Thriving in challenging times

It is not in doubt to all Nigerians, that these are challenging times occasioned by a steep decline in the price of our predominant commodity export – crude oil and further exacerbated by volume decline resulting from pipeline disruptions by militants in the Niger Delta. Both factors in addition to some say delayed and ambiguous fiscal and monetary responses have resulted in a recession evident to the man on the street by continued devaluation of the Naira, rising prices of food and services, job losses, delayed payments and much more. In the healthcare sector, I have seen patients defaulting from treatment, deferring treatment or negotiating cheaper alternatives. The costs of operation of healthcare providers have gone up while their revenues have stagnated or declined. Receivables and payables are at an all-time high. Sectoral structural and operational inefficiencies previously papered over by high economic growth are now exposed.

However, in this crisis which has been described as the worst in 32 years, I see an opportunity for stakeholders in the healthcare sector to lead and thrive through remodeling or reinventing our paradigms and business models. The 2 most important paradigms I consider that need reinvention are:

1.   Doing things, the same old way

2.   Doing everything by ourselves

Firstly, consider doing things the same old way. In spite of process, product and business model innovations within and outside the healthcare sector, there has been little or no change in the practice of healthcare in Nigeria. Operational inefficiencies are perpetuated as new generations of providers replicate wholesale (copy and paste) the business models of their predecessors without adjustments for contemporary market needs and realities. I have seen advancements occasioned by innovation in the banking, telecommunications, media, education and other sectors in Nigeria. None of these sectors has remained the same over the last decade. This is the time to leverage innovation within and outside our sector to deliver better health outcomes at reduced costs alongside improving patient and clinician experience. We need to consider inputs or processes we can eliminate, modify or increase to be more efficient and patient centred.

Secondly, let us consider doing everything by ourselves. The average Nigerian healthcare service provider (doctor, nurse, pharmacist, laboratory scientist, physiotherapist etc) attempts to provide a wide range of services under one roof: a one-stop shop. For doctors, typically they provide a range of general and specialist services across out-patient and in-patient units using their own staff, within their sole occupied property powered by their own generator and secured by their own security personnel. At the best of times, sectoral capacity utilization was about 60% and lately due to the macroeconomic realities this has declined below 50% in many practices. This is the time to consider shared medical offices, group practices, group purchasing, mergers and other collaborative mechanisms among practitioners which increase capacity utilization and decrease the cost of service per patient. This is the time to further consider how to achieve successful public-private collaborations. We also need to consider innovative collaborative mechanisms with non-health stakeholders such as banks, telecommunications firms, construction companies etc. We have sufficient mutual economic and social rationale which we can advance in favor of such collaborations.

Furthermore, in order to guaranty our sustainability in these challenging times, we (the diverse stakeholders in the healthcare sector) need to unite around a common cause, our survival. The united collective needs to increase public sector advocacy to ensure that structural constraints and appropriate innovations to tackle them are given favourable policy attention. Such policy opportunities span universal health coverage, medical education, access to finance, task shifting, telemedicine, quality accreditation, health insurance, medical tourism and much more. Indeed, long-standing market failures can be efficiently resolved by appropriate policies while unfavourable policies or policy flip-flops will exacerbate our distress and decline.

Economic cycles are a reality of modern economies. No swing is eternal, the current downturn will expire, we need to ensure that we embark on appropriate mitigating changes as outlined above in order to outlive the downturn and be ready for the boom when it returns.