Leveraging private sector to achieve universal health coverage in Nigeria

NIGERIA is often referred to as the ‘Giant of Africa’, owing to its large population and economy. In spite of all these, public health challenges have been a nagging problem bedevilling the wellbeing and stability of the country for a long time.

The persistent underfunding of the health sector by the Nigerian government, with low allocations earmarked every successive year and the poor health system performance are reflected in key health indices of the country.

Notwithstanding, there is evidence that the private sector could be a key player in delivering health services and impacting health outcomes, including those related to healthcare financing.

This underscores the need to optimise the role of the private sector in complementing the government’s commitment to financing healthcare delivery and strengthening the health system in Nigeria.

The development was the thrust of the 2023 Future Health Conference of Nigeria Health Watch, with the theme ‘The private sector as a catalyst for a resilient health system’, in Lagos.

“We recognise the indispensable role of the private sector, not just as a provider of services but as a catalyst for transformative change,” Vivianne Ihekweazu, Managing Director, Nigeria Health Watch, said.

She added, “The reality in Nigeria is that we have a mixed health system; patients navigate healthcare between the public and private sectors. This demands better strategic integration between public and private providers.

“By leveraging the innovation and expertise within the private sector, we need to strengthen our healthcare system, ensuring its resilience in the face of challenges. We must accelerate progress to improve health outcomes in the country.”

Health financing, she said, is very critical, adding that without partnerships, the health sector cannot grow, deliver quality services, or achieve universal health coverage for all.

“Even though the government is spending heavily, especially on primary health centre (PHC) facilities, we recognise the roles of the private sector in strengthening the health system and we need to leverage these strengths and opportunities to foster relationships between the public and private sectors,” declared Dr Salma Ibrahim Anas, Special Advisor to the President on Health.

She added, “By leveraging on the existing opportunities and possibilities of public-private partnerships, Nigeria can make substantial progress towards achieving UHC within a very short time.”

Achieving a resilient health system requires a multisectorial and multifaceted approach, where both the public and private sectors collaborate and synergise to accelerate progress towards this goal.

But such a resilient health system, Dr Ibrahim Anas said, requires crucial reforms that will establish clear rules and responsibilities with a robust government framework, transparency and accountability mechanisms to ensure the interests of both the public and private sectors are well safeguarded.

Dr Ibrahim Anas added, “Universal health coverage, using the continuum of care that no one is left behind, is not possible without privatising and positioning the health sector to be more resilient and be more responsive to the needs of the people.”

In a remark, Coordinating Minister for Health and Social Welfare, Professor Muhammad Ali Pate, said there are partnerships that could be constructed between the public and private sectors to leverage each other’s capabilities and to make investments in infrastructure, training, manufacturing, logistics and the supply chain to further drive economic development.

He stated that private sector financing for health system strengthening in a bid to achieve universal health coverage is very important, particularly as the country is undergoing several transitions, including a shift in the burden of diseases to the fast-growing non-communicable diseases and an increasing youthful and elderly population.

Professor Pate declared, “Health investments are important drivers of growth and prosperity, but they can also be a consequence of growth and prosperity. At the moment, there’s a gap between where our health is as a people and where it should be or could be, given the tremendous resources that we have in human and material resources as a country.

“President Bola Tinubu mandated us, in the context of the Renewed Hope agenda for Nigeria, to drive the transformation of the various sectors. We articulated a four-point agenda; our focus is on improving the overall governance of health and bringing stakeholders into the mixed health system that we have.

“The second aspect is to do things that will improve population health output. Whether it is the delivery of basic essential services like immunisation,  maternal and child health services, or reproductive health commodities for women through public and private channels, it requires human resources that can be trained both by the public and private sectors. That will require additional financing, not only from government resources but also from private capital, which can play an important role.

“The NHIA reforms and expansion of insurance coverage would go a long way in improving the affordability of healthcare and protecting our population from exorbitant health expenditures. It will also enable private sector partners to count on a predictable source of financing, making investments to contribute to this journey that we are embarking on available.

“The third plan is to unlock the value chain of health; the private sector can play an important role in the manufacturing of basic things. We have imported 70 to 80 percent of our generic drugs and consumables, so we can begin to domesticate the production of these consumables, basic pharmaceuticals and even medical devices.

“That is an important agenda that we will pursue and will do in a cross-sectoral way. It is not only the Ministry of Health but also the ministries of trade, finance, and other key regulators, with the private sector as partners with the government.

“Finally, it is to deal with health security as a matter of economic and global security. It is key to national security. The private sector also has a role. When pandemics occur, they also suffer when businesses are locked down. So, firms have a vested interest in looking at health security as an important aspect and being prepared for eventualities.”

Professor Pate declared that improving the affordability of healthcare and protecting the population from exorbitant health expenditures also requires NHIA reforms and the expansion of insurance coverage to enable private sector partners to count on a predictable source of financing and ensure investments that can support universal health for all.

No doubt, the role of government in the partnership revolves mainly around initiating policies to guide what goes on in the health sector and to regulate the activities of the private sector. However, Professor Akin Abayomi, Lagos State Commissioner for Health, stated that the role of the private sector is to drive and support healthcare.

Abayomi, speaking through Dr Olusegun Ogunye, Permanent Secretary, Lagos State Ministry of Health, declared that ensuring that the private sector players who want to participate in the health sector are able to do so is also the role of the government.

He declared that the partnership between the public and private sectors is helping greatly to improve health services, citing Lagos State’s central planning, which revolves around the public sector but leverages private-sector capacity and private-sector funding to achieve a fit-for-purpose healthcare infrastructure.

Through what is called the medical diagnosis and services provision scheme, Abayomi said Lagos State is now having private-sector partners come in to provide laboratory services and other diagnostic services, as well as to get modernised medical equipment for its healthcare facilities.

“We allow these partnerships as long as they don’t collide with what the hospitals themselves are able to provide. Where a hospital is able to provide lower-level services, we leverage the private sector to provide a more advanced service, even in those settings. It is clear that working together ensures that quite a lot could be achieved,” Abayomi added.

Dr Tinuola Akinbolagbe, Managing Director/CEO, Private Sector Health Alliance of Nigeria, made a case for the private multi-sector to invest in health in Nigeria.

“Now, we have the finance sector investing in Nollywood entertainment. So why can’t the multi-private sector invest in healthcare. We need to educate them to understand that in healthcare generally, you can’t have short-term investments. It is more of a middle- and long-term investment and we need to put processes in place such that when the government changes, it doesn’t affect the public-private partnerships.”

Dr Jadesola Idowu, Chief Operating Officer for Axa Mansard Health Ltd., said healthcare innovations are important to ensure that Nigeria can make healthcare accessible to all, regardless of their status or where they live and ensure a reduction in out-of-pocket payments for health.

She declared that Axa Mansard Health Ltd., through its innovations, has brought in a lot of ideas, like its microinsurance product that requires paying N450 per head per month to access healthcare services by individuals largely unreached in the community.

Dr Tolulope Adewole, Managing Director of NSIA Advanced Medical Services Limited, said the investment by the NSIA Healthcare Investment and Development Company in cardiology, orthopaedics and oncology is to liberalise access and to demonstrate to the private sector that these are doable and they can also key into them.

“As we speak, between 2019 and now, from one epileptic linear accelerator, we now have 14 linear accelerators in Nigeria today; from having two diagnostic centres to 25 diagnostic centres across the geopolitical zone; and from one cancer centre to four cancer centres. For us, these are the real successes and we want the private sector to see that this is doable. The private sector is keyed into it, and that is growing,” Dr Adewole said.

“That is the impact, so we are making the impact investment and, for us, that’s why we believe we can contribute to liberalising access to care and continuing to achieve universal health coverage,” Dr Adewole said.

The private sector has played an important role in the growth of the Nigerian economy, from banking and entertainment to fintech. Now, more than ever, leveraging the private sector’s capacity to deliver quality care and quality improvement in the public health sector in Nigeria is a priority.