Involvement of Private entities to participate in healthcare strengthening has been a drive to achieve national health goals in Nigeria. Public Private Partnership (PPP) in Health is the collaboration of both governmental and non-governmental stakeholders, working harmoniously to harness and optimise the use of all available resources, knowledge and facilities required to promote efficient, effective, affordable, accessible, equitable and sustainable healthcare for all people in Nigeria.
In the MDG era, National Policy on Public Private Partnership for health in Nigeria was adopted in 2004 to meet the healthcare need of the entire population. The involvement of Private interest groups and actors in healthcare provisioning was due to the deplorable national health profile and declining resource allocation to health.
Government resource for health was not sufficient to maintain existing health facilities, increase access to service and improve healthcare quality. The poor performance of public health service delivery systems and the desire to expand the choices available to patients also initiated Federal Ministry of Health to search for solutions which yielded Public Private Partnership in Health.
In Pursuance of the national health policy, the Partners in health were identified in both public and private sectors. The Public sector “Players” potentially involved in PPPs include the Executives and Legislative bodies in all tiers of Government, as well as other public institutions (including the key health parastatals).
Private Sector Players are exceedingly diverse and range across: the multiplicity of Health providers, enterprises, economic Institutions, distribution companies, chamber of commerce, labour unions, faith based organisations, non-governmental organisations, philanthropist clubs, societies, other Civil Society Organisations, and cooperatives. Other key partners include professional councils and professional associations, consumers of healthcare such as Industrial, family and community members.
Furthermore, Nigeria Health Sector has adopted some evidence-based PPP models to foster private participation in an enabling environment. These models include but not limited to contracting, regulating, training, franchising and integration of private practitioners into public referral networks.
CHALLENGES AND WAY FORWARD
- Human Resources for Health (HRH)
Nigeria Health system is faced with the challenge of low healthcare workforce. Nigeria has one of the largest stocks of human resources for health (HRH) in Africa but like other 57 HRH crisis countries, has densities of nurses, midwives and doctors that are still too low to effectively deliver essential health services at 1.95 per 1,000 (WHO HRH factsheet).
In addition, inequitable distribution of health workers persists across the country due to urbanisation, tribalism and work environments which contribute to staff motivation.
Lastly, there is also lack of human resource planning resulting in imbalance health workforce staffing of different categories of health workers.
As a way to balance human resource for health for improved health system, we can enhance capacity, harness and redistribute available workforce within public/private coordination by
- Promoting professional development and continuing education in collaboration with training institutions and professional bodies.
- Creating HRH need assessment in each state, and transforming the assessment to a viable strategic plan on HRH.
2. Monitoring and Evaluation
We have had several policies and interventions on health over the years however, carrying out an objective and transparent monitoring and evaluation process is a challenge. This challenge is associated with inadequate record keeping, data management and follow-ups.
A proper health care monitoring and evaluation in both public and private sector will go a long way in assessing tract progress towards equity, compliance to regulations, quality of healthcare and access to health services. Health system monitoring and evaluation of both sectors should be carried out annually by constituted team representing all stakeholders. The M&E should assess equity, compliance, quality of services and facilities.
3. Financing for different forms of Public Private Partnerships for Health
Healthcare provisioning to a populace of about 170 million people is no doubt capital intensive and requires financial commitment from the government. Financing is a major challenge; this is due to low budgetary allocation from the public sector and also the profit orientation of most private providers thus shifting the burden to patients at high cost.
Under the auspices of PPP, funding strategies could be used to facilitate patterns of financial inflow which will help improve healthcare provisioning and promote greater value for money. Some of the funding strategies include:
- Encouraging partnerships and collaborations in Clinical and non-clinical support services to improve value and efficiency.
- Promote health promotion advocacy to improve consumer awareness and invite funding partners.
- Health insurance schemes.
- Promote health equity by improving quality of traditional medicines and allocate grant support to the underserved interest groups.
- Increase Public sector budgetary allocation and explore every other funding options likePublic private collaboration in the area of investment, Tax relief/rebate for manufacturers of health products, Credit options for private sector capacity building, the promotion of private finance initiatives, establishing drug bulk stores, and Private sector distribution mechanisms.