The Bill and Melinda Gates Foundation says it has committed two million dollars to the Nigerian Basic Health Care Provision Funds to fast-track implementation by the government toward the realisation of Universal Health Coverage (UHC).
Dr Paulin Basinga, the Deputy Nigerian Country Officer of the foundation disclosed this on Wednesday in Abuja during a visit by officials of the National Institute for Policy and Strategic Studies (NIPSS).
The NIPSS paid a study tour on the foundation and Development Research and Project Centre (dRPC) which is under the Partnership for Advocacy in Child and Family Health (PACFaH ) @scale project.
Basinga described the money that was donated by the foundation as a strategy that would allow money to flow from the Central Bank of Nigeria (CBN) account down to primary health care facilities.
He explained that the 2014 National Health Act stipulates that one per cent of the nation’s consolidated revenue should be channelled toward funding basic healthcare provision fund that would guarantee access to health by all.
However, he lamented that till date the policy has not been implemented.
He further noted that the organisation has signed a Memorandum of Understanding (MoU) with the government to enable it meet its commitment of buying vaccines among other consumables that would drive UHC.
Basinga identified funding as a major gap in the realisation of UHC.
He said there was need to build a stronger PHC system in the country to ensure preventive and curative measures of diseases at the community levels.
Basinga flayed the present funding of healthcare system in the country by channelling more resources to the tertiary and secondary health levels.
He urged the government to make strategic legislation to funding UHC.
“Through this legislation, funding priority will be geared toward revitalisation of primary healthcare system thereby reducing the nation’s disease burden and death rate.
“If the nation has strong primary healthcare system the health needs of 90 per cent of Nigerians will be addressed.
“We are excited in this journey toward UHC and we have been stirring the government to build a stronger PHC system through improved funding among others so that the UHC can be a reality,’’ he said.
Basinga identified the six building blocks of UHC as financing, facilities, human resources, commodities, religious and community leaders as well as data.
He emphasised that in order to drive UHC there was need for facilities to be situated in places where they can easily be accessed by all the pregnant women and children, among others, without hitches.
According to him, commodity must be readily available at all times like the test kits and treatment for malaria and typhoid, among other diseases.
He further noted that the capacity of health workers at the health facilities must be built to adequately meet the health needs of the populace.
He however called for collaborative efforts by philanthropists, civil society organisations, individuals and policy makers to ensure realisation of UHC to guaranty accessible, affordable and quality healthcare services for all irrespective of status.
AVM Dahiru Sanda, the Leader of NIPSS delegation, said their tour of the organisations was for the participants to be abreast with the relevance of the organisations in to funding of UHC delivery in the country.
Sanda identified the theme for their study tour as “Funding UHC delivery in Nigeria”.
“These organisations are key funders of UHC delivery and our focus is on framework and challenges they have in funding healthcare delivery in the country,’’ Sanda said. (NAN)
Kenyan Small and Medium Healthcare providers to get boost in accessing financing for Medical Equipment purchases
The Medical Credit Fund (MCF) and GE Healthcare are partnering towards improving access to quality healthcare services for patients in underserved areas with high populations
NAIROBI, Kenya, April 18, 2019 – Small and medium private healthcare providers can access loans for the purchase of medical equipment by providing their MPESA /MTIBA statements.
GE Healthcare (www.GEHealthcare.com) and Medical Credit Fund (MCF)-part of the PharmAccess group- (www.MedicalCreditFund.org) have entered into a partnership to enable small and medium private healthcare providers to access loans for the purchase of GE Healthcare manufactured medical equipment. The announcement was made during a Radiology Clinical Day organized by GE Healthcare and the Kenya Association of Radiologists (KAR).
The partnership aims to improve access to better quality healthcare for patients living in underserved areas by financing the purchase of various diagnostic equipment. Under the partnership, the MCF will provide access to mobile-based lending and business improvement programmes to eligible healthcare providers, while GE Healthcare will support the program through provision of GE equipment and technical support.
Borrowers which qualify for loans include eligible healthcare facilities in the private sector offering a broad array of primary care services and especially with an explicit focus on family and mother-child care. Under the partnership, borrowers will be able to secure loans of up to $100,000, by providing limited information notably their MPESA /MTIBA statements, with a 24 months repayment plan.
“There is a case for innovative financing models and technical support to healthcare SMEs to support them to grow and improve the quality of healthcare services they deliver to underserved populations. Together with GE Healthcare, we are looking at social entrepreneurship in the healthcare space as an entry point to strengthen the healthcare system and to support the achievement of UHC goals.” said Mr. Isaiah Okoth, Country Director Kenya, PharmAccess Foundation.
On his part, Mr. Andrew Waititu, General Manager for GE Healthcare East Africa said, “We are committed to developing new delivery models that improve access, clinical quality and patient outcomes as we progress towards Universal Healthcare Coverage. Our collaboration with Medical Credit Fund is a significant step towards attainment of this goal”.
The interest rate cap regulation has further reduced lending to SMEs, with banks preferring to lend to larger, well established and less risky customers.
One of the first beneficiaries of the program, James Ndaba Head of Administration at Trinity Care Centre said, “We always wanted to upgrade to the latest Ultrasound machine, but financing was a challenge. Through the MCF and GE Healthcare financing program, we were able to easily acquire an ultra-modern Ultrasound machine which our patients like and hence prefer our facility over others nearby. We have also seen the number of our patients per month increase by over 40%.
According to Kenya Master Facility List, Kenya’s healthcare landscape is 50% public and 50% private. The public sector struggles to meet the dual demands of growing populations and limited resources. As a result, over 50 percent of Kenyans are using private healthcare facilities. But the private-sector also faces an uphill struggle in delivering quality, affordable healthcare. The small and medium enterprises (SME’s) that serve lower income groups often function with sub-standard infrastructure and equipment and a scarcity of skilled medical staff. Despite demand and an obvious need, health SMEs have difficulty accessing capital to improve this situation. This is because of the perceived high investment risk due to a lack of banking history and limited collateral.
Destination Universal Health Coverage: Can PPPs be the vehicle to get us there?
PharmAccess Foundation’s journey in PPPs has shown significant promise and evidence of the organisation’s successful partnerships can be seen in the revitalised primary health centres in Lagos and Delta State. Photo source: PharmAccess Foundation
Almost everyone in Nigeria has directly or indirectly experienced the catastrophic impact of emergency out-of-pocket expenses on healthcare. We can no longer keep on doing the same thing – and hope for different outcomes – it is time to think differently and do things differently. It is time for strategic private sector engagement.
We all agree that the desired destination is Universal Health Coverage (UHC), i.e. ensuring that everyone in Nigeria has access to quality healthcare. As defined by the World Health Organisation (WHO), UHC means that “all people and communities can use the promotive, preventative, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship“.
Image credit: Nigeria Health Watch
The current state of the Nigerian health sector
The Nigerian health sector has suffered from chronic underfunding, 72.24% of current health expenditure is out-of-pocket, leaving patients to bear the burden of funding their own healthcare. This has led to sub-optimal healthcare delivery with many of our health indicators below national targets and international standards. Eighteen years after the Abuja Declaration where African Union states pledged to allocate at least 15% of their annual budget to health, Nigeria continues to default. Low budget allocation (and it is reducing rather than increasing) has crippled the Nigerian healthcare system in many ways. We forget that a healthy population is truly the best insurance we can have for our economy to thrive. Several studies have shown that investing in health leads to economic development.
If primary health care provides whole-person care for health needs throughout one’s lifespan, not just for a set of specific diseases, why do we neglect PHCs in Nigeria? Why do we still have wards that have no functional PHCs? Why do Nigerians visit secondary and tertiary health facilities for illnesses that should be treated at the primary level? This is likely because the primary healthcare system has failed them.
The important role of the private sector
There are competing demands on Nigeria’s national budget and health has not been given sufficient priority, leaving it underfunded. In a recent speech by Christine Lagarde, Managing Director of the International Monetary Fund (IMF), she stated that the Nigerian economy will struggle due to low revenue generation, given the country’s tax-to-GDP. This will have implications on the country’s ability to direct sufficient resources at the health sector and there is little hope that more funds will be made available to strengthen our already weak health infrastructure.
The role of the private sector is therefore critical in enabling improved access to health for all. It is clear that our public health system faces limitations, as it is not able to meet the healthcare needs of the population. The private sector, however, has the capacity to provide the technical efficiency required to deliver health services. Engagement of the private sector has, therefore, become critical as with the growing population in Nigeria, the public health sector is overcrowded and slow to innovate. Many initiatives have been tried to bolster the health sector and public-private partnerships (PPPs) in healthcare have emerged as a possible vehicle to enable the advancement towards UHC.
Yet, this is not an easy space. It is littered with failed projects and lost investments. It requires extensive thought leadership – an area that we at Nigeria Health Watch partnered with PharmAccess Foundation to address through a recent health policy dialogue.
PharmAccess Foundation – Systems transformation through PPPs
The private sector can play an important role in strengthening health systems in Nigeria. Through their expertise and capacity and PharmAccess Foundation has an integrated approach that focuses on the supply side of healthcare delivery, not just the demand side. The health policy dialogue on the 11th April 2019, organised by PharmAccess Foundation and Nigeria Health Watch, titled “Disrupting health care – PPPs as a model adoption for health system strengthening in Nigeria” highlighted PharmAccess Foundation’s journey in revitalising primary health care centres in Lagos through PPPs. This is not PharmAccess Foundation’s first foray into PPPs, the organisation had worked with Hygeia Community Health Care and the Kwara State Government on a PPP to develop the Kwara State Community Health Insurance Scheme, with the aim of providing affordable access to quality healthcare through the introduction of subsidised health insurance.
“Quality is not a pass or fail process in our own books. It is about improvement”, Ms. Njide Ndili, Country Director, PharmAccess Foundation. Photo source: PharmAccess Foundation
“All health PPP projects must consider dimensions of quality including technical competence, access to services, effectiveness, safety, efficiency and continuity”, Dr. Ibironke Dada, Director of Quality at PharmAccess Foundation. Photo source: PharmAccess Foundation
“Trust drives financial services. Trust drives lending. Trust is capital for the doctor and equipment supplier”, Mr. Olufisayo Okunsanya, Business Development Director of the Medical Credit Fund. Photo source: PharmAccess Foundation
What drives the lending system? Trust. Trust. Trust. Trustworthiness matters in all financial transactions; healthcare transactions are not excluded. At the policy dialogue, Mr. Olufisayo Okunsanya, Business Development Director of the Medical Credit Fund, explained how trust is key between all stakeholders and in its absence, lending does not occur. “Trust drives financial services. Trust drives lending. Trust is capital for the doctor and equipment supplier”, he said. In addition, when looking at the challenges in funding healthcare in Nigeria, the inconvenient truth is that the government cannot fund the infrastructure requirements of the health sector. The bulk of the federal government’s expenditure is spent on recurrent expenditure leaving little for capital expenditure.
“To ensure that adequate domestic resources are allocated to the health sector, dedicated analytic, policy, and advocacy efforts are required”, Dr. Olamide Okulaja, Director of Advocacy and Communications at PharmAccess Foundation. Photo source: PharmAccess Foundation
Healthcare needs to be seen as a business and only bankable ideas get funding. With PPPs you cannot do collateral borrowing and so the healthcare provider is borrowing against the future cash flow that will come from the business. This provides reassurance for the financing organisation for the loan will be repaid. We all have an enlightened self-interest, so it is in our best interest to fix healthcare in Nigeria and look for solutions outside of traditional government financing to address the funding challenges in healthcare.
Case study – Toronto Hospital brings healthcare to the Polobubo Community
How do you provide health care for a community left out of the health system for many years? That is the story of Polobubo, in Delta State, one of the most remote hard-to-reach communities in Nigeria. With a population of about 75,000 inhabitants, the community had until recently no access to healthcare due to their extreme isolation and remoteness. Accessing Polobubo through its closest town Warri, requires a 3hr 45mins boat ride, travelling with a 200-horsepower double engine speed boat, through the Niger Delta creeks, and across the Atlantic Ocean.
“We are breaking boundaries and getting healthcare to areas no one will dare”, Dr. Emeka Eze, Toronto Hospital. Photo source: PharmAccess Foundation
Now what? The Scalability of the PPP model in healthcare
In the 2019 health budget, about ₦50billion has been allocated for capital expenditure. Clearly, this amount is unable to cover the infrastructure gap in the healthcare industry and cater for the health needs of Nigeria’s burgeoning population of almost 200 million people. Can PPPs fill the gap in health funding? The government does not trust the private sector due to fear that they will put profit before performance, however, there appears to be a sea change. For the first time in Nigeria, two state governments are releasing funds to the private sector to revitalise some of their healthcare facilities. This is a testament to the political will in Lagos and Delta State to partner with the private sector.
The PPP model registered 2,639 enrolees who pay an annual premium of N7,000 and attended to 3,990 cases, including caesarean sections, minor surgeries, appendectomies in the Polobobo health facility, within two months of operation. Photo source: PharmAccess Foundation
The first panel at the policy dialogue focused on financing healthcare projects. Photo source: PharmAccess Foundation
Under the stewardship of Prof. Chris Bode, the Chief Medical Director at the Lagos University Teaching Hospital, a state of the art Cancer Centre was commissioned in partnership with a consortium that included the Nigeria Sovereign Investment Authority (NSIA) in February 2019.
The second panel at the policy dialogue focused on creating synergy for PPPs to strengthen primary healthcare delivery. Photo source: PharmAccess Foundation
A detailed report of the policy dialogue will be made available. Please contact [email protected] for further details. If you would like to watch the live coverage of the event and see photo highlights, kindly visit our Facebook page. To view some of the presentations from the event, click here
Health For All: Achieving Universal Healthcare Coverage in Nigeria | Adaku Efuribe
Incurring catastrophic expenses for health care is a global problem. In richer countries in Europe, Latin America and parts of Asia, which have achieved high levels of access to health services, increasing numbers of people are spending at least 10 percent of their household budgets on out-of-pocket health expenses.
UHC means that all people and communities receive the health services they need without suffering financial hardship?
UHC enables everyone to access the services that address the most important causes of disease and death and ensures that the quality of those services is good enough to improve the health of the people who receive them.
UHC is not just about health care and financing the health system of a country. It encompasses all components of the health system: systems and healthcare providers that deliver health services to people, health facilities and communications networks, health technologies, information systems, quality assurance mechanisms and governance and legislation.
Can community health care workers address the Primary healthcare Crises in Nigeria?
‘Community health –care workers know the traditions, cultures and practices of their communities, making them indispensable especially during an outbreak of emergencies’ (WHO)
With the reduction in the number of doctors in Nigeria today, it is high time the health ministry makes use of ad hoc staff to fill in the gap in suitable aspects of primary care provision,
In many developed countries of the world who can boast of a good number of primary health care centers per geographical area/population; they still make use of physician associates, health visitors, advanced nurse practitioners, pharmacist independent prescribers, nurse advisors, and health care assistants etc to fill in the gap.
In Nigeria we do not have enough medical practitioners per population or geographical area. This is the time to train and retrain more community health care workers as this will help in managing long term conditions, reduction in child hood illnesses due to lack of immunization.
Trained birth attendants will also help reduce maternal mortality and community nursing care will reduce infant mortality.
Studies have been conducted in some developing countries and there is enormous evidence to portray the importance of integrating lay health workers in the primary health care force.
I believe this is a step in the right direction if we must provide universal health coverage in Nigeria.
The systematic integration of community health workers at a large scale could be an effective and a rapidly implementable approach to the current primary care workload crisis we have in Nigeria
I feel there is a sense of urgency for this; and I’m calling on all stakeholders to work together towards achieving UHC in Nigeria.
Reference: [World Health Day, WHO]
Adaku Efuribe is a Pharmacist with professional experience in medicines management, clinical pharmacy and integrated healthcare.
Adaku is a strong advocate of Universal health coverage and has an inspiring vision of what this should look like in the future. She is passionate about achieving the United Nations SDG goals and committed to advancing health promotion and integrated Healthcare.
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