The Nigerian Health Care System, The Rot And Hope – Tolu Oluyemi

The consumers of health-related articles especially as it affect Nigeria must obviously be inundated with the plethora of malaise affecting the sector raised daily and adequately backed with over-referenced, undeniable statistics and facts from recognized and verifiable sources, and reputable journals. The challenges of the Nigerian health sector are multi-dimensional but unfortunately remains the same for eons now; hence, there isn’t anything new in the mix as it were.

According to the 2009 communique of the Nigerian national health conference, “Health care system remains weak as evidenced by lack of coordination, fragmentation of services, dearth of resources; including drug and supplies challenges, inadequate and decaying infrastructure, inequity in resource distribution, and access to care and very deplorable quality of care. The communique further outlined the lack of clarity of roles and responsibilities among the different levels of government which therefore further compound the situation.”

One may reason: “Is there a gross deficit or outright dearth of critical, analytical, introspective and good thinkers in the nation? Such a horde that can promulgate functional policy and chart a noble path out of the rot and protracted quagmire the health sector is in. The answer to this question is not far-fetched owing to the unfolding narratives.

The implementation of the Alma Ata Declaration of 1978 by Professor Olikoye Ransome-Kuti which led to the building of Primary Health Centers (PHCs) across the entire nation under the dogged leadership of the late noble statesman lends credence to the imaginative reasoning of Nigerians to improve the lot of Nigerians in Nigeria. The Nigeria Demographic and Health Survey report of 1990 lucidly captures the health priorities and programs of the government where it was noted that “The Federal Government’s systemic efforts to develop the health sector over the past three decades have resulted in noticeable improvements in the range of available healthcare facilities and in the services being provided. The 1981-1985 Fourth National Development Plan established a government commitment to provide adequate and effective primary health care that is promotive, protective, preventive, restorative and rehabilitative to 80% of the population by 1985; and to extend same to the entire population, within the available resources by the year 2000.”

Any wonder why the Ministry of Health under the leadership of Professor Olikoye Ransome-Kuti built functional PHCs in all the 774 local government areas of the country along with the establishment of the National Primary Health Care Development Agency (NPHDA) in 1992 primarily in advancement and achievement of sustained preventive healthcare for the citizenry.

According to an article by Bolaji Aregbesola and Samina Khan, “the military takeover of government that occurred in 1993 brought to an end the giant strides recorded under the leadership of Professor Olikoye from 1985 to 1992.” With the obvious systemic rot in the health sector, an effort by the Federal Government to revitalize the worsening state of healthcare and ensure that all Nigerians had access to good healthcare services was set in motion with the establishment of the “National Health Insurance Scheme (NHIS)” in 2005; however, Ladi Awosika was quick to point out that the scheme was first proposed in 1962 under a bill to Parliament by the then Minister of Health, Chief Moses Adekoyejo Majekodunmi C.F.R. This also is a further attestation to the good and futuristic thinking of Nigerians for Nigeria.

In October, 2008, an appendage program of the NHIS was launched under the Millennium Development Goals and it might be apt and right to note that this was an aftermath of the “Nigerian National Health Conference” held in 2006 to X-ray the burgeoning challenges of the health sector and chart a new way forward. Different Ministers of Health since inception of the fourth republic have always promulgated health sector policies, reforms and actionable plans that looks amazing and laudable on paper while there have been series of injection of thoughts from within and outside; consequently, I believe that the problems of the Nigerian health sector have nothing to do with good thinking or policy formulation.

Any nation that prides herself on being effective and efficient in the delivery of healthcare services to her citizenry must have as its fundamentals: a sustainable healthcare policy, a strategic implementation outlook that harnesses and leverages the input of the different levels of government and an effective monitoring system that is broad in approach but simple in actualization. Nigeria cannot pride herself in this regard. The deficiencies of the health sector are no doubt transcendent in that, it has spanned years, has defied the good intents of successive governments and results does not match the grandiose investments that has been sunk in the sector.

Perhaps it is safe to say that one of the major albatross of the sector is poor or inadequate funding; for example, where the World Health Organization (WHO) recommends a minimum of 15% of the national budget to be allocated to the health sector, Nigeria undulates between 4% and 7% and this crassly undermines the sector. However, the question is “how well has the funds allocated to the sector been judiciously used?” In her sitting on 16th February, 2022, the Senate decided to probe N400 Billion nationwide health center projects. According to Transparency International, “Countries plagued by corruption can attest to the fact that once it becomes entrenched, it can be found in all sectors of her economy.” Corruption in the Nigerian health sector takes many shapes and forms; therefore, what constitutes corruption is disguised and often rationalized away or considered as the norm. Take for example; diversion of patients to private hospitals owned by practitioners in government hospitals, improper billing of patients, diversion of government revenue due to manual and orthodox processes of processing transactions, laissez-faire attitude of health workers, outright diversion of funds meant for capital projects, etc, all constitute acute corruption.

The problems of the sector aside from corruption which is the monster in the house and around which many other challenges of the sector revolve are: Policy summersault, faulty policy implementation processes, mass exodus of health workers to greener pastures, inadequate and obsolete infrastructures, dearth of/inadequate modern medical equipment, inadequate staffing, lack of training and retraining, constant intractable labour issues, inter-professional conflict and above all, political and bureaucratic corruption. Well, once the problem of a thing is known, the solution shouldn’t be far-fetched and one of the solutions is the identification of a peculiar problem and willingness to attack it headlong.

There must be a good degree of intentionality on the part of political and bureaucratic eggheads to revamp the fortunes of the health sector so as to commence the reversal of the dastard statistics that hallmark the sector. One of the recurring snags of the Nigerian system is “Revenue Leakages” and the health sector is not left out. While reflecting on the 7 major challenges facing the healthcare industry in 2022, “Invoicing and Payment Processing” or “Revenue Automation” was identified by Hugh Sullivan as a fundamental way of achieving patient-centred services while simultaneously guaranteeing returns on investments made by healthcare stakeholders.

Our fixation as a nation, especially for the egg heads of the health sector must be solution-centred; meaning that strategic engagement must be in top gear to ensure that revenue that should accrue to government is not lost to corruption that is inevitable due to orthodox and obsolete processes of revenue management. Revenue cycle management struggles, faulty health information management system, financial impropriety and poor patients’ experience are negative trends that must and can be reversed through the adoption of smart and digitized “Revenue and Health Information Management System” which is presently in force in our nation; albeit in minimal proportion.

The major and remarkable difference between developing and developed nations is sustained reliance on innovation and technology. As a major player in the global economic order, Nigeria cannot afford to stay aloof or become a minimalist in the adoption of innovation and technology, especially in the health sector. What accrues to the government in revenue in juxtaposition with investments made and patients serviced is next to nothing; especially in the face of actual payment for services received by the patients. This situation thus calls for a review of revenue management processes at our government hospitals with a view to plugging all forms of leakages while scaling patients’ experience.

Flexible payment preferences for patients, and price transparency which assure reduction of patient confusion, wrong billing issues, vagueness, arbitrariness and sharp practices by billers must be scaled. There is no gainsaying that patients and indeed the world is getting smarter through tech-savviness; hence, this must be harnessed to the ultimate benefit of the patient and hospital managers. Effective billing/invoicing system that gives basic data/metrics useful for healthcare managers in planning, automated revenue management system that gives real-time account/cash balance summary accessible anywhere in the world through any internet-enabled device and multi-layered stakeholder involvement for accountability must be a major adoption for the Nigerian health sector at the Federal, state and local government levels.

Scarce resources like liquidity at our government hospitals must be well trapped through a well-designed revenue and data management system such as Avancee Pinnacle Ltd (AVPL), owners of PayOne have developed for the improvement of our health sector. AVPL is taking the lead in reshaping and redefining patients’ experience through their ease of making payments while also plugging leakages thereby making more revenue available for the government for developmental purposes.

Innovation and technology must be the bedrock upon which any and indeed all development rests and stakeholders in the health sector must of a necessity move in this right and proper direction.

“Tolu Oluyemi is the CEO / Co-Founder Avancee Pinnacle Limited, owners of Pay1One Smart revenue assurance platform, developed to plug leakages while  automating the entire payment and service delivery processes in public hospitals. A health sector enthusiast who’s simply just keen about revamping the public health care system, leveraging technology.”