A travel from one continent to
another one can really change one’s perspective to life and people. I got a
similar opportunity to travel and train my perspective on Nigeria during my
current assignment. Along with my colleague, I am in Nigeria for a 3 week multi-project
visit. One of the things we are doing is trying to understand the Nigerian
healthcare delivery system through the eyes of the Nigerian providers. I am in
the 2nd week of the visit, so this post is coming right from the
Nigerian soil at the city of Port Harcourt in Rivers state.
I would not make this post a
travelogue. Rather a quick gist of some interesting observations about the
country and its healthcare setup from the eyes of an Indian who travelled to
this country for the first time. So you can expect a whole lot of comparison,
because that’s a natural outcome of my observations. We have already visited 3
cities in the first week, i.e. Abuja, Lagos and Calabar. Abuja is the national
capital; a very modern city built with a western town-planning. Lagos happens
to be Nigeria’s commercial capital as most businesses are based here. Calabar
is like Goa, an exotic place with a life of its own and an ample amount of
peace to offer.
Abuja is a city with most of
Nigerian federal govt. setup, so one can easily observe a lot of govt. offices
of all sorts in the city. I was amazed to visit such a modern city and it
appears and feels very formal, very bureaucratic. We were there in the city for
a day only, but from our discussions with various healthcare providers and
through our own visit to various places in the city, I felt the healthcare
system in the city not upto the mark. More on it would come during the third
week of our Nigerian visit. But an important thing to note is that there are
embassies of many countries in the city and headquarters of many multi-national
corporations in the city, so it has a healthy number of expats (with shifting
population) who would pay well to access quality healthcare.
We spent most part of the last week
in Lagos. The city has a long history as a major trade centre of Nigeria and
continues to attract businesses as an important hub of financial activity. Mostly
the roads get chocked by the traffic, yet one can feel the seriousness about
business in this city. Spread over mainland and island suburbs, the city was
better on healthcare delivery system availability. Yet, Lagos is very expensive
in terms of healthcare costs and I think this can be partly due to the high
commercial property rates and expensive labour in the city. Another source of
high cost is power/electricity. It is mostly not available from the public
utilities company, NEPA/PHCN. So most people and businesses use their own DG
sets and power generators and UPS set-ups. Some hospitals quoted that as high
as 90% of their power consumption is met by alternative sources only. Round-the-clock
electricity availability is apparently the top-most worry of any Nigerian
healthcare provider. But the good thing is that there are some good private
hospitals and diagnostic centres that have done fairly well in attracting and
retaining patients and building a brand over time. Lagoon Hospitals, Eye
Foundation Hospital, Me Cure Diagnostic Services, Pathcare etc. have built
great infrastructure in the city to enable good quality delivery system. There
were other providers too who are trying to do good work in whatever little
infrastructure they have built. But definitely there is a lot of appetite among
the healthcare providers to attract investments and collaborate with other
healthcare facilities across the globe to offer more and better healthcare
services to their patients.
Calabar, to me, is like a small
village. Quiet place with a small fixed native population. The whole atmosphere
is the city is so laid back, waiting to go back to sleep each moment of the
day. The people of the city are also mostly from middle and lower income category.
Calabar is relatively cheaper than the other 2 cities that we visited, but
there aren’t any decent private healthcare setups in the city. The city offers
a good opportunity to create affordable healthcare facilities as many patients
from the neighbouring states pour into the city for their healthcare needs.
Now time to share some
interesting observations about the country. Nigeria is the most populous and one
of the wealthiest African nations owing to its oil reserves (it is the 12th
largest producer of petroleum). Most of the GDP is contributed by oil exports
and this happens to be a major source of employment. Nigeria has very little
domestic production; therefore it is a major importer for almost everything
that a common man requires. You name it, they import it. Therefore there is no
concept of fixed MRP (Retail Price) in the country. 10 people would sell the
same thing at 10 different prices. It took us time to understand that there is
no apparent logic in pricing in this country. An Indian rupee (INR) is
equivalent to about 3 Nigerian Naira (NGN), and 1 USD = 157 NGN. But we went
mad trying to apply conversion here, because most things cost much higher
compared to their prices in India. Mostly that is due to the reckless pricing
that sellers do here. To their good fortune, buyers pay whatever money is
charged to them. To give you an example, we were in a restaurant in Lagos which
did not display prices of the items on the menu! (Of course, it was an
exception).
In terms of road network and
other infrastructure, we felt Nigeria is way ahead of India and a visit to
Abuja can really give an Indian an inferiority complex. But Nigeria also falls
short of India in many other sectors, including healthcare. I would say,
Nigerian healthcare market is like Indian healthcare market of 1980s and 1990s
when very little healthcare infrastructure existed, and with less focus on
quality of care. Indian healthcare market witnessed a boom because of the
larger and widespread participation of private healthcare businesses who
invested heavily in expanding the infrastructure. Consequently, Indian doctors
now-a-days find lesser reasons to work abroad. But that’s not the case with
Nigeria. Brain-drain is very strong and many Nigerian patients would trust
expat doctors more than their domestic doctors. Medical travel is partly a
fashion and partly a necessity in this country. It is ironical to find extreme
wealth and extreme poverty co-existing in Nigeria. Those who can’t afford don’t
have access to any medical facility. And those who can afford would prefer to
spend their money in seeking care abroad because of higher assurance of quality
of care and status symbol.
There are just a few healthcare centres
of excellence in Lagos, otherwise you won’t find a nationwide strong healthcare
brand. Another peculiar thing about Nigerian healthcare market is that the
providers do not like to advertise themselves much. While there are strict
norms on healthcare advertising in India, nothing of such sort exists in
Nigeria. But it still beats me why Nigeria providers do not spend on marketing.
Very few would have a website of their own and many of the hospital websites
are in such a bad shape.
I believe healthcare is in its
infancy in Nigeria and probably the country needs to import ideas for
healthcare innovation to build an efficient system and create affordability for
the masses. For those looking at investing in Nigeria, I think you have made the
right choice. But spend some dollars in understanding the market and the people
before you bump into any surprises. For example, bank lending rate in this
country is 20% plus. Yes you read it rightly. The bank would lend you for more
than 20% and would expect you to repay within 12-24 months max. That’s crazy! Health
insurance is near- absent and Nigeria would beat India in terms of
out-of-pocket expenditure on healthcare. And Nigerians love to transect in cash
because Nigeria is notorious for credit card and internet frauds. A consultation
with a specialist can vary from 10K Naira to 30K Naira, that’s about 3K to 10K
Indian Rupees just to meet the doctor! Of course, this is in-line with the high
cost of living in this country.
We are currently in week 2 of our
visit and stationed in Port Harcourt, another major trade centre in Nigeria. Wait
till the next week for interesting insights on this week’s tour.
