Health
Appraising and Re-tooling Nigeria’s Public Health Delivery Model in the Post COVID-19 Era
By Christopher Samuel
That the ravaging COVID-19 which has since the beginning of the year spread rapidly around the globe could leave a very serious public health crisis in its wake is no longer news.
In many parts of the world, attention is shifting to how to concretize local, regional and continental health partnerships that focus on not just how to successfully contain or tackle the virus, but, more importantly, to ensure that life-saving and essential health delivery services are sustained and maintained to entrench a robust system that maximizes the learnings gained from the current pandemic.
Like other developing countries, Nigeria now, more than ever before, has to seriously confront the challenge of creating a modern health services delivery system that guarantees efficient, fast and accessible solutions capable of curtailing fatalities associated with common diseases and their devastating impact on families, communities, and development.
While speaking recently on the threat of malaria in the country, the Minister of Health, Dr Osagie Ehanire, revealed that “though fever testing amongst children under 5 has increased consistently from 5% in 2010 to 11% in 2013, to 13% in 2015 and 14% in 2018, it is still very low when compared with the second objective of the Malaria Strategic plan which is to test all care-seeking persons with suspected malaria using RDT or microscopy.”
According to the World Malaria Report, Nigeria still accounts for 25% of the global malaria burden and 19% of global malaria deaths. Nigeria, it is estimated accounts for 81,640 annual malaria deaths – about 9 deaths per hour – and the situation is worsened by very low levels of investment in malaria elimination at both the sub-national levels and the private sector.
Apart from the frightening mortality and morbidity data on malaria, lack of access to functional health services delivery system has also been responsible for avoidable havoc caused by many other common but potentially deadly illnesses, such as STDs, diarrhoea, hypertension, and diabetes on a large segment of the 52% of the country’s population that lives in the rural areas.
To compound the situation, the country’s rural areas mostly lack good and functional infrastructure while the unavailability of competent healthcare personnel, coupled with high levels of poverty and illiteracy continue to make public health a daunting task in the country
Despite the country’s strategic position in Africa, it is highly underserved in the health care delivery sphere. Health resources such as facilities, personnel and medical equipment are inadequate, especially in rural areas.
Latest data from a survey of Africa’s 10 largest economies show that only Ethiopia has fewer hospital beds per capita than Nigeria. The most recent WHO data puts the number of hospital beds at only five per 10,000 people in Nigeria.
Beyond hospital beds, however, public healthcare delivery is hampered more by the inadequacy of healthcare resources particularly personnel, drugs and other medical equipment needed for holistic patient treatment.
For instance, the doctor to patient ratio is currently 1:6000. Most of the available qualified doctors are concentrated in urban cities and towns while the rural areas have next to nothing, thereby leaving room for quacks and other unqualified hands to tend to citizens’ health needs.
This poor picture makes the healthcare system particularly fragile and always at major risk of being overwhelmed at the breakout or in the aftermath of any pandemic with a serious presence in the country.
Yet, as an important element of national security, the need for public health is non-negotiable. Public health not only functions to provide adequate and timely medical care but also tracks, monitors, and controls disease outbreaks.
The Nigerian health care environment has suffered several infectious disease outbreaks year after year. Hence, there is a need to tackle the problem decisively now in order to forestall a repeat of the chaotic national response to the COVID-19 pandemic.
While the government has regularly come up with reforms to address the wide-ranging issues in the health care system, implementation has sadly been poor.
According to the 2009 communique of the National Health Conference, health care system remains weak as evidenced by lack of coordination, fragmentation of services, the dearth of resources, including drug and supplies, inadequate and decaying infrastructure, inequity in resource distribution, lack of access to care and a very deplorable quality of care. The communique also pinpointed a lack of clarity of roles and responsibilities among the different levels of government to have compounded the situation.
To further underline the fact that the Nigerian health care system is poorly developed, experts have often observed that there are no discernible and well maintained adequate and functional surveillance systems in the sector.
A successful modern-day health care delivery model requires routine surveillance and medical intelligence as the backbone of the health sector. This is because medical intelligence and surveillance represent a very useful component in the health care system and control of diseases outbreak.
The provision of timely information aimed at combating possible health menace among many other things is an important function of public health.
Hence, inadequate tracking techniques in the public health sector can lead to huge health insecurity, and thereby endanger national development, peace, and security.
There is, therefore, an increasing role of automated-based medical intelligence and surveillance systems to complement the traditional manual pattern of document retrieval in an advanced medical setting as seen in western and European countries.
Given the above prognosis, the primary challenge confronting the country’s public health today could, therefore, be framed as how to create and sustain an information-rich and patient-focused health care system that reliably delivers high-quality care.
Learning from experience is crucial, both for effective emergency response and to rebuild for the future.
Past experiences have shown that in the wake of health pandemics, the government has often been discovered to have diverted statutory health budget and resources to tackle the immediate challenge of the pandemic. This often leaves the healthcare services delivery sector more fragile, weaker and more overwhelmed, especially in the efforts to contain common citizen health needs.
For instance, in the aftermath of the Ebola crisis, many people died because of the inability of the overwhelmed health systems to treat malaria, HIV, and tuberculosis than from Ebola itself.
A similar trend can only be avoided in the aftermath of this fight against COVID-19 if efforts are geared towards putting in place a proactive, revolutionary and easily affordable and accessible health services delivery the model that can ride on the strong deployment of technology to strengthen healthcare accessibility at the grassroots.
Nigeria needs to urgently come up with an innovative approach to creating different layers of health services delivery model that can deliver effective and efficient medical services to the most vulnerable in society, to achieve the best health outcomes, such that location and socio-economic status will not be a barrier to accessing quality healthcare services. This need to also be done as cheaply as possible, given the dwindling economic fortunes of the country.
In this regard, the country needs to look towards the innovative and revolutionary community health hub idea which is capable of leveraging technology to offer a holistic solution to the identified gaps in the existing healthcare delivery systems, particularly in the underserved areas, as a way of maximizing the scarce human resources for health (HRH).
The best of this community health hub ideas is grounded on tele-healthcare model and not the anachronistic brick and mortar community healthcare facility model.
The growing popularity, spread, reach and utility value of mobile telephony and other digital devices should challenge health administrators and service providers to think out of the box in coming up with solutions that can deliver efficient health services to the majority of Nigerians, especially in the lower socio-economic cadre.
The current pandemic has demonstrated the central importance of health in our national life — without it, we have nothing. It has also shown how we can do things differently as regards to making our public healthcare system truly patient-focused.
We should not expect the world to stand still for us to move at a pedestrian pace when everybody else is sprinting to make their systems better.
Christopher Samuel is the Project Coordinator for Telehealth Nigeria Initiative (TENI) based in FCT, Abuja.
By Adedapo Adesanya
The National Health Insurance Authority (NHIA) says the number of Nigerians enrolled in health insurance has risen to more than 22 million.
The Director-General of NHIA, Mr Kelechi Ohiri, said this resulted from the implementation of the mandatory health insurance, which has gained momentum nationwide.
He said this on Wednesday at the Annual General Meeting of the Nigerian Association of Insurance and Pension Editors (NAIPE) in Lagos.
Mr Ohiri said enrolment had increased to 22.03 million, representing a 35 per cent year-on-year growth, attributing this to stronger collaboration with state social health insurance agencies, ministries, departments and agencies, organised labour, employers, the private sector, and the gradual implementation of the mandatory health insurance provisions of the NHIA Act.
He said that the country had moved beyond policy formulation to delivering measurable improvements in healthcare access, service quality and consumer protection in line with the federal government’s health sector reform agenda.
According to him, Nigeria already has the necessary policies and legislation to achieve Universal Health Coverage, positing that the key challenge was effective implementation.
“The decisive variable is now implementation- consistent, rigorous and accountable execution that converts political commitment into healthcare access for real Nigerians,” he said.
Mr Ohiri said that the transition from the former National Health Insurance Scheme to the NHIA had strengthened regulation, consumer protection, accountability and strategic purchasing, while providing the legal and operational framework for achieving Universal Health Coverage.
He added that improving the experience of enrollees remained central to the Authority’s reform agenda.
According to him, NHIA has strengthened its complaints management system, introduced faster resolution timelines, and intensified compliance monitoring of Health Maintenance Organisations (HMOs) and healthcare providers.
He further added that NHIA had sanctioned facilities that failed to meet the required standards, adding that his organisation had resolved 3,878 complaints, representing an 87 per cent resolution rate, while 95 per cent of the cases were concluded within prescribed timelines.
Mr Ohiri noted that more than N14.2 million had been refunded to enrollees, while non-compliant healthcare facilities had been sanctioned.
He said NHIA had also introduced service standards, including a one-hour treatment commencement target for enrollees requiring urgent care, to improve access to timely and quality healthcare services.
The NHIA boss further disclosed that capitation payments to healthcare providers had been increased by 93 per cent.
He said fee-for-service reimbursements rose by 378 per cent to enable providers to invest more in personnel, equipment and infrastructure.
According to him, 7,592 healthcare facilities have been assessed under the SafeCare quality framework as part of efforts to institutionalise continuous quality improvement across the country.
Mr Ohiri also highlighted interventions targeted at vulnerable groups, including support for more than 48,500 pregnant women, expanded maternal and newborn healthcare services, the Vulnerable Group Fund, and improved access to healthcare for pensioners and retirees.
He said Universal Health Coverage could only be achieved if every Nigerian, regardless of income or location, had access to quality healthcare services.
By Modupe Gbadeyanka
The new one-hour authorisation response time ultimatum policy introduced by the National Health Insurance Authority (NHIA) has received the full backing of SUNU Health Nigeria Limited.
This policy was introduced by the agency to ensure enrollees get prompt approval codes to access care.
Healthcare service providers have been urged to report any Health Maintenance Organisation (HMO) that violates this initiative through an email, with the HMO in copy and a timestamp attached as evidence of the request. They may proceed to offer services to enrollees thereafter.
Speaking at the company’s second-quarter Providers’ Forum for the Lagos-Ogun region in Lagos recently, the chief executive of SUNU Health, Dr Moyosore Olomola, expressed optimism that this policy would improve healthcare delivery in the country, especially for enrollees, who crave quality service.
At the event themed Improving Quality and Access to Care Through Stronger Provider Network, and held at the Nigerian Institute of Medical Research (NIMR) in Yaba, Lagos, Mr Olomola reaffirmed the HMO’s commitment to operating within legal and operational frameworks to guarantee adequate care for enrollees.
“Access to care and quality of care remain key priorities in our healthcare systems. We know quite well that deliberate collaboration, strategic partnerships, and a shared commitment to excellence are required to achieve these priorities.
“A strong provider network is doubtless the backbone of any effective healthcare system. It ensures that our mutual enrollees receive the right care, at the right time, in the right place, and at the right price,” Mr Olomola, represented at the programme by the organisation’s Chief Operating Officer (COO), Dr Faith Nwachi, stated.
He further assured that SUNU Health would strictly adhere to the one-hour authorisation limit, stressing that this aligns seamlessly with one of the organisation’s core values—promptness and its corporate slogan, Humanity is the centre of our initiatives.
In a bid to further improve access and quality of care, SUNU Health also demonstrated its new operational software and Mobile app, aptly named SUNU Legacy.
Also speaking at the event, the NHIA Lagos State Coordinator (Ikeja), Dr Bethuel-Kasimu Abraham, noted that the forum’s expected outcome is to significantly reduce delays in accessing medical care.
Other key expectations include ensuring continuity of care, improving patient outcomes, and strengthening accountability among HMOs.
Addressing specific pain points faced by enrollees, the NHIA Ogun State Coordinator, Mr Dare Adefeso, acknowledged that the agency had received complaints regarding out-of-stock drugs and the discrimination of enrollees by certain providers.
He affirmed that the NHIA is actively addressing these issues, stressing that moving forward, every facility must ensure enrollees are properly catered to regardless of their status, provided they have an active health insurance plan.
Corroborating the long-standing legacy of SUNU Health, the Ogun State Director of the National Orientation Agency (NOA), Mrs Aishat Tiamiyu, shared that her agency is responsible for public information dissemination and has been enrolled with SUNU Health for over 25 years.
Commending the HMO’s stellar service over two decades, she called for the immediate enrollment of new NOA staff into the scheme.
The Providers’ Forum remains one of the strategic channels employed by SUNU Health to consistently engage healthcare providers, understand their operational challenges, introduce new software updates, and solidify partnerships aimed at fostering premium healthcare delivery across Nigeria.
By Aduragbemi Omiyale
The National Agency for Food and Drug Administration and Control (NAFDAC) has announced the recall of a sexual enhancement product known as WAP Sensual Enhancement Capsules.
In a statement on Monday, the Nigerian agency disclosed that the recall is due to “undeclared pharmaceutical ingredients” in the product, whose country of origin is unknown, but is marketed and distributed online in the US through eBay.
It was emphasised that the recall is being “voluntarily” made by the manufacturer, Best Supplements Best Prices Company.
The detection of the undeclared pharmaceutical ingredients was made by the US Food and Drug Administration (FDA).
Laboratory analysis by the US FDA revealed that the product contained undeclared sildenafil, tadalafil, and flibanserin, which were not mentioned on the product label. Such substances may include phosphodiesterase type-5 (PDE-5) inhibitors or related compounds commonly used for the treatment of erectile dysfunction, the statement by NAFDAC stated.
Sildenafil and tadalafil are ingredients in FDA-approved prescription drugs used to treat erectile dysfunction.
It was noted that these undeclared ingredients may interact with nitrates found in some prescription drugs, such as nitroglycerin, and may lower blood pressure to dangerous levels. Consumers with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates.
Flibanserin is the active ingredient in an FDA-approved prescription drug used to treat low sexual desire in women. Flibanserin can cause drowsiness, sedation, dangerously low blood pressure, and fainting, especially when combined with alcohol.
Consumers have been encouraged to report compromised products (medicines or medical devices) to the nearest NAFDAC office, call 0800-162-3322, or send an email to sf******@********ov.ng.
