The novel coronavirus pandemic has stretched the limits of Nigeria’s weak healthcare system, presenting an opportunity to adopt a public-private partnership model that attracts investments and strengthens efficiency.
Nigeria’s political elite and high net worth individuals, aware of the dilapidated nature of the countries healthcare system prefer travelling abroad for medical treatment. Africa’s most populous country loses an estimated $1 billion yearly to medical tourism.
Nigeria has some of the worst health indicators in the world thanks to many years of utter neglect by the ruling class. The country’s health system is bedevilled with a lot of challenges due to low budgetary allocation, poor infrastructure and low remuneration for medical staff. Public-private partnerships are helping the address similar problems in India.
Per thousand, Nigeria has less one hospital bed space per thousand Nigerians, that is 0.9, same as India but the United Arab Emirates has 1.4, the United States of America 2.8, the United Kingdom 2.5 and Australia 3.8. Hospital beds are used to indicate the availability of inpatient services in public, private, general, and specialised hospitals and rehabilitation centres
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In terms of the ratio of physicians to patients per thousand, Nigeria has again less one doctor per thousand Nigerians, that is, 0.4; India has 0.6, the United Arab Emirates 2.4, US 2.6, the UK 2.8 and Australia 3.8.
For intensive care units (ICU) per thousand, a facility that is a critical component in the fight against COVID-19 Nigeria has 0.0007 per thousand Nigerians, India 0.07, UAE 0.1, US 0.3, the UK 0.08, Australia 0.09.
“Many of our facilities can’t boast of modern-day equipment like ventilators that can take care of an average of 50 patients. The best centre in Nigeria is at best in level two, and they are privately owned with our teaching hospital likened to the mortuary, yet we are named as spending the most on healthcare treatment abroad,” Olusegun Ogunnibi, a consultant psychiatrist, public health physician and lecturer told BusinessDay in an earlier report.
Although some of Nigeria’s healthcare indicators are similar to India’s, the latter is leveraging on private-public partnerships to reverse this tide and Nigeria has lessons to learn from the 1.4 billion people strong, South Asian country.
For example in Uttarakhand, a state in northern India, the government of the state procured 13 mobile health vans (MHV) fitted with different types of equipment and handed them over to a private company to operate and maintain through a public-private partnership for five years. The aim of this is to resolve the difficulties Uttarakhand residents encounter in accessing timely medical services.
At a webinar organised by the Infrastructure Concession Regulatory Commission (ICRC) and CRISIL Infrastructure Advisory, Olorunimbe Mamora, Nigeria’s minister of state for health acknowledged that the Federal Government is looking at various models of PPP because government alone cannot fund the best healthcare facilities for Nigerians. This, according to Mamora is because the government has several competing concerns and needs private sector interventions through viable PPPs.
Public-private partnerships are designed to meet local needs and no size fits all situations. The location, infrastructure, financial capacity of government to provide loans or grants and size of the population are factors that are taken into account in designing a PPP model.
“The key components of an effective PPP model are patients, pricing, payment and performance monitoring,” Mohit Ganeriwala, director, Infra and Public Finance Practice at CRISIL said.
Nigeria’s human capital sector, that is, health and education has suffered significant market failures. Both sectors have known poor quality and access and some experts say Nigeria’s economy managers need to rethink how these sectors are managed to incentivise private investment inflows.
“For education, the government needs to remove subsidies. It costs about $600 to train a medical doctor in Nigeria’s public universities but over $40, 000 per year in the USA. Then those trained in Nigeria emigrate to developed countries,” said Bongo Adi, senior lecturer at the Centre for Infrastructure, Policy, Regulation and Advancement, Lagos Business School. “Nigeria is subsiding medical education for other countries.”
Adi argued that Nigeria needs instead to use its budgetary allocation to education to design a system of incentives and build PPPs in the education sector. Just as similar effort is being made for health.
