Verraki Africa: The Promises of Digital Transformation in the Nigerian Healthcare Sector
Health is wealth, but healthcare indicators in Nigeria have continued to deteriorate. The country has struggled for decades to establish a functional primary healthcare system, talk less of tertiary healthcare. According to the 2022 world health statistics of the World Health Organization (WHO), healthy life expectancy at birth in Nigeria is 54.4years, whilst under-five mortality rate is 114 deaths per 1000 live births (second highest globally). Only 43 per cent of births in Nigeria are supervised by skilled health personnel, hence the high maternal mortality (1 death for every 109 live births – the fourth highest in the world). Across other indices such as emergency response, malaria, tuberculosis, HIV infections and Hepatitis, Nigeria performs worse than the average African region ratings. These indices typify a healthcare system in need of serious reforms.
Verraki says it is passionate about helping businesses and governments in Africa solve seemingly intractable challenges, adding that Healthcare is one area it desires to see huge transformation in the years ahead.
According to Verraki, Nigeria’s population has doubled in the last 30 years to 218 million people (2022 estimates). By the year 2050, (in 28 years’ time) the population is projected to hit 440million people, to emerge the world’s 3rd largest. The country certainly and urgently requires a swift, unprecedented, and technology-driven healthcare reforms and investments to position for this population boom and change the current narrative that puts Nigeria as one of the countries with worst health outcome globally.
The challenges confronting the Nigeria healthcare system are multidimensional. According to data from the WHO, Nigeria accounted for the largest (31.9%) of the 627,000 global deaths from malaria in 2020; followed by the Democratic Republic of the Congo (13.2%). Available data puts out-of-pocket health expenditure in Nigeria at 70.5% (31% in sub-Saharan Africa) of annual health expenditure, an indication of poor health system financing, which the population tries to remedy through household spending. By implication, a very large proportion of the population have a high risk of financial distress or death in the event of any severe health challenge, given the 40% poverty rate. This is very troubling.
According to the founding documents of the WHO, “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”. Good health is also clearly determined by other basic human rights including access to safe drinking water and sanitation, nutritious foods, adequate housing, education, and safe working conditions. For context, the primary healthcare is managed by the local government, the secondary care is administered by the state government and tertiary care falls under the control of the federal government. Ideally, the first major point of contact of the populace with the healthcare system should be the primary healthcare facilities nationwide, but these facilities are neither adequate nor functional, for the most part. Yet, primary healthcare is fundamentally effective in the management of Noncommunicable diseases (NCDs) which is responsible for 41 million deaths each year, equivalent to 74% of all deaths globally. Low- and middle-income countries (Nigeria inclusive) accounts for 77% of global NCD deaths.
Healthcare can be financed through a combination of public expenditure, private expenditure, or external aid.
According to World Bank report, the WHO recommends allocation of 15% of national budget to healthcare, but the Federal Government of Nigeria spends less than 5%. Protracted poor funding is arguably the root cause of many challenges confronting the Nigerian healthcare system, from weak health infrastructure to the frequent industrial actions by healthcare workers, and the exodus of Nigerian trained doctors and healthcare workers abroad. In the 2022 budget, the Federal Government of Nigeria planned to spend (4.7%) N820 billion (about US$2billion) to cater for the healthcare needs of over 200 million people and this will complement the spend by states and the local governments. South Africa (with a population of about 50 million) budgeted R259 billion (about US$16 billion) for health in the same year. Current health expenditure (% of GDP) is 3.0% in Nigeria, and 9.1% in South Africa; whilst health expenditure per capita for both countries stood at US$71.5 and US$546 respectively. Relative to the size of the economy and population, Nigeria’s public healthcare expenditure is one of the lowest in Africa.
The World Bank document further said Nigerian health system primarily relies on out-of-pocket (household) expenditure, given the limited spread of universal health coverage (UHC). Such reliance on a population with US$2,085 per capita GDP would imply perpetual funding shortages for the healthcare providers, and further social-economic challenges for the people. The government kick-started the National Health Insurance Scheme (NHIS) in 2005, but the scheme today covers less than 10% of Nigerians mainly private sector workers plus federal and state government workers. Also, less than 3% of the Nigerian population are under the private health insurance (PHI) coverage. The National Strategic Health Development Plan 2 (2018–2022) sets a target of reducing out-of-pocket expenditure to 35% of overall health expenditure, however the latest available data shows that out-of-pocket expenditure still accounts for the largest 71% of all health expenditure in the country, according to World Bank report.
Data from the WHO shows that Nigeria has the second highest health donor funding per capita amongst Africa’s five largest economies but ranks the lowest in most health indices. A recent report from the ICIRC documented that Nigeria received about US$1.1 billion in foreign aid to fight malaria between 2014 and 2017, from donor agencies such as the Global Fund, World Bank, USAID, DFID, UNICEF, WHO and UNITAID. Nonetheless, the 2021 World Malaria Report shows that Nigeria accounts for about 32% of global deaths from malaria, the largest globally. Donor funds will have greater impact when the government demonstrates institutional agility, spending effectiveness, financial transparency, and accountability to implement targeted programmes; and with firm commitments from state governments to pay counterpart funds promptly. Nigeria is yet to score high in these areas.
Verraki believes that digital healthcare transformation holds great potential for Nigeria. According to Verraki, it’s optimism is built not on the readiness of healthcare institutions and policy makers for such a leap, but rather emphasise the relative readiness of the market, investors, and the Nigerian people.
Verraki says for digital healthcare to thrive across locations, there must be institutional, infrastructural and policy support that will facilitate the emergence of new business models in care delivery. There must be targeted investments –in digital infrastructure, in governance, in institutional capacity, in people and processes, and in ecosystem enablers. A desired outcome of these investments is empowered practitioners and patients towards the achievement of healthcare for all.
Verraki highlighted some of the building blocks to achieve digital healthcare in Nigeria to include the following:
That Nigeria needs a robust digital healthcare policy. Over the years, the government did come up with various policy frameworks to revitalise healthcare in the country. These include the National Health Act (NHAct) 2014; National Health Policy (NHP) 2016, Health Financing Policy and Strategy 2017, amongst others. Recently, the President signed the National Health Insurance Authority Act 2022 which repeals the National Health Insurance Scheme (NHIS) Act. The new act makes health insurance mandatory for all Nigerians. Nigeria’s current second National Strategic Health Development Plan (2018-2022) has five strategic pillars and 15 priority areas. Digital health did not feature in either category.
Verraki believes that a carefully designed digital healthcare policy will serve to protect the Nigerian people, healthcare professionals and health systems against misinformation and the misuse of information, malicious cyber activities, fraud and exploitation, inappropriate use of health data and human rights violations within the framework established by international platforms such as the WHO.
According to Verraki, the digital divide refers to the gap between individuals, households, business and geographic areas at different socio-economic levels with regard to both their opportunities to access information technologies and use such technologies for a wide variety of activities. While digital transformation has undoubtedly changed the world for the better, the benefits of digital tools in healthcare have not always reached the population segments that need healthcare the most due to digital exclusion.
Verraki is of the view that available broadband internet, electricity, and IT infrastructure especially in rural areas is grossly inadequate. There are low digital literacy levels, poverty, and high resistance to change including among healthcare workers. Social and cultural beliefs and attitudes to new technologies as well as huge set-up cost for IT infrastructure in rural communities are major hurdles limiting digital heath adoption. The challenge therefore becomes how the current health care architecture can be adequately adjusted, modified, or otherwise improved. Going hybrid entails the adoption of the best of in-person and digitally enabled systems to deliver healthcare that is more efficient while creating a more rewarding patient experience for all.
Verraki says starters, patients and doctors in Nigeria must continue to adapt to new technologies and workflows that are powering remote consultations, remote monitoring, and personal health records. These include tools for appointment self-scheduling, appointment reminders, digital registration and check-in, patient surveys, 2-way patient text, mobile billing, and continuous utilisation of smart mobile devices for health monitoring. We must however continue to strategically invest in primary health care, and consistently push for motivated health workforce, improved financial protection and improvements to the National Health Management Information System to realize better-performing primary health care systems that deliver significantly improved health outcomes to every region of the country, pending nationwide digital access.
Verraki says the Nigerian government, and Ministries of Health and Education need to re-evaluate what the medical schools must be able to provide as part of medical training and should formulate and implement sustainable educational policies that will favour the application of ICT in the training of medical doctors. Capacity building of the local healthcare workforce is a major prerequisite to maximize the benefits from the innovations made possible with the spread of digital health technologies.
Verraki says healthcare providers should be compelled to have a standardised electronic health record (EHR) system in their facility and use it for every patient.
Verraki believes that health-tech can deliver local solutions but requires increased investments.
“Nigeria is Africa’s largest health care market offering immense health-tech investment opportunities. Funding for health start-ups has however not been as robust as for Fintechs, e-commerce, agro-tech, and other sectors,” Verraki said.
