Private partnership critical in revamping nation’s health sector

The statistics are damning and thought-provoking, especially when one considers the over used cliché “Nigeria is the giant of Africa.” Whereas, events have shown that perhaps we may not merit that tag.

In recent past, Nigeria’s health sector has been marred with a myriad of problems; weak and inefficient health systems, dearth of infrastructure and personnel, ineffective primary healthcare units at the various Local Government Areas (LGA), to name but a few.

Little wonder from the unborn child to the aged, Nigerians are currently in want of quality healthcare. Only recently, a recent report in the scientific Journal, Lancet, stated that Nigeria records 42 stillbirths out of 1000 live births recorded per time. Worst still is the fact that those who are eventually carried to full term and born are unlikely to live up to their fifth birthday, as records also show that of every 1000 babies born in Nigeria an estimated 91.50 are likely to die before the age of five.

While Nigeria’s health profile remains deplorable as typified by high infant and maternal mortality, HIV/AIDs prevalence and vast majority of Nigerians at risk of malaria and non-communicable diseases (NCDs), experts and key stakeholders in health sector believe that with strategic private sector engagement in various aspects of healthcare management and service delivery, Nigeria could be saved from these scary indices even as a corresponding rise in the country’s economy is expected if a suitable climate is created for public private partnerships (PPPs).

Speaking recently with newsmen in Lagos, Onyebuchi Chukwu, minister of Health, revealed that about 70 percent of expenditure on healthcare in Nigeria born by out-of-pocket means by individuals, families and households even as over 60 percent of service delivery in Nigeria taking place in the private sector.

While noting that partnership between both arms remains central toward achieving a more effective health care delivery system in the country, the Health minister noted that the recently launched National Strategic Health Development Plan (NSHDP) by President Goodluck Jonathan is not to only ensure partnership by all tiers of government (federal, state and local Governments), but would also serve as blue print to stakeholders in the health sector toward provision of quality healthcare for Nigerians.

According to the minister, “one of the major reasons responsible for the present situation is the system’s inability to harness all human, financial and material resources for the wellbeing of Nigerians. No serious efforts were made to take advantage of the abundant human and material resources in both the public and private sectors for the benefit of the population.”

Chukwu further added that, “it is for this reason that fostering effective collaboration and partnership with all health actors is one of the seven strategic objectives of the National Strategic Health Development plan. The NSHDP is an overarching development plan which was developed through a consultative process using a bottom-up approach from LGAs, to states, to federal and all aggregated into a single plan. The plan seeks to deliver health service delivery; financing for health; community ownership and participation; partnerships for Health.”

Analysing the Ghanaian example of PPP in the health sector, Joseph Mettle–Nunoo, deputy minister of Health, Ghana, disclosed that while the Health ministry recognised the full potential of the private sector in the improvement of the health of the people, the current approach of the government is to court the private sector in a partnership at all levels by producing clear policies that would improve access, quality, effectiveness of care, and public-private collaboration toward the realisation of wealth creation through health.

For Mettle-Nunoo, “the major challenge lies in identifying a range of services which will complement government efforts at meeting the strategic objectives of the medium term and investing in capacity building to ensure sustained implementation and financial security in the partnership arrangement. These services may be brought on board as a means of strengthening existing services with the view to modernise health care, strengthen management and raise standards through new and innovative approaches such as PPPs. However, PPPs in Ghana are structured around the health sector medium-term programme of work and are guided by common management arrangements to ensure continuing focus on the health sector goals.”

There is no gaining that there are limited examples to be used to guide such partnerships in developing countries as there is the danger of PPP leading to complete reorientation of the public sector, interference with organisational priorities and weakening the administrative and management capacity of the public sector.

For Biodun Fatade, chief executive officer, Crest View Diagnostic Centre, Lagos , “The government alone cannot do everything, and if we are talking about quality, you realise that there is every need to involve the private sector. The government already has the tools needed to drive a private sector-led innovative drive to solving Nigeria ‘s health problems. We know that the government has money to spend, but it must rely on the private sector to bring up innovations that could make the money work otherwise we will just be moving in one cycle as we have seen.”

On how to ensure that the private sector is encouraged to participate in processes that could improve access to quality health services, Fatade said: “As it is done in many parts of the world, the Nigerian government must seek to provide enabling policies for PPP.”

He, however, cautioned that, “Proper documentation, well structured agreements, a joint committee that would monitor and evaluate progresses made in any project involving both sector could ensure better implementation.”

While changing policy and legal environment have become more favourable with significant protection for investors in the health sector, basic prerequisites such as funding mechanisms for services and investment codes that guarantee sustained support being put in place will further open for enduring partnerships with the private sector.

Interestingly, some private sector-led initiatives domiciled in public health institutions are already thriving in Nigeria .  In diagnostics for instance, Deux Projects, a private Turnkey Diagnostic Centre is currently partnering with Lagos State University Teaching Hospital (LASUTH). Also, Crest View, an X-ray and diagnostic centre in Lagos , is in close partnership with National Orthopaedic Hospital , Igbobi. The same is said of the University College Hospital (UCH), Ibadan , which is home to 64 computerised Tomography equipment, installed through a PPP involving JNC International.