Nigeria is Africa’s largest economy and most populous nation. It is an emerging health innovation hub which requires adequate public, private and philanthropic health investments to build a highly productive and competitive workforce that can contribute to sustained economic growth in the 21st century. The country’s low public investment in health has slowed progress as reflected in low life expectancy at birth and poor maternal and child health indices. The status quo offers opportunities to deploy new approaches to mobilize resources from domestic and external sources to scale data-driven solutions that can reduce disease burden, improve citizens’ wellbeing and raise national productivity.
Maternal and child mortality rates are prominent indicators of socio-economic development. According to the 2018 Nigeria Demographic and Health Survey (NDHS), 1 in 8 children died before their fifth birthday in 2018 compared to 1 in 6 deaths in 2008. This represents a 16% reduction in child mortality rate over a decade compared to a 36% reduction between 2003 and 2013 based on NDHS data. These rates decline with better education for mothers, higher household income and residence in urban areas. The decade of action for the Sustainable Development Goals could spur accelerated progress.
There is some improvement in maternal health. The proportion of women receiving antenatal care from a skilled provider increased by15% from 58% in 2008 to 67% in 2018. Only 39% of women deliver at health facilities: public facilities take twice the number of deliveries at private facilities. There was an11% increase in the number of facility-based deliveries between 2008 and 2018. These have implications for innovative products and services targeting facility-based delivery. Six out of 10 deliveries take place at home with nil or limited access to obstetric care to detect and respond swiftly to complications. Most home deliveries take place in rural areas where there is an opportunity to reach the last mile through community-based tools and health workers.
According to 2016 data from the World Health Organization, communicable diseases, maternal, child health and nutritional conditions are responsible for 63% of all deaths in Nigeria while non-communicable diseases and injuries account for 29% and 8% of deaths, respectively. Geographical, financial, cultural and health system barriers including trust and quality issues limit access and use of health services in Nigeria. Beyond disease-specific interventions, there is room to improve system governance, invest in research and health information system, and enhance supply chain management. Prospects abound in training, equitable distribution and retention of health workers especially in underserved areas. Health finance innovations can help reduce out-of-pocket expenditures by household through pre-paid risk pooling approaches.
While current health indices may appear discouraging, they represent opportunities to create timely solutions that leverage public, private, donor and philanthropic investments to reduce maternal and child deaths as well as ameliorate a double disease burden.
The government is investing in primary healthcare through annual health allocations at national and sub-national levels with additional resources from the Basic Healthcare Provision Fund (BHCPF). The BHCPF is at least one percent of the consolidated revenue before it is split across levels of government. There are also attempts to increase health insurance penetration to reduce financial barriers to health services through national and state-led health insurance schemes harmonized under the ‘Health Insurance Under One-Roof’. These initiatives require context-relevant process and product innovations built on effective public-private partnerships to improve the wellbeing of citizens and raise productivity across all sectors.
New investments in public health system strengthening can leverage complementary private, donor and blended capital to improve health outcomes hinged on a right-based approach that guarantees health for all. The private health sector represents a significant share of the health market in Nigeria – covering roughly two-thirds of service delivery. The sector comprises private pharmacies, health facilities, health maintenance organizations, manufacturers and distributors of health products, and ancillary health businesses. There is also an increase in the number of digital health enterprises and startups developing solutions to system challenges within the framework of existing tools and laws. In many parts of the country, the private sector provider is usually the first point of contact with the health system.
There is ample opportunity to design new solutions to improve the efficiency of the public and private sectors for synergistic, high-quality health service delivery at all levels of care. The Private Sector Health Alliance of Nigeria and the Nigerian Healthcare Federation seek to harmonize structural improvements and investments in the private sector through a multi-stakeholder approach that complements strategies and progress in the public sector. Ongoing reforms at the continental level to integrate markets offer new pathways to attract investments in health innovations and infrastructure development that can stem the tide of medical tourism and make low-cost high-quality health services available and accessible to all, with economies of scale.
Nigeria represents a strategic health market where home-grown solutions and tools can be scaled across the continent. The country is an emerging health innovation hub with several startups that have attracted global attention and investments. Leading startups such as LifeBank, 54gene, Kangpe, Helium Health, MDaaS, mDoc, Life stores, Drugstoc and MedSaf are leveraging apt tools to develop timely solutions to improve health indices. Incubated at Co-creation Hub, LifeBank won the inaugural Africa Netpreneur Prize and recently attracted multi-partner investments by the United States Agency for International Development (USAID), US International Development Finance Corporation, Merck for Mothers and Credit Suisse to scale access to life-saving health products for mothers and children across Africa.
Nearly half of all African startups admitted to the competitive US-based YCombinator (YC) investment program in the last decade originated in Nigeria: Kangpe – RelianceHMO, Helium Health and 54gene are health-focused YC investees. Drugstoc and Medsaf are deploying context-relevant technologies to enhance access to safe, quality-assured medicines for providers and patients. MDaaS provides low-cost diagnostic and primary care services in underserved markets. Life stores’ pharmacy chain aims to drive efficient distribution of health products and scale new models of managing chronic diseases. Doctoora leverages its infrastructure-as-a-service platform to connect hospital managers, healthcare providers and clients. And mDoc, a winner of the 2019 USAID Inclusive Health Access Prize, is redefining models of care for chronic diseases in resource-limited settings.
Despite the complex nature of the country’s health system and wider socio-economic constraints, these innovators are leveraging entrepreneurial skills and available resources to solve problems and amplify the value of the health innovation ecosystem for better health outcomes in Nigeria and across Africa. While access to capital, talents and basic infrastructure are leading challenges for entrepreneurs, an improvement in the regulatory, fiscal and investment landscape for health enterprises can stimulate further research and innovation for continued growth of the ecosystem. The space is ripe to attract more players as attention shifts towards continental market integration, increased domestic financing, targeted official development assistance and impact investments from local and international investors. As Africa’s largest economy, the country is well-positioned to attract investments and leverage its pluralistic health system to enable healthy, educated citizens contribute to inclusive economic growth.
Abiodun Awosusi is a TEDMED Research Scholar and Health Economist at Health Systems and Development Enterprise.
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