Adekunle Adeyemi's Perspectives On Healthcare Financing in Nigeria

In the period leading up to the European Development Days, we had a conversation with Adekunle Adeyemi, one of the panelists for the PharmAcess session on Healthcare financing.  Adekunle is the Executive Director of Crystal Specialist Hospital, a private institution established in 1980. Serving up to 350 people a day and performing 100 deliveries every month the hospital’s patients come from a broad spectrum of socio-economic background in LagosNigeria. According to Adekunle, the clients from the low income and informal sector make up the majority of their clientele. A 2013 situational analysis by SafeCare shows that over 80% of the people in the hospital’s catchment area are poor. For the two million people in the area, Crystal Specialist Hospital’s range services which includes Obstetrics, Gynecology, Pediatrics, Internal, Family & Preventative Medicine, are a critical provision for their health needs.

Like most parts of Sub Saharan Africa, Nigeria faces major health care challenges. Among some of them are issues related to maternal mortality and infant mortality rate which are more than double the world average. This presents a daunting challenge for the care providers like Crystal Specialist Hospital. Given Nigeria’s average child to Pediatrician ratio of 160,000 to 1, access to affordable quality of care is often limited.

Despite the seemingly negative situation, there are hopeful stories from the region. Adekunle sees a compelling positive outcome from the insurance subsidies and commercial subsidies being channeled towards the private sector. According to Ade, “since the inception of the (Community Health Insurance) program in 2006, the gap between affordable high quality care and the most vulnerable socio-economic groups in our area has narrowed”. Traditionally, the low-income earners are not always willing to seek treatment, they take a ‘wait-and-see’ approach, where they hope to get better before they fork out some money to pay the healthcare providers. If their illness persists their preferred option is usually the cheap and unregistered health posts usually manned by health practitioners with bogus credentials. This situation exposes them to high risk as they delay seeking professional and quality care, further complicating their condition.

According to Adekunle, among these low income groups, there is a view that private healthcare providers are meant for the rich and well to do in society. Such a perception used to discourage people from seeking medical treatment in the private sector. The perceptions are changing particularly with the introduction of insurance programs such as PharmAccess’ Community Health Insurance. The insurance programs have come as a life line for both the practitioners and the patients because low income earners are now able to seek medical care when they need it, which translate to more income for the care providers like Crystal Hospital. It is noteworthy to point out that insurance programs may not work if applied in independent of other important inputs such as quality assessment. While increased access to finance is a key ingredient to the sustenance of the private players, benchmarking and improving the quality of service is equally important. Quality of service helps in luring and retaining people who are willing to prepay for their health insurance coverage.

The steady growth of some of the private health care providers has become a testimony challenging the traditional hesitant approach by bankers and insurers when it comes to financing private and small clinics. There is a growing resounding evidence for business and social viability of the private healthcare providers. Adekunle observes that the major health challenges facing Africa require innovative forms of collaboration and approaches to problem solving. “We cannot solve the healthcare problem with an overburdened and typically dysfunctional public health system”, he argues. Taking a lesson from his own experiences he urges that, “The fusion of private health insurance schemes for the most vulnerable patient groups and conventional commercial capital investments in healthcare delivery is a compelling proposition”.