‘Impact of interventions, activities in healthcare sector needs to be measured’

Chibuzo Opara, Co CEO at DrugStoc, Co-Founder at Integra Health, a health systems expert with international experience in clinical and commercial healthcare management with healthcare financing experience speaks to BusinessDay’s Anthonia Obokoh about tackling the issues around financial barriers, challenges around human resources, infrastructure, clinical governance, quality of care, transparency to achieve Universal Health Care in Nigeria.

What is universal health coverage and how do we achieve it in Nigeria?
Universal health coverage, (UHC), is an aspiration by a country, like Nigeria, to provide her people with affordable quality healthcare.
In Nigeria, this will entail ensuring everyone has access to healthcare, (this could be via public or private health services). Practically speaking, it would mean that no one is denied access to healthcare because of financial reasons, gender reasons, issues related to geographical barriers or any other issues which might create a barrier to healthcare access.
Financial barriers to healthcare access resonates clearly and widely across the country because as you know, we have over 100 million people living below the poverty line and out of pocket payments, (i.e. cash payments), account for over 70% of healthcare financing in the country. This creates affordability challenges for the average Nigerian when it comes to healthcare. However, even if we solve the issues around financial barriers, there are still challenges around human resources, infrastructure, clinical governance, quality of care, transparency etc. You can therefore see that financial barriers to healthcare access often mask several other issues.

How do we approach these issues?
At the end of the day, universal healthcare is about elaborating equitable and affordable healthcare.
In order to create a catalytic process within the system we need to focus on tackling one, two or three key issues and not more with measurable goals and targets. Once these are done, we recalibrate and move on to the next set of challenges. One clear example of improving transparency in disbursements could be tying budget disbursements to specific healthcare results or outputs from a hospital or health facility with clear repercussions if they are not met, i.e. performance based disbursements.
Circling back to the issue of financial access to healthcare, the first thing to note is there is no free healthcare in the world. Someone always foots the bill. Secondly, there are two aspects to financing healthcare, the demand and supply side. Supply has to do with the provision of healthcare services in hospitals, health workers, drugs, supplies and so on, while demand has to do with patients and people consuming care. With the demand side, you want to have mechanisms that ensure that at the point of care, there are no financial barriers to receiving care. This can be either through health insurance, provider based schemes, voucher schemes, co-payments that do not plunge the patient into any form of catastrophic medical expenditure or poverty and so on.
Tackling the supply side in Nigeria means increasing and improving the quantum and scope of healthcare services. Quality is very important on so many levels simply because once quality is improved, it has one of those long lasting and catalytic effects on a system leading to cheaper and more effective care in the long term.
Another crucial point to effect system change is holding individuals and entities accountable and measuring the impact of interventions and activities in the healthcare sector. For far too long we have been concerned with just how much money and inputs go into the healthcare sector, (i.e. how much in salaries, or what items are being procured, etc.), with too little attention paid to measuring outputs and outcomes of the system. Decision makers and healthcare providers need to be held accountable for health outcomes. There should be an agreement and a commitment between citizens and decision makers on where we place universal healthcare among the 1000 priorities that are important and urgent as a country. Once that is done, and internalised within our civic and political processes, leaders should begin to be held accountable for healthcare, that way policies which are tied to impact, outcomes and outputs will naturally evolve from the system.
Governance and transparency are quite crucial. They will serve to manage our lean resources effectively in addition to attracting the necessary private sector funding to plug the gaps in the fiscal space for healthcare. Currently over 60% of health sector funding is private but it is fragmented and often reactive. These private sector resources can be better streamlined and leveraged once processes, policies and people are put in place around a clear governance framework.
Thirdly, as with most sectors, infrastructure challenges are still a key issue; most hospitals scrimp on necessary supplies to pay for power, water, etc. It is the same reasons hotels and schools have issues, however, hospitals are one place you don’t really want them economising on supplies.
On a final note, there is a need to sensitize and make people aware of the inherent advantages in a healthy population, especially now that we are still a young aged country. You want people to grow up healthy as this reduces the eventual healthcare expenditure bill when the mean age of the population shifts to 60 years or 70 years old. Right now the mean age is somewhere between 20 and 30 years old and as such the outlook is still quite a young one. 7 out of 10 people in Nigeria are below 35 years old, therefore when you speak to them about healthcare when they are not sick, it sounds very far removed from their reality but the truth is that unless we all contribute resources when we are well in addition to investing in disease prevention, then there will be no resources for us when we are sick.

What can the government do right now that doesn’t require so much resources?
With regards to some things that can be done right now, without expending extra resources, there are a few. They include things like making healthcare decision making more inclusive across all tiers of government and giving local governments more resources, skills and tools to do more at the rural area levels in addition to creating incentives for health workers to go spend some of their work time in the rural areas.