HEALTH INTERACTIVE WITH DR. AMINU MAGASHI

Public / Private Sector Partnership in Health Matters

My article ‘ GSM Operators , Health  and Development that was published on this column sometime early this year generated mix feelings from my readers with some carpeting the call and my advocacy to the operators to invest in Health and Development as a waste of time , while others believed that it was a worthy attempt. Two regular readers of this column could not resist calling me about the same issue. One was someone within the corridor of Power and working at the Nasarawa State Government House, who sounded very pessimistic about my call to the operators. The other person was a young female student with the Abubakar Tafawa Balewa University in Bauchi State who carpeted me as a dreamer building a castle in the air.

In that article I mentioned among others that with the repeated problems and the high tariff and the colossal profit the companies are making every day, it would not be a bad idea if some percentage of what they make is channel towards Public Health and Community Development, at least the common man and the subscribers’ disenchantment will be compensated to some extent and above all the companies has social responsibility to support communities where they are reaping a lot of financial benefits. I lamented that how these companies will be convince to do that, would remain a fantasy to me as of then.

On Tuesday 21^st June 2005 under Fund for Leadership Development of MacArthur Foundation, I convened a Lunch Meeting with some few selected members of the Private Sector in Kano to share a research findings on Maternity Services in Kano with a view of advocating to them to wake up to their social –corporate responsibility towards community development and health care delivery system . To my astonishment, I invited 20 Institutions and 18 of them turn up, with the two sending regrets of their unavoidably absence. Area and Branch Managers of Banks and the same GSM operators that I was pessimistic of their commitment were in attendance.

Coming back to the Health Sector and why people like us are calling Private Sector to become active players, the answer could not be far-fetch. Our experience in the last two decade shows that Government cannot shoulder the responsibility of Health Problems alone, for many reasons, among them, is the bustling population of the country couple with dwindling infrastructures and low purchasing power of Naira. Other problems of the Health Sector are: Poor performance of existing health systems, consumers unhappy about poor treatment, public expenditures skewed toward rich and neglect the poor, particularly women; resources are scarce and demands increasing. Other problems are related to Routine Immunization coverage rate which in the past had reached up to 80 %, but quite disheartening, currently it is about 13 % coverage. There are a very high proportion of primary health care facilities which serve only about 5-10 % of their potential patient load due to consumer’s loss of confidence in them, our secondary health care facilities are in shamble and terrible condition, diagnostic and investigative equipments in tertiary health institutions are outdated and lastly the referral system between various types of facilities is non functional or ineffective.

In a recent research conducted by Society of Gynecologist  and Obstetricians   of Nigeria  ( SOGON ) in 6 states of Nigeria ( Lagos , Enugu , Cross River , Plateau , Borno and Kano ) , the Maternal Mortality Ratios of some of the states is above 3000 death /100, 1000 live birth . At the rate women are dying during pregnancy, we are approaching a scenario of having one death out of every ten live birth. Nigeria is accounting for 10 % of the global estimate of maternal mortality ratio, even though our population only accounts for 2 % of the world population. And the irony of this aware some figures is the fact that, majority of the causes of maternal death are preventable using simple and basic means. In line with such discovery, Nigeria has become the most unsafe place for a woman to be pregnant and go in to labour.

Above mentioned are some of the problems in our Health Sector which need to be address by concern citizens and stakeholders and I strongly believe through Public and Private Sector partnership, many of such problems can be address towards improved Health Indicators. One problem that first need to be address is the wrong believe among many Government Officials that such partnership would not be a welcome development by the populace and policy makers. It is pertinent to mention that while at the federal level and other states like Lagos and Oyo, there are a lot of good examples of such partnership yielding positive results. Coming back to Northern States in the country, such partnership is not substantially being explored for the benefit of the common man.

At a Feed back Workshop on Scoping  Mission on the operation of Hospital Management Board ( HMB ) in Kano between 9 to 10 August 2005 organized by PATHS Project of DFID for the Staff of Health Ministry , Hospital Management Board and all  Zonal and Chief Medical Directors of Secondary Health Centers and other players in Primary Health Care , when asked about other potential source of funding to the operation of HMB apart from Government , I made mentioned that HMB and Hospitals under it can partner with Private Sector towards sustain and quality services .  From various responses from the audience, it was vividly clear I was on my own on that recommendation.

This pessimism by the Government Officials, if one is to do a brief survey in other Northern States; one is bound to find same attitude and response. Before I conclude this discourse, let me mention some approach towards sustain Public and Private Sector Partnership in Health Sector. All of us know the sorry nature of our Laboratories, X-Ray Departments and Pharmacies which are devoid of even essential facilities and drugs. Our laboratories in Nigeria in many Secondary Health Centers are so bad to the extend  that if someone is to send Distilled Water for analysis, depending on what one requested, the result will come back with a lot of bizarre findings of high or low level of Sugar, Protein and Bilirubin.

Private Institution can partner with a secondary health center to manage its Laboratory, X- ray Department and/or its Pharmacy, that way quality services on regular basis will be reassured and the hospital and the private institution should work out the formula of percentage benefit. Although prices may be a little bit high, but I am sure it will not be the same with a Private Health Institution where the sole aim is maximizing profit by all means. Another area Private sector can come in , is through sponsoring air time towards awareness creation of so many health problems afflicting our society  and lastly one can influence the kind of advertisement messages in such a way that such messages will serve as another means of  awareness creation and campaign towards achieving the Health related Millennium Development Goals .

I am under no illusion that Public and Private Sector partnership and the involvement of GSM Operators and Banks specifically to invest in Health is not a one day campaign and advocacy, However I strongly believe that, it is highly possible through educating the Public and Government Officials on its benefit and advocating to the Private sector through meetings on the best way to partner by all development workers in the Media, Civil Societies and Governmemt.

Dr Magashi is the Executive Director of Community Health and Research Initiative , Kano , Nigeria and can be reached at healthinteractive@hotmail.com