Reimagining the Nigerian healthcare sector

Whether by design or natural occurrence, whatever may be the merit or lack thereof in our responses as countries or even individuals, there is little doubt that the coronavirus has forced a collective pause in our lives. And in the process, like a dry stream bed, it has laid bare in stark and very painful relief, the connective tissues of our lives and the baked-in inequities, in a manner like no single global event in recent memory.

From the Malam in Kano Nigeria to the Wall Street trader in New York City, from the African immigrant student in Hubei Province, China to the anti lockdown protester in Sacramento, California, though our resource base may differ markedly, we are held down by the same interlocking web of forces unleashed by the coronavirus. 

But as we battle to deal with the realities of the moment and steer thoughts towards a resumption of our lives, I do wonder if we are not collectively missing an opportunity. I wonder, should we not also be contemplating a reset?

A reset of our lives and our relationships, our economies, companies, and countries, in a direction that reinforces the very same interconnections, brought into sudden, sharp relief by a relentless virus…

I refer specifically to the need for a reimagining of the Nigerian healthcare sector towards sustainable links health outcomes, healthcare financing, innovation, and regulatory capacity.

In the decades since independence, the healthcare sector has been driven by government control, from tertiary hospitals to primary care services. Yet, especially in the last few decades, the biggest changes in the sector have come from private investment in hospitals, specialist clinics, labs, and medical imaging. Many of these have little or no regulatory oversight.

In the last half-decade also, the Nigerian health sector has been redefined by the phenomenon of international travel for medical treatment, especially to India, South Africa, the United States of America, and increasingly to the Emirates. This phenomenon has in turn spurred new linkages between Nigerian doctors, clinics and hospitals and their foreign counterparts.

Conventional assessment of the Nigerian healthcare sector often begins (and sometimes end) with a chronicle of the lack of government investment. In reality, most of this refers to a lack of investment in institutional infrastructures and administration, with little linkage or consideration for the impact on improved health outcomes. In turn, government response to these assessments leads inexorably to a doubling down on the top-heavy, top-down approach…

There is an urgent need to reimagine the Nigerian healthcare sector. One that recognises the fact that the old British approach of general hospitals and maximum government control is out of sync with the Nigerian reality of private entrepreneurship.

This requires first, a reimagining of the role of Ministries of Health, at state and federal levels, from owners of specialist and general hospitals to regulatory (not ‘strangulatory’) and health promotion agencies.

It requires a clear understanding of the various sub-sectors that make up the healthcare system, from clinical delivery (primary and specialist care), financing (venture capital, health insurance), facilities (hospitals, labs, diagnostics, and imaging), and the regulatory oversight needed to link these together to form a sustainable healthcare system.

A re-imagined Ministry of Health would transition from ownership and budgeting for the management of general hospitals to regulating the licensing of doctors’ clinics, hospitals, labs, and medical diagnostics and imaging facilities and investment in wellness, prevention, and health promotion programmes, including mandatory childhood vaccination, anti-smoking, etc.

A re-imagined Health Ministry would invest in building a culture of health prevention, literacy, and awareness, promoting annual wellness visits and traditional Nigerian diets as opposed to the fast-food culture… It would pivot administrative capacity towards the licensing and regulatory oversight to ensure minimum standards and faithful maintenance of scope of practice by doctors, in collaboration with the respective professional medical associations.

Like many aspects of governance in Nigeria, healthcare financing is often burdened by a failure of imagination. The vast majority of healthcare financing in Nigeria comes from private self-pay, often with uncertain returns in terms of accountability for outcomes or professional service delivery.

The challenge and focus should be on:
How to capture this under a health insurance framework without the complexity and burden of a system such as the American health insurance system and

How to use the government reimbursement system to finance a private sector-led primary care service delivery, prevention services, etc.

The challenge is also how to bring the tremendous expertise and resource of the Nigerian medical diaspora community as a force multiplier for the healthcare system. Many Nigerian-born doctors and allied healthcare professionals that I know in the diaspora would love the opportunity to extend their practice of medicine in the direction of the homeland, as long as the regulatory system is such that the security of their investment and their ability to practise at the top of their licence is assured.
Onugu is the director of Contracting and Healthcare Management United Medical, LLC Bear, Delaware, USA.