POLITICAL MATTER •

“Access to basic healthcare is not just a health issue; it is a human rights issue.”

The WHO estimates that there are over 500,000 deaths from malaria alone every year on the continent. And indeed, many of the issues facing the Nigerian healthcare system are similar to those faced in much of the rest of Africa. What then, does the new Buhari administration need to do in order to address some of the persistent problems facing Nigeria’s public health infrastructure?

Today, the whole of the African continent faces a very unique set of healthcare challenges. In most western countries, the diseases that historically killed the largest numbers were infectious diseases such as the plague, cholera, and measles. With the introduction of antibiotics, immunizations, and good quality primary healthcare, however, many of these diseases have effectively been combated.

In modern times, the health problems that many countries in the western hemisphere face are linked with chronic diseases such as cardiovascular disease, diabetes, cancer, and chronic disease in the elderly.

On many parts of the African continent, however, infectious diseases remain a significant problem. And Nigeria is no different in this respect. In addition, much like the economically developed parts of the world, many African countries – including Nigeria – also suffer from the onslaught of non-infectious diseases, such as cardiovascular disease, diabetes and cancer.

This double threat requires a unique strategy. We must address the burden of infectious and non-infectious diseases simultaneously.

Nigeria has the resources, the expertise, and the willpower to develop a world-class healthcare system. But we must be unorthodox and creative in doing so. If we are to be effective, we must replicate what countries such as the United Kingdom, the United States, and Germany have done well, but be even more assertive about identifying things that do not, and will not, work.

We must avoid at all costs, what I call the ‘Sugar Daddy’ approach to healthcare; which is to say, we must not take the easy route in simply copying the systems of other countries wholesale without first assessing how applicable these systems can be in the local environment.

There are three important areas that must be included in any coherent strategy to ensuring an improved and more inclusive healthcare system for Nigerians.

Costs:

The cost of global healthcare is rising; and it is a cost that disproportionately affects many economically developing countries, which tend to have smaller healthcare budgets.

It is paramount that aggressive cost-reduction strategies be implemented; and quickly. The development of tele-health and mobile health will be essential cost saving measures. Giving patients the ability to virtually consult with specialists, and circumvent distance, will revolutionise the quality of healthcare provision for rural populations; as well as reduce costs.

The World Economic Forum has suggested that it would take economically developing countries 300 years with the existing infrastructure to achieve the same doctor to patient ratios that exist in many western countries. We can neither afford, nor do we need to wait on a 300 year plan. We need a ‘right now’ plan to save lives today.

We must, therefore, also begin to quickly transition out of a doctor-centric model of healthcare delivery; as currently, there are simply not enough doctors. Our model must be one led by community health workers and auxiliary nurses who would employ clearly defined protocols to treat common ailments; with doctors left to provide more specialist care.

E-health and mobile health will not only reduce the need to build new hospitals and clinics, but adopting a community health worker/auxiliary nurse model will, further, reduce staffing costs.

The cost of medical equipment and pharmaceuticals also contributes significantly to the cost of healthcare delivery. To tackle these costs, we should continuously look, both internally and externally, for lower cost healthcare solutions. For example, the SureVent transport ventilator reduces the cost of a ventilator for pre-hospital patient transport from $30,000 to just $700. Or the embrace infant baby warmer, which costs a mere $200, can keep a new-born infant warm for hours. The cost of a conventional baby incubator can be up to $50,000.

Such innovations, and the foresight to take advantage of them, will be central to driving down healthcare costs in Nigeria and in many other countries like it.

It is clear that Nigeria must come about its advancement in this sector by boldly and strategically ‘leapfrogging’. By which I mean, we must find ways of taking shorter routes to the future than those historically travelled. For centuries, Nigeria – and other African countries – has been apprehensive about embracing technologies and ideas that haven’t yet been tried and tested in the more economically advanced parts of the world. We cannot, for long, continue to display this lack of courage.

Universal Coverage:

Suffice to say, that should all this be achieved and not be made available to all Nigerian citizens, a wide scale and inexcusable injustice will have been committed. Access to basic healthcare is not just a health issue; it is a human rights issue.

Nigeria provides healthcare cover for only 3% of its population; while countries such as Rwanda have achieved 90% coverage. Nigeria must take its cue from countries such as Kenya, where the National Hospitals Insurance Fund has been established to give the very poor access to both formal and informal providers of healthcare through the Household Insurance Subsidy Programme.

The expansion of Nigeria’s health insurance programme is paramount. It will require innovative financing in partnership with the private sector. Enrolment in the insurance system by all formal healthcare providers – as in the Kenyan system – must be compulsory.

There will be numerous challenges to achieving this, but compulsory cover will be the only way to achieve the critical mass required to at least partially fund the basic healthcare requirements for every Nigerian.

Preventative Care/Public Health Promotion:

Many western countries have made a fundamental error which Nigeria must not repeat. They have developed systems that are focused almost exclusively on the treatment of illnesses, instead of on health maintenance. And indeed, it could be argued that they have created ‘sick-care’ systems rather than ‘health-care’ systems.

The United States, for example, spends $2.7 trillion annually on health care— more than any other country in the world. But America fails to achieve the best healthcare outcomes in the world. Furthermore, the United States spends hundreds of billions of dollars annually to treat preventable illnesses and diseases.

This highlights two main points. First, that increased healthcare spending does not definitively or inevitably produce better healthcare results. Second, that a great and unnecessary proportion of healthcare funding is spent treating diseases and illnesses that are preventable.

A Harvard University study revealed that a preventative mobile health programme returned $36 in savings on healthcare costs for every $1 spent on prevention. Creating a culture of health – as opposed to a focus on illness – requires a commitment to prevention. Nigeria must focus on preventing diseases and injury as it is the most cost-effective, common-sense way to improve health.

The problems of healthcare provision in Nigeria are manifold. There are many approaches and theories on how the situation could be improved for the millions of Nigerians currently without access to basic healthcare. Driving down healthcare costs, providing universal healthcare coverage and concentrating on public health will all factor into a unique solution for Nigeria.

One thing is for sure, and that is that a concerted multi-sector effort is required to reform and rehabilitate an industry that is responsible for keeping Nigerians alive and healthy.

Dr Olamide Orekunrin is a medical doctor and founder of Flying Doctors Nigeria (De Flight Medics Ltd). FDN was the first indigenous air ambulance service in West Africa and provides air ambulance services across the region.