The focus of this year’s World Health Day is achieving Universal Health Coverage through primary health care. Universal health coverage is WHO’s number one goal. Key to achieving it is ensuring that everyone can obtain the care they need, when they need it, right in the heart of the community. 

Progress is being made in countries in all regions of the world, but I have observed that this is not the case in Nigeria. Millions of Nigerians still do not have access at all to health care. Millions more are forced to choose between healthcare and other daily expenses such as food, clothing and even a home.  

According to the World Health Organization, primary health care is a critical foundation for universal health coverage. It can address the vast majority of people’s health needs throughout their lives. Universal health coverage (UHC) is about ensuring all people can get quality health services, where and when they need them, without suffering financial hardship.

• No one should have to choose between good health and other life necessities.
• UHC is key to people and nations’ health and well-being.
• Everyone can play a part in the path to UHC, by taking part in a UHC conversation.

Too many Nigerians are currently missing out on health coverage;
“Universal” in UHC means “for all”, without discrimination, leaving no one behind. Everyone everywhere has a right to benefit from health services they need without falling into poverty when using them. We must begin to make UHC a priority agenda in Nigeria.

I am calling on the Nigerian Government to take UHC very seriously and provide the very basic healthcare needs of the populace. UHC is everyone’s business, this includes the leaders, health care workers, patient’s etc, and we should all work together and make our voices to be heard.

Here are some facts and figures about the state of UHC today (Source: WHO)

Incurring catastrophic expenses for health care is a global problem. In richer countries in Europe, Latin America and parts of Asia, which have achieved high levels of access to health services, increasing numbers of people are spending at least 10 percent of their household budgets on out-of-pocket health expenses.

UHC means that all people and communities receive the health services they need without suffering financial hardship. UHC enables everyone to access the services that address the most important causes of disease and death and ensures that the quality of those services is good enough to improve the health of the people who receive them.

UHC is not just about health care and financing the health system of a country. It encompasses all components of the health system: systems and healthcare providers that deliver health services to people, health facilities and communications networks, health technologies, information systems, quality assurance mechanisms and governance and legislation.

Can community health care workers address the Primary healthcare Crises in Nigeria?

‘Community health –care workers know the traditions, cultures and practices of their communities, making them indispensable especially during an outbreak of emergencies’ (WHO).

With the reduction in the number of doctors in Nigeria today, it is high time the health ministry makes use of ad hoc staff to fill in the gap in suitable aspects of primary care provision.

In many developed countries of the world who can boast of a good number of primary health care centers per geographical area/population, they still make use of physician associates, health visitors, advanced nurse practitioners, pharmacist independent prescribers, nurse advisors, and health care assistants etc to fill in the gap.

In Nigeria we do not have enough medical practitioners per population or geographical area. This is the time to train and retrain more community health care workers to help in managing long term conditions, reduction in childhood illnesses due to lack of immunization.

Trained birth attendants will also help reduce maternal mortality and community nursing care will reduce infant mortality.

Studies have been conducted in some developing countries and there is enormous evidence to portray the importance of integrating lay health workers in primary health care force.

I believe this is a step in the right direction if we must provide universal health coverage in Nigeria. 

The systematic integration of community health workers at a large scale could be an effective and a rapidly implementable approach to the current primary care workload crisis we have in Nigeria.

I feel there is a sense of urgency for this; and I’m calling on all stakeholders to work together towards achieving UHC in Nigeria.

Reference: [World Health Day, WHO]

KAIOS Technologies is a startup on a mission to  bridge the digital divide by connecting the next billion non consumers who are at the base of the pyramid and not served by the current telco players without access to internet in emerging countries.

In developing countries such as in Africa, internet infrastructure is not available to millions across the continent and where it exists in some parts due to corruption, it costs a lot which makes it unaffordable for many. 

Google’s  Project Loon was conceived to fix this friction in emerging markets while Facebook launched it’s Internet Access Free Basic programme to provide accessibility to basic internet across Africa. These initiatives have still not made internet consumption a basic affordable commodity, which will help to provide the opportunities that will empower Africa’s young generation to unlock their potentials for prosperity.

KAIOS believes that it’s emerging operating system for smart feature phones will redesign the mobile communications market focused on the lower income consumers with more than devices running on it’s platform already shipped in Canada, USA, Asia, Europe and other parts of the world. Devices which run on it’s Operating System requires limited memory and still offers a rich user experience with access to apps like Google Assistant, Whats App, Youtube, Facebook, Google Maps and Twitter.

KAIOS brings apps, Wi-Fi, GPS and other advanced features to non touch smartphones and has established partnerships with leading Original Device Manufacturers/Original Equipment Manufacturers and carriers such as AT&T, Sprint, T-Mobile, Reliance Jio, HMD Global, Micromax, Doro, Bullit, Maxcom, MTN which launched it’s feature phone powered by KAIOS this year in Nigeria, Africa’s largest market, Orange and China Mobile and plans to be embedded in over 150million devices globally before the end of 2019.

Recently, while walking through Divine Estate, Amuwo Odofin, Lagos, I observed the parking lot of a private school in that vicinity. I counted about seven buses parked within the compound. These buses were parked because the school is currently on vacation (3^rd term holiday). As a typical Igbo Man, I began to calculate how much revenue those buses could have been generating if they were deployed on the roads during this holiday.

Recall, the holidays started July 12^th, 2019 and most schools will reopen 9^th September, 2019. This means we are talking about 60 days (approx.2 months) with those buses being idle. Apart from the holidays, weekends and public holidays, those school buses are also idle generating zero revenue. Come to think of it, we are talking of some brand new Toyota Hiace buses with market value of between N18 million and N22 million sitting idly for 60 days. Some of them that were bought fairly used may have market value of between N5 million and N10 million.

I reflected on the reasons why most private schools choose to own school buses and the reasons include:

1. To ease the transportation problem of their pupils who probably come from far distances.
2. To advertise the school within the vicinity of the school’s target market.
3. To ensure the safe delivery of the pupils to their parents by a system they can trust and have control over.
4. Most parents specifically request for this service as they do not have the luxury of time to do such school runs.
5. This is a means of revenue generation for most schools when managed properly.

However, on a Facebook group of school owners, many of the school owners complained bitterly about managing their own school buses. These are some comments from them:

“Maintaining a school bus is a headache on its own…”- I.O

 “I have parked mine for the past two years. Am healthier. Drivers and mechanics were my major headache. I told myself I was too young to come down with high blood pressure.”… E.O

 “It swallows up the school finances. You end up spending school fees to fuel the car.”…R.B.J

 Other observations from the comments include:

1. The school bus drivers colluding with mechanics to inflate cost of maintaining the vehicles.
2. Parents complaints of poor service by either the bus drivers or late arrival of the drivers.
3. Multiple taxations from local government revenue collectors, etc
4. Excessive cost of fuelling the vehicle which ends up not adding up when compared to the revenue generated
5. Parents’ resistance to pay new rates that incorporate the high cost of running the school bus.

Since these schools are not transport companies, I make a case for them to outsource these buses. Transport tech startups can fix this market friction. For one thing, these schools already have the buses. The major thing they require is a system to effectively manage these buses and generate more revenue from these buses. Instead of allowing these buses lie idly during the holidays and weekends, they can be aggregated to be used for school runs during the school hours (peak period) and holidays and weekends (off-peak period).

Instead of having more than ten different schools buses deployed to Ago Palace way for instance, you can have say 5 buses dropping off students at each of the partner school during the peak period. The transport tech company can track the movement of all its buses and know where to quickly deploy more buses especially during the peak period (6:30am -8:30am). The same pattern will definitely happen during the closing period (2:00pm-4pm). During the off-peak period in between,the buses can be utilized intra-city so that it would be easily available for the school closing time. Holidays and weekends afford the buses the opportunity to be used both inter-city and intra-city for transportation.

One of the issues that any startup desiring to go into this niche market should put as top priority is the safety of the children onboard the buses. It should be able to design a tracking system whereby these buses safely deliver the children to their parents. With the rising cases of kidnapping in our society today, such tech startups should be able to assure both parents and the schools that the safety of the children is assured.

Most times when I pass through Doyin bus-stop, Iganmu-Orile around 7:30am to 8:00am on weekdays, I see a good number of pupils trying to board tricycles (keke) to their various schools. The same situation plays out on Babs Animashaun Road by Gate. This makes me to wonder why Zido(the Keke aggregator) is not keying into this opportunity. Its aggregated tricycles could work with private and public school authorities to pick and drop these pupils to and fro school. At the rate of N200 (N50 per passenger), they could do 10 trips between 6:30am and 9:00am and the same average between 2pm and 4pm (closing time). This can generate N4000 per tricycle within the school rush period on such routes as Doyin to Masha, Doyin to Shiita, Doyin to Eric Moore, Gate to Shiita, Gate to Eric Moore,etc. The revenue generated could be more if the parents choose the option of having their children dropped at home rather than the bus-stop.

As the new school year begins in few weeks time, I believe that transport tech companies can explore the market opportunities of transporting schoolchildren across our major cities with their securities assured and revenue generated for both school and the companies.

PS: Names have been abbreviated to hide the identity of the commenters.