Repositioning Nigeria’s health outcomes: The private sector perspective

Nigeria’s health negative indices have continued to place the country under the spotlight of international agencies like WHO and UNICEF. This, private sector players in the country, seek to redress through involvement in impact investment, innovation and strategic partnerships writes ALEXANDER CHIEJINA.

Considered Africa’s economic powerhouse, Nigeria’s health indices has remained a source of concern to health experts as many Nigerian children aged five and below continue to die from childhood diseases such as pneumonia, malaria, measles, and other treatable infectious diseases.

Despite efforts by the three tiers of government (federal, state and local) to improve the country’s healthcare delivery, the nation has continued to witness high infant and maternal mortality rates.

Latest report by the United Nations Children Fund (UNICEF) reveal that every single day, Nigeria loses about 2,300 under-five year olds and 145 women of childbearing age. This makes the country the second largest contributor to the under–five and maternal mortality rate in the world.

Underneath the statistics lies the pain of human tragedy-for thousands of families who lose their children (under-five category) from preventable childhood diseases. Even more devastating is the knowledge that essential interventions reaching women and babies on time would have averted most of these deaths, according to recent research.

Although analyses of recent trends show that Nigeria is making progress in cutting down infant and under-five mortality rates, the pace still remains too slow to achieve the Millennium Development Goals of reducing child mortality by a third by 2015.

Preventable or treatable infectious diseases such as malaria, pneumonia, diarrhoea, measles and HIV/AIDS account for more than 70 percent of the estimated one million under-five deaths in Nigeria.

UNICEF noted that malnutrition is the underlying cause of morbidity and mortality of a large proportion of children under-5 in Nigeria, accounting for more than 50 percent of deaths of children in this age bracket. More worrisome is the physiological manifestation of malnutrition which can induce reduced physical and mental development during childhood.

The deaths of newborn babies in Nigeria represent a quarter of the total number of deaths of children under-five. The majority of these occur within the first week of life, mainly due to complications during pregnancy and delivery reflecting the intimate link between newborn survival and the quality of maternal care. Main causes of neonatal deaths are birth asphyxia, severe infection including tetanus and premature birth.

In the same vein, a woman’s chance of dying from pregnancy and childbirth in Nigeria is 1 in 13. Although many of these deaths are preventable, the coverage and quality of health care services in Nigeria continue to fail women and children. Presently, less than 20 per cent of health facilities offer emergency obstetric care and only 35 per cent of deliveries are attended by skilled birth attendants.

Meeting 2015 MDG target

Following significant challenges in addressing the nation’s health indicator outcomes (in particular MDGs 4, 5 and 6) which seeks to reduce child mortality, improve maternal health and combat HIV-AIDS, malaria and other diseases, at current trajectory, Nigeria is racing to meet the health-related MDG targets, less than 1,000 days away.

The Federal Ministry of Health unveiled the Integrated Maternal Newborn and Child Health (IMNCH) strategy, to reposition primary healthcare and significantly extend coverage of key maternal and child health interventions.

While the strategy was to be implemented in three phases of three years, each to benchmark the progress towards the 2015 MDG target, to fast-track the progress set by the FG, a coalition of private sector business leaders christened ‘Private Sector Health Alliance of Nigeria’ (PHN) have created a platform with a focused strategy to meet its objective of building a world-class private sector-led coalition that accelerates Nigeria’s progress in achieving MDGs 4, 5 and 6 by 2015 and beyond.

Until now, limited coordination and fragmentation of private sector participation and contributions to health has continued to confront Nigeria’s health sector. This has resulted in unrealised synergies and suboptimal impact. Added to significant challenges in addressing the weak health indicator outcomes include limited application of innovation and technology that has led to missed opportunities in revolutionising healthcare delivery in the country.

Private sector initiative

The nation’s private sector currently accounts for, at least, half of healthcare service provision and has the potential to expand access to health services, improve the quality of care, contribute to job creation, and the country’s Gross Domestic Product (GDP).

This, Muhammad Ali Pate, former minister of state for health, alluded to during a summit convened by the Federal Ministry of Health (FMOH) “Unlocking the Market Potential of Nigeria’s Private Health Sector” recently. Pate stated that the private health sector has a significant role to play in addressing these challenges and accelerating progress in meeting the health-related MDGs.

In view of enormous potential the private offers Nigeria’s healthcare delivery, Private Sector Health Alliance of Nigeria (PHN), a coalition endorsed by Bill Gates, Aliko Dagote, Jim Ovia, Muhammad Ali Pate, Aig Imokhuede Aigboje, Sola David Borha, and other corporate leaders is focused on leveraging innovation to leapfrog progress and increase access to healthcare. This in turn is expected to revolutionise Nigeria’s health outcomes.

Besides seeking synergies within the private sector and building strategic partnerships with the public sector to support interventions in the Saving One Million Lives Initiative- prioritising nutrition and malaria, the PHN is hinged on four pillars-innovation, strategic partnerships, advocacy and impact investments.

In an interview with BusinessDay, Muntaqa Umar-Sadiq, chief executive officer, PHN, said that the body seeks to create a Nigerian health innovation market place to spur innovation in health and provide market linkages between innovative programmes, technical partners and funding sources in the private and public sector

While noting that its objective is to build a world class private sector-led coalition that accelerates Nigeria’s progress in achieving MDGs 4, 5 and 6 by 2015 and beyond, he said the coalition aims to meet its goals by focusing on innovation, strategic partnerships, and impact investments.

According to him, “They are out to mobilise and inspire Nigeria’s private sector to harness its collective capabilities to realise synergies for catalytic impact. While we undertake high level advocacy engagements for priority policy interventions that will aid in shaping health markets for better private sector engagement, they would take ownership and be collectively responsible for achieving MDGs 4, 5 and 6; save the lives of women and children which is at the heart of everything they do”

In the area of investment in Nigeria’s Healthcare system, Muntaqa Umar-Sadiq maintained that they would facilitate impact investments in the most promising innovative pipeline projects from the health innovation market place and invest in critical segments of the health sector that benefit the undeserved. Included in its impact investment portfolio is to foster better coordination of private sector investments and philanthropy through co-investments to optimise social and economic impact.

To realise these goals, he informed that PHN would invite thought leaders as well as industry leaders from the private sector to join it across its different membership categories, including companies and business leaders with a natural connection to healthcare, either through their core business (e.g, pharmaceutical, medical technology, hospital, health insurance) or indirectly (e.g, financiers of healthcare infrastructure, developers of technology to improve health, business interest in healthy population).

Malnutrition at a glance

Over the years, malnutrition has continued to remain a key health challenge in developing economies, including Nigeria. A 2008 National Demographic and Health Survey shows that 41 percent of Nigerian children were stunted, as a result of malnutrition for which children appear short of their age. The survey also reveals that Nigeria is one of the six countries that account for half of all child deaths from malnutrition worldwide.

More worrisome is a recent report by United Nations Education Fund (UNICEF) which reveals that several states in the country, especially the North, are at risk of Sahelian crises following increasing incidents of severe acute malnutrition of the Sahel region.

Given this worrisome indices, the PHN kicked off the first ever Nutrition Market Shaping Private Sector Engagement in Nigeria in line with its vision to save one million lives by 2015. The body wasted no time in focusing on the leading causes of mortality and intervening through an innovative programme.

Malnutrition is the underlying cause of about half the number of deaths recorded in children under the age of five years in Nigeria, with severe acute malnutrition (SAM) affecting millions of Nigerian children, a condition that has led to numerous complications for children under the age of five.

Ready to Use Therapeutic Foods (RUTF), has revolutionised the treatment of severe malnutrition. However, in spite of the demand, there is currently no manufacturing capacity for this life saving commodity in Nigeria, leading to significant stock-outs of RUTF. As a result, tens of millions of dollars are spent in Nigeria every year procuring RUTF from countries such as Niger, USA, and France.

To address this, within two weeks of its launch, the Private Sector Health Alliance of Nigeria in partnership with UNICEF mobilised over 20 private sector companies as well as public sector agencies such as NAFDAC, NPHCDA, Ministry of Agriculture and donor partners to kick off the country’s first ever Nutrition RUTF Market Shaping Private Sector engagement with 20 potential local producers of RUTF.

The goal here is to build the capacity and prime the private sector to ensure that by 2015/2016, Nigeria is more advanced in its quest to have at least 1/2 RUTF local producer that meets WHO/NAFDAC quality standards.

Proffering solution

Muntaqa Umar-Sadiq, executive director and chief executive officer, PHN said that it engaged 20 private sector players including the regulatory agencies by building their capacity with the United Nations Children Fund (UNICEF) providing technical and operational guidelines on best practices needed to begin the manufacture of RUTFs.

“We are committed to mobilising Nigeria’s private sector to harness its collective capabilities to realise synergies for catalytic impact,” Umar-Sadiq stated.

Following increasing incidents of SAM of Sahelian states, UNICEF tasked the government to create separate budget for the implementation of state nutrition plan of action to identify malnourished children in the communities and give them the required treatment.

While the consequences of malnutrition are dire, the United Nations Standing Committee on Nutrition asserts that malnutrition is the largest contributor to non-communicable diseases in the world. To health experts, the physiological manifestation of malnutrition at an early age can induce reduced physical and mental development during childhood.

Recently, UNICEF set up 216 Community-Based Management of Acute Malnutrition (CMAM) sites in the seven Sahelian States — Gombe, Jigawa, Borno and Yobe, Adamawa, Bauchi and Kano states. CMAM is a community-based approach in treating children with severe acute malnutrition. In the sites, children admitted with SAM are given specialised feeding and therapeutic care to help rehabilitate them.

Surveys show prevalence of malnutrition beyond 10 percent known as Global Acute Malnutrition, (GAM) in 5 to 15 percent in all surveys across all states.

Research shows that lack of access to highly nutritious foods, rising food prices, poor feeding practices, such as inadequate breastfeeding, offering the wrong foods, and not ensuring that the child gets enough nutritious food, contribute to malnutrition.