Ugo Aliogo examines the commitment of the private sector to reposition healthcare delivery through the establishment of Private Sector Health Alliance of Nigeria (PSHAN)
The Nigerian healthcare sector is plagued by several challenges across the value chain. Most primary health centres are poorly equipped, with only about one-quarter of all facilities able to achieve up to 25 per cent compliance with stipulated minimum requirements. Drug availability is also a cause for concern, with less than half of all Primary Healthcare Centre (PHC) facilities having the listed essential drugs in stock.
Healthcare is majorly driven by the private sector, which serves as the first point of call for over 80 per cent of patients. In total, the private sector currently accounts for around 65 per cent of all healthcare provision in Nigeria. Most Nigerians pay for healthcare services out of pocket.
To address this gap in the health sector, the establishment of Private Sector Health Alliance of Nigeria (PSHAN), must be recognised. PSHAN is an unprecedented country-owned private sector-led coalition focused on mobilising the private sector’s collective capabilities, influence (advocacy), innovation, and resources to complement governments’ efforts in advancing the health Sustainable Development Goals (SDGs) and accelerate improvement in health outcomes.
The transition from Millennium Development Goals (MDGs) to Sustainable Development Goals (SDGs) provides a compelling opportunity for Nigeria to distill lessons from its MDGs experience, reshape its aspirations and engage the private sector through partnerships and innovative approaches with an overarching goal to support Nigeria’s Universal Health Coverage agenda.
In line with the government’s Universal Health Coverage (UHC) priorities as well as the 2030 Sustainable Development Goals (SDGs), the Alliance refreshed its mandate to complement government’s efforts in accelerating progress in women, adolescent, and child health in four programmatic areas: Expand basic services through strengthening Primary Health Care and providing integrated care at the frontlines, encourage healthy living and good quality of life by emphasizing prevention of disease and other areas.
PSHAN’s Vision
The Alliance was inspired by Alhaji Aliko Dangote, Mr. Jim Ovia, Dr. Muhammad Ali Pate, Mr. Aigboje Aig-Imoukhuede, Mrs. Sola David-Borha and other corporate business leaders in Nigeria in 2013 with a vision to be the country’s foremost private sector platform. The organisation is established to complement the federal government, partners and implementers’ effort in accelerating improvement in health outcomes by leveraging private sector innovation, advocacy, impact investments, and partnerships to support the Federal Ministry of Health’s Save One Million Lives Initiative.
PSHAN based its strategic approach on the premise that the vibrant and fast-growing private corporate sector in Nigeria with its business techniques, innovative approaches, influence, reach, resources and capabilities can yield huge gains in the health sector if harnessed strategically and aligned to the government’s priorities.
The alliance focuses on four main strategic pillars; innovation, partnership, advocacy, and impact investment.
The transition from Millennium Development Goals (MDGs) to Sustainable Development Goals (SDGs) provides a compelling opportunity for Nigeria to distill lessons from its MDGs experience, reshape its aspirations and engage the private sector through partnerships and innovative approaches with an overarching goal to support Nigeria’s Universal Health Coverage agenda.
Positioning Health Sector
In a bid to improve healthcare delivery in Nigeria, the Private Sector Health Alliance of Nigeria (PSHAN) is seeking to use Adopt-A-Health Facility Programme (ADHFP) as a vehicle. The initiative was conceptualized by one of the Board Members, PSHAN, Mr. Aigboje Aig-Imoukhuede, and PSHAN with the aim of delivering at least, one global standard PHC in each of the 774 Local Government Areas (LGAs) in the country.
The proposed initiative will implement a market-based private sector-driven intervention to provide low-cost, high-volume health services to the public. ADHFP will operate through a chain of integrated Primary Healthcare Centres in each of the 774 LGAs and will be sponsored by high net worth individuals (HNIs)/private citizens who will be known as ‘adopters’. The primary target market consists of the low-income population, living in rural areas and urban slums. Adopters will build or adopt the health facility, take responsibility for all aspects of making it functional, efficient, and effective throughout the adoption period which, in the first instance, is five years.
To further conversation on the initiative, PSHAN convened a roundtable of over 40 stakeholders to discuss the PHC Adoption Initiative, put forward knowledge from similar programmes, concerns, questions, suggestions and agree on various workstreams that would be required to take the initiative to the next level.
In his opening remarks, Aig-Imoukhuede, spoke about basic rights and the right to health, and emphasized the need to serve humanity.
He reiterated the need to create a private stakeholder group, which can assist the government in improving healthcare in the country, adding that this led to the concept of the PHC Adoption Initiative “where each of the 774 Local Government Areas (LGAs) in Nigeria has a functional PHC that can deliver global standard healthcare services to the surrounding communities.”
“For I was hungry, and you gave me food to eat, I was thirsty and you gave me drink, I was sick and you visited me. If we form a coalition of private sector stakeholders, we can work with government and do bold ambitious things in the health system,” he noted.
Aig-Imoukhuede opined that it would be easier for philanthropists to get the government of their respective LGAs on board since they would have more influence in their states of origin.
On her part, the Senior Special Assistant to the President of Nigeria on Sustainable Development Goals (SDGs), Princess Adejoke Orelope-Adefulire, lauded the initiative and also pledged her support.
Orelope-Adefulire hinted that the brownfield model is better because constraints like acquisition of land would be avoided.
She revealed the importance of incorporating health insurance to the scheme and suggested using the National Youth Service Corps Doctors to man the PHCs.
She recommended that provisions should be made to accommodate the health workers close to the PHCs and also drew attention to the inadequacy of Schools of Nursing.
She expressed assurance that she would bring the State Governors onboard.
The event also provided the platform to present the Concept Note, which was done by the Chief Executive Officer, PSHAN, Mr. Sonny Nwarisi, who reiterated the need for a functional primary healthcare system.
He highlighted the present challenges being faced by the PHCs, categorizing them into demand sided challenges such as poor quality of care, poor accessibility and inability to pay for services, and supply-side challenges like inadequate funding, talent, infrastructure, and governance.
He stated that it would cost NGN141million in the brownfield model and NGN182million in the greenfield model to adopt and run a PHC for 5 years.
War Against Malaria
The PSHAN in partnership with Access Bank Plc and GBC Health convened private sector partners including Banking/Financial Services, Telecommunications, Fast Moving Consumer Goods (FMCGs), Development Partners and other stakeholders in April 2016 launched the ‘Malaria-to-Zero’ Initiative, an innovative financing platform, to galvanize private sector assets, resources, and capabilities for sustained support towards averting at least one million malaria cases and deaths by 2020.
The launch of the initiative is seen as a first step towards complementing government’s effort in achieving its malaria pre-elimination goals by 2020 and a Malaria-Free Nigeria by 2040. The Alliance believes that transition from malaria control to elimination provides a compelling opportunity to inspire bold, innovative approaches, and complementary non-traditional public-private partnerships, to disrupt poor malaria outcome and catalyze a path towards achieving Nigeria’s pre-elimination targets by 2020.
Since the launch of the MTZ initiative, over 15 corporate organizations signed and committed to the malaria pre-elimination project, including Dangote Foundation, Stanbic IBTC PLC, Zenith Bank PLC, GlaxoSmithKline and Etisalat. In Q1, 2017, benefitted from Behavioural Change Communication and effective demand creation materials as well as Long Lasting Insecticide Trated Nets (LLINs) in under-served communities while stimulating in-country production of LLINs.
Strengthening Maternal Health
The PSHAN is contributing to strengthening the nation’s health care system by improving demand creation promotion, delivery and utilization of health and nutrition services by women and children, increasing coverage of MNCH Week interventions and improving human resources for health capacity of health workers to deliver quality health care services.
Until now, the demand for critical maternal newborn and child health services have remained low for vulnerable pools during Maternal Newborn and Child Health (MNCH) Weeks campaign, a biannual national mass campaign.
The need to urgently interrupt and reverse the trend necessitated the Alliance to deliver a package of high-impact maternal, newborn and child health interventions in several states of the Federation, proven to be effective in both reducing mortality rates and improving mother and child health during the bi-annual MNCH weeks. The benefiting States are selected following needs-assessment analysis against the backdrop of poor maternal and under-5 health indices as well as their MNCH week needs.
The impact
Aig-Imoukhuede stressed that the initiative would be funded by Nigerians and hinted that if it is shown to work in a particular state, other philanthropists would be encouraged to replicate it in their own States and there is a potential for replication even beyond the borders of Nigeria.
He further explained that the various workstreams would be constituted for the purpose of the initiative.
The expected impact of the initiative includes; saving lives, improvement in health outcomes, job creation, stronger civic engagement, greater government accountability, and others.
Solution
Orelope-Adefulire stated that the brownfield model is better because constraints like acquisition of land will be avoided.
She also highlighted the importance of incorporating health insurance to the scheme and suggested using National Youth Service Corps Doctors to man the PHCs.
She recommended that provisions should be made to accommodate the health workers close to the PHCs and also drew attention to the inadequacy of Schools of Nursing, while assuring that she would speak to the governors to get them on board.
The Founder, Flying Doctors, Dr. Olamide Brown, saida unlike in the United Kingdom, patients in Nigeria visit secondary and tertiary health facilities without going through the PHCs leading to increased pressure on the secondary and tertiary health centres.
On his part, Aig-Imoukhuede opined that it would be easier for Philanthropists to get the government of their respective LGAs on board since they would have more influence in their States of origin.
The President, Health Federation of Nigeria’s Mrs. Clare Omatseye noted that 26 States have signed the mandatory health insurance and that there is a need to look at partnerships with the state health insurance.
She pointed out that power is still a major issue and severely limits the quality of healthcare that can be provided.
She also reiterated the need for reorientation of health workers and suggested that advocacy should be done at various levels.
Omatseye posited that the N21million budgeted for the brownfield model should be looked at because it would cost way more than this to restore a PHC in a very dilapidated state.
The Chief Executive Officer, Aliko Dangote Foundation, and board member of PSHAN, Ms. Zouera Youssoufou, highlighted the importance of focusing on the quality of service.
She added that patients would not come back if there is poor quality of service.
