Medical tourism to India is a racket, says minister
• FMoH, HFN propose establishment of Bank of Health, set up technical working group, timelines to be achieved with private sector as third national Health policy ready for presidential assent
• Minister promises to fast-track passage of revised NHIS Act making health insurance compulsory
• Revitalize seven teaching hospitals, 10,000 PHCs next year
• Begin implementation of $500m from World Bank for Save One Million Lives initiative
• Reward best state on maternal, childcare with $1.5m, establishes indicators
• Ondo emerges best in South West on all relevant sector indicators
Determined to improve the health fortunes of the country and as part of activities to mark his first year as the Minister of Health, Prof. Isaac Adewole, has begun fresh consultations with the private sector and states even as he rolled out his revised blueprint.Adewole at different fora in Lagos including a breakfast meeting with Chief Executive Officers (CEOs) and Health Care Federation of Nigeria (HFN) tagged “Unlocking the Potentials of the Private Healthcare Sector” said that medical tourism to India is a racket and the country loses billions of naira yearly due to the fraud.
A racket is a service that is fraudulently offered to solve a problem. Also, the Minister at the operationalization meeting of Saving One Million Lives Programme- for Results (SOML PforR) South West Zone, tagged “Improving Health Outcomes in Numbers,” said the country has began disbursement of the World Bank’s $500m grant to Save One Million Lives of women and children.
The World Bank through the Federal Ministry of Health (FMoH) has began disbursement of $500 billion grant to 36 States including the Federal Capital Territory Federal for the improvement of health outcomes of women and children in Nigeria.To address the problem of poor funding and lack of credit for health, the FMoH and HFN have proposed the establishment of Bank of Health; and to discourage medical tourism, they plan to begin advertisement of skills and facilities available in Nigeria.
The group, also, at the breakfast meeting set up technical working group and timelines to be achieved.President of HFN, Mrs. Clare Omatseye, said it is already a huge success the fact that government has clearly engaged the private sector, which is critical to unlocking the potential of the health sector. Omatseye said the private sector is ready to take on the new horizon and invest but it cannot do without the government.
Meanwhile, the Minister disclosed that the third National Health Policy is ready for Presidential assent and there are plans to fast track passage of revised National Health Insurance Scheme (NHIS) Act to make health insurance in the country compulsory.
Adewole decried a situation where there is great burden on teaching hospitals because even people with diarrhea that can be treated at the Primary Health Care centres (PHCs) still besiege the highest level of care. He said only 20 per cent of the 30,000 PHCs are functional and only five per cent of rural women delivery under supervised care.
To address the situation, Adewole said the federal government plans to revitalize seven teaching hospitals and 10,000 PHCs in 2017.The Minister also condemned a situation where the country import insecticide treated nets (ITNs) from Tanzania and vaccines even from other African countries despite the fact that we have the capacity to produce these essential items.
Adewole said to reverse the situation the country is already planning to reactivate the vaccine production plant in Yaba Lagos and reviving capacities to produce ITNs.The Minister admitted that the country does not have the capacity to handle emergencies and therefore not prepared for such.
On maternal and child health, Adewole said the country is the largest contributor to Mother to Child Transmission of HIV (MTCT) with 30 per cent; 40 per cent of children in northern Nigeria are malnourished; and 970,000 women and children die yearly from birth-related issues.
HIV is Human Immuno-deficiency Virus that causes Acquired Immune Deficiency Syndrome (AIDS).Adewole, however, said some states have done well on maternal and child health with Ondo emerging best in South West even as he said there are plans to reward best state on maternal and child health with $1.5m based on performance indicators.
On the medical tourism to India racket, Adewole said: “I sat down as a minister and the first thing is I kept on getting these request of people who want to travel out and to me is like a racket. It is framed between N9 million nine and N11 million, it is not one million not two million. I may look at some and say something must be wrong somewhere, some of the referrals are written by senior registrars on behalf of consultants. Later on I got to know that when you send four cases to India, they give you the money of the fifth one, so it is a racket and we must stop it. Thereafter I decided I would only approve if it was written by a consultant and endorsed by chief medical director saying, ‘there is no facility to handle it in the country.’
“…The thing is that it is a racket and I have tried to send them back. Few weeks ago, a case cam up and I said Prof. Sokunbi in University College Hospital (UCH) why would we have to refer such could do this. They say he cannot do it, but he did it, there is a lot we can do.”
“We need to advertise the skills set available, the facilities that can do it and we can work together. Am quite impressed when I listened to the array of skills present in this room, but we need to market it. We run down what we have, we create an impression that nothing is working in this country and that is not too correct.
“So let us work together with you. Both public and private facilities, can we advertise them? These are facilities and these can be done here. There are centers here doing renal transplant, a lot of Nigerians go out for renal transplant, but it is done in this country. So let us use these facilities, we are not marketing or advertising Dr. XYZ but we market the facilities and services, and we are ready to work together with you.”
Omatseye said: “We have heard the minister today, he said that the private sector is for his second year in his tenure, his main stake is that for private public partnership to be able to galvanized, what is required is to unlock them through incentives through public partner sponsorships, this we think is the way to go.
“For us the patients is at the centre of all we do, this will give access to quality health care that is affordable and sustainable, we do not want these circles all of a sudden you build a hospital and there is no maintenance of equipment and after that it goes down. There is more to hospital than healthcare service. It is not about the building and equipment it is about people, it is about partnerships and it is about sustainability. Through this sustainability we can not only build what we have, but also we can build the infrastructures that is required and the ecosystem of the hospital brand, new pharmaceutical companies that can manufacture in the country for Nigerians.
“We are talking of more than 180 million Nigerians, it is a pity that we have to import almost 80 per cent of our drugs. We will now be able to create jobs and have a better notion of what we really have in our medicines; you know there is a lot of faking and adulteration. When the drugs are made in Nigeria we can be really sure of the quality. We also think the procurement chain management will be improved. The whole chain, the whole issue to deal with data so that we can use our Nigerian data rather than quoting other individuals around the world. We think that at the end of the day the poor patients will now have access to care.
“We believe that healthcare insurance is something that should be mandatory it is something that every Nigeria should have access to but we cannot do this alone so the public private care partnership that collaboration and communication is what we set up today.
“Twice a year we set up a technical working group to look at the big issues in healthcare from financing healthcare on the demand of the supply side to the issues to deal with incentives to unlock the potentials. The issues is education and lifting the standard of education and medical schools, we also know that human resources for healthcare is a challenge and overnight even if we are to graduate all the university students right now, we will still not be able to close the gap of the human resource challenges and therefore we need to think of new ways, leverage on technology to be able to do task shifting. Where nurses and midwives can do some of the work than a doctor can do, we will do special curriculum to upgrade the skill, set on certain area of certain tasks of human resource healthcare and this is the start of great things to come.
“Gone are the days the public sector tell the private sector what to do amid the policies. Now we have talked about open collaboration and joint formulation of policies making sure that we can pass the NHIS bill, we can get incentives for the private sector but the new policy for private sector partnership dedicated to healthcare not for building bridges and roads, it is for us a new beginning for us and the able minister who is so proactive, we have a President who said that the private sector is a way to go and that they cannot do it alone.
“The HFN was built several years ago because we realised that healthcare in the private space is very fragmented, there are several people speaking at different voices at the level of policy making and by the end of the day we cannot galvanise what is going on because there are too many voices, so we said we need to have one voice and one umbrella body that united the whole of private sector to speak with one voice in policy making, for advocacy and to look at the big thing that cross curtain across the entire industry and this is what we have been able to do and the success that you have seen today.”
Meanwhile, the SOML Programme will be financed by a $500 million International Development Association credit to Nigerian government over a period of four years, and the funds would be disbursed to states based on performance.Adewole said the Ministry conceived the idea of Saving One Million Lives as a new strategy to save the lives of mothers and children by increasing access to and utilisation of a set of high impact essential commodities and services.
National Programme Manager SOML PforR, Dr. Ibrahim Kana, said states are rewarded (money) based on improvements in key SOML interventions and quality of care.
Kana explained: “Results are measured by independent surveys carried out according to World Health Organisation (WHO) and United Nation Children Fund (UNICEF) standards. States are rewarded for improvements from their own baseline – not absolute levels. Within each zone the most improved state will earn extra funds; also there will be a national champion. Rigorous auditing system in place with funds to be exclusively utilised in health.”
Programme Officer SOML PforR, FMoH, Dr. Chima Elenwune, in his presentation said states can earn money based on their focus on Disbursement Linked Indicators (DLIs) and that states are expected to produce plans for achieving reductions in maternal, perinatal and under five child mortality.
Elenwune said the states would be judged based on their improvements on six key health indicators: vaccination; insecticide treated nets used by children under five; contraceptive prevalence rate; skilled birth attendance; HIV counselling and testing during antenatal care; and Vitamin A coverage of children six months to five years.
He said States are rewarded annually for improvements in performance from their own baseline and performance is based on the sum of changes in all six indicators. Elenwune further explained: “A minimum threshold of six percentage points improvement from the previous year must be exceeded to receive performance bonus. Value of disbursement is $205,000 for each percentage point increase in performance above the minimum threshold, across all six indicators. Zonal and National Champions that is Best performer in each zone gets an additional $500,000 while overall best gets $1 million.”
What have been the challenges to improving healthcare in Nigeria in this last one year? The minister said: “This meeting is actually the celebration of my one year in office, as my appointment as a minister. We were actually allocated with portfolio November 11 last year, so meeting you today is like looking back and saying lets work together. When I came on board I spent the next one-week out of the ministry. I think I reported on November 11 and went for one week to really develop the health agenda and I came back one week after to the ministry and said this is going to be my plan, which I shared with the minister of state and the permanent secretary. We took it to the technical working team group at the ministry, but then to have a plan is one thing and to handle it is another.
“We were than faced with lots of challenges, that we could not even on time implement those plans. We where faced with Lassa fever and it was as if Lassa fever never existed in this country. The media said we are not doing anything and it is killing all Nigerians, so we had to face Lassa fever then we have to look at the issue of polio and many other things in the last one-year.
“But now we are fairly stabilized and this is now the time to say work ahead and develop stable policies that would impact the health of Nigerians. In the last year, we have logged into the National Health Policy. We have had three policies in the history of this country, one in 1988, another in 2004 and we approved another one this year, which would be the third one. So the title of it is to accelerate the health, socio economic development in Nigeria through the promotion of health care system. Just trying to reframe the message that when we improve health, we can eliminate poverty and have share prosperity and actually contribute to social economic development in Nigeria, and then we move on.”
Going forward, what are your plans? The Minister said: “We wanted to do what do a revitalization of the primary care system and the president set up an inter-ministerial committee and we said if we take this as a federal government initiative, the states would run away. They would abandon it and we would have no choice than to keep on managing.
“…So we tried to turn things around and say lets use the save one million lives initiate to flag off the revitalization of the primary care centres and some states have started. Niger have started, I went to Niger to launch it, I have been to Borno, I would be in Abia, and so many of the states are taking it on and am encouraging them.
“…Today we have four cases of polio in Borno. All of the children have no access to healthcare for the last five years so is not unexpected, so we are working hard with the military, army medical services to address the polio challenge and we are trying…
“…I know clearly that we need the private sector. Two reasons, you have the resources, the discipline and I believe that working with you would enable us deliver more. This second year I think one of the primary things we want to do is to partner with you. We would need to improve on policy and I have no problem with that, we need to enhance sector collaboration, we need to strengthen in partnership and cooperation and embark on a more aggressive prioritization for those high impact interventions we really want to attain…”