Nigeria’s healthcare growth in 2021 has been a mix of past failures rising back to haunt the country’s defence in the eye of a public health crisis, out-of-pocket health payments squeezing millions of uninsured under one of the worst inflation rates and private investors taking huge bets on the future of high-end care nevertheless.
The year took off on the lofty goal to vaccinate about 70 percent of the population against the coronavirus pandemic, without an operative vaccine plant, decades after approximately N12 billion was expended.
At least 42 million out of roughly 300 million doses were expected under COVAX provisions to lower and middle-income countries until more COVID-19 variants emerged, nudging major vaccine producing countries to shift focus from external donations to their dying populace first.
India, the world’s largest producer of vaccines and anchor of COVAX vaccine deliveries around the world locked up exports also, blocking supplies to many countries including Nigeria. Nigeria had access to only about 4 million doses of AstraZeneca vaccines which was only sufficient for less than two percent of its population for the period that the vaccine drought lasted.
There was no structure to urgently activate in the short or medium term, not even the capacity to prepare vaccines or handle last stage processes of packaging and labelling that countries such as Egypt, Morocco, Senegal, South Africa and Tunisia already had in place.
And when the US and German biopharmaceutical companies, Pfizer-BioNTech in July were scouting Africa for companies to integrate into their vaccine supply and manufacturing network, Nigeria missed the chance. There was no immediate readiness to repurpose facilities for large-scale production required of such partnerships.
“Who knew which was going to work, whether AstraZeneca or Pfizer? Nobody. Their government took a random bet that if A doesn’t work, B will and if B doesn’t C should. Then what do we do? We are accusing them of hoarding vaccines. We are waiting for COVAX. Their governments were proactive while we were seating in our room. They plan for their people,” Oyewale Tomori, retired professor of virology told BusinessDay.
Nigeria now chases its own vaccine production plant, the groundwork hopefully to begin to piece together by 2022.
The project to cost $51 million is being pursued under a partnership between May and Baker, a private company and Biovaccines Nigeria Limited, a joint venture with the government and will span between five and seven years, according to Tomori a team lead.
Going by the calculations of the World Health Organisation, setting up fresh manufacturing plants are not expected to be of much use to the current pandemic as hurdles such as agreements on intellectual property and technology transfer remains hanging.
With relevant global stakeholders to build capacity and capabilities of local manufacturers specifically to enable technology transfer to facilitate vaccine manufacturing to occur domestically at a larger scale so Africa can better control its supply of the vaccine over time.
“The proposed factory in Ota will have a production centre, storage centre, research and development centre. We are looking forward to the time that in two or three years Nigeria will begin to produce its own vaccine. In fact, what we will need for 2022 is being procured by Biovaccine Nigeria Ltd. The talents in Nigeria’s ecosystem will be bringing research together for production,” Tomori said.
Read also: Nigerians unspared as healthcare cost impoverishes millions globally
Soaring healthcare cost
From medical examinations to treatment, the burden of healthcare did not get easier for the majority of Nigerians, who were already squeezed as high inflation impacted the cost of care negatively.
With headline inflation near 17 percent for most of the year, and a quarter-long strike by the National Association of Resident Doctors (NARD), the cost of care in private facilities grew just as drugs and consumables also jumped in prices, expanding the size of out-of-pocket expenditure on health.
The World Bank’s latest report on Nigeria’s development shows that inflation pushed eight million Nigerians into poverty between 2020 and 2021, an increase from seven million reported in June 2021.
A combined report by the World Health Organisation and the World Bank also indicates that health services out-of-pocket further pushed many into extreme poverty, with a projection that the pandemic is likely to worsen the situation by over half a billion.
About 83 million or 40 percent of Nigeria’s population live below the poverty line of N137, 430 ($381.75) yearly, the National Bureau of Statistics (NBS) states in a 2019 Poverty and Inequality in Nigeria report.
While Nigeria’s out of pocket spending ticked 79.3 percent as of 2019, the government’s spending stayed abysmally low at 79.3 percent, data from WHO shows.
However, new records show things are changing.
For instance, in the proposed 2022 budget of N16.39 trillion, the federal government allocated N821.4 billion to the health sector, a 101percent increase compared to N407 billion allocated in 2021.
If the N16.39 trillion budget proposed by the President is released, further analysis showed the cost of medical care budgeted for every Nigerian stood at N3,987 in 2022. This is an improvement on last year’s figure pegged around N1,975 per citizen.
The Missing Link
“At the federal level, insurance needs to be made mandatory, not voluntary, for all. It doesn’t work if you leave it open. It will cost political capital. That is the missing link, on paper in Lagos for instance, it is already compulsory,” Femi Olugbile, former Permanent Secretary, Lagos Ministry of Health told BusinessDay.
“It is one thing to pen down and it is another to apply it. Right now we are looking at a coverage between five and 10 percent which is like a drop in the ocean and the basic healthcare fund will not solve. It is a political decision that needs to be made.”
Increased private investment
One of the achievements of 2021 is that the private sector is looking more actively involved in the business of medicine. More private-sector money, including venture capital, were directed towards domesticating high-end healthcare services.
The sector saw the birth of multi-billion naira projects such as the Evercare Hospital Lekki, the Dutchess Hospital, Ikeja, Eurocare Hospital, Victoria Island and several others around the country.
And this is likely to increase next year, according to Analysts. They say the future of high-end healthcare belongs in the private sector and the government ultimately should be a facilitator.
Although investments are long term and show trust in future of the industry, the viability of the private sector will be largely affected by political decisions that need to be made, Olugbile told BusinessDay.
He said the business case of healthcare is not sustainable if facilities cannot operate at a reasonable capacity.
The numbers that are served really have to be approximate to the numbers of people who have an actual need for those services, he explained, noting that they should not be filtered just to the number of people who can afford as the majority Nigerians might be filtered out.
“People who put billions of naira into setting up Ultra-modern hospitals and staff with highly paid consultants and other personnel who are getting salaries that are on such a magnitude that they are not tempted to go away and be part of the brain drain…then the least that you expect is that the traffic should be such that it can sustain the cost of the service,” Olugbile said.
“If you have an interventional cardiologist, and is only seeing five patients in a month because those are the number of people in that area who can afford the cost of the service and meanwhile, maybe there are 500,000 people who could benefit from that service…health funding that is sustainable is crucial even for the business case of the private sector.”
One aspect that analysts say Nigeria must address in the coming year is the Basic Health Care allocation fund which is meant to help to bring solace and help facilitate care for the underprivileged and children.
The federal and the state government currently function in parallel with the federal entity insisting on operating as a federally imposed thing, while some states are also looking at operating similar initiatives to the basic healthcare provision fund.
If these efforts are integrated into a whole, analysts expect that it maximises impact and cut down wastage or duplication of functions.
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