PPP- ROLE OF BUSINESS IN AFRICA S HEALTHCARE THE HYGEIA GROUP S EXPERIENCE
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1 PPP- ROLE OF BUSINESS IN AFRICA S HEALTHCARE THE HYGEIA GROUP S EXPERIENCE FOLA LAOYE MARCH 2006
2 NIGERIAN HEALTHCARE OVERVIEW ROLE OF PPP IN NIGERIA HYGEIA S RESPONSE TO PPP IN NIGERIA
3 NIGERIAN HEALTHCARE OVERVIEW
4 DEMOGRAPHICS Life Expectancy 45 years Infant Mortality 98 (per 1,000) Under 5 Mortality 198 (per 1,000) No of Hospital Beds 0.73 (per 1,000) Source: WHO Statistical Information System 2004
5 HEALTH EXPENDITURES Total Expenditure as % of GDP 4.7% Per Capita Expenditure on Health $19 Govt Expenditure as % of Total 25.6% Private Expenditure as % of Total 74.4% Source: WHO Statistical Information System 2002
6 KEY ISSUES Government Allocation to Healthcare grossly inadequate - Rapid Population Growth - Rising Public Expectations (the Millenium patient is no longer patient!) - Worsening National Health Profile Burden of Healthcare Delivery on Private Sector Providers - Lack of Access to Financing for upgrade/growth - Lack of Standards/Low Barriers to Entry Main payors for healthcare - Government as Employer Increase access to modern healthcare Ensure equity in population distribution of access to healthcare (NHIS) Increase long term capital sources by creating pool of funds (NEEDS) - Organised Private Sector Shift from Retainership Model Efficient Management of Healthcare Spend Increase access to modern healthcare Improve employee productivity Provide health system to tackle the HIV/AIDS problem
7 ROLE OF PPP IN NIGERIA
8 PPP- GOVERNMENT PERSPECTIVE Healthcare Reform drive of Federal Minister of Health, Prof. Eyitayo Lambo, resulted in National Consultative Meetings on PPP with the following objectives:- Bringing the relevant stakeholders in the Public & Private Sector together Effectively harnessing the private sector via Contracting; Regulation; Information Sharing; Education & Capacity Building Growing Private sector-led health services Conversion of public ownership of health services to private hands (BUT with a human face AFFORDABILITY & ACCESSIBILITY) SOURCE: Report on National Consultative Meeting on PPP in Health in Nigeria, April 2005
9 PPP- PRIVATE SECTOR PERSPECTIVE From the private sector health industry s perspective, PPP is crucial for the following reasons:- The 5 elements for an improved health sector are all taking shape at this time Political Will Economic Reform Increased Government expenditure Improved Infrastructure Health Sector Reform Increase in Investment (via Per Capita Expenditure) on Healthcare Growth of affordable & sustainable healthcare schemes (insurance) Much needed investment for upgrade of sector s facilities Improved compensation packages to attract our Nigerian Health Skills in the Diaspora Investment in Management Structures & Systems for the Industry Recognition of Private Sector by Donor Community Incentives are better aligned to deliver improved outcomes Existence of Corporate Governance frameworks for better accountability Attention to Healthcare Financing methods which achieve sustainable models of healthcare delivery
10 HYGEIA S RESPONSE TO PPP IN NIGERIA
11 EVOLUTION OF HYGEIA FROM LAGOON HOSPITAL (since 1986) TO HEALTHCARE SERVICES GROUP (2006) LAGOON HOSPITALS HYGEIA HMO HYGEIA FOUNDATION
12 LAGOON HOSPITALS 3 LOCATIONS: APAPA, IKEJA & VI 65 BEDS UNDER MANAGEMENT 60 DOCTORS: 30 SPECIALISTS; 30 MEDICAL OFFICERS 100 NURSES 60 PARAMEDICAL & ADMINISTRATIVE STAFF CENTRES OF EXCELLENCE RADIOLOGY: MRI, CT, FLOUROSCOPIC XRAY CRITICAL CARE & TRAUMA: ER, ICU, HDU& STROKE CENTER OTHER SPECIALTIES INCLUDING ORTHOPAEDICS, NEUOROSURGERY, CARDIOLOGY, UROLOGY, O&G, PAEDIATRICS TO DEVELOP CARDIOTHORACIC SURGERY & ONCOLOGY
13 PPP INITIATIVES (I) HEALTHCARE DELIVERY MATCHING GOVT S INVESTMENTS IN TERTIARY HEALTHCARE LAGOON APAPA UPGRADED AT THE SAME TIME AS 2 TEACHING HOSPITALS (UCH IBADAN & ABU ZARIA) WITH MRI, CT, & ICU FACILITIES WORKING WITH LAGOS STATE EMERGENCY SYSTEM PROVIDING AFFORDABLE SCANNING FACILITIES FOR ALL TRAUMA CASES BUILDING INTERNATIONAL RELATIONSHIPS & CAPABILITIES WITH APOLLO HOSPITALS INDIA CAPACITY BUILDING FOR PRIVATE & PUBLIC MEDICAL PROFESSIONALS -CONTINUING MEDICAL EDUCATION SERIES WITH EXPERTS FROM NETHERLANDS, INDIA & UK AS WELL AS UCH IBADAN
14 HYGEIA HMO HMO MODEL OF HEALTH INSURANCE PREMIUMS SET FOR ENROLLEES CONTRACT WITH PRE-IDENTIFIED PROVIDERS UNDER MANAGED CARE TERMS: CAPITATION & FEE FOR SERVICE MEMBERS SERVICES & QUALITY MONITORING NETWORK MODEL OWNED HOSPITALS (LAGOON) & CONTRACTED 165,000 ENROLLEES 1200 CONTRACTED PROVIDERS (NATIONWIDE) 24 WORKSITE CLINICS RETAIL PLAN THROUGH GTBANK BRANCHES NATIONWIDE
15 PPP INITIATIVES (II) NATIONAL HEALTH INSURANCE SCHEME (NHIS) Govt scheme for growth of Social Health Insurance, currently covering Fed. Govt Employees & dependants To be rolled out over the next 2 years to cover Private Sector Employees (formal & informal) Community (Rural & Urban) Vulnerable Groups (incl. Under 5 s, Aged) Benefit package as defined in the Law setting up the Scheme, covering primary and secondary levels of care, with exclusions for high cost illnesses Scheme is run by 20 govt-accredited private sector HMOs (Hygeia HMO rated as No 1 by Agusto & Co Study) Fastest Growing Health Insurance Scheme in the world 700,000 enrolled in last 6 months; 1.5 million additional enrolments by 2007
16 PPP INITIATIVES (III) PARTICIPATION IN GOVT HIV ART PROGRAMME ONLY PRIVATE SECTOR HIV/AIDS SCHEME WORKING WITH GOVT TO ACCESS FREE ANTI-RETROVIRAL DRUGS UNDER GATES & PEPFAR PROGRAMMES 100 PATIENTS UNDER TREATMENT WITH POTENTIAL TO SCALE UP TO 500 OVER THE NEXT 12 MONTHS ADVOCACY ROLE IN BUSINESS COALITION S RESPONSE TO HIV/AIDS IN BUSINESS CONTEXT HYGEIA FOUNDATION AS CAPACITY BUILDING SYSTEM AMONG PRIVATE & PUBLIC SECTOR HEALTH PROVIDERS FOR HIV/AIDS, TUBERCULOSIS & MALARIA PROGRAMMES
17 PPP INITIATIVES (IV) COMMUNITY INVOLVEMENT WORKING WITH APOLLO HOSPITALS TO CREATE SUSTAINABLE MODELS OF HEALTHCARE DELIVERY AT PRIMARY, SECONDARY & TERTIARY LEVELS FOR STATE GOVTS WORKING WITH DUTCH GOVERNMENT & TO CHANNEL DONOR FUNDING INTO COMMUNITY HEALTH INSURANCE PROGRAMMES TARGETING POPULATIONS AT-RISK FOR HIV/AIDS
18 CONCLUSION (I) CHALLENGES FOR PRIVATE SECTOR IN HEALTHCARE DIFFICULTY IN ACCESSING FINANCE SHORT TERM (MAXIMUM OF 3 YEARS; 5 YEARS RARE!) EXPENSIVE (INTEREST RATES > 20 YEARS) COMPETING WITH HIGHER ROI* INDUSTRIES (eg. TELECOMS) INFRASTRUCTURAL ISSUES POWER POTABLE WATER WASTE DISPOSAL SHORTAGE OF HUMAN CAPITAL SPECIALIST CONSULTANTS ADMINISTRATIVE MANAGEMENT
19 CONCLUSION (II) OPPORTUNITIES FOR PPP NATIONAL HEALTH INSURANCE SCHEME & OTHER HEALTH INSURANCE PROGRAMMES CREATING DEMAND FOR SERVICES OPPORTUNITIES FOR INVESTMENT AND MANAGEMENT OF HEALTHCARE DELIVERY FACILITIES, AT ALL LEVELS PRIVATE SECTOR INVOLVEMENT IN DISEASE PROGRAMMES SUCH AS HIV/AIDS, ROLL-BACK MALARIA TO ACHIEVE MUCH NEEDED SCALING UP ADVOCACY IN PUBLIC HEALTH POLICY GOVT ACTIVELY INVOLVING THE PRIVATE SECTOR IN REFORMS PROCESS INCREASE OF FINANCIAL INVESTMENT & SKILLS BASE BRING YOUR TREASURE & YOUR TALENT!
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