Crisis looms over plans to sell LUTH, UCH, ABUTH, others
Benefits of proposed sale, by ministry
IF the Federal Government goes ahead with plans it has so far made, apex public health institutions like the Lagos University Teaching Hospital (LUTH), the University of Nigeria Teaching Hospital (UNTH) Enugu, University College Hospital (UCH) Ibadan, Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, among others, will be put up for sale or rather privatisation, soon.
But health workers have rejected such plans. Last week, they, excluding medical doctors, petitioned President Muhammadu Buhari over the plans to privatise the health sector and vowed to resist what they have called “a version of reforms in healthcare that are self-serving in terms of their narrow commercial interests and those of foreign pay-masters.”
The plan by the Federal Government to ‘sell’ public health institutions was confirmed in a document prepared by the Federal Ministry of Health (FMoH) in November 2014 titled “Recommendations for a National Policy on Incentivising Healthcare Investments.”
Because of the success recorded by reforms in the telecom, energy and banking sectors, advocates of the sale option believe it will bring in additional private capital that will encourage better quality care at the lowest cost and improved benefits to all stakeholders in the sector.
That in turn, according to them, would guarantee an economic imperative to invest into healthcare for a healthier population.
It will also stem the pressure on the naira from foreign capital flight due to outward bound medical tourism.
The health workers under the aegis of Joint Health Sector Unions (JOHESU)/Assembly of Healthcare Professional Associations (AHPA) alleged that the health sector is one of those sectors placed under the supervision of Vice President Yemi Osinbajo and that six doctors including agents of Western donor agencies in Lagos State that championed the commercialisation of health facilities were charged with the responsibility of crafting the health policy of the Buhari administration.
The health workers said one of the key recommendations of the six-man committee was to canvass a ‘‘reform of the Federal Ministry of Health and reduce the number of agencies from 14 to three based on alignment of scope and deliverables.’’
The health workers had alleged that the Buhari administration has sought views and position papers on healthcare agenda from strange templates, especially a particular group of entrepreneurs in healthcare rather than the true representatives of healthcare providers who are well structured into various healthcare professional associations and trade unions.
They further alleged that the pecuniary motives of the entrepreneurs in healthcare who belong to an array of professions and background remain an inclination to access funds provided by the International Finance Corporation (IFC). “They plan to lord their concept of privatisation and commercialisation on the health sector, notwithstanding the damaging effects it will bring to consumers of health services and the economy of the Federal Republic of Nigeria. It is apt to put on record that the operatives of International Finance Corporation who are citizens of Nigeria have no respect for our laws,” they said.
The health workers added: “They insist on a version of reforms in healthcare that are self-serving in terms of their narrow commercial interests and those of their foreign pay-masters.
“The team has been canvassing the agenda of bringing foreign chain retail promoters in pharmacy practice into Nigeria for instance.”
The health workers warned that foreign company domination prevents Nigeria from building capacity through Nigerian providers.
They called on Buhari to redress the impending damage the re-structuring of healthcare sector will occasion, in the public interest by directing appropriate quarters to embrace rational and home grown-initiatives to tackle challenges in the health sector.
Proposed benefits of planned ‘sale’ by FMoH
According to the document, the incentives being proposed will specifically impact the healthcare sector through: Improving healthcare delivery infrastructure within the sector; improving access to medical technology necessary for the practice of modern evidence-based medicine; increasing the level of technical skills within the industry, (public and private sector) through trainings, re-trainings, quality assurance and improvement programmes, certifications, investments in medical technology among others.
It would also create new opportunities for employment and growth within and outside the sector, especially for women and the youth. These opportunities would include: providing logistics; home and hospice care; clinical and non-clinical roles; information technology (IT) and health information management; research and development; diagnostics support personnel and preventative care promotion among others.
X-ray of private-sector healthcare investments
According to the document, the Federal Government has facilitated rapid diagnostic surveys on private-sector healthcare investments, with a view to expanding these initiatives, and some of the constraints identified include the difficulty in accessing growth capital; the high cost of doing business; the general lack of market information; the fragmented nature of the sector; a difficult business climate; restrictive fiscal policies; burdensome regulations and limited business/financial knowledge amongst health care delivery business owners.
It reads: “Consequent to this, the Federal Government mobilised private-sector-led approaches to expanding access of patients to quality healthcare, with a view to leveraging on the unique strengths inherent to the private sector including competition and efficiency. This approach is even more relevant in recent times as government funding to the healthcare sector continues to decline, both in real terms and as a percentage of Total Health Expenditure. The era of a government-dominated sector, with central control of health care service provision is gradually coming to an end and the private sector needs to be positioned and strengthened to plug the resultant gaps.
“Nigeria’s current population of about 160 million is estimated to increase to 200 million by 2020, which is then projected to double in another 30 years. Aside from providing much needed healthcare to its citizens, growing the sector will also translate to massive employment and entrepreneurial opportunities, for both skilled and unskilled labour.
“This incentives programme aims to focus on improving investments into the healthcare sector through strategic partnerships across all levels of government (Federal, State and Local), the private sector, development partners, donor organisations as well as development finance institutions and other financial institutions.
“It shifts the current healthcare industry focus from healthcare as a social programme of the government to a healthcare industry focused on service delivery and quality of care centred around the patient with robust participation of the private sector.
“Investing into healthcare will yield immediate benefits in the form of stemming the pressure on the naira from foreign capital flight due to outward bound medical tourism, as well as positive returns on investment and social capital for the private sector and the population.”
Nigeria and poor health financing
The document argues that Nigeria has had a steady rate of Gross Domestic Product (GDP) growth in the last decade annualised at 6.8 per cent per year and is now Africa’s largest economy (National Bureau of Statistics 2014).
Unfortunately, all of this has not translated into shared prosperity nor has it produced a reduction in extreme poverty. Despite the Federal Government’s commitment to improving healthcare delivery to its citizens, health outcomes continue to be sub-optimal with poor quality healthcare services and insufficient financial risk protection. In addition, infrastructural challenges, human resource constraints, a fragmented system and a lack of investment into the sector continue to haunt the healthcare sector.