Ugonna Ogueri is Managing Director, Crystal Thorpe; a hospital operator, in this interview with ENE OSANG, speaks on how the newly introduced private wing at the University of Abuja Teaching Hospital (UATH) can help boost healthcare service delivery, training of clinicians and non-clinicians as well as enhance productivity in the health sector.
Tell us about yourself? I left Nigeria to Europe when I was 16 years old for my education because my Dad wanted me to acquire additional exposure and training. I studied law up to masters’ degree and also went into management and obtained an MBA which give me the right foundation and skills. While I was waiting to complete my solicitors training in England a friend was setting up an agency to hire doctors and nurse for hospitals and asked me to join them.
So I got involved in placing clinicians for hospitals in England which was my fi rst venture into the healthcare industry subsequently I worked for various other private healthcare organizations. I joined the NHS in the UK when Tony Blair was Prime Minister and the government decided it wanted to attract other professionals from the private sector especially with business and fi nance background into the National Health Service (NHS) to help improve operational performance and effi ciency of the health system, deal with patient satisfaction issues and reduce waiting time.
Th at was how I got recruited into hospital management where I worked for some years and rose to associate director in charge of projects and service improvement. What point did you decide to return to Nigeria? Coming back home has always been on my mind. First from a personal experience my mother worked in government hospitals in Nigeria as a nurse until she died partly due to inadequate treatment in a government hospital. So when my father had prostate cancer we brought him to England he had a key-hole surgery performed and was discharged 48 hours after his surgery. However, my father’s friend had the same prostrate almost at a similar time but did not want to travel abroad. He had an open surgery in Nigeria which was successful but he died from poor postsurgery management. Both experiences stayed on mind ever since and I thought how can I make a diff erence.
Meanwhile at the NHS, I was in charge of service improvement for the organisation looking at the quality of care, analyzing how it can be better delivered in a more efficient manner. This also included reducing the “waiting time” for patients to do certain procedures like hip, knee replacement etc. I worked with Nigerian doctors and nurses and sometimes managing patients that had travelled from Nigeria to London for care. At some point it struck me that we could see these same patients at home in Nigeria.
In 2011, I was invited to speak at an event organized by Nigerian clinicians in Diaspora under the umbrella of Medical Association of Nigerian Doctors across Great Britain (MANSAG) at a debate on whether the Nigerian Diaspora should come back to support healthcare Th ink about it most people who can pay for healthcare today are going abroad to seek services which depletes the resources available at home to support local-made-in-Nigeria services. Nigeria loses around $1 billion annual to medical tourism which if available at home we would be able to address a lot of challenges. development in our country or not.
At that conference what struck me was that we had over 250 Nigerian-born clinicians of diff erent areas of specialty in the hall and most of them had their basic degrees in Nigeria. So I said to them during my speech let’s go home to help develop our country but some of them complained about the quality of facilities at home and said if we could deliver the kind of facilities you have in Europe they would come back to practice in Nigeria and help train younger clinicians. Th at is why we are here today. How long have you been back, any challenges? I have been coming home since 2011 but have been based in Abuja since 2016.
We have experienced so many diff erent challenges but challenges were expected so no surprises there. Tell us about this wing in this hospital? Th e private wing is a co-location center within University of Abuja Teaching Hospital (UATH) compound.
It is similar to private wings in the NHS. It is one of several government initiatives to support the teaching hospital and encourage private sector participation to increase access to healthcare for the masses in Nigeria, curb medical tourism, reverse brain drain and support training of health workers. Governments the world over have struggled to meet the growing healthcare needs of its population due to dwindling resources and paucity of funds especially as people live longer these days and disease burden continues to evolve towards lifestyle related long-term conditions most of which requires investment in technology and skills which is currently in short supply in Nigeria. This could also partly explain the medical tourism phenomenon.
Hence most governments are looking for other ways to meet the needs of their population. In 2012 we were invited again to a MANSAG event and this time we had offi cials from Federal Ministry of Health wooing Nigerians in Diaspora to come and invest back home. Several of the doctors complained about the challenges at home which included the ease of doing business and administrative bottlenecks.
But we took up the challenge, wrote to the ministry on partnering with a government hospital to support services. Th e ministry introduced us to UATH. What difference will this private wing make to the hospital being in same location? The private wing will increase access to healthcare for Nigerian masses. It will enhance patient care and human capital development which is what healthcare is about. The center will render complementary services it will not substitute the hospital because there would always be government hospitals. Most importantly it will give the average Nigerian a choice and attract patients that would ordinarily not seek services in a government hospital. Basically what we off er is complementary service, enhance service delivery and support training of clinicians. For example, to start with we are introducing minimal invasive surgeries and interventional cardiology services at the center which will support diagnosis, treatment and training for clinicians.
At the moment, most hospitals do mostly open surgeries which increase the average of length of stay for patients, infection risk and cost. The center will focus on quality care by “putting patients fi rst” and human capital development. For us training is essential to quality patient care and increasing the level of confi dence in our health system. We are working with Nigerian doctors in Diaspora who would come home to support the development of specialist clinical services, knowledge transfer and training in areas such as but not exclusively interventional cardiology, oncology and surgeries in general.
How accessible would it be in terms of bills? Our focus is on delivering standardized quality care to Nigerians and ensuring that our patients get value for money when they come to seek care. We believe that by increasing accessibility for Nigerians and encouraging patients to seek care at home we would achieve the critical mass that helps deliver cost effi ciencies and lower cost of service delivery.
Our billing model is very transparent we have an itemized charging system to ensure that patients pay for only what they utilize. Th is would help the center meet its own cost, pay doctors, nurses and buy consumables to be able to continue to deliver services. Th ink about it most people who can pay for healthcare today are going abroad to seek services which depletes the resources available at home to support local-madein-Nigeria services. Nigeria loses around $1 billion annual to medical tourism which if available at home we would be able to address a lot of challenges. What do you think is lacking in the Nigerian healthcare system?
We need to develop infrastructures with the necessary technology and boost training of specialist clinicians to support the changing disease pattern in the country which is now tilting towards noncommunicable, longer term conditions. We have done well in tackling communicable diseases. As part of developing infrastructure we also need to enforce processes, protocols and procedures to ensure that the system functions and introduce remedial actions and sanctions where necessary.
Health systems function as an ecosystem where the linkages well established between primary, secondary and tertiary care units support by a strong referral system. Also we need measure performance by outcomes and set benchmarks for clinical excellence which is measurable and understandable by all practitioners. Finally we need to update our healthcare laws, policies and regulatory framework to support the practice of modern medicine. How best can government solve the myraid of problems in the health sector?
Just as I said earlier I think that if the government can implement a performance based “payment by result” model it will help appraise where we are today in the health sector and then we can begin to forecast where we want to be. Th is will also help boost productivity in the sector and put patient care at the focal point for clinical excellence. Another thing to consider is for the government to make tertiary hospitals independent so that they can generate their own resources, fund their own expenditure and pursue medical research.
Th is would position Nigeria as a hub for healthcare in West Africa and attract investment into tertiary hospitals. If this is done properly, it will generate lots of jobs and employment for our teeming population, boost the sectors’ contribution to GDP and generate tax revenues for the government. For example, most Nigerians that travels to London for healthcare visit NHS hospitals due to the cost of private clinics over there. Again Nigerians and indeed other nationals can visit those government hospitals in the UK because they are independently run as “foundation trusts” and provide services to them as private patients.
Are you saying doctors are currently underpaid? I say outcome, performance, payment by results, they are all linked. Th ere should be a direct link between quality of care and remuneration for clinicians. There are so many consultations, laboratory tests and surgeries that need to be done in a day, a week, a month etc for which patients visit hospitals.
And if we can increase productivity in the health industry as a nation, some of the issues around remuneration would have been addressed. In turn it will bring about improved quality of care for patients as most people will opt to stay at home rather than go abroad for treatment. How do you feel coming back to work in the Nigerian system? Th e Nigerian system is unique which makes it interesting.
I feel there’s a lot to be done to get to where we want to be, hence we want to move at a pace but at the same time adapting things to suit our environment which is challenging. We have had our fair share of challenges but it is the opportunities that those challenges have presented to us that matter most. My passion is to see that healthcare works in Nigeria and that Nigerians can stay at home to receive care if they wish and not travel just because the services are either inadequate or not available.
