SETTING NEW STANDARDS IN A CHALLENGING ENVIRONMENT FOLA LAOYE IFC HEALTHCARE CONFERENCE 2009

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Rudolf Baldwin
8 years ago
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1 SETTING NEW STANDARDS IN A CHALLENGING ENVIRONMENT FOLA LAOYE IFC HEALTHCARE CONFERENCE 2009

2 BACKGROUND ON NIGERIA Nigeria Most populous country in Africa and 8th most populous country in the world; population of over 140 million The health care system in Nigeria is ranked 197 out of 201 countries Listed among the "N11" economies by Goldman Sachs, but also noted that the country s low Life Expectancy will hamper its growth potential if not immediately addressed The healthcare sector is still under-developed because of resource constraints, even though total health expenditure (THE) per capita expenditure is now about $27 with 75% being Out-of-pocket Private Sector currently delivers almost 50% of all care in the Country

will hamper its growth potential if not immediately addressed The healthcare sector is still under-developed because of resource constraints, even though

3 KEY HEALTHCARE INDICATORS Source: WHO Statistical Information System 2003 MMR U5MR Life (per 100,000) (per 1,000) Expectancy Benin Cameroun Ghana Niger 1, Nigeria Togo MDG 2015 Target: 75 30

Benin 850 154 53 Cameroun 730 166 48 Ghana 540 95 58 Niger

4 HEALTHCARE FINANCING REGULATORY ISSUES It has thus become necessary to seek alternative sources of financing and access to health care, shifting to demand-based and output driven schemes. This has led to the growth of Risk Pools, starting with the formal sector (public and private workers) and directed by the regulatory role of the National Health Insurance Scheme, and administered by Private Sector HMOs The result of this has been significantly increased access to modern healthcare services with about 4 million people presently covered nationwide, thereby adding about $1 per capita to the nation s healthcare expenditure 4

This has led to the growth of Risk Pools, starting with the formal sector (public and private workers) and directed by the regulatory role of the National

5 HEALTHCARE FINANCING CHALLENGE Approx. 70% of Nigeria s population outside formal sector, i.e. most of informal sector and rural communities cannot afford to pay for health insurance Their inability to take part in risk pooling & solidarity schemes endangers them as they remain unable to access healthcare readily Organized Private Sector Public Sector Formal Sector 70% of Population require subsidy Informal Sector Rural Communities

6 RESPONSE: DEMAND SIDE APPROACH Subsidy injection Introduce a financing system and subsidise membership to stimulate demand financing Collective healthcare financing system including: Pre-payment Risk pooling financing Healthcare revenues are guaranteed, meaning investments can be made in healthcare quality DEMAND: Healthcare membership Medical care usage SUPPLY: Quality healthcare Higher quality of services further fuels demand delivery

financing Healthcare revenues are guaranteed, meaning investments can be made in healthcare quality DEMAND:

7 WHY FOCUS ON QUALITY? Fragmented Healthcare Delivery System with rapid growth of number of health facilities (public & private) from less than 10,000 to over to 30,000 in 20 years Weak & Fragmented Regulatory System (Federal Government licenses practitioners while State Government licenses facilities) Lack of Data which makes it hard to distinguish what proportion of severe mortality pattern is due to medical errors Shift to 3 rd party payor system which expects standardized levels of healthcare delivery across provider networks Increasing health literacy i.e. growing consumerism & consumer advocacy Good Business: Increase in Footfalls & Elimination of unnecessary costs

Fragmented Regulatory System (Federal Government licenses practitioners while State Government licenses facilities) Lack of Data which makes it hard to distinguish what

8 ABOUT HYGEIA

9 OUR VISION To be the 1st Choice for Healthcare Solutions of International Standards in Nigeria

11 OUR BUSINESS LAGOON HOSPITALS (since 1986) 75 beds across 3 facilities Multi-specialist with emphasis on Critical Care Annual capacity utilisation of over 100,000 outpatient attendances; 17,000 inpatient days & 1,700 surgeries HYGEIA HMO (since 1998) Over 250,000 enrollees in formal sector (public & private) Over 300 providers in private scheme network HCHP (since 2007) Over 55,000 enrollees (with subsidy from Dutch Health Insurance Fund) & fast growing with additional Grants from World Bank & Local Govt HYGEIA FOUNDATION (since 2006) Capacity Building work with private sector providers Assisting providers (under Global Fund HIV/AIDS programme) to deliver treatment to over 9,000 patients

network HCHP (since 2007) Over 55,000 enrollees (with subsidy from Dutch Health Insurance Fund) & fast growing with additional Grants from World Bank & Local Govt HYGEIA

12 OUR STRATEGY QUALITY & ACCESS Target Market Group Hospital Business Quality Group A Flagship full-service International Accreditation (incl. Tertiary care) Specialist Clinical Training Research & Publications Group B Nationwide secondary network care HMO Quality Accreditation & Monitoring Group C Rural/urban primary care network HMO Quality Accreditation & Monitorin Public Health Vertical Disease Programmes

Tertiary care) Specialist Clinical Training Research & Publications Group B Nationwide secondary

13 OUR QUALITY FOCUS ACCREDITATION FOR THE LAGOON HOSPITALS JCI accreditation process with emphasis on patient safety Change Management using younger doctors as auditors Provider Community Engagement (eg. WHO Hand washing Day) HMO QUALITY INITIATIVES Managed Care Quality Group (MCQG) in 6 geographical locations Use of Guidelines in Malaria, Diabetes & Hypertension Monitoring & Evaluation of Provider Network HCHP INITIATIVES Active Monitoring & Evaluation system with PharmAccess Quality Upgrade of Infrastructure & Manpower ADVOCACY ACTIVITIES Society for Quality in Healthcare in Nigeria

WHO Hand washing Day) HMO QUALITY INITIATIVES Managed Care Quality Group (MCQG) in 6 geographical locations Use of Guidelines in Malaria, Diabetes

14 LAGOON HOSPITALS: INCREASE IN FOOTFALLS

15 HMO PROVIDER MONITORING & EVALUATION 0-m easurem ent 1-m easurem ent 2-m easurem ent The M&E reviews demonstrate improvement in the performance of the providers & also fosters competition among providers 45% 39% 36% 37% 37% 35% 33% 33% 31% 41% Ol Ol O O l R Sh A B C D

performance of the providers & also fosters competition among

16 HCHP TOP 10 THERAPIES IN 2007 vs ,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2, Analgesics Vitamins(others) Artesunate tab Amoxycillin cap Vitamin C Iron tab Vitamin B Complex Folic Acid tab Anti-hypertensives Chloroquin tab Changing Prescription Behavior of Physicians for the treatment of Malaria

Analgesics Vitamins(others) Artesunate tab Amoxycillin cap Vitamin C Iron tab Vitamin

17 THE SOCIETY FOR HEALTHCARE QUALITY MISSION STATEMENT To lead, advocate and facilitate the continuous improvement of quality and safety in healthcare in Nigeria through Education, Collaboration, Training & Accreditation MEMBERSHIP Public & Private Hospitals Development Partners/NGOs Payors (Corporates; HMOs; Individuals) Medical Professionals & Students

Education, Collaboration, Training & Accreditation MEMBERSHIP Public & Private Hospitals

18 KEY FUNCTIONS OF THE SOCIETY Initiating Programmes to promote healthcare quality across the country Promoting Training in the field of healthcare quality Formulating a common basis for local & international accreditation for healthcare facilities in Nigeria To establish and maintain a support network for those actively involved in healthcare quality improvement and risk management To develop and foster alliance with related international bodies

for healthcare facilities in Nigeria To establish and maintain a support network for those actively involved in

19 MAIDEN CONFERENCE: FOCUS ON ACCREDITATION July 2009 Guest Speakers include: Managing Director of JCI Middle East Managing Director of COHSASA (South Africa) FOLLOW-ON PROGRAMMES Formulation & Advocacy for localized Accreditation system Quality as part of Stewardship role in Health Systems Training: Certified Professional of Healthcare Quality (CPHQ) Taking Advocacy to Professional Associations

Advocacy for localized Accreditation system Quality as part of Stewardship role in Health Systems

20 POSITIVE OUTLOOK FOR HEALTH EXPENDITURES Growth of the middle class over 7 million Nigerians now have per capita income of $4,000 and above Increased government expenditure on Health Debt Relief gains & legislation for fiscal increases Increased Donor commitments to move the country forward on MDG goals DEMAND FOR BETTER QUALITY SERVICES Increased spending will increase demand for quality Large payors (eg. Shell) now mandate accreditation as part of buying decision Competitive pressure will necessitate data for tracking outcomes Race towards MDGs will necessitate stronger health system stewardship

goals DEMAND FOR BETTER QUALITY SERVICES Increased spending will increase demand for quality Large payors (eg.

21 THANK YOU Q & A

PPP- ROLE OF BUSINESS IN AFRICA S HEALTHCARE THE HYGEIA GROUP S EXPERIENCE

PPP- ROLE OF BUSINESS IN AFRICA S HEALTHCARE THE HYGEIA GROUP S EXPERIENCE FOLA LAOYE MARCH 2006 NIGERIAN HEALTHCARE OVERVIEW ROLE OF PPP IN NIGERIA HYGEIA S RESPONSE TO PPP IN NIGERIA NIGERIAN HEALTHCARE