Understanding Nigerian healthcare system and business scenario: Experiences from week 1 of my visit

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 2^nd 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 12^th 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.