Dr Allan Pamba, Director Public Engagement & Access Initiatives at GSK.

Guardian article: Making a change from the inside

Allan Pamba recalls his experiences as a doctor in Kenya and why he decided to work for ‘the enemy' - a pharmaceutical company.

Ten years ago, my working days were spent pacing the wards of various Kenyan hospitals, stethoscope around my neck. Never could I have imagined that a decade later I would be working for a healthcare company – which I then viewed as the enemy.

  • 90%

    of deaths from malaria occur in sub-Saharan Africa

Now my day begins at 6.30am, driving to work through the heavy Nairobi traffic. The streets are already crowded with people making the long walk to the industrial area where our offices are based, hoping that there will be a job at the end of their journey. They are the lucky ones as many aren’t healthy enough to do that walk. It reminds me of why I do what I do and why I made the move I did.

I was born in Kenya, one of nine children, and grew up in a village with my grandparents. The 1970s was a time of malaria, malnutrition and pneumonia – thought to be caused by evil spirits, treated by traditional medicine. Many children never made it to their fifth birthday. At the age of six I went to Nairobi where my parents lived, all of us in one small house. I never once doubted what I wanted to be: a physician – to make a difference, starting with my family.

Having trained as a doctor at the peak of the HIV epidemic in the early 2000s, I set up a HIV clinic in the coastal town of Kilifi. All the patients died quickly – when I met them I knew I’d be signing off their death certificates within three or four years. I also lost two of my brothers at the time. I thought that I should have been able to make a difference to these young peoples’ lives, but the medicines were just too expensive – it wasn’t even a consideration. It was hard to accept.

Increasing access to healthcare goes beyond medicines

My experience of contracting malaria was also a formative one. When I was growing up, malaria was something that everybody had – and you might get it once a year. It is a horrible disease: you feel as sick as a dog for four to five days with a profoundly painful headache, weakness and high temperature. I was lucky to survive. Children with severe malaria can have convulsions and go into a coma, and as a doctor, I saw too many youngsters die. One time in London I was suspected of contracting malaria and was rushed to hospital. The world stopped around me while tests were ran and professors came to observe. It turned out to be flu, but it made me realise how seriously malaria is viewed in developed countries.

For most families in Africa, if the main breadwinner contracts malaria they can soon be reduced to poverty. The economist Jeffrey Sachs estimates that malaria costs Africa $12bn a year – roughly equivalent to all the foreign aid coming into the region. And while mortality rates for malaria have improved, there are still more than 500,000 deaths a year, the vast majority of them children under five.

All of this informed my decision to turn to GSK – the most prominent healthcare business in Kenya. I believed that rather than fighting companies whose medicines we could not afford, I would try to change things from the inside. It was difficult to leave my patients, but I saw what a company such as GSK could do for healthcare in my part of the world.

  • 70%

    of deaths are children under five

Five years ago, while working in research and development at the London office of GlaxoSmithKline (GSK), I talked to the company about my own experience with malaria. I then went back to Kenya to make a documentary about what GSK was doing to treat malaria – including researching a potential vaccine – and what more it could be doing.

We subsequently created a new business model for developing countries that could help improve access to medicines and support healthcare’s long-term growth. This flipped the usual model around, so we are now looking at high volumes with low margins. Sales targets in Tanzania, for instance, are focused on volumes of medicines and vaccines, not price.

Increasing access to healthcare goes beyond medicines. So we also made a commitment to reinvest 20% of the profits made in the least-developed countries back into the health infrastructure. Experts in government departments, NGOs and other organisations advised us that the biggest return on this investment would be in training frontline health workers. This is happening now in conjunction with AMREF Health AfricaCare International and Save the Children.

We are developing our business model in Africa, so it has a strong domestic manufacturing and research and development base. As our business in Africa grows, so our conversations increase with governments. They see us very much as a partner driving sustainable healthcare, as well as a business contributing to the overall development of the countries involved. Inevitably, much of my time is spent travelling – be it hosting a sales conference in Tanzania for my east Africa team or meeting health officials in Ethiopia.

This is easier now I am once again based in Nairobi, having moved back at Christmas. The situation has changed a lot since I left. Nairobi is now much more affluent and has a growing middle class. Still, a lot remains to be done to help people live healthier lives, especially with the emerging threat from diseases such as cancer and diabetes. But at least now business plays a part in this – a good example is the new pricing models opening up access to HIV medicines – and that role is appreciated by more and more colleagues across Africa.

  • 25,000

    on-the-ground health workers supported by GSK

As for the HIV clinic where I used to work? It has now had thousands more patients through its doors. That makes me incredibly proud.

Allan Pamba is vice president for East Africa, GSK, and was interviewed for this article

This feature first appeared on The Guardian as part of a series exploring global health challenges.