Banks are denying indigenous practitioners access to CBN funding to end medical tourism – Elochukwu
In response to the COVID-19 pandemic, the Central Bank of Nigeria created a N100 billion intervention fund to enable healthcare operators modernise their operational infrastructure. So far, about N10.5 billion has been disbursed to applicants. Elochukwu Adibo, whose El-Lab Limited is an ISO-certified medical laboratory that engages in collaborative research with international health organisations, shares with Modestus Anaesoronye frustrations of practitioners in accessing the fund.
Give us background of EL-LAB Limited
EL-LAB is among the first three indigenous medical laboratories in Nigeria to attain international accreditation known as ISO 15189, which is a standard to measure competence and the quality of work done in a medical laboratory, all over the world. We hit the mark in 2016 and right now we are getting the accreditation renewed. We have gone through the processes and in a couple of weeks we will receive the renewed accreditation.
Are you saying that the results of laboratory investigations done in your facility can be taken to any hospital anywhere in the world?
That is absolutely 100 per cent correct, and that’s actually what we have been seeing and testimonies abound from foreign medical facilities. I have had calls and emails from doctors in the US, Europe, Egypt, Dubai (UAE), South Africa and India who are impressed with the quality of our work and the laboratory reports we have given to Nigerian patients who went on medical tourism to those countries.
However, it is not an exciting testimony that doctors have to call from these countries to commend our work. I would rather love a situation where our people stay back in Nigeria to access quality healthcare of international standard. We want to have our results given to clinics in Nigeria, to do the needful.
That brings me to the fact we can see what has happened in our country with respect to the pandemic. A lot of deficiencies in our health system have been exposed. The Needs Assessment Study we conducted as a corporate body showed that over 40-60 per cent of the high-end laboratory investigations required in diagnosing certain medical conditions are still outsourced to facilities in Europe and India and the results are then returned to Nigeria. What happens is that clinicians refer patients to the laboratories collaborating with them in this regard; samples are taken and sent overseas through the foreign courier companies operating in the country.
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Of course the patients won’t know that their samples are being sent overseas for analysis. You will be shocked at the volume of shipments of this nature done by the big three foreign courier companies operating in the country. What is happening is contributing to the high cost of the tests, capital flight and sustenance of foreign medical laboratories to the detriment of our indigenous facilities. Added to this is the loss of opportunity to enhance and grow the skills of our own practitioners as well as loss of associated job opportunities. Most indigenous laboratories lose out because they lack the capacity to conduct the tests. For instance, our accreditation is restricted to a particular scope, and we still have limitations in the sort of investigations we are allowed to do. Currently, we are not able to do molecular genetic forensic investigations. It is a very painful thing, when you have the knowledge, skill and experience to do such investigations, but you lack the right equipment. You see, in Britain where I practiced before returning to Nigeria, I was exposed to such investigations.
In response to COVID-19, the Central Bank of Nigeria created a fund for private sector health facilities to acquire modern equipment. As an ISO-certified laboratory, has your facility made any effort to access the fund?
On March 25, 2020, the Central Bank of Nigeria announced the creation of a special N100 billion intervention fund to help private sector healthcare organisations such as hospitals, medical laboratories, and pharmaceutical manufacturing firms acquire modern equipment that would enable them boost drug production and also provide higher quality service and be able to offer more intricate clinical interventions, and by so doing substantially deepen the knowledge base of our practitioners in such areas that compel our people to engage in medical tourism. We were excited and happy to hear the announcement, but then the story changed as the typical Nigerian Factor got into the process. First, the word ‘intervention’ means getting in to close a gap. I mentioned earlier that we did a need assessment to identify critical infrastructure required by medical laboratories to conduct specialised investigations for clinicians in Nigeria with the hope of ending the practice of sending samples overseas for analysis and thereby save foreign exchange for the country. Today in the world, most investigations are going molecular with respect to public health issues, diseases and infections such as COVID-19, Lassa fever, tuberculosis, HIV, serological investigations, among others. We felt the CBN move would help end what we consider an intellectual slap and blight on our practitioners when such needed investigations are exported and the results returned to the country as if we lack the intellectual capacity to conduct them here in Nigeria. What we lack is necessary equipment to do these things. The high-end laboratories set up in Nigeria by foreigners do not do investigations in the country. Essentially, what they do is to consolidate batches of samples collected from patients referred to them by clinicians and send to their laboratories abroad for analysis, and then the results are returned to Nigeria. Nigerian medical laboratory scientists are not involved in the investigations and hence their knowledge-base is not deepened or broadened in the process because the experience that comes from hands-on involvement in the investigative analysis of the sample is denied to them.
The government and the CBN must reasonably and urgently walk the talk in respect of the intervention fund for the health sector. Polymerase chain reaction (PCR) is a molecular diagnostic test. When the COVID-19 pandemic started, the country had only three laboratories with capacity to conduct PCR analysis of samples. Today, we have 64 laboratories in about 33 states. In addition to the government-funded laboratories, some private sector facilities now have capacity for molecular test analysis. Notwithstanding this positive development, the number of molecular laboratories is still very low. As a country of 200 million people we still have insufficient laboratory capacity to meet the glaring need.
One week after the CBN announced the fund, we applied for a loan to finance our expansion project. We wanted to set up a high-end molecular diagnostic laboratory that would meet present and future needs like deep human genomics investigation and HLA typing tests which are absolutely necessary for organ transplant interventions, to see whether there is a match between the donor and the recipient. Currently, HLA typing test is not being done in the country.
The CBN initiative was a perfect answer to our desire. I approached four different banks – Zenith, UBA, Access and Sterling. The first three turned down our proposal but we are still in discussion with Sterling Bank. The banks are simply not interested in giving out loans under the CBN scheme because the interest rate is too low and the moratorium is not attractive. Instead, they rather want to lend their own funds at high interest. They also insist on huge equity participation. For instance, if you need about N100 million, you are expected to provide about N25 million or more as equity in addition to collateral that covers the balance of N75 million. The banks said they could not carry the risk involved 100 per cent as stipulated in the CBN guidelines.
They also said the projected turnover should be in the billions. If we could generate that kind of turnover, why do we need the loan in the first place?
It is quite obvious that credit analysts of the banks do not understand the dynamics of healthcare practice. They would not visit your facility to see how you operate; instead they just sit in the comfort of their air-conditioned offices and tell you that your proposal would not fly. Such armchair banking cannot grow the health sector.
The health system is deteriorating, we are not closing the gap, we are not meeting the glaring needs and Nigerians are dying. It is wholly painful, agonising and traumatising to think about. Five months after the intervention fund was established, can the CBN publish the names of the healthcare facilities that have received loans under the scheme? We know ourselves, we know who deserves what and has capacity to utilise the funds judiciously. If the CBN gives money to EL-LAB, the whole world deserves to know what we are doing with it and how we are moving forward to expand capacity. There is absolutely no need for secrecy. The CBN should tell us what has happened after almost five months since it announced the intervention fund. Nigerians deserve to know the whole truth.
I have asked most of my colleagues, to know if any of them has accessed the CBN intervention fund, and the replies I got are in the negative. So who has the CBN given the money it said it provided? As I said, we want to expand our capacity and set up a top-notch specialised Level-3 biosafety lab that will be able to do molecular testing for Lassa fever, COVID-19, other diseases and infections that are of major public health concern.
Since the banks are insisting on huge equity base, have practitioners considered joining forces to establish mega-labs rather than the go-it-alone way?
That is really a splendid idea. We would be happy to partner with Nigerian healthcare practitioners at home and outside the country to modernise and grow the health sector. The fact is that most clinical and diagnostic facilities are the result of collaborations, whereby people outside the country invest in their colleagues practicing here, especially people they have affinity with and who have integrity. Under such cooperative arrangement, the people here will do virtually nothing else other than to ensure that the projects succeed, generate reasonable return on investment, create jobs and deliver quality service to the people. It is a real possibility that would make the standard of practice to rocket up and put Nigeria among the comity of nations that have modern health facilities.