Private Sector, Public Impact: Building the Partnerships That Make Care Work - Part 1 | A Conversation with Njide Ndili

The private sector delivers up to 70% of healthcare in Nigeria, so why are partnerships with the public sector still so hard to scale?

In this episode, Njide Ndili joins us to break down what it actually takes to move public-private partnerships from buzzwords to real, working systems.

From financing and policy to trust and execution, this conversation explores the foundations needed to turn healthcare innovation into sustainable care.

Season 2 is about Building the Rails and this is where it starts.

🎧 Listen now

#TheCurePodcast #AfricanHealthcare #HealthSystems #HealthcareAfrica #TCHealth

Transcript

SPEAKER_00 0:07

Hello, healthcare enthusiasts, and welcome back to The Cure. This is the podcast where we're revolutionizing the business of healthcare in Africa one conversation at a time. I'm your host, Tim Topekoka, and in each episode, I sit down with the people shaping the future of healthcare in Africa, from founders to investors to policymakers and beyond. And our goal is very simple to infuse hope back into the narrative by spotlighting the momentum and the progress that's already unfolding across the continent. And at the heart of every episode is one key question: What does it take to revolutionize the business model in African healthcare? All our insights are powered by TC Health, your trusted source for healthcare and pharmaceutical insights in sub-Saharan Africa. So let's get into today's episode. We are in season two, and I'm very excited because we are exploring a new theme. So our season one theme was by Africa for Africa. So we were exploring what does it take for Africans to build innovations fit for purpose for Africa. But now in season two, we're exploring what does it take to build the rails? So the regulation, the financing, the partnerships, the infrastructure that turn a promising idea into reliable healthcare, into universal health coverage. And today's conversation sits right at the center of that theme. Here's a reality that a lot of people often overlook. The private sector provides and delivers about 60 to 70% of all healthcare in Nigeria. So that's private hospitals, pharmacies, clinics, diagnostics labs, HMOs, they're often the first and the only, in some cases, point of care for millions and millions of Nigerians. But the relationship between the private sector and the public system, while progressing in so many meaningful ways, can sometimes still be marked by fragment, fragmentation, mistrust, some missed opportunities. And so that's where public-private partnerships come in. And people talk about PPPs all the time. You know, PPPs have become this kind of buzzword in global health, in African healthcare. Everyone agrees that PPPs are important. I don't think there's any debate that PPPs are unimportant. But when you look at the track record, the number of PPPs that have actually scaled beyond maybe a pilot phase, et cetera, that have fundamentally shifted how care is delivered on the continent, that list, while incredible, can feel a bit short. So today we're going to unpack what it actually takes to make partnerships between government and the private sector work in practice and in reality. And my guest today is someone who has been at the intersection of this work for over 25 years. So I'm going to introduce Mrs. Injide Indili. I'm going to go into a lot of your background. So you might blush. But Mrs. Injide Indili is the president of the Healthcare Federation of Nigeria, the largest coalition of private healthcare stakeholders in the country. HFN represents everyone from hospital groups and HMOs to diagnostics companies, medical device companies, pharmaceutical manufacturers, all united under this belief, under this umbrella, that Nigeria can't reach universal health coverage without activating the private sector. By day, Mrs. Indilee also serves as the country director for Farm Access Foundation in Nigeria, an international NGO that has been on the ground for years actually building practical PPP models, which I'm really excited to unpack today all across the country, from health insurance in Lagos to also work in Ghana as well. And Tanzania and Tanzania. Yes. So this is these are the things we're going to jump into today. We've also seen quality improvement through safe care, which we're going to dive into revitalizing primary healthcare centers all across through PPPs. She was also the commissioner of for the Lancet and Financial Times Commission on Digital Health and AI, a commission which ran from October 2019 to December 2021.

SPEAKER_04 4:40

That's correct.

SPEAKER_00 4:40

And explored the impact of digital health, AI, and other kind of technologies on the frontier on universal health coverage, which is everyone's talking about AI, everyone's talking about digital health. And she was a founding member of the Digital Transformation for Health Lab, which identifies technologies that accelerate universal health coverage, particularly for low and middle-income countries. And young people. And young people, who are the vast majority of our audience.

SPEAKER_06 5:10

And digital uh natives that use the technologies, which is why it's very important.

SPEAKER_00 5:15

Yes. Yeah. And we talked about this in our episode five, I believe, of our last season with Michael Famarotti. So he's one of the co-founders of Steers. Okay. And they gather financial data all across the continent. And we were introducing this idea that because of how many young people there are in Africa, like our population is predominantly young, predominantly under the age of 18. And the youth are incredibly digitally native. Like we grew up with technology that creates this tipping point, this breeding ground for innovation and all of the ways that we can accelerate universal health coverage, health tech to really get us there because now you're looking at a population that is tech first. So that's a really interesting development, which ties really well. And then lastly, you sit on the steering committee of the Nigerian Economic Summit Group, Health Policy Commission. I love introducing my guests because it gives me so much joy to be able to actually speak to people with so much rich experience. So, Injide, welcome to The Cure.

SPEAKER_06 6:24

Thank you.

SPEAKER_00 6:28

Thank you. So before we dive in, I want to share something very exciting. The Cure is partnering with the World Health Expo Lagos, West Africa's leading medical trade event that's taking place from the 2nd to the 4th of June 2026 at the Landmark Center in Lagos. WHX brings together over 500 exhibitors, 8,000 healthcare professionals, and 30 world-renowned speakers across medical devices, diagnostics, healthcare infrastructure, digital health. The list goes on. This year's Hospital Investment and Buyer Leadership Forum is tackling one of the themes that, as you know, we care deeply about on this show. How do we build resilient health supply chains? How do we localize manufacturing? How do we create strategic partnerships, wink wink, that strengthen healthcare delivery across West Africa? That's a very Buy Africa for Africa theme. We're going to be on the ground at WHX bringing you live interactive content straight from the floor, interviews with key leaders, behind-the-scenes conversations, and the kind of insights that you won't get just from the press release. So we can't wait to bring that energy to our listeners and stay tuned for our WHX coverage. And if you're attending, come find us. I know and attending.

SPEAKER_02 7:50

Yes, we will find you.

SPEAKER_06 7:51

Please find us because uh we have been partners to WHX formerly uh Informa um over the last 10 years. Um bringing together public and private. So we run their leadership uh summit. Um and it's usually very interesting. This year we're going to have uh two directors from the Africa CDC. Wow, as you know, um the whole talk now is about Africa's health, security, and sovereignty. So I think it's important that we are all aligned. So I'm even surprised that you are you know aligning with uh WHX. So it shows that all the lines somehow are coming together. All the lines are crossing. I love it. I love it.

SPEAKER_00 8:31

Exciting. Very by Africa for Africa. I must find those directors. We'll find a way, we'll find a way to get maybe a few thoughts from them. Um but now, as always, before we jump into our conversation today, I wanted to take a couple of minutes to appropriately set the stage and outline some of the key signals in the landscape around public-private partnerships, the private healthcare sector in Nigeria, health financing, and just all the things that would frame our conversation today. Injude, I invite you to interrupt me, to jump in, to add some color to all the things that I'm saying. Um, but we'll go through a few themes around the context and the landscape. So, the first thing I wanted to touch on is the state of healthcare delivery in Nigeria. So, challenges, but also the momentum that we are seeing. Um, so let's start with the challenge. Nigeria's health system has historically been underfunded. Government health expenditure hovers around 3 to 5% of the national budget, which is well below that 15% target that was set by the Abuja Declaration. Out-of-pocket spending accounts for over 70% of total expenditure on healthcare, which places an enormous financial pressure on the households, on the average Nigerian. Um, in October last year, the Nigerian Association of Resident Doctors flagged that the actual doctor-to-patient ratio stands roughly at one doctor per over 9,000 people.

SPEAKER_06 10:04

That's correct. And getting worse because doctors are still leaving.

SPEAKER_00 10:07

Jakvar is still a thing. And that's almost 10 times below what the WHO recommends of one per 1,000. That's correct. So WHO recommends one per 1,000, and we're at one per 9,000, over 9,000. The number is actually 9,000 and something. Um so that's something that really serves as a limiting factor to how we can deliver healthcare in the country. Um, but there are real signs of momentum. I actually attended the HFN 2026 conference. Um, it was amazing. I shared some of my thoughts on LinkedIn. Um, but it was revealed on the public sector roundtable where we had the state commissioners for health for Lagos State, Open State, we had representatives from Algon, yeah, yeah, yeah. Um and the Lagos government, the state governors forum. And it was revealed on that panel that nine states have actually hit that 15% Abuja Declaration target. So while federally or as a whole, we're around 3 to 5%. There are actually nine states in Nigeria that have actually hit 15% of their state budget um on healthcare. Ogun State is primed to join that list. I think the health commissioner, um, Dr. Tomikoka for um Ogun State mentioned that um they're around 13%. So they're inching closer and closer. Um and in May 2022, the National Health Insurance Authority Act was signed into law, and that replaces the old NHIS and is making health insurance mandatory for all Nigerians and legal residents for the first time. And this was a landmark shift from a voluntary scheme that had failed to enroll more than 10% of the population to now it's mandatory. There's real enforcement kind of going on, and states are starting to act on it. So, in that same panel, that panel, it's it's probably on your website somewhere. Can we listen back? Yes. I would implore everyone to please go back and listen to that panel. Um, because at that panel, um, the health commissioner for Lagos State, Professor Abayomi, announced that Lagos State is the first to move toward actually mandating and actively enforcing compliance with the NHIA Act. And that means if you live in Lagos, if you're a resident of Lagos, very soon or already it is mandatory. And we will, the government is ensuring that everyone has access to health insurance throughout the state. And that's significant because Lagos being huge, when Lagos moves, other states tend to follow just because of their share size and influence. And I believe you are involved in that mandatory health insurance, working with the Lagos state government.

SPEAKER_06 12:55

Well, we're we're we're supporting um and also you know trying to collaborate because it's not really just about enforcement. You have to be sure that you know the supply side is ready. Yes. And that's where we're working with uh LASHMA, which is the Lagos State uh health insurance agency, to ensure that you know there are hospitals that are good enough for people to uh to visit um if if they ever fall sick. So um I think it's you know the the the enforcement is just about to start. It hasn't started, uh, but um the word is that this year, 2026, you know, it will it will start.

SPEAKER_00 13:33

Yeah. And I think that's the beauty of public-private partnerships, because on one side, the public sector has a mandate, they have a directive, it's signed into law, and it's the opportunity to improve and expand health insurance coverage. But on the other side, the private sector has the technical expertise to raise the questions of let's make sure our facilities are ready. How do we kind of advance that? And when those two come together, that's when things fundamentally shift. Um and the private sector, like I mentioned, this includes um hospitals, clinics, etc., even faith-based organizations, delivers an estimated 60 to 70 percent of healthcare services in Africa. And even according to the WHO, Nigeria actually has the highest proportion of care seeking in the private health sector in all of Africa. So many nine for many Nigerians, we know the pharmacy, the pay-to-medicine vendor, the private clinic is their first point of entry into the system when they fall ill. Um, some may view this as a gap in the system, but it is the system. Like it quite frankly is the system. Um, and I say this because the private sector is cross-cutting across the wealthy and the poor. So when we think private sector, we tend to think, oh, it's it's it's only for the richest of the rich or people who can afford it. But the WHO actually noted that the private sector in Africa caters to all wealth quintiles. So when we say private sector, everyone has access to some private care. So the private sector has managed to kind of uh I think infiltrate is a poor word choice, but all across, you know, the rich, the poor, the underserved, the rural, the low-income, and most families rely on.

SPEAKER_06 15:28

It's basically about trust. Who do you trust? You know, so if you're rich, you still go to who you trust. If you're poor, you still go to who you trust. So there may be different uh uh strata of uh clinics or help providers that they access, but it's still really about trust.

SPEAKER_00 15:46

Yeah, and and that's a conversation we are going to have in this episode. Like, how do we build that trust? You know, there's certain things that, you know, have happened in the past year that really put that spotlight on how do we build trust in the healthcare system. Um but now we'll jump into the depth and the breadth of Nigeria's private healthcare system. Um, when we say the private sector delivers healthcare in Nigeria, we're not just talking about one type of provider. We're talking about a huge diverse ecosystem. So Nigeria has some of the largest private hospital groups in West Africa. We have companies like, you know, Lagoon Hospitals, Nisa Premier, Reddington, etc. We have private HMOs, Hygija, um, AXA, Total Health Trust, managing insurance for so many Nigerians. Um, diagnostic chains, we have Sin Labs, Serba Lancet, you know, building that brick and mortar labs across the country. And then we have the pharmaceutical manufacturing sector, which we expanded on in our first episode with Charles Ogumwui, who's the CEO of SciGen. Um, it's one of the largest in Africa. So we have over a hundred registered manufacturers in our sub-region of ECOWAS. 60% of drug manufacturing takes place in Nigeria. The market is valued at around $4.5 billion, and it's growing. Um, so homegrown companies like MZOL and FITSIN are expanding capacity and showing incredible profitability. And I think one fantastic example recently, the founder of FITSIN and his family um are set to take home, I think, over $1 million in dividends. Dividends following 20 standout 2025, that the performance was just underscoring the company's growing dominance on the Nigerian exchange group. I think their profits grew 125% from um, I believe 9.8 billion to 109 billion. Like it's just showing the potential in the private healthcare sector in Nigeria. And then we have the health tech ecosystem. Um, it's among one of the most active on the continent. So health tech is our third largest startup sector in the country by startup count. So we're behind fintech and e-commerce. We have companies like Helium Health, which raised a $30 million Series B in 2023. That was the second largest ever for an African health tech company. And they've digitized over 3 million patient records across eight countries. Um, and across Africa in 2025, health tech raised $215 million in equity funding, which represented an over 200% increase from the previous years. So when we talk about the private sector in Nigerian healthcare, we're talking about everything from a community pharmacy in a rural state in northern Nigeria to a biotech startup in Yabba to a cancer center in Leki, like it's everything. And the question is just how do we re how do we connect all of that energy and capacity and capital from the private sector to the public sector that needs a lot of this technical expertise, needs a lot of this energy, a lot of this capacity. Um and then the last point that I'll raise, which we'll expand on, is obviously PPPs, public-private partnerships. They have been a fixture in Nigerian health policy conversations for years. Like I said, everyone agrees they matter. There's no debate. But the honest truth is that most have remained at the tertiary level or as one-off projects rather than these scalable system-wide models. That said, we have seen some very meaningful proof points. Um, Pharmaccess developed the Access to Finance scheme, which is a PPP model designed to revitalize, run down government primary healthcare centers. And they do this by bringing in the private sector operators, um, backing this up by low interest loans from the medical credit fund and the bank of industry, um, bundled with safe care to actually, like you said, government has a mandate, but we need to make sure that the quality of the facilities is up to that mandate. Um, and this model has been deployed in Delta State, in Lagos State, with remarkable results, um, including, and again, I referenced the panel from the HFI conference. This means you need to go and listen to it. This third time is the charm. Um, remarkable results. Um, I think it was the representative from the Association of Local Governments of Nigeria, Algon, that mentioned that um such a um PPP occurred, and through a structured model, 15 facilities were operationalized. Um, and then we saw zero maternal deaths over a five-year period in those remote primary healthcare facilities. So it just touches on the sheer need for these things to work and to scale. So that's the landscape. Um, I don't want to talk about it. I'm impressed. Thank you. Thank you. We we pride ourselves on coming in informed so that not only our audience kind of has enough context to follow on in our conversation, but also for us to really be aware of the context in which we're speaking of. Um, you live it on a day-to-day basis.

SPEAKER_06 21:37

I'm impressed, very comprehensive.

SPEAKER_00 21:39

Thank you. Thank you. So we're going to unpack a lot of this today because a private sector that is already carrying the bulk of the weight, growing in scale, growing in sophistication, um, and a public system that is stretched thin, but beginning to put the right Legislative frameworks in place. The question is, how do we combine? How do we bring both together? How do we build the structures, the trust, the incentives to make private sector involvement count at scale? So the question is not, is it possible? The question is, it is possible, but how? And how do we make that scale? So that's exactly what we're going to be unpacking today. I say all of this context and background, but I actually want to start with you and your journey. Injinea, you've spent over 25 years in healthcare leadership, not just in Nigeria, but in the US as well. You've worked as a consultant, you led, you're leading pharma access in Nigeria. Now you lead the biggest private sector healthcare coalition in the country. I want you to take us back. What drew you to healthcare in the first place? And how did your path lead you to this intersection of private and public? Especially because I need all our viewers to know you study computer science for your undergraduate degree, which seems quite far off from what you're doing today. And I think that's a fascinating trajectory in itself. So I'd love you to just talk us through your journey of where you started and how you got here today.

SPEAKER_06 23:18

So it's been a really uh interesting journey for me. Um, I come from a family of medical people. Um, I have six siblings, and uh, five of them have PhDs in pharmacy, and one is a medical doctor. Um initially I looked at how long they were spending in school and the size of the books they were reading, and like nowhere on earth. So I went the opposite way to computer science. Um but very quickly, you know, you know, working in the United States, um I found myself working for startup HMOs. Um I started out with Amerih, um, then progressed to Independence Blue Cross in Philadelphia, then Cigna Insurance. And that was when I really, it all started making sense to me. I started connecting my computer science background with systems. Uh the fact that healthcare is really all about systems, architecture, data flow, process flow, uh interoperability, you know, and uh trust, you know, because one without the other, it it doesn't it doesn't matter how talented you are, especially in the healthcare system, it breaks down. So um that was really how I started. I moved back to Nigeria in 2020, uh 2003. Um and uh my initial foray was with one of the largest HMOs. I was a consultant to them. Um, but there was an interesting uh dynamic. Um my father, uh, who at the time lived in Enugu, was extremely ill. In fact, I crossed paths. Once I uh I arrived in Nigeria, I went to see him within two days, and he was actually, you know, bloated, he was being treated for cough. Um so by the time I relayed this to my siblings in the US, they're like, okay, let's get him on a plane, and you know, so we flew him out to Houston. It turns out he had a kidney failure.

SPEAKER_00 25:25

Oh wow.

SPEAKER_06 25:26

Um and he never treated for cough. And he was because he was the his body was retaining water, you know, probably affecting his lungs, and he was coughing, so the treatment was focused. So he was misdiagnosed. Um, so of course he left with my mom, who just took a handbag and off they went to Houston. They never made it back to Nigeria. Um, they but at least they got 10 years of life uh because he had to go on uh uh dialysis three times a week and so on and so forth. But you know, it kind of um got me thinking, really. I mean, at that age, having served the Nigerian government for many years because it was a civil servant, you know, when a civil servant was really a civil servant, and then he's stuck in the US because he doesn't trust the healthcare system that initially misdiagnosed him.

SPEAKER_05 26:18

Yeah.

SPEAKER_06 26:18

So, you know, that also propelled me, you know, what can I do uh to help the system here? Yeah. Um, aside from, you know, all the work that we do trying to build structures and so on, but a system that I myself can access. I don't want to go back and live in the US in my old age. I want to be here around my friends and family, you know, places I'm familiar with. So that for me, that was uh a lesson and a turning point that actually the passion that drives me today is how can I create a system that um I can also utilize that is fit for purpose, no matter how you know, whether I start in a small uh community and scale it. But really, that is really my passion. So for me, computer science is really the backbone because it helps me see it from a bigger picture, the connectivity, yeah, the fact that it's a system, it's not just uh hospital doctor focused or pharmacy focused, but really interconnected ecosystem that you know trust must be the you know the currency, yeah, and it must be anchored on digital technology. Yeah, so for me, that's where my computer science comes into play. Yeah, without the data, you know, you can't improve the system, you don't know what you're measuring, yeah, and so on and so forth. So uh for me, that's really the connection. Um, how you know I'm navigating this. And by the way, people keep calling me doctor, doctory. I'm not a doctor.

SPEAKER_00 27:51

That's why people call you doctor.

SPEAKER_06 27:53

I keep correcting them, and now it's it's against the law.

SPEAKER_00 27:56

You might as well be in the healthcare space for how long?

SPEAKER_06 28:00

For a long time, but it now it's against the law. But the Minister of Education just said yes, you cannot except you have a PhD. You can't become doctor, you can be called doctor. So I'm saying this out to everybody. Please don't put me in jail. Disclaimer, don't put me in jail. Yes, it was just uh proclaimed uh maybe a couple of days ago. Oh, wow you cannot use doctor in your name except you have a PhD. Oh wow, I'm not about to get a PhD.

SPEAKER_00 28:28

Be very careful, but it's interesting you mentioned the move from the US back to Nigeria and the parallel move of your parents to the US. I'm curious, what did you see first in the Nigerian healthcare landscape that made you feel like this is where I need to be? And also what lessons did you bring from the US landscape into the Nigerian landscape? Not just, oh, this is it works so well in the US, but what doesn't work that we shouldn't replicate, and what works that maybe you see, you know, being appropriate for our landscape?

SPEAKER_06 29:04

So uh first of all, you have to uh look at the two um systems as one well resourced and the other not very well resourced. I mean, even though we call ourselves resource restricted, there's still a lot of resources in Nigeria. Um, but the US uh fought me um quite a number of lessons. One is that um the payment system, the financial system, actually drives the behavior of the system. What that means is how you reimburse, how the payments are structured, actually drives how care is provided. So a typical example is you know, in the fact that uh you have insurance in the US.

SPEAKER_05 29:49

Yeah.

SPEAKER_06 29:49

Um it enables people to seek care when they need it, but at the same time, it also you know influences the way providers bill, for example.

SPEAKER_03 30:00

Yeah.

SPEAKER_06 30:01

Uh so it has its ups and downs. Um so on the one hand, that is well resourced doesn't mean it's very efficient.

SPEAKER_05 30:09

Yeah.

SPEAKER_06 30:09

But bottom line is that the way the system is structured and the payment uh flow determines the way care is delivered, is accessed, the quality, and so on. So it's very important to look at the healthcare sector as a system with multiple stakeholders that must work together to ensure that you know the patient is at the center and you know revolves around the patient. Um so so that's that's on the one hand. On the side of Nigeria, for me, I thought, you know, a country of 220 million people, of which I wasn't counted, nor was my husband. I mean, and yet you can't really trust that you go into a hospital and get the quality of care that you need because there's no transparency. We're still paying out of pocket. Um, people are not even trusting the hospitals per se. There's a public, there's a private. So how do you how can you intervene? How can you make this, you know, um a system that can show transparency? You're able to benchmark between a hospital in Victoria Island and a hospital in Ushhodi. What are the, you know, how can you compare apples to apples, yeah, systems, people, uh, processes, equipment, you know, so that in and of itself is um where we need to start. That was the gap I was seeing. And luckily for me, um I started out with um helping one HMO, I would try not to mention any names, um, to structure their systems, their processes, because it was at the time when the national health insurance schemes were being rolled out.

SPEAKER_05 32:01

Yeah.

SPEAKER_06 32:02

Um, and I know for a fact uh from my own background in the US, where uh, you know, very easily uh Cigna Independence Blue Cross is covering 10 million people, huge, multiple fee schedules, different types of plans, coordination of benefits. So the systems are actually quite complex. Then you come back to Nigeria where it's paper-based, you know, um HMO has maybe at the time, maybe 50,000 lives, but yet there's one doctor who is looking at the claims and approving it. So shifting that mindset to be ready for inflow of uh enrollees and patients required a structured system approach. So defining processes, being able to um, you know, uh lay out on technology, being able to train people to recognize the codes, coding methodology, yeah. What are you using so that that way you're able to automate, auto-adjudicate? These are the baseline really for a system, for it to be automated, yeah, for it to be transparent, for it to be efficient, predictable, you know. So these are some of the things I saw. For me, it was exciting because you know, I bring back all the knowledge and I have to try and retrofit it into a context where the infrastructure is shaky, yeah, uh, the knowledge is also shaky. Uh, the people don't know their rights, yeah, you know, because you know that there are quite there's quite some huge gaps. So for me, you know, this was an environment where I could deploy quite a lot of what I'd learnt in the US. And um I've been doing that uh since since I returned.

SPEAKER_00 33:50

I'm seeing how your computer science degree would have been incredibly helpful. And I also like the point that you raised about um the way that the payment systems are designed will influence the patterns in which people seek or deliver care. Because um, so I've spent a lot of my career in advising in the US system and advising pharma companies on how to launch their drugs, how to get reimbursed by the Cygners of the world, the BCBS of the world. And um we're seeing how a lot of pharma companies are now their pipelines are going into the most innovative types of drugs you've ever seen, like gene therapies. You take one injection and you're cured of a genetic disease. Cured we can't really determine cures yet, but virtually cured, but they're pricing it at like three million per dose, four million per dose. And when it was just one for like a really often, like very rare disease product or disease area, it was like, okay, we could stomach this for you know, the one child out of five hundred thousand, you know, that's not going to affect our bottom line in a significant way on a regular basis. But then every pharma company started launching two million, three million here, four million there. So now they're having to redesign the systems of like how do we even design our benefits package? Like, we might have to carve this out as its own benefit package at a higher cost. And then I juxtaposed that with we had a conversation with uh Dr. Nato in our last um season. So he's the founder of Weller Health, they do micro insurance. Um and he was talking about how Nigerians the way they seek care, they pay for curative care. They don't want to pay for preventive care because there's no system that's scaled enough to cover that care. So they only want to spend when it's a curative procedure. So he crunched the numbers and he was like, the vast majority of spending, out-of-pocket spending, goes to curatives. They come and they say, Give me medicine, give me something to cure this headache, give me something to take. And even if you may not even need a pill, there's something about receiving a pill and paying for, yes, I paid for this medication that Nigerians just trust, you know.

SPEAKER_06 36:27

That's our experience, really. Um, and the definition of uh patient uh satisfaction varies. We found very quickly that uh some of our implementation that the number of drugs you give a patient you know makes you a very good doctor. Yeah. But really, you know, do they really need all those drugs? You know, so the the what's what the patients um uh describe as quality care may not really be actual quality quality care. So this is where behavioral change needs to happen, provide um and really education, patient education. Yeah, and a lot of that falls under the preventive where they need to be aware. But I must say that things have changed because we did a lot of work uh back back maybe about 10 years ago around that changing behavior, changing even the doctors prescribing behavior and so on. And we've come a long way. I can say that things are changing. I think people are now a little bit more aware, yeah, yeah, yeah. You know, so it's very important.

SPEAKER_00 37:35

Yeah, yeah. And I'd love to then talk about this the private sector reality. So we set the stage earlier with that striking statistic that the private sector delivers up to 70% of healthcare in Nigeria, and for a sector that carries so much weight, it often feels like it has to fight an uphill battle in policy conversations. And so, as someone who leads the federation that represents these private sector providers, can you just help us understand the composition of Nigeria's private healthcare sector? So, who are the players? What do they look like? What are their biggest challenges? Um, when we say private sector, people might picture one large hospital chain. But what does the typical private healthcare provider in Nigeria actually look like? How many are SMEs, sole proprietors, faith-based? There's a range, and I'd love you to.

SPEAKER_06 38:31

No, no, you you're you're quite right, and you're mentioning them. Majority of private providers are SMEs. And they are, you know, in the rural areas, hard-to-reach areas. There are your mom and pop, you know, chemists around the corner, pay to medicine vendors, community pharmacies, maternity homes. Um, and to be honest, even I don't know the number. Yeah. You know, uh, because a lot of them are unseen, a lot of them are operating under the radar. Yeah. Um, but really that's where people go. That's where the communities go. That's where, you know, they are trusted, they are accessible.

SPEAKER_05 39:13

Yeah.

SPEAKER_06 39:13

You know, they they've been known for a while, you know, in their communities. So people just go there. Yeah. Whether they are providing the right kind of care is then the question we need to be asking.

SPEAKER_05 39:26

Yeah.

SPEAKER_06 39:27

Um so I think it's important that we don't overlook them. Um, but rather, how do we begin to imagine a healthcare system or imagine the private sector um as, you know, that gap, uh, you know, as we will call it, where people they are filling a gap that exists. Yeah. Because people are not able to go to the bigger tertiary hospitals or what have you. They go to where they feel they can get care. So our role really is um to ensure that we improve the quality of care where people are going. Yeah. You know, and I'll come to that later because that's really Pharmacess's view in terms of, you know, how do we ensure that the informal sector and the fragmentation of the healthcare system, especially around the private providers, is um, you know, we create a system that is workable to improve their quality, to enable them, you know, kind of go step by step to improve the the care that they deliver. Um I must add this that a friend of mine, who is a renowned medical doctor, owns right now, currently owns um about four clinics or running four clinics uh in Nigeria. His father was killed by a painter medicine vendor who gave him an injection and it was an overdose of the medication he was supposed to. Yes. So, and this is in the raw area because I was the closest to him. He went there, and by the time you know the son went over there, show me what you gave him, and I realized that it was an overdose.

SPEAKER_00 41:13

Oh my gosh. Right?

SPEAKER_06 41:15

So the point is don't neglect those guys. Yeah, yeah, yeah. But how do you create a referral pathway? How do you equip them with the tools and the knowledge and the skills and the connectivity so that they can refer or they can, you know, there's a referral linkage to a better system. Yeah, that's what we need to think about, and not about shutting them down because they are not licensed and so on and so forth. So that's one thing. But coming back to the issue of challenges for the private sector providers, of course, there are many. One, and then the most important one is the power situation. Power is so integral to healthcare. Yeah, healthcare is very power-intensive.

SPEAKER_05 41:58

Yeah.

SPEAKER_06 41:59

And if you don't have power, then what are you doing? Yeah, your water, maybe there's a water pump, you know, the power for surgery and so on.

SPEAKER_00 42:07

Yeah. Even this morning, um, looking at Tink Talk, where the executive assistant, we got here and there was no light. And all of these, I mean, this is a microcosm of what a hospital would even need. All of these need lights, these mics, these lights, everything. So we were outside, like getting to pump the diesel into the generator and turn the switch.

SPEAKER_06 42:32

And these are basic infrastructure that needs to power the healthcare system. By the way, I wrote an op ed we have a partnership with Business Day to write ops. Yes, to write op eds about issues in the private health sector space, but also proffering solutions. So we're not there complaining, but actually giving solutions of what could be done, you know, mini grids that you know you can have in an area where other providers can tap into, and maybe non-healthcare providers can also tap into. So yeah, power is one major one, yeah, so that we stop you know doing surgeries with uh your phone light, touch light.

SPEAKER_05 43:12

Yeah.

SPEAKER_06 43:12

Two is uh the Jack Pass syndrome, the fact that we're losing staff, uh, the fact that and we're losing staff not because uh uh they don't want to stay in Nigeria, but because the conditions around which they provide care or they want to operate, uh sometimes is not there. And then, of course, you talk about their family economic situation and so on. So for me, as far access, in the last three years, I think I've lost about 12 doctors to Canada. Um so you see talented workforce migrating. So private sector, you're seeing uh uh turnover of staff, and that is actually financially uh burdensome because you have to keep retraining. Yeah, yeah, you know, there's very little continuity. So that's another problem. Third problem is financial.

SPEAKER_05 44:04

Yeah.

SPEAKER_06 44:04

You know, if there was a way to reward, you know, in a structured way, reliability of finance, you know. So for example, uh insurance systems, um national health insurance uh schemes, how do you pay providers on time uh so that they're able to run their practices efficiently?

SPEAKER_05 44:28

Yeah.

SPEAKER_06 44:28

Um, but even for those paying out of pocket, which is also a problem because oftentimes you hear about uh patients being held hostage because they're owing. And so that these are just some of the issues, then regulation, sometimes, you know, regulation can be complicated and complex, especially when it comes to manufacturing, uh pharmaceutical manufacturing, yeah, and so on. Um so so that all these problems, you know, really affect uh the ability of a private provider to operate uh at their peak.

SPEAKER_05 45:04

Yeah.

SPEAKER_06 45:04

You know, because you're you're working in a very constrained environment and trying to do your best.

SPEAKER_05 45:10

Yeah.

SPEAKER_06 45:10

You know, so um so I would say, you know, the the challenges are a lot and um they are not going away. Um in fact, last year the um Guild of Medical Directors mentioned that um about 40% of the private facilities have closed because you know, either you know, they just couldn't keep up with the the operation uh and the cost of operations, and the SMEs majority.

SPEAKER_00 45:41

SMEs, yeah.

SPEAKER_06 45:42

The SMEs. So these are some of the challenges that private sector is is facing. So for us, is how do we align uh the you know the problems, how do we align our voices, how do we advocate? Yeah, and that's really where HFN comes in because we're now trying to aggregate all the different voices because we are stronger together instead of each association going and meeting the same regulators and saying, Can you do this for me? Or even access to finance. Yeah, you know, how do financial institutions um understand and give uh funding uh or loans to the banks oftentimes uh to the hospitals or private sector providers? Oftentimes is at ridiculous interest rates. So there's a lot of factors affecting the private uh uh health sector, but they remain resilient and uh pushing forward. So yeah, that's why I'm trying my best, um, at least while I have the leadership of uh uh healthcare federation to push forward, advocate, make sure I'm in the room, and uh, you know, highlight some of the problems that uh they they they have come up with.

SPEAKER_00 46:59

Yeah. And I actually want to spend a moment on the efforts of HFN because you mentioned, you know, you've painted a picture of what the private sector looks like. You've painted a picture of the challenges that the private sector providers face. And you you noted that there's this advocacy that needs to happen, this joint voice of advocacy. And I won't spend a moment on a recent policy win for HFN that I think deserves all the attention, all the alarm bells should be ringing. Um so for listeners who may not know, APIs. So I'm just gonna define the thing so that I can contextualize the actu the sheer scale of this win in policy. An API is an active pharmaceutical ingredient, it's like the core chemical compound that makes medicines work. So paracetamol is an API, ibuprofen is an API, um, they're the raw materials for every drug. Nigeria and a lot of Africa, not just Nigeria, imports the vast majority of its APIs from India, China, you name it. And the taxes and duties on these imports, because when you import goods, there's usually taxes and import duties that are applied on that, so fees basically that you have to pay, directly inflate the cost of the locally manufactured medicines that come from these imported APIs. So as much as we're seeing that ramp up of local manufacturing on the continent, the sheer fact that a lot of the APIs are imported and these import duties are placed on them means that that cost inevitably is passed on to the final price of a medicine. So when the pharmaceutical, a Nigerian pharmaceutical company wants to produce an affordable drug locally, they're immediately at a cost advantage because of what it costs to even bring in the raw materials. But, and this is a very big butt, HFN began these high-level engagements with the Nigerian customs in June of 2024. Yes. Building on advocacy that actually started in 2022 because there was a paper submitted to the Federal Ministry of Finance.

SPEAKER_01 49:17

Yes.

SPEAKER_00 49:17

Well, finance, budgets, and national planning. And over time, the effort brought together a broad coalition. So there was the PVAC, so Presidential Initiative for Unlocking Healthcare Value Chain, the Federal Ministries of Health and Finance, the Nigeria Sovereign Investment Authority, and the Nigeria representatives of overseas pharmaceutical manufacturers. And this coalition together worked to define what the framework for actually implementing this sort of policy would be, identifying the eligible companies and outline which pharmaceutical inputs or which APIs would be covered. And as a result, there was a two-year, or there is now a two-year import duty and VAT waiver, i.e., the fees are waived, on pharmaceutical raw materials. And that was implemented by Nigerian Customs in early 2025.

SPEAKER_06 50:13

Yes, early 2025. Yeah.

SPEAKER_00 50:16

I saw that and I was like, this is amazing. I would love you to walk us through that journey of what did the advocacy strategy look like in practice? Like how did you build? Because we just talked about the challenges faced, but I would love to deep dive on how you've actually solved some of those challenges through this coalition, through this advocacy.

SPEAKER_06 50:37

So it was um a collective effort, first of all.

SPEAKER_00 50:41

Yeah.

SPEAKER_06 50:42

Um, I recall that um the prior president of the healthcare federation, uh Dr. Pamela Jai, and you know, a few of us had were invited even before the current uh president was elected into office to help, you know, write a strategy, uh, define, you know, what could be done in the healthcare sector as part of the manifesto. So it started from that. Um, but also the fact that we normally bring our members together uh to tell us what their pain points are. That is actually what defines what we work on, what our advocacy would focus on.

SPEAKER_05 51:25

Yeah.

SPEAKER_06 51:25

What are you know, we bring together the leaders because a lot of them are associations. So we bring together the leaders of the association, yeah, and then each makes a presentation. Sometimes we have uh um maybe the the chair of the national of the health um uh forum in the National Assembly sitting so that the policymakers that can hear directly on the wall. Yeah, then after that we we follow up. We like to write position papers so that we understood very quickly that for government you have to leave something behind. So it's not about talking, document it, justify it, and what is your ask? Very important. Yeah. So um, so this bubbled up the fact that all the APIs are imported, sometimes a slap duty of 70%, 40%, yeah, all sorts of uh very steep. In fact, um uh aside from the APIs, for example, somebody complained about bringing in theater lights, and they were charged almost 60% uh uh uh import duty, classifying it as a chandelier, you know. So yes, yes, uh somebody brought in um an ambulance, it was duty, it was classified as a luxury car. So there were we were finding there were all these misclassifications. So uh first of all, we wrote a position paper, we submitted it to the Ministry of Health. Um, but as we started engaging with the Ministry of Health, we realized that you know it's much more than that.

SPEAKER_05 53:04

Yeah.

SPEAKER_06 53:05

For um VAT and for import duties, it's custom. So we went to Custom, and Custom says, well, we get a directive from the Ministry of Finance.

SPEAKER_00 53:17

Interesting.

SPEAKER_06 53:18

So, you know, that we were finding out as we went along that there's a lot of interministerial agency decisions that needed to be made. So we started walking that that pathway. Uh luckily for us, um, or because of the pressure we were putting, because we were always flying to Abuja, having all these meetings, they were listening to us. Yeah, we made a presentation, we brought customs closer. And the last um honorable minister of health, Dr. Lausa, was actually very helpful to us because he literally brought the Comptroller General of Customs into HFN conference and had him sit and there declared that he was going to give us um a desk within customs so that we could then uh relate directly with customs. But anyway, having said that, you know, this was flagged. Um, we then had to bring, we found out that there were a lot of other people, agencies that needed to be involved. And then PVAC was established, uh, you know, so uh NSIA also got involved. So, you know, all of a sudden, to be honest, we initiated it, but at some point the ball started rolling. Yeah, yeah, and you know, we just took a step back because it was now between agencies and you know having them iron out what the issues are, but ultimately the result is the result. Yeah, there was the the waiver, and it's actually trickling down to the cost of drugs being produced because that waiver has made it cheaper, or at least removed a significant amount of cost from the API. So it's translating into the final cost of the drug and then to the patient. Yeah, and you know, I dare say that the likes of fitting.

SPEAKER_00 55:07

Yeah.

SPEAKER_06 55:08

Um dividends next year, but then you don't say that too loudly because they say, Oh, you're making all this profit. So hey, you know, it's supposed to translate to the patient, but at least we are seeing that companies are benefiting, which is very, very important. Now, um, I'm also in discussions with PVAC to because only a two-year waiver, yes, whether this needs to be extended, um, and what what so there's a lot of analysis going on from their end, and we have an MOU with uh PVAC also on how to advance these kinds of policies, not just for APIs, but in other areas, sectors um in the healthcare sector, uh, to you know create you know efficiency in the value chain. So um I must say it's it was a Herculean task, but um proud that we got it or we were involved in getting it done. Uh there are a lot of players that were also involved, like PMG man, the um association of pharmaceutical manufacturers. So there were different stakeholders, like identifying who needs to benefit, identifying which API needs to, because not all the APIs that get the way, you know, so things like that, you know, the granular detail of it. We were involved to some extent, um, but there were very other many uh actors or players that made sure that you know we're seeing the results that we're seeing now.

SPEAKER_00 56:33

Yeah, and I one, I love what you said when you engage with government, you have to leave something behind. I think that's a tactical and practical lesson that I myself can take and also our listeners can take. But the second I make sure it's stamped received, yeah.

SPEAKER_06 56:51

Somebody received it. Yeah, someone received it. Because what we were told is that that paper is what creates a file, and if you don't have a file in a government agency, like a literal paper file, yeah, yeah, yeah. So once it's received, yeah, they have to open a file. Yeah, and that's when your case starts. So if you don't have any file, then you haven't made any complaints. There's nothing to show that you even visited, yeah. So that was a learning point for us. So everywhere we go now, we prepare a position, but even if we've spoken to it already, but as we're leaving, we hand it over.

SPEAKER_00 57:28

There's you know, signed, received, yeah, evidence that you were there. Yeah, so I love having these conversations because that in and of itself is like a gold mine of advice. Um, I also I'm I'm I'm still just stuck on just the impact. I can't get over the impact of what this kind of policy will have because a 70% line item on your like PL can tank a business opportunity for any even the large to small, like depending on and you know, we're not pharma companies aren't just importing 2 kg of API. I mean, they're importing like large quantities. So when you multiply that, it's it's yeah, it's it's a really big thing. And I think you know, part of my day job, I I advise, you know, global health companies about access to medicines in low and middle income countries. And one of our projects, we're we're advising a a particular partner on how do we lower the cost of goods and API cost when you look at just when you're looking at the stack of costs that ultimately lead to the transfer price or the the actual price of a of a drug, it's huge, it's big, and there's also and this is you know a global company. So I can imagine the sheer impact of something like this for a fitsin for an MZO. And even for the smaller pharmaceutical manufacturers, this is and yes, like we we said, it it will be transferred over to the patients. Patients will feel that when I go to the pharmacy or anything, and I pick up my maybe I have malaria or whatever, you feel that impact that it's gone from 20k to 15k, it's now gone to 10k. You know, like you can feel that impact. So but it's also important now.

SPEAKER_06 59:28

Um, I don't know if you're aware, but uh there's this African Union uh declaration or uh you know policy now on uh sovereignty and security. So yeah. So the whole idea is about how can you produce all you need for your healthcare sector within your uh sovereign uh nation. So if you're telling me that you know um I need to produce all of my, you know, all of my pharmaceuticals, yeah, there's a transition period, right? Before we even start to locally produce uh APIs, you know, there has to be some transition from a transfer of uh of um technology, you know, partners from you know, how do instead of manufacturing it out there, can they import the APIs and manufacture here before they transition locally? So it borders on um, I think the impact is huge and it still needs to be um you know maintained if I if I dare say that, at least for while we stabilize because otherwise, you know, we're gonna go back to our old ways. Yeah, um, yeah. Yeah. So I think it's very important. It's a very important policy.

SPEAKER_05 1:00:44

Yeah.

SPEAKER_06 1:00:44

And I really appreciate uh the His Excellency, the President, because he was very swift. You know, within all this happened within two years of you know, the start. Yeah.

SPEAKER_00 1:00:56

That's a short timeline for this kind of policy. Yeah, exactly. I think people maybe might see two years and say, uh, it took two years, but some things can take.

SPEAKER_04 1:01:07

Yeah, yeah, yeah.

SPEAKER_06 1:01:08

The National Health Insurance Act, how long did it take? Yeah, it was uh at least 15, 20 years when it was initially passed, but yes, we're still here. So I think it's uh it's worthy of recognition.

SPEAKER_00 1:01:20

Oh, for sure. I had to take a moment to just pause and talk about that. But that then, because that is a it was bred from public-private partnership or collaboration to get to that policy. There's advocacy from the private sector and then champions from the public sector that then took it. So that pivots us into actually touching on PPPs, public-private partnerships. Like I said, we use this term a lot. Everyone talks about it. Very few have made it work at scale and sustainably over a long period of time. But you have experience leading the design of PPPs, the implementation of farm access. Um, and we want to dig into what separates the partnerships that actually deliver results from the ones that maybe stay on paper, stay on a disk. And I want to spend some real time in this section because I think this is where our conversation gets the most valuable to our listeners. It's almost like peeking behind the curtain of PPPs. Um, so I don't want to talk about them in the abstract. I want to talk through the actual like mechanics of how these deals come together, where they they they're strong, where they might break, what it takes to make it stick. Um, so I'm going to present if like we're gonna do a case study. I'm gonna do a few farm access projects, and I I would love for you to take us behind the scenes, pull back the curtain, and just walk us through. So the first project is supporting Lagos State's mandatory health insurance rollout. Lagos State, the most popular state in Nigeria, I think the population has surpassed 24, maybe approaching 25 million people, is the first state to move toward mandating and enforcing compliance with the NHIA Act. Farm Access has been technically assisting that rollout of the state's mandatory health insurance scheme using the CarePay platform, um enrollment processes, administration. I would love you to talk us through Farm Access's role in this. How did the partnership with Lagos State originate? How long did it take to get the concept from concept to implementation? Um, Professor Abayomi announced that Lagos is actively enforcing it now or is moving to actively enforce. How is Farm Access supporting that? So really pull back the curtain and show us the bones behind this partnership.

SPEAKER_06 1:03:56

Okay, so it this is um our relationship with Lagos State has been phenomenal and over a period of time. Um and I'll pull back the curtain starting where we originally started um uh as as pharmacists, because there's a thread that runs through. Um, pharmacist came with the concept of um, you know, that that there's quality and access to quality healthcare um really is in a paradigm, right? Um anchored on several pillars, you know, there's the demand side, the supply side, the governance, uh the behavioral change when it comes to patients, and anchored in the middle is the trust factor, yeah, and anchored on digital technology, right? To create that transparency. Um but we we felt that you know, in order to change a vicious uh cycle into a virtuous cycle, there needs to be trust infused. So, how did all this start? Um uh the Netherlands, as you know, is a country, a small country that produces, by the way, a lot of the food that is exported into the rest of the world. Yes. So so they're very they're well known for their um technology around agro, you know, food production.

SPEAKER_05 1:05:31

Yeah.

SPEAKER_06 1:05:32

Uh and they're very well, you know, um, they try to export their technology around food, but they also have a fantastic healthcare system. So Farm Access is a technical assistance partner of the Kingdom of the Netherlands. So we are funded by the Dutch government. Okay. Uh, and it's what we do is really aid in fulfilling their aid to trade agenda, right? So the work that Farm Access does uh with its funding. Is to s to support the healthcare system in Nigeria as well as other African countries by helping improve the way the system is designed. So we see ourselves as entrepreneurs. You can see me in so many different uh areas, but really if we implement, then we're better able to diagnose and figure out what the what the problem is. So in Lagos, we started because we wanted to, you know, we said that for people to pay for uh healthcare, first of all, they have to trust the system.

SPEAKER_05 1:06:35

Yeah.

SPEAKER_06 1:06:36

But that people need to um also be catalyzed or to motivated to pay for their healthcare system. But how do we show them what a good healthcare system needs to be? So we started by uh subsidizing healthcare premium. Uh in Lagos State market women, we just selected a small uh community of market women that had a leadership. Uh then it was your lodger that we were dealing with. And we were subsidizing their insurance by 90%. So the, you know, you can pay, I think then it was like 200 naira for whole year's insurance, or so many years ago. But it was a learning process for us. How do people access care? What is their definition of care or patient satisfaction and so on? Um, so our findings from that system, which we at some point had to shut down because you know, it wasn't really we we got the results that we needed, yeah. Um, was then what informed um the fact that health insurance in Nigeria doesn't need to be voluntary, it has to be mandatory because that was a voluntary scheme. If you remember, the the National Health Insurance Act before was not mandatory. So it has to be mandatory so you don't have adverse selection. Um at some point we're delivering over 100 babies a month in Lagos State from the cohort of enrollees. Yeah. So you could see the adverse selection. So it's all of it's no more insurance, it's now maybe a sickness fund or whatever. Yeah, yeah. Right? That that's the first thing. The second thing is that you have to enroll families. Um, so not just the pregnant women, but the the husband, the other siblings, so that you can spread risk. After all, insurance is risk-pooling.

SPEAKER_05 1:08:27

Yeah.

SPEAKER_06 1:08:28

Um, but most important is that on the supply side, you have to intervene, improve the quality in the hospital so that when the patient goes in, then they are, you know, they are happy with the care that they're giving them. That they would now want to pay for their own insurance by the time we remove the subsidy. But very quickly we learn that there is a cater of people that have to make a choice between eating, yeah, sending their children to school, going to the hospital, and so forth. And that's actually what gave birth to the equity fund of the federal government. The fact that there's a band of people that the government has a responsibility to pay their premium.

SPEAKER_05 1:09:12

Yeah.

SPEAKER_06 1:09:13

So that's really how we started. And Lagos was the first one to pass a health insurance bill into law.

SPEAKER_05 1:09:21

Yeah.

SPEAKER_06 1:09:22

Um, adopting health insurance, the fact that you have to prepay. Then we, you know, we work with Lagos State to help design the benefit package. What goes into the benefit package, actuarial analysis to determine the price, the benefit package price, the premium that will be paid. Working with the hospitals to improve the quality of care delivered.

SPEAKER_05 1:09:43

Yeah.

SPEAKER_06 1:09:44

And that's where SafeCare was born. Uh, safe care is a quality improvement methodology that was developed uh by Pharmaccess Kosasa uh in South Africa, which is a quality accreditation agency, and joint commission international in the US for resource-restricted countries. So it's a stepwise approach to quality improvement. Um so for Lagos, we brought all our knowledge in because then it was a pilot. So we're designing it together with Lagos State, you know, business process manual. Uh we worked with HEFAMA at the time. Yeah. When we were working with HEFAMA, there was it was just a desk within the Ministry of Health, but subsequently they moved out. Uh, we leveraged additional funding from different donors, uh, like Global Fund, uh, FCDO, USAID at the time to support Lagos. So we are the backbone that helped, you know, put in structure around implementation of a mandatory health insurance scheme in Lagos State. So we continue to be their partner. Um, you know, for example, Lagos State, a health insurance uh management agency, LASHMA, is the first agency in the world, and it's been profiled by World Economic Forum to incentivize providers based on their quality uh score. And they're using safe care. So you can look that up because it's on the World Economic Forum.

SPEAKER_00 1:11:15

I knew they were, but I didn't know it was the only first in the world.

SPEAKER_06 1:11:18

It's the first in the world. So the the point now is that can you use that as a model to encourage providers to improve quality, yeah, quality of care. So there's a carrot that they can walk towards.

SPEAKER_05 1:11:31

Yeah, yeah, yeah.

SPEAKER_06 1:11:32

Um, so uh uh safe care levels go from level one to five. Uh so it's like a hotel rating system. Yeah. Yeah. So at least when you go to a level one clinic, you know what to expect. If you a level two clinic, you know what to expect. So the whole idea is you know, if you're level one to three, you get a certain reimbursement for your claims. Uh level, you know, uh four, no, no, one to two, then level uh three and four, you get fifty uh 30% more, and level five, you get 50% more than uh uh those on level one. Yes. So um it is an incentive, but really how do you ensure that providers continue to improve quality? Yeah, because quality is not uh stationary or stagnant. You have to keep you know working on it and improving. So these are just some of the things that you know we try to embed within systems. And what we do is we as farm access, we are not looking to be the continuous implementer. Like I said, we see ourselves as entrepreneurs or innovators, yeah, but we must have a local partner or an agency who we work alongside to ensure that um you know there's scale, there's ownership, there's sustainability and the likes around um some of our innovations. So in Lagos, we're we're very proud uh of the work that they've done. Also in Delta State, by the way. Delta uh currently, I just uh saw the the statistics released by the National Health Insurance Authority around uh enrollments by states. Yeah, and Delta is number one. So they they remain at the forefront. And I I dare say that you know some of the the successes is linked to the PPP that we did in primary healthcare level in Delta State because we went from zero encounters because the clinics were abandoned, the PACs were abandoned, to over 200,000 footfalls within the clinics. Wow, wow. Over a period of time. And as you mentioned, yeah, zero maternal mortality, um, even infant mortality, you know, there's you the numbers that we were recording were uh, you know, were shocking. Yeah, you know, so it it gave us evidence to be able to make a case for PPP or private sector involvement at the primary healthcare level. So which is why we're currently also trying to engage with uh ALGOM to see how this can be replicated. I've made presentations to the governor's forum. Um, but again, what we are trying to work out is the payment system because of course the private sector needs to be paid on time. Yeah and if the funding is with a government agency, then you know there are delays. And the private sector, you know, they they they have to have you know uh uh what I'll call consistency in the fund flow for them to be able to pre-plan and to run the operations efficiently. So um, so yes, it's it's been an interesting um interesting journey supporting uh Lagos State, especially. And I m I must say that Lagos State is unique in the sense that the people in on the government side are very enlightened and very passionate.

SPEAKER_05 1:14:56

Yeah.

SPEAKER_06 1:14:56

So it makes interaction easier, yeah. But then um it's all about the speed of execution, yeah, the speed of um you know implementation as you call it, to make sure that uh it's it's sustained and scaled. Yeah, yeah.

SPEAKER_00 1:15:13

I have so many follow-ups. I will try and streamline them into two. The first one is you mentioned that it started off as a pilot. If you could summarize what were the most important factors from transitioning from pilot to a wider scale with that PPP with the Lagos state government, I would love to understand that because I think that's where a lot of PPPs go to die after the pilot phase, you know, it just dies a slow death. So I'd love to understand what was the most important factor that drove that pushed it from pilot to now it's something that's now kind of being widely implemented. That's my first follow-up. Um, I'll resolve my second follow-up. I'll let you answer the first one. Yeah, yeah, yeah.

SPEAKER_06 1:16:04

The second one is not related to the So the most important thing I must say.

SPEAKER_00 1:16:08

Our conversation with Mrs. Injude in Delhi was so rich and insightful that we had to split it into two parts. We've been discussing everything surrounding public-private partnerships and really what it takes to scale them beyond a pilot phase. So come back in part two for us to continue this discussion. Bye. See you in the next episode.