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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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outline
OUTLINE
  • RATIONALE FOR PUBLIC-PRIVATE PARTNERSHIPS
  • PARTNERSHIPS MECHANISMS IN HEALTH
  • OPPORTUNITIES IN THE HEALTH SECTOR
slide4
Contributing factors
  • Dilapidated infrastructure & Equipment
  • Public expenditure on health < $10 per capita ($34 internationally)
  • Donor contributions inefficient and redundant
slide5
Healthcare Financing

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

slide6
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

slide9
Growth of Private Sector Funding

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.

slide10
Are SSA governments able to meet this demand?
  • 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
slide11
Nigerian Resource and Financing Gaps

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

slide12
Healthcare Financing Gap for Nigeria

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)

slide14
PPP adoption in healthcare
  • 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 FMOHThe 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.
slide16
Five imperatives for Private Investment

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

slide17
Tenets of PPP in Healthcare
  • Affordability
  • Accessibility
  • Acceptability
  • Effective regulation
  • Equity
slide21
Public-Private Partnership Concepts
  • Shared Risk
  • Shared Reward
  • Clearly defined roles and responsibilities
  • Discrete endpoints and outcomes (BOT options)
  • Monitoring
slide22
Opportunities in Nigeria

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
slide23
Opportunities in Nigeria
  • 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,
slide24
How do I participate ?
  • 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
slide25
Conclusion
  • 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)
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