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Health Systems &Private Sector Bill Brieger | 02 Feb 2009 11:05 am

Infrastructure, the market and health in Nigeria – any solution for malaria?

“Nigeria (is) one of the emerging countries that is being penciled down by leading global economists and market observers as the most dynamic market driven economies on the African continent,” according to Eze Nwagbaraji reporting in the Vanguard Newspaper.  Certainly much of health care in Nigeria is market based.

On the other hand, Salisu Suleiman in the Daily Trust stresses a government role. “… government uses resources at its disposal to provide a number of goods and services, particularly those that may not be efficiently provided and equitably distributed through the market system. They include public goods, and services like education, health, water and power supplies, postal service, police protection, defense etc.”

What really happens? Nwagbaraji describes Enyiogugu, a large city in Imo State, and in particular points out that, “The community health center is a parasite – ill equipped and almost non-functional.” No wonder people look to the private sector for health care. Nwagbaraji suggested infrastructure bonds as a source of financing as well as the possibility of the private sector undertaking the upgrades and managing the results.  This may be the way to go since the public sector appears incapable of maintaining infrastructure improvements in places like Enyiogugu to date.

In the short term, where do people get help? Recognizing that the private sector accounts for a very large proportion of malaria treatment, Nigeria’s Global Fund recipients reformulated its Phase Two plan for the Round 4 Malaria Grant to involve patent medicine vendors (PMDs) in selling subsidized anti-malarials.  Informally, the Principle Recipient thinks that approximately 20% of PMVs in the 18 target states are participating in the plan.

This PMV approach is a good start. Since we estimate that 50-80% of the people get their malaria treatment from PMVs, this effort may serve as a pilot scheme. Is wider application possible?

Recently the Future Health Systems Consortium held a conference on the role of innovators and entrepreneurs in improving the performance of private providers of healthcare in Abuja, Nigeria. Actual social entrepreneurs presented innovations ranging from training PMVs to appropriate technology for district hospitals, health maintenance organizations for the poor and community involvement to improve health service quality in both public and private sectors.

These innovations must not only be encouraged but taken to scale if the market can truly help Nigerian in need of health care, including malaria treatment.

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