Garki Hospital: Model for Access to Healthcare through PPP

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By Remi Adebayo

At the centre of everyone’s priority is good health. In fact, no life is worth living without a complete state of wellness wherein the physical body can sustain a functional mind towards productive living.

The World Health Organisation, WHO, defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Indeed, only absolutely healthy individuals can contribute meaningfully to the society, their immediate families and the world at large.

However, with about 70 percent of the Nigerian population living in the semi-urban and rural areas, affordability and access to quality healthcare remains a major challenge. Those in urban centres have peculiar challenges to cope with.

For instance, population in the Federal Capital Territory has grown from 1.5 million in 2007 to 3.4 million, representing an annual increase of 5.67 percent. Estimated increase in 2020 stood at two million. The number of people living in the FCT has doubled in about 20 years, tasking government’s response in the provision of infrastructure and services.

To the average FCT resident, government hospitals remain the option when considering accessibility, affordability and quality service; they are however often mindful of the costs, waiting time to see a doctor or have their laboratory tests conducted.

To bridge these identified deficiencies and also bring the decaying public hospitals back to life, the FCT Administration in 2007 initiated the Public-Private-Partnership model which led to the concession of the Garki General Hospital to Nisa Premier Hospital. The initiative was to offer guaranteed services, upgrade facilities and improve healthcare for all categories of Abuja residents.

Nisa Premier Hospital emerged tops after a keenly competitive bid to manage the government-owned Garki Hospital, which had earlier been shut for six years, to allow a turn-around. The concession on PPP basis is reputed to be the first of such model in the health sector in Nigeria.

The PPP idea was meant to support and stimulate collaborations between healthcare providers and consumers as a response to challenges of underfunding, poor maintenance culture, poor staff attitude and frequent industrial actions in the public hospitals.

The Medical Director, Garki Hospital, Abuja, Dr. Adamu Onu recommends the PPP model in addressing the shortfall in the Nigerian healthcare sector. The ‘marriage’ between Nisa Premier and Garki Hospital has successfully passed this test. Since the partnership was sealed in 2007, the hospital has not shut its doors for a single day and not a single staff has been laid off, Dr. Onu said in an interview.

“It is clearly evident that the PPP model of which Nisa Garki Hospital, Abuja is the exemplar, provides a clear pathway to upgrading and extending the Nigeria healthcare sector to world best standards, especially at this time when government finances are severely constrained,” Onu stated.

Earlier last year, the Chairman, Presidential Task Force on COVID-19, who is also Secretary to the Government of the Federation, Boss Mustapha admitted that the coronavirus pandemic provided a unique opportunity to x-ray the state of the health care sector which is in dire need of reforms and funding.

Nigeria’s current estimated population is 211.4 million, placing it as the seventh most populous country and expected to rank third globally by 2050 going by United Nations’ projections. While such growth rate can be an economic advantage considering the benefits of a large market, planners are concerned about the pressure on infrastructures and basic services such as health care, potable water and transportation.

This perhaps has led to recurring labour unrests; situations that create worker – government confrontations in Nigeria. Unfortunately, the health sector has not been spared. But disputes leading to the closure of hospitals are alien to Garki Hospital since 2007.

For those that are yet to experience its services, it will be quick to predict the curiosity to understand the significant achievements, aside from staying on their humanitarian duty post for unbroken fourteen years that Nisa Premier has taken charge of Garki Hospital.

The first has to do with affordability, and the records are there. Management believes that the cost of health care should not be determined by the size of the patient’s pocket. So, through the PPP, the hospital has helped to bring down the direct and indirect cost of health care by offering globally available tertiary health services within proportional rate and shortened consulting period. This is facilitated by the deployment of cutting edge ICT technology across the value chain: consultation, laboratory, radiography and even payment processes. The hospital is ICT-complaint and users can attest.

Dr Onu disclosed that the vision of the partnership is to offer world class health care. “The truth of the matter is that this hospital is fully digitalized. You come in here without files being pushed up and down. You are not going to have the story of ‘Oh sorry, we have misplaced your file, we cannot find it.’ That is not a question that arises here, the in-patient, the out-patient, the labs, the pharmacy, everywhere is fully computerized.

“So right from the consulting room, the doctor can see the patient’s lab result. Here it’s unlike other places where you have to go and queue up in the lab to collect your result before you go and see the doctor. That is an example of what I call indirect cost. Time is money and then you spend like 30 minutes to pick up your test result, may be you spend another before you see the doctor; that is completely eliminated here,” Dr Onu further explained.

Outside the issue of waiting time, the Hospital has also stepped up its services to include advanced diagnostic aid, CT scan, advanced MRI with state-of- the- art tools for monitoring, such as fibroid scan among others.

Head, Department of Obstetrics and Gynecology, Dr Fidelis Bakut, an obstetrician gynecologist, explained that the department has gone beyond routine antenatal care and some basic gynecological operations. It now safely delivers premature babies weighing less than one kilogramme; and from just basic fertility management to providing low–cost in vitro fertilization (IVF) since 2014 with high success rates.

The hospital has similarly acquired modern equipment to handle highly specialized gynecological and laparoscopic surgeries. There are plans to acquire more and undertake advanced laparoscopic and endoscopic surgeries.

In October 2019, the Garki Hospital became the first in sub-Saharan Africa to carry out Sleeve Gastrostomy, a surgical weight-loss procedure performed by inserting small instruments through multiple small incisions in the upper abdomen. By implication, Nigerians should no longer seek medical tourism in view of the feat at Garki Hospital.

The Hospital is deliberately pursuing manpower development even as it gains recognition for advanced medical training.

“All our medical officers and doctors here receive Advance Cardiac Life Support Training. We are an accredited center for training house officers; a key area with lot of issues in other establishments. We have newly graduated doctors that need to have post registration training before they become fully registered doctors. There is shortage of training slots across the country and we stepped in and got accredited by the Nigerian Medical and Dental Council,” said Dr. Onu.

The Nisa Garki PPP has earned accreditation for Post Graduate Residency Training in several specialties including obstetrics and gynecology; family medicine, pediatrics, and anesthesia. The hospital remains the only center accredited in the whole of West Africa for Post Fellowship Diploma Training in Assisted Reproductive Technology. Indeed, it also prides itself as the only centre in West Africa to have achieved that feat and it has created opportunity for consultants from other hospitals to train and obtain their diploma from the West African College of Surgeons.

With the success posted by the Nisa Premier-Garki Hospital partnership, the Infrastructure Concession Regulatory Commission in 2017 indicated the possibility of replicating the initiative to revive more fledgling health care centres in Abuja. The plan entailed a world class case study of the hospital in order to ascertain the factors responsible for its success and possibly deploying same to replicate the same arrangement across the country.

Data from Healthy Partnerships in 2010, relying on a World Bank report, declared the Garki Hospital as a model PPP hospital. Here a private provider manages a government structure and a pattern where patients get higher-quality services than at public hospitals and at cheaper rates than other private centers.

“Resources available to government are limited and there is so much that they need to do; why not invite the private sector so they can also share that burden and deliver health care to Nigerians. That is what the government has been able to achieve here in Garki Hospital,” said Dr. Onu.

The PPP initiative involving Nisa Premier and the FCT in managing once moribund Garki Hospital has proven to be amazing as a creative solution for policy makers. It is necessary for government to speedily embrace revitalizing the insufficient health facilities due to limited resources at its disposal and realities of the populace in need of unhindered, quality and affordable health services.