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Ola Brown(Orekunrin) @NaijaFlyingDr
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1. Thread on how to fix #healthcare in #Nigeria, sorry this is going to be long and boring for people now interested in health
2. With a total population of approximately 182,200,000, Nigeria has some of the poorest healthcare outcomes in the world. For example, the under-five mortality rate has been reported by the World Health Organization at 117 per 1000 live births.
3. The main reasons why so many children die in Nigeria; Malaria, Acute Respiratory Infections and Diarrhea, are particularly concerning because they are all preventable. Yet Nigeria remains one of the most dangerous places in the world to be a child under 5.
4. Child mortality is not our only problem. From the number of people that die from road traffic accidents, to the number of mothers that die during child birth to malaria deaths to malnutrition; the statistics paint an abysmal picture of Nigeria’s healthcare system.
5. As our population continues to grow at rates as high as 4% the need for healthcare reform has never been more urgent.
6. The ‘McKeown thesis’, was proposed by Thomas McKeown in 1950. He postulated that improvement in health in the West, was primarily attributable to better standards of living ,diet & nutrition, sanitation and vaccinations rather than life-saving advancements in medicine.
7. McKeown’s postulation resonates strongly with Nigeria. Only 3.7% of its GDP is utilized on health expenditure. In stark contrast, developed countries such as the USA and the UK utilize 17.1% and 9.1% of their GDP on health expenditure respectively.
8. This cost constraint can be alleviated by long-term social improvements that focus on prevention rather than treatment. This will not only translate to reduced morbidity and mortality rates, but also relieve the burden of patient load in Nigerian hospitals.
9. Hospitals are a big part of Nigeria’s problem. Our politicians love to launch them, celebrate them, we are sentimental about them, we are constantly order expensive equipment for them, but in the grand scheme of things; they don’t really matter.
10. Nigeria’s hospital-dominated health system overemphasizes medical interventions at the expense of public health and primary care.
11. Hospitals focus on the very sick, using very expensive interventions to extend or improve life for a small number of individuals. This means that their potential to actively promote health is limited.
12. A preventative health system would be primary and community-care led, and hinge on the shift in resource allocation from tertiary institutions (hospitals) to community and primary care facilities.
13. Comprehensive vaccination programmes, health education, institution of basic sanitation and water-provision infrastructure are not novel ideas and have been employed with great success in other developing countries.
14. Our focus should be on emerging technologies and social reforms which Nigeria can tap on even at this stage to achieve modest morbidity and mortality rates.
15. These include telemedicine, remote support for paraclinical healthcare staff, institution of robust systems to manage patient journeys, protocolization of common and easily preventable disease management guidelines and efficient referral systems.
16. Refocusing and developing primary care will save billions of dollars and millions of lives
17. Costa Rica is a great case study!!
Costa Rica, is a developing country in South America, it’s citizens have access to one of the most effective primary health care systems in the world.
18. The system produces better health outcomes, while spending less than most other countries in the world. It has 3rd highest life expectancy in the Americas, well ahead of the United States & infant mortality is half the average of the Latin America and the Caribbean region.
19. Health reform in Costa Rica was conducted in deliberate and targeted pursuit of the country’s vision of achieving equal health care for all.
20. Reforms were implemented in an iterative fashion — supported by strong measurement and monitoring — which allowed for ongoing adaptation and continuous improvement and refinement.
21. The result of the reforms is a robust primary health care system, rooted in public provision of care, that supports comprehensive, continuous, coordinated, and equitable care for the entire population.
22. 'What about HOSPITALS???' You pipu scream!! I'm coming, I will shock you with my next tweet......
23. The number of hospitals in Nigeria needs to reduce, not increase.

Yes I said it!!
24. The main expansion should be in primary care centers. This may seem counter-intuitive, but allow me to explain why.
25. As healthcare advances, more can be done to treat patients that have what were previously disabling or life-threatening conditions like burns, severe injuries or strokes.
26. But, in order to provide complex healthcare safely, professional teams need to see sufficient volumes of patients with a particular condition. The potential benefits from specialisation are greater for many life-threatening conditions like heart attacks and major injuries.
27. But the safest treatments cannot be provided at small general hospitals because there are not enough patients for teams to maintain their skills. More lives can be saved if advanced services are centralised in fewer specialist hospitals.
28. Look at this study showing lives and costs saved in London when stroke services were treated at a large central specialist centre as opposed to a smaller general hospital…
29. Premature babies are up to 50% less likely to die in high volume neonatal centres…
30. Even in accidents, injuries and trauma, the evidence is clear. Bypassing a small hospital and going to a central, specialist large, high volume hospital clearly saves more lives, improves doctors skills and reduces the cost on the healthcare system
31. The importance of focusing on determinants of health that lie upstream from hospitals cannot be overstated.
32. Health systems in Nigeria should focus on optimizing resource allocation to focus on community care for the majority, rather than extending life for the minority.
33. The quality of tertiary healthcare is critical, but it should not come at the expense of public and primary healthcare.
Remember kids, health policy doesn't have to be sexy, but it must achieve these three aims👇
34. We need Nigeria's young people fit and healthy, so we can get to work innovating and building to fill our missing middle.
35. Read my entire article on Re-Inventing Primary Care in Nigeria here:…
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