Nigeria’s Health Sector in The Wake of a Pandemic

The emergence of the Covid-19 pandemic has further shown the decay and rapid decline in the Nigerian Health-care sector and the growing need to focus on the development of this sector, making it a top priority and having possible investments into it. As they say, “Health is Wealth”.

Asides the evident rot in this sector, there are huge lapses in the remuneration for workers in this sector. The health sector got a relatively low appropriation in Nigeria’s 2020 budget, an amount of N427. 30 billion which is only 4.14 percent of the 2020 budget allocation. This reveals that the focal priority of the present administration is not health and it is evident in the appalling state of the sector and poor wages and allowances for the personnel in this sector.

Nigeria’s current health care indices reveal how dire the situation is and how much of a boost it requires. According to the World Health Organization (WHO), Nigeria is “the country where nearly 20 percent of all global maternal deaths happen. Between 2005 and 2015, it is estimated that over 600, 000 maternal deaths and no less than 900, 000 maternal near-miss cases occurred in the country”. The maternal mortality rate is approximately estimated at 800 per 1000 live births and 58,000 maternal deaths in 2015 alone. According to Health-care for Women International and Relief Web, only 61 percent of pregnant women have access to antenatal services. Trading Economics estimates that births attended to by skilled health staff at 2014 is 35 percent. UNICEF says that 4.3 million children miss out of immunizations yearly.

Thus far, The Nigerian government says she has spent over N32 billion handling the pandemic, which is $83,660,128. These funds were spent on tents, equipment, public awareness, patients welfare but no notable input into hospitals and hospital infrastructure or increase in remuneration or allowances of the sectors workforce. Suffice it to say that when the Covid-19 pandemic blows over, the health sector will still remain the same.

The country’s health care sector needs to urgently be overhauled and there is need to begin to look into exploring possible opportunities of private investments and partnerships. Dealing with a pandemic in a country of about 200 million people with a porous health care system has made the evident challenges in this sector more glaring than before.

Recently, the health care budget was reduced by nearly 50 percent supposedly because of the sharp decline in crude oil prices and reduction in the country’s crude oil production quota as a result of the ongoing pandemic. The former budget was not even up to 8 percent as against the 15 percent initially agreed between the government and stakeholders. There is a pressing need for public and private sector partnerships as the Nigerian economy is majorly dependent on crude oil production and exports  and may not be able to adequately develop and effectively boost the health care sector especially with the recent slash of nearly 50 percent in its health budget.

The healthcare sector in Nigeria consists of primary, secondary and tertiary. The three tiers of government run the public health system in Nigeria. The Federal government takes charge of the tertiary health care which consists of Federal Medical centers and University Teaching Hospitals. The State government runs general hospitals while dispensaries are under the local government.

In late 2014, the National Health Act was signed by the Federal Government. This act approved the establishment of state supported health insurance scheme by the National council on Health. Through this act, the private sector has been given the opportunity for a large participation in the healthcare system across Nigeria.

There is a huge deficiency of medical and diagnostic equipment and a pressing need for financing to improve infrastructure. The presence of Covid-19 has shown the importance of data collection in managing crises and how important digital medical records solution is. Hospitals require digital health technology and the use of artificial intelligence to greatly improve health care experience for both the professionals and patients.

Nigerians spend and estimated $1 billion on medical tourism annually. As large and as diverse that the Nigerian healthcare sector is, most investors have inverted in specialist hospitals and diagnostic facilities which is tertiary healthcare. The primary healthcare sector has not gotten a lot of investments. The healthcare technology system in Nigeria is grossly outdated. There are a myriad of different investment opportunities in areas like digital medical records and diagnostic technology, ambulance services, mobile clinics, pharmaceutical manufacturing, franchise partnerships with global healthcare providers as sole local manufacturers of globally renowned drugs and medical products. There is a huge market for Nigerians who seek high quality medical care and are able to afford it.

The investment opportunities in the health care in Nigeria are numerous. Investments are largely required in the pharmaceutical sector from research down to local production of raw materials, manufacturing and distribution. Fidson health care in Nigeria recorded significant growth in the first half of 2020. Its revenue grew by 11.31 percent to N8. 2 billion in the first half of 2020 from N7. 37 billion in the first half of 2019. Its profit after tax grew by 81. 43 percent to N500. 64 million from N275. 94 million in 2019. Earnings per share appreciated to 24 kobo from 13 kobo and this shows an 81.43 percent growth. Fidson healthcare is a privately owned, pharmaceutical manufacturing company. They manufacture anti-infective, anti-bacteria, anti-fungal, anti-malaria, antihistamine, cough & cold, antacids, anti-ulcers and other numerous medical products. Some of their popular products include Arthemed, Astyfer, Astymin, Ciprotab-500, Gascol and many others. They are a top player in the pharmaceutical sector and their drugs are commonly used in most Nigerian households.

There is the area of health-technology which hasn’t received as much attention as it should. World Health Organization (Who) defined Health Technology as “the application of organized knowledge and skills in the form of devices, medicines and vaccines, procedures and systems developed to solve a health problem and improve quality of lives”. There are a number of  health-tech companies that require financing to develop efficient, innovative digital health solutions. Adequate market sector research is required before delving into public-private partnerships and investing into it so as to yield great returns.

In Ethiopia, Dr Wuletta Lemma, Director of the Centre for Global Health Equity at Tulane University worked with Microsoft to create a 100 percent locally run and maintained e-health system. Currently, over 3000 healthcare institutions across the country are using this system. It has aided in digitalising health records, gathering patient data and streamlining their experience. In Rwanda, an Internet based app called TRACnet has been developed. It gathers patient data load and drug supply levels of HIV related data. SMS based M-health projects in Kenya, Mozambique and Uganda remind patients to take medication and helps them keep their medical appointments. Wireless Reach Initiative in Kenya took this further by providing 3G connectivity to anti-retroviral treatment centres for keeping track of patients’ drug adherence. Microsoft and the Botswana Innovation Hub launched Africa’s first telemedicine service. With it, doctors can carry out consultations for patients in very remote areas via Skype for business. Patients can be examined in real time, diagnosis made and treatments prescribed immediately.

There have been a number of private health-tech innovations in Nigeria, albeit on a small scale. Flying Doctors Nigeria is the first air ambulance service in West Africa and it has 20 charter aircrafts in good condition. It is a medical emergency service that specializes in providing air ambulance services, remote site medical solution services and medical logistic services. It was founded by Dr Ola Orekunrin Brown. Safermom and Babymigo was founded by Adeloye Olanrewaju. It is a mobile service for pregnant and nursing mothers of 0-3 year old babies to access health information and make informed health decisions through calls, SMS, helplines and a mobile app. It also aids in tracking of pregnancy and nursing milestones, home remedies, prevention tips and vaccination dates. Mothers can also access vital health information, important announcements and government schemes in their indigenous local language by dialing a short code. Redbank, founded by Adereti Francis, is a startup that connects hospitals and patients to the nearest blood banks. It has a number of hospitals and blood banks on its radar and aids patients and their families to find the needed blood types closest to their locations within the shortest time. Medsaf was set up to give hospitals, clinics and pharmacies access to high quality medication from manufacturers at affordable rates thereby reducing incidences of consumption of fake, substandard drugs and accompanying complications. It was founded by Vivian Nwakah.

The success of Fidson Pharmaceutical and the aforementioned startup innovations and others that already exist show that there is a huge market for private investments in the healthcare sector in Nigeria. This is clearly a sector worth investing in, with glaring, identifiable loopholes that the Nigerian government may not be able to handle on her own. Despite the budget limitations in healthcare sector, there has been quite a number of laudable health-tech innovations. However, there are other areas that are untapped. Areas like digital records and diagnostic services, medical logistic services, telemedicine service, pharmaceutical manufacturing, mobile clinics and other areas. The healthcare sector in Nigeria remains largely untapped and offers an array of opportunities for investors. Imagine if the estimated $1 billion spent annually on medical tourism by Nigerians and even more was instead generated locally as returns on investment or public-private partnerships. This is a sector that has been under tapped and one that will definitely yield great dividends.