Article originally published in Ventures Africa.
Each year, over 250,000 newborns die in Nigeria within their first 28 days of life – and most of these deaths are preventable. The Federal Ministry of Health has been paying attention and has developed strategies and implementation plans to help newborns survive and thrive. To be successful, these plans require participation at all levels – the Federal Ministry of Health, State Ministries of Health, professional associations, non-profits, and families and mothers themselves. But saving newborn lives hinges on the involvement of one group in particular: the Nigerian private health sector.
Why the private sector? First of all, the private sector is where the patients are. Many Nigerians access healthcare services and products via the private sector by visiting proprietary and patent medicine vendors (PPMVs), chemists, and private health facilities. It is also where the bulk of the spending is: 75% of the money spent on healthcare in Nigeria is in the private sector. Furthermore, the Nigerian pharmaceutical market is one of the top ten largest in Africa – with a number of local manufacturers producing health commodities.
It is also in the private health sector’s best interest to help reduce neonatal mortality. Nigeria is projected to be the third largest country in the world by 2050, and each healthy newborn expands the private sector’s future customer base. What’s more, mothers with high-risk babies can be some of the hardest consumers for the private sector to reach for reasons such as location and income levels. By joining public sector efforts targeting these mothers and babies, the private sector can expand its consumer base – particularly in rural areas with high birth rates – and serve customers at a lower cost. What’s more, every dollar spent on reproductive, maternal, newborn and child health has a potential return of US$20 in economy-wide benefits. Such an increase in economy-wide benefits can result in more disposable income and additional investments in business – all of which can benefit the private sector.
We know the private sector can help reduce under-five mortality because we’ve seen it before. Coverage of oral rehydration salts with a zinc supplement (Zinc/ORS), a life-saving product and diarrhea treatment, grew 14 percentage points in Nigeria over two years. This was in large part because the Nigerian private sector recognized the commercial viability of the product, increased local manufacturing, and marketed the product to increase consumer demand. Given that today Zinc/ORS is primarily distributed through private sector channels in Nigeria, its rapid scale-up would likely have been impossible without private sector commitment.
Similar to Zinc/ORS, Chlorhexidine (CHX) is an over-the-counter product with considerable life-saving potential. CHX, an antiseptic gel applied to the umbilical cord after birth to prevent infection, reduces all-cause neonatal mortality by an average of 23%, according to clinical evidence. The Federal Ministry of Health has advocated for widespread application of CHX to newborns in Nigeria and has plans underway to quickly accelerate its uptake. To meet the Federal Ministry of Health’s ambitious targets related to CHX, the private sector must be involved – especially by producing CHX locally, marketing CHX to generate consumer demand, and distributing it to the “last mile” of the population.
As the above examples demonstrate, successful scale-up of life-saving products requires strong public-private collaboration and private sector commitment from the outset. In the years and months preceding the scale-up of Zinc/ORS and CHX, the Nigerian private sector played an active role in helping develop the scale-up strategy for each product – and is now playing a fundamental role in implementation at both the national and state levels.
The private sector can amplify public sector efforts to achieve health goals and help create the market for life-saving health products by leveraging its existing capabilities to reach more consumers. For example, in the case of CHX and Zinc/ORS, the Federal Ministry of Health and pharmaceutical manufacturers have already worked together to develop and grow markets nationwide. This has included a call by the Federal Ministry of Health to Nigerian manufacturers to produce the products, ongoing public-private consultations, and working together to generate demand (a recent example being the demand generation toolkit for chlorhexidine, available on the Healthy Newborn Network website). At the state level, State Ministries of Health are working to ensure that a sufficient supply of life-saving products reaches the population. Private manufacturers could consider other ways to distribute new life-saving products – such as CHX, for example, by bundling it with other maternal and child health products (e.g., baby powder or products to treat post-partum hemorrhage) and selling, marketing, and distributing products in tandem.
Looking forward, the private sector will play a critical role in Nigeria’s ambitious goal to reduce the number of newborn deaths in Nigeria. The Nigerian private sector’s ability to manufacture, distribute, and/or apply CHX will help ensure that newborns can benefit from CHX’s life-saving properties. In turn, the private sector can benefit from the economy with wide benefits such as increased income associated with investments in reproductive, maternal, newborn and child health.
CHX and Zinc/ORS are only three of the products on Nigeria’s Essential Medicines List – the federal government’s list of drugs that satisfy priority health care needs of the population– and learnings from these scale-up efforts could help expand access to other life-saving products. Beyond Nigeria, world leaders recognize that achieving the ambitious Sustainable Development Goals will require engaging the private sector early and often. Building competitive markets for the manufacturing and distribution of public health goods – such as Zinc/ORS and CHX – is one way to do so. And by helping expand access to life-saving products, the Nigerian private sector has the opportunity to serve as a leading example for other markets across the world.
Authors: Erin Barringer of Dalberg Global Development Advisors (DGDA); Olufunke Fasawe of Clinton Health Access Initiative, Inc. (CHAI); David Milestone of the US Agency for International Development (USAID); Joseph Monehin of USAID; Nikki Tyler of USAID; Sylvia Warren of DGDA; and, Ian Warthin of DGDA. The authors are from organizations that have done significant work in advancing gains in maternal and child health outcomes and have identified the private sector as a key partner in accelerating such gains. This piece reflects the views of the authors and is not reflective of the views of their organizations.