The healthcare sector in Nigeria is in need of urgent development. Only when this change is led by the most influential players can the results be tangible. Titans of the industry and stakeholders from other sectors of the economy came together in Lagos recently to deliberate on solutions based on the public-private partnership model. The policy dialogue tagged ‘Disrupting Healthcare: PPPs As A Model For Health System Strengthening In Nigeria’ was organized by Nigeria Health Watch and PharmAccess group, two bodies improving access to healthcare in Nigeria using advocacy and technical assistance respectively.
Through partnerships, international organizations have rehabilitated health centres that had hitherto been operating below par. Most of this effort is targeted at the primary care level which is the first contact for eighty per cent of the population.
Nevertheless, health transformation is a struggle that must be undertaken across different levels. Much emphasis was placed on the new idea that for it to be sustainable, healthcare must be run as a business and not a social service.
Simple yet effective solutions like clean water and sanitation will yield the remarkable results in a country where forty-six million citizens stool in public. Currently, there is the binary option of care with the rich accessing the best available care and the rest of the country scrambling for what is left. The level of care in some primary healthcare centres is tragic. Quality is, therefore, a key element of viable healthcare PPPs.
There were two panel discussions with members from government and private institutions. The first emphasized the need for a stronger influence by doctors and other health stakeholders to push for reform at the federal level. The masses are more likely to protest against fuel price hikes but this energy is not reserved for another vital aspect of life- the dismal healthcare obtainable in many parts of the country.
It was also noted that the nation is in dire need of more health economists, health finance experts to formulate policy in the various health ministries. The current situation where every decision is made by only doctors whose training sadly often doesn’t include these fields will not help us achieve our goals.
Panel Session 1Session 1: Mr Voke Oshevire, Executive Director, Dr Ola Orekunrin-Brown, CEO, Flying Doctors Nigeria. Dr Jide Idris, Commissioner for Health, Lagos State. Mr Anthony Abou Nader, CEO, Tanit Medical Engineering. Dr Olaokun Soyinka, Director, Independent Verification Agent for Saving One Million Lives Nigeria. JNC International Ltd. Mr Abiodun Amokomowo CEO, Ibile Holdings Limited. Mr Felix Ezeh, Investment Executive, GroFin.
According to a recent TechCabal report on health tech sector, there are over eighty health tech companies in Nigeria providing solutions to a myriad of problems. Unfortunately, many entrepreneurs often lack access to financing and incentives to scale their companies. Creating an option for medical or premise licenses to be used as collateral was put forward.
Contrary to popular belief, finance is not limited to cash but includes personnel, material, endowments, real estate. It is imperative we are open to options and not be myopic. Patience is required of all involved for the process often isn’t an overnight one. Available resources must be maximized as wastage poses a huge threat to the proper utilization of allocated funds.
The true measure of a community’s health is the quality of its maternal care. –Dr Ifeanyi Nsofor
Government initiatives put in place through the Basic Health care Fund include those that simplify the payment process for people in need of care. The banking sector is contributing to healthcare by improving access to funds, educating providers on the cost benefits of establishing optimal services and facilitating partnerships. They also help health facilities bring their accounting systems to standard, provide flexible payment models and ensure controls are put in place to tackle the lack of trust.
In between the discussions were documentaries highlighting different missions to underserved areas showing the drastic impact personnel and cash financing bring to underserved communities, many of which are remote. Through initiatives like hospital camps, free emergency surgeries, education and health insurance; the quality of life in these communities was vastly improved with the joint efforts of PharmAccess and Toronto Hospital, local and state governments.
Panel Session 2
Session 2: Dr Tayo Lawal, Permanent Secretary, Lagos Primary Healthcare Board. Mrs Clare Omatseye, President, Healthcare Federation of Nigeria and Founder, JNCI. Dr Ben Nkechika, DG Delta State Contributory Health Commission. Dr Jide Idris, Commissioner for Health, Lagos. Prof Chris Bode, Chief Medical Director, Lagos University Teaching Hospital. Dr Oyebanji Filani, Senior Technical Assistant, Hon Minister for Health. Engr Chidi Izuwah DG/CEO, Infrastructure Concession Regulatory Commission.
Distrust of digital health records is rife in many centres necessitating gradual implementation and compromise. Pregnancy should not be an emergency as there is ample time to plan for childbirth. The absurdity of the current risk associated must be communicated with all members of the community. Mobile health clinics can be used in some areas to provide care and this circumvents the huge cost of facilities. These are a few examples of the unconventional options being applied in interventions across the country. In addition, adapting from a wide variety of working health systems worldwide to our local context will help us move closer to the desired level of development.
Nigerians spend millions of dollars on healthcare abroad. This amount is comparable to the health budget. This is a symptom of a deeper problem! Efforts need to be amped to ensure the working conditions here are brought to standard if we are serious about stemming the current tide of brain drain and haemorrhaging of funds to countries with better health systems. While some level of specialized care is available, most Nigerians do not know about it or trust it.
Documentary
The onus is on us to build and maintain world class institutions to keep our health professionals, patients and money at home. To achieve this, the expertise and management of the private sector should be combined with the infrastructure and political will of the public sector. The distrust that currently exists between them can be mitigated by putting quality control in place. Within the private sector itself, collaboration rather than competition should be the watchword. This will help the health sector to be unified force and voice at the policy-making table for lasting progress.
The future is so bright, you are going to need sunglasses.
–Mrs Clare Omatseye
On the bone of contetion that is health insurance in Nigeria, theappalling extent of coverage ofe constitues a barrier to providing universal health care. This has left the crowdfunding method of health financing as the only hope of many in need of expensive care. The estimates hover around one to five percent. Only twenty-eight states have a legal framework for health insurance with some like Lagos and Osun implementing state level schemes.
Through public-private partnership, government centres have been outsourced to the private sector with improved efficiency of service delivery, a marked reduction in mortality, increased profits and sustainability. Adequate communication at all levels with all stakeholders is however crucial to the success of these models as there exists cynicism towards it. Infrastructural gaps have been filled.
It is reassuring to see many stakeholders working and committing to improving the Nigerian health sector. Hopefully, these forged partnerships yield measurable results soon. To achieve the phenomenal change needed, we must be ready to disrupt!
Dr Mariam Toye
Oumissa Inspire 