CHAPTER SIX (RESEARCH SUMMARY)

6.1 INTRODUCTION

Chapter 6 of the study titled “Innovative Health Management Strategies for enhancing the Primary Health Care Delivery in Nigeria” contains summary of the research findings and a detailed explanation of how study objectives were attained. Based on the results, the author also presents a final conclusion, some workable recommendations, and contribution to the body of knowledge. Recommendations will be delivered to university libraries, the federal ministry of health, Nigeria, as well as the Anambra state government as a call for action, specifically to review the conceptualization and integration of innovation and strategic management in primary health care delivery. The study will basically provide a background for more advanced studies in the areas of health innovation, technology diffusion, health administration models and performance appraisal metrics as applicable to the Nigerian health innovation ecosystem. In addition, the recommendations will, to a great extent, help policymakers address systemic challenges to delivering quality, affordable and accessible health care in Nigeria.

6.2 THE KEY FINDINGS REVISITED

This study is focused on evaluating the conceptualization and operationalization of heath innovation and strategic management in PHC administration, specifically in Nigeria.

6.2.1 KEY FINDINGS

Many developing countries focus on the distribution rather than quality of health care services available to individuals and households. But results from this research show that quality of care—or lack of it—should be the basis of every discussion and policy about health care delivery. For example, a 2018 analysis of paediatric care in Papua New Guinea indicates that about 70% of primary health care (PHC) workers reported that they checked for only two of the four examination criteria for pneumonia cases. Only 25% of PHC employees had proper knowledge of the right treatment for malaria. Further, an observation of clinical encounters at the health centres (including aid posts) showed that PHC workers used minimal examination criteria in as low as 1% of cases. In Pakistan, about 55% of care providers use acceptable diagnostic standard for viral diarrhoea, but only 35% met the acceptable standard for treatment. On this premise, it is glaring that developing countries have a dire need for new, inexpensive medical innovations to improve health interventions and outcomes.

Innovative Health Management Strategies for enhancing the Primary Health Care Delivery in Nigeria

6.3 ACHIEVING THE RESEARCH OBJECTIVES

6.3.1 OBJECTIVE ONE: MANAGEMENT OF PHC AND HEALTH INNOVATION IN NIGERIA

This first objective delves into the Nigerian health sector to understand how health administrators integrate innovation in the management of PHC system. As presented in the literature review, health management involves the enactment and implementation of health policies. It also refers to the overall administration of health-related activities in insurance companies, pharmaceutical firms, healthcare facilities (such as clinics, health centres or hospitals) and departments or ministries of health. The growing demand for efficiency in global healthcare delivery, thus, highlights the value of technology diffusion in clinical services. Although this qualitative study indicates that heath systems need to have adequate IT-based infrastructure and well-trained health personnel to achieve efficiency in care delivery, the key challenges to delivering quality, accessible and affordable care represent neither incompetence nor compassion on the part of health professionals. Also, the dysfunctional state of Nigeria’s PHC system is not necessarily an outcome of scarce economic resources.

The Nigeria example of PHC administration shows that the major setbacks to exploring the benefits of health innovation and strategic management are a result of knowledge gaps among health workers and policymakers. The improper use of opportunities from available technologies as well as resistance to change in many health organizations and countries are also some of the factors mitigating against health outcomes. Also, PHC systems in developing countries have failed to properly measure clinical practice, align practitioner incentives and objectives, and link quality improvement to better health outcomes. But research on historical evidence from the 1990s and early twenty-first century indicates that the quality of health care can be improved rapidly. Yet, the efforts to improve clinical practice requires that health administrators should first define care quality, ascertain how it should be measured, and take appropriate steps to achieve health objectives.

6.3.2 OBJECTIVE TWO: KEY HEALTH MANAGEMENT STRATEGIES UTILIZED IN THE NIGERIAN PHC

Research findings show that interpersonal skills are integral to the effective management of healthcare systems. Technology adoption is also crucial to the efficient delivery of clinical services. Thus, the future of technology-driven healthcare services is quite encouraging because technological innovations in recent years have significantly transformed the quality of patient care. A result-oriented health innovation ecosystem should therefore integrate strategic health management approaches and models to generally improve health outcomes. Research findings show that the goal of healthcare management (HM) is to improve people’s quality of live and extend their life span. However, the growing demands from care users and the resultant policy change in global health systems demand a transformation approach in the recruitment, training, remuneration and retention of health workers. On this premise, the HM strategies practiced in Nigeria’s PHC system are expected to make health business more attractive, profitable and beneficial to every individual and household.

Transformation is the first HM strategy implemented in Nigeria’s PHC system. The approach emphasizes establishment of a high-functioning analysis platform that enables seamless gathering and processing of health data sourced internally or externally. The purpose of this HM strategy is to ensure accuracy, transparency and equity in population health management. It is worth noting that the transformation stage of HM strategies requires incorporation of clinical data as well as information relating to health behaviours (such as cost data, claims data, environmental data, engagement data, socio-economic data, and physical data), and other sources. Findings from the Nigerian health system shows there is limited access to health data due to the low level of technology use. Moreover, health workers are poorly trained to leverage assistance from health technologies and improve quality of care. The author found that health administrators can enhance data transformation by prioritizing data sources, educating stakeholders on the available data, defining supporting logic (for example, by attribution) and increasing investment in human capital sourcing and development.

Data transformation processes require strong governmental support and huge investment in health facilities and infrastructure such as digital health technologies and hardware to sustain improvement in clinical diagnosis, treatment and prescription. However, healthcare administrators have different opinions on the real value of data management to healthcare delivery. Despite evidence that adequate data management enhances use of health technologies and the quality of healthcare services, the effect on cost reduction is less significant and inconsistent in Nigeria.

Analytic transformation as a second HM strategy implemented in Nigeria’s PHC system involves creating a structure that enables quick and continuous identification of systemic risks, ICT-based vulnerabilities, and opportunities in the health model. But in a health system where technology adoption is low and the poverty level is below United Nations’ average; it is very difficult to change health outcomes for a large number of people through analytic transformation. Findings show that health administrators in Nigeria are not properly equipped with accurate data systems needed to analyse population demands and distribute health resources. An equitable distribution of health benefits from any health model requires basic understanding of the target population as well as a guideline for synthesizing and prioritizing opportunities. Therefore, health managers should look beyond diagnostics codes and maximize other reliable sources of data such as signs, symptoms, and pharmacy information.

Payment transformation highlights the role of costing in the overall efficiency of healthcare delivery. Efforts to lower cost of healthcare services while improving the quality of health outcomes for communities are widely considered unrealistic among scholars who argue that reforms (such as technology diffusion in care delivery) come huge costs that should be distributed. In most cases, patients are the worst hit. However, stakeholders in the health innovation ecosystem should conduct a careful analysis of country-specific cost structure and take proactive steps towards reducing expenditure while at the same time sustaining quality of care.

The payment transformation level of HM strategy requires health systems to consistently review and adjust their adopted fee-for-service payment models. But research findings show that health administrators in Nigeria, especially those in federal and state health facilities, have clear understanding of the total cost of care borne by patients. But health professionals in both private and public sector organizations are obligated to balance finance risks in favour of their employers, thereby defeating patients’ expectations from a value-based PHC system. Health administrators in Nigeria therefore need clear understanding of the total cost of healthcare and regularly conduct risk assessment of contracts to ensure that patients pay reduced charges for services received.

Care transformation is the last stage of HM strategy adopted in Nigeria’s PHC system. It highlights the responsibility of clinical managers to identify risks and implement necessary policies that significantly improve performance of care delivery models. Care transformation therefore entails optimizing care management processes and outcomes to support individuals and households across the continuum of care. But findings from the Nigerian health system show there is inconsistency in care modelling. Moreover, the dysfunctional state of PHC infrastructure makes it difficult for health managers to adopt a well-streamlined health management approach capable of enhancing people-oriented activities. For these reasons, health professionals in Nigeria are yet to fully explore vast opportunities in health innovation to transform inpatient and outpatient care. With knowledge of the opportunities presented by innovation in PHC systems, as well as proper use of these HM strategies (data transformation, analytic transformation, payment transformation, and care transformation), stakeholders in the Nigerian health sector can approach healthcare from a broader continuum-care-care perspective that ensures health resources are distributed according to needs.