Nigeria’s $82 billion health-care hole: Traders stand by

A security guard administers disinfectant to a visitor to a government hospital in Lagos on February 28, 2020.

PIUS UTOMI EKPEI | AFP via Getty Images

The coronavirus pandemic has sharpened the lens of a significant health spending gap in Africa’s largest economy, and international investors are trying to fill the gap.

When it comes to health care, Nigeria lags behind its comparable African neighbors in terms of spending and access.

For example, Nigeria’s public health spending amounts to just 3.89% of GDP (gross domestic product) of $ 495 billion, compared to 8.25% in South Africa and 5.17% in Kenya, according to the latest available figures from the World Bank.

According to a recent report by real estate consultancy Knight Frank, Nigeria, it would take 386,000 additional beds and $ 82 billion of investment in healthcare real estate to hit the global average of 2.7 beds per thousand people.

According to the United Nations, Nigeria’s 206 million population is expected to nearly double by 2050, which would make Nigeria the third most populous country in the world.

All of this – especially in connection with the coronavirus pandemic – has sparked interest in this sector among foreign investors.

A Knight Frank poll of 140 global investors in June found that 80% are considering investing in African healthcare infrastructure in the face of the coronavirus crisis. This interest has mainly focused on hospital-related real estate and operations businesses in collaboration with domestic experts.

As in much of the African continent, Nigeria has managed to keep the number of coronavirus cases relatively low given the size of the population. According to data from Johns Hopkins University, 90,080 cases and 1,311 deaths were recorded on Monday morning.

International interest is growing

Even before the pandemic, African health goods had aroused broader interest. The International Finance Corporation, part of the World Bank, partnered with the Health in Africa-II Investment Fund (IFHA-II) in November 2019 for a US $ 115 million acquisition vehicle for health care companies in the eastern and southern US to form continent.

European development finance organizations such as Swedfund, the Swedish development finance institution, have supported IFHA, along with Pfizer and the Stichting Social Investor Foundation for Africa, whose supporters include Aegon, Heineken, Shell and Unilever.

Since the outbreak of the pandemic, the Nigerian government has spent 100 billion naira ($ 254.6 million) on government credit facilities for healthcare, from pharmaceutical companies and product manufacturers to service providers, which it seems has piqued the interest of private investors. The Bank of Industry, a Nigerian development finance institution, is providing an additional 50 billion naira.

“There is a very compelling opportunity for the development of world-class healthcare facilities across Africa, particularly in Nigeria,” said Hafeez Giwa, managing partner at HC Capital Properties, which has begun investing in healthcare facilities in Nigeria.

Hafeez Giwa, managing partner at HC Capital Properties, has started investing in Nigeria’s healthcare infrastructure.

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“Most of the public hospitals here were built over 40 years ago and only a handful of investments have been made since then,” Giwa said in a report released Monday by frontier market consultancy New Markets Media & Intelligence.

Tosin Runsewe, CEO of health investment firm AfyACare Nigeria, highlighted another possibility: Compulsory health insurance for federal employees would reduce insurance costs and the percentage of health costs covered could increase to 20% to 30% by 2030.

Currently, around 72% of household health care spending is out of pocket, compared to the sub-Saharan average of 35%, the Knight Frank report points out, and only 5% of health care is insured.

“If we could reach a critical mass of 40 to 60 million Nigerians with health insurance, the cost of this treatment could be covered by health insurance premiums of only about 20,000 naira ($ 50) a year, half the current average cost,” Runsewe said.

“There are a number of opportunities for investors to invest in private primary health clinics that can provide services at affordable costs.”

Commuters wearing a protective face mask walk on the streets of Lagos on March 26, 2020 to take preventive action against the spread of the new coronavirus COVIC-19 in Lagos.

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According to Giwa, HC Capital Properties invested in Nigeria because of both “extreme needs” and government initiatives that have made it easier to develop high quality assets that provide affordable care. He suggested that two types of investors are currently exploring these options.

“On the one hand, there are local institutional investors and local pension funds who, in the case of Nigeria, are naira investors and have no currency risk concerns,” said Giwa.

“On the flip side, there are developmental investors and institutions that are excited about the prospect of providing quality health care to low- and middle-income Nigerians.”

He believes the pandemic has resulted in a “permanent change in thinking” that places greater emphasis on the quality of home health care.

Currently, Nigeria is losing up to $ 1 billion a year to outbound health tourism among wealthier Nigerians due to inadequate access to the interior, according to a recently released PwC report.

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