How to Achieve Efficient Healthcare Ecosystem in Nigeria

Hyacinth Nwabueze Achime

At no time in the history of Nigeria has healthcare issues topped national discourse as we have today. The reasons for this pre-eminence are multifaceted, the advancement made in the sector globally, the exodus of seasoned medical practitioners – doctors, pharmacists, nurses etc. – the dwindling quality of care in our hospitals, the high cost of living which includes high cost of medicines or healthcare products/services, and the issue of multi-dimensional poverty which the National Bureau of Statistics put at 63 percent or approximately 133 million Nigerians, among other factors.

Unfortunately, this discourse has been driven all along by the policymakers, who have minimal knowledge about the workings of the sector, with very little input from the healthcare practitioners, who tend to be more focused on their practice than the overall development of the sector. This has led to a scenario, where the crux of the discussion is centered around the perceived treatment of the symptoms rather than the root causes, resulting in the precarious situation we find ourselves today – a lot of motion without any tangible progress in addressing the challenges in our healthcare sector.

For example, the Nursing and Midwifery Council of Nigeria (NMCN), issued a circular on February, 7, 2024 revising the guidelines for requesting verification of certificates for nurses and midwives. In the revised guidelines, the NMCN, a body mandated by law to regulate the standards of Nursing and Midwifery education and practice in Nigeria, states that applicants seeking verification of certificates from foreign nursing boards and councils must possess, at least, two years of post-qualification experience from the date of issuance of the permanent practicing license.

They must also pay a non-refundable fee that shall cover the cost of courier services to the applicants’ institutions of training, places of work, and foreign boards; must present letters of good standing from the chief executive officers of their places of work and the last nursing training institutions attended; and must have active practicing licenses with a minimum of six months to the expiration date. This verification is mostly needed by nursing and midwifery practitioners who are seeking employment in foreign countries.

Earlier, in 2023, a bill to prevent Nigerian-trained medical or dental practitioners from being granted full licenses until they have worked for a minimum of five years in the country, passed through the second reading in the House of Representatives. The bill titled, “A Bill for an Act to amend the Medical and Dental Practitioners Act, Cap M379, Laws of the Federation of Nigeria, 2004 to mandate any Nigerian-trained medical and dental practitioner to practice in Nigeria for a minimum of five years before being granted a full license by the Council in order to make quality health services available to Nigeria; and for related matters (HB.2130),” like the NMCN’s new guidelines, is aimed at discouraging Nigerian medical practitioners from leaving Nigeria for greener pastures in foreign lands.

The aforementioned measures, in addition to the increased clamour for a ban on public office holders from travelling abroad for medical treatment are, in the long run, aimed at developing the country’s healthcare sector and improving the health status of Nigerians.

 The question is: how far can these measures go in achieving these desired goals? The truth is that, even on full implementation, these measures will not address the challenges of the healthcare sector, unfortunately. The reason is simple. They are all ill-conceived and bereft of scientific basis because they do not take the critical factors that affect the healthcare system into consideration. While the first two measures are driven by the false narrative that the health sector is a matter of medicine and only medical practitioners can determine what should be done to achieve the desired impact, the third measure is driven by another false narrative that if you merely discourage the policymakers from seeking medical help abroad, they will be forced to enact policies that will lead to the development of the local healthcare sector.

If we must achieve a considerable growth in our healthcare sector, we must cause a paradigm shift from looking at the sector from purely the medical prism to looking at it from the prism of economics. The reason is not far-fetched. Health products and services are, like other products and services, governed to a very large extent by the same economic theories and principles.

Economics, as a subject of study, has many definitions, depending largely on the interest of the economist but for this article, we look at it as the study of allocation of scarce resources among competing ends. This indicates that resources are scarce and not available in sufficient quantities and, due this scarcity, these resources must be wisely allocated among alternative ‘competing’ ends. How does this definition, which could easily resonate with us in terms of products and services in most other sectors, resonate in the healthcare sector?

To answer the above question, we turn to health economics. Health economics is a branch of economics that is concerned with issues relating to the efficiency, effectiveness, value and behaviour in the production, distribution exchange and consumption of health and healthcare goods and services. In general, health economists study the functioning of the various healthcare systems as well as health-affecting behaviours such as the use of dangerous drugs, casual sex, alcoholism and smoking.

Although health economics, like other areas of economics share the same principles – of scarcity, supply and demand, distinctions between need and demand, opportunity cost, discounting, time horizons, margins, efficiency and equity, it is distinguished by some factors. The sector is highly regulated, with extensive government intervention; intractable uncertainty as to the outcome of efforts; asymmetric information that puts the physician at an advantage over the patient; barrier to entry and externalities and presence of third parties, including the health practitioners and insurance companies/Health management organisations (HMOs).

To get the country’s healthcare sector out of the woods, health economics will proffer a study of the Nigerian healthcare sector, on the micro and macro levels, to come up with a comprehensive masterplan that, if implemented, will achieve the desired results of improving the overall health status of the country.

While the study on the micro level will focus on the people – their cultures, their access to health facilities and consumption patterns (orthodox or traditional or mixed) the study on the macro level will look at the efficiency, effectiveness, value and behaviour in the production, distribution exchange and consumption of health and healthcare goods and services. It will also study the current socio-economic development of the country like the GDP, the healthcare statistics like the doctor-patient ratio, availability and adoption levels of third-party agents like the HMOs etc. and the presence and prevalence of such social realities as drug abuse, alcoholism, sexual promiscuity among others.

This entails a lot of work as the government will need to convoke a multi-disciplinary/multi-sectoral team that will include all stakeholders to study these various factors and come up with a well-articulated blueprint that will address the many challenges that face the country’s healthcare sector and move our healthcare sector forward.

*Achime is a professor of Economics and author of ‘Economics of Health and Illness: The Victims’ Choice.’ He wrote in via tcachime@yahoo.com