Professor Akande, co-evaluator

On Thursday, February 13 2014, Professor of Public Health Tanimola M. Akande delivered the University of Ilorin’s 142nd inaugural lecture. With his team of researchers, Professor Akande has played an instrumental role in the impact evaluations of PharmAccess health programs in Kwara State, Nigeria.



In his lecture, titled ‘Population with Ill-Health Burden; Faced with a Sick Health System,’ Professor Akande gave the audience a comprehensive overview of the Nigerian health system. “In many African countries, including Nigeria,” Akande said, “the reality is that the health care system is not providing cost-effective services in ways that would have the greatest impact on the major causes of death and illness. One result of this weak health system, for example, is that Nigeria loses about 81 billion Naira annually to medical tourism to countries like India. This money could have contributed to improving the health system of our country.”

Nigeria faces a heavy burden of communicable and non-communicable diseases as well as poor geographical, financial and cultural access to health care, especially in the rural areas where the majority of the population lives. Akande: “Good health does not only contribute to better quality of life but is absolutely essential for a vibrant labor force for socio-economic development of the individuals and nation.” According to Akande, health insurance is a good entry point for breaking the vicious circle of ill-health, poverty and underdevelopment and ensuring a virtuous circle of improved health status, prosperity and sustainable development.

Journey towards universal health coverage
Akande explained that the establishment of the National Health Insurance Scheme (NHIS) was supposed to be a first step towards improved access to adequate and affordable health care and universal health coverage for Nigerians. The need for the NHIS was identified in 1962; it was approved by the Federal Government in 1997, signed into law in 1999 and officially launched in June 2005, when former President Olusegun Obasanjo directed that Nigeria must achieve universal coverage by 2015. “After forty years on the drawing board and almost ten years of operations, only about 7% of Nigerians are enrolled,” Akande says.

Community health insurance in Kwara
In the summer of 2009, the Kwara State Community Health Program was launched in Kwara Central. It consists of subsidized health insurance and upgrading of healthcare facilities. The Kwara State Government subsidizes 60% of the premiums and has committed to extend the program to 600,000 people over the next five years. The program is also funded by the Dutch Health Insurance Fund with support from the Dutch Ministry of Foreign Affairs, and implemented by PharmAccess and the Nigerian health maintenance organization Hygeia. During a visit to Nigeria, UN Secretary General Ban Ki-moon spoke about the program’s unique character: ‘The groundbreaking Community Health Insurance of the Kwara State Government is exactly the kind of innovative partnership that we should replicate – here in Nigeria and beyond.’ This program represents the first time that a state government in Nigeria has partnered with the private sector and an NGO to provide statewide health insurance for its citizens.

The health services included in the Kwara program cover the most common medical problems found among the target groups and consist of primary care, secondary care, medication provision and reproductive health services, including HIV/AIDS prevention and treatment. More specifically, treatment for opportunistic infections such as malaria and tuberculosis are covered. Over 70,000 people in rural Kwara State are currently enrolled. Enrollees have access to healthcare providers that are involved in a continuous quality improvement program called SafeCare.

Evaluating impact
Professor Akande has been highly involved with researching the Kwara State health plans since 2007. Most notably, he was one of the key figures in the impact evaluation of the Kwara State Community Health Program. This impact evaluation is part of a multi-year operational research program into healthcare quality improvement and health insurance for low-income people in several countries in Sub-Saharan Africa (SSA), led by the Amsterdam Institute for International Development (AIID) and the Amsterdam Institute for Global Health and Development (AIGHD).

“The health plan has had a dramatic effect on people in the region,” Akande says. “Health facilities have been able to improve the quality of their services, and many people are now able to visit healthcare facilities when they are ill. Before, they either couldn’t afford to go, or they didn’t know they were ill. Kwara has a high incidence of non-communicable diseases such as cardiovascular disease (CVD), and of modifiable risk factors for CVD such as hypertension and diabetes. These risk factors have decreased, and first results for maternal and child health also suggest a positive impact. Through screenings that we conducted during our baseline survey, many people became aware of their condition and are now in treatment. This has had a multiplier effect throughout the community.” In general, health awareness has increased tremendously. Healthcare utilization has increased by more than 90% among enrollees and more than 15% among the total population in the treatment area. At the same time, out-of-pocket expenditure has decreased by 50%, even when including the cost of the premium.

Capacity building
The Kwara impact evaluation and Professor Akande’s research work in general is generating large amounts of unique data. Policy makers, managers and care providers in the Nigerian health system often lack adequate information on which to base decisions. Professor Akande has contributed to knowledge-sharing through 110 publications in peer reviewed local and international journals. He has trained and supervised projects of more than one hundred medical students, supervised dissertations of more than 30 Master students as well as 15 Fellows in Public Health. In addition, he is currently supervising three PhD students in the department and two students of Amsterdam University as co-supervisor.

“Our collaboration with PharmAccess and AIGHD has been and continues to be of fantastic value to the region and to Ilorin University,” Akande says. “It is of great importance that we continue this success story, not just for the rural populations but also for our university. In terms of capacity building, the collaboration has allowed us to train a critical mass of young researchers, who have developed into excellent academic professionals. The invaluable experience they have gained in evaluating the health insurance programs has helped them to hone their researching skills, source local grants and distinguish themselves from their colleagues at other universities. I am extremely proud of their achievements, and I look forward to seeing them grow in their careers.”

A scholar of the University of Ilorin reads along with Professor Akande's inaugural lecture



A correspondent of NTA Ilorin (Nigerian Television Authority) interviews Professor Akande after the lecture, for television broadcast later that evening