The rate of revenue generation is falling and this naturally impacts on health care financing. What is the way out?
We are facing fiscal headwinds as a country given the decline in oil process and volume of crude oil. Investing in healthcare yields a lot of returns because it is part of human capital development in Nigeria. Health is wealth. What that means is that, when we look at possible interventions, primary health care interventions are some of the most cost effective interventions you can invests in.
By investing in primary health care, we are averting expenses or costs that we would incur later. For instance, it’s cheaper to tell someone to exercise and reduce salt intake than to treat issues that arise from severe hypertension. Investing in primary health care is good value for money.
How can we get the private sector in Nigeria to invest more in health care delivery?
Nigeria is a mixed health care system where the private sector accounts for a significant portion of service delivery. Take Lagos for instance, there are about 3,000 health facilities ; 2,700 are private while 300 are government owned.
That is a ratio of 9-1 so clearly there is a significant private sector investment in health care in Lagos. In many states you find out that between a-third and two-third of health care is provided by the private sector.
Any private sector enterprise means private individuals have invested in it, perhaps not on a scale you find in some other countries because of limited resources.
However, a few years ago, the then Minister of Health, Dr. Mohammed Ali Pate, worked with some private sector leaders like Alhaji Aliko Dangote, Jim Ovia to mention a few, and they set up the Private Sector Health Alliance of Nigeria (PHN) which is currently managed by Dr. Muntaqa Umar-Sadiq. One of the aims of that organisation is to harness and coordinate the Mobilisation of private resources to bring to bear on general health care delivery – public and private.
That is why Health Leadership Academy , is partnering Private Sector Health Alliance of Nigeria on the LEAPS programme. PHN is one of its kind – you don’t have this in many countries where the organized private sector have come up together to set up a platform with an explicit mandate to invest in health.
We need to also create an enabling environment to attract private sector investment in health care to compliment what government is doing. When many Nigerians go abroad for medical care, they go to private providers. Also how do we set the right policy framework to ensure care is accessible to everyone – rich and poor.
So what options would you proffer?
There are several market failures that needs to be addressed, one of which is access to capital. Other sectors have had intervention funds, they had ways of reducing the cost of capital and I think the health sector needs something of that nature. Either intervention funds or a market driven approach to reducing the cost of capital.
It could be by risks guarantee or other financial instruments. Also doctors and medical directors need to understand how to run a business so they can run the hospitals profitably.
As an investor, if you want to invest in hospitals, you want to be sure the money will be managed appropriately and you want to look at the management and financial controls as well as corporate governance in the hospital. So we want to build the competencies among medical directors that would make investors want to invest in hospitals.
What does LEAPS intends to achieve?
LEAPS is Leadership Enhancement and Accountability for Public Sector. It is one of the programmes of the Health Leadership Academy (HLA) of which I am a co-founder. The purpose is to work with public sector leaders, to equip them with the skills set to be effective programme leaders and policy makers.
What leadership gap have you noticed among health care managers and how has that impacted on the quality of health care delivery in Nigeria?
Leadership is a journey and there is no one that has gotten it 100 percent. It’s about recognizing the fact that it’s a journey of continuously improving ourselves.
Our health care system in Nigeria is a mixed health care system. With a population of about 180 million, 36+one federating entities, the kind of skills set you need goes beyond what you learn in medical school for the doctors, and it also goes beyond what you learn in the universities. That’s what we try to build and improve.
What are these skills set you seek to impact your trainees?
One of the key constraints that most health oragnisations face is the ability to work with finance and budget. Most heath care people mean well. They want to save lives. They want to improve the quality of services being provided. On the other hand, the person that is to manage the tight budget wants the money utilised efficiently and effectively.
That creates a tension especially where improving services may cost much more money than may be available. When you learn about budget and understand the financing process as a health person, you will understand the language the people in budget and finance speak, you will be able to speak their language and communicate specifically what you really need and strategize better.
They would also budget with better understanding of what the health care issues and challenges are. It facilitates better communication alignment between those in the technical departments and those in the finance and budget.
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