From all indications, the federal government alone cannot provide the health care requirement of Nigerians. This is why a private sector group has picked up the gauntlet, to bail the health sector out through a public/private sector periodic meeting. Steve Dada writes
That Nigeria’s health care delivery system is in a deplorable situation is an understatement. This is corroborated by the World Health Organisation’s (WHO) rating of Nigeria as number 187, out of 191 member countries of the world. Its health indices are nothing to write home about, as a country only better than India, in terms of maternal mortality and child morbidity globally.
Indeed, the complexity of health care system in Nigeria places a huge burden on the sector’s primary health care delivery institutions, which are almost non-existent.
This is why a private sector group, ThistlePraxis Consulting, has considered it necessary that a strategic means of bailing the country’s heath sector out of its present debacle is necessary and that is, to create a healthy synergy between the public and the private sectors. The group has been organising public/private stakeholders meetings and had thus organised the third in the series recently, witnessing the presence of experts on health, where issues affecting the country’s health sector were on the front burner in the discussion at the meeting.
The Cross River State Commissioner for Health, Dr. Mrs. Angela Oyo-Ita in her view on how to proffer solutions to the nation’s challenges in providing effective delivery of health care services for a revamp of the health sector said that a sector-wide participatory approach is required.
This approach according to her would consist of an inter-ministerial collaboration, integrated logistic supply chain as well as an effective monitoring and evaluation framework. In addition, duplication of interventions without integration into the central strategy accounts for the seeming low indices of health care delivery in Nigeria will need to be visited.
Oyo-Ita berated donor agencies for not integrating their interventions with the systems in place by the local authorities. In her experience in Cross River State, a conscious sector-wide participatory approach has ensured the milestones recorded so far. According to her, development is often centred at the urban areas and capital cities with donor organisations insisting on sponsoring particular health facilities rather than a widespread distribution of resources to service points where they are most needed.
With well-articulated case studies in Cross River State, the Commissioner also cited the belief of Nigerians and their frequent refusals to carry out autopsies to determine true causes of deaths as a factor which hampers information generation to better handle future cases. She also explained that resources are often wasted because tertiary facilities are saddled with both primary and secondary health cases as people have long lost faith in the other levels of service delivery.
She also harped on superstitious beliefs as a root cause of the lack of confidence in the public health system. She advised stakeholders, especially development partners to provide details of various monitoring and evaluation exercises for integration into planning exercises and public sector frameworks rather than hoarding them.
According to her, information through public awareness and constant review plays very vital roles in management and planning. She said people need to be aware of basic self-help and Do-It-Yourself tests for certain prevalent medical conditions.
The Chairman of Hygeia Group of companies, Fola Laoye at the forum advocated the need for government to consult the private sector in policy making processes for the health sector, noting that the key roles of the Private Sector as partners in Sustainable Development cannot be overemphasised.
Laoye also said that whilst the recent partnership between public and private sectors for health care development was good, the opinions of investors are usually not sought early enough. She also summarised the Hygeia Group story in changing the business model to align with the demands of the sector. However, she admitted that the unstructured, fragmented nature of data and varying demand across all socio-economic classes still posed a challenge for investors.
In a recent case study, she stated that the annual per capita spend on health was an average of 10, 230 NGN ($62 USD) whilst that for GSM airtime was an average of 9, 234 NGN ($ 57 USD) and this shows the value of investments placed on health care by the citizenry. From her experience so far, Laoye advised the use of health visits (which stand at an average of four visits annually) as tools for effective data collection and service delivery assessments.
The Hygeia Chairman also stated that, “there must be a Return on Investment (ROI) for health through incentives and actual returns expected from this sector for investors to participate actively.”
On the call for deepened partnerships with the public sector, she advised private players in the sector to emphasize on quality and effective service delivery as ways to influence public sector attitude.
The South-West Regional Coordinator for United Kingdom’s Department for International Development(DFID) Dr. Sina Fagbenro-Byron, who participated as a discussant noted that the deterioration of the health industry witnessed in the past decades has been traced to inexperience in health care planning and administration as well as the trend of appointing doctors into positions of Chief Medical Officers, Chief Executive Officers and other administrative positions of health care facilities.
In proffering solutions to the challenges of service delivery, the DFID Coordinator reviewed the history of the Nigerian health sector which used to be ranked as one of the best in the sub-region. He highlighted the fact that facilities such as the University College Hospital, Ibadan were the best in Tropical Medicine on the continent with many referral cases from the sub-region. Prior to the town-hall-styled event with a select crowd of participants, Dr. Ike Anya, Co-Editor of Nigeria Health Watch delivered a background presentation entitled: ‘Influencing the health of the people of Nigeria” and thus provided an excellent background to the torrent of bright ideas that followed.
Summarising interventions in the Nigerian health care system, by DFID, Byron stated that the comprehensive survey carried out by the development organisation at the request of former President Olusegun Obasanjo initiated the establishment of SERVICOM, an initiative to improve service delivery in the Public Sector.
In his remarks, the Honourable Minister of State for Health, Dr. Mohammed Pate has said that a lot of activities are ongoing between the ministry and the stakeholders in the health sector, but believes in working more than talking about the plans of the Health Ministry.
The Minister made the statement in defense of the ministry’s failure to organise periodic stakeholders’ forum as a possible strategy to move the health sector forward.
Pate further stated that, “whilst we believe it is useful to tap into such networks of individuals, a monthly stakeholders forum may result in talking more about the issues than getting the work done.’’