Healthcare System Strengthening Project in Nigeria: An Implementation Study Prepared by: Venkitasubramanian Akshay Team Leader- External Relations Stop Cancer Foundation, Abuja-Nigeria [email protected] Wanshyun Lee Intern-External Relations Stop Cancer Foundation, Abuja-Nigeria [email protected]

Current Healthcare Scenario in Nigeria: Nigeria is a country with an estimated population of 150 million with age structure as described below : Age Structure

% of Population

Male

Female

0-14 years

43.71

2,78,42,225

2,78,42,225

15-64 years

53.47

3,44,56,738

3,32,59,194

65 years & Above

2.82

17,80,862

17,82,410

The population growth is estimated at 2.61%. 1 The current infant mortality rate is 73.34 death/1000 live births (2001 est.) and life expectancy at birth 51.07 years (this mean that a child born in Nigeria toady is only guarantee to live for 51 years). This situation is even worse if we look at the quality of healthy life a child born in Nigeria today we live. For the first time ever, the World Health Organization assessed the performance of health systems of its 191 member countries in achieving three main goals for the health system: health, responsiveness, and fairness in financing. The primary summary measure of population health used is disability-adjusted life expectancy, or DALE, which measures the equivalent number of years of life a child born in Nigeria today is expected to live in full health, (i.e. without disease, STOP CANCER FOUNDATION / 92, Aminu Kano Crescent, Wuse II, Abuja / +234 803 596 5739 / +234 807 816 6555 / [email protected] / www.stopcancerfoundation.org

injuries and disability) or healthy life expectancy. Of all the 191 countries Nigeria was ranked (187) by the World Health Report released in 2000. 2 Most countries in sub-Saharan Africa such as Nigeria do not have a reliable death certification system and so useful information on deaths outside hospital is virtually non-existent. Mortality in Nigeria and other sub-Saharan Africa is higher than the other major regions of the world. Several issues of major concerns suggest that mortality decline in Nigeria and other African countries may have slowed further or been reversed in recent years. The reasons for this pessimism can be related to the following factors; the economic difficulties that have afflicted most African countries since the 1970s; the mortality trends in parts of Africa due to civil, ethnic warfare and other conflicts. Furthermore, another development in Africa in relation to which it is hard to find any grounds for optimism is the epidemic spread of HIV. Nigeria and Africa as a whole, lack adequate vital registration system. Mortality data are a standard information resource to guide public health action. Nigeria does not have a representative morbidity and mortality surveillance and adult risk behavior surveillance system. Hence, it is very difficult for the government to plan adequately for their citizens. Out of the estimated 27 million women of reproductive age, one in thirteen die due to causes related to pregnancy. Recent figures indicate that the maternal mortality ratio (MMR) is 800/ 100,000 live births in Nigeria. However, there are wide regional disparities in the statistics. Whereas the Southwest region reports an MMR of 165, the Northeast region reports 1,549. Maternal mortality rates are twice as high in rural settings as they are in urban ones. Of the annual 3 million pregnancies in Nigeria, approximately 170,000 result in death that is mainly due to complications during pregnancy and childbirth. The main causes of maternal mortality in Nigeria are hemorrhage, which accounts for about a quarter of all maternal deaths, sepsis 15%, complications of unsafe abortion 13%, hypertensive diseases of pregnancy 12% and obstructed labor 8%.3 Only 36% of Nigerian women are in the adult work force according to the United Nations’ World Women Report 2000, which ranks Nigeria at 151 on the gender-related development index among 174 countries. Reasons for this are the low social status and inequality of women which limits their access to education and ultimately, economic resources. This in turn limits their ability to make decisions about their reproductive health.2 Approximately 35% of Nigerian women experience their first pregnancy by the age of 19. The Nigerian Demographic Health Survey (1999) further states that only 15.3% of married women STOP CANCER FOUNDATION / 92, Aminu Kano Crescent, Wuse II, Abuja / +234 803 596 5739 / +234 807 816 6555 / [email protected] / www.stopcancerfoundation.org

are currently using contraception, of which only 8.6% are using modern methods (e.g. condoms and birth control pills). 3 Only 60% of women receive antenatal care and approximately 31% of all deliveries take place in a health care facility. Moreover, only one-third of all deliveries are attended by skilled attendants in Nigeria. A study conducted in the northern part of the country indicates that 25% of all deliveries take place in the home with no assistance or attendance present.2 Health care facilities in the country are generally in poor condition with chronic shortages of essential equipment, drugs and human resources. The most severe is the lack of adequate skilled attendants which are the most essential element of quality health care, because they often leave to the private sector, or move to other facilities due to lack of resources or proper remuneration.

Objectives of the Healthcare Systems Strengthening Project 1. Evaluation patient care delivery systems of the hospital 2. Economical Analysis of the Hospital 3. Developing a sustainable model for primary healthcare system for Nigeria 4. Organization of National Healthcare Conference 1. Evaluating Patient Care Delivery Systems of the Hospital. Overview: SCF will partner up with leading organizations as well as experts in the fields facilities, equipments and human resources. The main objective of SCF is to help the hospital understand its strengths and weakness of its organization so that the hospital can improve its treatment delivery mechanisms. Moreover, SCF can use this data to help its patients choose the right hospital. Execution This phase of the project will be evaluated by a team of clinical engineers, doctors, biomedical engineers and architects. The Clinical Engineers and Architects will evaluate the facilities and be able to understand the layout of the hospital. The layout of the hospital plays an important role in spread of the infection, and hence this factor will help us understand the efficiency of the hospital. Secondly, the clinical engineer and the biomedical engineer will be able to carry out a study of the hospital equipments. This will be aimed to STOP CANCER FOUNDATION / 92, Aminu Kano Crescent, Wuse II, Abuja / +234 803 596 5739 / +234 807 816 6555 / [email protected] / www.stopcancerfoundation.org

help the hospital to understand its technological capabilities. These play a vital role in cancer diagnosis among many other diseases. Furthermore, these machines augment the patient care factor and assist in treatment. Finally, a team of doctors will be responsible for evaluating the human resources of the hospital. They will review hospital protocols and test the staff. This will give the hospital a better understanding of their staff. The doctors will be able to report to the hospital on its overall readiness and its capability to handle patients. 2. Economical Analysis of Hospitals Overview: One of the major problems in today's hospitals is that the cost of the treatment is very high. For diseases like cancer where treatment can be given, cost is a major hurdle. Hence, an economical analysis of Hospitals will help SCF understand the various factors which add to the treatment costs. With the help of doctors and biomedical engineers, SCF will try to come up with alternative plans so that the cost of the treatment can be reduced. Execution: This phase of the project will be jointly executed by doctors and biomedical professionals. They will take down the cost of treatments in the hospitals along with all the procedures. They will also get a price breakdown. The SCF team will reevaluate the treatment procedures and try to create a new treatment plan in order to reduce the costs. This will be a win-win situation for both the patient and the hospital. The role of the biomedical engineer is to advise the hospital on cost effective technologies as well as educate doctors on the use of them. This is done in order to assist doctors make quicker, smarter and effective decisions thus helping the hospitals to cater to more patients. This in turn will reduce the cost per patient. On the other hand, this will increase the hospital revenue as it can handle more patients. The doctors on the SCF team will design newer protocols in order for the hospitals to assimilate new techniques in to their system. The main objective of such a project is to help the hospital stay on par with new practices and reduce its cost to treat patients. 3. Developing a sustainable primary health care system Overview: Nigeria is ranked 163 out of 191 WHO member countries. According to experts, Nigeria bears witness to some of the worst health-care statistics in the world and comes STOP CANCER FOUNDATION / 92, Aminu Kano Crescent, Wuse II, Abuja / +234 803 596 5739 / +234 807 816 6555 / [email protected] / www.stopcancerfoundation.org

close to the bottom of virtually every development index. Most of other countries that are ranked higher than Nigeria have suffered significant internal conflict and have considerably lowered per capita gross domestic products. Experts further state that a poorly structured health service that relies on vertical programmes for HIV, TB and Malaria means that coordination is chaotic, and already scanty resources fail to reach the lower levels in which they are needed most. Each component of the three-tier governance structure - federal, state and local government is involved in the provision of health care, which results in chaotic coordination and communication, poor accountability, and considerable disparities throughout the country. SCF along with partner organizations will create a new model for Nigerian Healthcare system and propel it in to 21st century. Execution: The development of a new primary healthcare system will be a joint effort between SCF, USAID, Federal Ministry of Health and other leading organizations that work in the Nigerian Healthcare industry. The data collected from the previous stages will be useful is assessing the current medical situation in Nigeria. The team can work out a proposal so that there can be a public-private partnerships with the hospitals who have the capability to deliver basic healthcare. Another task that this group will have to perform is creation of a team of medical professionals who can train the locals on the basics of hygiene and educate them on diseases. This will be in concerted effort to reduce the spread of diseases and increase the awareness of general public. This team will also be responsible for creating a road map to transform the public healthcare system in Nigeria. 4. Organization of National Healthcare Conference Overview: The National Healthcare Conference will be a summit to track the progress of the Healthcare System Strengthening Project executed by SCF. The conference will invite leading healthcare experts around the world to reassess the Nigerian Healthcare Scenario. It will also review the road map created in the last stage and make the required changes to adapt to the scenario. It will be also be a place for expert to discuss the Nigerian Health crisis such as HIV/AIDS, Cancer, TB among many other diseases and formulate an action plan to combat them. This can also be the forum for discussing reviewing the National STOP CANCER FOUNDATION / 92, Aminu Kano Crescent, Wuse II, Abuja / +234 803 596 5739 / +234 807 816 6555 / [email protected] / www.stopcancerfoundation.org

healthcare policies of Nigerian Government and economic optimization of the macroallocation of the health care funding. Execution: The SCF team will be responsible for organization of the conference. The SCF team will scout for the venue, sponsorship and overall event management of the conference. The partners of HSS project will be responsible for speakers as well as designing the conference agenda.

STOP CANCER FOUNDATION / 92, Aminu Kano Crescent, Wuse II, Abuja / +234 803 596 5739 / +234 807 816 6555 / [email protected] / www.stopcancerfoundation.org

Bibliography 1. Alakija W, Essentials of community health, primary health care and health management, Medisuccess Publications, Benin City. 2000 2. World Health Organization, World Health Report 2000, World Health Organization, Geneva 2000 3. James, Wunsch et. al.: USAID Governance Initiatives in Nigeria: A Strategic Assessment of Primary Health Care and Local Government. USAID, Lagos (1994).

STOP CANCER FOUNDATION / 92, Aminu Kano Crescent, Wuse II, Abuja / +234 803 596 5739 / +234 807 816 6555 / [email protected] / www.stopcancerfoundation.org