Khama Rogo is lead Health Sector specialist with the World Bank and head of the World Bank Group’s Health in Africa Initiative. Prior to his WB career, he taught Obstetrics and Gynecology at the University of Nairobi, before becoming the vice president of Medical Affairs Africa for Ipas. A native of Kenya, Rogo, a professor, received his MD and M.MED from the University of Nairobi and earned a Fellowship and PhD in Gynecologic Oncology in Sweden.
A prominent advocate and global authority on reproductive health issues, he is a visiting professor at several universities and author of over 100 papers and book chapters. He has been a consultant to WHO, UNFPA, UNICEF, USAID, and DFID, and advisor to many other bilateral and unilateral international organisations. Rogo is past president of the Kenya Medical Association and Kenya Obstetrical and Gynecological Society. He was also the chairman of Kenya’s National Council for Population and Development, and served on the Gender Advisory Panel of WHO, the Advisory Committee of the David and Lucile Packard Foundation, and the board of the Centre for African Family Studies. He is currently on the board of INTRAHEALTH, among other responsibilities.
Nigerian visit
I am in Nigeria to work with the Ministry of Health and the private sector to engage better in terms of harnessing the resources in Nigeria to help them achieve their objectives. Specifically, we had started carrying out some work on NHIS by doing an assessment on what is happening in NHIS and providing recommendations on the way forward to beat the Nigerian objective of universal coverage and access to healthcare.
Nigeria in the context of Africa
We have to see Nigeria in the context of the whole of Africa. In Africa, we inherited the colonial health system which is not meant to cover everything. When independence came, we started to eradicate poverty, disease and ignorance but this was a tall order capacity. When we came to the point to sign the millennium development goals, we hoped that it would take us to the next level, we have found that in 2013, two years before the 2015 MDGs, no African country will be able to meet the set target so a few years back, the World Bank in collaboration with the Bill & Melinda Gates Foundation did a research and looked critically at why Africa is not meeting her goals despite all they have and one thing that stood out was that it was because Africa was not harnessing the potentials and resources available at both public and private sectors. From our findings, we observed that the private sector was doing more so we concluded that it would be better for both public and private sectors to meet at a point so they can carry the big load together.
Nigeria is following suit…
First of all, Nigeria is taking examples from countries we have worked with and has shown that working together is important but most importantly, there is a clear understanding by the private sector that individually, they cannot do it all alone.
The private sector in Nigeria has a bigger chance of excelling more than other countries both in terms of intellectual capacity and in terms of potential resources that are not harnessed yet. The commitment of Nigeria to expand health insurance is a whole new opportunity for both public and private sectors. These are things that risk the commitment of the government to move forward. The signs are there to work closely; also the people are ready if integrity can be upheld.
Funding
There is enough money around that if properly harnessed, it will greatly improve the Nigerian healthcare system. For example, if you look at the amount that is invested in medical tourism in Nigeria, it is enormous. If channeled properly, you will be amazed at what Nigeria can gain from this.
Secondly, Nigeria sends about 30,000 people yearly for healthcare outside the country which amounts to millions of dollars. If the money is channeled here, this will help the healthcare system. Nigerians have specialists all over the world. If these needed facilities are here, there is nothing stopping them from coming to be of service here. It is not for lack of money but it is because of lack of focus. If you look at the private sector, they are willing to invest. They may not put a figure that is so impressive but there are lots of people looking for investment in the pharmaceutical sector and the infrastructures are
enormous. Right now, GE (General Electronics) is in discussion with the ministry of health in Nigeria offering opportunities for helping to improve diagnostic capacities in health institutions across the country and it is on Nigeria to determine how and when that will work.
Right now, when most African countries think of diagnostic equipments, they think of buying one and then using it but most times, when bought, there is no contract for servicing so when it breaks down in six months time, it causes setback and the next six months it’s not usable. The rest of the world is moving towards leasing mode. You can lease and pay for the service it gives you rather than the equipment you are buying.
Look at the area of resources, in Africa, we have relied totally on the government for everything. We do know that private sector can support, all we need to do is put forward strict regulations that have to be followed for that to happen. It is not a question of only how much money is out somewhere but it is a question of doing things differently.
World Bank relationship with Nigeria
We are working with the private sector in three areas:
First is the public/private dialogue, this means bringing together the public and private sector together for them to have a voice in policy making, strategy and investment.
Secondly, on the government side, we are building that capacity for them to be able to dialogue. We have started this in Abuja and we hope to trickle it down to the other states. The policies and regulations that will make investing in Nigeria attractive has to be made. There is a PPP framework in the finance level but it has to engage all parties concerned.
In Nigeria, owning a pharmacy means you have to be a pharmacist but that is not what it is meant to be, it should be that there must be a pharmacist working in that pharmacy. Investors who want to invest in that area are limited because they are not pharmacists. This is not meant to be so. The regulations need to be worked on and strengthened. In the financing area, there are a lot to be done.
Thirdly, we want to look at opportunities for investment where there are direct credit facilities to entrepreneurs. People who can come to borrow directly from IFC provided you have a bankable proposal.
We are beginning to identify banks where we can put in money so that those who want to borrow in dollars or those who want to borrow in smaller units like SME banks can have access to funds. We are looking at the tenure of it, but most people say in getting loans, the rates are high and an elongated tenure is preferred because one can’t borrow and expect returns quickly in the healthcare sector like others. So long term borrowing is on the front burner.
We have also invested in some equities that have started investing in Nigeria already. The equity firms that require partnership, the firms that want to grow and don’t have the capital, we are encouraging these equity firms to come and join hands, grow with them and they can become better.
We are speaking with the government. Health groups are collaborating with the Ministry of Finance because it is not just the health sector. We are speaking with the private sector to bring them together and find a collective means of making it work. We are bringing together development partners too.
In a month’s time, we shall be launching a special programme by Gates Foundation, looking into piloting franchising in health. Branding clinics to have same type in various parts of the country with same quality and standards. We have in Kenya, Ghana and Nigeria is next. This is to get the small providers to work together and scale up their practices.
Nigeria’s untapped resources
The potential that Nigeria has is the most untapped in the health sector that you can ever have. If you leave to UK to seek specialist care, it is most likely that you will be treated by Nigerians. You hardly find such services here and that is why people go out to seek better services but the question is: why can’t this brilliance be retained here? Private sectors can drive this force. Imagine if Nigerians spend their contribution to the 1billion or more than India receives every year on medical tourism within the country, it will go a long way. Primary, secondary and tertiary levels of healthcare will be better for it. There is a big health market here this is untapped. It is important to inform Nigerians about the possibilities because there is hope and it’s not all about gloom.
KEMI AJUMOBI
