Chidi IzuwahSubmitted as Final Project for online FFD MOOC Course

December 2015

Proposal for Public Private Collaboration to Finance the Expansion of Health Care Delivery to Rural and Peri Urban

Nigeria using Privately Managed Solar Powered Mobile Medical Units

Goldman Sachs projections places Nigeria as;

• the 20th largest economy by 2025 on the basis of GDP

• 21st on per Capita Income (2025).

• 12th largest economy if Nigeria maintains its growth trajectory to 2050,

overtaking Korea, Italy and Canada on GDP.

Projections (Top 20 League)

......Nigeria centre of the world

Health Care Pedigree in Nigeria

UCH Ibadan goes back to 1948. UCH as it is today was commissioned on 20th November, 1957 @ 500 beds

Amongst first 8 Hospitals in the Commonwealth in the 60s (Commonwealth includes -UK, Canada, Australia, Malaysia, Singapore, New Zealand, South Africa, India, Pakistan, Botswana, Mauritius)

Saudi Royal Family used UCH in the 60s; Referral hospital for the whole of WA in the 60s plus

WB/IFC – Queen Mamamotho PPP Hospital opened in 2011 (425 beds)

Health Care Pedigree in Nigeria

Open Heart Surgery at University of Nigeria Teaching Hospital – First in Nigeria and Sub Saharan Africa in 1974 (Professors Yaccoub, Udekwu, Nwafor, Anyanwu…continued by Prof. Martins Aghaji)

Portable Anesthesia Ventilator invented by Prof. Eziashi

Health Care Pedigree in Nigeria at Large –Admiral John Agwunobi

John O. Agwunobi, MD, MBA, MPH served as the 12th Assistant Secretary for Health (ASH) from December 17, 2005 to September , 2007. During his term as the ASH, he was a serving member of the United States Public Health Service Commissioned Corps, a uniformed service, and held the rank of four-star admiral. Agwunobi was born in Dundee, Scotland. His father trained as a medical doctor in Great Britain and then returned to his native Nigeria, so Agwunobi was largely raised in Nigeria. He received his medical training at the University of Jos, where his father was a professor of medicine

Health Care Pedigree in Nigeria at Large – Dr. Sam Dagogo-Jack

Samuel E. Dagogo-Jack is the A.C. Mullins Endowed Professor in Translational Research, Professor of Medicine, and Chief, Division of Endocrinology, Diabetes and Metabolism at the University of Tennessee Health Science Center, Memphis, TN. He is also Director of the Postgraduate Specialist Training Program in Endocrinology, Diabetes and Metabolism at UTHSC, and Director of the Clinical Research Unit, Clinical and Translational Research Institute at UTHSC. Dr. Dagogo-Jack earned his medical degree (MBBS) from the University of Ibadan Medical School in Nigeria. US Presidential Award Winner

Achievements Continue till today

Renal Transplant Lagos University Teaching Hospital – since 2011

IVF Babies

Best Medical Student in Ghana 2013 – Ms. Tinuade Okoro

Best Medical Student in Russia 2013 – Victor Olalusi (GPA 5.0)

Aminu Kano Teaching Hospital (AKTH) – Renal Transplant Jan 2013

Delta State University Teaching Hospital Oghara – Pace Maker Implant April 2013

Coronary Artery Catherization, Angiopasty & Stenting – UCH

AKTH – Fertility and Child Birth by 54 year old woman

......Gapminder – Health Situation Now

Health Equity – Rural Nigeria Poor Carecentre of the world

Case for Action

Updated GAPMINDER chart clearly shows that life expectancy in Nigeria is in the wrong quadrant due to absence of quality healthcare infrastructure

The Nigerian Health Equity map clearly shows that rural dwellers are at a big disadvantage with respect to access to healthcare facilities

The result is high maternal and child mortality rates by emerging countries standards of healthcare provisions

The rich and urban in Nigeria can afford health tourism but the rural poor are left to their hard luck’(and die they do)

This situation is unconsienable and unacceptable

…Proposed Solution

• Create a Public Private Collaboration Platform with the National Primary Healthcare Delivery Agency (NPHCDA) of Nigeria as Lead Agency (NPHCDA Lead PHC agency of the Federal Government of Nigeria)

• Platform to Provide Public and Private Sector Funding

• Funding will be use to procure 2 Solar Mobile Medical Units and 2 support vehicles to serve each Local Government in Nigeria (There are 774 Local Governments in Nigeria)

• The Operations and Management of the Solar Mobile Medical Units will be concessioned to private sector health operators

• Private Sector Health Operators will provide contracted health care services to rural Nigerians

• Private Operators will be paid a fixed monthly fee by the Community Health Insurance Scheme pool of the National Health Insurance Scheme based on the worldly acclaimed Obio Community Health Insurance Model. Community members will be required on affordability basis to subscribe to the Community Health Insurance Scheme to received services

• The poorest community members will be served subscription free as funds from private Philanthrophy will be sourced to pay their bills

Partners

National Primary Health Care Delivery Agency – Lead Agency

Bill and Melinda Gates Foundation

Dangote Foundation

MTN Foundation

Private Sector Health Alliance Nigeria

States and Local Governments

Contracted Qualified Private Health Care Providers

National Health Insurance Scheme (Community Health Insurance Scheme Pool)

SOLAR POWERED MEDICAL MOBILE UNITS (SMMU) PROJECT

Objective: To provide primary health facilities to people living in the rural areas of

Nigeria. Since there are often no hospitals in rural areas. The proposed public private

colloboraton will procure SMMU and concession them to qualified private health care

operators. A fixed budget from the CHIS of the NHIS will be paid to each SMMU

operator. The SMMUs will provide the same facilities as a basic hospital. The SMMU

operators will be selected by competitive bidding

NPHCDA + Partners

SPV Private Health Care

Operator

NPHCDA + Partners M & E

NHIS (CHIS)

RURAL PATIENTS

Concession and Service

Agreement

Monitor

MonitorPayments

Co –Payment if

necessary/Subscriptio

n

TRANSANCTION STRUCTURE

......Solar Powered Mobile Medical Unit

SMMU should be a fully air-conditioned TATA 709 chassis or equivalent vehicle of similar

dimension from a reputed manufacturer. It should fitted with an up-to-date Global Positioning

System (GPS) in order to keep track of the vehicle. The mobile van should be designed

keeping in mind the following criteria: ease of deployment, privacy, community acceptance

and cost.

A second vehicle (TATA Sumo/ Mahindra Bolero/equivalent) will accompany the medical van;

this second vehicle is used for the purpose of carriage of the medical personnel and it is also

to be used as an ambulance for transporting patients in the case of an emergency.

The SMMUs will be equipped with 33 life-saving drugs, which will be issued free of cost to

patients in need. They are also equipped with various medical tools and facilities: Semi Auto-

Analyzer, Portable X-ray Unit, Portable ECG, Microscope, Screen, Stretcher, O.T Table with

standard accessories, Stools, Dressing Trolley/Instrument Trolley, Dressing Drums, Oxygen

Cylinder, Suction Machine, Ophthalmoscope, Refraction Set, Horoscope, Mobile Light/ Ceiling

Light (OT Light), Centrifugal Machine, Hemoglobin Meter, Glucometer, Autoclave, Incubator,

Urine Analyzer, Vaccine Carrier, Weighing Machines - adult and infant, Stethoscope, BP

Instrument, Suture Removal Kit, Pregnancy Test Kit, IUD Insertion Kit, Starter, Regent Kit, HIV

Testing kit, General Instrument Kit, First Aid Kit, various other test and surgery kits, normal

ambulance appliances like foldable furniture, waste basket, linen, mattress, mackintosh

sheets, fire extinguisher etc. It also has a silent DG set, Audio-Visual equipment with

projection system, 40” LCD, P&A System and a cell phone.

Functional Specifications and Requirements for SMMU

Responsibility of SMMU Operators

• Takeover and maintain SMMU vehicle, equipment’s and software

• Install, operate and maintain additional appropriate facilities

• Provide technical manpower to run the SMMU and provide medical services to assigned area

• Provide technical back up for maintenance of the system

• Provide detailed reports and maintain database of SMMU services as per pro formas provided at the time of signing of the contract, or as issued by the NPHCDA from time to time

Medical Services Provided by SMMUs

• Referral of complicated cases

• Early detection of tuberculosis, malaria, leprosy and other locally endemic communicable diseases as well as non-communicable diseases such as hypertension, diabetes and cataract cases.

• Minor surgical procedures and suturing

• Anti-natal checkups and related services

• Promotion of institutional deliveries

• Immunization clinics

• Treatment of common paediatric illnesses, diarrhoea, pneumonia, respiratory tract infections, sexually transmitted diseases

• Family planning services - counselling for spacing and permanent methods, distribution of contraceptives

• Investigations like haemoglobin, urine examination for sugar and albumin, clinical detection of tuberculosis.

• Issue ART drugs and insecticide treated nets

Manpower Specification for SMMU

• The manpower required for the program is to be providedby the SMMU Operator

• Each SMMU is accompanied by the following: 1 veryexperienced Doctor, 1 nurse, 1 pharmacist, 1 operationtheatre assistant, 1 x-ray technician, 1 lab attendant, 1Auxiliary Nurse Midwife (ANM) and 1 driver. The SMMUoperator should be able to attend to about 120 patientsper day.

Next Steps for PPC Solar Mobile Medical Units Projects

• Hold Stakeholder Buy in Workshop• Develop and approve business case by stakeholders• Arrange lifecycle financing for 5 years• Set up governance and operations structures• Specify and procure Solar Powered Mobile Medical Units• Procure Private Operators – Competitive Bidding• Hold Training and operational testing phase• Commence operations all over rural Nigeria with a significant

Presidential Launch Event• Carryout regular monitoring and evaluation

THANK YOU

7 Things That Will Destroy Us

Wealth without work

Pleasure without conscience

Knowledge without character

Commerce without morality

Science without humanity

Worship without sacrifice

Politics without principle

- Mahatma Ghandi

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