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MISSION STATEMENT

U.S. HEALTHCARE TRADE MISSION TO AFRICA

Date: October 22 – 27, 2017

MISSION DESCRIPTION

The United States Department of Commerce, International Trade Administration is organizing a U.S. Healthcare Trade Mission to South Africa and Kenya scheduled for October 22-27, 2017. Optional add-on post mission stops will be available for selected mission companies that seem to appropriately fit market opportunities. These additional stops would include customized appointments with pre-screened potential foreign partners in: Ethiopia, Ghana, and Mozambique for an additional fee (space limited).

This Healthcare Trade Mission is intended to include representatives from various U.S. medical/healthcare industry manufacturers, service providers, associations and trade organizations. In addition to new-to-market companies, the mission also will assist U.S. companies already doing business in South Africa and Kenya to expand their footprint. Target sectors holding high potential for U.S companies include:

  • Medical equipment/devices
  • Laboratory equipment
  • Dental equipment
  • Emergency equipment
  • Imaging and Diagnostic equipment
  • Physiotheraphy and Orthopedic equipment/devices
  • Healthcare information technology
  • Products and technologies for other allied health sectors

The mission will introduce the participants to the government bodies, end-users, and prospective partners whose needs and capabilities are best suited to each U.S. participant’s strengths. Participating in an official U.S. industry delegation, rather than traveling to South Africa, Kenya and the optional add-on stops on their own, will enhance the participants’ ability to secure business and government meetings. Business meetings will be designed to match the delegates with potential business partners, distributors, or importers in the markets. The mission will include appointments and briefings in Johannesburg, Nairobi, and possibly other cities that are healthcare industry hubs.

The delegates will meet with experts to obtain firsthand information about the regulations, policies, standards, and procedures for importing the medical devices into South Africa and Kenya. Participants will also visit healthcare facilities to get acquainted with specialized care facilities. Trade mission participants will have the opportunity to interact extensively with U.S. Embassy/Consulate Officials and Commercial Service healthcare specialists in South Africa and Kenya to discuss industry developments, opportunities, and sales strategies.

The U.S. Healthcare Trade Mission to South Africa and Kenya will draw on the resources of several U.S. government agencies and NGO’s, including Centers for Disease Control and Prevention (CDC), U.S. Patent and Trademark Office, U.S. Trade Development Agency, U.S. Agency for International Development, and World Health Organization.

U.S. companies in this sector, as well as relevant U.S. trade associations/organizations are encouraged to apply. Selection criteria for participation, as set out below, apply equally for all applicants.

COMMERCIAL SETTING

South Africa and Kenya

Although the size of the healthcare market in South Africa is significantly greater than that in Kenya, these two countries share many similarities, including growing populations, and increasing rates of chronic diseases typically associated with growing urbanization and lifestyle changes. South Africa carries the title of having the highest hypertension prevalence in the world (SAGE Study, WHO 2014), whereas one in eight Kenyans living in poverty suffer from hypertension, according to the African Population and Health Resource Center (APHR). In both countries however, there is low public awareness on these silent killers. Both countries are at varying levels of development and sophistication in healthcare access and service delivery, but have advanced in Information and Communication Technologies (ICT), and are putting focus on Health IT through the use of technological products and services designed to improve and coordinate patient care, address growing health costs, and confront the long-term burden of disease. Both the Kenyan and South African governments have committed significant resources to modernize their respective healthcare systems. The new priority is to achieve greater efficiencies based on patient-centric care, and U.S. companies are well suited to implement the next generation of healthcare delivery solutions needed in these markets.

Optional Add-On Markets: Ethiopia, Ghana, and Mozambique

The Government of Ethiopia is working to strengthen the healthcare system to align it with the Millennium Development Goals of the country.  Ethiopia has a large, predominantly rural, and impoverished population with poor access to safe water, housing, sanitation, food, and health service. This has resulted in the exposure of the local community to communicable diseases like TB, malaria, respiratory infection, diarrhea, and nutritional deficiencies. HIV/AIDS, high fertility rates, and low contraceptive prevalence remain problems in Ethiopia. GOE is also looking to combat non-infectious diseases such as cancer, diabetes, heart diseases, high blood pressure. Sub-sector best prospects for U.S. firms include: Equipment and services to new hospitals and health centers; Construction of modern hospitals and health facilities; Health IT support; and Cold storage facilities.

Ghana relies on imports for approximately 80% of its total health care consumption. In 2005, Ghana moved from a ‘pay as you go’ system, where individual health expenditures were paid in cash prior to treatment, covered entirely by patients. The National Health Insurance Scheme now provides wide coverage for a limited scope of health issues, primarily insuring for treatment against the most prevalent diseases (malaria and others). Ghana has sought to introduce more private sector participation into the health care sector and the most dynamic growth and most exciting opportunities will be found in privately invested hospitals and clinics. Most coverage is focused on basic treatments of commonly occurring illnesses. Under publicly funded health care outreach programs (often funded through grants or loans by multinational development agencies) there is a strong focus on driving basic health care services to smaller towns and villages in rural Ghana. U.S. companies have profited in the Ghana market by providing mobile health equipment that can be used in rural settings, often in regions that are off the power grid.

The Government of Mozambique continues to show its commitment towards the development of healthcare infrastructure by tackling the country's shortages of health professionals and clinic with the aid of foreign investors. Estimated value of medical device sales for 2014 was USD 35.6 million, and is projected to rise to over USD 50 million in 2015 and USD 78 million by 2016. Diagnostics and consumables have the highest values. (Source: BMI). Communicable diseases remain the main health challenges in Mozambique. The HIV/AIDS pandemic is now responsible for one-third of deaths, and the mortality rate for children under five suffering from malaria is 1,159 per 100 000. Non-Communicable Diseases are also on the increase, such as hypertension, which affects a considerable portion of the population. Large increases in health sector investment and policies favoring upgrading and expanding the public sector health network have prioritized maternal and child health in Mozambique.

South Africa

South Africa is the largest economy in Africa and is classified as a Middle Income Country with total health spending of $29.8 billion USD (2013: Deloitte). South Africa’s GDP in 2015 was USD312.8 billion (World Bank)

South Africa's health system consists of a large public sector, and a very sophisticated private sector and an NGO sector. The public health sector is funded by the state with 40% of all expenditures on health coming from the National Treasury. Public health consumes around 11% of the government's total budget and is allocated mostly to nine provincial departments. This is higher than the 5% of GDP recommended by the World Health Organization (WHO) and reflects the major burden of disease management and treatment carried by the public sector in South Africa. This includes the treatment of HIV and tuberculosis (TB) as a large component of the disease burden in South Africa. There is growing concern about the country’s non-communicable diseases: a growing cancer profile; as well as hypertension, cardiovascular disease, and diabetes, placing South Africa second to Nigeria amongst African nations when it comes to the NCD burden in these disease categories.

The high levels of poverty and unemployment in the country mean that healthcare remains largely the burden of the state with the National Department of Health holding overall responsibility for health care, with a specifically for the public sector (approximately 80 percent of the population). Despite this high expenditure, health outcomes are poor in comparison with other similar middle-income countries, reflecting an inequity in healthcare in the country. A shortage of key medical personnel further hampers the public sector. There are 4200 public health facilities in South Africa with each clinic providing on average for 13,718 persons (a figure that exceeds the WHO guidelines of 10,000 per clinic.) People averaged 2.5 visits per year to public health facilities and the bed occupancy rates were between 65% and 77% at hospitals. Since 1994, more than 1600 clinics have been built or upgraded. For 2.5 million South Africans, their nearest clinic is more than three miles by foot away from their homes. There are 376 public hospitals in the country; 143 in urban areas and 233 in rural areas. Diagnostic and health research services are provided by the National Health Laboratory Service (NHLS), the largest pathology service in South Africa with 265 laboratories, serving 80% of South Africans. There are 165,371 qualified health practitioners in both public and private sectors, registered with the Health Professions Council of South Africa, including 38,236 doctors and 5,560 dentists. In the public service, there is one doctor for every 4,219 people, compared to one doctor for every 243 patients in the private sector. Seventy-three percent of general practitioners work in the private sector. Each year, about 1,200 medical students graduate and provide two years of community service in understaffed hospitals and clinics throughout the country.

The market is expected to grow at a compound annual growth rate of 8.7 percent (in local currency terms, but will contract in US dollar terms due to the weak Rand and fluctuating exchange rate) from 2012 through 2017. The sector may experience further downturn if economic growth slows further. The market is extremely price-sensitive, both in private and public, but notably so in the public sector, where the budget is stretched more thinly. Although largely import-dependent, there is growing small scale local production, mostly centering around consumables, hospital furniture, basic surgical equipment, and supplies.

Local production is also becoming increasingly sophisticated, with additional investment in R&D and public-private partnerships that largely facilitate these developments. For example, the Aceso Imaging system for screening breast cancer, designed and developed by Cape Ray in Cape Town and launched by the Department of Science & Technology is believed to be a world-first imaging system that combines mammogram and ultrasound technologies and allows for instant detection of cancer cells, particularly when looking at dense breast tissue. The Industrial Development Corporation are funding this technology, Lodox, another South African invention, is the only system in the world that can take a high quality full body x-ray in less than 13 seconds.

The sophisticated South African medical community is generally interested in new technology developments and products (mostly private sector), and many of the private hospitals and clinics reflect the quality and standards enjoyed in Europe and the USA.

The private sector, which spends roughly the same amount as the public sector, USD 1.4 billion on about 17 percent of the population, is run largely on commercial lines and caters to middle and high income earners who are generally members of a medical insurance. Most health professionals in South Africa are found in the private sector. This sector boasts high quality facilities and state-of-the-art equipment, comparable to Europe and the United States.

The South African government is also revamping public hospitals and building new clinics as part of their campaign to introduce and develop national health insurance (NHI), however there are considerable delays and challenges in implementation, largely due to the lack of funding and transparency in procurement processes.

Opportunities:

  • This is largely an import driven market (90%) The U.S. enjoys a good reputation and is a front-runner. Interest is high for highly innovative, cutting-edge medical technology in

§ Advanced Point-Of-Care devices and diagnostics

§ Advanced surgical devices

§ Advanced laboratory equipment and clinical chemistry devices

§ Advanced cancer treatment and diagnostics devices. There is a growing disease burden throughout Sub-Saharan Africa for cancer with a high associated mortality rate due to lack of adequate screening and treatment

§ Dental equipment and devices

§ Telemedicine and e-Health (although this is constrained by funding, broadband costs, and slow implementation)

  • Public-Private Partnerships regarding R&D, technology and skills transfer as this reduces costs.

A key concern is the pricing of products. Most often, procurements are made based on price and whether medical insurances in the private sector are prepared to reimburse the use of a medical product in a procedure.

Kenya

Kenya’s healthcare markets are one of the fastest growing on the African continent and are expected to register strong double-digit growth with medical devices at 10% annually through 2014-2018, clinical chemistry, and diagnostic products at 15-25% annually and pharmaceuticals at 14-16% annually over the same period. The Kenyan healthcare market relies almost entirely on imports of medical devices, pharmaceuticals (at least 70-80%), dental products, laboratory equipment, healthcare IT, clinical chemistry, and diagnostics. Kenya is the key logistical conduit into East Africa (Tanzania, Uganda, Rwanda), and many foreign suppliers operating here do business under their own name to manage penetration into the larger, regional market.

There are regional differences in the quality and distribution of care, with the best facilities located in Nairobi and the Central Province, and the most underdeveloped facilities in the North-Eastern Province. Primary care facilities in rural areas often suffer from shortages of staff and medical equipment. Some patients choose not to seek care due to the distance that they would have to travel to reach the nearest health facility. Only 30% of the rural population has access to health facilities within 4km of their home, compared with 70% of the urban population.

U.S. healthcare suppliers are in an excellent position to increase their market share in Kenya due to U.S. technical competitiveness in assuring quality and reliability of U.S. healthcare products although price is occasionally an issue. Leading private sector hospitals are very active in modernizing their medical equipment inventories, while public sector hospitals are constantly re-equipping with improved budgetary allocations.

Additionally, the passage of a new constitution in August 2010 established 47 county governments, each of which is responsible for providing health facilities and services. These county governments, managed by a county governor, receive at least 15 per cent of their annual funding from the central government and a large portion of this funding is being used to re-equip county health facilities through a managed equipment services contract/leasing program that the Ministry of Health launched in February 2015. Under the plan, two public hospitals in each of the 47 counties will be fully equipped with state-of-the-art medical equipment, over a 12-month period. The KES38bn (USD 404.3mn) plan will be fully financed by the Ministry of Health. This mega project provided opportunity for American firms to be identified as key strategic technology and solutions partners after a competitive tender process. One company will provide a comprehensive package that includes deployment of over 500 units of diagnostic imaging equipment, including X-ray, and ultrasound systems supported by a long term servicing contract. They will also provide establishment of a Healthcare training center in line with the company's focus on skills development and capacity building which is a major component for working with the Government of Kenya.

The government of Kenya has a well-defined e-Health policy, “Kenya National e-Health Strategy 2011-2017” which is focused on five key pillars which are; Telemedicine, Healthcare Management Information Systems, Information for Citizens, mHealth, and e-learning. In addition, there is focus on expansion of cancer treatment centers, and a focus on public-private partnership growth as the government seeks to enlist private sector support in healthcare infrastructure projects. The challenges in supply chain management, accessibility, efficiency, and human resources bridging of the workforce skills and development.

Past government tenders for medical equipment indicate requirements for basic equipment such as anesthetic machines, anesthetic trolleys, hydraulic operating tables, delivery beds, infant incubators, mortuary trolleys, hydraulic operating tables, mercurial sphygmomanometers, and oxygen flow meters among others. Used and refurbished medical devices have an open market in Kenya so long as they conform to national standards.

Major suppliers of healthcare products include India, China, Germany, Switzerland, and the United States.

Best Prospects

Best prospects for electro-medical devices include: CT scanners, ultrasound units, X-ray equipment, mammography units, MRI equipment, angiography, endoscopy, and biochemistry, hematology, and immunology systems. Best prospects for clinical chemistry and diagnostics are in serology/hematology, immunochemistry, urinalysis, electrolytes analysis, diabetes testing and cardiac markers.

Opportunities

  • E-Health and M-health systems
  • Diagnostics for labs and clinical chemistry devices
  • Dental Devices (Can say something about dental needs in commercial settings?)
  • Cancer treatment devices
  • Orthopedics, and trauma treatment
  • Telemedicine systems
  • Hospital infection control systems (isolation wards) and personal protective equipment
  • Equipment for emergency operations centers (EOCs)
  • Disability devices such as artificial limbs and hearing aids

Other Products and Services

The foregoing analysis of the Healthcare opportunities in South Africa, Kenya and Sub-Saharan Africa is not intended to be exhaustive, but illustrative of the many opportunities available to U.S. businesses. Applications from companies selling products or services within the scope of this mission, but not specifically identified, will be considered, and evaluated by the U.S. Department of Commerce. Companies whose products or services do not fit the scope of the mission may contact their local U.S. Export Assistance Center (USEAC) to learn about other business development missions and services that may provide more targeted export opportunities. Companies may call 1-800-872-8723, or go to http://help.export.gov/ to obtain such information. This information also may be found on the website: http://www.export.gov.

MISSION GOALS

The mission will help participating firms and associations gain market insights, make industry contacts, solidify business strategies, and advance projects, with the goal of increasing U.S. exports to South Africa, Kenya, and Sub-Saharan Africa. By participating in an official U.S. industry delegation, rather than traveling to Africa on their own, U.S. companies will enhance their ability to secure meetings and gain greater exposure.

The goals of the of the mission are as follows:

  • To introduce the delegates to the vibrant South African, Kenyan, and Sub-Saharan African healthcare markets
  • To help participants gain market exposure among South African, Kenyan, and Sub-Sahara African buyers
  • To match participants with business prospects for increasing U.S. exports of goods and technology to South Africa, Kenya, and Sub-Saharan Africa
  • To educate the delegates on how they can leverage government resources and programs to increase their exports

MISSION SCENERIO

The U.S. Healthcare Trade Mission will begin in Johannesburg, South Africa with market briefings, one-on-one business meetings, meetings with government officials and organizations, and networking opportunities. Following two days in South Africa, participants will travel to Nairobi, Kenya for one-on-one meetings and meetings with government officials and organizations. Potential add-on post mission stops will be available for selected mission companies (that seem to appropriately fit market opportunities) to conduct customized appointments with pre-screened potential foreign partners in: Ethiopia, Ghana, and Mozambique for an additional fee.

PROPOSED TIMETABLE

Sunday, October 22

Johannesburg, South Africa

  • Arrive Johannesburg and hotel check-in
  • Welcome reception/ice breaker

Monday, October 23

Johannesburg, South Africa

  • Welcome and overview of Trade Mission
  • Market briefings from the U.S. Commercial Service and industry experts
  • One-on-one business meetings
  • Networking reception in Johannesburg

Tuesday, October 24

Johannesburg, South Africa

Pretoria, South Africa

  • Hospital/Clinic tours and meetings
  • One-on-one business meetings
  • Government meetings
  • Mission participant speaking opportunities

Wednesday, October 25

Johannesburg, South Africa

and Nairobi, Kenya

  • Depart for Nairobi, Kenya (AM)
  • Market briefings from the U.S. Commercial Service and industry experts (PM)
  • Networking reception in Nairobi

Thursday, October 26

Nairobi, Kenya

  • One-on-one business meetings Nairobi
  • Government meetings
  • Some delegates depart for add-on stops

Friday, October 27

Nairobi, Kenya

and possible add-on Post stops

  • Government meetings
  • One-on-one business meetings
  • Mission ends

Saturday, October 28 &

Sunday, October 29

Travel to optional stops over weekend

  • Ethiopia, Ghana, or Mozambique (Optional add-on locations)

Monday, October 30

  • One-on-One Meetings at optional locations and networking opportunities

PARTICIPATION REQUIREMENTS

All parties interested in participating in the trade mission must complete and submit an application package for consideration by the U.S. Department of Commerce. All applicants will be evaluated on their ability to meet certain conditions and best satisfy the selection criteria as

outlined below and will be notified whether they are chosen to participate in the mission. A minimum of 12 and a maximum of 15 companies and/or trade associations/organizations will be selected from the applicant pool to participate in the trade mission.

FEES AND EXPENSES

After an applicant has been selected to participate in the mission, a payment to the U.S. Department of Commerce in the form of a participation fee is required. Upon notification of acceptance to participate, those selected have ten (10) business days to submit payment or the acceptance may be withdrawn.

The participation fee for the U.S. Healthcare Trade Mission to South Africa and Kenya is $4,375 for small or medium-sized enterprises (SME)1 and $5,975 for large firms or trade associations. The fee for each additional representative (large firm or SME or trade association/organization) is $950.

The additional fee for the optional add-on stops to: Ethiopia (space is limited to 2 companies), Ghana (space is limited to 2 companies), and Mozambique (space is limited to 3 companies) for an additional fee of $1,000 for an SME and $1,325 for a large firm.

Delegation members may take advantage of U.S. Embassy rates for hotel rooms. Interpreter and driver services can be arranged for additional cost.

The mission fee does not include any personal travel expenses such as lodging, most meals, incidentals, local ground transportation, and air transportation from the U.S. to the mission sites, between mission sites, and return to the United States. Business visas may be required. Government fees and processing expenses to obtain such visas are also not included in the mission costs. However, the U.S. Department of Commerce will provide instructions to each participant on the procedures required to obtain necessary business visas.

Trade Mission members participate in the trade mission and undertake mission-related travel at their own risk.  The nature of the security situation in a given foreign market at a given time cannot be guaranteed.  The U.S. Government does not make any representations or guarantees as to the safety or security of participants.  The U.S. Department of State issues U.S. Government international travel alerts and warnings for U.S. citizens available at https://travel.state.gov/content/passports/en/alertswarnings.html.   Any question regarding insurance coverage must be resolved by the participant and its insurer of choice.

CONDITIONS FOR PARTICIPATION

Applicants must submit a completed and signed mission application and supplemental application materials, including information on their products and/or services, primary market objectives, and goals for participation by June 30, 2017. All applications will be reviewed on a comparative basis soon after June 30, 2017. If the U.S. Department of Commerce receives an incomplete application, the Department may either: request additional information/clarification, take the lack of information into account when evaluating the application, or reject the application.

Each applicant must also certify that the products and services it seeks to export through the mission are either produced in the United States, or, if not, are marketed under the name of a U.S. company and have at least fifty-one percent U.S. content by value. In the case of a trade association or organization, the applicant must certify that, for each firm or service provider to be represented by the association/organization, the products, and/or services the represented firm or service provider seeks to export are either produced in the United States or, if not, marketed under the name of a U.S. company and have at least fifty-one percent U.S. content.

In addition, each applicant must:

  • Certify that the products and services that it wishes to market through the mission would be in compliance with U.S. export controls and regulations;
  • Certify that it has identified any matter pending before any bureau or office in the U.S. Department of Commerce;
  • Certify that it has identified any pending litigation (including any administrative proceedings) to which it is a party that involves the U.S. Department of Commerce;
  • Sign and submit an agreement that it and its affiliates (1) have not and will not engage in the bribery of foreign officials in connection with a company’s/participant’s involvement in this mission, and (2) maintain and enforce a policy that prohibits the bribery of foreign officials; and
  • Certify that it meets the minimum requirements as stated in this announcement.

In the case of a trade association/organization, the applicant must certify that each firm or service provider to be represented by the association/organization can make the above certifications.

SELECTION CRITERIA FOR PARTICIPATION

The following criteria will be evaluated in selecting participants:

  • Relevance of the company’s (or in the case of a trade association/organization, represented companies’) business to the mission goals;
  • Company’s (or in the case of a trade association/organization, represented companies’) market potential for business in Africa;
  • Provision of adequate information on the company’s products and/or services, and communication of the company’s (or in the case of a trade association/organization, represented companies’) primary objectives;

Balance of company size and location may also be considered during the review process.

Targeted mission participants are U.S. companies, trade associations/organizations providing healthcare equipment, technology and services that have an interest in learning more about the African market. Target subsectors holding high potential for U.S exporters include innovative medical devices, Health IT (including telemedicine), health education and training, wellness programs and products (i.e. health wearables), hospital management, and other population health and well-being companies are encouraged to apply.

Referrals from political organizations and any documents containing references to partisan political activities (including political contributions) will be removed from an applicant’s submission and not considered during the selection process.

TIMEFRAME FOR RECRUITMENT AND APPLICATION

Mission recruitment will be conducted in an open and public manner, including publication in the Federal Register, posting on the U.S. Commerce Department trade mission calendar (http://www.export.gov/trademissions/) and other Internet web sites, press releases to general and trade media, direct mail, broadcast fax, notices by industry trade associations and other multiplier groups, and publicity at industry meetings, symposia, conferences, and trade shows.

Recruitment for the mission will begin immediately and conclude no later than June 30, 2017. The U.S. Department of Commerce will review applications and make selection decisions on a single fixed selection basis beginning June 30, 2017 until a maximum of 15 participants is selected. Applications received after June 30, 2017, will be considered only if space and scheduling constraints permit.

CONTACTS

Michelle Ouellette, Senior International Trade Specialist

U.S. Department of Commerce

Boston, MA

Tel: 617-565-4302

E-mail: Michelle.Ouellette@trade.gov

Johannesburg, South Africa

Brian McCleary, Deputy Senior Commercial Officer

U.S. Commercial Service

Tel: +27-11-290-3227

E-mail: Brian.McCleary@trade.gov

Felicity Nagel, Commercial Specialist

U.S. Commercial Service

Tel: +27-11-290-3332

E-mail: Felicity.Nagel@trade.gov

Nairobi, Kenya

James Rigasso, Senior Commercial Officer

U.S. Commercial Service

Tel: +254-20-363-6424

Email: James.Rigasso@trade.gov

Janet Mwangi, Commercial Specialist

U.S. Commercial Service

Tel: +254-20-363-6725

E-mail: Janet.Mwangi@trade.gov


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