Wanted: A new architecture for Nigerian healthcare

Covid-19 presents an opportunity for Nigerian officialdom as well as the citizenry to take another look at our healthcare system and redesign its architecture. The faux pas of two key officials should point the way forward. Health Minister, Osagie Ehanire, did not know if personnel at the frontline of managing this pandemic earned extra allowances and then opined that they did not deserve more than the routine, an opinion contrary to global best practice.  Secretary to the Federal Government and Chairman PTFCovid19 Boss Mustapha was frank about his ignorance of the poor state of health infrastructure.

Ehanire’s position speaks to human resource in the health sector and how we manage it. Mustapha’s admission addresses the more holistic concern about the poor understanding of the issues by persons at the highest decision-making levels of our bureaucracy. The political leadership of our health institutions is not on the same page with the technical team. Such persons had their sights on medical tourism out of Nigeria and could not see what stood before them. Not anymore, thankfully.

There are several issues to tackle in Nigerian healthcare. They cover policies, infrastructure, human capital and its management, equipment and medications, health insurance as well as technology, and enabling environment.

Nigeria has a well-articulated national health policy. There have been three policy documents, in 1988, 2004 and 2016. There is also the National Health Act 2014. We are united with the world in the pursuit of universal health coverage.

The 2016 Policy Document painted an unflattering picture. It stated: “The analysis showed that the Nigerian health system is weak and, hence, underperforming across all building blocks. Health system governance is weak. There is an almost total absence of financial risk protection and the health system is largely unresponsive. There is inequity in access to services due to variations in socioeconomic status and geographic location. Other problems related to health services include: curative-bias of health services delivered at all levels; inefficiencies in the production of services; unaffordability of services provided by the private sector to the poor; limited availability of some services, including VCT, PMTCT and ART; low confidence of consumers in the services provided, especially in public health facilities; absence of a minimum package of health services; lack of proper coordination between the public and private sectors; and poor referral systems.”

The summary provides a good foundation. Costs and transparency are some of the biggest issues facing healthcare globally. They are even more so in Nigeria. Insurance is a driver of healthcare provision in most parts of the world. Why is ours not working optimally to deliver huge enrolment numbers in line with our population?

The consumer experience of healthcare in public hospitals as well as private ones is unpleasant and suboptimal. The delivery system is another challenging area for medical and non-medical services.

Contrary to the claims of one of our ministers, we do not have adequate human capital in healthcare. According to the Global Health Force Alliance, “Nigeria has one of the largest stocks of human resources for health (HRH) in Africa but, like the other 57 HRH crisis countries, has densities of nurses, midwives and doctors that are still too low to effectively deliver essential health services (1.95 per 1,000). In recent years migration to foreign countries has declined and the primary challenge for Nigeria is inadequate production and inequitable distribution of health workers. The health workforce is concentrated in urban tertiary health care services delivery in the southern part of the country, particularly in Lagos.”

The report attributes the inequity to lack of public and private sector coordination; favouring indigenous hires; commercial pressures in the private sector that lead to poor quality work; and work environments that contribute to low motivation, less-than-optimal productivity, high attrition -especially from rural areas; and lack of planning based on staffing projection needs resulting in an overproduction of some categories of health workers and a lack of others (Federal Republic of Nigeria HRH Strategic Plan 2008-2012).

There is no coordination and linkage among the three healthcare systems that Nigeria operates: orthodox, alternative and traditional. Then there is the matter of infrastructure. A clear policy, collaboration with the private sector and a deliberate push for results should yield world-class hospitals in Nigeria that would render efficient service and stop the medical tourism outward. We submit that now is the time to have a new architecture for healthcare in Nigeria.