The Role of Institutions in African Development

By Adeyemi Adewole 

“Average per capita health spending is low in Africa, but higher than in South Asia. Yet South Asia, in general, has better health outcomes. So Africa not only needs more money for health, it also needs more health for the money” – Key message from Africa Health Forum 2013

As Africa’s demographic and economic realities transform, solutions addressing health risks and sustainability are evolving. A growing urban population and a burgeoning middle class have adopted tenuous diets and lifestyle trends, giving rise to chronic non-communicable diseases. In addition, a lack of sanitary facilities, poor solid waste management, uncontrolled industrial effluent, and inappropriate sanitary behaviour have added to health hazards and resulted in the proliferation of communicable diseases.

As a result, many African countries face a major challenge to sustainable development. In the face of these demographic trends, current public infrastructure is ill-equipped to manage these changing realities. Inadequacies in both human and material infrastructure create an environment in which negative health outcomes not only effect individuals but also create a major challenge for sustainable development more generally.

The Center for Sustainable Health and Environment in Nigeria is being set up as part of an effort to improve health outcomes  through high-level research, demand and project-driven knowledge, and education.  As part of the proposed Sustainability School in Lagos, the Center will be positioned to tackle the health and environmental challenges being witnessed in Nigeria and later throughout West Africa.

Using Lagos—Nigeria’s largest city and commercial—as a pilot site, the Center‘s  activities will focus on technology and innovation, health and environment, and public policy as it impacts health. As one of Africa’s fasting growing cities, experiencing all of the advances and issues of the large 21stcentury metropolis, Lagos’ actions and affairs have not only had a rippling effect on neighbouring cities and states, but may also hold many lessons for cities and countries around the world. As a result, initiating the program in Lagos will provide us with a good understanding of its potential and achieve impact both throughout Nigeria and the larger West African region.

The main focus areas of the Center will be health (communicable and non-communicable diseases and disabilities), environment (sanitation and waste management) and innovation – particularly in the areas of M-health and telemedicine practices- that will allow not only for more efficient patient care, but also improved project monitoring and evaluation, stakeholder participation, and data collection.

As a physical structure with necessary staff and other resources, the start date for operations at the Center will depend on when the Sustainability School commences operations. As the School will need to get accreditation from the Universities commission as well as other licences from the regulatory authorities, our target is to open in three to five years. However, since projects will be our main focus, we are able to begin much of our work immediately in collaboration with partners such as the Global Institute of Sustainability at Arizona State University. As the Center begins to come online, these projects will be reintegrated into its overall structure and activities.

An example of the type of projects that CSHE will undertake is the creation of Renal Resource Centers (RRCs). A consequence of either direct, indirect, or by both, allied diseases (cardio-vascular, cancer, diabetes and hypertension) and life-style changes, kidney disease currently affects 20 to 25 percent of the Nigerian population above the age of 18 and accounts for six to 12 percent of the medical admissions. Kidney failure is the 12th cause of death globally, and in Nigeria it has a prevalence rate of 25 per 100,000 (WHO, 2013; Vanguard, 2013; Punch, 2012; World Life Expectancy, 2014; Sunday Trust, 2013).

The RRCs were set up with the aim of developing and utilizing project-centered, data-driven efforts to reduce the incidence and the impacts of kidney disease on the public and will provide both medical care and education while serving as repositories of data through the establishment of renal registries. The RRCs will also spearhead the creation of a r enal reimbursement program. The intention is to deliver innovative and quality renal care services to patients afflicted with the disease—especially to the underserved and less privileged—while providing a buildin base of data and knowledge that can be utilized in future research to lower the incidence and impact of kidney disease. As currently envisioned, the RRCs will also strategically deploy mobile dialysis units to remote areas where access to dialysis has previously been impossible.

In order for the Center to kick off as envisaged and create the necessary impact in the areas of sustainable health and environment, diverse resources for research and implementation need to be tapped. To this end we are hoping to take advantage of the current interest in public-private partnerships, particularly those that look to improve health and environmental outcomes.

Currently the Federal Government of Nigeria is vigorously pursuing a policy for the entrenchment of public-private partnerships in the healthcare sector – where government, NGOs, and multilateral development organizations have been working on plans to achieve the millennium development goals and continue the fight against epidemic scourges like HIV/AIDS.

On the state level, Lagos State, has utilized public-private partnerships to take major strides in urban vegetation and environmental cleanup. As a result they have inspired other cities in Nigeria and West Africa more broadly to pursue similar initiatives. This increased level of private sector participation in initiatives that address issues of health and environmental infrastructure, and the need to approach these issues from a research and data focused perspective, has created  the opportunity  to deploy accelerated project-focused initiatives, using innovative strategies to improve health.

The focus areas and resources previously mentioned will combine to successfully tackle and complete projects in the areas of waste-to-energy, sanitation, and health care projects. And help ensure that Nigeria’s greatest asset, its people, will continue to embrace innovation, creativity, and learning, while achieving social and economic development in a sustainable environment.


Adeyemi Adewole is the managing director of ADCEM HEALTHCARE LIMITED, Nigeria and is a co-promoter of the proposed Sustainability School, Lagos, Nigeria.