Saturday, 23 February 2008

Improving surgical skills in Africa

I spent a delightful day recently in discussions with three individuals who are passionate about improving healthcare in Africa. The irony though, is that none of these individuals are African.

First person was my boss. Ok, so I have recently received my annual bonus but that only makes me ambivalent about praising him. The fact is, he has spent most of his professional life pursuing interests aimed at improving healthcare in Africa. These include sponsoring several training programs, funding training centres and institutes, channelling J&J corporate contributions to areas of need in Africa and supporting the surgical colleges of East and West Africa.

Second individual we were meeting is Professor Chris Lavy, an orthopaedic surgeon at University of Oxford. I have not met many people who have the energy and passion for doing things in Africa with an African perspective and he is certainly one. He set up an Orthopaedic hospital in Malawi many years back and is focused on helping children walk. He was also one of the founders of the COSECSA - College of Surgeons of East, Central and Southern Africa and has been a key supporter of their activities. We spoke about how to increase the number of surgeons produced in and practicing within the region. It is interesting to learn how much commitment there is among the African surgeons in the region to expanding access to surgical care in the region. Prof Lavy mentioned that he has passed on management of his hospital to another generation of managers to enable it grow and thrive in his absence... That is amazing leadership!

And finally, the three of us were gathered to attend a meeting with Baroness Lynda Chalker. I first heard Baroness Chalker's name during a visit she made to Nigeria while she was in government and my overwhelming memory of her (likely formed by media coverage) was of an extraordinarily powerful and tough lady! I have subsequently heard her speak at a Botswana investment conference and I was really impressed by her knowledge of and interest in Africa. None of these compare to the admiration I developed from meeting her and hearing from close quarters about her lifetime of service, and her devotion to the African continent. She had a lot of ideas on how COSECSA can achieve its goals and it was a good meeting. And during dinner, I found that she has a good sense of humour as well!

I came away from the meetings with all three people with a sense that Africa has many friends but that if the same passion that is present in those friends can infect a greater fraction of African leaders, there will be far more change than any amount of aid can produce.

Monday, 18 February 2008

Between Ghana and Nigeria - caliberation using African countries

I have just returned to London following two weeks visiting Nigeria, Ghana and Sierra Leone. During my visit to Freetown, my host described the country as being somewhere between Ghana and Nigeria. I found this description quite interesting and have given it some thought since I first heard it.

First, I loved Freetown. Beyond the anxiety of riding on a helicopter from the airport to the city, it felt a lot like home. I found it interesting that a lot of people had Nigerian names and the Creole sounded a lot like Nigerian pidgin English (not the Warri type though!). Their mountainous landscape made for spectacular views and their unspoiled beaches were amazing. Driving up the hills was quite nervous given the ever-present threat of falling off a cliff, but otherwise, it was fun.

The reason though that I found the description (between Ghana and Nigeria) interesting is that in this statement, I heard all that was good and bad about Nigeria. For a country just emerging from a bruising civil war, I felt remarkably safe. Power supply was erratic and a lot of people were clearly unemployed and poor. Yet, the people were warm and friendly. I would certainly go back again.

I was in Freetown attending a conference of the West African College of Surgeons. The conference itself was very successful - credit to the organising committee and I got to meet the Sierra Leonean president (if his walking past me with a smile admiring my exhibition stand qualifies as meeting him). This gathering of the cream of West Africa's health care professionals highlighted Africa's healthcare manpower challenges. IFC's recently published report (see http://www.ifc.org/ifcext/healthinafrica.nsf/Content/FullReport) show that a lot of private sector participation is required to improve healthcare in the continent. I look forward to being part of that improvement.

Between Nigeria and Ghana. I wish Nigeria was a lot more like Ghana! The spirit of the Ghanaian team at the Cup of Nations was commendable even if the talent to deliver was not available. The food, the warm people, the exciting nightlife, the... Great country Ghana!

Re: Time to Dis-Virgin Nigeria

I have followed the Virgin Nigeria/MMA2 issue with interest and experience a mixture of amusement, surprise and disappointment both at the dispute and the coverage it has received in the media. In a piece by a Mr Bello-Barkindo in Thisday Newspaper, I am really quite shocked.

To state my position on the issue, I feel that in a dispute as this one where there is a legal basis (MOU signed by the Nigerian government) for Virgin Nigeria to hold on to its position, the government should be looking for a strategic solution rather than trying to coerce the airline into compliance. Quite simply, the Nigerian government has more to lose than the airline. In particular, the government's credibility as a respecter of agreements entered into is at stake and this extends beyond the immediate conflict. In that situation, I would try to negotiate a solution with the airline, which would probably include a pay-off and some other concessions. To deny that a move away from the MMA will affect the airport hub model is amusing because the complexity of integrating operations across the physically separate premises for passengers, the airlines and ground handling is probably exponentially more than from operating in one site. Hence, Virgin Nigeria is being asked to make a move that will potentially affect their commercial performance and quite rightly is resisting the move. The best approach in my view for the Nigerian government is to do the business impact analysis that Virgin Nigeria presumably is performing and figure out ways to make the relocation attractive to the airline.

I also own up to being a fan of economics and game theory and make assumptions that individuals (or organisations) tend to make rational choices that are in their own self or commercial interest.

In a world where cynicism about the role of the media (is it true reporting or news placement by spin doctors?) I find reporting on this issue really more emotional than factual. I haven’t read anyone present an interview with an independent aviation operations expert; financial expert and/or a credible airline industry person. By credible and independent, I assume firstly that they know what they’re speaking about. Rather, I am reading Mr Bello-Barkindo’s piece, which is a mix of excited activism; poor analysis and unsupported allegations.

I am not an expert on airport safety so cannot comment on the safety or suitability of the MM2. I have flown through there as a passenger and found it sufficiently attractive and certainly a whole lot better than the old airport (and perhaps in some respects even better than the MMA). Unless any contrary evidence is supplied, I have to assume that Virgin Nigeria would only refuse to move if it has a genuine reason to. And it is difficult to dismiss their concerns about safety for two reasons: regardless of ownership structure, the airline bears the Virgin name and so the brand owners will be extremely reluctant to jeoperdise their reputation (Nigeria’s air safety reputation over the last few years is less than inspiring). Second, the investment by Virgin in the airline – both for local and international flights is at risk if any safety issues arose from either side. As a rational investor, I would take every legitimate step to protect the airline’s safety record first before any other consideration.

The problem for the Nigerian government is that the claim about airport security is not credible. Unless it can point to security lapses caused by Virgin’s presence or even a more general security threat at the airport, how does it explain its original willingness to allow the airline operate from MMA? National security is a vague term but surely suggests that the government perceives some type of threat. Other countries deal with this threat by tightening security at the airport not kicking out airlines! My suspicion is that a claim of expanding capacity by relocating local flights would have more traction.

Taking some of the issues Mr Bello-Barkindo raised in turn:

Why would an airline want to “…bury… the beauty of MM2…”? What evidence does he have of this? And what rational reason can he supply?

He says Virgin Nigeria was given a “superfluous concession”. What does this mean? Was the right to operate flights from MMA a “concession”? If this was considered a concession, why weren’t clauses inserted in the agreement that gave the government opt outs?

In a business transaction, I am shocked that a journalist would describe the Nigerian representatives as “magnanimous”. If this is correct, then all those involved were either incompetent or worse: saboteurs. Their job was to secure the best possible deal for the country and so their brief did not allow for magnanimity.

I sense that Mr Bello-Barkindo is suggesting that by moving Virgin Nigeria to MM2, the Nigerian government is withdrawing an unfair advantage the airline currently enjoys over other local airline operators. I am inclined to agree with this because international passengers (less price sensitive and paying foreign currency) are less likely to leave MMA to catch flights on the other airlines. I think this is a legitimate concern but again, this should have been considered at the point of initial negotiation. In any case, Virgin Nigeria’s profits are shared with the Nigerian government (and other Nigerian shareholders) so it perhaps has an incentive to promote this advantage.

I think the most absurd part of Mr Bello-Barkindo’s write up is his claim that “…it feels entitled to a special treatment as an old colonial master. It also does not wish Nigeria well…” He also accuses Mr Branson of interference. For me, this is the kind of ‘cop – out’ that unenlightened individuals latch onto whenever they wish to explain away their own short comings. I expect that a journalist would rise above this and stick to facts. A problem of this claim is that given the influence the media have on public perception, it propagates the kind of unnecessary animosity that hurts Nigeria’s efforts at being an investment destination.

It is unfortunate that Mr Bello-Barkindo made racist allegations against Virgin Nigeria and I hope that he is able to support this with evidence. He says the airline applied stringent rules – presumably designed to exclude Nigerian pilots. Are those rules different from the ones applied by Virgin in other countries? I am amazed that on the issue of safety, a journalist will be so flippant. Given the incidents of the last 3 years and the low level of trust in Nigerian air travel, I suspect that most people would avoid flying in aircraft where pilots hold inferior qualifications to others. It does injustice to the families of those who have perished in Nigerian air disasters to say pilots should be allowed to fly aircraft when they have not been properly trained (just because the Nigerian aviation industry is comatose!). Hope Mr Bello-Barkindo won’t mind his tailor perform heart surgery on him given that open-heart surgery is not currently performed in Nigeria.

There are several other unsubstantiated claims made in the write up which could be criticised but I feel the point is clear – people like Mr Bello-Barkindo do not help in resolving this matter. Instead, they fail in their roles as journalist and whip up sentiments that in addition to complicating the immediate issues create problems that last long after Virgin Nigeria and the Nigerian government kiss and make up.