Dr. Dorothy Jeff-Nnamani is the Managing Director/Chief Executive Officer, Novo Health Africa Limited, is a National Health Maintenance Organisation providing health care across Nigeria and accredited by the National Health Insurance Scheme. In this interview, she highlights measures governments at all levels in the country must take to transform the healthcare sector. Obinna Chima brings the excerpts:
Some have argued that Nigeria’s healthcare sector is on the brink of collapse, what is your own assessment of the sector?
We have been hearing for over 10 years now that the sector is on the brink of collapse. I personally feel it is comatose. Nigeria’s healthcare is underfunded; we don’t have the resources and infrastructure; we don’t have modern medical facilities; we are suffering brain drain; medical tourism, and everything you can think of has gone wrong with the system. We have policies, but are they being implemented? There are some areas that also need serious regulations and of course, laws to be established by the federal government. Luckily, last year, there was hope as the National Health Insurance Bill was signed into law by President Mohammadu Buhari. What that was supposed to do was to drive health insurance. However, there are so many other challenges in terms of infrastructure, skills, poor wages and the doctors are always on strike. So, the sector is comatose, it has collapsed and needs resuscitation.
So, how can these challenges be addressed?
The government needs to be committed to healthcare. The problem is that our governments have not been able to link healthcare to development. If they can appreciate the interdependence of health and development, they would focus more on healthcare. You hear government often talk about poverty alleviation programmes, but if health is not tackled, being an enabler for poverty alleviation, then it will be difficult to achieve poverty alleviation. The poor people are the ones who are always vulnerable to ill-health and when they are ill, they don’t go to the hospital because they the finance and when they don’t go to the hospital, their health deteriorate and when they are at the point of death, they start selling their assets which makes them poorer and as they get poorer, the poverty is being transferred in the family. So, we must look at health from an economic growth point of view, and from a social development point of view. Our population is our assets, but they have to be healthy. It is only a healthy human being that can work and it is only in good health that we are able to work and enjoy life. Imagine the people we lost during the COVID-19 pandemic. So, that appreciation of what health has to play in development would make the government spend the right amount on health. Our budgetary allocation for health is still very poor. Countries such as Togo, Malawi, Rwanda are all meeting the 15 per cent allocation for health that was committed to at the Abuja Declaration, but Nigeria’s highest budgetary allocation to the sector is still around five per cent. So, it is terribly underfunded and government has a heavy role to play in healthcare. Nigeria has a pluralistic health system – the public sector and the private sector. In the public sector we have the local government and the state government, but we ought to have healthcare at the ward levels. If we can have wards for people to vote during elections, why can’t we have a primary healthcare at every ward? We complain about medical tourism; our problem is outbound medical tourism, if we have in-bound medical tourism, we won’t be complaining. People leave America to other countries for healthcare as well. There is nothing wrong with medical tourism, but Nigeria is crying because all we have is outbound. People are travelling out to look for healthcare, mostly because of ailments that cannot be treated in Nigeria. So, we have to do the connectivity between healthcare and poverty alleviation. If we don’t connect it, we won’t be able to appreciate where our problem started. The primary healthcare level that is supposed to take care needs are not available and a simple high blood pressure now deteriorates to kidney failure and if you want to treat kidney disease, there are only two dialysis centres. So, they have to look for money and go to India for treatment. So, the foundation is primary healthcare and we must address it. And when I mean primary healthcare, I am not talking about just building two rooms, which to me is ridiculous. You are treating people in the village and you are behaving as if you are doing them a favour. Health is not a privilege for some few, everybody deserves to get the best treatment to keep them alive. It really bothers me that we are not taking healthcare serious.
What advice do you have for the new health minister on how to transform the sector?
If I am to sit with the new Health Minister, I will tell him that, yes, we know that there are competing needs, but there is something that Nigerians are good at that we have not tapped into, which is philanthropy. We need to tap into philanthropy in health. It is done everywhere in the world. You go to big hospitals in the United States and other developed countries, you will see medical facilities that were sponsored by philanthropists. Nigerians are givers and we need to tap into that to develop our healthcare sector. Today, people are building churches of N100 million or even more and donating to churches and we need to do that for healthcare. How come we don’t have grants? How come there are no such opportunities for research and development? We need Nigerians to take hold of their healthcare; let’s involve Nigerians and give them incentives such as tax break or reduction in their tax. There ought to be a structured way of approaching it. Now for medical mission. I personally don’t like the way we do medical mission in this country and we need to structure it. You can’t just and set up and give people medication and go, because you might end up doing them more harm than good.
If it abroad that you want to do medical mission, you must get clearance and there is a process that needs to be followed. Also, it has to be what the people need. Sometimes, people just want to use medical mission to chase clout. A lot of it is happening in Nigeria, whereby they come, administer whatever medications they want and go and nobody cares how they react to the drugs that were administered on them. So, medical missions in this country needs to be structured. There should be inter-sectoral connectivity between the Humanitarian and Poverty Alleviation ministries. Again, for the diaspora, let’s turn our brain drain to brain gain. We have a number of them outside this country, but they have to incentivised to support Nigeria’s health sector, even from abroad. Technology is driving everything today. Many of them that left this country, their eyes are watching what is happening back home and if they see any move by the minister, they would support him. I was speaking with my colleague recently and she told me that some doctors are now poor. In the past, doctors were never poor. They might not be too rich, but they have always been okay. A doctor could afford to buy a car and they work and enjoy their work. So, why are doctors in Nigeria not enjoying their work? You have to take care of the caregivers so that they can take care of their patients. If you don’t take care of the doctors, they go on strike and people suffer; if you don’t take care of them, there would be sharp practices because they want to make money. Our sector is health insurance and it is difficult. With what is happening in the system, people sort of put health insurance at the back and you are practically begging for people to take up health insurance.
What role is Novo Health Africa playing to addressing some of the challenges in the sector?
Novo Health Africa is a Health Management Organisation. We are in the business of health insurance and you know that health insurance is at the centre of universal health coverage. So, we have a very important role to play in universal health coverage and we are doing it by ensuring that we are bringing more people to that insurance pool. We understand the dilemma of Nigeria, we understand that there is poverty and that many people don’t have disposable income. For you to be taking insurance cover for risks that have not happened and may or may not happen, it is with disposable income and you have to take out that fund from somewhere. Many families cannot even feed and you find out that the insurance sector till today has not been covered. So, what Novo Health Africa is doing is to be at the forefront of that, designing and developing a lot of health financing programmes that can accommodate the people in the formal sector. There are people that want to cover their elders and many HMOs are not covering that, but Novo Africa has such plan.
So, through research, because we are a data-driven and techonology-driven organisation, we are able to develop programmes that can satisfy different organisations, associations, communities or people. Also, in acknowledging that the people who are using our services need better experience to continue improving on their health-seeking behavior, we use technology to improve on our services. Recently, we launched the Novo Apoyo, which was the first in the industry. It has never been done anywhere. Novo Apoyo is to enable our clients have better health experience when they go to the hospitals. It also enables our clients to see themselves as healthcare consumers and with that, they are more involved in decision making about their health. Also, we create awareness. Novo Health Africa is at the forefront of mental health awareness and we do this to make people to be conscious of their psychological and emotional wellbeing. That is because health is the complete social, physical and mental wellbeing of a person. You know that affordable healthcare is one of the criteria of universal health coverage – affordability, efficient and quality. We are also creating awareness to let people know that affordable healthcare does not mean sub-optimal standard of health. Like I said, we design programmes looking at different models of healthcare financing and recently Novo Health Africa was one of the winners of the WiNFUND – the Women in Healthcare Innovation Fund. There was a paper that I wrote about healthcare financing that would ensure that people who are poor. The ceremony was done in Rwanda and we were one of the 50 selected. We are working with them.
Can you tell us more about Novo Apoyo?
One of the monumental headaches we have in health insurance is communication issue and it is a big challenge when people get to the hospital. There is a lot of mistrust in our society and as I said earlier, people don’t pay attention to healthcare. Health is normally the last on the list of preference, but when they fall sick they want heaven to fall down. I also said earlier that we work with data and when we analysed all the complaints, including administrative delays, we thought of how to bridge the gap so that the hospital can concentrate on their core job of diagnosis and treatment. We are a consumer-driven service provider and we want our customers to have good client experience. We are probably the only HMO, but I know that we have a customer service charter, they are five and we believe in it. It is a reflection of our commitment to our customers. So, we looked and it and with the use of technology, we developed the Novo Apoyo. You know in technology, you have the innovation and the transformation and both of them are always done to better a process. So, the enrollees can self-check themselves in when going to the hospital. You don’t need to get there and they start calling your HMO.
Even if they don’t have network, it doesn’t concern you. Also, there are cases of misrepresentation of medical records because people are still using paper to document records and many hospitals do not have the technology to drive their digital process. But with Novo Apoyo, we have your medical records, no matter where you are and your health profile comes up immediately. So, it is empowering to the patient. And for the companies that we are covering, with Novo Apoyo, we have on-time, real time utilisation. So, Novo Apoyo is a game-changer and it is solving a lot of issues, even for the providers. For examples, if we have 20 people standing at the reception waiting to be attended to and they have just one person at the front desk keying everything in, which takes a very long time. Nobody has the luxury of manpower in Nigeria right now because of ‘japa.’ With Novo Apoyo, they all come to the hospital already checked in. All you need to do is to take it and validate. It solves different headaches in the industry and we hope there would be Apoyo 2.0 and probably Apoyo Pro Max.
What other innovations should your customers be expecting from Novo Health Africa?
One thing about a developing economy is that you just have to keep being creative and innovative. You cannot help but to be creative to solve your problem. Every nation is thinking, depending on the challenges they are having. So, we are going to keep being innovative. Today in Nigeria, not up to 20 per cent of the population are covered under health insurance. Health insurance ought to be the first thing in a complicated healthcare system like Nigeria. We want to cover more people and I think people should put health insurance first because you never know what happens next. There would be many more innovations. Like the plan we are developing with the WiNFUND, I hope that by next year, we would roll that out
Finally, what is your advice to the government?
I would say to the government that they need to increase their budgetary allocation to health; they need to invite the diaspora, promote philanthropy in healthcare and they also need to establish the right laws and policies that would guide the healthcare system. A lot of things need to happen in the area of research and development. If the government can do all these, then we have a direction for healthcare.