In new book, Ezuma-Ngwu interrogates healthcare in Nigeria

Title: Universal Healthcare and Access to the Lower-Income
Population: An Exploration of
Capitation in Lagos, Nigeria
Author: Charles Ezuma-Ngwu
Publisher: Archway Publishing Year: 2021
Pages: 110
Reviewer: Gregory Austin Nwakunor

It is not every time research conducted as part of a PhD is converted into a book for reasons best known to the researcher. It is, however, valuable for the researcher, who has spent countless hours carrying out the work to turn it to something valuable to the generality of people.

This is what Dr. E. Charles Ezuma-Ngwu, an award-winning top-performing Financial and Budget Analysis and Strategic Performance leader, with a proven track record of over two decades, has done in his book, Universal Healthcare and Access to the Lower-Income Population: An Exploration of Capitation in Lagos, Nigeria, which was publicly presented on September 14.

This book presents a research-based exploration of Universal Healthcare and the benefits of healthcare providers’ capitation payment method in many developing economies, especially in a country like Nigeria, where the national healthcare system, the National Health Insurance Scheme (NHIS), has often been described as being low quality and poorly run.

The NHIS was initially conceived and implemented to encourage competition among participating providers. Unfortunately, the implementation of this goal has been weak and unsustainable.

The problem addressed by the book is the continuing gap between the Nigerian government’s efforts to provide healthcare access to all its citizens and the inability of the NHIS to reach the lower-income population in Lagos.

Like a Ph.D thesis, the book is divided into abstract, acknowledgement and foreword. There are five chapters and each chapter treats a particular issue from what the author understands as the challenge of health care in Nigeria.

Using the academic house style, the author begins the research study by describing the history of healthcare in Nigeria and exposes a country’s healthcare problem that must be addressed to ensure healthcare access to the low-income population.

To the author, while the Nigerian government’s goal is to provide healthcare to the masses, effective implementation of this goal, including focused government support and resources, has fallen short of expectations.

While revealing issues related to notable disease reporting, clustering of clinics in urban areas, and geospatial identification of disease clusters, the book provides a roadmap on how governments and policymakers can allocate scarce healthcare resources to indigent individuals, families and communities participating in public-funded, population-based capitation payment health insurance systems.

“A firmly established scenario that emerges in this book is the possibility that public-private healthcare partnerships anchored on valid population-based data can lead to viable, creative funding mechanisms and templates to address health disparities. Furthermore, this book details the creative use of secondary data analyses from existing public records to make far-reaching policy and operational recommendations on strengthening existing healthcare delivery mechanisms in defined populations,” says Dr. Chinua Akukwe in his foreword to the book.

Akukwe says that the scourge of diseases and mortality in many underserved populations in the world remains a daunting task to overcome. “We must continue to innovate in ways that propel needed healthcare services to these populations. Productivity in these countries depends on access to quality healthcare,” he says.

“The author has laid out a template for delivering healthcare to defined populations in underserved communities. The research discussed in this book introduces a geospatial method for delivering healthcare to lower-income populations,” Akukwe points out in the 110-page book.

For Akukwe, “Governments around the world can use existing data to design and implement credible funding mechanisms to expand access to health services among target populations.”

In the book, Enuma-Ngwu explores a universal healthcare approach to the distribution of private healthcare centres, especially in low-income areas, and incentives to attract these private facilities to serve target populations in poorer communities with demonstrable healthcare needs.

Utilising geocoded census data for Lagos from the United States Agency for International Development (USAID) for all private outpatient clinics and reported notable diseases and demographic data from the Lagos State government, Nigeria Bureau of Statistics, the author provides a compelling picture of healthcare disparities and unmet needs.

With the geocoded clinic locations and other data inputs incorporated into this study, a theme begins to emerge regarding gaps in delivering healthcare to impoverished locations in the city.

The author expands on the growing body of knowledge regarding the use of geospatial methodology to study and make recommendations on viable health policy and healthcare financing options on providing quality, timely, affordable health services to impoverished populations.

The author, with all complements of the research, provides an evidence-based solution to expanding access to the previously unreachable communities with quality healthcare.

The goal of universal healthcare in Nigeria will not be realised until healthcare access to the informal sector population is accomplished in a meaningful way. While disbursing PBCPs through the Nigerian HMOs is making some marginal progress, expanding PBCPs to the vibrant network of private clinics, hospitals, and other healthcare centers will ensure greater penetration of healthcare access to the poor members of the population.

The book explains that as a result of attempts at improving access to healthcare for the poor and middle class, which is a significant concern of politicians around the world, including many West African countries, such as Nigeria, many individuals and communities began to seek healthcare at private clinics or traditional medicine locations. The provider-based capitation payment models (PBCP) are considered an efficient solution if the goal is to reach the lower-income population for prevention and treatment.

The capitation model encourages providers to manage their pool of patients with a primary focus on disease prevention to control costs. Several studies have found that publicly subsidised health insurance increases healthcare access to the lower-income population.

The PBCP model can provide the needed access to poor communities using private clinics and community centers. It allows for early detection and enhanced outbreak interventions, provides additional healthcare data, and ensures more efficient monitoring of epidemiological conditions for the general population.

To deliver a successful capitation payment model for healthcare providers in Lagos, the author incorporates a framework model that included incentives and sanctions through an indirect principal-agent relationship, where the principal (enrollees) holds the government accountable for the healthcare provider’s actions. The study in this book concludes by delivering a visual template for transitioning from FFS based healthcare payment system to a more productive environment for both healthcare providers and patients to deliver and receive quality health outcomes and reach the lower-income population.