When I think of certain government parastatals, my first thought usually is ‘old’. All shades of old; the decaying infrastructure, the backward technology, quite a number of unprofessional hostile workers. Going to government offices give me some 1980s vibe (even though I wasn’t born then*smirk*). The management issues in the Nigerian government establishments runs deep and cuts across several sectors from the hospitals/PHC’s to libraries to the post office.
According to statistics, only 20% of PHC’s in Nigeria are functioning, this explains why our maternal mortality rate is one of the worst in the world with 58,000 deaths occurring in 2015. This is equivalent to about 30 of the Boeing 737 2019 plane crash happening in Nigeria every week. Nigeria ranks 152 of 157 countries in the Human Capital Index report released by the World Bank in 2018. This shows how much we lose as a country through lack of education and health. The point of this article is not to show you how bad the health system is but changes that can help.
My little research in preparation for this article made me realize Nigerian healthcare issues are vast and more than I anticipated. I had too many questions but very few answers. One thing that evident is how Private Public Partnerships (PPPs) can help. My firsthand experience on PPP was in LUTH Radiography Department and Breast Clinic. As at 2018, I had cause to see a doctor and get some scans done in the radiography department, LUTH which seemed to be managed strictly by LUTH management. My experience then was not pleasing at all, sometimes I had to wait for over 3hours for a less than 20 minute consultation. As at the time of writing this article, there is some sort of collaboration with Medivation Health Limited in managing the radiography department. There is not so much news about it on the internet, but from my experience using their services some weeks ago, there has been visible difference in such short time. From great ambience, to reduced waiting time and lesser stress for patients with NHIS. There is definitely still room for improvement but I was satisfied with the quality of care I got. Also, LUTH in collaboration with Run for a Care Africa (an NGO), launched a breast clinic in 2015. I was diagnosed with fibroadenoma at some point, so I’ve had reason to go to that breast clinic. The ambience was the first thing I noticed and instantly I knew it wasn’t managed by just the government. Waiting time is a lot I must admit, but it was evident that the staff of this NGO cared. It was also evident that there was some form of accountability for the staff. They were professional and assisted the patient when needed. I was called a day or two before my appointment just to remind me. Some patients get assisted with collecting their results from the radiography department before their next appointment just to save the patient some time and stress. It is quite obvious that the private sector have better reputation in management expertise compared to our government due to certain factors that are beyond the scope of this article. So far, certain tertiary health institutions in Nigeria like UCH (Ibadan), Garki Hospital (Abuja), FMC (Ebutte-Metta) have PPP in some departments and have been doing pretty well. People however react to the idea of PPP differently as seen in the crisis in FMC (Owerri).
Nigeria is a low-income country, and considering our budget for healthcare there is not much it can do in meeting SDG 3 for about 200 million individuals. The ₦427 billion set for healthcare by the government in 2020 was not enough to provide standard care for majority of Nigerians. It is sad but truthfully, we don’t see that amount changing significantly in the nearest future. We need to go past glorying in mere survival to providing quality, accessible health care. The WHO constitution defines health as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’. As a country we can boast of being polio free and averting Ebola Virus Disease (EVD) epidemic in 2014. But, the absence of certain diseases is not equal to a state of good health. In the Nigerian health sector, funding also come from donors but usually these funds are for specific disease interventions and are not even carried out in all states so they’re perceived to be inequitable. These funds go a long way, but don’t comprehensively tackle our healthcare problems. Time is fleeting, our health system is failing, lives will continue to get lost unnecessarily if we remain like this.
Nigeria needs to have steady sustainable growth in the health sector through more investments from the private sector. Recent Foreign Direct Investment (FDI) statistics indicates that Nigeria is not as attractive as it should be for investors. There is need to look into policies, legislations and other factors not in the best interest of investors. This will reduce pressure on our fiscal budgets.
Yes, funding is a big issue but doesn’t solve all the issues we face. USA for instance has the highest spending per person on healthcare; about $9,237 but still doesn’t have the best health outcomes. Countries like France, Switzerland who spend less have better outcomes than the USA. Nigeria is in dire need of funding, but getting all the money we need would not necessarily solve all our issues. PPPs can serve us in many other ways such as higher quality standards and timely provision of public services. PPPs can to some extent reduce the effects of bureaucracy in managing the healthcare facilities. Unlike sole management by private sector, effective PPPs can help with intersectoral collaborations with other government sectors towards achieving quality health care. While the private sector does most of the managing and funding of facilities, the public sector can focus on collaborating with other sectors such as housing and educational sector towards improving preventive health measures in achieving not just SDG 3 but also other SDGs.
I will end by applauding Mr Aigboje Aig-Imoukhuede for the Adopt-a-Healthcare-Facility-Programme (ADHFP). The aim of the programme is to get angel investors to build decent primary health centres across the 774 local governments in Nigeria. This is a huge feat to attain with undoubtedly a lot of challenges especially in attracting these investors to primary care (and not the usual tertiary institutions) as well as the complex adaptive nature of the health system. This and many other programmes like this will go a long way and I can’t wait to see the change it brings.
