Healthcare Financing Conference:

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2 Healthcare Financing Conference: Equipment Leasing as an Innovative Healthcare Financing Mechanism E k o CONFERENCE HIGHLIGHTS 1 4 O c t o b e r C o n v e n t i o n C e n t r e, L a g o s, N i g e r i a

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4 Background The Nigerian healthcare industry is currently experiencing a severe shortfall in the amount of finance that is required to meet the growing healthcare demands of the population. Innovative financing mechanisms, such as equipment leasing, must be rigorously explored as an option for the healthcare sector. The Equipment Leasing Act, which was recently signed by former President of Nigeria, Dr. Goodluck Jonathan, creates a legal framework that will encourage the growth of the equipment leasing industry. The Healthcare Federation of Nigeria, Medic West Africa and the Equipment Leasing Association of Nigeria have collaborated to host this conference. The goal of the conference was to bring various stakeholders together in order to initiate discussions around a framework for achieving greater utilisation of equipment leasing in the healthcare sector.

5 Opening Address: Healthcare Financing in Nigeria: The Need for Innovative Approaches Mrs. Clare Omatseye, President, Healthcare Federation of Nigeria The IFC estimates that Nigeria would require a total of $4.5 billion in capital investments to make quality health services available. However, a total of only $1.7 billion was allocated to the health sector in 2014 Lack of access to finance is a significant constraint preventing the upgrade of current healthcare facilities and infrastructure It is now time to seek innovative mechanisms for financing healthcare in order to close the financing gap Equipment leasing is one approach that has been successfully employed in other industries in Nigeria and this model should be adapted for use in the healthcare sector

6 Key Note Address: Equipment Leasing as a Means of Sustainable Healthcare Financing in Nigeria Mr. Chuka Onwuchekwa, Chairman, Equipment Leasing Association of Nigeria Leasing is beneficial for SMEs, particularly in the current environment in which it is difficult to secure loans from banks at attractive interest rates Leasing activity in Nigeria is very active, but healthcare leasing constitutes a very small proportion of the overall leasing business A variety of leasing models are possible, but payments must be structured in a way that makes sense and that matches the cash flows of the lessee

7 Equipment Leasing Act: Opportunities and Challenges Mr. Andrew Efurhievwe, Executive Secretary, Equipment Leasing Association of Nigeria Equipment leasing started in Nigeria in the 1960s and is currently being utilised in a number of sectors, including manufacturing, telecoms, agriculture and transportation Leasing is a contract between a lessor and a lessee, which gives the lessee possession and us of an asset in exchange for payment of rentals over a specified period The two most common types of lease arrangements are finance leases and operational leases, but there are numerous variations that can be tailored to suit the client Players in the leasing industry include banks, equipment vendors, insurance companies, independent leasing companies, etc There is tremendous potential for growth in the industry, as market penetration is still low Challenges to the industry include funding, default, lack of market awareness, inadequate fiscal incentives The Equipment Leasing Act will have a significant positive impact on the industry, since it creates a legal framework for the practice of leasing and contains key provisions that clearly outline the roles, responsibilities and protections for the lessor and lessee

8 Equipment Leasing Case Study: Narayana Health Dr. Mambidzeni Madzivire, CEO, Haralago Ltd. Leasing is based on the premise that income is earned from the use of assets, not from their ownership Narayana Health is an Indian multispecialty hospital chain that provides high quality services at low cost Narayana Health uses an asset light model to achieve its low cost goals while ensuring top of the line equipment. Some equipment is leased on a pay-per-use basis, but for this model to work, accurate measurements of the variable is critical Both the lessee and lessor must benefit from the lease arrangement the arrangement must be cost effective for the hospital while generating sufficient revenue for the lessor Leasing is not always the appropriate solution financial analysis may show that an outright purchase would be more sensible. There is no one size fits all solution, and facilities should use a combination of tools depending on their needs and financial position Innovating financing mechanisms require an enabling environment, e.g. stable tax regime, effective laws and legal institutions, ability to assess credit worthiness

9 Q&A /Discussion Session The principle of lease what depreciates and buy what appreciates can be used to guide leasing decisions Leasing involves creativity the client s needs can typically be met with the appropriate structure. For example, tailored payment terms In the instance of technological obsolescence, the lease arrangement can be structured such that old equipment is traded for updated equipment Leasing arrangements allow the lessee to specify the vendor and equipment that is to be acquired. Cross border leasing is allowed under the new Equipment Leasing Act Some members of ELAN have access to the SME fund, which can be used to finance equipment at lower interest rates PPPs and leasing are similar in that both relay on a negotiated contract which clearly stipulates the role and responsibility of both parties For leasing to be successful, the lessor, lessee and equipment vendor must cooperate for a win-win-win arrangement

10 Panel Discussion: Equipment Leasing in Healthcare A Viable Model for Supply Side Health Financing?

11 Panel Discussion: Equipment Leasing in Healthcare A Viable Model for Supply Side Health Financing? Dr. Leke Pitan, Former Commissioner for Health, Lagos State: Leasing in the healthcare sector is viable and should have been utilised much sooner Mrs. Oghogho Olakunrin, Consulting Manager, GE: Manufacturers cannot deal directly with providers at this time. The process must be structured to assure adequate protections for the OEM and equipment owner. GE signed an MOU with the Federal MOH for 5 areas: spreading healthcare technology, capacity building and training, primary and rural health, healthcare financing and PPPs. GE was unsuccessful in negotiating single digit interest rates from banks. Single digit rates were successfully negotiated with Bank of Industry, but only 4 out of 47 clients met their requirements Mr. Voke Oshevire, Executive Director, JNCI: JNCI has been doing some transactions that are very similar to leasing, however the level of risk exposure is very high. ELAN, OEMs and finance houses must work together. There need to be incentives for banks to lease, e.g. through an intervention fund Dr. Umar Sanda, President, Healthcare Providers Association of Nigeria: Leasing is facilitated with a Fidelity loan scheme for healthcare, which is currently at an interest rate of 9%, down from an earlier rate of 14%

12 Panel Discussion: Equipment Leasing in Healthcare A Viable Model for Supply Side Health Financing? Mrs. Chidinma Lawanson, Head, MSME & Agency Banking, Diamond Bank: The main problem for banks is to try to find the credit worthiness of the customer. There needs to be good governance by the client and assurance that the facility can generate sufficient cash flow. Diamond wants clients to make a contribution at the beginning of the transaction, which reduces the probability that they will walk away from the deal at a later stage Dr. Cheluchi Onyemelukwe-Onuobia, Executive Director, Center for Health Ethics, Law and Development: Many lawyers were not aware of the progress of the leasing act. Broadly, the Leasing Act is a step in the right direction, but there are a few concerns. For example, the penalty for moving an asset without lessor consent is only N50,000. The Act may need to be reviewed and revised. The law needs to be gazetted so that it can be accessed more easily and the registration authority must be set up so that the Act is effective Pharm. Gbenga Falabi, National Chairman, Nigerian Association of Industrial Pharmacists: 70% of drugs in Nigeria are imported. The pharmaceutical industry is characterised by high costs and significant investment is required to develop the manufacturing and distribution infrastructure. Equipment leasing is a viable option for Nigeria to build up pharmaceutical manufacturing capabilities

13 Panel Discussion: Equipment Leasing in Healthcare A Viable Model for Supply Side Health Financing? Dr. Patience Osinubi, Director, Hospital Services, Federal Ministry of Health: There is a wide perception that healthcare is a social service, and the willingness to pay for treatment is not high. This puts a strain on the cash flows of facilities and equipment leasing is a way in which payments can be spread out over time. Nigerians are not using public sector services because of the lack of confidence in the quality of services Mr. Babafemi Ehindero, COO, Utopian Healthcare Consulting: Utopian has secured financing for procuring equipment, but they need guarantees from local financial institutions. Leasing is an important tool, but it is not the total solution. A well functioning health insurance industry could potentially deliver greater impact, as it would encourage growth in the private sector by ensuring proper reimbursement for treatments Mr. Roosevelt Ogbonna, Executive Director, Commercial Banking, Access Bank: Lending to the healthcare sector by commercial banks has increased by 100% every year since Access Bank has a new social impact finance product called Access Baby, to support maternal health practitioners. The various stakeholders must look for ways to partner in order to petition the government for a health sector fund. The MD of Access Bank has made a commitment to facilitate the opportunity for the health sector to be heard by the Central Bank of Nigeria, through the Bankers Committee

14 Panel Discussion: Equipment Leasing in Healthcare A Viable Model for Supply Side Health Financing? Rev. Dr. Titilola Olawale, President, Association of General Private and Nursing Practitioners of Nigeria: Although the banking sector is often criticised by healthcare practitioners, it is important to congratulate the banks who attended the conference. The reality is that even lessors use the banks to get loans to finance the equipment purchasing Mr. Olayinka Dada, Product Manager/Business Advisor, Fidelity Bank: Leasing, hirepurchase agreements and loans are all forms of credit. Fidelity has disbursed significant amounts through the Federal Government s MSME Development Fund. Healthcare was included as a target, but there appears to be a knowledge gap and health practitioners are not aware of the product. Many healthcare providers are not trained to run businesses, and capacity building in this area is critical

15 Q&A/Discussion Session Healthcare practitioners need to improve their understanding of how the banking sector works and to become more financially literate Healthcare needs to make an investment case to the Federal Government, like the power sector successfully did. The correlation between healthcare and productivity must be made, and the private sector should take the lead in this effort Banks need to do more aggressive follow up after these types of forums and engage more with the health sector

16 HFN Presentation - Current and Upcoming HFN Initiatives Dr, Itunu Akinware, Executive Secretary, Healthcare Federation of Nigeria HFN is set up to speak with one voice for the Nigerian private health sector HFN focuses on three pillars- Access to Finance, Industry Growth(Capacity Building) and Advocacy In light of the feedback received from its members, HFN currently has submitted proposals to donor agencies for funding of capacity building workshops targeted to healthcare professionals. HFN is a member of the technical working group for the National Health Act. HFN is also working to advocate for investment incentive policies, e.g. to improve tariff regime.

17 Vote of Thanks Mr. Remi Adeseun, Chairman RODOT, Assistant Publicity Secretary Healthcare Federation of Nigeria Expressed gratitude to the speakers, organizers and to all in attendance Expressed hope that the day s discussions would be the first step to actualizing innovative approaches in healthcare financing

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