Transforming Nigeria’s primary health care sector

ABCHealth is committed to the transformation of Africa’s healthcare system, originating universal access at the primary level. Chairman, Aigboje Aig-Imoukhuede, who also chairs GBCHealth, recently provided insights into a new idea to transform Nigeria’s primary health care sector named ‘The Adopt a Primary Health Facility Programme’which will bring many benefits including the provision of quality healthcare to people regardless of geographic, social or financial barriers. The programme has the backing of the Private Sector Health Alliance of Nigeria (PSHAN) founded by Aliko Dangote, Jim Ovia and Aigboje Aig-Imoukhuede.

GBCHealth: What’s your vision for ADHFP? What's the anticipated timeline for creation and implementation and, importantly, what's the potential impact for Nigeria?

Aigboje Aig-Imoukhuede: The Adopt-A-Healthcare-FacilityProgramme’ (ADHFP) is driven by my belief that the African continent will continue to carry the painful and shameful burden of high disease mortality long after the rest of the world has overcome such challenges unless we address the poor state of healthcare systems at the primary level.The goal is to establish a chain of Primary Healthcare Centers (PHCs), across Nigeria’s 774 Local Government Areas and apply market-based reforms to provide low-cost health services at decent standards to the poor and vulnerable. We expect to complete the programme design phase by Q3 2020 and commence pilots before the end of the year.

The ADHFP is a multi-impact initiative with several benefits for Nigeria including:

• Reduction in mortality rates

• Creation of new jobs, entrepreneurship opportunities and health-focused start-ups

• Improved public sector accountability

• Female gender empowerment

• Increased uptake of micro-health insurance

• Successful health policy reform

GBCHealth: Why ADHFP − focusing on healthcare facilities/systems/standards/infrastructure − and why now? How did the pandemic influence this decision? How will COVID-19 inform the design of the programme? What will change as a result?

Aigboje Aig-Imoukhuede: The ADHFP was conceived early in 2019 well before I had ever heard of the word 'Coronavirus'. Interestingly, whilst championing the Global Citizens global goal live campaign in Davos this January, I made the case that it is unacceptable for Africa to continue suffering the effects of pandemics like HIV and malaria long after the rest of the world has put them to bed. I said Nigerians and other stakeholders must launch a movement to revive our ailing healthcare sector starting by fixing the 80 per cent of our 30,000 primary health care facilities, which are currently comatose. COVID-19 is a burning platform for change and reform in Africa’s health sector. With COVID-19 beaming a spotlight on the weaknesses and inadequacies of our health system, the pandemic has simply reinforced, with devastating effect, the reasons ADHFP was conceptualised in the first place. As the pandemic spreads, it has become evident to Nigerians that our primary health system must be fixed with urgency, otherwise our people will continue to die needlessly.

GBCHealth: Why a private sectorled initiative? What is the business case/value proposition for 'angels' to adopt one or more PHCs? Have conversations started, and if so, what's the response? Do you think this is an easier 'sell' in today's environment, in the midst of the pandemic, when health and healthcare are the recurrent lead stories and priorities?

Aigboje Aig-Imoukhuede: The government’s track record on annual health spending falls far short of the 15 per cent Abuja Declaration to address the heavy burden of HIV, AIDS, TB and malaria agreed upon by African heads of state in 2001. Revenue challenges due to global commodity prices as well as poor governance and corruption have also constrained what is spent on health by the government. Funding must come from other sources such as foreign assistance and the private sector. But beyond funding, Nigeria’s primary health sector is largely the responsibility of the local government tier of government, which suffers from weak capacity poor governance, and an absence of accountability. So beyond funding, we will continue to perform abysmally at the primary healthcare level without the involvement of capable and engaged citizens in the running and administration of our primary health system, hence the need for private sector organised participation. The programme will be implemented as a private-sectordriven initiative. ADHFP will be sponsored by angel investors who could be individuals or institutions. Each “angel” will take responsibility for one or more PHCs. They will build and operate the PHCs for the period of adoption under strict rules and guidelines.

Serious work is ongoing to make this vision a reality. The work is led by the Private Sector Health Alliance of Nigeria (PSHAN) founded by Aliko Dangote, Jim Ovia, myself and a number of notable organisations who have established themselves as serious actors in the field of Nigerian philanthropy and have rallied to the cause. They include: Global Citizen, Africa Business Coalition for Health (ABCHealth), Bill and Melinda Gates Foundation, United Nations Economic Commission for Africa (UNECA), World Bank, International Finance Corporation (IFC), MTN Nigeria Plc, Dangote Group, Zenith Bank, Access Bank, Stanbic-IBTC Bank, PwC, Cisco, Ford Foundation, Nigerian Stock Exchange, Flying Doctors Nigeria, Africa Practice, Cedar Advisory Partners, GBCHealth, Health Federation of Nigeria, Health Law, Eti-Osa Local Government, JNC International Ltd, Johnson & Johnson, Justice in Healthcare, Lagos State Government, MSD for Mothers, Nigeria Economic Summit Group (NESG), ONE Campaign, PharmAccess Foundation, Women-At-Risk International Foundation as well as the SSA to the President on Sustainable Development Goals among others.

GBCHealth: What are some of the challenges you are anticipating and how are you planning to mitigate those? Do you see this as a replicable model for other countries?

Aigboje Aig-Imoukhuede: The ADHFP is a ground-breaking, innovative, private-sector driven initiative, but there are a number of risks and challenges associated with its development and implementation. At the moment, the most significant risk is the on-going COVID-19 pandemic, with attendant effects arising from restrictions in movement, risks to life and the damage to the Nigerian economy. Fortunately, a number of tried and tested business continuity strategies have emerged that we can apply to mitigate pandemic risks. Another major risk to be mitigated is the possible loss of enthusiasm by ADHFP sponsors, donors and implementing partners. These are mission critical stakeholders whose interest must be sustained through the highs and lows of reform implementation.

Great reliance will be placed on our ability to engage the hearts and minds of donors and implementing partners. Adopting best practices in project management, getting some quick wins and successful delivery of programme objectives will go a long way to ensuring that our angels stay the course. Another risk is misinformation about the ADHFP. To mitigate this, an effective communication strategy will be developed to ensure PHC host communities are carried along. In addition, traditional institutions, civil society and the media will be carried along through traditional and technology enabled channels. Extensive stakeholder consultations with both current and past actors at state and local government level is also ongoing with the purposeful intent of getting them to support ADHFP. Once we have demonstrated that we can effectively manage these risks, I am quite confident that ADHFP will become a model of reference for strengthening primary health care delivery across Nigeria. Indeed, through the Africa Business Coalition for Health (ABCHealth), it is our intention that the initiative will become a flagship community health development strategy in Africa.

GBCHealth: Your legacy already includes building and strengthening Nigeria's financial and capital markets and the public sector through AIG. Is reimagining the healthcare system the missing piece on theway to a more prosperous Nigeria?

Aigboje Aig-Imoukhuede: There are many missing pieces required to solve the Nigerian puzzle. It takes leadership for a community to reach its full potential. I know that each of Nigeria’s 774 local government areas is blessed with citizens who have the capacity to transform the quality of primary health care available to their people. Let’s join forces and become partners in the business of saving lives.