The ravaging COVID-19 pandemic presents an opportunity for the Nigerian health system to harness the potential available in the private sector to fill in the acute gaps as a result of much reduced and in most cases unavailable capacity in the public health system.
As different countries deploy their suppression or mitigation strategies, the capacities available in the private sector have allowed countries to respond to dealing with the COVID19 surge.
In China acute shortage of public health resources in Wuhan led to the incorporation of private health and third party diagnosis facilities.
Singapore treated acutely ill patients at the publicly funded National Centre for Infectious Disease and as soon as they got better were moved to the privately-owned Mt Elizabeth of the Parkway group.
Timeliness, enhanced testing capacities and adaptability are critical success factors regardless of the strategy.
The Nigeria private health sector is large and provides services for more than 70 per cent of the population.
As is to be expected, a higher proportion of the private-for-profit health facilities are mostly concentrated in urban areas where there is a higher willingness to pay for services.
Poor and vulnerable Nigerians also go private, patronising PPMVs, drug sellers and the like. Clearly the heterogeneity in the private provision of health services makes the trio of equity, quality and affordability a major concern.
Despite the concerns enumerated the capacities available in the Nigeria private health sector ought to be leveraged in the COVID-19 response. Before discussing this we highlight the response of the Nigerian government thus far.
It has deployed a suppression strategy as the main policy option over mitigation. The chosen option was recently made more stringent thereby moving Nigeria above the line on the Stringency-Risk Ratio.
For a country with an extremely fragile health system weakened by inadequate public expenditures and insufficient availability of much needed human resources for health there was no other feasible option.
As expected, suppression strategy comes with severe socio-economic challenges with possible impact on health and well-being. It has therefore being advocated that countries like Nigeria implement substantial targeted fiscal, monetary, and financial market measures to help affected households and businesses.
In this regard the Central Bank of Nigeria (CBN) has made monetary policy pronouncements as part of its sectoral intervention to the health sector.
The CBN proposed a bouquet of support to include a wide range of healthcare businesses including pharmaceutical drugs and medical equipment; healthcare service providers/medical facilities – hospitals/clinics, diagnostic centres amongst others.
Modeling studies indicate Nigeria will hit its 10,000 COVID-19 positive cases landmark by late April 2020.
Assuming that the current trend of five to 10 per cent are in the moderate to severe categories, it means that we will need and should have at the ready a minimum of 1000 critical care beds by the middle of April 2020 in at least two locations (Lagos and Abuja).
However expansion of testing capabilities and even community transmission might lead to the exponential growth as seen in other countries.
Furthermore, one quick way to assess the preparedness of the health system is the ventilatory surge capacity – an issue which has highlighted the need for ventilators especially for the cases who will fall into the severe category.
While a count of such device in Nigeria is necessary they might not be sufficient as there are other components essential for adequate ventilator therapy.
The four key components necessary to provide ventilation therapy to a patient include the necessary equipment such as ventilators and ancillary supplies including circuits and bacterial filters (supplies), hospital beds equipped for ventilation and comprehensive critical care (space), and specialised medical personnel to manage patients on mechanical ventilators (staff).
However it is estimated that there might be just under 400 ventilators in the country at the moment and difficult to tell if all of these are full-feature mechanical ventilators which are the sort indicated in the treatment of COVID-19 patients.
Clearly Nigeria does not meet the most basic capacity level that is Conventional not to talk of the other two – Contingency and Crisis capacity levels. The almost nonexistent ventilatory surge capacity is an indication of the lack of surge capacity which characterizes the Nigerian health system inability to deal with a surge expected in phase two or three of the pandemic. Quick adaptability of options in the private health sector is a much needed option to pursue.
Taking advantage of the CBN measures earlier enumerated, private health providers can make immediate investment in ICU infrastructure. Working through commercial banks who aggregate interested providers a minimum of 300 new ICU beds can be added to the health system. For hospitals with some existing ICU infrastructure a further 200 ICU beds can be added with only minimal capital outlay unlike in the first group.
It is heartwarming to see the Healthcare Federation of Nigeria rose to the occasion by organising a teleconference to articulate a strategic response on how the Private sector can be mobilized. Several of its leaders are members of the Presidential Task Force on the National COVID response. In a similar vein the organised private sector in Nigeria has come together in record time to set up the Private Sector Coalition against COVID-19 (CACOVID). This extraordinary coalition of some of the leading businesses and high net worth individuals in Nigeria is set to deliver about 2,500 beds including critical care beds and molecular testing labs in the next three weeks.
The frequency of testing is another area where the capacities in the private sector can be rapidly harnessed. Nigeria needs more testing. A million tests in the next four weeks should be possible. It is argued that allowing the private sector to test will boost the collector workforce, scale up operation, and reduce further person-to-person transmission. According to guidelines by the NCDC, the diagnosis of COVID-19 must be confirmed by reverse-transcription polymerase chain reaction (RT-PCR). There are companies like 54gene who have capabilities for molecular testing but also several of the privately owned labs can be used to collect samples for onward transmission to the accredited molecular testing sites.
At the end of the day the resolve of Government to partner with the private sector will be tested – it must be ready to contract and abide with the terms of such contracts. It will need to defer tedious rules and policy for more nimble engagement with the private sector. As we have seen from other lands where countries adapt quickly in dealing with COVID-19 such countries are one step ahead of the virus. The Nigerian Private health sector could provide Nigeria with that much needed head start.
…Okunola is a Senior Health Specialist for the World Bank Nigeria
(Views expressed in the article are those of the author and not of the World Bank)