HEALTHCARE IN AFRICA

I initially wrote this article 20 months ago. I wrote from a hospital ward where a dear family member seemed to be taking his last breaths as he battled with a second episode of stroke. At a point, it became expedient to move him for a CT scan. But the closest center was at least 3 hours away and it was quite risky to move him out of the hospital. I wondered how he would survive when the hospital even lacked a basic patient monitor though it was the best in town! 

As I watched him helplessly, I pondered the healthcare industry in Nigeria and indeed the world over. Here are my thoughts.

Healthcare is a largely fragmented industry with so many players doing their "own thing". In the hospital setting, we have so many small practices incurring multiple administrative costs and making healthcare expensive to the majority of Citizens. At least, I can afford a good standard of care for my loved ones. Not many can say that.

Having many small practices has been the norm for a long time. But the effect is that we miss out on economies of scale. Economies of scale help us to spend less money per unit of good produced. This happens when we pool our resources together and produce in large quantities. i.e., the larger the production plant, the cheaper the cost of production. Economies of scale is a proportionate savings in cost gained by an increase in the level of production. However, a point may be reached when an additional unit of output does not add to the savings in cost. Rather it leads to a further increase in cost.

Let’s take a simplistic healthcare example:

 Hospital A (GP) sees 12 patients pay day and spends N 10,000 maintaining its facilities daily. Hospital B (ENT) sees 5 patients and spends same N 10, 000 on daily overhead. Hospital C (OBS/GYNE) sees 15 patients and spends N 10,000 daily.

 It will make more economic sense if these three practices operate under one roof. That way, their overhead cost will reduce because each practice will bear part of the overhead cost. The unit cost of processing each patient will also reduce making it possible to charge less money from patients.

At several fora where I have had the opportunity to speak, I have often advocated that doctors pool their resources together to create mega hospitals instead of having mushroom clinics all over the place (my apologies).  If the hospital that admitted my relative had a CT scan, he may have lived longer. If we have mega hospitals that possess quality facilities and skills, we will definitely do better as a healthcare professionals.

It is my opinion that having bigger and better managed hospitals will help increase the standard and quality of healthcare in Africa.. We need to save more lives; we need to reduce patient morbidity. There is work to be done!

The fragmentation in healthcare is not the only problem we have. There are lots more. But I just want to highlight this issue for now. 

What is your opinion? Can doctors partner successfully? Can we come together to grow bigger and better? Think about it and send in your comments.