#9Questions with Dr. Zipporah Kpamor, Country Representative – Nigeria, Management Sciences for Health
Zipporah Kpamor is the country representative for Nigeria. She is currently the project director/chief of party of the Community Based Support for Orphans and Vulnerable Children in Nigeria project. She is a manager, technical expert, and a board certified disciplinary public health physician with over 20 years of experience in public health practice and over 10 years of experience with high-level reproductive health and TB-HIV integration program management. Prior to her current role, Zipporah was the project director/chief of party for Nigeria’s Indigenous Capacity Building Project for the Christian Health Association of Nigeria, from 2007 to 2011. After this, she went on to work at the Institute of Human Virology Nigeria (IHVN) where she was the head of department of community medicine services.
Zipporah received her bachelor of medicine, bachelor of surgery (MBBS) from University of Jos in Nigeria and is a fellow of the National Postgraduate Medical College of Nigeria. She is published in several journals and holds professional affiliations with the Nigerian Medical Association, Association of Public Health Physicians of Nigeria, the Academic Staff Union of Universities, Medical and Dental Consultants Association of Nigeria, and is an Associate Member of the Institute of Strategic Managers of Nigeria. Zipporah is well-versed in English, Hausa, and Aten.
We are glad to have her share expert insight and advice on the healthcare systems in Africa.
- How would you rate health care systems in Africa? In what area(s) do we need improvement the most?
Health is central to well-being and is a necessary foundation for a satisfying and rewarding life that is why national health is a basic objective of governments the world over. Generally, improvements in world health have been dramatic in the past 60 years. In the 1950’s, 290 of every 1,000 children died before their fifth birthday in the developing world. That number had fallen to 118 per 1,000 in low-income countries, and 57 per 1,000 in middle-income families by 2008. Majority of these countries are in Africa.
Despite considerable improvements, African countries continue to face great challenges as they seek to improve their health care systems. If improvements in health care systems in the developing world could be made in the areas of preventing infectious disease, increasing immunization coverage, improving water and sanitation, reducing malnutrition rates and improving the health of women and children more than 8 million children who die from preventable diseases would be saved each year.
The health of Africans will benefit from poverty reduction measures, controlling growing globalization, improving infrastructure and more equitable resource allocation, which are just a few factors that contribute to certain countries’ poor health care systems.
- The MDGs have come and have been translated into the SDGs. In your opinion, how well do you think the African continent has fared in achieving the health goals of the MDGs and do you think Africa is likely to meet the health-related goals of the SDGs by 2030?
The MDGs had mixed results; there was success in poverty reduction, school enrolment and gender equality. Up to the mid-2000s Africa saw economic growth that led to poverty rate declining at about one percentage point a year. There was also some evidence that maternal and child mortality in Africa, after stagnating for some time, began to fall sharply during the same period as delivery of health services improved across the continent. Countries such as Rwanda, Ethiopia, Gambia and Malawi saw declines of 25-40 percent in under-five mortality and primary completion. However with the economic recession of the late 2000s, these progresses have stalled and in some instances receded.
There is evidence that policies have been put in place to enable the achievement of the MDGs. With concerted effort by African governments, civil society organizations, the private sector and the international community, hinged on strategic partnerships, robust policy frameworks and renewed political commitment, Africa can meet the Sustainable Development Goals by 2030. We are optimistic that the achievement of the SDGs will accelerate progress towards achieving a prosperous, healthier, green and an equal planet.
The greatest cause for optimism can be found in projections on ending extreme poverty, economic growth in African countries and halting deforestation – it has been said that we are on course to get more than halfway towards each of these targets by 2030. However, a larger number of targets, including much of the MDG’s ‘unfinished business’ like ending hunger, reducing maternal mortality, secondary school completion, ending child marriage, access to sanitation, access to energy (electricity), industrialization in Low Income Countries, reducing violent deaths, and domestic resource mobilization, will require revolution in order to speed progress by multiples of current rates to see success in time. A final cluster that includes reducing inequality, limiting slum populations, combating climate change, reducing waste, and protecting marine environments, requires outright reversal in trajectories.
- Although not as notorious as HIV/AIDS, tuberculosis and malaria, mental health is a global issue in need of more attention than currently being given. (In 2003, 450 million people worldwide were estimated by the WHO to have some type of mental health issue; twelve years later, it is likely that this number has increased especially in Africa with multiple challenges). What in your opinion, can be done to prioritise other health threats in Africa?
It is important to pay attention to other health issues, not only the communicable ones. Non-communicable diseases like mental illnesses, diabetes, high blood pressure and cardiovascular diseases have become silent killers and have reached epidemic proportions. Now Africa is grappling with epidemics of communicable and non-communicable diseases at the same time.
Prevention by making lifestyle changes, avoidance of stressful conditions, screening for early diagnosis and treatment are the key to ending the epidemics of non-communicable diseases. It is also important to create awareness of the risk factors and use available data to advocate for and mobilize resources for control.
- The sudden sporadic spread of Ebola and Lassa Fevers in West Africa happened when the region was least prepared for it. It seems Africa usually acts only after a disaster has happened. What measures can African governments take for disaster preparedness and to be proactive about health threats in Africa?
While modern medicine has made great progress in eradicating certain threats such as smallpox, most of the greatest killers — flu, plague, tuberculosis, HIV and AIDS, cholera, and Ebola — are still with us today. There is broad agreement that the Ebola crisis was not quickly contained, reversed, or mitigated because national health systems in countries with outbreaks were under-resourced, under-staffed, and poorly equipped and thus poorly prepared to respond to the threat.
Disaster preparedness measures the extent to which national health systems and communities create plans in order to reduce vulnerability to health hazards and cope with disasters such as epidemics. These do not avert or eliminate the threats; instead, the plans focus on decreasing the effect of disasters. In the event that an outbreak does occur, it is important to have a plan prepared to mitigate the effects of the outbreak so it does not turn into an epidemic, as well as to ensure that the health systems and communities continue to function. Failure to create and follow disaster management plans could lead to damage to assets, human mortality, and lost revenue.
In order to proactively plan to avert health threats in Africa, all hands must be on deck to identify health risks quickly, evaluate the risks and respond to significant risks by way of either tolerating, treating, transferring or terminating them. Government and communities must find resources for risk control measures, develop reaction plans, report & monitor risk performance as well as review the risk management framework about health on a regular basis. That is why Management Sciences for Health and its partners on the ‘No More Epidemics Campaign call on all to join hands in containing outbreaks and preventing epidemics by investing in people, fostering community recovery, training local health care workers, and helping to strengthen and rebuild health care systems.
- Adequate financing for the health care sector has been identified as one of the reasons Africa is lagging behind in system planning and delivery. How can health-financing reforms be scaled up to improve the performance of African health systems and sustainable development?
Results Based Financing approaches are achieving good results; increasing coverage as well as quality of services while targeting resources to vulnerable populations. A well-designed RBF program can strengthen core health system functions, increasing value for money and accountability of the health system.
- What policies and practices can be effected to protect the poor in Africa in terms of health care delivery and how can African governments better use budgets for widespread impact?
Through Universal Health Coverage, health systems can provide health care and financial protection to all citizens of a particular country, such that citizens can access health services without incurring financial hardship.
Increasing government allocation for health care through enhanced domestic resource mobilization and targeting funds at PHCs and emergency services would be one way to protect the poor. Improving the efficiency and equity of the health system through best practices such as performance based financing will be another way of protecting the poor. Additionally, regulating the health sector will improve the quality of care and this in turn will protect the patients including the poor. Health insurance, particularly community based insurance schemes empower the poor to pay for their own health care at a minimal cost.
African governments have so many promising policies on how to improve the health and well-being of their population. For example the Nigerian government through interventions such as universal health coverage, primary healthcare under one roof, national health act and many more intends to improve the well-being of its population. However, despite all these policies, Africa is still faced with the challenges of ownership and policy implementation. There is need for African governments to take the issue of health seriously by instituting actionable policies that are not just sitting in our offices, but are really the way we do business.
African governments should ensure that funds budgeted for health are dedicated to primary healthcare in the first instance where most of the issues like reproductive, maternal, neonatal, child and adolescent and HIV/ AIDS and Tuberculosis can be addressed.
- No development can be achieved without the combined efforts of the Public and Private sectors, what can the private sector contribute to the public health agenda?
The private sector is making a growing contribution to health care in much of Africa. Using data from 26 African countries, the World Bank has shown that nearly half of the sick children from the poorest segment of the population were found to have made use of private health care providers. Additional to provision, the private sector also plays a major role in financing health care with roughly 60 percent—predominantly out-of-pocket payments by individuals—being financed by private parties, and about 50 percent also captured by private providers. A link has been established between the private health-care financing and delivery in low- and middle-income countries with quality of care, drug availability, patient access and equity, provider training and provider knowledge, and changes in public-sector health care delivery in the same settings.
The predominance of the private sector in health care in Nigeria is largely a consequence of the government’s failure to keep pace with the growing health-care needs of Nigerians. The government’s economic policies, the rapid influx of technology and the increasing number of Nigerians who have some improved income in urban areas have also encouraged expansion of the private sector. Although the growth of private-sector health care has generally increased access to health-care providers, there are concerns that private care is too expensive, poorly regulated and associated with inadequate training and a general lack of practice standards, particularly in the for-profit sector.
With regards to the contributions of the private sector to health care, reports show that the private sector is currently playing, and will continue to play, a vital role in the financing and provision of health care in Africa, and that in order to improve access to health care on the continent, we must engage the entrepreneurial talents of the private sector by harnessing new approaches to collaboration between the private and public sectors.
- With a lot of mobile applications and gadgets out there, it is clear that technology is a dominant tool in various sectors, how can this become a means of enabling access to healthcare across the continent?
Mobile technology has found lots of application in the health care sector. In the recent past, there has been an explosion of health activities around the world and specifically in Africa. The most common application has been in the creation of health call centers, which respond to patient inquiries. This has been followed by using SMS for appointment reminders, using telemedicine, accessing patient records, measuring treatment compliance, raising health awareness, monitoring patients, and physician decision support. Reports show that with increasing access to mobile devices, there is also increased access to health care. This holds a lot of promise for many African countries where there are issues with geographical access as a result of poor roads, insecurity etc. Since access to mobile application is already wide spread, the next step is to train health care workers to take advantage of these devices to provide health services.
- In your own perspective, what lies ahead in the future for the sector in Africa?
Healthcare situations in Africa are changing. Ensuring access to clean water and sanitation,
while battling ongoing communicable diseases and stemming the tide of preventable deaths still dominate the healthcare agenda in many African countries. However, the incidence of chronic disease is rising fast, creating a new matrix of challenges for Africa’s healthcare workers, policy makers and donors.
For the vast majority of Africans who are still unable to pay for health provision, new models of care spring up, as governments prioritize preventive methods over curative action. This, in turn, will empower communities to make their own healthcare decisions. At the same time, there will be an upsurge of different forms of universal health provision as countries focus on equitable access to services. While for the few who are able to pay for their health care, they will turn to the private sector that provides better health care facilities, thus this will increase the private sector share of the pie as poverty reduces.