a healthy society,” Van Boxmeer said. “Businesses can play a stronger role in the development agenda, but they should not and cannot be asked to take over the role of government.” During his address, Heineken’s chairman stressed that the private sector is becoming more and more sensitive to its integral role in society, explaining there is a greater expectation for businesses to step in. But Van Boxmeer recognised that there are conflicting aspects, as businesses are ultimately profit-driven organisations, and in many cases, the magnitude of social instability is beyond the scope of private sector resources.

Van Boxmeer indicated that partnerships perhaps represent the next evolution of business involvement in health care: “More and more we recognize that the challenges are so complex, that they cannot be solved unless governments, NGOs and industries work together effectively. We have to get used to working together and to trust each other. This is a challenge, given the fact that we have different backgrounds, knowledge and use of language. We are gradually realising the common ground that exists between us and acting together to improve the situation.”

Van Boxmeer concluded his address by offering his personal thanks to Dr Henk Rijckborst, Heineken Health Affair’s Director, applauding the doctor’s efforts over the past two decades