HEALTHCARE MANAGEMENT C O N F E R E N C E Public 2 0 1 6 Private Partnership in Health Nigeria Creating New Quality & Efficiency Frontiers and Reversing Medical Tourism VOLUME 14
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His Excellency, Muhammadu Buhari, GCFR giving oral polio vaccine (OPV) to his grand-daughter to mark
One Year without Polio in Nigeria
Sustain the Wind of Change! NPHCDA
FEDERAL MINISTRY OF HEATH
TURNKEY MEDICAL EQUIPMENT SERVICES
30 Raymond Njoku Street, O Awolowo Road S/W Ikoyi, Lagos, Nigeria E: customerservice@jnciltd.com T: +234(0) 1 463 0227 Customer Service: +234(0) 810 100 0020, +234(0) 810 100 0030
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WINNING IN THE NEW REALITIES
Medical Tourism: ...a sunrise industry.
24
The Future is Us
28
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We are trailblazer in the world of clinical laboratory automation Please contact us today and we will Automate your Clinical Laboratory
DCL LABORATORY PRODUCTS LTD. HEAD OFFICE: DCL Laboratory Products Ltd, DCL House, Plot 1299, Fumilayo Ransome Kuti Road, Area 3, Garki, Abuja. P.M.B 690 Garki, Abuja, Nigeria. T+234-929-036-70, +234-803-265-8433, Fax: +234-909-999-5259, e-mail:info@dcllabx.com, Url: www.dcllabx.com, FOREIGN ASSOCIATES.
The Big
Question
As Public Private Partnership
The Strategic and Economic aspects of PPPs in Health.
PPPs in the context of Primary Healthcare and SDGs
32 36 38 44
Financing Nigeria Health System Adopting an integrated approach
e Power of Partnership & Collaborations
The Economics of Medical Tourism
Strategic Opportunities in Nigeria for Medical Tourism.
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DEVELOPING MEDICAL TOURISM
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LESSONS FROM
Dubai
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ABOUT DCL DCL Laboratory Products Ltd is a national leading provider of Medical laboratory equipment, instruments and consumables to major hospitals, clinics and research centers. We have over 74 full-time employees with branches in Abuja, Lagos , Benin, Port Harcourt, Ghana and a Liaison ofďŹ ce in Dallas, Texas. OUR AREAS OF SPECIALIZATION INCLUDE: Clinical Chemistry Immunology Hematology Blood transfusion Microbiology Molecular Biology/PCR IVF(PGD) Histopathology Immunohistochemistry. We have strategic alliances with world industry leaders, such as ElitechGroup(Holland), Eschweiler(Germany), Haemotec(USA), Becton Dickinson (USA) Fioccetti (Italy), Slee(Germany), BlueGnorme(UK,) Illumina(USA), Adaltis(Italy), Giesse(Italy), APDIA(Belgium), Bosch(USA),MPBiomedical, Sherwood(UK), Convergy(Germany), Optima Inc(Japan), Medax(Italy), Erma Inc(Japan), Nichiryo(Japan), Kyowa(Japan), Baur(Germany), Kern(Germany)...etc. Visit us at www.dcllabx.com
@rovahmr www.facebook.com/rovahealthmgt www.linkedin.com/in/rovahmr
EDITOR IN CHIEF Emmanuel C. Abolo SENIOR EDITORS Godwin Odemijie Moji Makanjuola INTERNATIONAL AFFAIRS BUREAU CHIEF Vicky Akai Dare DIRECTOR - EDITORIAL OFFICE Nkechi D. Abolo STAFF GRAPHIC DESIGNER James David Chinedu Iroegbulam SCRIPT EDITOR Tinuke Obikoya RCHE FACULTY ADVISORS Prof. Rowland Ndoma-Egba Prof. Femi Adebanjo Prof. Okey Mbonu Dr. Ibrahim Wada Dr. Emmanuel C. Abolo (Jnr) Dr. A Dutse Dr. Kabiru Mustapha Barr. Charles Okei Mr. Fidel Anyanna CONFERENCE CONSULTANT Oluwakemi Lawanson
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“You have to learn the rules of the game and then you have to play better than anyone else.� --Albert Einstein
WORKING PARTNERS
The following organisations have demonstrated their commitment to health in Africa by supporting this publication.
Health In Africa Initiative
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Moji Makanjuola
Conference Coordinators and Conversation Oluwakemi Lawanson
Lead
Azuikpe E. Ogbonna Healthcare Management Review PAGE Volume 14
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EA
LTHCAR
An annual meeting for those who do business, create opportunities and drive change in the world of healthcare. A two - day transformational experience for healthcare leaders and investors looking to achieve extra ordinary results. A platform for ideas and trends that are shaping the future of healthcare business.
E
H
HEALTHCARE MANAGEMENT CONFERENCE
A Transformatonal experience for results-focused healthcare leaders and investors Winning in the new Realities
The DNA of Healthcare PPPs & Transaction Dynamics
Medical Tourism Breakfast Meeting
Financing and Investment Forum
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Public Private Partnership in Health Nigeria
HEALTHCARE MANAGEMENT CONFERENCE 2016
Creating New Quality & Efficiency Frontiers and Reversing Medical Tourism
needs of those who do business, create opportunities and drive change in the world of healthcare. The Health Management conference provides the platform for evolution of innovative ideas, and trends that are shaping the future of the healthcare business space. It is worthy of note to state that, we have recorded wide acclaimed success stories from beneficiaries both nationally and internationally.
EMMANUEL C. ABOLO Dean - Rova College of Healthcare Executives
T
he Healthcare Management Conference is a vision of ROVA College of Healthcare Executives birthed out of its committed management leadership to avail healthcare leaders and investors a forum for transformational experience by those seeking to achieve extraordinary results and compete at the winning st edge of the current 21 century global health initiatives and innovations. The conference is an annual event that attracts participants from all and sundry in the health sector with carefully chosen themes to meet the
This year, 2016, the conference is themed ; PublicPrivate Partnership(PPP) in Health Nigeria and it is designed as a strategic meeting between healthcare stakeholders, policy makers, finance institutions and investors, to explore how the capital and operational structures provided by PPPs can be leveraged more broadly in healthcare to address government demand for efficiency and customer's quest for quality services with a particular focus on reversing Medical Tourism. I expect us to be inspired by the stimulating interactive discussions and debates through all the sessions with all the wide span of invited healthcare business strategy and financing experts. Hopefully, our experience in this conference will be truly rewarding professionally, intellectually, and personally to expand our healthcare business space in Nigeria . Healthcare Management Review PAGE Volume 14
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EXECUTIVE
SUMMARY
I
n recent times, the Federal Government of Nigeria stepped up its commitment to infrastructural development with the aim of improving the socio-economic status of the nation. The Health sector, through the Federal Ministry of Health has taken a queue from this initiative, using the Public - Private Partnership (PPP) platform as an entry point in line with the National policy on PPP. The main objective is to improve the quality of health care delivery and efficiency of care services accorded to the populace in view of preparing the Nation for the full roll out of the Universal Health Coverage under the National Health Insurance Scheme (NHIS). It is against this backdrop of firm commitment, that the 2016 Rova College of Healthcare Executives Annual Health Management Conference themed “PPPs in Health Nigeria” - Creating new quality & efficiency frontiers and reversing medical tourism was organised, to reinforce the unequalled value of PPPs in Health care and intensify advocacy to expand its scope while providing a central networking platform for more potential PPP ventures in Health care to evolve and thrive in Nigeria. The conference was organised in collaboration with the Federal Ministry of Health, Infrastructure Concession Regulatory Commission (ICRC), NISA Premier Hospital and International Finance Corporation (IFC)as working partners. It provided a platform for strategic meetings between Healthcare stakeholders, Policy makers and Investors with a bid to exploring how the capital and operational structure provided by PPPs can be leveraged more broadly in healthcare to address government demand for efficiency and customer's quest for quality services particularly to reverse Medical Tourism. A two days discussion with experts, couple with experience sharing and critical insights from institutions and organizations already engaged or trying to engage in PPPs in Health reveal the following, which when addressed will help negotiate tough choices that often accompany PPPs in Health and manage the politics, external and internal influences and alliances. Healthcare Management Review PAGE Volume 14
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CHALLENGES OF PPP IN NIGERIA HEALTH SECTOR 1.
Regular “Strike Action” / Civil Strife Circumstances
2.
Issues of appropriate ethics and poor referral systems/ process
3.
Inadequate Skills sets/capacity building of the Medical Team
4.
Poor Attitude of some key public officers
5.
Poor Understanding of Healthcare Business
6.
Absence of Risk sharing Policy; e.g Monthly debt repayment shortfalls.
7.
Protection of professional turfs.
8.
Encouraging pro-poor programme. The private sector have always had to bear this cost alone which infringes on their net profit
SUCCESS FACTORS FOR PPP IN HEALTH CARE TO THRIVE IN NIGERIA 1. A clear understanding of the transaction dynamics to avoid complication of funds management. 2. Capacity building of key players is Critical to ensure WIN-WIN – first, build skillsets in General Business Management (Finance, Legal, Administration, PPP Unit set-up) for both parties. This is a major priority success factor. 3. Preparation and clear goal setting/objectives of the PPP venture by both parties 4. Patient-Centricity. 5. Welfare component for the staff to be agreed by both parties. 6. Increased accountability on the part of the public institutions. 7. There is need to increase the knowledge of the human resources on Change Management. 8. There should be flexibility for Term Renegotiation: Tenure/Upgrade etc. as inevitable circumstances change per time. 9. Regular re-appraisal of outcomes & impact to generate lessons learnt for future improvement in service delivery processes. 10. Reduction of bidding and concessioning fees. 11. Government should be willing to serve as guarantor for long term loans to boast quality development of modern equipment for effective services and health insurance should be tied to community heath insurance of NHIS. 12. Transparency during out sourcing. 13. Universal Health Coverage (UHC) is critical factor in sustainable finance of the Nigerian Health System and improving coverage will greatly improve private sector confidence and participation in PPP programme. It will also sort out the challenge of off takers in PPPs especially if backed by a policy statement.
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KEY RECOMMENDATIONS FOR PPP IN HEALTH NIGERIA Making PPP's work in Healthcare 1.
There is need for continuous engagement and more advocacy for PPPs in Health Nigeria to bridge the knowledge gap and build technical capacity.
2.
Change management is a key area that must be addressed in ensuring successful PPPs in Healthcare.
3.
ICRC to respond to FMOH on the new simplified PPP guidelines submitted to take it to the next level of approval and adoption.
4.
PPP's in healthcare must be assessed differently from other industries; focus must not be on only infrastructure but must also be on improving our national health indices and outcomes/service provision.
5.
In the light of cost considerations, there is need to develop template model outline for PPP Business cases in the sector in various service delivery areas e.g. Diagnostics, Hospital building projects, staffing, service delivery management etc. These templates can be approved by the Federal Executive Council (FEC) and then adapted based on individual projects.
6.
FMOH to convene and facilitate a meeting with all identified stakeholders to discuss roles and responsibilities of each party in ensuring a successful PPP project.
7.
The prompt Circulation & Adoption of the newly developed guidelines on Incentivising Healthcare Investments in Nigeria, developed in collaboration with NIPC, FMOH, IFC, HFN and other stakeholders in Health, (Noted NCH, March 2016).
8.
Garki Hospital PPP pilot programme should be studied, modified and replicated nationally as evidence by its success story.
9.
To bridge the funding gap, the Primary Healthcare system drivers should accelerate its repositioning strategy to attract PPP programme inline with the ICRC act of 2005 and National Policy on PPP.
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REVERSING MEDICAL TOURISM
“Medical Tourism is a sunrise industry and Nigeria should take advantage of the opportunities it presents.” Key issues for consideration. Glocalization:
Ÿ
I
Tapping into the new trends of International hospital brands establishing in developing economies and increasing the healthcare business space.
ii
Encouraging Local and International partnerships and collaborations.
iii
Hospital to hospital partnership and group practice.
Value Innovation:
Ÿ
I
Applying the economics of scale and operational efficiency.
ii
Adopting the hybrid strategy by creating pro-poor programmes.
The quality imperative:
Ÿ
I
Leverage on the growing interdependence to deliver quality and sustainable healthcare service.
ii
Seek International accreditation.
Adopting an integrated approach to promoting Medical Tourism:
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I
Developing a thriving Medical Tourism Sector takes a deliberate, conscious and multisectorial effort, as evidenced by the UAE Medical Tourism programme.
ii
Understanding the experience of other countries and contextualising the concept for Nigeria to develop a thriving Medical Tourism Sector.
Medical Practice and Hospital Advertisement.
Ÿ
I
A review of the Medical/Hospital Advertisement Laws to enable hospitals & medical st practice effectively deploy the versatile 21 century platforms such as enhanced organisational website to deliver customer & service information. Healthcare Management Review PAGE Volume 14
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WINNING IN THE NEW REALITIES
PROF. ISAAC ADEWOLE HON. MINISTER OF HEALTH, FEDERAL MINISTRY OF HELATH Healthcare Management Review PAGE Volume 14
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“
I wish to draw our attention to the fact that the health sector PPPs is different from other sectors. Hence Healthcare PPPs are complex and should be given serious consideration of applicability. They must be carefully designed to meet short term health delivery needs and meet the country's specic health needs.
”
“
Provision of healthcare is widely recognized as government's responsibility. However, across the globe, private capital and expertise is being used to ease scal constraints and improve efciency.
Competing infrastructure and public service need make it imperative to nd new nancing and healthcare delivery models. The changing nature of healthcare also places importance on improving operations and maintenance, as well as adaptability of infrastructure.
PPPs in health are considered a cornerstone in accelerating healthcare infrastructure development and the delivery of quality, accessible and affordable healthcare. It is a new approach to an old problem.
”
Hospitals and healthcare infrastructure represents only a small part of what keeps people healthy. Investments need to shift from assets to efcient operations as efciency gains are mostly in service delivery and not buildings. We have to ensure that the process ensures that the sources of value generation are addressed and maximized in structuring a partnership. The private sector must understand that engagement is not just for prot. A pro-poor orientation, quality assurance, research, and development, specically against disease should be the main anchor.
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Dr. Amina M. B. Shamaki, mni Permanent Secretary FMoH.
To exploit this opportunity, the Federal Ministry of Health is taking a holistic approach and encouraging new initiatives, among these are; The Ministry is embarking on rehabilitation of our Federal Tertiary Health institutions to attain world class standard. Some of these Federal Tertiary Health Institutions will be designated Centres of Excellence. Example: In Cardio-Vascular diseases (UNTH, UCH) In Kidney transplant (OAUTH) Regenerative medicine (UBTH), etc. Healthcare Management Review PAGE Volume 14
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Medical Tourism: ...a sunrise industry.
“
Medical tourism is a big business and Nigeria will do everything possible to exploit the opportunities it presents to generate revenue, improve healthcare, create job opportunities and expertise.
”
An example of such initiative embarked by the Federal Ministry of Health include v w
The PPP conceptualization of the Abuja Medical City: This is projected to provide a One stop platform for indigenous and Diaspora health professionals to provide critical and high quality specialist services to Nigerians.
As the oil prices are falling and budgetary allocation dwindling: v It is hoped that reversing medical tourism and making Nigeria the hub of medical tourism would result in a diversified economy v There is need to engage private partners to deliver public benefits v This will mobilize private sector expertise and funds to provide effective and efficient services v The Public Private Partnerships will bridge infrastructure gap and services
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Healthcare PPPs score card
“
The PPP Unit of the Federal Ministry of Health has continued to receive proposals for PPP projects from the various stakeholders in Health.
Listed below is an update on the PPP projects of
”
the Federal Ministry of Health.
1. Ware House in a Box project- The PPP project is to procure a management team to manage the ware house- Bids for Transaction Advisory services have been evaluated and scored. Terms of Reference has been developed for the Phase one of the Transaction Advisory services. 2. Construction of Staff Housing Estate and Shopping Complex and Construction of new House Ofcer's Quarters for the University of Port Harcourt Teaching Hospital. – The Expression of Interest for Transaction Advisory services has been advertised in national dailies. The next step is for the PDT to sit to develop Terms of Reference.
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Dr. O. R. Olowu, mni Head: PPP/Diaspora Unit FMoH
3. LUTH Center for Advanced Medicine -- an ultramodern diagnostic and treatment center at LUTH based on the partnership between Nigeria Sovereign Investment Authority and Federal Ministry of Health – The project is at the stage of procurement of Transaction Advisory services through World Bank funding. 4. Construction of maternity complex and modern amenity ward at the University of Calabar Teaching Hospital -- The PDT is yet to be inaugurated 5. Abuja Medical City –PDT inaugurated and met several times. Presently, at the process of consideration of study tour to Dubai for express sharing. The Rehabilitation of the third phase of the Teaching Hospitals by VAMED is currently under PPP. PDT yet to be inaugurated. Healthcare Management Review PAGE Volume 14
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What is our vision for the future, and our understanding of the present?
PPP in Health is designing the future ...the future of health systems ...the future of leadership ...the future of relationships ...the future awaits our choices
The future belongs to hospitals and healthcare executives who engage in …bold innovative and creative thinking, …new business models, …new arrangements and relationships. Healthcare Management Review PAGE Volume 14
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PPPs provides new strategic opportunities to add value to existing healthcare delivery systems in Nigeria
Emmanuel C. Abolo
Dean - Rova College of Healthcare Executives Healthcare Management Review PAGE Volume 14
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e future is no longer the prolongation of the past. How do we manage the changing landscape of how healthcare is delivered?
Is the current business model robust enough to survive and thrive for a genera on or longer?
How do you enable the current system architecture to deliver value to our customers within a dynamic adap ve complex system?
What are the ineďŹƒciency spots?
This is a crucial time for private investment in healthcare, ...a time to be creative and go beyond reactive problem solving
...a time to recalibrate the economics of healthcare.
What will be the new healthcare industrial map?
Which old way will give way for the new order to survive?
...a time to draw energy from dreams or vision of what people really want to see.
...a time for new possibilities,
...a time for collective ambition, Healthcare Management Review PAGE Volume 14
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“It is clear that we are not living in the past anymore, but we have not yet started to live in the future. We are stuck between two paradigms. The old model does not fit anymore, but the new one isn’t available yet”.
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Question
The Big
How can the health sector be revamped and become attractive for big players in the private sector? What steps should be taken to halt the brain-drain in the health sector and attract Nigerian physicians in the Diaspora back home?
“
It is worthy to note that “No government in the world has enough resources to deliver its health objectives to its citizens because as developments in research and technology makes health care more expensive, it has become the only reasonable option that governments should partner with the private sector to be able to fund the health needs of the population.
”
In Nigeria, concerns on the quality and financing of health-care delivery especially in the public sector have initiated reforms including support for publicprivate partnerships (PPP) at both the Federal and State Levels.
already thriving at the Lagos State University Teaching Hospital and National Orthopedic Hospital, Igbobi, both in Lagos, Nigeria. Also this arrangement have received significant progress at the Garki Hospital, Abuja.
PPP refers to the establishment of on-going relationship between public and private actors; so far, evidence supports such interventions in all aspects of the economy and it has been shown to have a positive impact on health-care delivery in areas where it is practiced. Already the private sector plays a significant role in delivery of health services in Nigeria, serving both urban/rural as well as the rich and poor.
Experts and key stakeholders in health sector have observed that Nigeria could record phenomenal improvement in healthcare deliver y and a corresponding rise in the country's economy if a suitable climate is created for private, public partnerships.
Though there is no conclusive evidence that private sector offer significant price variation, they are preferred because of responsiveness to consumer preferences and accessibility. Interestingly, some PPP initiatives domiciled in public health institutions are
Although the stakeholders are of the view that the government has a critical role to play in creating a suitable template for such partnerships, they are not leaving it to them alone. Consequently, they have decided to ride on existing platforms as created by already existing policies that suppor t such partnerships to advance moves in that direction. Healthcare Management Review PAGE Volume 14
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Dr. Kayode OBEMBE PRESIDENT, NIGERIA MEDICAL ASSOCIATION
The Stand of the NMA on PPP in Health and our commitment towards reversing medical tourism in Nigeria includes: 1.
To ensure effective management of the IGR and other finances of our health sector.
2. To reduce financial recklessness as being experienced in some health facilities. 3. To Promote professionalism and reduce quackery in the pursuit of effective healthcare delivery. 4. To create a system that will easily evade the conventional regulations of some irregular statutory professional bodies that create bottlenecks in the running of health facilities. 5. To create an environment where private clinical services in government owned hospitals and state hospitals become more effective and where the patients are not short changed. “The NMA is glad to know that what the Federal and State governments have been discussing and have previously approved is to bring in PPP in Health to some aspects of hospital operations in Nigeria: drugs and commodities services; radiology and laboratory services; catering services for staff and patients; sanitation and environmental services; security; and mortuary services.”
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As Public Private Partnership Pharm. (Dr.)
Otakho Daniel Orumwense FPSN, FPC Pharm, Deputy President (south) PSN
T
he hospital based Drug Revolving Fund (DRF) as currently operated is already a functional PPP at work in most hospitals especially in the Federal Health Institutions (FHIs) and in some States of the Federation such as Delta, Ekiti, Kano, Niger etc, where DRF is in a huge success. Some FHIs have also made huge successes from the DRF. Such institutions include National Orthopedic Hospital Igbobi Lagos (NOHI), Neuropsychiatric hospital Aro- Abeokuta, UCH Ibadan, OAUTH Ile- Ife etc. With the introduction of the DRF our healthcare system once again gained respect and grew in stature, patients returned to public hospitals for attention and care, medicines were now more affordable, safer and made available to everyone. The populace began to patronize public hospitals which were once referred to as mere consulting clinics as at st 31 December 1983. Apart from the Federal Government, State Governments and LGAs also embraced the scheme. Many private hospitals that have functional Pharmacies and resident Pharmacists have also keyed in to the DRF and are benefiting. They have also recorded a lot of positive outcomes. In the early days of DRFs and indeed in centres where there is little or no interference, huge successes have been recorded. National Orthopaedic Hospital, Igbobi, Lagos (NOHI) is an example of such success; Delta State DRF is another success story. DRF as a quasi-business organisation was established to ensure uninterrupted supply of medicines, medical consumables and allied materials to the health facilities. I believe the DRF generally has not failed so
far. In order to strengthen the DRF, enhance productivity and performances, what we require are the following: 1.
Change of attitude by the hospital authorities.
2.
Strict adherence to the rules and guidelines of the DRF as provided for in the DRF guidelines and the National Drug policy of 2005.
3.
Less or non-interference in the running of the DRF.
4.
Prompt payment to suppliers and vendors.
5.
Strict adherence to the provisions of the newly introduced National Drug Distribution Guideline (NDDG). It provides that suppliers must be paid within a period of thirty days. This must be strictly adhered to by the hospitals. This, if fully implemented has the capacity to serve as a catalyst to transform the Pharmaceutical sector and the health care services thus ensuring a better and healthier nation.
6.
Institution of effective internal control mechanisms to check fraudulent operations in the DRF especially regular scheduled and unscheduled auditing of the DRF.
7.
Payment of DRF incentives (15% of Basic Salaries) as contained in the DRF guideline to motivate and to boost the morale of the Healthcare Management Review PAGE Volume 14
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“
For organisations that are desirous of engaging in PPP in public hospitals,
the PCN has produced and published relevant guidelines. Let it be known
in clear terms that only organisations that are ready and are willing to play
by those rules genuinely will be accommodated and chucked out as soon
”
they are observed to be in breach of any part of the guideline.
motivate and to boost the morale of the operators. 8.
Enforcement of the provisions of the DRF guidelines by relevant arm of the Ministry of Health and Ministry of Finance.
9.
Sanctions for organisations that violate the guidelines of the DRF.
10.
DRF can be expanded to provide services that will include some form of manufacturing of some medicines.
11.
Distribution of medicines to communities, community Pharmacies etc as contained in the Bamako Initiative Programme.
12.
Hospital pharmacies can be a centre for vaccine storage and storage.
13.
Public hospitals within the same zone can form alliances and or partnerships to enjoy large quantity purchase in order to enjoy higher discounts on economies of scale.
14.
Government should criminalise diversion of funds from DRF.
15.
Manufacturing companies should begin to re-package their products for hospital dispensing for many of their products. This will bring down the cost of medicines. (Multiple dose packages).
SUGGESTED AREAS OF PPP IN HOSPITAL PHARMACY. 1. Establishment of small and medium scale manufacturing factories. This can be done on zonal bases across the six geopolitical zones in Nigeria. 2. Quality control laboratories can also be established. The quality control laboratories will serve as quality checking concerns. Fees will be charged for services rendered. Private Pharmacies and allied organisations can benefit from this arrangement as well. These inclusions will no doubt help to improve on the quality of medicines and consumables. It will also enhance revenue generation as such services can be made available to private practitioners for a fee. It will also help to prevent some of the capital flight currently being experienced in Nigeria. It will help to improve on the quality of training available for undergraduate and graduate pharmacy students thereby improving skills and competencies of the Nigerian Pharmacists. A well run DRF has capacity to improve the overall quality of life for Nigerians. Healthcare Management Review PAGE Volume 14
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“
PPP is not synonymous to outright privatisation, commercialization or outsourcing. The belief of the AMLS of Nigeria is that all stakeholders should contribute to the success of the health sector. The Association is committed to the development of the health care delivery in Nigeria and his doing its best in maintaining a high standard of laboratory practices among its members and ensuring that quality service delivery is obtainable in the health facilities nationwide.
”
Alhaji Toyosi Y. Raheem, The National president of the Association of Medical Laboratory Scientists of Nigeria,
“
The Nigerian Association of Nurses and Midwifes is committed to the Association to the outcomes of the PPPs in health conference and pledge their continuous support to the development of the healthcare of Nigerians. We remain open to innovations and ideas that will improve the association and healthcare delivery generally in Nigeria.
”
Mr. Abdullahi D Yahaya, The representative of the Nigerian Association of Nurses and Midwifes
“
The Ministry of Environment is poised to take up roles in relation to their mandate to improve healthcare outcomes in Nigeria and minimize outbound medical tourism. This will be achieved by pursuit of sound environmental quality and aesthetics especially assisting the Health industry in addressing issues of healthcare waste management and general sanitization and hygiene practices.
Mr. Dominic Aboyi
”
Registrar, Environmental Health Officer Registration Council of Nigeria, Representative of the Honorable Minister of Environment
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We are trailblazer in the world of clinical laboratory automation Please contact us today and we will Automate your Clinical Laboratory
DCL LABORATORY PRODUCTS LTD. HEAD OFFICE: DCL Laboratory Products Ltd, DCL House, Plot 1299, Fumilayo Ransome Kuti Road, Area 3, Garki, Abuja. P.M.B 690 Garki, Abuja, Nigeria. T+234-929-036-70, +234-803-265-8433, Fax: +234-909-999-5259, e-mail:info@dcllabx.com, Url: www.dcllabx.com, FOREIGN ASSOCIATES.
The Strategic and Economic aspects of PPPs in Health.
Dr. Ibrahim Wada, OON, Executive Vice Chairman NISA Medical Group
“The Garki PPP demonstrates a sustainable alternative of financing public hospitals and ensuring accessible and reasonably affordable healthcare”.
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Case Study: Garki Hospital Experience
Garki pilot program needs to be studied, modiďŹ ed and replicated in the FCT as well as nationally. Health care PPP should be tied to community health insurance of the NHIS.
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“The Garki Hospital experience shows how PPP can transform a Health Institution from an average health facility to a center of excellence.
Dr. E. N. S. Miner
This can be attributed to visionary leadership, excellent management, and judicious use of resources which private investment guarantees as demonstrated by NISA Premier Hospital”.
Group Medical Director Garki - Nisa Premier Hospital Abuja
“Garki Hospital concessioning was the first attempt by government in privatizing a health institution to acheive effective healthcare delivery to the residents of Abuja and its environs. While we are grateful for the opportunity to provide world class health ser vices through the concession, we are burdened by certain legal constraints which has not created the needed incentive to derisk this PPP”.
Nekabari Annah Esq Principal Associate, ANNAH NEKABARI & ASSOCIATES Medical Law Experts and Chartered Negotiator & Mediator
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•The various investments by NISA Premier Hospital has seen Garki Hospital Abuja become a frontrunner in specialized healthcare provider in Nigeria. •This is evidenced by • 43 open heart surgeries; • 12 kidney transplants; • A subsidized IVF program; • State of the art laboratory and radiology unit; • VIP care; • Etc.
PPP & government The introduction of PPP by government across the various sectors is a welcome development. However the laudable objectives of the PPP suffers series of constraints like Legal/Legislative and regulatory constraints Institutional constraints Financial constraints Contract related constraints Capacity constraints Perception constraints
CONSTRAINTS v How the regulatory regime affects the delivery of services to the poor v Competitive disadvantage when compared to public sector providers v High concessioning fee v Absence of a re-negotiation clause in most PPP Agreements
RECOMMENDATIONS v Drastic reduction in bidding and concessioning fee v Serve as guarantor for term loans to boost quality deployment of mordern equipments for effective services delivery Institute a subsidy trust fund to augument the loss suffered by private investors in the treatment of the indigent v Liberalize the billing process so that cost for medical care are driven by market forces v Provide for clear cut re-negotiation clause to care for unforseen circumstances
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The Garki Hospital Abuja Public Private Partnership (PPP) Project Garki Hospital Abuja popularly known as Garki General Hospital, owned by the Federal Capital Territory Administration (FCTA), was established in 1988. Until the PPP in 2007 by the Federal Government, it was closed for full renovation in 2001. The National Health Sector Reform (HSR) policy of 2005 supported and invigorated expanded collaborations between healthcare providers and consumers. PPP is a key strategy in the policy. Thus in 2006 the Federal Executive Council approved the PPP initiative and the Garki Hospital Abuja became the first to be selected for the Government's initiative of running its hospitals through a PPP. The Garki PPP demonstrates a sustainable alternative of financing public hospitals and ensuring accessible and reasonably affordable healthcare. Achieving the clinical development plan would become a viable platform for local and international collaborations. st
Report of 1 five years (2007 – 2012) Setting up of clinical outpatients The foremost urgent activity was the setting up of the clinical outpatient services within the first five years. This was achieved Report of 2nd five years (2012 – 2017) To achieve a super specialist hospital, both local and international collaborations was sought in the development of subspecialties services that have succeeded immensely in accident and emergency, intensive care unit, invitro fertilization and surgical procedures in heart and kidney transplants. Also, within the second phase of clinical developmental plan, accreditation of some training programs was also achieved. Subspecialty services achievements • Open heart surgeries (27) • Kidney transplant (7) • IVF treatments (127) Accreditation of residency programs: • O&G (2013) • Family medicine (2011) • Paediatrics (2014)
Vaccination is Free, Safe & Saves Life! NATIONAL PRIMARY HEALTH CARE DEVELOPMENT AGENCY (NPHCDA) Plot 681/682, Port Harcourt Crescent, Off Gimbiya Street, Area 11, P.M.B. 387, Garki, Abuja. FCT Website: www.nphcda.gov.ng Email: info@nphcda.gov.ng
NPHCDA
FEDERAL MINISTRY OF HEATH
PPPs in the context of Primary Healthcare and SDGs
With the stepping down of support by Global partners due to the rebasing of our GDP, the funding gap have to be met through PPP
Dr. Umar Ibrahim Director of Procurement NPHCDA
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The Strategy is to “Create Innovative Partnerships” to establish and improve the Primary Health Care system in Nigeria to provide an efficient and equitable healthcare for all Nigerians.
At the National Primary Health Care Development Agency (NPHCDA) the PPP unit was created through a restructuring that took place in 2011 under the Executive Director's office and was later moved in 2014 to the Advocacy and Communication Department, Resource Mobilization Division. The Strategy is to “Create Innovative Partnerships” to establish and improve the Primary Health Care system in Nigeria to provide an efficient and equitable healthcare for all Nigerians. The aims of the PPP unit are to: i.
To e s t a b l i s h a n d s u s t a i n partnerships for the purpose of mobilising resources outside existing channels (Nationally and internationally) for all activities in the Agency
ii. To d e t e r m i n e i n t e r a c t i o n opportunities, options and priorities as well as obtain corporate support from the private sector for PHC services iii. To harness all available healthcare resources in the public and private sectors for the attainment of Sustainable Development Goals and other
National Health Policy targets iv. To identify, classify and document stakeholders and advocate for the participation of key role players in mobilising the authorities and public to participate and support PHC services. To address these issues, our Agency therefore aspires to proactively reposition in the promotion of Public Private Partnership in Primary Health Care service delivery in line with the Infrastructure Concession Regulatory Commission – ICRC (Act 2005) and the National Policy on Public Private Partnership. Hitherto the enactment of the ICRC Act 2005 on PPP, in recognition of the importance of Partnerships, the Agency continually collaborates with various international, National Partners and organizations over the years. The NPHCDA since the establishment of the PPP unit has made some strides mostly with training of staff to know the rudiments of PPP and ensure that the process is done right. Although no formal
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OPPORTUNITIES AVAILABLE IN PHC Physical facilities Drug/equipment Cold chain and logistics Power and water supply Human resources for health
agreement has been reached, the Agency is still in the process of developing a business case for PPP in Primary Health Care. Most PPPs are tailored toward secondary and Tertiary healthcare systems, as these are more lucrative fields of healthcare unlike the Primary Healthcare where most of the services provided are either free or subsidized by the Federal Government with just very few services paid for “Out of Pocket”. This has been the major funding process for Primary Health care in Nigeria. This “free policy” translates to healthcare for people of low income and has also led to lower quality and provision of services in most cases and thus has become unattractive for the Private sector to invest in. The question to answer now becomes how do you recoup your investment on a free or Government subsidized service? This is the major challenge the Primary Health Care system is facing coupled with the fact that with the present economic challenge the nation is experiencing shortfall in funding for most of these services are not up to par as was previously.
Solutions therefore need to be provided firstly to improve the quality of services provided by the PHC system and secondly to ensure bankability to the Private Sector that wish to invest so they can receive a good return on their investments into PHC. At the NPHCDA we are constantly looking for solutions on how to ensure primar y healthcare needs of all Nigerians are met no matter their location, level of income, status in the society and at the most affordable price for paid services. Considering the economic status, especially those in the rural areas even what is considered a reasonable price it may be too much for these individuals. Which is why this conference is timely for us at NPHCDA so we can meet and discuss with others in the Public sector and also the Private sector to come up with templates, efforts and ways out for the provision of primary healthcare services in the most efficient and equitable means to all Nigerians while still being profitable for investors.
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Barr. Olubusayo U.C.H Ibadan
Philanthropic: Partnership is a discrete effort with an emphasis on ď€ nancial contributions.
Opportunistic: Partnership is a program or action that brings shortterm gain and may leverage core competencies but in an ad-hoc manner. Healthcare Management Review PAGE Volume 14
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Public Private Partnership in Health
...which Model Works? (United Nation Global Compact)
Strategic: Partnership uses core competencies to develop markets, products and services deliberately, but is often a two-party agreement and set within an existing system.
Transformational: Partnership is a multistekeholder engagement that addresses a systemic issue, leverages core competencies, and has built-in structure to address scale and scope.
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Philanthropic Partnership:
Opportunistic Partnership:
Discrete effort with emphasis on financial contribution.
Short Term Gain / Ad-hoc Leverage on Core Competencies
Chief Tony Anenih Geriatric Center Government Effort: N230,000,000.00 Philanthropic Effort: N100,000,000.00
Wolex-UCH PPP Private Investor For Consumables: N20,000,000.00 UCH Contribution: Zero
Strategic Partnership:
Transformational Partnership: UCH-KDF-Yemetu Alaadorin Community
Utilizes Core Competencies of Investor Develop Market and Products Two Party approach within an existing system Private Investors: Hospital Equipment Manufacturers / Distributors Public Sector: Clientele / Patients to utilize services
Multiple Stakeholders Addresses a Systemic Problem Primary Health Care Center built by KDF in 2011 UCH took over Management in 2011 Community Participation Environmental Enumeration and Documentation of all inhabitants Healthcare Management Review PAGE Volume 14
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Mrs C. Omatseye CEO JNC International
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There is need for a clear understanding of the business case, short-long term needs and choice of the appropriate & sustainable technology- ensuring multiple streams of services and income.
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In light of cost considerations, there is a need to develop template model Outline PPP Business Cases in the sector in various areas e.g. Diagnostics, Hospital build projects etc. These templates can be approved by the Federal Executive Council (FEC) and then adapted based on individual projects.
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There is need to simplify and harmonize current ICRC guidelines for PPPs in Healthcare and also to assess PPP’s in the sector based on social impact rather than only a pure financial matrix.
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Change management is a key area that must be addressed in ensuring successful PPPs in Healthcare.
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“Building Hospitals is the easy part, Operating them is the challenge. Health insurance will not only directly benefit everyone in Dubai but also it will help bring financial stability to the health sector” His Excellency: ESSA AL MAIDOOR Director General; Dubai Health Authority
Sharing
Experience
Ugonna Ogueri Managing Director Crystal Thorpe
e PPP/CO-LOCATION MODEL
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It is not competition but complimentary service.
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...plug gaps not duplication ...no one loses their job Healthcare Management Review PAGE Volume 14
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(University of Abuja Teaching Hospital) - Crystal Thorpe Trauma and Multi-Specialist Centre EX P ERI ENC E
UATH
Crystal Thorpe
Co-location hospital on the site of the teaching hospital
R e t rofi t a n d i n s t a l l m e d i c a l equipment in co-location hospital
Provision of enabling environment for co-location and complementary infrastructure Support referrals to co-location facility Support the processing of permits and authorization
Trauma and MultiSpecialist Center
Fund the retrofit, medical equipment cost and working capital Provision of clinical and nonclinical services Provision of medical Staff local, Diaspora and expatriates
Benefits The Trauma Multi-Specialist Centre will support UATH for training and medical research It will boost IGR for the Teaching Hospital through its share of prots and rental income. The revenues are ring fenced alongside governance. There is income for clinicians on site within acceptable practice. It Provides enabling environment for service delivery.
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Financing Nigeria Health System Adopting an integrated approach
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PPP is simply a procurement strategy in which case you have agreed to partner a public institution. The concept and procedure of PPP needs to be understood well before going into the venture to avoid complications to funds management
�
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Dr. Okunola Olumide IFC: Health in Africa Initiative
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Kenneth Opara General Manager Managed SMEs, Trade Missions & Multilateral Agencies Division Fidelity Bank Plc
FIDELITY BANK STORY IN HEALTHCARE AND PRODUCT OFFERINGS Our Story…..
2007 The year Fidelity Bank pioneered healthcare financing in Nigeria st
st
1
The 1 bank to create dedicated products for the healthcare sector in Nigeria, working with Guild of Medical Directors and the Associa on of Community Pharmacists.
N3.5 The total loan granted by the bank to healthcare related businesses in billion Nigeria to about000 customers. Fidelity Bank Product Offerings
Fidelity Medical Support Scheme (FP-EDSS) Fidelity Pharmacist Support Facility (FPSF) CBN MSME Development Fund (CBN MSMEDF)
Product Highlights
FP-MEDDS Product Designed for Private Medical Doctors to purchase drugs and to acquire hospital equipment's. Tenor is 6months for drugs and up to 48 months for Equipment's. Single Obligor limit for Drug is N3m for Overdraft For Single Obligor on Equipments, customers can access up to N5m
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SME Healthcare Financing In Nigeria The Fidelity Bank Experience
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In our engagement with operators of hospitals and pharmacies, we offer advisory services to enable them develop operational tools for their businesses
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Fidelity Bank Advisory Offerings Clear Organizational Structure Performance Management Framework Budget & Planning Templates Concise Market Denition & Business Strategy Funding Techniques Risk Management Programmes Innovation
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Opeyemi Oke Head Business, Sterling Bank
Emeka R. Ofor Director Investment Facilitation and Incentives Administration Nigerian Investment Promotion Commission (NIPC)
Cutting through the complexities of Legal and Regulatory Framework for PPPs in Health. ...a discussion with ICRC
Mr. Emmanuel Onwodi (DD Head Special Projects, ICRC)
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These training and advisory services can be designed around an Executive education as provided by Rova College of Healthcare Executives with different streams that focus on competency levels.
“Simplicity is the Ultimate Sophistication.� Leonardo da Vinci
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Optimise Collaboration and Creativity
e Power of Partnership & Collaborations
“In todays world, it is almost impossible to do anything alone. This is especially true in our health sector where corrosive poverty abound in the face of rising cost of health care delivery, changing disease patterns and increasing use of sophisticated and advance technology.”
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There is universal recognition that where doctors, pharmacists, nurses and other health professionals work together, mutual respect abound and the patient gets optimal benefits.
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Dr. Prosper Igboeli Chief Medical Director - M&M Hospital
“Healthcare experts are calling on private healthcare providers and hospitals to take up the mantle to spur medical facilities in different specialties to form group practices”. Healthcare Management Review PAGE Volume 14
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M & M Hospital, Abuja is a BeneďŹ ciary of Reverse Medical Tourism,
M&M/US STEM CELL CLINIC PARTNERSHIP Complete Regenerative Medicine Platform
We Have Seen Pa ents From Usa, Canada, Australia, Uk, Eu They Are Sa sďŹ ed With Our Services And Transparency. Their Compliants Are Infrastrures And Security.
Medical tourism generates foreign exchange, reversing brain drain and raises clinical standards of the country.
Delivering Service via Partnership TURNKEY MEDICAL EQUIPMENT SERVICES
Experience Sharing
PPP’S for ‘Quality’ Outcomes Outcomes of the UCH-JNC PPP’s 50 Cardiac Catherisations & stenting 50 Open Heart Surgeries Adult: Coronary Artery Bypass Graft (CABG), multiple Valve replacement, ASD’s Paediatric: Repair of TOF (Tetrall of Fallot) complex surgery 5 Angioplasty’s 20 – Transvenous cases for Heart block NHIS commitment to cover a fixed amount A huge wait-list of >300 patients aged 2 months to 75 years May: 2016 More Open heart surgeries & Cardiac Cath.
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Case Study:
UCH-JNCI Cardiac PPP Toshiba 64 Slice CT ScannerInstalled Jan. 2011; >8,500 Scans done till Feb 2016; 1st in Public Sector
A major constraint in the acquisi on of cri cal medical equipment is Finance – Capex budget is ght; there are compe ng needs; and banks are not readily disposed to financing procurement of healthcare equipment in the Public sector JNCI and UCH successfully collaborated for the acquisi on, installa on and commissioning of a Toshiba 64-slice highdefini on CT Scan machine and accessories This collaboration also extended to the training of suitably qualied UCH personnel. The objective is to upgrade UCH’s diagnostic capabilities & commence the intervention Programme…….. With reaching IMPACT. This was achieved via a strategic alliance of the nature of a Public Private Partnership (“PPP”), between JNC International, a medical equipment solutions company and EXCLUSIVE partner to TOSHIBA, Japan and UCH, Ibadan a foremost tertiary healthcare institution Healthcare Management Review PAGE Volume 14
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Experience Sharing
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PPP provides opportunity for employment and increase Internally Generated Revenue
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Senator Eze Ajoku Chairman Darlez Nig. Ltd
There is a general fear by Hospital staff that PPP will lead to loss of jobs. The approach of a foreign owned Laboratory has strengthened this fear and caused the current resistance to PPP. As an indigenous company, Darlez has proved this to be the contrary. A public Private Partnership should be a team work, a collaborative relationship between the Public and private sector aimed at harnessing (and optimizing the use of) all available resources, knowledge and facilities required to promote efficient, effective, affordable, accessible, equitable and sustainable health care for all people in Nigeria.
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In our two cases of PPP both in Lagos State Universities Teaching Hospital HIV screening lab with Lagos State and Federal Medical Center (Former Federal Staff Hospital) Airport Road where we partner with them to manage all five labs, no staff lost his/her job; rather we pulled our “resources and energies” to strengthen the labs and made each more productive.
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At Philips we strive to make the world healthier and more sustainable through innovation.
Ayodele Kofoworola
We target healthcare customer and consumer needs along the health continuum.
PHILIPS Healthcare
”
The Philips approach is different Providing support
Focused on the patient
Focused on the clinician
Focused on the administrator
- Supporting faster, more confident
- Supporting better patient care - Enabling more focused time with
- Supporting improved quality
patients and more time on disease management - Increasing job satisfaction
- Increasing equipment utilization - Improved revenue cycle - Reducing costs throughout the
diagnosis - Improving patient satisfaction and experience - Increasing comfort and decreasing stress for the patient and family
of care
system Healthcare Management Review PAGE Volume 14
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Medical Equipment Operating Room Equipment & Surgical Instruments
ICU, Neonatology Equipment & Hospital Furniture
Infectious Waste Treatment & Sterilization Systems
Laboratory Equipment & Dialysis Systems
Partnership with Siemens AG Healthcare
Partnership with Varian Medical Systems
Installation, Training, Maintenance & Consumables Engineering, Planning & Consultancy Services Turkey Execution of Projects
Where Creativity and Technology Meet to Tailor Modern Healthcare Solutions
Contact Us Now Address: 20 O ld Wharf Road, Apapa - Lagos. Telephone: +2348 035251436 Email: sales.nigeria@tanitgroup.com Website: www.tanitgroup.com
We are committed to partnerships that will provide quality healthcare delivery in Nigeria Anthony Abou Nader CEO TANIT Medical Engineering Nig. Ltd.
“ “
Banks should make an effort to better understand healthcare. This would help reduce the risk of the transaction (interest) and provide adequate financing packages (Loan term, equity contribution etc).
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The government have a big role to play in enhancing healthcare in the country. However perhaps their most important role is how to incentivize the private sector to increase efcient treatment capacity throughout the country. The starting point for the government in encouraging the involvement of the private sector is to activate initiatives that would create revenue streams enabling investor to secure nancing (National Health act, NHIS, HMOs, Private Insurance etc...)
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When structuring any PPP, investors should accommodate the less fortunate segments of the Nigerian population.
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The Economics of Medical Tourism
Emmanuel C. Abolo Dean - Rova College.
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The traditional Ricardian Model of International trade reveals that “the economics of outbound and inbound medical tourism is based on the advantage of cost, quality and access”.
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We have to find a new way to put the value at the centre of the Nigeria Health system
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Medical Tourism …it’s all about value. …it’s all about value agenda. Healthcare Management Review PAGE Volume 14
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The shifting trends in Medical Tourism Developed Economy Treatment …at developing Economy price
Commodi za on & Convergence “Technology and Medical Know-how has dissolved into emerging markets”
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In a globally Integrated World of information and technology Borders or Boundaries hold no relevance …time and space have collapsed and boundaries are broken.
The free flow of on-line information has opened up the slice gates in terms of choices.
“Global Brands are going into Local Environments”.
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Interna onal partnerships in Canada, Austria, Egypt, Saudi Arabia, United Arab Emirates.
Have you explored opportuni es to aďŹƒliate around the globe?