The Nigeria Governors’ Forum hosted its First Public-Private Partnership Network in Health meeting (NPPN) via zoom with the Infrastructure Concession Regulatory Commission (ICRC) on Tuesday, April 26th.

The meeting was the first of its kind in 2022 and the Executive Director of the NGF, Mr. Abdulateef Shittu said he was glad to meet all on the journey to recovery.

‘‘I believe the deliberations from this meeting would be robust and there would be a sustainable approach to improving the social structure and thus, a better use of taxpayer’s money,’’ said Mr. Shittu.

The objectives of the meeting were to discuss the NPPN interventions that came about in Kaduna and Yobe State.

To better inform participants of the work being done by the ICRC, a presentation was made by Mike Ohiani, the Acting Director-General of the ICRC.
He highlighted that some of the responsibilities of their agency are to take custody of every concession agreement made under the Act and monitor compliance with the terms and conditions of such agreement.

The responsibilities also include ensuring efficient execution of any concession agreement or contract entered by the Government.
They ensure compliance with provisions of the Act and perform any other duties as may be directed by Mr. President.

Other responsibilities of ICRC also pertain to the partnerships with the United Nations in the delivery of the Sustainable development goals (SDG), the partnership with FGN in achieving the Universal Health Coverage (UHC), and other government health policies.

They also ensure that PPPs have cost-efficient and high-quality healthcare thereby reducing the financing gap.

In terms of what the PPP entails, a PPP (Public-Private Partnership) is a contractual agreement between a public agency (federal, state, or local) and a private sector entity, through the agreement, the skills, and assets of each sector (public and private) are shared in delivering a service of the facility for the use of the public.

In addition to the sharing of resources, each party shares in the risks and rewards potential in the delivery of the service and or facility.

The benefits of the PPPs are equitable risk sharing; innovation; service delivery and private financing, and opportunities abound for private sector participation along the healthcare value chain in Nigeria.

The PPP framework in Nigeria is common law jurisdiction, the framework preceded the ICRC Act. There is the Infrastructure Concession Regulatory Commission Act 2005, the National Policy on PPP, and the Regulations, Guidelines, and Circulars.

Regarding ICRC's achievements in line with the PPP framework, it includes the concession of the Garki Hospital to a private party as the first in the health sector.

The PPP contract was signed in March 2007 for a period of 15 years after which the hospital will be handed back to the Federal Government.

The ICRC took custody of this contract through a legacy project and has been managing it. The ICRC has also been involved in mediation between both parties when they had issues when the contract was about to expire.

The PPP contract is currently in dispute and the parties are in court. But contracts still render quality medical services to the community.

A second achievement of the ICRC is the Warehouse in a Box project which was in response to the substantial gap in warehousing of essential primary and secondary healthcare products.

The ICRC worked with FMoh and the USAID/Donors to concession the operation and maintenance of 2 world-class warehouses in Abuja and Lagos to a private party for a period of 5 years.

As for the implementation of the project, it was a huge success with over 100% utilization even during the COVID period. The project was also a major revenue earner for the Government.

Thirdly, the ICRC issued a certificate of compliance to the NNPC Medical Limited for the establishment of multi-specialist hospitals in Abuja and Port-Harcourt through PPS.

The fourth was the renovation and upgrading of the School of Nursing Student Hostel University College Hospital Ibadan. ICRC issued a certificate of compliance.

Though the ICRC has recorded some success, there are some challenges that it must overcome.

Some of the challenges the ICRC faces is that Nigeria spends less than 5% of its budget on health as opposed to the recommended 15% of the total budget best practice.

Another challenge is most of the stock of 55 Federal Tertiary care facilities in Nigeria built and equipped are between 20-115 years ago.
There is also the issue of quality in the financing, efficiency, and sustainability of health care.

More healthcare challenges include maternal mortality rates. There are 576 per 100,000 live births, with infant mortality of 64.6 per 1,000 live births. This is often due to the wrong diagnosis, poor sanitation, and hygiene, disease surveillance, accidents and emergencies, and corruption.
After the discussion on the challenges faced by the ICRC, the Honourable Commissioner of Health in Kaduna State, H.E. Amina Mohammed Baloni informed the participants of the Investments in the State Health Sector.

The vision of the Public-Private Partnership in Kaduna State is to contribute to the attainment of Universal Health Coverage (UHC) through effective public-private partnerships.

The mission is to promote equitable and effective partnerships between the public and private sectors for the provision of quality and affordable health services.

The overall goal of this policy is to use the Public-Private Partnership (PPP) arrangement to enhance and harmonize access to quality and affordable healthcare services across the state, especially in rural communities.

Kaduna state entered PPP arrangements on drugs and other health technologies among others.

This includes a zip line that has a logistics network of autonomous delivery drones to improve access and availability of routine and emergency medicine to health facilities, services will operate around the clock from their distribution centres equipped with 30 drones and deliver to over 1,000 health facilities.

A second initiative is the PMG MAN: this is in the pursuance of the State Government in ensuring the supply of quality and affordable essential medicines to the citizens of the state the PMG-MAN local pharma companies were engaged in a Public-Private Partnership.

Some of the success in Kaduna State are the zip line operations which includes the construction of the first out of 3 distribution centers for Kaduna State in Pambegua that is complete.

There is also the step-down training and baseline assessment for onboarded zipline health facilities conducted.
Some of the benefits of the zipline to the state are that it will improve the on-shelf availability of life-saving health commodities like essential medicines, vaccines, and biologics.

It would eliminate delays in delivering life-saving commodities to hard-to-reach areas in terms of difficult terrain and insecurity thereby making available commodities that would impact improvements in key health indices such as maternal and child mortality.

The zipline would also transform the setting in which healthcare is delivered, expanding equitable access while decreasing costs and enabling more data-driven decision-making in public health.

As for the interventions in Yobe State, the Honourable Commissioner for Health, Dr. Muhammad Lawan Gana discussed YODMA.

The Yobe State Government established Yobe State Drugs and Medical Consumables Management Agency (YODMA) as an Agency under the Ministry of Health to strengthen the State’s public health care value chain towards the achievement of universal health coverage.

YODMA was established in December of 2019 for governance and coordination of procurement, storage, and distribution of medicines, medical and laboratory supplies, and medical consumables in Yobe State.

The Agency started storage and distribution of health commodities initially with the Central Medical Stores (CMS) in Damaturu and scaled up through the establishment of zonal warehouses in Gashu’a and Potiskum Zones respectively.

Some of the key milestones of YODMA include that from August 2020, ARC_ESM has brokered the PPP relationship between YODMA and 5 members of the Pharma Group and one International Distributor for the supply of high quality and affordable health commodities.

As a result, YODMA stockout rate has significantly improved from 23.5% baseline in December 2020 to 12.24% in the year 2021, and 7% in Q1 2022.

In addition, YODMA conducts periodic forecasting and quantification with the Local Manufacturers for improved planning at both levels, thereby contributing to the strengthening of local manufacturing.

YODMA has achieved a 98% coverage rate for planned health facilities in 2021, that is 200 of the targeted 204 capitalized health facilities that were covered with an uninterrupted supply of health commodities.

Other key milestones include that YODMA partnership with PMG-MAN has led to the capacity building of YODMA staff through on-the-job training and internship placements. During health emergencies, there is easy access to medical supplies.

YODMA and other DMAs are working with PMG-MAN and the NGF to improve conditions for local manufacturers to ensure medicines' security for the country.

There would also be periodic review meetings that help to align business processes thus ensuring smooth implementation of the MoU.

By Isioma Ononye,
Social Media Officer

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