Ill-equipped PHCs, Bane of Nigeria’s Healthcare System – Famacare CEO, Ofulue

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On a mission to reinforce the fact that primary healthcare is an integral aspect of Universal Health Coverage and to change the face of primary health care in Nigeria, Famacare Centre was established by Uzor Ofulue in 2019. Since then, they have been committed to providing quality primary healthcare services to residents of densely populated areas. In this interview with Precious Ugwuzor, several issues surrounding primary health care and its importance in the entire health sector in Nigeria were brought to the table

Who exactly is Uzor Ofulue?

I like to refer to myself as a meta leader intentionally linking and leveraging the efforts of multiple stakeholders to achieve the required objectives. I have about 17 years of progressive work experience spanning five sectors: Healthcare, Management Consulting, Technology, Insurance, and Shipping. I am a strategic healthcare business leader through my involvement and successful delivery of numerous innovative healthcare products and solutions that cut across private and public sectors.

I am currently the Founder and CEO of Famacare Centre Limited – a network of integrated clinics that leverages technology to provide low-cost, high-value primary healthcare services to densely populated communities. I am also a Partner at Lauren Parker limited – a professional services company that provides consulting and advisory services in Strategy Formulation, Business Process Management, Optimisation, and Improvement.

Outside of work, I am keen on giving back and have been an executive member of the Delta Economic Summit Group (DESG) for the past six years. I am an active part of the team, responsible for delivering youth employability programs and other strategic projects in Delta State.

I have a BSc in Microbiology from the University of Lagos and an MSc in Health Economics from the University of Sheffield.

One of your main focus is on effective malaria management in the communities. What impact has your organisation made in these communities? 

In the three years we have been in existence, we have worked on improving primary healthcare services in various communities. We now have two main centres in Lagos: Egbeda and Abule-Egba. On April 25, which is World Malaria Day, we offered free malaria testing and treatment to residents of our host communities. We tested approximately 200 individuals for free, and those who tested positive for malaria got free consultations followed by dispensing the necessary treatment.

We have weekly health talks where we educate the community about malaria prevention by cleaning surroundings, emptying congested drainages, getting rid of stagnant water, and regular fumigation – a cheaper and more effective option using kerosine in place of insecticides.

We also discovered that nutrition is a major issue in the country and balanced diets are major immunity boosters. Because of the economic situation and our busy lifestyles, most people do not pay enough attention to their nutritional needs and cannot afford expensive supplements that can provide the body with the relevant immunity boosters. So, we educate them that by simply introducing fresh fruits and vegetables into our diets, we can give our bodies the nourishment to keep both adults and children healthy.

Why is it taking Nigeria so long to tackle the malaria scourge effectively?

Sadly, the malaria scourge has lingered for a long time in Nigeria, but it’s not just Nigeria. According to the World Malaria Report published by the World Health Organisation (WHO) in 2021, a new cause-of-death methodology was reported across 32 countries in sub-Saharan Africa. It revealed an increase in malaria in African children every year since 2000.

However, I believe challenges such as funding, inadequate healthcare facilities, brain drain of qualified healthcare personnel, poor access to healthcare centres due to rurality, road conditions, and drug-resistant malaria slows down the fight against malaria.

In addition, the lack of adequately equipped Primary Healthcare Centres (PHCs) with effective and efficient resources, including manpower, is a major bane in the pressure experienced at the country’s secondary and tertiary healthcare facilities. Therefore, trained medical practitioners should treat some medical conditions at the PHC level to eliminate the pressure at the secondary and tertiary levels of care.

Also, extensive research on malaria treatment needs to be done. If researchers have access to grants and funding, there will be more studies to solve this problem.

The theme of World Malaria Day 2022 is “Harness innovation to reduce the malaria disease burden and save lives.” How can diagnostics and antimalarial medicines speed the pace of progress against malaria?

Diagnostics are critical in accelerating the treatment of any disease, not just malaria. Unfortunately, wrong diagnoses are increasing and an ongoing challenge within the sector. When patients are not appropriately diagnosed, the wrong treatment is administered, leading to complications and death in some extreme cases. Famacare has adopted the Gold Standard Thick and Thin Blood Film test against the more popular rapid diagnostic test for effective diagnosis.

Antimalaria medicines prevent malaria, referred to as chemoprophylaxis in medicine, as it kills the blood stage of the malaria parasite, preventing the symptoms of the disease and eliminating the parasite before it can cause illness. Antimalaria medicine is an alternative to all the other preventive measures I mentioned earlier; hence if all else fails, antimalaria treatment can equally achieve the same objective.

 Antimalarial drug resistance is a significant threat to malaria. How does this need to be tackled?

Research suggests that malaria parasites become resistant to antimalarial drugs. Parasite mutation rates, the overall parasite load, and dosage strength of the medicines are factors driving the resistance.

Many years ago, it was customary to treat malaria with Chloroquine. Then came Artesunate, Artemisinin-based combination therapies (ACTs).                                                                                                                                                                                                                                                                                                                                                                                    This is because the parasites become more resistant to the previous treatments. Also, people must adhere to the treatment guidelines, read the doctor’s/pharmacist’s prescription, and follow the guidelines on administering the dosage; complying with instructions is critical.

Furthermore, the menace of fake drugs cannot be ruled out in the malaria scourge. This is an ongoing battle in Nigeria, and the regulatory bodies are trying their best to put structures and frameworks to mitigate this scourge.

What is your take on the malaria vaccine?

I believe this is a giant leap toward the fight against the disease. According to the WHO, over one million children in Ghana, Kenya and Malawi have taken one dose of the RTS, S vaccine. This first antimalaria vaccine will go a long way to curb the disease. Unfortunately, while the report further states that the vaccine was pioneered in Malawi about three years ago and certified by the WHO as safe and will substantially reduce severe malaria cases, it failed to mention when it will be available in Nigeria.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        

Is data paucity a frustrating battle against malaria in Nigeria?

Yes, data paucity frustrates the battle against malaria. Where data is unclear, inconsistent, or unavailable, it is pretty challenging to address the problem of malaria. However, various country programmes are reviewed to clarify and fill in the gaps where necessary.

Countries need to have an accurate database of malaria cases as this is helpful in the fight against malaria. That is why at Famacare, we have completely digitalised our processes. All patients’ records are captured and saved to the cloud. This means we already have a data warehouse from our patients over the last three years and working with cyber security experts to ensure the data is protected.

This approach has drastically reduced wait time at the clinic. In addition, there is no paper file or crosschecking data, instead, the patient’s entire medical history can be viewed with a simple click on the computer.

This also means that even when patients change locations, they can walk into any of our partner health facilities, and with the help of technology, their medical records can be accessed without the need for fresh medical investigations.

With all these data pooled together, the various country programme coordinators and health administrators can seamlessly collate the data, analyse and extract the information needed to fight malaria.

 Why is the country not attracting more private capital to tackle the malaria scourge?

I believe many corporate organizations don’t really consider malaria a ‘major’ ailment; however, it can have devastating impacts on the economy.

For instance, a report by the National Malaria Control Programme under the Federal Ministry of Health on ‘Engaging the private sector to eliminate malaria in Nigeria’ stated that Nigeria loses about US$1.1 billion annually due to malaria-related absenteeism and treatment costs.

When adults are infected with the malaria parasite, they are off work for three to five days, and when their children fall sick, they still have to care for them. This affects the organization, employed or self-employed, whether in the public or private sector. Based on this significant impact on corporate organizations, they must explore avenues to fund/sponsor the various ongoing malaria programmes.

While governments are the biggest drivers of healthcare capital investments, this is the time for private sector partnership.

For instance, we have seen the rise of many private sector-led interventions and funding in the fight against malaria; an example is the End Malaria project, supported by notable organizations within the private sector. However, we need to see more of these collaborations, and this can only happen if companies begin to consider malaria as a major disease with a tremendous economic impact.

What are your thoughts on the Nigerian health tech system?

Technology in the health sector has made the industry more efficient, simplifying operations and helping better manage patient records/ data ( amongst other aspects) to be easily stored and accessible irrespective of the location.

At Famacare, we are pretty big on technology. For instance, we run paperless operations; hence patients’ registrations, test results, and drug purchase processes are digitized, meaning patients’ medical records are digital, and documents can be accessed from other clinics/hospitals when we refer our patients. Furthermore, other operations besides patient onboarding and care have been digitized; our procurement, HR, Finance, and other core processes have been digitized to minimise human interventions and manual processes.

So adoption of technology in the sector is very impactful; it reduces the cost of operations and ultimately boosts the healthcare system.

Quote“The lack of adequately equipped Primary Healthcare Centres (PHCs) with effective and efficient resources, including manpower, is a major bane in the pressure experienced at the country’s secondary and tertiary healthcare facilities”