As part of the debate on health systems in West Africa, WATHI met with Dr Francis Ohanyido, President of the West African Academy of Public Health, to discuss the challenges of health systems in West Africa and specially in Nigeria. In this second part of the interview, we discuss about innovations, start-ups, and the potential influence of Nigeria on the West African Health Organization.

• What innovations can be generalized to make health care cheaper and more accessible in West Africa?

Let me look at this from the essence that innovations generally have the potential to make West Africa to be able to provide quality health care for less money. The answer is of course a resounding ‘yes’.  But I will say so while still pointing out again as I had earlier that all the countries of the region have their peculiarities. However, there are more systemic similarities than differences, and also similar systemic challenges that many innovations will solve.

Technology innovations that are increasingly redefining doctor patient relationships and overall care as mobile penetrance and broadband internet coverage increases across the region. They have made it easier to improve telemedicine and general eHealth.

The use of electronic personal information records for care is helping to increase a paperless care environment. A social medium technology as simple as WhatsApp is roundly used now by physicians for consultations and follow up among many other ways.

The power challenge is very pronounced in Nigeria where it has led to many facilities including primary care centers being unable to provide a desirable 24-hour emergency and routine service delivery

For example, in the area of eye care, many eye specialists in West Africa now look to Forus Health’s inexpensive and portable imaging device that allows them to scan for cataracts and detect eye problems at very little cost.

The rise of financial technology firms and their potential to redefine how we pay for health care and associated services may help bring down cost including how we engage with health insurance and expand coverage in the long run. Innovations around cheaper sources of energy for health facilities can also contribute to how health care cost is viewed and efficiency dimensions improved.

• Can Nigeria lead the way to strengthen West African Health Organization (WAHO)and develop regional health policies? How would it do it?

Nigeria is well-positioned to work with other members of the Economic Community of West African States (ECOWAS) to strengthen WAHO to develop regional policies. It needs to drive a regional policy agenda with WAHO that invests in health as a key asset for regional integration, development and competitiveness, as this will help to reduce economic and social disparities in West Africa and fast-track attainment of UHC.

Such investment outlook should be driven on regional health policies that address a number of different areas such as healthcare infrastructure and sustainable health systems, revitalising primary health care, health information technologies, health coverage, and health financing strategies plus peer review systems. I believe the current WAHO led by Professor Stanley Okolo is forward looking and appreciates the value of broad-based partnership as well as country engagement.

The region has started growing the kind of privately-owned health care systems

Nigeria can also support WAHO through funding to strengthen its evidence to policy processes, so that our health systems are defined by our own experiences. I am a strong advocate for better financing of WAHO so that it can take up stronger regional role of strengthening enabling environment for health and wellbeing of West Africans. The region has had enough time to understand its peculiarities and we have a lot to learn from one another and to develop overarching regional health policies.

However, Nigeria needs to also lead by example by ensuring that it ramps up its domestic resource mobilisation for health care, meets up with the Abuja Declaration and also ensuring that it fully implements the expectations of its National Health Act. This would serve as a signpost for the West African region as it strengthens its support for the regional health agency.

One critical policy gap that the leadership at WAHO can drive with Nigeria’s support could be the ‘Health in All Policies’ which has the potential to increase the momentum for UHC and the SDGs by extension.

• There is an increase in entrepreneurship in the health sector? What are the solutions that social entrepreneurship brings to the health sector, and how to stimulate this trend?

Yes, there is gradually increasing entrepreneurship with innovative approaches that can help reverse capital flights and even medical tourism. The fact is that most of the state-run health care systems in the region are not in the best of shape which practically cuts across issues relating to all traditional building blocks: leadership, finance, human resource for health, health information, drugs & equipment and service delivery.

The region has started growing the kind of privately-owned health care systems which are providing services that the quality of care is beginning to meet global standards at lower costs. In some places, public private partnerships have actually worked to deliver health care despite initial teething problems. Among these enablers are the ubiquity of good quality generic drugs which are helping to crash cost of care including use of equipment that can be recycled, standardizing surgical materials and increasing ratio of reusable supplies as much as possible to reduce costs. They have also focused on improving the flow of patients and supplies through their health facilities and setting clear performance indicators. These have reduced general medical and surgical costs for clients.

One critical policy gap that the leadership at WAHO can drive with Nigeria’s support could be the ‘Health in All Policies’

Social entrepreneurship brings a pro-poor transformation to the health care industry within a market-focused evolving private sector. They provide innovative bridges for an industry battling with budgetary cut-backs and generally rising cost of doing business in the health system. They tackle problems with cost effective ideas and technologies in a way different from traditional businesses.

To ensure this trend of growth of entrepreneurship continues, the region needs to ensure that the enabling environment is in place to grow and nurture the industry. This includes enabling policies, access to finance and ease of doing business, as well as ensuring the availability of power and Internet backbone. There is also a great need to ensure the preparedness of health care professionals to become entrepreneurs which has rather been largely discussed and implemented by a few institutions. However, mentoring systems and structures to ensure incubation and hands-on skills have been largely lacking.

What impact the universal electrification and the drop in the price of the Internet expected in West Africa can have on the health sector?

The dyad of universal electrification and drop of price of Internet access will definitely be major game changers for the healthcare ecosystem in West Africa because of their potential for widening the base of health service delivery and scale up. They drive innovations that can have massive disruptive influence on the health care market space.

Power has remained a major problem for the health sector. There is no gainsaying that access to reliable electricity in health facilities is a vital enabler of quality, essential health services for citizens and is essential to achieve the Sustainable Development Goal in both health and energy. So, to achieve universal electrification in the region would happen through either main grid extension or off-grid energy solutions to reach the unserved population. Off-grid systems are particularly lifesavers in mostly isolated and hard to reach areas. The power challenge is very pronounced in Nigeria where it has led to many facilities including primary care centers being unable to provide a desirable 24-hour emergency and routine service delivery.

There is also a great need to ensure the preparedness of health care professionals to become entrepreneurs

The increasing powering of such centers, especially the hard-to-reach facilities and giving them off the grid power has enabled them to witness increasing uptake of services. Because West African communities are still largely agrarian, for non-severe ailments nor debilitating health challenges, most of the populations would prefer to go to facilities after returning from the farm or the market, usually in the later part of the day.

So, I was excited last December when I saw that Sierra Leone’s President Julius Maada Bio officially commissioned lights in 54 rural communities across his country as part of a renewable energy project which will hopefully provide energy to public health facilities there. You can only begin to imagine the impact this will have on such communities.

West Africa like elsewhere is feeling the impact of globalization in health care with ubiquity of Internet. Reduction in cost around internet access would further give room for use of digital technologies which will go a long way in improvement of the health of our population. The impact would also mean that we will require new policies, care models and technologies that help to focus on the drivers of health and speedup early diagnosis, treatment response and outcome irrespective of distance. With more advanced low-cost digital technologies, it would be easier to segment or categorise services and also have a better picture of the client.

 

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