Dorothy Jeff-Nnamani, an expert on healthcare financing, is the MD/CEO of Novo Health Africa, an organization committed to creating value through coordination and delivery of healthcare services. In this interview, Jeff-Nnamani speaks on the task ahead of the Coordinating Minister of Health and Social Welfare, Prof. Ali Pate, to transform the sector and seeing to the implementation of the 15 per cent budgetary allocation as agreed by heads of the African Union at the Abuja Declaration in April 2001. Excerpts:

By Olayinka Ajayi

How would you describe the state of healthcare services in Nigeria?

For over five years now, healthcare in Nigeria has been on the brink of collapse. So, I personally feel she is in a state of comatose. It is underfunded; we don’t have the resources and infrastructure; we don’t have modern medical facilities; we are suffering brain drain; we are suffering medical tourism; so, everything you think could have gone wrong has gone wrong with the system.

Some areas need serious regulation. We have policies, but are they being implemented? Luckily, last year, there was hope. The National Health Authority Bill was signed into law by former President Muhammadu Buhari, but what that is supposed to do is drive health insurance in the country.

However, there are so many other things in terms of skills and infrastructure that are in a collapsed state and need resuscitation.How can these issues be addressed?

The government needs to be committed to healthcare. The problem is that our government has not been able to tie healthcare to development. If they could appreciate the interdependence of health and development, they would focus on healthcare. You hear the government say things like, ‘”we want to do a poverty alleviation program”, but health is not tackled because health is an enabler for poverty alleviation. There’s a vicious circle between poverty and ill-health. Poor people are the ones who are always exposed to ill-health, and they don’t go to hospital because of a lack of finance, so they get sicker.

When they are almost dying, what happens? They are selling their assets, and selling them makes them poorer. So, there’s a need for government to appreciate interdependence from an economic growth point of view and from a social development point of view. There’s no gain in productivity without people being healthy. Only a healthy human being can work. Imagine what happened during COVID-19 and the types of people we lost. So, that appreciation of what health has to do with development will make government spend the right amount on health. Our budgetary allocation for healthcare is still very poor.

Imagine that countries like Togo, Malawi, and Rwanda are all meeting the 15 per cent that was committed in the Abuja Declaration, and Nigeria has the highest health budget allocation at 5 per cent. So, our healthcare is terribly underfunded, and government has a heavy role to play. Nigeria has a pluralistic health system in the public and private sectors. In the public sector, you have the local government and state government.

If government can add wards to an election for political reasons, why can’t we have primary healthcare in every ward? If you recognize that you are going to capture people’s votes per ward, why can’t you consider their health? We complain about medical tourism; our problem is outbound medical tourism. We don’t have any…if we have inbound. There’s nothing wrong with medical tourism, but Nigeria is crying because what they have is outbound. So, people are going out because those illnesses cannot be treated in Nigeria.

Why are they going? Because you have to connect them. If you don’t appreciate connectivity and find out where our problem starts, you cannot solve it because, at the primary healthcare level, those who are supposed to take care of your basic healthcare needs are not primary healthcare. So, people don’t go there because a simple high blood pressure could lead to kidney failure, and if you want to treat it, you only have two dialysis centers. So, you then take your money to India for treatment. So, the foundation of our development is primary healthcare.

And we must create a working primary healthcare system. I don’t mean creating two rooms and naming them primary healthcare center. I have seen buildings like that, and it’s ridiculous. You don’t treat people as if you are doing them a favor. Because illnesses are unfortunate, patients must get the best treatment possible to keep them alive. There’s a saying that the state of a nation is as good as the health of its people. If you want to drive technology, is it a human being that would do it? If you want to do transportation, is it a human being that would do it? If you don’t have people who are productive, those things cannot exist. So, there’s a need for the government to understand that health is at the core and at the center of development.

So what has been the conversation among your peers in trying to propose a solution to this ordeal?

The funny thing was that the association of medical physicians in Nigeria met after what happened to the doctor who died in an elevator in Lagos, so it’s difficult to tell people not to Japa (runaway). People want decent work. A colleague recently asked if I was aware that doctors are now poor. Before, doctors were not rich, but they had okay lives. There’s a need for government to take care of caregivers who take care of the people. If they are not taken care of, some will engage in sharp practice to make money, and people will suffer, and it can affect anybody. So, like in other sectors, the conversation has been to stay in there and hang on. Our own sector is health insurance, and it’s difficult because hospitals want to get paid. What is happening in the system is that people tend to put health insurance on the back burner. If you observe an organisation when you ask them to pay for the health insurance of their staff, they would first pay for their car insurance and see health insurance as either secondary or unnecessary.

How would you advise the Minister of Health, Prof. Pate, to address this?

There’s an area Nigeria has not tapped into, which is philanthropy in the health sector. There’s an urgent need to tap into that. It is done everywhere in the world. You go to a hospital in America, and you see the Alex and Susan Cancer Center.

They sponsored it. It is not an American government. You go to other places and see Joseph and so school of medicine. Nigerians are givers. Some individuals are voluntarily building churches worth billions. How come we don’t have that in the health sector? We need Nigerians to take control of their healthcare. Let government leverage these by creating an enabling environment that will spur people to want to do them. And also the Diaspora… Let’s turn brain drain into brain gain through incentives.

They did it in India. My friends and I are sponsoring the Africa Research League at UNN. We encourage students to do research in their own little way, but it can be bigger. The problem is that there’s no system. Many Nigerians have left, but their eyes are on what is happening, and if they see any genuine move by the minister, they will all support him.

How is Novo Health filling these gaps, what role are you playing, and how are you driving the process?

Novo Health Africa is an HMO, and we are in the business of health insurance. You know that health insurance is at the center of universal health coverage. So, we have a very important role to play in Universal Health Coverage, or UHC, and we are doing that by ensuring that we are bringing more people into that fold. We understand the dilemma of Nigerians; we also understand that there’s poverty, many people don’t have disposable income; and we discovered that the informal sector is not covered.

We are a data-driven organisation, so we understand how data and technology have helped developed countries. So, we used data to develop a recent program called the Niovo Apoyo. It is the first in the industry. It has never been done. It would help enrollees have a better health experience by seeing themselves as healthcare consumers, and they would be more involved in making decisions about their health. We are also at the forefront of mental health. Recently, Novo Heal was one of the winners of the Women in Healthcare Education Fund.

There was a paper that I wrote about healthcare financing, and we make sure that people who are poor will register. The ceremony was done in Rwanda. We are a consumer-driven service, and we use technology in these processes so that enrollees can check themselves in when they go to the hospital without calling their HMO, even if they don’t have an internet connection. All they need to do is use their mobile phones. So, just as technology is driving the financial sector, it can also drive healthcare. In other words, Apoyo is a game-changer.

But as a leading HMO, are there plans to improve with more transformative moves to change the narrative?

Technology is the future. We cannot help but be creative. Every nation thinks differently, depending on the issue at hand. But there would be much more innovation to develop the sector.

How would you charge government to bring these into reality?

There’s a need for government to increase its budgetary allocation to the health sector. They need to promote philanthropy in healthcare, and they need to formulate policies that guide the health system. There is a need to set up a system so that everybody can come on board. If government can do that, we have a direction for healthcare in Nigeria.