Transforming the Nigerian healthcare system from the ground up

When we evaluate the healthcare system in Nigeria, it is really easy to play the blame game by pinpointing the failings of the government as the reasons for the many problems in the system. This is quite understandable as we have seen how the different administrations have been unable to adopt robust strategies that tackle these healthcare issues head-on. In 2017, the Federal Government unveiled its plans to revitalize at least 10,000 primary health care centers with the goal of ensuring that every ward in the country had at least one functional health centre.

Fast forward to August 2019, this is still a pipedream with many state governments claiming that not a single PHC in their states has been rehabilitated. But beyond seeking these top-down solutions, there is the need for healthcare leaders and stakeholders to develop and implement strategies that transform the system from the ground up. As expected, these solutions will be geared towards the primary healthcare system, which is the first point of care and is easily accessible to more than half of Nigerians.

In this article, I have taken a cursory look at the strategies that have worked in several African countries as well assome states in Nigeria. And I believe that we can effectively replicate these achievements as long as we focus on these three aspects of the primary healthcare system.

• Equipping the workforce
A few months ago, Aliyu Ya’u a graduate of the College of Health Technology, Pambegua in Kaduna State was arrested for killing a patient after a failed hernia surgery. During the interrogation, Ya’u revealed that he had carried out countless successful surgeries and it was just unfortunate that the last operation didn’t end up as planned.

Clearly this is an unacceptable case of malpractice and Ya’u should be prosecuted for impersonation and possibly homicide (if he has not). However, the fact that this graduate of a health college successfully carried out surgeries in the past isan indication of the capability of healthcare workerswhen properly trained and equipped.

In recent years, there has been a clamour to implement the task-shifting policy in order to equip allied healthcare professionals to effectively meet the needs of the populace, especially in areas where there are no doctors. With the implementation of the task-shifting and sharing policy, community health workers can be trained to provide skilled and quality care thatis comparable to centers where doctors are available. Apart from providing care, the task shifting policy also has the potential to serve as a viable option for cost saving and improved efficiency in the healthcare system. Thankfully, this program has been adopted in several states in the country and it has been quite successful to the extent in which the community health workers are well-trained. However, there are still many states that are yet to adopt this system.

• Improving infrastructure
In 2019, the FG allocated less than five per cent of the annual budget to the health sector and this has been the trend for many years. As a result of these budgetary constraints, it has become increasingly difficult to improve infrastructure within the healthcare system. According to the World Health Organization, one in four health facilities in Nigeria lack electricity. In fact, there have been reports of erratic power supplyleading to interruptions in theatre rooms causing doctors to carry out surgeries using the light from their mobile phones.

In 2015, the UNDP partnered with the Zambian Government to set up solar powered systems in three primary healthcare centres in rural Zambia. The impact of this project was quite profound with the clinic staffs reporting how the constant power supply guaranteed the quality of their medicines and laboratory reagents. The electricity generated also provided cold chain storage for vaccines as well as a means of sterilizing equipment. This is certainly an excellent initiative that should be available in not just Zambia but in different parts of Africa including Nigeria.

Another private-led initiative that has been quite transformational in improving infrastructure is the Medical Credit Fund, a brainchild of the PharmAccess Group. The provisions from the Fundhave led to the revamping of over 40 healthcare centres in Lagos with the initiative also moving to Delta State where renovation projects are ongoing. But there is just so much one organization can do as there are still many PHCs across the nation languishing in decay due to lack of funds.

• Empowering communities
One of the major barriers to care, especially in the rural parts of the country is poverty. Although many of the services rendered in the government hospitals are subsidized, rural residents still find it difficult to access care because of their inability to pay. Currently, less than five per cent of the Nigerian population is covered by any form of health insurance and an estimated 70 per cent of the healthcare spending in the country is out-of-pocket. With the average Nigerian living on less than two dollars a day, the impact of a disease or a life-threatening injury is most likely destitution.

To solve the problem of financial risk protection when it comes to accessing care, it is important we seek effective means of empowering individuals and communities by providing viable health insurance schemes. One of such is the community-based health insurance, which adopts the principle of risk sharing in order to provide financial risk protection. This system is an excellent option for those on the lowest rungs of the economic ladder as it makes care affordable and ensures that no one is left behind when it comes to accessing care. We can take a cue from Rwanda, a country that went from having seven per cent of the informal sector population covered in 2006 to 74 per cent in 2013. The country successfully implemented the community health insurance scheme, which led to its healthcare system becoming one of the most impressive systems on the continent.
Ogunsipe is a pharmacist, wrote from Lagos