Despite operating a healthcare sector largely bedevilled by poor financing, low resource pooling for insurance coverage, poverty and loss of human capital, some areas of growth and improvement still lie under-explored. It is a trend that the industry players could latch on to democratise improved access to healthcare. In this interview, TINUOLA AKINBOLAGBE , chief executive officer, Private Sector Health Alliance of Nigeria (PSHN) sheds light on this and more. TEMITAYO AYETOTO brings the excerpts.
In Nigeria, things are a bit off the mark in almost every sector of society. Infrastructure is weak, primary education has been debased, and no sector reveals our lack of safety nets for the poor and middle class like our inability to provide good and affordable healthcare for millions of Nigerians. What are the key improvements required to revitalize the healthcare needs of the country?
Unfortunately, poverty and poor healthcare are inextricably linked; poor healthcare exacerbates poverty as it limits the ability to work and earn a living, whilst poverty severely limits the available healthcare options. This deprives us of valuable manpower who can contribute significantly to the economy.
The most vulnerable in society would benefit from access to sustainable, essential health services provided at the community level through a focus on primary healthcare services. This can be funded through the pooling of scarce resources via health insurance and with specific interventions in the reproductive, maternal, newborn, child, and adolescent health services. This would provide a safety net and protection from catastrophic health expenditures which threaten their financial security.
Despite economic success, poverty levels have remained stubbornly high. Seventy percent of Nigerians still live below the poverty line, and the country ranks 153rd out of 187 countries on the UN’s Human Development Index. What are the impacts expected from PSHAN’s ADHFP Initiative?
The Adopt a Primary Healthcare Facility Programme (ADHFP) is an initiative ideated by Aigboje Aig-Imoukhuede and PSHAN targeted at supporting the government in improving Nigeria’s healthcare system at the community level. Our mission is to deliver a world-class primary healthcare facility (PHC) facility at each of the 774 local government areas of Nigeria. We will rebuild public trust in the PHCs and redirect the tide of patients who currently clog tertiary healthcare in a bid to access primary health care services.
The impact will be immediate, we are focusing on seven of the Sustainable Development Goals (SDGs) because we are not just providing medical care, but we are improving the entire value chain. We will provide security, potable water, power, infrastructure, healthcare staff and associated costs, drugs and medication, medical equipment, monitoring and evaluation and quality control.
Nigeria has the capacity to act as a hub and provide excellent healthcare services for the West African and greater African market as was the case back in the seventies and early eighties.
Healthcare is limping from one problem to the other, with no major attempts to upend the status quo, start over, and set ambitious targets. What is PSHAN doing in this regard to improve health results in Nigeria?
PSHAN was incorporated by our founding members, the Aliko Dangote Foundation, Access Bank, Zenith Bank and Stanbic IBTC to complement the government’s efforts in the health sector and has raised over N6 billion in the past six years to this end. We have had a lot of success stories such as the Malaria-to-Zero program in conjunction with Access Bank, and the Nigeria Health Quality initiative (NHQI), which involved improving the quality of health services in Nigeria.
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We have had the Nigeria Health Innovation Marketplace (NHIM) and the focus of this was to scale innovations in the healthcare space that could improve the health of Nigerians. We also had the ARC project, which is the Africa Resources Centre for Supply Chain management, and it was done in conjunction with the Bill and Melinda Gates Foundation. The project was instrumental in the eradication of polio in Nigeria.
Our ADHFP initiative is an ambitious project, we have never had an initiative of this scale and scope in Nigeria which is private-sector driven and funded and this would set the standard for future private-public interventions in the healthcare sector in Nigeria.
Access to good healthcare is a nightmare for most Nigerians. While the government has proven its ineptitude over time, its roles in healthcare delivery in Nigeria to maximize impact and value remain enormous. In what areas can the government intervene?
The government has a critical role to play as they are directly responsible for providing public services, including healthcare services, to the citizenry. As demonstrated at the height of the pandemic, the private sector has a role to play but this must be in collaboration with the government at all levels.
The government has set a 2030 target for the attainment of the United Nations sustainable development goals (SDGs) and for universal health care to be achieved, they must take the bold step of mandating health insurance.
This has been domesticated already in several states in Nigeria and should be done at a federal level. Suitable incentives, as detailed in the recent Nigeria Economic Sustainability Plan, should be provided to increase FDI and local investments in health infrastructure. Nigeria has the capacity to act as a hub and provide excellent healthcare services for the West African and greater African market as was the case back in the seventies and early eighties.
With a doctor-to-patient ratio of 1 doctor to more than 5000 patients (still one of the highest in Africa), there is an ongoing hemorrhage of healthcare professionals from the country. It is now standard for an average Nigerian doctor to take the PLAB or USMLE test, or both. Nurses leave for the UK daily. What are your thoughts on this and recommendations for the reform of the healthcare sector in Nigeria?
Brain drain is a major challenge facing the Nigerian health system, leading to a dramatic reduction in the number of doctors in the country. This is a long-standing issue, though we have seen an upsurge in recent years. It is a multi-factorial problem that would require very deliberate efforts on the part of all stakeholders to stem the tide. We cannot compel skilled personnel from seeking better opportunities in other climes, but we can provide incentives that encourage them to stay in Nigeria and contribute their quota.
Improving the healthcare system, providing infrastructure, improving remuneration, and offering training options are all steps that would boost morale, increase capacity, and improve the commitment of the healthcare workforce.
The political economy of healthcare revolves around the sustainable financing of health and the policies that are supposed to lead to maintenance and health promotion. What areas need imminent attention based on outcomes from previous years; and the exact types of services that need investment and improvement?
Nigeria is a signatory to the Abuja declaration of 2001, which states that member countries of the African Union would dedicate at least 15 percent of their annual budget to improve the health sector. We have never been able to achieve that figure and have hovered at about 5 percent for the past few years.
Areas of immediate need are the primary health care space with a focus on reproductive, maternal, newborn and childhood services. This would greatly improve our current maternal mortality and infant mortality ratios which are worse than countries in similar socio-economic situations as Nigeria.
We also need to focus on drugs and medication, local production should be encouraged in a bid to lower costs and surveillance systems deployed to check the spate of counterfeit and substandard medication.
Other areas of concern are the rising incidences of non-communicable diseases like hypertension, diabetes mellitus and the worrisome plague of drug addiction which is further worsening the security situation in the country.
One legitimate question government and health care professionals have refused to ask is this — do Nigerians really want better healthcare? And what exactly would better healthcare mean to the average Nigerian?
In an ideal world, every citizen of Nigeria would have access to affordable, acceptable, accessible, and qualitative healthcare and wellness services. Health is not just the absence of disease but rather a state of complete physical, mental, and social wellbeing as defined by the World Health Organization.
Better healthcare services should be sustainable and reduce or eliminate the need for out-of-pocket spending on healthcare and the effects of catastrophic healthcare expenditure on the family income. Nigerians would thus be able to plan better, utilize their resources more judiciously and engage in activities that add value to the economy.
Access to better healthcare would translate to earlier interventions in the disease cycle with resultant improved health outcomes, decrease in morbidity and mortality. This would help break the tragic cycle of poverty and disease and result in an improved economy and overall security of the nation.
What current trend or recent innovation provides the greatest opportunities for positively impacting healthcare improvement in Nigeria and Africa?
The recent integrative approach to healthcare delivery where we take a holistic, “whole person” approach patient care rather than treating just a particular disease condition in the patient has been shown to promote optimal health and wellness with resultant changes in lifestyle behaviour. So, in practical terms, when a child comes to the PHC facility for example, that opportunity could be used to immunize the child, do a health screen, assess milestones, perform nutritional counselling, or conduct a baseline eye and dental check among other things.
An area of increasing awareness is the power of collaboration between the public and private healthcare sectors where the private sector provides training, health infrastructure and high-tech equipment whilst the public sector (government at all levels) would provide access to market , regulatory services, and quality control. This would result in the provision of affordable health services to the populace without the government having to deploy resources for high-tech equipment.
The tech market is a booming industry in Nigeria, contributing nearly 8 percent to its recent boost in GDP. Innovators are also relying on technology to reach Northern Nigerian communities where years of conflict and weak infrastructure have made health care delivery particularly difficult. With these challenges in mind, how do we leverage technology to solve some of Nigeria’s Healthcare worries?
Recent technology developments have provided emerging economies like Nigeria the opportunity to leapfrog ahead in the provision of healthcare services. Modern technology can greatly add value in the healthcare facility, helping providers improve performance and reduce variability
Various mobile applications, the use of artificial intelligence, telehealth services, and the use of drones for delivery to difficult terrains are some cost-saving and effective uses for technology in healthcare. More efforts should be made to digitize our medical records and centralize our health database so that we can make informed decisions based on accurate data analysis.
