Our Work in Nigeria
Managed Care and Family Wellness in Nigeria
While Nigeria is a vibrant, modernizing country, it suffers from poor health outcomes. Mortality for children under five is estimated at 201 per 1,000 live births and maternal mortality is about 800 per 100,000 live births. Total fertility is 5.7 with only 8% prevalence of modern contraceptive methods. The public health care system in Nigeria is struggling to meet the health needs of the population.
At the request of USAID/Nigeria, the Abt Associates-led Private Sector Partnerships (PSP-One) project developed a strategy to expand and improve the provision of family planning (FP) and reproductive health (RH) products and services in the private health sector.
PSP-One saw that the introduction of the National Health Insurance Scheme (NHIS) presented an opportunity to address the needs of private providers and to encourage them to promote family planning and other preventive care. The NHIS launched a new national health insurance plan in 2005 that it is implementing through private health insurance companies using a preferred provider model. Participating consumers choose their primary care provider, who receives a set capitation fee every month for most basic services. This provides an incentive for providers to keep their patients healthy and to manage their costs effectively. The NHIS accredits these local companies, called Health Maintenance Organizations or HMOs, to enroll providers and clients and administer the program according to the benefit package.
The PSP-One project in Nigeria expects to succeed by addressing two needs of private providers: (1) learning how to manage their practices differently with more clients under a fixed monthly capitation fee and (2) providing them technical updates in key preventive care areas of family wellness - FP, malaria, nutrition and routine immunization.
PSP-One initiated the project in late 2006 partnering with one of the leading HMOs, Total Health Trust (THT). One of the first HMOs in Nigeria, THT started in 1990 and now has over 3,000 provider clinics and specialists among its enrolled providers. The providers comprise individual physicians, primary health clinics, maternity homes, mission and private hospitals. With financial and technical support from PSP-One, THT took the lead in teaching managed care and worked in partnership with Society for Family Health (SFH), a local social marketing NGO, which is responsible for teaching the family wellness health modules.
By the end of 2007, the project developed Managed Care and Family Wellness (MCFW) training modules and trained over 360 private providers across five states. The project commenced work with the Medical and Dental Council of Nigeria towards accreditation of the training curriculum for continuing medical education credit. Obtaining this accreditation will help sustain provider interest well beyond the life of the project and allow the HMOs to charge a fee to cover the costs of the training. Memoranda of Interest have been signed with six new HMOs, which will increase the pool of trainers. The increased pool of trainers will help scale up the MCFW training to nine states.
Access to Finance Program
Upon a USAID Nigeria request, PSP-One conducted an assessment of the interest of commercial banks for private health sector credit-enhancement instruments and identified the constraints to health sector lending and the role that DCA guarantee could play in mitigating those constraints. Based on the findings, in August 2007, PSP-One prepared a training program for private health service and product providers with subcontractor Banyan Global to improve provider business practices and increase their access to credit. PSP-One launched the access to finance training in Lagos with the training of medical providers from THT. The program was recently expanded to Abuja with the training of 24 pharmacists from the Community Pharmacists of Nigeria. By the end of 2007, the project trained 199 providers and trainers and conducted two training of trainers workshops involving participants from the THT, Guild of Medical Directors, and another HMO, United Healthcare, to prepare them as master trainers to educate other providers. PSP-One has also initiated work with local banks to increase lending in the health sector so private clinics can expand their practices and reach a larger share of the population. One bank has developed a loan product specifically for pharmacists. The project is also seeking opportunities to expand the Access to Finance training program to the other sectors of Nigerian economy through collaboration with other donor-funded programs.
Making Oral Contraceptive Brands More Affordable in Nigeria
The PSP-One project in Nigeria will promote and facilitate the private sector provision of affordable contraceptives in an economically sustainable manner through the introduction of Locon, a new low-dose mid-priced oral contraceptive (OC) manufactured by FamyCare, an Indian generic pharmaceutical company.
A 2006 assessment of the Nigerian contraceptive market by PSP-One found commercial oral contraceptive brands to be several times more expensive than social marketing products. The absence of affordable commercial brands, together with users’ reliance on free and subsidized commodities, was in sharp contrast with other pharmaceutical categories. Using average drug prices in pharmacies as a basis of comparison, the assessment team concluded that an oral contraceptive product priced below $1.50 USD would likely be affordable to mainstream users.
Following the assessment, PSP-One initiated discussions with potential suppliers for the Nigeria market among manufacturers based in various countries. In January 2007, PSP-One brokered a distribution contract between a reputable Indian manufacturer and a local social marketing organization with an interest in diversifying its product portfolio.
Marketing a product at a commercially sustainable price in a largely subsidized market however is extremely challenging. In order to build added value (and justify a higher price), a different formulation would be needed. In addition, the brand would need dedicated promotional support above and beyond what the current market potential might call for until a critical market share was achieved. The low-dose OC Locon will be launched with the intent of shifting urban consumers with a higher willingness to pay from highly subsidized social marketing brand and government-supplied oral contraceptives. Society for Family Health (SFH) will serve as a local social marketing distributor of the product. Partnering with an NGO is an innovation that tests the ability of the non-profit to establish product lines that are fully sustainable and that may have the potential to cross-subsidize other social marketing activities.
This public/private partnership is innovative in several areas: USAID (through the PSP-One project) supported the introduction of a commercial product in a highly subsidized African market; an Indian generic manufacturer enters the commercial market in another developing country; a new OC formulation will be registered in a market where consumers previously had little choice; and a local NGO has been contracted to distribute a for-profit commercial brand through its social marketing program.
