Following the road map for the health sector, as captured in the Economic Recovery and Growth Plan of the federal government, major stakeholders in the sector at a round table by the Healthcare Federation of Nigeria and the Health in Africa Initiative, said prioritisation, impact and implementation of the plan will go a long way in revamping the sector. Martins Ifijeh writes
On March 7, 2017, the Nigerian Government, in its bid to strengthen the economy and end the present recession, launched the long-awaited plan to restore macroeconomic stability in the short term, and the structural reforms and investments in the social sector in the medium and long term, which it termed the Economic Recovery and Growth Plan (ERGP); a plan for 2017-2020, broadly targeting restoration of growth, human development and globally competitive economy.
The plan, which the government said was an ambitious move to achieve a seven per cent economic growth for the country by the year 2020, represents a policy and reform framework to boost productivity in all sectors and achieve sustained diversification and inclusiveness.
According to the document, which was midwifed by the Presidency and the Ministry of Budget and National Planning, 60 critical initiatives have been outlined to form the strategy the government said represents the blueprint for the type of foundation it wants the country to follow.
A critical look at the 60 listed strategies showed that at least five of such strategies give a clear design to what President Muhammadu Buhariâ€™s administration has in stock for the healthcare sector.
The federal government, in the document said it would invest in health and education to fill the skills gap in the economy, and meet the international targets set under the United Nationâ€™s Sustainable Development Goals (SDGs). Adding that it will improve the accessibility, affordability and quality of healthcare, and expand coverage of National Health Insurance Scheme across the country.
It is in discussing this document, as it relates to healthcare, that the Healthcare Federation of Nigeria (HFN) and the Health in Africa Initiative of the World Bank Group organised the ERGP Stakeholders Consultative Forum in Lagos where major players in the healthcare industry were brought together to brainstorm on the role of the private sector in achieving the strategies, and how on a broader perspective, the ERGP can change positively the abysmally poor health indices of the country.
Among plans listed in the ERGP for healthcare is that the federal government will give a new lease of life to primary healthcare system through revitalising 10,000 Primary Healthcare Centres (PHC) and establish at least one functional PHC in each ward to improve access to healthcare; fully implement the PHC refinancing programme to mobilise domestic resources; drive progress to meet UN SDGâ€™s health targets; and reduce infant and maternal mortality rates.
The ERGP says the federal government will roll out universal health coverage through expanding the National Health Insurance Scheme (NHIS); enforce the Tertiary Institutions Social Health Insurance Programme for students in tertiary institutions; pilot the Public Primary Pupils Social Health Insurance Programme to provide quality health services to pupils in middle-and lower-income socio-economic levels who are less likely to have insurance; and scale up the Mobile Health Insurance Programme to provide coverage for the poor.
The government economic document also shows that the federal government will strengthen delivery beyond the PHC system through provision of anti-retroviral medication to people living with HIV/AIDS; ramp up projects to eradicate polio, measles and yellow fever; make strategic investment in tertiary healthcare institutions in collaboration with the National Sovereign Investment Authority (NSIA) and other relevant stakeholders; and develop and adopt an e-health scheme to connect specialised hospitals to rural communities via mobile tele-medicine.
The ERGP suggests the federal government will partner with the private sector to construct model mega-health centres through partnership with private sector to develop at least one mega-health centre in each state to provide high quality preventive and curative healthcare.
The strategic document also shows that the federal government will build the capacity of healthcare personnel to improve service delivery through the provision of rural service allowance and basic amenities to health workers in rural areas to retain qualified personnel; identify and fill gaps to optimise the health worker-to-population ratio by recruiting and training more health workers and attracting talent from abroad; and develop the Diaspora Medical Assistance Programme to attract and encourage Nigerian medical professionals abroad to provide volunteer health services in Nigeria.
While the healthcare strategies are laudable, and represents steps in the right direction if the sector must be at par with those of developed countries, grey areas needing answers are whether the issues noted in the strategies were being prioritised accordingly, whether the government has the capacity to implement the strategies, whether there is the political will to make drastic-but-important decisions for the sector to achieve its desired goal, as well as whether there is capacity to monitor all players responsible for achieving the goals?
It is in providing answers to these salient questions that the roundtable brought together major healthcare players and institutions across the country to discuss how best the healthcare strategies in the ERGP can best make maximum impact in the lives of the over 180 million Nigerians, many of whom have lost faith in the countryâ€™s healthcare system.
Speaking during the roundtable, the Country Manager, International Finance Corporation in Nigeria, a member of the World Bank, Ms Eme Essien Lore, said the successful implementation of the ERGP calls for adequate public and private financing and on strong coordination with the sub-national governments.
She stated that the implementation capabilities of the private sector will be useful in ensuring strategies are delivered to the population that needs healthcare the most and in good time too. Adding that the principles enshrined in the ERGP are also consistent with the twin goals of the World Bank Group as it supports the drive to ending extreme poverty and promoting shared prosperity. She also urged Nigeria to take advantage of the new IDA allocation to the country.
Also contributing to the discourse, IFCâ€™s Regional Industry Head for Manufacturing, Agribusiness and Service in sub-Sahara Africa, Ms Mary-Jean Moyo, stated that MSMEs were the elixir of private sector participation in healthcare across the continent.
To buttress this point, she announced that, â€œIFC made an investment of $4.5 million in the Medical Credit Fund (MCF), part of the PharmAccess Group, to increase access to quality healthcare in Africa. This investment allows the MCF to deploy its extensive training programme to improve both business and clinical performance for healthcare SMEs, using internationally accredited SafeCare standards.
â€œThe ERGP needs to place emphasis on this kind of investments in order to address the participation of the private sector in Nigeria and showcase that SMEs must be supported. The Nigerian Government must be able to attract other financing institutions who are able to replicate this kind of investment if the country wants to rapidly improve the health outcomes of our women and children,â€ she added.
Moyo acknowledged efforts by the government in setting up the new Development Bank of Nigeria and efforts by the local financial institutions like the Bank of Industry who are making available financing for SMEs in Nigeria. She asked that the health sector needs to take advantage of the opportunities provided by these institutions.
Olumide Okunola of the World Bank informed the audience that with the limited financial and operational capacity in the public sector and with the private sector already responsible for more than two thirds of the healthcare delivery in Nigeria, especially to the lower-income population, it was imperative that those responsible for the implementation of the ERGP provides the enabling environment for the private sector to deliver more healthcare especially to poor populations.
He stated that the recent signing into law of the Collateral Registry Act was a significant victory for MSMES in the health sector who can now use their movable assets as collateral for raising capital.
One of the panelists, Dr. Afolabi Ogunlesi suggested that the availability of Project Development Finance will be critical to the success of the strategies especially the Mega model health centres listed in the ERGP. He was of the opinion that there has been far too many laudable initiatives either interminably delayed or have to be outright voided because of the lack of Project Development Finance. To address this issue he urged development institutions like the World Bank to support the implementation of the ERGP with transaction advisory support to enable the upstream aspects of such projects to be funded with partner support.
According to the President, HFN, Clare Omatseye, the reason behind the roundtable was to dissect policy objectives and strategies articulated in the ERGP document, which she said was designed to drive a structural economic transformation with emphasis on improving public and private sector efficiency in key sectors, including health.
She said the ERGP was a laudable one with an all inclusive, affordable and accessible healthcare objective, but added that the private sector has a big role to play in actualising the initiative in revamping the countryâ€™s healthcare system.
According to her, one area the government must focus on is primary healthcare, which remains a big part requiring priority. â€œIf Nigeria can get primary healthcare right, the country would have saved the secondary and tertiary hospitals from treating diseases such as malaria.
â€œIf government can provide the enabling environment, private sector can drive some of the primary issues at the primary care level,â€ adding that the federal government has no business building new health centres but can get private sectors involved in revitalising, reequipping and more importantly running the existing ones.
â€œA good strategy for this to work is when government partners with private sector which comes with a lot of efficiencies and know-how,â€ she added.
Continuing, Omatseye said, â€œWe donâ€™t have enough doctors in the country; we can get midwives, clinical health extension workers to help man some of the centres. We can be more preventive in our approach as against waiting for people to walk through the hospitals. These are the things we think can be done in a short term. We think this is a perfect mix where you have the existing building partnering with the private sector to take over the centres as well as providing human resources and alternative resources to man the centres.â€
On the proposed mega hospitals, Omatseye said the idea of a mega hospital was a brilliant strategy but needs to be articulated. â€œGovernment shouldnâ€™t be building hospitals. Partnership with private sector can make a difference. We want to make a difference. Nigerians need and deserve high quality healthcare and that access is what we are here to do.â€
At the end of the roundtable event, stakeholders agreed that the Nigerian private health sector can play a big role in the implementation of the health strategies listed out in the ERGP. They also urged the government to contract private providers to make existing public PHCs functional.
They also agreed that there was need to fast track the expansion of pro poor risk pools in Nigeria which will further incentivize the delivery of services by public and private providers empaneled under the NHIS.
The stakeholders, while commending the government for business friendly policies like collateral registry act, investor friendly executive orders and the recent proposal to set up a diaspora commission which will allow for overseas based Nigerian professionals in the health sector to relocate back to Nigeria, they urged development partners like the World Bank, DFID and others to support the implementation of large health projects with transaction advisory support.