Private Sector as Catalyst for Resilient Health System

Experts at the recently concluded Future of Health Conference organised by the Nigeria Health Watch in Lagos State spoke on the importance of the private sector as a catalyst in building a resilient health system in Nigeria. Sunday Ehigiator reports

According to the World Health Organization’s (WHO) health system building blocks, a well-functioning system requires suitably skilled human resources for health.

Nigeria is facing the problem of the international migration of healthcare professionals, also known as a ‘brain drain’. This undermines the nation’s ability to attain universal health coverage and the health-related sustainable development goals (SDGs).

Notwithstanding, the private sector is driving efforts to reverse the trend, providing much-needed expertise and investments to provide Nigerians with quality care.

Health services are increasingly being provided through mixed health systems that include both public and private providers, with the private health sector serving as an essential source of health-related products and services, particularly those for the poor.

According to the MSD, more than 40 per cent of women in low and middle-income countries, including women in the lowest income quintiles, receive antenatal, labour and delivery care and family planning services from private health providers.

To improve access to quality and affordable healthcare, the private sector must be integrated into quality improvement initiatives, with strong governance structures, ensuring stronger alignment with public healthcare systems.

Hence the Nigeria Health Watch’s ‘2023 Future of Health Conference’ (FHC), lent itself as one of the platforms which sought to promote improved involvement of the private sector in building a more resilient health system in Nigeria.

The Conference

Discussions at the conference which was held in Victoria Island Lagos, premised on how best to harness the private sector’s capacity for investments in healthcare, innovation, and efficient resource management for improved public sector healthcare delivery.

It was held in partnership with MSD for mothers, CEPI, Bill and Melinda Gates Foundation, PharmAccess, MSI Nigeria, SCIDar, MacArthur Foundation, and Policy Innovation Centre.

Other partners include TY Danjuma Foundation, Clinton Health Access Initiative, Riders, ECEWS, acioe Associates, Sydani Group, Private Sector Health Alliance of Nigeria, The Shell Petroleum Development Company of Nigeria Limited, and Healthcare Federation of Nigeria.

In her opening remarks, the Managing Director, of Nigeria Health Watch, Vivianne Ihekweazu, noted that the reality in Nigeria is that we have a mixed health system, which makes patients navigate for healthcare between the public and the private sector.

“This demands better strategic integration between public and private providers. This year, our focus centres on ‘The Private Sector as a Catalyst for a Resilient Health System’ as a theme that resonates deeply with the complex dynamics of healthcare delivery in our country.

“We recognise the indispensable role of the private sector, not just as a provider of services, but as a catalyst for transformative change. By leveraging the innovation and expertise within the private sector, we need to strengthen our healthcare system, ensuring its resilience in the face of challenges.

“We in this room all know and must acknowledge that we must accelerate progress to improve health outcomes in the country, our stats are just moving in the wrong direction.”

She said the objectives of the conference were to curate profound insights into the private sector’s role in healthcare, initiate learning by bringing diverse sectors together, and explore opportunities for fruitful public-private partnerships.

“We seek to create a platform where ideas converge, and strategies emerge, bridging the gap between potential and action. Moreover, we will aim to outline actionable steps for the government, crowding in different perspectives and amplifying these discussions.”

Health as Human Rights

In her keynote address, the Special Adviser to the President on Health, Dr. Salma Ibrahim Anas said the health of Nigerians is a “fundamental human right and a matter of national security that requires a resilient health system to ensure the provision and maintenance.”

According to her, the government is greatly investing in the health sector but there has to be an active involvement of the private sector to secure the coverage and sustainability for sensible national growth, development and progressive prosperity.

She said the attainment of the health-related Sustainable Development Goals of ‘health for all’ based on Universal Health Coverage (UHC) using the continuum-of-care model where no one is left behind “is not possible without prioritizing and positioning the health sector to be resilient and more responsive to the needs of the people.

“This administration of President Bola Ahmed Tinubu has prioritized engagement of stakeholders especially the private sector to achieve the desired goals for the health sector’s growth and development.

“With over 70 per cent of private expenditure on health as a share of the total health spending in the country, having strategic and meaningful partnerships and collaborations between the public and private sectors is key towards unlocking the huge potential and improvement of the overall health sector in the country.

“Consequently, by leveraging on the existing opportunities and possibilities of public-private partnerships, Nigeria can make substantial progress towards achieving UHC, advancing healthcare delivery, improving access, ensuring financial protection and having a resilient health system for all Nigerians.

“However, this will require crucial reforms that establish clear roles and responsibilities with robust governance frameworks, transparent and accountability mechanisms to ensure the interests of both the public and private stakeholders are safeguarded.”

She therefore concluded that “achieving a resilient health system requires a multisectoral and multifaceted approach where public and private sector collaborates and synergize to accelerate progress towards this goal.

“With this, Nigeria can have the right policy space, enhance healthcare infrastructure, and requisite manpower, deploy appropriate technologies, guarantee pharmaceutical supplies with supportive logistics, improve service delivery, mobilize additional resources and promote equitable access to quality healthcare for all its citizens.

“This is in line with the Renewed Hope mantra of this administration of inclusivity and partnership especially between the public and private sector for developmental growth that leads to national prosperity.”

Private Sector Financing for Health Systems Strengthening

Speaking on strengthening the health systems to achieve Universal Health Coverage (UHC) by leveraging private sector financing, the Managing Director, of Nigeria Sovereign Investment Authority (NSIA), Dr Tolulope Adewole, said, “Since inception, healthcare has been designated a focus sector for investment through the Authority’s Nigeria Infrastructure Fund (NIF).

“The sector is characterized by numerous challenges including but not limited to poor and inadequate infrastructure, inaccessibility, insufficient financial investment, poor customer service, substandard pharmaceutical products and fake drugs, brain drain and a dearth of skilled/adequately trained personnel.

“NSIA Healthcare Development and Investment Company (NHDIC) were thus established to invest in Nigeria’s healthcare sector. The company sets out to catalyze private sector investment to address the infrastructure gap in the healthcare sector, improve manpower and improve key health indicators of the country.”

Adewole revealed that there is a lack of adequate diagnostic capability in Nigeria. “Intervention in the diagnostics space (secondary care) is thus required to support tertiary care. “

He also noted that investments in pharma and vaccine manufacturing are currently insufficient to ensure product scale and quality. He said it is also insufficient to ensure Nigerians’ drug and vaccine security.

“60 per cent of the funds spent on medical tourism relate to four specialities requiring tertiary care: Oncology, Orthopedics, Nephrology and Cardiology.

“In keeping with its strategy, NHDIC has executed three demonstration projects in the healthcare sector in Nigeria.

“NSIA deployed several leading-edge medical equipment including three linear accelerators, a brachytherapy system, a 1.5 tesla MRI, a 128 slice CT scanner, a mammogram, digital X-rays, ultrasound scanners and laboratory pathology systems in the country.

“At the time of deployment, the NLCC was the first to install a linear accelerator in Nigeria and remains the centre with the highest number of linear accelerators in West Africa.

“Over the three years of their operation, the centres have recorded unprecedented success in terms of exponential growth in client patronage, ground-breaking partnerships on education with internationally renowned healthcare education and research organisations, participation in world-class quality assessment schemes, and publication of research material.”

Private Sector Partnerships to Sustain Diaspora Brain Gain

Speaking on leveraging the private sector partnership and collaborations to sustain diaspora brain gain, the Country Director, of PharmAccess, Nigeria, Njide Ndili, said Nigeria’s Health systems are constrained by a vicious cycle of poor demand
and poor supply creating an obstacle to achieving UHC.

“Only 20 per cent of PHCs are estimated to be functional. Secondary facilities account for an average of 61 per cent of total expenditure receipts between 2010 and 2017. 15 per cent of radiology providers are standing alone. 60 per cent of X-ray equipment is obsolete, aged 10+ years.

“50 million diagnostic X-ray examinations are carried out annually. Health Insurance penetration remains at 10 per cent and is projected to hit 70 per cent coverage by 2030. Nigeria’s UHC service index is currently rated 44 as against the global average of 67”

Ndili said Nigeria still grapples with 99 per cent of its medical devices still being imported and valued at 4186 million and $202 million in 2022 and 2023 respectively.

“Also, health revenue is projected to hit $315.2 million and $704 million in 2022 and 2027 respectively at a CAGR of 17.42 per cent. Health user penetration is to hit 13.4 per cent and 19.2 per cent in 2022 and 2027 respectively, according to Statista.

“Medical tourism expenditure hit $1.9 billion in 2019 with oncology, orthopaedics, nephrology, and cardiology as leading drivers. Nigeria pharma accounts for 60 per cent of the market in the ECOWAS block.

“OTC medicines account for a significant share of the Nigeria pharmaceutical market. Prescription ethical pharma and OTC pharma products are valued at $500 million and $900 million respectively.

“There are 132 licensed pharma manufacturers in-country. There are 5,795 licensed pharma distributors and 350 importers. For every $1 pharma export, Nigeria imports $99 worth, while OOP accounts for 75 per cent of healthcare financing in Nigeria.”

Also speaking, Executive Medical Director, Regions Healthcare, Dr Benjamin Anyanwu, harped on how private healthcare institutions can collaborate with skilled healthcare workers in the diaspora to introduce advanced medical treatments and technologies, such as in the field of neuroscience that might not be readily available locally.

He said addressing brain gain requires collaboration beyond the private sector. “Healthcare organizations like Regions Stroke and Neuroscience Hospital need to work with government bodies and policymakers to address policy gaps that hinder the effective integration of diaspora healthcare expertise.

“Also, collaborations with diaspora healthcare professionals can significantly improve patient outcomes and healthcare services.”

Earlier while speaking, President, of the Nigerian Medical Students’ Association (NiMSA), Ejim Egba Clement said, that the sustainable development of Nigeria’s healthcare sector lies largely with private partnerships and collaboration.

“One key way to harness this is through a valuable resource I’d like to call ‘Diaspora Brain Gain’

“Also, PPPs and collaboration hold the key to sustaining the Diaspora Brain Gain in the Nigerian health sector. Leveraging the skills and expertise of Nigerians in the diaspora, along with the resources and capabilities of the private sector, can transform the country’s healthcare landscape.

“As Nigeria continues its journey toward achieving universal health coverage and addressing the challenges plaguing its health sector, the synergy between diaspora professionals and private sector entities will play a pivotal role in ensuring a healthier and more prosperous nation.”