Dr Folarin Olasogba is the Chief Project Officer of PreDiagnosis Telehealth Consult.

The organization is responsible for driving the initiative of PreDiagnosis International to deliver affordable basic healthcare services to 20 million poor and vulnerable Nigerians between 2020 and 2030.

In this chat, he spoke on the challenges of public health management in the country as well as PDI’s efforts at delivering healthcare to the grassroots.

With the ravaging COVID 19 putting all nations of the world on their toes, do you think we are doing enough, as a country, to curtail the pandemic?

My personal assessment of the country’s emergency response to this current health crisis is very positive. To the extent that the COVID-19 pandemic is a novel experience that caught the whole world unawares and to the extent that even the world’s best, in terms of health management systems, have been struggling with the pandemic, Nigeria, through the National Centre for Disease Control, has provided a mature, organised and commendable plan for managing the pandemic in the country. I am sure that our experience, knowledge, and systems will improve tremendously from this turn of events.

Are there lessons learnt by Nigeria at all from this pandemic? If yes, what do you think can be done to institutionalize and domesticate them as policies for better preparedness for medical situations and emergencies now and in the future?

It is not an exaggeration to say that the novel Coronavirus pandemic otherwise called COVID-19 has exposed the soft underbelly of our country’s health care system no thanks to our ill-preparedness for outbreaks of such magnitude.

More than anything else, the deadly disease has practically shown the necessity for greater collaboration on health issues as well as the power of data and digital tools to combat the outbreak of pandemics or even some opportunistic infections.

It has also reinforced the need for targeted digital health strategies to help countries like Nigeria get the most out of digital technology tools. Without the right strategies and technical and resource support, it is now increasingly clear that the gap in the digital divide will produce nothing but failing health outcomes.

Across the world, digital health is fast becoming the fad especially among low and medium-income countries with the huge responsibility to overcome traditional barriers to better health care, which includes the dearth of medical staff and professionals and other physical resource constraints.

Whether as electronic health (eHealth), mobile health (mHealth) and other emerging areas such as the use of artificial intelligence (AI), big health data and genomics, digital health now holds a lot of promise as it is making health information, care and diagnosis more accessible to health seekers.

Nigeria must urgently intensify efforts along these lines from now on.

Considering the growing relevance of technology in health care, what important role do you see medical intelligence and surveillance playing in the public health space, particularly the prevention and management of deadly infections and diseases in the country?

Sadly, despite Nigeria’s strategic position in Africa, it is highly under-served in the health care delivery sphere. Health resources such as facilities, personnel and medical equipment are inadequate, especially in rural areas.

Significantly, 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 self-medication and also for quacks and other unqualified hands to tend citizens’ health needs. As at today, most PHCs, especially in rural areas, rot away due to lack of capable personnel to man them.

Given the above scenario, the primary challenge confronting the country’s public health system today is how to create and sustain an information-rich and patient-focused health care system that reliably delivers high-quality, affordable and accessible healthcare services that can ride on strong deployment of technology to strengthen healthcare accessibility at the grassroots.

You believe the current model of public healthcare delivery in the country is not working?

Healthcare services delivery must undergo a transmutation from the physical, brick and mortar format to a more tech-driven approach. This means the concept of tech-for-health or Health ICT must be elevated and Nigeria, now more than ever before, must confront using technology to transform her healthcare delivery system in a way that ensures a win-win for all.

It is also important to point out that the growth and the sophistication of Nigeria’s telecommunications and ICT sectors in the last two decades as well as the increasing global tilt towards greater deployment of ICT for health (Health ICT) have continued to point health service providers in the country in the direction of embracing innovative new thinking required to strengthen and revolutionize the health system. The time is now.

The issue of health financing has become so critical considering government’s revenue challenges leading to poor budget allocation for the health sector year in, year out. What do you think can be done to augment and address the situation at present?

Over the years, public health financing has been a major barrier to building a strong health care system in many countries, not just Nigeria alone.

Regarding Nigeria, at the moment, the total health expenditure is derived from the allocations for health and allocations for the Basic Health Care Provision Fund, which is put at 1% of the consolidated revenue fund.

Since the inception of BHCPF, however, its allocation has always been below the earmarked 1% of CRF; the allocation in 2020 is about 50% less than the value of the 1% of CRF.

Because of the worsening financial capability of the country, expecting additional government funding for the health sector is a mirage; and without something significantly revolutionary being done in this ugly circumstance, demand for healthcare services, especially critical care services, may become overwhelming for the public health sector. This is likely to have long-term consequences for the health sector, as well as spillover effects to the rest of the economy in many ugly forms.

Many experts have postulated that to confront the problem of dwindling economic fortunes which impacts availability of funds for developmental efforts, the best model of public health delivery the country needs to embrace is one that can deliver quality healthcare services to the remotest, undeserved villages across the length and breadth of Nigeria by leveraging technology to maximize the scarce human and operational resources for health through effective and efficient deployment.

From your experience, how possible and easy is it to deliver affordable healthcare, most especially for the poor and vulnerable people in the rural areas and rustic communities?

It is very possible and cheap, too. Remember that modern-day public healthcare is efficient only when health services can reach the hard to reach areas, when location, economic and social status do not dictate access to quality health services, when they have and have not have equal access to basic healthcare services and only when all people and communities can use the promotive, preventive, curative and rehabilitative health services they need insufficient quantity without exposing them to financial hardship as declared by the World Health Organisation.

For us at Pre Diagnosis, we have achieved remarkable progress in our burning desire to harness modern technology to effectively deliver quality healthcare to two million vulnerable Nigerians annually, in a cost-effective way that maximizes scarce human resources. It is our modest demonstration of how it is possible to deliver efficient healthcare as enunciated by WHO.

Could you be more explicit on how these efforts could benefit the poor and vulnerable in the society, given the general poverty level they face?

At the center of our commitment is the deployment of ultra-modern technology to create the PDI Telehealth Hub and the PDI Telehealth App for macro and micro-management of public health delivery.

The PDI Telehealth Hub is a Community health platform in the form of a solar-powered mobile clinic that can be placed anywhere and manned by a specially trained staff recruited from the host community. The hub is connected to the expansive PDI telehealth central control the room where doctors are available 24/7 to micromanage these hubs. The result is delivery of continuous medical services on the ground within a community (remotely) by our medical doctors, leveraging technology but totally adapted to the culture, lifestyles, and worldview of the host communities.

On the other hand, PDI has also harnessed technology to develop an app that allows individuals to consult and receive wholesale treatment for many minor and major health challenges from doctors via the cellphone without physically visiting the hospital.

The PDI App is available on Google Play for download by android phone users. It is an interactive mobile application that gives users immediate access to highly trained and experienced doctors who can assist them access free quality healthcare from any location in the country.

The best thing about the App is that it is developed for the poor and vulnerable members of the society and therefore very cheap to access by all.

Let’s talk about your company, PDI. What can you say stands PDI out among the list of health care providers in the country? What exactly is the company’s cutting edge?

Our organisation, PreDiagnosis International, is a semi-philanthropic, hybrid telehealth service provider founded in 2018 to help in bridging the dangerous and widening gap in the Nigerian healthcare delivery system. We operate as a quasi-charity entity and not strictly a business-for-profit concern. So, we are on a compassionate national rescue mission.

PreDiagnosis International’s goal is to offer cheap, affordable and innovative telehealth solutions that would be at the forefront of reducing the disparity that exists in the availability, accessibility, and affordability of quality healthcare services in the urban and rural areas on the one hand, and between the elites and the poor and most vulnerable citizens, on the other hand.

What are PDI’s target projections for the health sector in its bid to contribute to the realization of the country’s and United Nations’ goal of better health for the people?

The Vision, Mission, and Target of the PDI initiative is encapsulated in the PDI RRF 20-2030 brand Mantra. Under our Reach, Rescue and Fortify Mission, PDI has the target of helping Nigeria to deliver qualitative healthcare services to, at least, two million Nigerians annually between year 2020 and 2030 using technology-driven but largely grassroots focused platforms and model. This, in a nutshell, is what we have termed Project RRF 20-2030.

This Project RRF 20-2030, which is the core of our mandate, aims to deliver quality healthcare services to the remotest, under-served areas across the length and breadth of Nigeria by leveraging technology to maximize the scarce human resource for health (HRH) through effective and efficient use.

At PDI, we believe that our mission would not be fulfilled until when quality health services have reached the hard to reach areas; when location, economic and social status do not dictate access to quality health services; when the have and have not’s have equal access to basic healthcare services, and when all citizens and communities can enjoy the promotive, preventive, curative and rehabilitative health services they need, in sufficient quantity and without exposing them to financial hardship as spelt out in the World Health Organisation’s policy on Universal Healthcare.

Partnership, collaboration and integration are fast becoming a trend across the world for better service delivery in both private and public sectors. How best can we take advantage of this new possibility particularly in the health sector in the wake of the dreaded COVID 19 pandemic?

Stakeholders in the health sector need to collaborate on diverse levels as a way of bridging the gap in the nation’s health delivery landscape. A robust alliance between the public and private sectors for overall healthcare services development in the country should be of primary concern to all. For instance, under our Corporate Initiative, PDI has a thriving collaboration with the Project ECHO Institute of the University of New Mexico, ALBUQUEQUE, USA.

Project ECHO which stands for Extension for Community Healthcare Outcomes is a collaborative model of medical education and care management programme designed to empower local clinicians (Consultants, Doctors, Nurses, Technicians, etc) to deliver better care and treatment of chronic, common and complex diseases, especially in remote and underserved locations. PDI is the Nigerian Official Replication Partner with the Project ECHO Institute of the University of New Mexico.

This is an innovative tele-mentoring programme designed to create virtual communities of learners by bringing together healthcare providers from all over Nigeria and subject matter experts (from all over the world) using video conference technology, brief lecture presentations, and case-based learning to foster an “all learn, all teach” approach.

How does Nigeria stand to gain from projects and collaborations like this your Project ECHO?

The mission of PDI in undertaking the Project ECHO is to assist the country develop the capacity to safely and effectively treat chronic, common, and complex diseases in rural and undeserved areas across Nigeria and to monitor outcomes of this treatment while leveraging our Telehealth consult platform.

The Project not only uses innovative technology to bridge the gap between urban and rural healthcare specialists and providers in the country; it helps health services providers to undertake co-management of patients’ treatments, thereby fostering knowledge depth and technical competencies, in addition to reducing professional isolation.

By encouraging collaboration and communication between rural and urban service providers and specialists, the Project helps health professionals in the country to become highly skilled in the treatment of diverse chronic and complex diseases, thus creating a center of excellence in many remote communities.

This means with the PDI Project ECHO Initiative, we are committed to building a Clinical Knowledge Platform that combines authoritative contents and shared experiences are drawn from the expertise available in the Nigerian healthcare community and across the world so that Physicians, medical students and other healthcare workers will be able to tap into Nigeria’s largest, most powerful Continuous Professional Development (CPD) network to resolve challenging questions at the point of care for mostly lower-income patients for different diseases.

Nigeria needs more initiatives like this to truly create a modern health service sector post-COVID-19