Dr. Godswill C. Okara is National President Association of Medical Laboratory Scientists of Nigeria (AMLSN), Chairman, The Assembly of Healthcare Professional Associations (AHPA) and  executive member of Joint Health Sector Unions (JOHESU). Okara recently, addressed journalists, his colleagues and other members of the public on the need for implementation of public-private partnership (PPP) in diagnostics and medical laboratory services to achieve universal health coverage in the country among other contemporary health matters. 

 

Excerpts:

 

Please give an overview of public-private partnership operation:

The practice of public-private partnership (PPP) is an effective means of achieving universal health coverage in Nigeria. Available records show that private health care providers play a great role in the provision of health services in Nigeria, since 43.20 per cent of health facilities (that is clinics, hospitals, medical laboratories, pharmacies, nursing homes, physiotherapy clinics, eye clinics etc) belong to private health practitioners, whereas 53.40 per cent belong to government. Universal health coverage cannot be achieved through the current practice of building and equipping health centers by government in rural areas. We cannot continue to do the same thing and expect different results. The money for awarding contracts for building and equipping such infrastructures should be channeled to the provision of community health insurance cover to rural dwellers, while private health practitioners should be encouraged to set up their practice in the rural areas. Once practitioners know that if they set up their facilities in rural areas their services to rural dwellers would be paid for through an insurance arrangement by the National Health Insurance Scheme (NHIS) at an agreed period; this will address and resolve the problem of mal-distribution of health professionals across the country. It will also address the problem of rural dwellers having to pay out from their pocket for health services when they need them, thereby solving the problem of lack of access to and affordability of health services.

 

Is there any policy guiding laboratory services?

Yes, the National Medical Laboratory Services Policy, 2007. Nigeria has a well-thought out national medical laboratory services policy which underwent a rigorous process of approval through the Federal Ministry of Health, National Council on Health and the Federal Executive Council to ensure a well structured and orderly provision of laboratory services in all the three tiers of the health system. The practice of Public Private Partnership in medical laboratory services should be guided by the Nigeria National Medical Laboratory Services Policy. The policy is a framework that seeks to ensure accessible and affordable high quality laboratory services in all tiers of the national health system.

 

Whats the distinguishing point between medical laboratory science from medicine and surgery

The point has to be made that medical laboratory service is a distinct professional endeavour different from medicine and surgery, the bulk of which is to be planned, designed and provided by medical laboratory scientists. The tendency to confuse the highly technical nature of laboratory services with clinical services will continue to deprive the national health system the professional contribution of medical laboratory scientists. The key is the development and implementation of the national technical guidelines for quality assured, cost-effective and affordable laboratory services.

 

What are the dangers of  outsourcing laboratory services?

The outsourcing and commercialization of laboratory services to shylock business outfits being canvassed by the Nigerian Medical Association (NMA), amounts to a policy summersault. It is a reactionary step to mislead Nigerians.

. It will put the cost of laboratory services out of the reach of most Nigerians. It will promote corruption and selfish manipulation of the hospital facility by top management. It betrays a wholesale admission of the inability of the managers of our health institutions to manage the healthcare system, a function usurped from professional health service administrators.

. It is a ploy to sabotage the well-intentioned national medical laboratory services policy and mortgage our public hospitals to commercial predators. It is meant to spite medical laboratory scientists because of their persistent call for a halt to the gross mismanagement of our public hospitals in Nigeria. It is interesting to note that despite the increasing reported cases of patients sleeping and queuing endlessly in Nigerian hospitals to see a doctor as published in one of the National Dailies. 

 

The NMA is not saying anything about outsourcing or commercializing clinical services and theatres to foreign investors and South Africans in the name of public-private partnership. We have not heard of discussions, advertisements and invitation to build, own and operate clinics and theatres in the premises of public hospitals in Nigeria. “He that comes to equity must come with clean hands”. Enough of the deceit, grandstanding and double standards in the Nigerian health sector!

 

Could you list the long-term vision of the National Medical Laboratory Services Policy 

. To provide all Nigerians with an appropriate, cost effective and high quality laboratory service as a functional component of a reliable national health care delivery system within the next five years.

. To develop and implement national technical guidelines for quality assured laboratory service at each level of health care delivery.

. The goal of an efficient and effective healthcare delivery system as a social obligation of government is to make quality health services accessible and affordable to all the members of the society in a manner that is acceptable to them when they need the services. Available data indicate that 43.20 per cent of healthcare institutions in Nigeria are privately owned, while the government-owned health institutions constitute about 53.40 per cent. Religious and Community owned health institutions make up 1.93 per cent and 1.46 per cent of health institutions in Nigeria respectively. It is therefore imperative that the partnership of the public and private (PPP) sector providers should be encouraged, promoted and vigorously pursued both for the achievement of universal health coverage and sustainable financing of health care services on the long-term. This is more compelling in a developing economy like Nigeria with scarce resources and a myriad of competing infrastructural development demands.  The challenge is how do we achieve this laudable objective?

 

Achieving Universal Health Coverage through PPP in the rural Areas, how feasible is it?

The bulk of the population of our country lives in the rural areas. Available records show that 83 per cent of the government or public health facilities in Nigeria are in the rural areas in form of Primary Health Centres (PHC), Comprehensive Health Centres (CHC), Village or Ward Health Outposts and General Hospitals. Over the past few decades Nigeria has invested substantially in building these facilities in the 775 Local Government Areas (LGAs), but most of the Centres lack the compliment of skilled health personnel to offer the desired level of health services in these facilities. There is hardly any provision for medical laboratory services in most of the facilities. In this 21st century, Nigerians whether they are rural or urban dwellers are entitled to have medical treatment guided by empirical evidence of rudimentary laboratory data. The days of “if you have fever treat for malaria” should be abolished in our healthcare practice.   It is a waste of resources of both the patient and the attending practitioners. The Association of Medical Laboratory Scientists of Nigeria had earlier submitted a position paper on ‘Integrating Minimum Medical Laboratory services in Primary Health Care Centres in Nigeria.’  It must be pointed out that we cannot continue to do the same thing all the time and expect different results. The emphasis by government on building more health facilities in the rural areas will not solve the problem of poor health coverage.

 

A policy of radical involvement of private health professionals in the rural areas will solve the problem on the long term. The money for building and equipping more health facilities and residential buildings for staff in these rural areas should be channeled to community health insurance cover on a pilot basis through the National Health Insurance Scheme (NHIS). Like I mentioned earlier, the craze to cluster their practice in the cities and urban centres will be drastically reduced; as soon as health professionals know that their services to rural dwellers will be paid for through a guaranteed insurance mechanism, they will establish their practice in the rural areas. Also, if a doctor, a medical laboratory scientist or a pharmacist knows that if they set up their practice in remote villages, the rural dwellers will patronize their services without paying from their pockets, instead, they would be paid at the end of the month or periodically by the NHIS; the incentive to establish their facilities in the villages would be there. One, they are sure of patronage of their facilities; two, they are guaranteed of reimbursement through an insurance mechanism; three, there is no doubt that health services would be provided to the rural dwellers when they need them, in a manner that is acceptable to them. The National Primary Health Care Development Agency (NPHCDA), NHIS and the relevant professional regulatory Councils will then be more concerned with specifying and enforcing the standard and quality of facilities and services to be provided by the health professionals.  This will solve the perennial complaint of concentration of health workforce in the cities and urban centres, and the absence of health professionals in rural areas.

 

PPP in diagnostics and medical laboratory services!

There is no gainsaying that 21st century healthcare practice is technology and equipment driven. There is a critical lack of this modern equipment in our healthcare facilities. This is more so in diagnostic and medical laboratory services. The concept and practice of PPP in medical laboratory services should key into partnership arrangements with equipment manufacturers and manufacturers’ representatives in Nigeria for wet lease agreement as it obtains abroad. This enables manufacturers to deposit their equipment in public health facilities with guarantees of purchase of reagents and consumables for such equipment by the facilities over a sustained period of time. This ensures that the manufacturer or their agents have a sustained market for their products which guarantees profitability over time. It also ensures constant service and maintenance backup for the equipment by the manufacturers. When newer and upgrade models of the equipment are introduced, the manufacturer will usually replace the old one through a trade-in arrangement. This type of partnership arrangement will avoid escalation of the cost of diagnostic tests and investigations which often put services out of the reach of most patients and clients.

 

The current practice of commercialization and outsourcing of core health services to shylock business outfits in the name of PPP is an aberration and indeed betrays the abysmal failure of management of these hospitals. In modern management principles and practice ancillary services are outsourced in order to maximize effort on the core business of an organization. Any attempt to outsource the core business means there is an abysmal failure of management or what may be termed the obituary announcement of the business. Core versus non-core business exists in healthcare practice. Core business includes clinical, nursing, laboratory and pharmaceutical services. You also have non-core or ancillary business

 

World Health Organisation’s (WHO) concept of healthcare 

Patient is in the centre of a circle with healthcare professional team forming a circle around the patient, providing efficient, quality, affordable, timely and humane professional services to restore his health and wellbeing. Quality of professional service is the goal of training in the professions.

 

What is the way forward?

The way forward is to vigorously pursue the implementation of the approved Nigeria National Medical Laboratory Services Policy and institutionalise partnership with known and credible equipment manufacturers and their representatives to promote wet lease of equipment in our health facilities in Nigeria.

 

By CHIOMA UMEHA 

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