Dr. Folarin Olasogba is the Chief Project Officer of PreDiagnosis Telehealth Consult. In this interview with Nseobong Okon-Ekong, he spoke on the challenges confronting public health management in Nigeria and how these can be surmounted. He also talked on how PDT hopes to deliver affordable basic healthcare services to 20 million poor and vulnerable Nigerians
With the ravaging COVID 19 putting all nations of the world on their toes, do you think Nigeria is doing enough to curtail the pandemic?
My personal assessment of the country’s emergency response to this current health crisis is very positive. To the extent that the COVID-19 pandemic is a novel experience that caught the whole world unawares and to the extent that even the world’s best, in terms of health management systems, have been struggling with the pandemic, Nigeria, through the Nigeria Centre for Disease Control (NCDC) has provided a mature, organised and commendable plan for managing the pandemic. I am sure our experience, knowledge and systems will improve tremendously from this turn of events.
Are there lessons learnt by Nigeria at all from this pandemic? If yes, what do you think can be done to institutionalize and domesticate them as policies for the future?
It is not an exaggeration to say that COVID-19 has exposed the soft underbelly of our country’s healthcare system. No thanks to our ill-preparedness for outbreaks of such magnitude. More than anything else, the deadly disease has practically showed the necessity for greater collaboration on health issues as well as the power of data and digital tools to combat the outbreak of pandemics or even some opportunistic infections. It has also reinforced the need for targeted digital health strategies to help countries like Nigeria get the most out of digital technology tools. Without the right strategies and technical and resource support, it is now increasingly clear that the gap in the digital divide will produce nothing but failing health outcomes.
Across the world, digital health is fast becoming the fad especially among low and medium income countries with the huge responsibility to overcome traditional barriers to better health care, which includes dearth of medical staff and professionals and other physical resource constraints.
What role do you see medical intelligence and surveillance playing in prevention and management of deadly infections and diseases in Nigeria?
Sadly, despite Nigeria’s strategic position in Africa, it is highly under-served in the healthcare delivery sphere. Health resources such as facilities, personnel, and medical equipment are inadequate, especially in rural areas.
Significantly, public healthcare delivery is hampered more by inadequacy of healthcare resources particularly personnel, drugs and other medical equipment needed for holistic patient treatment. For instance, the doctor to patient ratio is currently 1:6000. Most of the available qualified doctors are concentrated in urban cities and towns while the rural areas have next to nothing, thereby leaving room for self-medication and also for quacks and other unqualified hands to tend citizens’ health needs. As at today, most PHCs, especially in rural areas, rot away due to lack of capable personnel to man them.
Given the above scenario, the primary challenge confronting the country’s public health system today is how to create and sustain an information-rich and patient-focused health care system that reliably delivers high-quality, affordable and accessible healthcare services that can ride on strong deployment of technology to strengthen healthcare accessibility at the grassroots.
Is the current model of public healthcare delivery in the country working?
Healthcare services delivery must undergo a transmutation from the physical, brick and mortar format to a more tech-driven approach. This means the concept of tech-for-health or health ICT must be elevated and Nigeria, now more than ever before, must confront using technology to transform her healthcare delivery system in a way that ensures a win-win for all.
How can Nigeria address issues around healthcare financing?
Over the years, public health financing has been a major barrier to building a strong healthcare system in many countries, not just Nigeria alone. Regarding Nigeria, at the moment, the total health expenditure is derived from the allocations for health and allocations for the Basic Health Care Provision Fund, which is put at one per cent of the consolidated revenue fund. Since the inception of BHCPF, however, its allocation has always been below the earmarked one per cent; the allocation in 2020 is about 50 per cent less than the value of the one per cent of CRF.
Because of the worsening financial capability of the country, expecting additional government funding for the health sector is a mirage; and without something significantly revolutionary being done in this ugly circumstance, demand for healthcare services, especially critical care services, may become overwhelming for the public health sector. This is likely to have long-term consequences for the health sector, as well as spillover effects to the rest of the economy in many ugly forms.
From your experience, how possible is it to deliver affordable healthcare, most especially for the poor and vulnerable people in rural areas?
It is very possible and cheap, too. Remember that modern day public healthcare is efficient only when health services can reach the hard to reach areas, when location, economic and social status do not dictate access to quality health services, when the have and have not have equal access to basic healthcare services and only when all people and communities can use the promotive, preventive, curative and rehabilitative health services they need in sufficient quantity without exposing them to financial hardship as declared by the World Health Organisation.
Could you be more explicit on how these efforts could benefit the poor and vulnerable in the society, given the general poverty level they face?
At the center of our commitment is the deployment of ultra-modern technology to create the PDI Telehealth Hub and the PDI Telehealth App for macro and micro management of public health delivery.
The PDI Telehealth Hub is a Community health platform in the form of a solar-powered mobile clinic that can be placed anywhere and manned by a specially trained staff recruited from the host community. The hub is connected to the expansive PDI telehealth central control room where doctors are available 24/7 to micromanage these hubs. The result is delivery of continuous medical services on the ground within a community (remotely) by our medical doctors, leveraging technology but totally adapted to the culture, lifestyles and worldview of the host communities.
On the other hand, PDI has also harnessed technology to develop an app that allows individuals to consult and receive wholesale treatment for many minor and major health challenges from doctors via the cellphone without physically visiting the hospital.
The PDI App is available on Google play for download by android phone users. It is an interactive mobile application that gives users immediate access to highly trained and experienced doctors.
What stands PDI out among the list of healthcare providers in the country?
Our organisation, PreDiagnosis International, is a semi-philanthropic, hybrid telehealth service provider founded in 2018 to help in bridging the dangerous and widening gap in the Nigerian healthcare delivery system. We operate as a quasi-charity entity and not strictly a business-for-profit concern. So, we are on a compassionate national rescue mission.
PreDiagnosis International’s goal is to offer cheap, affordable and innovative telehealth solutions that would be at the forefront of reducing the disparity that exists in the availability, accessibility, and affordability of quality healthcare services in the urban and rural areas on the one hand, and between the elites and the poor and most vulnerable citizens, on the other hand.
What are PDI’s target projections for the health sector?
The Vision, Mission and Target of the PDI initiative is encapsulated in the PDI RRF 20-2030 brand Mantra. Under our Reach, Rescue and Fortify Mission, PDI has the target of helping Nigeria to deliver qualitative healthcare services to, at least, two million Nigerians annually between year 2020 and 2030 using technology-driven but largely grassroots focused platforms and model. This, in a nutshell, is what we have termed Project RRF 20-2030.
This Project RRF 20-2030, which is the core of our mandate, aims to deliver quality healthcare services to the remotest, under-served areas across the length and breadth of Nigeria by leveraging technology to maximize the scarce human resource for health (HRH) through effective and efficient use.
At PDI, we believe that our mission would not be fulfilled until when quality health services have reached the hard to reach areas; when location, economic and social status do not dictate access to quality health services; when the have and have not’s have equal access to basic healthcare services; among others.
How best can we take advantage of partnerships, especially as it relates to COVID 19?
Stakeholders in the health sector need to collaborate on diverse levels as a way of bridging the gap in the nation’s health delivery landscape. A robust alliance between the public and private sectors for overall healthcare services development in the country should be of primary concern to all. For instance, under our Corporate Initiative, PDI has a thriving collaboration with the Project ECHO Institute of the University of New Mexico, ALBUQUEQUE, USA.
Project ECHO which stands for Extension for Community Healthcare Outcomes is a collaborative model of medical education and care management programme designed to empower local clinicians (Consultants, Doctors, Nurses, Technicians, etc) to deliver better care and treatment of chronic, common and complex diseases, especially in remote and underserved locations. PDI is the Nigerian Official Replication Partner with the Project ECHO Institute of the University of New Mexico.
How does Nigeria stand to gain from projects and collaborations like Project ECHO?
The mission of PDI in undertaking the Project ECHO is to assist the country develop the capacity to safely and effectively treat chronic, common, and complex diseases in rural and undeserved areas across Nigeria and to monitor outcomes of this treatment while leveraging our Telehealth consult platform.
The Project not only uses innovative technology to bridge the gap between urban and rural healthcare specialists and providers in the country; it helps health services providers to undertake co-management of patients’ treatments, thereby fostering knowledge depth and technical competencies, in addition to reducing professional isolation. By encouraging collaboration and communication between rural and urban service providers and specialists, the Project helps health professionals in the country to become highly skilled in the treatment of diverse chronic and complex diseases, thus creating a center of excellence in many remote communities.
This means with the PDI Project ECHO Initiative, we are committed to building a Clinical Knowledge Platform that combines authoritative contents and shared experiences drawn from the expertise available in the Nigerian healthcare community and across the world so that Physicians, medical students and other healthcare workers will be able to tap into Nigeria’s largest, most powerful Continuous Professional Development (CPD) network to resolve challenging questions at the point of care for mostly lower-income patients for different diseases.
Nigeria needs more initiatives like this to truly create a modern health service sector post COVID-19.