We Will Scale Up Healthcare Intervention In Next 12 Months – NSIA MD

The Managing Director/Chief Executive Officer, Nigeria Sovereign Investment Authority, Mr. Uche Orji in this Exclusive Interview with THE WHISTLER spoke on the Authority’s intervention in the health care sector, quality of services and equipment used in these medical facilities as well as plans for the sector in the next 12 months among other issues. EXCERPTS…

NSIA is investing funds in Nigeria’s health sector, how much has been invested so far and what is the motivation? How are the investments structured?

The health sector is one of the six strategic investment areas for the NSIA. You cannot talk about future generation without being healthy and alive. And so, we wanted to invest in this as a strategic and important area for Nigeria.

Secondly, we believe the health sector has suffered some years of neglect and so equipment, for example, that is needed for determining health status or managing disease conditions are not as adequate as they should be. Based on personal experience, when I lived in the US, one of the areas Nigeria has comparative advantage is in Medicine. One could reasonably estimate that nearly six out of every ten black Doctors in America are Nigerians.

But it just so happens that we have not equipped our hospitals and healthcare facilities within the country to enable them to operate effectively to deliver life-saving care. Our aim is to develop model centres which will enable Doctors to function appropriately and thereby expand access to quality care across the country.

Thirdly, the health sector is an economically viable one which if accorded due attention has the potential to create significant opportunities not just for our Doctors to work, but also for patients to spend less on the cost of care. 

What areas of medical challenges are you focusing on and why?

We took a hard look at the domestic healthcare sector, spent some time reviewing data and designed a strategy based on key areas of need.

Firstly, we looked at areas of demand in health care. And, we asked basic but pointed questions such as “Where are people spending money?”, “Which ailments force Nigerians to go outside the country?”, and “Can we create an opportunity for people to seek medical care domestically?”

Considering these, we looked at a research done many years ago by the Ministry of Health which showed that the leading causes of medical tourism for Nigerians centre around treatment for cancer, Kidney related diseases and Surgeries.

Recognizing that these are the areas of need, we decided to narrow down and focus on addressing them. Our strategy was very simple. We chose to partner with tertiary medical institutions including Federal Medical Centers and Teaching Hospitals to create Centres of Excellence specifically designed to address the areas identified. 

At the onset, we drew up a pipeline of 13 projects in the healthcare space. But, because we had not invested in the sector before, we decided to start with three projects in the first phase. We commenced with one in each region of the county covering in Kano in the north, Umuahia in the east and Lagos for the west. This was so that we can execute them successfully and start to expand thereafter.

Our first was with the Lagos University Teaching Hospital where we set out to rebuild the Cancer Center with world class equipment. In fact, one of the equipment installed at the facility, following our investment, is only the second of such in the whole of Africa. The Cancer Centre in Lagos commenced operations last year, 2019 and has been very successful so far.

Nigerians no longer have to leave the country to visit Ghana for cancer treatment. The equipment in Ghana are not as good as what we have in LUTH. We have highly trained Nigerians in LUTH and the cost of care at LUTH is about 25 per cent of it costs in Ghana. With this centre, we have been able to provide world class treatment in Nigeria for a fraction of the price of what you pay in Ghana let alone going to Dubai or Germany.

We opened the second centre to cater to needs in diagnostics and radiology in Kano. The facility is located within the Aminu Kano Teaching Hospital. The Kano centre started running earlier this year, 2020. The performance has been stellar so far.  

For the third centre, we partnered with Federal Medical Center Umuahia to build a world class diagnostic and radiology center. Umuahia ought to have started running earlier this year but because of Covid-19, it will start running this month. 

Presently, these are the three healthcare centres the NSIA has developed and operationalized across the country. Having run them now, we have a proper handle of things and we are now moving into other areas. Our plan is to expand our footprint in Cancer treatment while we are also looking at creating centres of excellence for Dialysis and Kidney Transplant.

Additionally, we are also considering investments in Pharmaceuticals. This is an area of importance for us particularly during this period of Covid-19. We realised that most of the world’s generic medicines come from India while the pharmaceuticals ingredients needed comes from China. So, when these two countries shut down because of Covid-19, many countries could not get access to drugs anywhere else. 

If you look at available statistics, it evident that cases of high blood pressure are near epidemic proportions in Nigeria. However, for a country with such high incidence report, it is frightening that we do not have locally produced drugs to manage the disease. “How many high blood medicines are made in Nigeria?”

Similarly, if you look at HIV statistics, you will find a similar situation. Yet, how many Nigeria pharmaceutical companies are developing and producing drugs to manage HIV/AID? The other pertinent questions are “Why aren’t we producing these drugs”, What is the reason for lack of investment? Why don’t we have any pharmaceutical companies that are WHO certified?”. Yet, Nigeria is blessed with over 200 million people with the possibility of servicing about 400 million people in the ECOWAS region. 

Beyond all the points I have raised, pharmaceuticals are a new addition to NSIA’s healthcare strategy. More importantly, beyond the potential in term of the need, the demand, and the market size, it is a case of national security now. Our planned investment in pharmaceuticals is against the backdrop that one cannot think of saving for the future generation if one is unable to keep the current generation alive. So, over the next 12 months, we are going to be very active in pharmaceutical and build a few more heath centres.

Nonetheless, our five areas of infrastructure investment focus are agriculture, healthcare, roads, power, and industrialization.

At what stages are these projects and what are the economic potentials of the investments?

All the healthcare centres of excellence are running. We are looking at making the same commercial returns as we make in other commercial projects. For the NSIA, all three are profitable investments. If they are not, we will not be doing more.

What informed the location of these projects and what are the components of the investments? 

When we started the programme, we reached out to various Teaching Hospitals and Federal Medical Centers across the country. However, some were not interested in partnering with us. As you know, the programme is a Public-Private Partnership which requires participation from partner tertiary healthcare institutions. 

Of the 12 or 13 hospitals that responded positively to the programme, only three outlined terms that were workable for both parties at the time. In some instances, the participating healthcare institution provides a building or land. When NSIA comes in, we build it, operate it, run it, re-coup our investment with returns and then transfer it back to them. 

Over the five- or ten-year period during which we are running it, we own it and make all the decisions. We invest in it and make sure it’s profitable. We have the right to hire and fire who employees. And then, over time, as we re-coup our investments and our profits, we walk you through a handing over process. 

We started small, learned our lessons and now, we are looking to expand. As it stands, we have one centre each in the North, East and West. We are considering more specialist treatment centres. Of course, there will be new areas as certain Teaching Hospitals will want a different area of focus.

In terms of standard and quality of services and equipment, what would be on offer in your medical facilities? 

We will not compromise quality. Our top three watch words are “Quality, Quality and Quality.” “Quality first and Quality last”. The cost in other countries are expensive as they charge you a huge premium for coming into their country. If you go to some countries, you will realize that there is one price for the locals and there is another for foreigners. So, what we are providing here in terms of costs is not free, but it is significantly cheaper than what you pay in other countries. 

Give us an idea of the number and type of jobs to be created from these investments? 

Job creation for us in the health sector is not the objective. If you look at what we have done with fertiliser, we have tens of thousands of jobs that have been created there. In this sector, job creation is not the most important metric for us. 

The most important metrics for us in the health sector is “saving of lives.” We are looking out for the number of people being treated and what we can do to ensure quality care is accessible domestically. For instance, in the whole of the South East, there are no labs that work for 24 hours but our Umuahia Lab does. 

We are going to set up collection centres in the whole of the South East. That way you can do MRI at midnight and collect your result in record time. Job creation is important, but it is not the most expedient criteria for us in this area. We are interested more in saving lives. We are still not near the number of people we want to be treating in our Lagos centre.

Our Lagos centre has the capacity to treat 200 patients a day. We want to get to 300 or 400 a day and those are the numbers we are pushing for to the point where we can treat a thousand patients a day.

What are your short term and long-term goals in the health sector?

We have operationalized the first three health care centres and we plan to build six more. In the next 12 months, here are the things you should expect. We will commence work in our Centre for Advanced Medicine here in Abuja. We will commence work on our Pharmaceutical Company and a few more investments in diagnostics and cancer centres. 

Another short-term goal is that, in addition to our cancer centre, we are building molecular labs to help the NCDC Covid-19 issue. And so hopefully we can deliver the molecular labs and do a number of testing for Covid-19. But it goes beyond Covid. The molecular labs will be used for other highly infectious diseases that may be challenging for us in the future. 

How will your interventions in the healthcare sector help to galvanized investment from the private sector?

It is already galvanizing investments from the private sector because we have a partnership with an external investor who will embark on the journey with us in the healthcare sector. That is being pursued at the moment.

Secondly, we are seeing Private Equity Funds trying to partner with us and inviting us to invest. One thing we have been able to show is that Public Private Partnership in teaching hospitals and Federal Medical Centers can work.  As people are seeing that we are able to make it work, then you may see more and more people coming to do PPPs in that area.

We are seeing medical equipment and private leasing company coming up and these are areas of interest. We are saying that in addition to building our own, we have capacity to invest in those we are doing too. So we will support the healthcare sector the way we support agriculture, roads, power and we are going to put a flag to it.

How is NSIA’s intervention in the health sector positioning Nigeria to tackle the issue of medical tourism?

Let’s start from the Cancer Centres! For every person that you treat there is one less person who goes abroad for cancer treatment. So hopefully, as people get to know about it through word of mouth and once we start the planned awareness programme after Covid-19 is over, we expect a gradual reversal of tourism for treatment of this disease. We want more people to use the Centre. 

Already, because of the shutdown of the air space, we have seen more people coming to our centre because they could not go abroad.  So we are going to be forced by the environment that we find ourselves to build these things for ourselves. 

Covid-19 has shown us that no matter how much money you have, there are circumstances which would prevent one from being able to go abroad. Indeed, that day has come! Clearly, we need to fix our healthcare system. More importantly, we need to realize that there is a viable market in Nigeria which is deserving of investment. It is about self-preservation.

We have fantastic people that supported us to do this. The Chief Medical Officer of LUTH, Prof. Chris Bode is a first-class individual because without whom we could not have done this. Without him and the Board at LUTH and of course the Ministry of Health, we would not have done anything on the Cancer Centre there. The contract for this kind of thing is not a joke and so we need to do more.  

Based on what you have seen, what is your view on the state of infrastructure in Nigeria?

You do not need to go abroad to know that our hospitals are ill-equipped and underfunded. There is no question about it. For instance, covid made us realize we have an inadequate number of ventilators in the country. If we experience a sudden surge in the occurrence of other maladies, we will get a clearer picture of the inadequacies in the sector. 

We have a long way to go and I hope that we capture the momentum of the covid situation to really invest in health care. A hospital is not the building, the most expensive part of hospital is the operations and those running it.

You need dedication to be able to run it effectively. You have to manage it and be on top of it. You cannot just leave it because it will fail. I want to do more of these PPPs where we take a hospital own by government and restructure it, maintain it, and commercialize it.

Our people want and rightly deserve systems that work. We have limited budget at NSIA, and we are hoping to create a health care fund that would allow us to be able to go into these sectors and solve strategic problems.

We want to do more but there are many challenges. There are people who like the status quo to continue and you have to come in there and change things. It’s not easy. 

How much have you invested so far in the cancer centres?

We invested $12m at the NSIA-LUTH Cancer Center. The Centres in Umuahia and Kano are between $4m and $5m each. The pharmaceutical business will cost us more in millions of dollars. Since we started investing in 2013, the NSIA has been profitable in every quarter. Whenever we look at our reports, we have not lost money.

With the outbreak of the Coronavirus pandemic, is the Authority considering making fresh investments in that segment of the health sector considering the shortage of Ventilators and other Protective Equipment?

That is an entirely different business. That’s medical devices and we don’t have the competence to go into that area. That sector is a very difficult one. The depth of expertise in that sector is just too much. So there is no competitive advantage that NSIA will be bringing in that sector. 

Today, there are five companies in the world that are world class in medical equipment. They are Phillips, General Electric, Siemens, and Toshiba and one Chinese company. This is a highly specialized sector and we will not go there.