Some of the major constraints to the healthcare innovation in Nigeria are as follows:
- Inadequate funding
The federal, state and local governments often earmark several millions of naira to the health sector during yearly budgetary allocations. The problem is: Nigeria’s PHC system gets minimal attention in development policies even though it caters for a larger size of the population. Instead, expenditure from both federal and state governments prioritizes teaching hospitals, federal medical centres and state-owned hospitals. Moreover, any discrepancy in the estimated annual budget to the health sector results in higher out-of-pocket costs for care users (Abimbola., 2012). To ensure sustainability of the Nigerian health system, policymakers and health administrators need to involve more private-sector investors in order to establish a cost-effective financing system. In addition to reducing the cost of care, especially at the community level, Obansa and Orimisan (2013) suggested proper training and adequate motivation for healthcare personnel so as to sustain preventive and curative services.
- Fake drugs
Nigeria has lost many lives to counterfeit or adulterated drugs. The World Health Organization (WHO) in 2006 reported that over 70% of drugs sold in most pharmacies and chemist shops across Nigeria are substandard. The National Agency for Food and Drug Administration and Control (NAFDAC) also buttressed the fact and reality of fake drugs in Nigeria with its pronouncement that an estimated 41% counterfeits are in circulation (Raids., 2008). The economic impact of fake drugs is quite enormous, and this trend requires attention from policymakers. Unfortunately, little effort has been made to curb to menace of fake drugs since 1990, when a total of 109 children allegedly died after the administration of fake paracetamol (McNeely., 2002).
- High out-of-pocket costs
Cash payment accruing from health services rendered to individuals and households are commonly referred to as ‘out-of-pocket expenditures.’ In Nigeria, care users pay for transportation to health facilities, and are further burdened with extra costs of consultation, laboratory tests, and treatments. The total charges often skyrocket for in-patient cases. Osakede (2021) attributed the exploitative healthcare situation to Nigeria’s relatively dysfunctional PHC facilities, lack of essential drugs, inadequate medical equipment, and poorly motivated health personnel who often blame their incompetence on a ‘helpless’ situation caused by uneven allocation of resources. For these reasons, Anyika (2014) asserted that a large number of care users in Nigeria have no better option than to patronise private-sector care providers, who charge outrageous fees for consultation, diagnosis and treatments.
- Poor health infrastructure
Availability of basic infrastructure and medical tools at different levels of health facilities is a necessity for the achievement of WHO’s “Health for All” agenda. But the reality of Nigeria’s unstable economy impedes realization of the global health objective. For example, many health centres in rural communities across Nigeria are bereft of essential drugs, steady electricity supply, basic health infrastructure (e.g. lab equipment, refrigerators, functional means of transportation, digital technologies etc), and modern buildings. Obansa and Orimisan (2013) found that most PHC centres lack pipe-borne water, toilets, and incinerators. Further, some PHC centres are located more than 5 or 15 kilometres away from the communities, thereby making healthcare inaccessible or problematic during emergency situations. The reality is: location of PHC structures is often based on political expediency rather than the perceived need of care recipients (Cueto., 2005).
- Apathy towards healthcare development
Most care users in Nigeria, especially in rural communities, are unaware of their responsibility and rights to participate in the formulation and implementation of health policies. It has also been observed that most consumers of healthcare services are ignorant of the available care services—even the free benefits such as health counselling and family planning. Therefore, apathy among care users has negatively affected policy research, as well as population health management outcomes. This highlights the importance of sensitizing various communities to create more awareness and encourage community mobilization and participation in issues concerning health of individuals and households (Anyika., 2014).
- Poor remuneration
Poor compensations of health workers—particularly doctors and nurses—has led to the brain drain syndrome (a situation where trained and qualified physicians leave the country in droves for better job opportunities abroad). Moreover, poor performance of health workers has been attributed to inadequate compensation and invariably loss of motivation. Obansa and Orimisan (2013) noted that several health personnel engage in strenuous, time-consuming jobs, and in most cases, unsafe work conditions at different facilities. And payment is not commensurate with labour exerted. In the last two decades, several thousands of Nigerian doctors and nurses have migrated to the United Kingdom and other developed countries in search of better work conditions and salaries. The Nigerian government must therefore consider this trend as a threat to the sustainability of healthcare system (Worlu et al., 2016).
- Bribery and corruption
Abimbola (2012) asserted that bribery and corruption have adversely affected growth of the Nigerian health sector. Citing documented evidence on the embezzlement of healthcare fund, inflation of budget, fraudulent claims on health insurance fund, and inflated purchase of medical equipment and other infrastructures, the scholar added that endemic graft in Nigeria also involves bribery of health professionals, policy regulators, and public office holders. Some health workers are regularly feeding fat on stolen medical supplies while others are inflating cost of care. Regular absence from work and use of informal payment methods have also lowered the performance level of health system in Nigeria. But the problem is widespread and systemic in nature. And for this reason, bribery and corrupt activities involving government functionaries are nearly impossible to eradicate. For example, Awosika (2014) found an outrageous hike of unit price of drugs purchased by Nigeria’s Ministry of Health (MoH) as part of nationwide efforts improve care for HIV/AIDS sufferers. Additionally, a former minister of health, Adenike Grange, and a former federal legislator, Iyabo Obasanjo, were convicted as accomplices to an organized criminal gang who allegedly misappropriated a whopping sum of ₦300 million. The indicted persons were later acquitted without charges despite the implications of their actions on the poor masses and supposed beneficiaries of the ₦300 million. These examples emphasize the need for accountability in the Nigerian health system (Fisher et al., 2009; Aransi, 2019).
Prospects of healthcare innovation in Nigeria
Nigeria is Africa’s most populous country. U.S Census Bureau Current Population (June 2020) rated Nigeria the 6th most populous country in the world, too. Interestingly, the Nigerian pharmaceutical industry was valued as a $1.4bn market in 2016, and with an estimated population size of 214,028,302, opportunities abound in the health sector. Therefore, health development projects should focus on revamping dilapidated primary health care (PHC) structures and rebuilding the health sector to a level that will not just dissuade affluent Nigerians from traveling abroad for medical treatment but will attract more foreign investors and development partners (Bhatia et al., 2020).
Yet no matter the level of technology adoption in the country, data encryption and privacy concerns might be a prolonged issue due to corrupt practices and incompetence of stakeholders in the Nigerian health innovation ecosystem. The implication is that lack of confidence in the system and mistrust among Nigerians underscore the psychological side of innovation that most theorists and scholars ignore (Platt et al., 2019).
However, Nigeria is a massive marketplace with over 200 million people, and only less than 10% of the population has access to medical health insurance. Thus, out-of-pocket payments provide health administrators with enough capital to reinvest in the sector—if public funds are properly managed. Additionally, COVID-19 challenges in the health sector and the large, unexplored market have broadened the horizon of opportunities for innovators to exploit. But collaborative efforts from policymakers, health administrators, industry regulators and the entire population is necessary for an all-inclusive action plan. Patients, communities and other stakeholders in the health innovation ecosystem can unanimously determine a suitable care model that enables innovative health care solutions (Ola et al., 2021).
Conclusion
The cultural chasm between healthcare professionals and technology specialists has been an area of interest in healthcare management. This widening gap should be bridged through government interventions for the benefit of global PHC systems. Interestingly, some change-oriented groups have already launched initiatives to support collaborations among diverse associations of health professionals and technologists. The efforts promote an ongoing and focused dialogue required to attain global primary care objectives. But even when the expected collaboration is achieved, there will be great need for the target group (communities) to understand benefits of optimal combination of tools in technology-based care delivery systems. Thus, healthcare managers and administrators should maintain focus on how to integrate/deploy new health technologies in a way that adds value for all relevant stakeholders.
It is also important to add that there are reasons to be both excited and cautious about developments in healthcare management. For example, studies show that by leveraging technology, healthcare organizations can conduct broadened research in a little time, use input from more diverse survey participants, and simultaneously analyse more hypotheses to provide answers to many research questions than ever before. With technology adoption, statisticians may also discover how data mining and machine learning together with massive volumes of data can underplay the relevance of inferential statistics.
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