The biggest challenge in Nigeria’s healthcare system, which is also an opportunity inadequately tapped, is operational delivery, Chike Ihekweazu, director-general, National Centre for Disease Control (NCDC) has said.
He describes it as a frustrating challenge pervading both the public and private sectors of healthcare, speaking during a fire chat session of the unveiling of a documentary on Nigeria‘s journey through the start of the pandemic outbreak and subsequent actions taken.
The crux of health service having to do with coordinating patient pathways between providers to ensure access to specialist resources and expertise is still missing, mainly due to a dearth of under-capacity.
Access to services when required, operating consistency, improved outcomes and increased productivity are still lacking at all levels of Nigeria’s healthcare delivery.
Despite manning the centre as a fairly fresh entity with less bureaucratic structure, Ihekweazu said getting the expertise to run and sustain some aspect of its operations posed a challenge as tasks were recycled among few experts hands available in the country.
As the Indian COVID-19 variant, B.1.617.2, spreads to 44 countries including Nigeria, for instance, the country is working with only three centres for genomic surveillance, implying a shortage of capacity to detect the circulation of new variants. Whereas, countries like the UK work with a COVID-19 genomic consortium fed by up to 73 facilities including universities, public health agencies and private bodies.
“The solution for healthcare delivery in Nigeria is dynamic to state. I don’t think one model will work for the entire country. It is easier to think you can be organised than to make what you have work,” he told BusinessDay on the sideline of the event.
“We have genomic surveillance in three centres in Nigeria. It is not something you can step up very quickly. You have to build capacity. We are working very hard on this. We have found three cases of the Indian variant already in Nigeria,” he said.
The documentary by Kadaria Ahmed, a media entrepreneur with support from the Ford Foundation, raised key questions about Nigeria’s preparedness for a public health crisis, how fast and effective curbing interventions were and leadership lessons learnt from the crisis.
Bothering on leadership and public trust in the middle of the pandemic, it mirrored the sufferings the pandemic inflicted on the poor, average and well-heeled Nigerians and captured the economic devastation that followed the decision to lockdown three states most exposed to the virus.
Babajide Sanwo-Olu, Lagos State governor, said retrospection had to be done on the intellectual profiling of Nigeria’s pandemic journey, taking important lessons of governance from it.
“Let us look at ourselves and ask what the lessons we can learn from these are. What are we doing differently? The structure of our governance system… cost of governance… change has to do with all of us,” he said
Akin Abayomi, Lagos commissioner for health, hinged the solution on revamping primary healthcare system, where 80 percent of health delivery takes place.
The challenge with primary healthcare persists in the public sector mainly because there is not a direct ownership and responsibility for the oversight, resourcing and regulation, he said, noting that some changes are beginning to occur.
“At the moment, we call it the orphan child because it does not seem to have a parent. It is just floating and does not have enough resources allocated to it because there are three tiers of government contributing to its sustainability. It is a bit of a confusing mismatch,” the commissioner said.
“But we hope now that there will be structure, harmonisation, and opportunities for the private sector to participate as well,” he said.
Speaking on parts that can be played by the private sector, Tosin Runsewe, chairman, Evercare Hospital Lekki, said the relationship between the public and private sectors must be a very collaborative one.
If access to healthcare must be created for 200 million Nigerians, he said mandatory health insurance must be established for all working, whether for small and medium enterprises or large corporations.
Runsewe equally stressed the need for adequate resourcing of human capital, possibly through expansion of training schools capacity to produce enough medical personnel to handle primary healthcare needs.
“We don’t have half enough medical personnel and the situation is getting worse because even those that remain are all looking for how to leave for the Western countries,” he said.
“We need to expand the capacity of our nursing schools and pay attention to the development and training. We have built a first-class hospital, which we will be very happy to make available to partner with universities,” he disclosed.