With triple bottom line reporting now standard practice across the Southern Africa Development Community (SADC) region, health ministers and private and public sector stakeholders in SADC are campaigning for the addition of a “fourth bottom line” covering health metrics and wellness programmes and their impact on company performance.
Triple bottom line reporting is an accounting framework comprising three parts: social, environmental/ecological and financial. These three divisions are also called the three Ps: people, planet and profit, or the “three pillars of sustainability”.
Health insurer Discovery is urging SADC nations to consider legislating reporting on employee health initiatives as a standard part of companies’ statutory reporting. This employee health “fourth bottom line”, said Discovery, would be beneficial both for socioeconomic development and for businesses’ bottom lines. Having coined the phrase and launched it to SADC health ministers at a conference held at Victoria Falls, Zimbabwe, in January, Discovery has positioned itself as the champion of this initiative.
At a high-level frank dialogue session hosted in Rosebank last week by Discovery Health, the Mail & Guardian and the SADC High Level Task Force on Innovative Financing, delegates assessed the merits of a fourth bottom line and debated whether companies should be compelled to report on their support for the health of their employees and communities.
Legislating fourth bottom line reporting might prove premature, delegates said. However, greater efforts should be made to encourage organisations to play a more active role in employee wellness.
Brett Tromp, chief financial officer for Discovery Health, conceded that greater investment in and reporting on employee health could prove a “hard sell” at first. “If we can get the chief financial officers — who tend to be the most skeptical — to understand the bottom line benefits of employee health, we will see significant success,” he said.
Discovery Health said that illness due to communicable, non-communicable and lifestyle diseases costs employers and the economy vast amounts in terms of lost productivity. Discovery Vitality research into Discovery’s own staff found that the productivity of the healthiest staff members is significantly higher than the productivity levels of the least healthy staff members. The healthiest staff members were found to be 6.5% more productive than average and the least healthy staff members 8.9% below average in terms of performance. The research indicated that employers who actively promote staff wellness realise a 5% drop in absenteeism and it even indicated that non-smokers performed better than smokers in the company’s call centre, with a lower risk of errors. Healthier companies also perform better overall than their competitors, said Discovery Health.
Dr Jonathan Broomberg, chief executive of Discovery Health, said: “It has become completely accepted for companies to report on the triple bottom line, covering social, environmental and financial performance. We would like to see SADC countries leading the world by taking the next step to create the ‘fourth bottom line’ and including health in their reporting.” He said global companies were increasingly seeing that business has to be about more than profit alone: “It is becoming about shared value — adding value for all the stakeholders.”
Public-private partnerships (PPPs) have been identified as a key financing mechanism in the SADC’s regional indicative strategic development plan, and were again highlighted at the meeting of the SADC ministers of health and those responsible for dealing with HIV and Aids at Victoria Falls in January. Encouraging enterprises to invest in initiatives to diagnose and treat the region’s “big three” — HIV and Aids, tuberculosis (TB) and malaria — diseases could significantly improve outcomes in the SADC region, said SADC health stakeholders.
The SADC health ministers noted during the meeting that the big three remain the largest contributors to morbidity and mortality across the SADC. At this meeting, the ministers and the private sector agreed to establish a regional health trust to combat HIV and Aids, TB and malaria.
Describing the regional health trust and the proposed fourth bottom line reporting as historic initiatives, Professor Sheila Tlou, UNAids regional director in East and Southern Africa and convener of the SADC High Level Task Force on Innovative Financing, welcomed the interest shown in the concept by major enterprises operating in the SADC region. “There is a need for better co-ordination and more mobilisation of resources to sustain a fight against these and other diseases as a partnership between public and private sector,” she noted. “We see determination among the delegates here to work together to improve health in the region.”
Dr Brian Brink, chief medical officer of Anglo American and chair of the SADC Private Sector Constituency for Health, said 54 companies from the SADC region were represented at the frank dialogue in Rosebank, a sign that business was concerned about the burden of disease and its impact on business. “Disease not only impacts the workers, but also the supply chain and, critically, the market,” he pointed out. “If we want to improve business, we must address the health of society.
“Governments cannot solve these problems alone. The secret of success is to work together. In the SADC region, we want to invent a model for doing so ourselves, and show a business case of investing in health,” he said. “We can’t just go to the private sector and say ‘we are going to tax you to support things that might not work’. We must instead encourage private sector support of things that do work.
“The private sector will want to see outcomes and impact. We need to inspire the private sector to invest. Global Aids funds have shown us what is possible. If we can work together to get rid of the burden of disease, we will save the region a great deal of money.”
He said the economic impact of disease could be staggering, and that investment in strengthening health systems could turn the situation around: “Look at Ebola. Its spread can be attributed to a weak health system. Once investments were made in strengthening the health system, the spread of the disease was curbed. We have not yet quantified the economic impact of the current outbreak, but once we do, the impact will be frightening.”
Speakers in the debate noted that health initiatives had to involve the entire region to be truly effective. “It is important to remember that large numbers of migrant workers cross between countries. We need to create continuity of care across the SADC region,” said Brink.
Governments look to support
SADC chair of health ministers David Parirenyatwa also welcomed the interest shown by SADC private sector enterprises, saying that African governments were often forced to rely on dollars and global partners for support.
“But the global situation propels us now to look inside our own borders and ask ‘what can we do for ourselves?’. We hope these initiatives will be taken up internationally, and not just within the SADC,” he said.
He noted that if enterprises had up-to-date databases of employees with HIV and the treatment and support they were being given in the workplace, it would give governments a clearer understanding of the situation in their countries.
Dr Marcelino Lucas, permanent secretary representing the former SADC chair of health ministers, outlined the Mozambican government’s journey to develop effective public-private partnerships to address public health issues. Mozambique’s Malaria Performance Bond works to increase funding for malaria interventions through shared risk and returns with stakeholders and a performance-based payment system for nongovernmental organisations implementing the malaria programmes.
Lucas said: “This journey started four years ago. At that stage, we did not know how to deal with private sector partners.”
Discussions followed on potential partnership models. “We considered whether the private sector should simply be donors. But at some point we realised that would not be a true partnership. We needed to work together with the same agenda, so we designed tools and came up with ideas, and the malaria bond was born. We are continually exploring new ideas, and the private sector involvement is helping us to reshape our focus, from process to results,” he said.
Dr Olive Shisana, chief executive of the South African Human Sciences Research Council (HSRC) and former director general of the South African department of health, said partnerships between governments and the private sector need not be based only on funding.
“It’s not just about money. There is a lot the private sector can do for the people. For example, business has systems that work — businesses can share information on improving efficiencies or using analytics effectively in the public sector.”
Brink agreed, noting that South Africa has a wealth of health professionals, but that they were not all working as efficiently as they might, due to a lack of information systems and advanced ICTs. “Compare the health system with the banking system. If our banks reverted to carrying out every transaction manually, on paper, it would slow systems down considerably. So the health system needs automation and information systems to become more efficient. We should not have doctors having to carry out mundane tasks that could be carried out by less qualified staff,” he said.
Sunil Geness, corporate affairs executive at SAP Africa, said accurate reporting was critical in understanding the scope of disease and tracking how interventions worked. “Information management and accurate reporting is incredibly important on issues such as diversity and employee health,” he said. As chair of the Information Technology Association of South Africa, Geness invited the SADC health stakeholders to engage with the ICT community to discuss partnerships to improve employee and community health in the region.
Transparency and privacy
On the question of patients’ right to privacy, speakers in the debate noted that there was no question of individuals’ right to privacy being breached. Broomberg said: “Reporting would never be about individual status — it’s about aggregated statistics at divisional or company level.”
Brink added that dealing with the treatment of individuals with HIV had taught the region valuable lessons concerning confidentiality and discrimination.
“We were tested on this with HIV. We have learnt to ensure that there is no discrimination, no stigma and complete confidentiality. With this human rights foundation in place, we have been able to make treatment available to those who need it, without them having to fear discrimination.”
Tlou noted that in funding health initiatives there could be trust issues. “It is important that we ensure transparency and an accountability framework,” she said.
To legislate or not to legislate?
Broomberg said: “The world is starting to understand the burden of chronic disease, but like any new idea, the concept of a fourth bottom line needs to gain critical mass. It needs to be driven from both sides — political leadership to take the idea forward and individual businesses to embrace the concept.”
Urging businesses across all verticals to step up employee and community health programmes and embrace the fourth bottom line concept, Brink said: “We need to start by identifying low-hanging fruit and demonstrating results.” He said effective management of some diseases required relatively simple interventions to deliver significant results. These successes will inspire greater investment, he said.
“If we want to improve business, we have to address the health of society. The secret of success will be for governments and the private sector to work together.”
SADC business challenged to support 2016 Aids conference
Sunil Geness, corporate affairs executive at SAP Africa, has challenged multinationals and businesses across the SADC region to become accountable for health in the region, and to come out in support of Dr Olive Shisana as she heads up the 21st International Aids Conference in Durban next year. It is expected to attract up to 20 000 health stakeholders, policymakers, academics and journalists. SAP and Discovery Health have each committed $150 000 towards the conference which will run from July 17 to 22 2016.
Curbing the cost of absenteeism
Discovery Health and Vitality research indicates that absenteeism due to illness costs the South African economy up to R16-billion a year, and that the more employees participate in wellness programmes, the lower their number of sick days. Chief financial officer Brett Tromp said Discovery Health engaged with SADC health ministers and promotes the fourth bottom line reporting concept as part of its drive to encourage companies to take more responsibility for employee health.
“The concept is revolutionary, and is generating a great deal of excitement, both within South Africa and abroad,” he said. “We are confident this is the right thing to do for our country and the economy as a whole.”
Key attendees made a difference
High level attendees of the Frank Dialogue included Zimbabwe’s Health and Childcare Minister David Parirenyatwa; Kenya’s Health Minister James Macharia; Gambia’s Health and Social Welfare Minister Omar Sey; Protik Basu and Alan Court, both from the United Nations Special Envoy’s office; Joy Phumaphi, executive secretary of the African President’s Malaria Initiative and former minister of health of Botswana; and Dr Brian Brink, the chair of the SADC Private Sector Constituency for Health.
Resolutions on health funding
Participants at the first formal dialogue between SADC health ministers and the private sector in Zimbabwe in January agreed on a public–private health financing partnership that includes:
– The establishment of a regional health trust fund before the World Health Assembly in May 2015;
– The creation of a public–private working group to meet twice a year on the sidelines of the SADC ministers of health meetings;
– The development of an online information exchange portal to enhance collaboration; and
– The strengthening of employee health programmes in the private sector and the introduction of fourth bottom line reporting.