TBY talks to Dr. Dapo Majekodunmi, CEO of Saint Nicholas Hospital, on the foundation of the institution, boosting the healthcare sector, and trend forecasts for the coming year.

Can you introduce the hospital and provide a background to your operations?

St. Nicholas Hospital was registered in 1952 as a private hospital. It consisted of a small bungalow for outpatient cases with day-to-day ailments and minor illnesses. Activities and prospects were good, so in 1968 the existing structure was demolished and a purpose-built hospital was established. Initially, it was just pediatrics and gynecology, but over the years, however, we have grown and developed, adding different medical specialties such as Oncology and Nephrology as well as surgeries, including spinal surgery and renal transplants. We have 320 members of staff, and in the last five years we have opened up new units and now have hospital clinics in Victoria Island, Lekki Free Trade Zone, and a hospital in Maryland (on the mainland). Our aim is to develop a hub-and-spoke model to feed our hospitals.

In early 2017, the hospital was listed by the LSE as one of the fastest-growing companies in Africa. What was the main driver behind this success?

The hospital has grown rapidly in the past five years; since 1999 we have opened new clinics, increased our staffing, and put in place new processes and protocols. We seek to build a healthcare system and have an institution that can run by itself, because it has a corporate governance structure. Our competitive edge is in our ability to remain focused on providing quality healthcare. I look at other hospitals not as competitors, but as being in the same business of trying to provide quality and effective healthcare for the large population. Healthcare should not be expensive and some hospitals here are too expensive. The whole point is to provide quality healthcare at a reasonable cost and we focus on that without cutting corners. There is a large gap in providing affordable healthcare. There are more entrants coming into the medical space and many from abroad, including India and Turkey, proving that the healthcare business in Nigeria is vibrant and there are untapped opportunities.

What should be done to reverse the trend of people seeking treatment aboard?

A great deal has to do with confidence in our system, part of this is educating people and giving them examples of what has and can be done. We have to rely on healthcare institutions to showcase their achievements; this would help in no small way. We can safely perform various treatments here; however, people still go abroad for operations, mainly to the UK. It is a matter of building confidence through publications, demonstrations, and citing examples. There are other problems and some hospitals and practitioners are not up to scratch so more work has to be done by the Nigerian Medical Association (NMA) to sanction and enforce regulations of what can and cannot be done in a hospital. My role in building up trust in Nigerian doctors is by running a company that patients can trust. If a patient needs to have a non-emergency surgery it can be done via laparoscopy or via open surgery. If we do not have the competence to do it via laparoscopy and the surgery might leave a small scar, then we let the patient know. We explain what we are able to do and what could be done if they choose to go abroad. A large number of the medical practitioners we seek for abroad are Nigerian.

What can the government do to boost the healthcare sector?

The government and Ministry of Health can do more and equip the doctors with what they need to do their jobs. In the teaching hospitals, they need to do audits just to raise standards. Hospitals must seek staff that are intelligent and can be trained. All doctors are trained well enough; however, there is a great deal of improvement that can be done there. Trying to do something with the government is extremely difficult; however, the sector needs stricter regulations and controls that must be enforced. The government needs to provide an enabling environment that encourages 'reverse' brain drain. Another important aspect of our trade is tools and medication. The costs of equipment are astronomical due to exchange rate, duty payment, tax – we do not manufacture these equipment, but they are necessary for meaningful healthcare. Everyday routine medical 'consumables' from the disposable couch covers or paper hand towels to disposable gloves are more expensive that they ought to be. Drugs for some chronic ailments, immunosuppressant types or for chemotherapy, are beyond the reach of most of the people that require them and this leads to avoidable deaths, 'poor' treatment, and various societal anomalies. Unless a there is a determined effort by the government to review the Healthcare space in Nigeria holistically we will continue to lag behind our peer nations.

What is your opinion of compulsory healthcare insurance?

There is the National Health Insurance Scheme is also designing a scheme of its own that will resemble the compulsory pension scheme. It should bring in more money to do our work as our payments will be guaranteed. This is one of our biggest problems: receiving payment for healthcare, which is a global problem as excellent healthcare is expensive. A health insurance scheme that runs effectively is a solution. If it became mandatory for every company to pay health insurance for its staff, if there are more than five employees there would be a large pool of money. Assuming this money is used as it should be, and then its impact would be significant.

What are the specific healthcare trends in Nigeria?

Non-communicable diseases such as diabetes and hypertension are becoming more prevalent, as chronic kidney disease, cancers of the breast, cervix, and prostrate are also on the increase. The number of strokes and cardiovascular diseases also continues to rise. On top of this, we still see common Nigerian diseases such as malaria.

What are your expectations from 2018?

The hospital will expand in 2018. It will be our 50th Anniversary next year and with four healthcare facilities, I want to ensure they are all running as efficiently as possible. I would like to increase our bed numbers; we currently have 65 beds in two hospitals and I would like to increase that to the hundreds. Also, I would like to perhaps open another hospital. In terms of the general operating environment, a great deal depends on things that are not under anyone's control. I do not think anything drastic will happen. In 2018, the country will prepare for the next election and that will have an impact on the economy as a whole. We do not expect any adverse effects to our business and hope to continue what we do as best as we can.