Health
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 info@nigeriahealthwatch.com 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
Inaugural Pan-African Nutrition and Health Summit set to shape a healthier continent
The inaugural edition of Africa’s Nutrition and Health Summit is set to convene on November 16, 2024, bringing together an extensive network of healthcare practitioners, nutrition experts, agricultural stakeholders, policymakers, and influential leaders from all over the continent under the theme, ” Soil to Wellness: Shaping a United Approach to Africa’s Health.” This groundbreaking summit aims to address the critical rise of non-communicable diseases (NCDs) across Africa through integrative approaches to preventive health, nutrition, and sustainable lifestyle practices.
This movement would explore holistic and practical solutions that unite stakeholders along the health and nutrition value chain, with a critical focus on how surging rates of NCDs like diabetes, hypertension, and obesity can be curbed via sustainable agriculture, improved food quality, and healthier lifestyle choices, to reshape our food and lifestyle culture, thereby laying a foundation for better health outcomes, for generations to come.
A Key Focus on Nutrition and Lifestyle Practices
The summit’s agenda will include panels on integrative approaches to nutrition and preventive health, the dual burdens of malnutrition and obesity, the impact of digital health in preventing diet-related diseases, and the role of sustainable agriculture in food quality. Our holistic approach strives to demonstrate how Africa’s diverse and rich agricultural resources can play a pivotal role in ensuring food security, balanced nutrition, and wellness for all citizens.
Call to Action
The inaugural edition of ANHS is especially relevant to anyone invested in the long-term health and wellness of the African continent. Such stakeholders are not limited to health professionals, nutrition experts, agricultural stakeholders, policy influencers, researchers, food producers, and processors. It is indeed a legacy-defining opening for businesses and community leaders interested in leaving their prints in the sands of policies that would advance health and wellness on the continent.
Participants will gain insights from leading experts and join the cause to champion Africa’s health by focusing on the most essential aspects of disease prevention and overall wellness. Now, more than ever, it is crucial to prioritize wellness at the societal level, addressing the connections between soil health, food quality, and sustainable practices that contribute directly or indirectly to healthy living.
Join us at the inaugural edition of Africa’s Nutrition and Health Summit on November 16, 2024, as we unite to shape a healthier continent – one that intentionally harnesses her resources and expertise to combat non-communicable diseases.
Register here to attend ANHS 2024
For more information, press inquiries, or partnership opportunities, please contact:
RSB
Official Branding Partner of ANHS
Health
Dr. Jesupelumi Adenihun: Adopting a lifestyle of sustainable health practices with food
Dr. Jesupelumi O. Adenihun (Image: Supplied)
You have likely heard the saying, “You are what you eat,” and it couldn’t be truer. What we consume plays a far greater role in our health than many of us realize. Over time, our eating habits can either support our body’s natural healing processes, leading to improved health and vitality, or contribute to nutrient deficiencies, inflammation, and even chronic diseases.
What this means is, our eating habits over time sets off a series of chain reactions in our bodies that impact our overall well-being. The good news, however, is that by consistently making the right food choices, we can put ourselves on the path to a state of good health and well-being. While this might sound daunting at first, it is often the small, consistent actions that yield the best results. Let’s take a look at 10 simple but effective habits you can begin to cultivate for better health and adopt as lifestyle practices:
- Substitute soda with water: No beverage is more refreshing or beneficial than plain water. It hydrates, cleanses, and confers numerous health benefits.
- Snack on nuts and seeds: When you are craving a snack, go for nuts or seeds, unless you have an allergy. They are nutrient-dense and can also be satisfying.
- Opt for grilled or baked over fried: Choosing grilled or baked foods helps reduce unhealthy fat intake without compromising on flavor. This also helps reduce the risk of developing high cholesterol levels which is a cardiovascular risk.
- Enjoy homemade smoothies over sugary drinks: When time permits, make homemade smoothies making use of reliable recipes. If you are short on time, consider vendors who provide fresh, nutrient-packed options.
- Practice mindful eating: Mindful eating means being fully present during meals, savoring each bite, and listening to your body’s signals. Eating mindfully is a game changer for a lot of people.
- Be well-informed about what you consume: Whether it’s food or drinks, it is essential that you stay conscious of what’s in your food and drinks. Many packaged products contain hidden sugars that the body doesn’t exactly need. Always take a moment to check the ingredients.
- Add more vegetables to your plate: Think beyond the usual veggies—some varieties exist which also depends on your geographical location. Be open and willing to explore new options and add color to your meals.
- Prioritize lean proteins: Not all proteins are created equal. Make lean protein choices and consider plant-based options to support your overall health.
- Use natural spices over salt-laden seasonings: High salt intake is known to be a contributor to heart-related conditions like hypertension. Opt for natural herbs and spices to add flavor without carrying on health risks.
- Stay physically active: Find an activity you enjoy and can commit to, whether you are at home or on the go. Consistency is key. Also seek the counsel of a coach if you need to.
Remember, true wealth lies in your health. Let each meal choice you make be a step toward a healthier, more vibrant life. Eat to wealth, health is wealth.
Written By: Dr. Jesupelumi O. Adenihun (Nutrition Coach, Preventive health care specialist).
Health
Bridging The Gap Between Menstrual Health and Mental Health in Africa
Menstrual health is not just about periods; it’s about breaking the cycle of exclusion and empowering the future of Africa – one girl at a time.
Empowering women and girls who menstruate worldwide starts with breaking the silence around periods. Eno, a 14-year-old girl from a remote community in the south, shrinks when her period arrives each month. Shame and fear are a constant part of her experience. “At school, whispers follow me. They call me ‘dirty’ because I can’t afford pads. I use the white piece of cloth my mother gave me and the extra layer of pad I had sewn on our neighbor’s machine using pieces from his shop.” Eno’s story, though heartbreaking, is far from unique. Across Africa, millions of girls and women face a hidden crisis: period poverty.
Period poverty refers to the inability to afford and access menstrual products, sanitation and hygiene facilities, and education and awareness to manage menstrual health. Globally, more than two billion people around the world menstruate monthly.
Menstruation, a healthy and natural biological process continues to be shrouded in silence and stigma across many parts of Africa. This silence perpetuates a cycle of neglect and exclusion, where the menstrual health needs of women and girls are ignored, leading to significant physical and mental health issues.
Daily, women and girls are unable to afford sanitary pads, forcing them to resort to unhygienic alternatives like old rags, leaves, old clothes, cotton wool, toilet paper, newspaper, and make-shift hygienic pads. This lack of access not only affects their physical health but also their mental well-being, as they experience anxiety, shame, and isolation during their menstrual cycles. With limited to no access to safe water and sanitation to manage their menstrual health and hygiene, these women and girls who cannot afford menstrual products do not live well within their rights and freedoms as their menses interrupt their day-to-day flow.
Human-Centered Stories
To truly understand the impact, we must listen to the voices of those affected. Nike, a 15-year-old girl from a rural community in Ogun State shared, “I have to stay home when I have my period because I don’t have pads. I miss out on school and feel ashamed.” Rukkayat, another young woman from a community in Abuja stated, “The stigma around menstruation is so strong that I can’t even talk to my teachers about it. It feels like a dirty secret. I feel dirty walking around my school. So, I’d rather stay at home when I’m on my menses to endure the pain and take care of myself.” These anonymous quotes reflect a common reality for many girls and women across Africa, highlighting the urgent need for change.
Addressing Stigmas and Period Poverty
Period poverty stems from persistent stigmas around menstruation. These stigmas include the belief that menstruating women are impure, leading to their exclusion from everyday activities and social interactions. Such beliefs not only undermine women’s confidence but also reinforce gender inequality. Periods, already a source of physical discomfort, become a breeding ground for anxiety, shame, and isolation. This can lead to depression, decreased self-esteem, and a reluctance to seek help. The link between menstrual health and mental health is undeniable.
To combat these stigmas, sensitization initiatives, and project outreaches need to provide menstrual products and education. These programs will empower girls with knowledge and resources, breaking the silence and changing societal attitudes toward menstruation.
Breaking the Cycle: Investing in Solutions, Empowering Futures
So, how can we bridge the gap between menstrual health and mental health by showing one can’t do without the other? By recognizing that menstrual health is intrinsically linked to mental well-being, we can create holistic approaches that address both.
- Combat Stigma Through Education: Open conversations are key. Educational programs that address menstrual hygiene and dispel myths can empower girls and communities. Schools and communities should provide comprehensive menstrual education that includes mental health support.
- Invest in Sustainable Solutions: Supporting the development and distribution of affordable, reusable menstrual products is crucial. Access to menstrual products should be seen as a basic human right, and efforts should be made to ensure that all girls and women have the necessary resources.
- Build Sanitation Infrastructure: Safe and private sanitation facilities in schools and public spaces are essential for dignity and hygiene management.
- Champion Advocacy: Investing in menstrual health advocacy at the local and national level can lead to policy changes that prioritize girls’ needs. From providing dignity kits to advocating for safe and private facilities, menstrual hygiene management is crucial for their well-being and development. Through advocating for women and girls, we can ensure every girl has the knowledge and resources she needs to thrive.
By investing in menstrual health, we invest in a future where girls like Eno, Nike, and Rukkayat can access education, participate fully in life, and thrive. Through increased conversations and heartfelt advocacy, the Going North Project initiative is addressing the urgent need for quality healthcare, education, and the eradication of period poverty through targeted outreach programs.
The Going North Project aligns with the Sustainable Development Goals (SDGs) of Education, Health, and Gender Equality, which are crucial for fostering a brighter future and empowering girls – one at a time.
Let us address the urgent need for accessible menstrual health resources and education, highlighting how this issue impacts individuals globally. This advocacy inspires and reminds us that menstrual equity is essential for a just and healthy world. Together, we can break the stigma and ensure menstrual equity for all.
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