THE NIGERIAN MEDICAL COMMUNITY

The Nigerian Medical Community
Dr. Olajide Joseph Adebola, Leader in Global eHealth

Interviewers at Focused Sun were able to reach Dr. Olajide Joseph Adebola through our CEO, Rene Francis, who maintains a number of high-level connections on the African continent, and Nigeria in particular for their constant leadership in telecommunication technology (O'Grady, 2020).  Dr. Adebola, Chief Technology Officer and Partner at Home Plus Medicare Services Limited, a telemedicine and eHealth company, is a Health Systems & Business Leader who maintains a number of prestigious positions in several professional organizations.  

Dr. Adebola is a member of the ISO/TC215 - Health Informatics group where he serves as Chair of the Technical & National Mirror Committee on ISO/TC215 - Health Informatics.  He leads the Nigerian Medical Community with experience managing the design, development, and implementation of telemedicine, eHealth & health ICT programs. While he leads pilot projects and the development of project management, he also manages the day-to-day operations of the Society for Telemedicine and eHealth in Nigeria, where Dr. Adebola serves as its Founder & pioneering President. 

The Society and its co-founders support the development of national telemedicine and eHealth programs, promote the cause of telemedicine and eHealth within public and private health institutions within Nigeria and abroad, and contribute to the dissemination and exchange of knowledge. 

In his role as Chair of the National Mirror Committee ISOTC215 - Health Informatics, Standards Organization of Nigeria, his team is currently coordinating the adoption of 33 International Organization for Standardization (ISO) Standards, updating the Technical Reports and Specifications for digital health standardization in Nigeria.  This project dates back to April 2019 and highlights Dr. Adebola’s expertise in digital health, eHealth consultancy services, project design & implementation, and workforce capacity building.

O'Grady, V. (2020, March 12). Nigeria still top of african mobile stats. Developing Telecoms. https://developingtelecoms.com/telecom-technology/wireless-networks/9323-nigeria-still-top-of-african-mobile-stats.html. 

1. What technical requirements do the Nigerian medical community have? (Energy, Power, Heat, etc)...

The rural clinics in the Nigerian community are made up of three levels of medical care: National, State, and Local.  The primary and first point of contact is the National Health System. The National Health System offers specialty hospitals as headquarters for medical doctors. Then there are district hospitals that are run by the state government. Finally, there is primary care that is run by local government authority and managed by the State Primary Health Care Board. As a whole, we are looking at 74 local governments with roughly 10,000 primary health care centers for the country of Nigeria alone. 

Each of these primary health care centers needs a minimum amount of electricity to keep these clinics running. Many of these remote clinics must rely on generators with equipment to power these clinics since there is a lack of infrastructure in Nigeria. Running costs are high with clinics depending on energy from an independent power supply, the national grid, or from other institutions. On top of high costs, clinics face blackouts on top of that. The Nigerian medical community faces many physical challenges outside of just blackouts. The cost to build the appropriate infrastructure can be anywhere from 100,000 to 300,000 dollars. A lack of reliable and consistent electricity is a major challenge for these clinics.

What is the process for setting up a Nigerian medical clinic?
In order to set up a Nigerian medical clinic, you must first have a medical license for individuals and the facility. Then you must indicate what purpose the clinic will serve for the community. Once that is complete you must set up the national registration. The country will then inspect the site and award the license. The number of beds determines the cost of the licensed facility. The number of beds is also determined by the size of staff that exists within the clinic. 

One thing that is missing is that there are no requirements by the government for sources of energy. If there were requirements, lobbying groups would come to fruition. The government will not enforce these requirements until they see more professionals become active in wanting to bring change. 

2. What are problems to solve in providing medical services where it is needed most?

Manufacturing hospital consumables are scarce at the local and in-country levels. This is due to a weak supply chain issue that needs to be strengthened. There are also specific locations throughout Nigeria that face problems with pharmaceuticals and getting approval for generic drugs. Access to medicine needs to be more readily available. In order for this to happen, the medical community needs more energy to produce these drugs and import them. 

Other areas to solve involve mental health and obstetrics. The Nigerian medical community faces high maternal mortality rates. This results from pregnant women not having access to skilled attendants like Obstetricians and Gynecologists. Getting different levels of care is a challenge throughout Nigeria.

3. How much electricity, heat, power, clean water, and cooling do Nigerian clinics use?

How much electricity depends on care, facilities, and services.  The amount of electricity to run clinics depends on the care the facility provides, the facility itself, and the services it offers. The manufacturing of hospital consumables is another factor. Many of these consumables are now disposable but the process is delicate.

The need for water is a greater emphasis now more than ever with the pandemic. People are in need of clean water for sanitation purposes. People need water to wash their hands, do laundry, clean surfaces and provide sanitation.

Air conditioning is not of much importance to keep these clinics running. What is essential is to make sure the pharmacy is kept running efficiently. Medicine that is stored must be kept cool to ensure the drugs do not go bad.

4. What opportunities do you see with renewable energy in the medical community? In rural areas? At what capacity?

Clinics
From a clinic perspective, the opportunities with renewable energy in Nigeria are vast. For starters, it will have a huge impact on our power supplies. This will allow our clinics to have consistent and reliable energy and not deal with issues like blackouts. With a Focused Sun microgrid operating locally, it can power clinics, and offer the opportunity to share with others. This can be guaranteed by integrating schools and other communities. Another factor to take into consideration is that the Foreign Exchange Market does not permit resources to be imported. Nigeria is only allowed to import 20% of its energy and manufacture 80% of it locally. If this can be accomplished this increases local employment.

One area we need to take into consideration is that there is very poor planning for Nigeria's energy sector. There needs to be a better-established roadmap to connect the national grid to industries that can pay for electricity. When Dr. Adebola visits his family in the United States, he can see the limitations that all health systems face, and is able to identify distinctly Nigerian obstacles and where unique solutions must be designed.

While all American clinics and hospitals are not the same, they are generally funded by organizations willing to spend money to improve service which in turn draws more patients into the system.  For Nigeria, clinics located in industrial areas, like bigger cities, follow a similar model to urban areas in the United States.  These industrial areas, run by private investors, are willing to pay for better service.  This allows better care in a 24-hour day, where the cost of production, including energy, is factored into the resources required.

Dr. Adebola and the organizations he serves are looking into these metrics to develop a baseline study.  What is the baseline for the cost of care at a level that is required for optimal delivery of healthcare at the most efficient cost?  The national road map for service in the three levels, from National to State and Local, will be informed by this study.  What procedures can be provided locally?  How do State services compare?  What National guidelines should be set?  The national road map will navigate the answers to these questions.

Funding
Do we know about grant opportunities with medical organizations?
Local funding comes from the same investors seen in industrial areas. There are long term loans from the World Bank that are allocated towards renewable energy. Funding in rural projects involving social and health sectors is also available. Another area that may be of interest is that the Nigerian Energy Commission has renewable energy research at the federal level. Research looks into how local materials can be used to start building community renewable energy projects. Must be noted that this is limited at the local level.

Do grants exist for medical community leaders to meet clinic needs?
There are funds to create a digital economy in rural telephony which also needs a power supply.
Around digital health tools, this funding can be applied to the renewable energy infrastructure.

What sources of funding are available for the medical community and their projects?
There are other sectors that offer funding like international funding. This funding can be applied to the medical community. The World Bank as well as other international parties may offer additional programs. In 2014, the “Basic Health Care Provision Act” was introduced. The fund allocates 1% of the consolidated national revenue. It is meant to pay for Nigerians “basic health care package,” with primary care for the vulnerable.

The National Primary Healthcare development gateway is one part of the 2014 Act, and the agency gateway is another.  Primary healthcare centers have a primary healthcare administration.  The government does not have access to those funds to prevent misappropriation.  In each state, there are six states with the 7th state as the capital territory.

Each state has a primary healthcare board and the money doesn’t go directly to the board.
The state provides some funds to assess the readiness and implement the funding.  Once services are provided by personnel with skills, each primary care center deducts money from their own account.  The money goes straight from the local and regional funds to healthcare.  This is called “Performance-based Financing” where the management of the funds is giving after work is done.

Here is a breakdown on how the Nigerian government allocates their funds and to where. 45% of the Basic Health Care Provision Fund is used in the National Primary Healthcare.  The NHIS (National Health Insurance Scheme) pays the healthcare providers.  There is a need to review the legislation as more people continue to use it.  The more who participate, the more healthcare services will be reimbursed, so the effectiveness of the program grows in size.

The remaining 5% is for public emergencies goes through two sub-gateways. 2.5% goes to the National Center for Disease Control, the NCDC, and another 2.5% goes to the Dept of Hospital Services, the DHS, to support the National Emergency Medical Services, the NEMS.  Pandemic and Epidemics can be managed with a contingency fund, which helps to help pay for the value chain including emergency services and ambulatory care.

5. What issues do you face with electricity?  Downtime if any? What temporary solutions did you use? How was it solved?

An issue that is constantly having to be dealt with is the blackouts the clinics face. The clinics face plenty of downtime which hurts the care they provide and damages the drugs stored. For this meeting alone, a generator is powering it. It is a constant theme in fact in which most homes and businesses are run on generators. There are also LAN and phone networks that exist, but the carriers running costs are reduced 

To deal with power outages, hospitals purchase their generators and moderate the usage when there is an emergency. Hospitals have set up a system called, “lights out time” and “lights on time.” This allows us to keep the hospital running sufficiently enough without incurring extra cost.

In order to reduce power outages, supply chain management would need to transition the generator salesmen and generator repairmen. The knowledge of the power industry will be valued as they move from generators to building renewable  Local factories producing renewable energy and making medical supplies could solve these issues

6. How is the cost of renewable energy viewed in your industry of the Nigerian medical community and its constituents?

In the healthcare sector, the initial cost is expensive. The cost of solar panels for instance. This depends on the amount of power, the cost of the batteries, and the amount of electricity being used. When you compare that with a diesel generator, the running costs seem to be more affordable. The amount of energy depends on the oil and diesel prices which can drive up the cost of energy. When you don’t have the power to run the equipment, the cost of renewable energy looks more affordable. 

While renewable energy may be more affordable, it’s not always available.  When basic lighting and air conditioning cannot be powered by renewable sources, convention methods must be used, at the going price as a variable cost. When you can’t charge for services associated with those energy costs, those services are less likely to have power over more profitable services.
In the big cities where the charges for electricity can be afforded, that drives up the cost for rural communities as the supply and demand curve is determined by urban economics and pushed onto rural communities.

7. What barriers are there when adopting renewable energy?

From the National Sector perspective, the organization of energy provision must be improved. The power generation company generates electricity, while the transmission company transports energy.  The distribution company then takes the power from transmission and distributes it through the community.  Ironically, discos receive the electricity first, and become brokers in the community for who receives power next.  This seems to work as the center of the town’s culture is the local dance hall, and they are happy for this institution to receive the lion’s share of the power first, followed by other buildings like clinics and hospitals.   This may be entertaining anecdotally, but it shows there is a strong need to regulate electricity, tariffs, and the need for stimulus to bring electricity into life-saving institutions ahead of discos.  The real problem is transmission and distribution, where only money-making businesses like discos are able to buy the power, while rural hospitals compete for the same resources.
The ability to create power and heat at the local level, while also producing medical equipment and supplies in the same factory where a solar microgrid is manufactured, starts to solve these problems of access to electricity and the costs associated. If the access to a power grid is itself a revenue stream in the local economy, the growth in equity allows for the growth in energy supply to grow with community need at the local level, as opposed to the economics of an urban area that force higher prices for urban communities from a central distribution channel.