Doctors and Nurses will stay if there are more development opportunities – Kola Oni
KOLA ONI is chief operating officer (COO) of 40-year-old R-Jolad Hospital, providing quality and increased access in the industry. Oni, in this interview with MODESTUS ANAESORONYE, shares the vision of R-Jolad Hospital and new investments into the industry. He further gives enlightened insight into the new Health Insurance Scheme and better prospects for doctors and nurses in Nigeria. Excerpts:
A few months back R-Jolad Hospital celebrated its 40th anniversary, what was exciting about these past years in terms of your growth and value creation in the healthcare sector?
Thank you very much. 40 years is a long time definitely, and for us to be the kind of healthcare organization that we are today, we must have had a number of exciting times. Since April 1982 when we were founded, we started as a 10-bed hospital from one location right here in Gbagada, Lagos. We had a major milestone when we moved to our main building, the iconic R-Jolad Hospital building that is at that intersection between Gbagada and New Garage.
Then, we also expanded and we set up R-Jolad Plus, which is another expression of the R-Jolad brand. About two years ago, the hospital took another giant stride, when we welcomed new investors, who decided to work with R-Jolad hospital to take this brand to new places.
Last year, the hospital took its first step towards multi-location expansion and expanded to Isolo through the acquisition of the former Kupa Medical Centre, which is now named R-Jolad Kupa Isolo, and then just last month, we opened our Agege branch which is another 50-bed Hospital.
Therefore, from a tiny 10-bed hospital that was started by Dr. Funsho Ladipo in 1982 in his very early 30’s, we are now a 185-bed hospital, spread across three different local governments or communities in Lagos.
Give us in detail what makes you unique in your service delivery which has positioned you as a major competitor in the sector you play in?
The R-Jolad promise is to provide affordable healthcare and we have done this by constantly proving that it is possible to serve a broad range of Nigerians with affordable healthcare.
We think about how our patients can afford our services first, and we operate a unique volume driven approach whereby the assets of the hospital are well utilized. This is better than having a lot of equipment in your lab, an x-ray machine, or even medical doctors who are not busy.
The underutilization of resource forces most hospitals to increase their tariffs to cover the cost of overheads and capex and make their services unaffordable to most people as a result. So, at the end of the day, you have a lot of underutilized assets.
What we have done is to ensure proper medical assets and system utilization which means we’re able to offer services to our patients at relatively more affordable prices than other hospitals.
We believe that this can be the bedrock of a new private sector led healthcare revolution in the country that would give access to quality healthcare to a lot more Nigerians.
When you say your services are affordable given the economic situation and the challenges Nigerians are going through now, what do you really mean?
Yes, what we mean is that we do not start first by thinking of how we can charge; the priority for us is how we can make the services available to the customers. I give an example, right now diesel prices are going up everywhere.
They have gone up by as much as 200 percent this year alone. The first instinct many times is to ask how we pass this cost to the customer but what we came up with is an arrangement with our HMO partners to find a convenient way around this for the patients and the hospital.
The biggest problem is getting the hospital to be busy instead of increasing prices to unaffordable levels. We say let us work with you to introduce a system of discounts, if the hospital is busy and engaged, we are better prepared to cope with the rising costs.
Through these means of collaborating and seeking to find a common ground between the pockets of the people as well as the interest of our staff and investors, we have been able to strike a balance.
Health Insurance in Nigeria is growing but not at a rate to enable significantly increased access. How can this improve?
Health insurance is very important. Going by our hospital data, I will tell you that our patients who do not have health insurance are 10 times more likely to be hospitalized than patients who have health insurance.
And when we looked at this closely, what we realized was that patients who have health insurance come to the hospital much earlier before their condition deteriorates but patients who don’t have health insurance on the average tend to stay back and try other means.
Unfortunately, by the time they eventually arrive at the hospital, there are chances that their conditions have worsened and it would warrant admission which often ends up being more expensive for the patient.
So, in the long run, health insurance is still the most sustainable lower cost plan to achieving universal healthcare. To make it happen in Nigeria, there are a number of things that we need to do and of course, some of these steps have been taken already.
Very commendable is the National Health Insurance Act that was recently passed as law. This makes health insurance compulsory for all Nigerians. We are looking forward to the implementation of that Act.
One other thing that needs to be done is that the National Health Insurance Scheme should continue to carry all stakeholders along especially when they are setting the prices for some of the services.
We at the hospitals are the ones who know the sort of services that people consume. So, as this stakeholder engagement continues, we’ll be able to leverage that National Health Insurance Act and use it to drive healthcare adoption across the country.
I am sure you must have seen that Act the way it is. What is critical in it to getting health insurance across to the population?
There are many good things about the Act, so we are looking forward to a very good implementation plan. First is the fact that it is mandatory.
Pension Reform Act of 2004 made pension contributions mandatory, and that has created a totally new economic sector for the country. We think the healthcare sector can also become more formal on the back of this.
The second thing is that the Act has a provision for vulnerable people. There is a vulnerable people fund embedded inside that Act, where the government is then able to assist people at the lower end of the economic spectrum who can’t afford healthcare.
Also, worthy of note is the fact that the health insurance scheme or this Act is a new scheme and is going to be managed through the support of the state governments.
That will ensure it does not get to a point whereby it will be so large and so bureaucratic that it may become unmanageable, each state government is then able to adapt it to the peculiarities of their environment. That also gives it a better chance of success.
Nigeria today continues to lose its healthcare sector skills- the nurses and doctors to advanced economies where they are paid better, leaving the country’s healthcare sector struggling. What in your opinion is the way out?
As we have looked at the healthcare sector over the past few years, one critical thing that you will see is that there is an inability to define the future for our young doctors and nurses.
When they get out of school, they ask: what am I going to be in 5, 10, or 20 years’ time. You don’t want to just be a doctor attending only to regular malaria patients for the next 20 years without getting other skills, and without becoming a specialist.
Most doctors, young or old want to become specialists, and then continue to do research and learn so that they can become global experts in their field. But the opportunities to become that are not here in the country.
So there is this inability to envision a future. Imagine, intelligent young people who were probably among the best in the secondary schools, that’s why they studied medicine in the first place, and now they are out of school and the society doesn’t really give them that much of a promise and there’s an opportunity in the global market, so they take these opportunities.
At R-Jolad, we’re working with the relevant regulatory bodies to see how we can create more opportunities. We are trying to work with the Medical Council to see how we can start residency and housemanship programs. These are all the schemes that are designed to provide the skills that medical professionals need.
We are working on how we can also support the system with a Nursing academy as well because people need to know that they will continue to be trained, so we can do a lot of this within the context of our own environment.
Of course, there are wider macro issues like security, and general cost of living issues that can make some people leave the country. Healthcare accessibility is also one of the key reasons for relocating.
But if we solve the challenges that are within our control, which is to give these young practitioners a sense of a better future; a sense that they can actually get better, and that there is a hospital, an organization where they can work; and where there is actually a prospect that these organizations will continue to live and not die with the founder. We believe this would go a long way to solve part of the problem.
Finally on R-Jolad Hospital, what is your long-term view given the operating environment, maybe in the next five years?
The impact of Covid-19 is very telling. Government should focus attention on the healthcare space. People have realized that you will not always be able to get on a plane and go get healthcare.
Historically, Nigerians have always seen healthcare as a social good, that is something that should be given free of charge. I think the impact of events in the past few years has also made many people realize that we need to change our mind-set towards Healthcare.
Healthcare is like a commodity like every other commodity in the world and we should pay for good healthcare.
So, we see a sector now that in the next five years, we would have a lot more organized private sector players that are going to emerge.
The way healthcare was done in the past is that a consultant will go and start the hospital and say this is my hospital, but when we say organized, I believe we are going to see people pull capital together and then start different healthcare organization.
You are going to see a lot of private sector players come into the healthcare space and because these private sector players are bringing in capital, they will help shape policies.
You will see them also push for more collaboration between the government and the private sector in healthcare delivery and what we expect is that with the health insurance Act, and the private sector coming in, we would start seeing much more stability, much more standardization and better access.