The Nigerian Economic Summit Group (NESG), in collaboration with the Federal Ministry of Budget and Economic Planning, on Thursday, convened a pre-summit dialogue to explore how stronger private-sector partnerships can help strengthen Nigeria’s primary healthcare system and advance the country’s progress towards Universal Health Coverage (UHC).
The virtual dialogue, with the theme: “Powering PHC to UHC: Unlocking Private Sector Partnership,” brought together stakeholders from government, healthcare delivery, philanthropy and the private sector to examine opportunities for improving primary healthcare financing, service delivery, infrastructure, quality and access.
In her welcome address, Dr Sade Adebanjo, a member of the Steering Committee of the NESG Health Policy Commission (HPC), described primary healthcare as the foundation and critical entry point of Nigeria’s healthcare system.
She noted that persistent gaps in financing, quality of care, human resources, infrastructure and service delivery continue to limit the ability of primary healthcare facilities to meet the needs of underserved communities.
Dr Adebanjo also highlighted the significant contribution of the private sector to Nigeria’s healthcare ecosystem, noting that it accounts for an estimated 60 to 70 per cent of healthcare service delivery.
She stressed that leveraging the resources, expertise and capabilities of both the public and private sectors would be essential to expanding access to quality and affordable healthcare and building a more resilient primary healthcare system.
During the panel session, Dr Ben Nkechika, Managing Director of Almond Healthcare Services Limited, called for greater clarity and alignment among stakeholders on the role of the private sector in advancing UHC through primary healthcare.
He explained that private-sector participation should extend beyond viewing private providers as contractors or profit-oriented businesses to include advocacy, health sensitisation, community mobilisation, demand generation, financing, technology and service delivery.
He cautioned against interventions that are disconnected from the realities of primary healthcare facilities, stressing that private-sector support should respond directly to the core functions and needs of PHCs.
He also emphasised the importance of engaging local governments and communities, which he identified as critical to the ownership and sustainability of primary healthcare services.
Drawing on the experience of a programme implemented in Delta State, Dr Nkechika said the concession of 15 primary healthcare facilities to private-sector operators, supported by incentives, technology, expertise and collaboration with Local Government Areas and communities, demonstrated the potential of structured public-private partnerships.
According to him, the participating facilities recorded zero maternal deaths over a five-year period, alongside improvements in infant health outcomes.
Dr Nkata Chuku, Deputy Director, Health Systems Strengthening & Primary Healthcare at the Gates Foundation, identified government ownership from the outset and sustainable domestic financing as critical to the scalability of public-private partnership models.
He noted that government participation should begin during the design and implementation of PPPs rather than after models have been developed and tested.
Dr Chuku stressed the importance of clear purchasing pathways that establish who pays for healthcare services, explaining that strategic purchasing mechanisms can protect poor and vulnerable populations from high out-of-pocket expenditure while creating a sustainable route for private providers to recover their investments.
He also identified viability gap funding and other de-risking mechanisms as potential tools for attracting private capital to underserved areas.
He advocated a pragmatic approach that builds on Nigeria’s existing health financing architecture, including the National Health Insurance Authority (NHIA), Basic Health Care Provision Fund (BHCPF) and state health insurance schemes.
Strengthening strategic purchasing, provider accreditation, quality assurance and payment mechanisms, he noted, could create opportunities for more private providers to serve underserved communities.
For Dr Ifunanya Ilodibe, Chief Executive Officer of EHA Clinics, said the key challenge is ensuring that financing for primary healthcare is sustainable and predictable.
She noted that even social-impact healthcare providers must operate within financially viable models and identified low insurance coverage, heavy reliance on out-of-pocket payments and delayed reimbursements as challenges to sustaining services in underserved communities.
Dr Ilodibe also called for greater accountability between public and private partners, describing the current situation as a form of “regulatory asymmetry,” where private providers face stringent accreditation, regulatory and auditing requirements while government obligations under PPP agreements may not always be enforced with similar rigour.
She advocated clearer contractual commitments covering facility upgrades, patient enrolment, capitation guarantees, payment timelines and penalties for non-compliance.
She further called for expanded health insurance coverage among Nigeria’s large informal-sector population, particularly in underserved communities, noting that predictable patient volumes and timely payments through the NHIA and state health insurance schemes would provide greater certainty for private providers to invest in PHC delivery.
Dr Amos Mogaji, Chairman, House Committee on Health Care Services/Establishments, identified weak revenue certainty, fragmented regulation, cumbersome government processes and weaknesses in contracting and procurement as barriers to private-sector investment in primary healthcare.
He noted that investors require greater clarity around risks, responsibilities and expected outcomes, while multiple regulatory and reporting requirements can create unnecessary bureaucracy.
Dr Mogaji also highlighted the lack of integrated systems linking public and private primary healthcare providers and called for clearer responsibilities and more streamlined engagement between both sectors.
To address these challenges, he proposed the establishment of a national PHC public-private partnership framework that clearly defines the roles, responsibilities and expectations of government and private-sector participants.
He also advocated a PHC investment and risk-sharing facility to provide greater clarity around investment risks and responsibilities.
Dr Mogaji further emphasised the importance of policy continuity across administrations, noting that frameworks and agreements established to support private-sector participation should be sustained to build investor confidence.
He said greater policy stability, institutional coordination and clarity would create an environment for increased private-sector investment, expertise and innovation in primary healthcare.
SOURCE: Independent