As the pandemic spreads over the world like wildfire, the effect continues to paralyze activities across our country Nigeria through its mass adoption of imported solutions – lockdown, border closures. Efforts are ongoing from all facets of humanity to curtail the scourge of the pandemic. How well our fragile economy will respond to the twin bombs of Covid-19 and the apocalypse of oil price is unimaginable. The response of governments has been fairly commendable, but the effort of the organized private sector is overwhelming. In Nigeria, as of April 1st (not an April fool joke), the newly birthed Coalition against Covid -19(CACOVID) has realized the sum of N19B (about $47.5m) – confirmed redeemed pledges. Superlative response!
Recently, the Minister of Finance put forward a proposal of a N500 billion intervention fund for the upgrade of medical facilities across the country. One can only imagine the fate of all the CAPEX that has been budgeted/allocated to this critical sector over the years. A quick review shows the Federal Government Nigeria CAPEX budgetary provision over the last 3 years – 2018(N71B),2019(50.15B), and N46 in 2020. Unfortunately, the country has budgeted below the WHO benchmark – 13% of the annual budget to be allocated to healthcare. It has also budgeted far below the Abuja Declaration of 2001 under which African leaders agreed to commit 15% of their annual budget to improve the healthcare sector. The same situations abound in the sub-national governments with over 70% of the sector budget expended on recurrent expenditure.
Whilst the sector has suffered massive underbudgeting of resources, the amounts allocated have not been prudently utilized as exemplified by the abysmal quality of our healthcare infrastructure. Little wonder a notable “His Excellency” in one of the states commissioned with pomp and pageantry a world-class, first of its kind state-of-the-art hospital in his state but unfortunately, upon a minor accident was flown abroad for treatment. What happened to the state-of-the-art hospital? Nevertheless, George Orwell remarked that some animals are more equal than others. One of my good friends’ critique of my last article was my inability to rebuke the government in strong terms, I had retorted, “I write about the living and not the dead”
Evidently, the government has relegated this sector through under provision of resources, massive corruption, politicization of healthcare, mediocre policies, poorly built and maintained infrastructure, and the dearth of modern equipment. The resultant effect has been the massive brain drain of our medical personnel. According to them it is perpetually frustrating to practice the profession in Nigeria where you witness children and adults die daily due to lack of ordinary oxygen or patients are compelled to purchase medical disposables for their examination and treatment. Doctor to patient ratio is still around 2500:1. The scale of this problem has unfortunately become too gargantuan and a Sisyphean task for the government to resolve. An African proverb says, ‘one person does not hear the sound of the gun’. We are therefore condemned to seek the intervention of the private sector. But these corporates pay their statutory taxes and levies to the various tiers of government in addition to the obnoxious operating environment. Hence, they have no obligation to further take up these existential roles of government. Incidentally, recent events have reaffirmed the old labor slogan “an injury to one is an injury to all”. Our government has failed and whereas we continue to demand accountability from them, we need to pick up the gauntlet and make hay while the sun shines. We can no longer stand and gaze or sit and look.
The private sector has not only shown expertise in the management of their various firms but has demonstrated elegant competence in rescuing the government in its core and critical functions – Education, Security, Public Infrastructure, etc. Several corporates have provided operational equipment to the security agencies, built a couple of facilities/research centers for various educational institutions, and even rehabilitated roads and other public amenities. But the question beckons, what has been the fate of these facilities weeks/months after handover to the authorities. Is there a mechanism for a post-handover review of these projects to ensure the retention of standards? How well have they met the objective over time? We can wildly conclude that most of them have been well mismanaged shortly after handover. The corporates need to review their existing model of Corporate Social Responsibility (CSR) to build sustainable institutions. My call is for business leaders to press the reset button and review their fanfare, advert based, “photo/social media charity” CSR models/programs. Several examples abound of where corporates have adopted a self-sustaining approach to build, operate, and manage (BOM). This model has been adopted by the International Oil Companies (IOC’s) to bring relative peace in the Niger Delta region. They (IOC’s) have succeeded in building several facilities (health, etc) jointly owned and managed with the host community with economic and social benefits. Available data also shows that the Dangote Foundation has constructed faculty buildings across several universities in the country amongst other projects. The current road reconstruction undertaken by Access bank around the Oniru axis, the Zenith bank reconstruction, and maintenance of the Ajose Adeogun road all in the Victoria Island of Lagos are handy examples amongst others. Little wonder the Ajose Adeogun road with an adornment of the spectacular Christmas decoration has become one of our foremost tourist destinations. Even the popular American rapper Belcalis Marlenis Almanzar professionally known as Cardi B took a tour of the road during her maiden concert in the country last December. These private sector-led projects have obviously been outstanding.
The corporates led by the banks need to mine the pool of data wasting in their bases. As banks begin to append their signatures to UN sustainable banking principles, they need to thoroughly review their portfolio. In line with the WHO & UNO guidelines for countries to provide a certain minimum percentage of their budget to the critical sectors – Education, Health, etc, banks should ensure that a reasonable portion of their loan books is available to the healthcare sector. They should not only provide funding but ensure that those firms survive through healthy business partnerships and fair pricing. I can vividly remember a top executive that frowns at any request to support local pharmaceutical companies. The claim is that they produce poisons (technically drugs are poisons), how many of us can afford the imported brands?
The banks also need to fortify their risk management with experienced healthcare professionals to guide them on financing for the healthcare sector. It cannot be guessed work or general knowledge as the partnership is expected to be long term and not solely profit first. As expected, every business should have public health professionals in their human resource management for prompt advisory services.
According to the Federal Ministry of Health, our annual expense on medical tourism is in excess of $1B. I am also aware that a bulk of the “China tents/kits” being purchased by the private sector intervention is imported. This further strains the epileptic foreign exchange (FX) reserve of the country. The corporates should extend this coalition post-COVID towards the development of smart “health/medical cities” to curb medical tourism and conserve our scarce foreign exchange. These medical hubs will have at least one standard (world-class) tertiary and secondary healthcare facility with the attendant ancillary services. The abrupt shut down of several private hospitals upon the visit of Covid patients reinforces the poor state of facilities and the begging need for massive investment in the sector. This shows that our existing health facilities lack adequately trained manpower and capacity to manage an epidemic.
Whilst it is contestable that the continuous lockdown is more hurtful than the virus, the new normal may include the continuation of the existing hygiene rules. As medical supplies in the international market is now highly prioritized according to the severity of the pandemic – no. of deaths etc, local production of materials – hand glove, mask, sanitizers, etc and other minor medical supplies/equipment need to be invented and upscaled. The creation of these “medical cities” funded by the corporates will not only generate thousands of jobs – MSME’s SMEs, mid-large size organizations but will provide the needed support – trained manpower, etc for the creation of a holistic medical ecosystem of global standard. FX will be conserved, trusted, and sustainable SME’s cultured.
I can only imagine a standard hospital across the country with First, GTB, Access, UBA, BUA, FAMFA, and Zenith logo. These hospitals can boast of any world-class equipment with the capacity not only to carry out several advanced medical procedures but updated medical research and training. These facilities will without doubt possess the wizardry of these great institutions – it will be centers of healthcare excellence. They have a mechanism to create special purpose vehicles(SPV) to manage these institutions without losing focus on their core competence.
Partnership with public health institutions (like the National Centre Disease Control (NCDC), Nigeria Institute Of Medical Research (NIMR), Health Ministries/Agencies) should be strengthened for effective disease surveillance. Prevention they say is better(cheaper) than cure. Such partnerships should be extended to the army of indigenous innovative healthcare start-ups.
The health insurance sector of the economy will require fresh investment. As of 2017, only 3% of healthcare expenditure in Nigeria was paid for using health insurance. This provides an opportunity to explore the untapped potential of the sector.
According to UNICEF, one in four Nigerians (47 million) practice open defecation and the country loses about 1.35% of GDP(N455B) due to poor sanitation with its attendant social, economic, and health impact on national development. In line with the “Clean Nigeria: Use the toilet” initiative to end open defecation in 2025 in the country, the corporates(corporate Nigeria) should explore options of building public toilets across the major markets smartly data-driven and operate with their banks/loyalty cards similar to our friends in Vietnam. That is the right promotion that they need to acquire customers, not our current knee-jerk approach. Expectedly due to the high standards of these facilities, the patronage generated can almost sustain their maintenance – revenue generated can self-sustain some of these facilities without compromising standards.
As it is stated in marketing, ‘put the right incentive on the promotion and the fish will bite the bait’. These sustainable structures are what the corporations require, not the ubiquitous and obscene images of “kalokalo(gambling)”, and lotteries they are wearily using to lure customers. Machine learning, Artificial intelligence, and “thick data” should be applied to build smart health centers. Today in Ho Chi Minh City, Vietnam, citizens can swipe a card on a 24/7 automatic rice dispensing machine and get a measure of the needed essentials. These cards can give a rebate/discount and other entitlements to the existing clients of the host organization upon the patronage of these facilities. I can not only imagine the mass of customers these corporates will unsolicitedly garner but the everlasting public allegiance to the brand – shortest and inexpensive route to brand advocacy and public appeal as against the millions of dollars expended in adverts(especially in international media).
There is an urgent need to look beyond the current management of the galvanized resources. We need home-grown solutions to address these challenges beyond the Covid era. The current make-shift response strategy though commendable and suited for the pandemic is not an ingenious and enduring solution. Unfortunately, the current solutions(donations) will have to rely on the existing poor demographic data in the country to be allocated. The coalition should look towards mutating into a trust, partner, public policy pressure group, and investor in the reform and revolutionization of the healthcare sector.
A stitch in time saves nine! Stay safe and observe all the guidelines as we assiduously wait and work to overcome this challenge.
Chijioke is an experienced Banker, Financial Services Consultant, and Social Commentator. He shares his thoughts from Lagos, Nigeria.