Nigeria: Assessing Private Sector's Involvement in Boosting Healthcare

25 April 2019

PATIENCE IHEJIRIKA takes a cursory look at the private sector's engagement in strengthening Nigeria's health sector in a bid to compliment government's efforts.

Like education and agriculture, health is too critical a sector to be left to government alone hence the role of private sector in addressing the challenges in health sector cannot be overemphasised.

Nigeria's health indicators are as frightening as they are disconcerting with healthcare services not available for most communities. The challenges are enormous and included but not limited to lack of equipment, poor manpower and brain drain. These factors have fuelled medical tourism where millions of naira are spent seeking health services abroad.

Although public sector funding in terms of budgetary allocation and concomitant releases for the health has been abysmally low, government has been doing its relative best in repositioning the health system.

However, it a settled opinion that public sector funding is not enough consequent upon which there are clamours for private sector involvement.

Over time, we have seen a growing commitment by private sectors to address gaps in the healthcare system, including a strong focus on primary health care, the frontline of health. The role of private sector's involvement in complementing efforts of the government in achieving the health Sustainable Development Goals (SDGs) and accelerate improvement in the country's health sector cannot be overemphasised.

With the launch of of the SDGs, the international community has taken more ambitious agenda to aggressively address the unfinished agenda of the Millennium Development Goals (MDGs), and build the foundation for Universal Health Coverage (UHC), for all.

Aside the fact that the Nigerian government has shown commitment to achieving universal health coverage (UHC), the role of the private sector comes into play because of the tight efficiency and financial muscle available in the sector, which can be leveraged beyond mere corporate social responsibility.

Understandably, the need for private sector involvement always dominate discussion when matters related to health financing are being discussed.

Conscious of this and mindful of the need to support a vibrant public-private-partnership(PPP) initiative in the health sector, Healthcare Leadership Academy(HLA), has been bringing stakeholders from the public and private sector under one roof for training so as to support efforts of boosting the health sector.

Recently, HLA trained experts drawn from Kaduna, Nasarawa and Niger States, in an attempt to complement government's efforts in addressing gaps in the sector.

Indeed, during the graduation ceremony of the training programme, tagged: "Leadership Enhancement and Accountability for Public Sector (LEAPS)", recently in Abuja, experts challeneged stakeholders to identify problems bedevilling healthcare delivery and proffer possible solutions.

Our correspondent reports that the nine months training had participants from Kaduna, Nasarawa and Niger States. No fewer than 30 multidisciplinary professionals were trained under the LEAPS programme.

Dr Ikrama Hassan is the Chief Medical Director of Dalhatu Araf Specialist Hospital Lafia, Nasarawa State and one of the stakeholders at the training.

He told LEADERSHIP that the Nasarawa state team at the training worked on two projects in a bid to improve the health care system in the state, noting that the training aimed at improving the education of healthcare professionals will allow for a better relationship between the community and the health sector.

Hassan said while at the training, his team emphasised on increasing skilled birth delivery in Nasarawa State, with the project targeted at reducing the measles, mumps, and rubella by increasing hospital delivery among pregnant women.

Hassan who explained that the Multiple Indicator Cluster Surveys (MICs) report showed a prevalence of 48%, suggested that the state ranked among the states with low Skilled Birth Delivery (SBD) in Nigeria. He said such has contributed to the high measles, mumps, and rubella of 1000 to 100,000 live births recorded in the State as aptly captured in the State's Strategic Health Development plan.

He said the project was aimed at increasing the percentage of skilled birth deliveries from 48% to 53% between July 2018 and April 2019 in Nasarawa State.

He further said that the project which was carried out through social mobilisation to encourage early decision making for hospital delivery, training of community health extension workers and provision of necessary equipment of health facilities, was successful in increasing the number of skilled birth attendants in primary health centres and increasing the number of PHCs with equipment for skilled birth delivery.

Furthermore, Hassan who said the team also emphasised on improving four Antenatal Care (ANC) visits in PHC facilities in the state while at the training, said women with poor antenatal care have a greater risk for adverse pregnancy outcome.

While explaining that Nasarawa State has 775 public PHC facilities with the provision of Antenatal Care (ANC) Services, he said in 2017, the proportion of pregnant women that completes four antenatal care visits was 50%.

"This is not surprising as statistics from MICS and Nigeria Demographic and Health Survey (NDHS) showed inadequate knowledge on ANC benefits by the community, 90% of women with more than a secondary education received ANC from a skilled ANC provider, as compared with 36% of mothers with no education.

" In addition, the reports revealed gaps in the skills of health workers required to provide quality ANC services, only 59.8 per cent of pregnant women received information of symptoms of complication as part of routine antenatal care visits in 2017," he explained.

However, he said the project was aimed at increasing the percentage of pregnant women completing four antenatal visits at PHCs from 50 per cent to 55 per cent between July 2018 to March 2019 in the State.

He further said that 85 per cent of target health workers of 1,510 were trained, 40 per cent of 147 communities held sensitisation meetings for pregnant women and women of child bearing age, while ANC equipment and commodities were procured and distributed to 100 per cent of health facilities as a result of proper planning while at the training.

Speaking on increasing modern contraceptive prevalence (mCPR) rate from 8% to 11% local government areas in Niger State by March 2019, the team leader of the state Joseph Barde, noted that there is low uptake of modern contraceptive among child bearing women.

Barde said the method used in getting result were quarterly provision of family planning commodities and consumables to 197 of 322 health facilities across nine local government areas of Niger State; increase private facilities reporting in District Health Information System (DHIS) platform from 3.06 to 27 .6%, and training of 60 religious leaders on family planning message.

He however said that integration of private facilities will help increase data coverage, consistent supply of commodities and consumables to provide free services and encourage turnout of clients.

He said the team further worked on reducing maternal mortality due to malaria in pregnancy through the use of sulfadoxine-pyrimethamine (SP) in Niger State and identified that uptake by pregnant women for the prevention of malaria in the state was generally low especially Intermittent Preventive Treatment of Malaria in Pregnancy (IPTp2).

He said the project aims to increase the percentage of pregnant women receiving IPTp2 for the prevention of malaria.

While noting that the Kaduna team worked on ensuring commodities availability across 92 primary health care centres in the state, the team leader, Hamza Ibrahim Isa, who said the team identified poor availability of the World Health Organisation (WHO) life saving commodities across 92 primary health care centres in Kaduna State by July 2018, said the aim was to increase availability of WHO life saving commodities in 92 PHC centres from 34% in 2018 to 85% by April 2019.

Isa, while noting that the team worked on increasing PENTA3 coverage from 35% to 83% in Kaduna State, said the group identified only 35% penta3 immunisation coverage in 255 PHC centres and 109 private health facilities in Kaduna State.

He added that the team drafted strategies of the provision of adequate solar direct drive refrigerators in 255 PHCs.

He however reiterated that more needs to be done to ensure commodities availability to the target population.

Speaking on the LEAP training, the Founder and Board Chairman, HLA, Dr Kelechi Ohiri, said the academy was established to drive transformative changes in healthcare and provide world class training to a wide range of healthcare professionals from providers to policy makers operating within the public and private domains of the African health sector.

Dr Ohiri added that the academy's target is to compliment government's effort in bridging the gap in health sector by harnessing and nurturing professionals, leadership potential, thereby inculcating within them a culture of accountability and continuous quality improvement, equip them with the skills, tools and capabilities they require to fully expand into their roles and catalyse system wide changes.

"Since its inception over four years ago, the HLA through its different programmes has trained and graduated over 250 multidisciplinary professionals, ranging from senior healthcare executives, administrators and policy makers to front line clinicians from all the six geopolitical zones of Nigeria. This seasoned professionals are drawn from private and public healthcare facilities, ministries and agencies".

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