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Fiemu E. Nwariaku, FACS, FWACS President, Association of Nigerian physicians in the Americas (ANPA Inc.). SUSTAINABLE AND AFFORDABLE HEALTH-THE PUBLIC PRIVATE PARTNERSHIP OPTION. OUTLINE. RATIONALE FOR PUBLIC-PRIVATE PARTNERSHIPS PARTNERSHIPS MECHANISMS IN HEALTH

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Sustainable and affordable health the public private partnership option

Fiemu E. Nwariaku, FACS, FWACSPresident, Association of Nigerian physicians in the Americas (ANPA Inc.)

SUSTAINABLE AND AFFORDABLE HEALTH-THE PUBLIC PRIVATE PARTNERSHIP OPTION


Outline
OUTLINE

  • RATIONALE FOR PUBLIC-PRIVATE PARTNERSHIPS

  • PARTNERSHIPS MECHANISMS IN HEALTH

  • OPPORTUNITIES IN THE HEALTH SECTOR



Contributing factors

  • Dilapidated infrastructure & Equipment

  • Public expenditure on health < $10 per capita ($34 internationally)

  • Donor contributions inefficient and redundant


Healthcare Financing

Chuke P. O. Nigeria: In Saltman, R.B. Ed. The International Handbook of Health Care Systems. Greenwood Press, N.Y, 1988


Of total health expenditure of $16.7 billion in 2005, about 60% (predominantly

out-of-pocket payments by individuals), was financed privately

Private providers captured about half of that total expenditure


Growth of Private Sector Funding 60% (predominantly

Private sector will grow faster than the public sector in the next decade , and will require investments in the range of $11–$20 billion over the same period to sustain this growth.


Are SSA governments able to meet this demand? 60% (predominantly

  • In 2000, 53 SSA African heads of state pledged to allocate 15 % of their national budgets to health care. Reaffirmed in October 2005 session of the Conference of African Ministers of Health in Botswana.

  • In 2003, only one country (Liberia) has reached this level of expenditure, while 33 countries have not even reached ten percent.

  • Private sector entities have the potential to deliver between 45 and 70 percent of the needed increase in capacity


Nigerian Resource and Financing Gaps 60% (predominantly

Funds required using our costed NSHDP as basis (US$ 26 per capita) =N 540 Billion ($ 3.6 Billion)

Funds from existing sources using NHA results projected to 2009 as basis = N 2.1 Trillion resulting in a negative gap of about N 1.56 Trillion.

Federal Ministry of Health


Healthcare Financing Gap for Nigeria 60% (predominantly

It is estimated that the market for healthcare in SSA will more than double by 2016, going up to $US 35 Billion

Estimates for Nigeria are 15% of this amount, or $5.25 Billion (N785 Billion)


World Bank State Level Country Data 60% (predominantly

(Nigeria)


PPP adoption in healthcare 60% (predominantly

  • Adoption of PPP as one of the main thrusts of Health Sector Reform 2004 – 2007; which effort yielded the National Policy on PPP in Health

  • Health was the first and the only sector, to date, that has articulated a sector specific PPP Policy.


The objectives of ppp in health shall include to

PPP Framework at FMOH 60% (predominantly

The Objectives of PPP in Health shall include, to:

  • Promote and sustain equity, efficiency, accessibility and quality in health care provisioning through the collaborative relationships between the public and private sectors.

  • Develop the regulatory framework for public private interactions and collaborations in health care delivery in the country.


Five imperatives for Private Investment 60% (predominantly

Develop mechanisms for creating and enforcing quality standards for health services and medical manufacturing and distribution

Include as many of the population as possible in risk pooling programs

Channel a portion of public and donor funds through the private health sector;

Enact local regulations that are more encouraging of a private health care sector; and

Improve access to capital, including by increasing the ability of local financial institutions to support private health care enterprises


Tenets of PPP in Healthcare 60% (predominantly

  • Affordability

  • Accessibility

  • Acceptability

  • Effective regulation

  • Equity


Public-Private Partnership Concepts 60% (predominantly

  • Shared Risk

  • Shared Reward

  • Clearly defined roles and responsibilities

  • Discrete endpoints and outcomes (BOT options)

  • Monitoring


Opportunities in Nigeria 60% (predominantly

Non-clinical Support Services

  • Security

  • Laundry

  • Maintenance of clinical equipment

  • Amenity wards

  • Catering

  • Cleaning/Ground Maintenance (Domestic)

  • Engineering Maintenance including Power, water supply, Telephone/Intercom

  • Record Keeping

  • Revenue Collection

  • Administration

  • Information technology

  • Technology transfer


Opportunities in Nigeria 60% (predominantly

  • Clinical Services

  • Intramural Practice

  • Locum for all cadres of health personnel

  • Restorative and Rehabilitation (e.g., Physiotherapy)

  • Primary Health Care

  • Contracting not-for-profit organizations

  • Provision of services in under-served and rural areas

  • Prevention and treatment for priority diseases such as vaccine preventable diseases,


How do I participate ? 60% (predominantly

  • Individual investors

  • Corporate investors (for profit or not-for-profit)

  • Partner with foreign companies and organizations to invest in the Nigerian health sector

  • Participate within the context of existing organizations FMOH/NNVS/MANSAG/ANPA


Conclusion 60% (predominantly

  • Health care represents a huge investment opportunity

  • A huge resource gap of more than ~ $5 Billion exists in the Nigerian health sector

  • Tremendous investment opportunities in the health sector in Nigeria (Federal, State and Local Govt)


Thank You! 60% (predominantly


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