LAUTECH Journal of Nursing Vol.

9, May, 2021

ENTREPRENEURIAL BUSINESS MODEL: PREREQUISITE FOR INCLUSIVENESS IN HEALTH CARE

DELIVERY SYSTEM IN NIGERIA

ADELE Hasimiyu Ademola, AFOLABI Yakibi Ayodele, OLADELE Patrick Olajide & AGBOOLA Olushola
Jacob
Correspondence address: haadele@lautech.edu.ng; +2348089920302

Abstract
The dynamics of sociocultural influences on access to public health has moved current thinking beyond the behavioural,
biological, environmental, and physical causes of diseases to embrace the relationships between health and social
contexts. This with a view to proffer direct and specific solutions to the pervasive predominant problems of healthcare
accessibility that matches each context. Thus, this study examined the effects of deployment of innovative business model
on the performance indicators of healthcare delivery system in the frontier countries, like Nigeria. Specifically, the study
examines effects of entrepreneurial business model on availability, affordability and accessibility of quality healthcare
services to all including the poor and vulnerable citizens. Primary data collected through the instrumentality of structured
questionnaire administered on twenty-five (25) senior staff and twenty-five (25) patients of purposively selected five (5)
hospitals operating in the southwestern Nigeria, and personal interview on five (5) CEOs also purposively selected were
analysed with the aids of descriptive statistics to determine the contribution of each identified variables. Findings revealed
that, any appropriate business model that will foster inclusiveness in health care delivery system in Nigeria must earn the
trust of the vulnerable, must be relatively affordable and geographically accessible. The paper concludes that stakeholders,
policymakers, and hospital management must consider the peculiarities of the subpopulation’s sociocultural factors in
designing their health care value propositions.

Keywords: Business model, healthcare services, accessibility, affordability, availability

Introduction
Health and human well-being constitute the most being, level of people’s satisfaction with healthcare
important elements in Human Development Index. services and the costs implications of these services
Thus, the United Nations, prompted by the closeness on the citizenry. And this is particularly to the general
between healthy living and economic wellbeing, people, irrespective of social status, gender, level of
describes its Human Development Index as a education, etc. to ensure healthcare system that is
composite index that reflects life-expectancy, available, affordable and freely accessible to all and
educational achievement, and real per capita income sundry.
(UNDP, 2019). These constitute the three most
essential elements required by people to enjoy a long Further, the Health Care Index can be described as a
and healthy life. And as posited by the World Health measure of the overall quality of the health care
Organisation (WHO, 2018), the health and well- system, its cost implications, health care
being of people around the world critically depend on professionals, doctors, nurses, staff, equipment, and
the performance of the healthcare system that serves all paraphernalia necessary to engender the well-
them. It is therefore not surprising that quite several being of a nations’ citizenry. And as asserted by
government and non-governmental organisations Ileana et al. (2015), it is an organisation of people,
focus attention on this important area of human institutions, and resources needed to deliver health
livelihood. care services to meet the health needs of a target
population. The Bloomberg (2019), in its Bloomberg
The World Health Report (2000) predicated the Healthiest Country Index, considering variables like
health care system assessment of nations on five life expectancy, environmental factors of access to
basic indicators: overall level of population health; clean water and sanitation, ranked Spain as the best
health inequalities within the population; overall level country with an excellent healthcare system as at
of health system responsiveness; distribution of 2019. Italy, Iceland and Japan were ranked 2nd, 3rd,
responsiveness within the population; and the and 4th respectively. The Bloomberg study conducted
distribution of the health systems financial burden their ranking using data from WHO, World Bank and
within the population. A closer look at these five the UN Population Division which also include a
indicators suggest that they are designed to examine guaranteed universal healthcare system, the healthy
the disparities in attention giving to people’s well- dietary habits, as well as a conducive healthy

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environment (Tapia, 2019). Other criteria, as improve access to healthcare and at the same time
applicable to all other countries are the number of increase returns to providers (Angeli and Jaiswal,
healthcare professionals (including Doctors, Nurses, 2016; George et al., 2015; Kim et al., 2013;
etc.); number of bed spaces, quantity and quality of Simanis et al., 2008).
facilities and equipment, etc.
While business model explains the underlying
It should however be noted that most countries with economic logic that describes how a producer can
the lowest rankings are the developing countries of deliver value to customers at an appropriate cost. It
Asia and sub-Saharan Africa with the attendant low is designed to identify customer needs, appreciate
life expectancies, prevalence of ill-health resulting his/her cherished value, and strive to meet those
from malnutrition, unhygienic environment, lack of needs while generating appreciable returns on
access to clean water and sanitation, HIV and AIDS investment. An appropriate business model that will
epidemics etc. The peculiarities of health deliver health care services to all, including the less
environment of the less-developed countries, as privileged must necessarily describes the rationale of
opined by Angeli and Jaiswal (2016) is characterised how the service provider creates, delivers, and
by poor living conditions, unhealthy dietary habits, captures the peculiarities of all and sundry, taking
dangerous exposure to diseases, and limited access to cognisance of sociocultural and economic contexts. It
healthcare services. These coupled with the is on this premise this study examined the effects of
predominantly low literacy level, low incomes, high deployment of innovative business model on the
unemployment and official corruption has ensured a performance indicators of healthcare delivery system
large proportion of the population lives in abject in the frontier countries, like Nigeria. Specifically, the
poverty resulting in a depleted quality of life that study examines effects of entrepreneurial business
contribute to reduced life expectancy. Corroborating model on availability, affordability and accessibility of
this assertion, The World Health Report (2000) quality healthcare services to all Nigerians including
affirms that the impact of health systems failures is the poor and vulnerable citizens.
most severe on the poor who have no financial
protection against ill-health but must buy health from The Sociocultural Health Environment of Frontier
their own pockets which drives them deeper into Countries
poverty. Also alluding to this position Angeli and The effects culture exerts on health of a people can
Jaiswal (2016); George, et al. (2015); Kim, et al. be very vast and encompassing. Culture can be
(2013) posited that the major cause of health systems described as a pattern of ideas, customs, believes,
failure in less-developed countries is the under- norms and behaviours shared by a group of people
optimal access to health care services. or a society. Culture shapes the perceptions of
health, illness and death. It greatly influences believes
Thus, the need for a paradigm shift in the way about the causes of diseases, it defines how illness
healthcare is provided has necessitated the call for and pains are experienced and expressed, how and
different approaches to ameliorate the deplorable where to seek medical attention. Thus, cultural bias
nature and arrest the decay in the healthcare systems often results in very different health-related
in these climes. Consensus in literature suggests that preferences and perceptions to the extent that both
patients, like customers are demanding more value patients and care givers are greatly influenced by their
for their monies, and that healthcare providers must respective cultures and which determines the overall
strive to render quality services, better care, and at success of a health system. As posited by Marmot et
lower costs (Berwick et al., 2008; Porter and Teiberg, al. (2008), the idiosyncratic believes, traditions,
2006; Smith et al., 2009). In the less-developed norms and institutional isolation do frustrate the very
nations’ context, traditional methods that have been process of health need recognition, as patients rely
successful in developed nations have proved on their networks, local communities to identify their
ineffective, no thanks to the peculiarities that are ailments (albeit wrongfully), to determine when and
markedly different between them. And as posited by which type of medical care to seek. It has been
(Hubley, 1986; Marmoth, 2000) much of the observed that healthcare services are characterised by
knowledge available on health determinants and high information asymmetry between patients and
disparities emanate from research efforts on the care providers across contexts (Lako and Rosenau,
interactions between socioeconomic variables and 2009; Marmot et al., 2008; George et al., 2015).
health in developed countries, which may not The strong influence of sociocultural believes,
necessarily be relevant to situations in the less- tradition and norms often ensure that the first point
developed countries. Also, the resulting interventions of consultation, in most less-developed countries, is
might not be sufficiently suitable for other contexts. the unqualified, uncertified traditional healers or even
Hence, extant literature is replete with the need to quacks that pervades chemists and mushroom drug
fashion out new business models in these climes to stores within the neighbourhood. Regular healthcare

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facilities are resulted to only when the ailment Access to Healthcare Service Delivery in Frontier
becomes critical and the cost of treatment must have Countries
risen. The environmental health of any nation, as Every individual craves for a better quality of life and
opined by Abolade (2018) must include, among a better functional capacity derivable from the ability
others: access to clean water, food hygiene, housing to command appropriate healthcare resources.
sanitation, health education, school health services, Having timely use of personal health services with a
air pollution control, prevention and control of view to achieving long and healthy living is the utmost
communicable diseases, care of the dead and so on. desire of man. Access to healthcare describes the
ability of every individual to seek and benefit from
The Nigerian healthcare system operates a three- effective healthcare services as at when needed. In
tiered governance structure where the primary their study on “Access to Primary Healthcare in
facilities (maternal, child, family, and dispensaries) is Brazil”, Boch, et al. (2016) describe access to
by the local authorities; secondary healthcare falls healthcare as a combination of fast availability of
within the jurisdiction of State governments, while quality care, affordable services and easy
tertiary healthcare responsibilities are under the geographical access to healthcare facilities. Thus, for
purview of both the States and Federal government. any healthcare system to function effectively good
However, with an estimated total health facility of quality healthcare services must be available in large
23,640 as at 2010, the WHO” s Global Healthcare quantity, at lower costs to the people and must be
Index 1990 - 2015 ranked the country 187th out of inclusive to all and sundry. However, extant literature
195 member states on health-related issues. The affirms that a higher proportion of the population of
WHO/UNICEF Health Development Index (2018) frontier countries do without healthcare from which
statistics indicated that with an estimated population they could benefit (OBG, 2019; O” Donnell, 2007;
of 200 million, the patient-to-doctor ratio stood at WHO, 2018). From the supply side, good quality,
2500:1, as against WHO” s recommended 600:1, effective healthcare services, can only be induced by
average life expectancy at birth of 52 years, infant an effective high-level of demand, this may not be
mortality per 1000 of 77.8, all compounded by a attractive to the poor masses. On the demand side,
healthcare financing of 8.17% of annual GDP many individuals, from the frontier countries, may
(WHO, 2018). It should however be noted that about not be willing to patronise good quality health
70% of healthcare services in Nigeria is provided by facilities due to a range of factors, chiefly poverty and
private health vendors, including NGOs (Welcome, illiteracy.
2011), hence, the inadequacy of the healthcare
delivery system resulting in only about 43.3% of the The complex and idiosyncratic characteristics foisted
population having access to healthcare (WHO, on the masses by the prevailing sociocultural factors
2018). that manifested in poor level of awareness and
reluctance to accept public health facilities has
The dysfunctional healthcare system is further ensured a poor health-seeking behaviour. Confirming
compounded by the fact that more than 50% of this assertion, Angeli and Jaiswal (2016), posited that
Nigerians live below poverty line of less than $1 a awareness and acceptability remain critical factors in
day, hence could hardly afford the costs of these climes due to the challenges posed by patient’s
healthcare. And as posited by Akande (2004) the limited health literacy and exposure to traditional
poor managerial functions of the healthcare delivery dissemination channels devoted to publicising socio-
system as manifested in the very poor referral system culturally acceptable (but substandard) solutions.
between the various tiers, coupled with the fact that Thus, even where good quality health care facilities
some 70% of drugs dispensed are alleged to be fake are available, patronising them becomes socially and
or substandard further complicates Nigerian health culturally a taboo. Preference is rather given to
system. Notable challenges to healthcare delivery traditional healers and unqualified chemists whenever
system in Nigeria, as observed by the WHO (2018) it becomes expedient to seek medical helps. And
Oxford Business Group (2019) and reported by where allopathic health care services are sought, it is
Medic West Africa (2019) includes: inadequate usually when the ailment has become dangerously
government funding; rising incidence of infant and bad. Thus, access to healthcare services in the form
maternal mortality; heavy reliance on out-of-pocket of fast availability, appointment with a medical
finance of health by private individuals; and with doctor, diagnosis, and treatment, as described by
noticeable decline in health workforce migration, the Boch et al. (2016), becomes elusive as a result of
major challenge remains inadequate production and some reinforcing sociocultural characteristics of the
equitable distribution (Medic West Africa, 2019). people.

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In his exploratory classic paper, Arrow (1963) employment, and other non-medical factors of
explain the specific differential of medical care as the population possess huge impact on preventing
object of normative economics in which its specific serious illness among vulnerable populations which is
problems are explained as adaptations to the capable to drive health costs. The systemic factors
existence of uncertainty in the incidence of disease include the coverage rates, disparities in coverage
and in the efficacy of treatment. While uncertainty and quality among vulnerable populations, and safety
and information asymmetry always exist in markets all with implications on preventive health and
across contexts, the willingness and preference for evidence-based practices. The operational factors
consumer products and services provide just enough revolve around existing and projected workforce
information and certainty for consumers to make shortages, rising prescription drug prices, rapid
purchase decisions. In a consumer market, value for technology adoption, as well as the burden of
money is the driver of competition, innovation, and regulatory compliance. In less-developed
product/service quality (Arrow, 1963). Every environment, consideration must be given to the
producer must therefore strive to beat the vulnerable poor whose out-of-pocket expenses is
competition by seeking to always identify customer driving them deeper into abject poverty.
needs to ensure improved value creation at the lowest
cost possible. Not so in the healthcare sector, since Provision of adequate geographic access to health
customer needs, expectations and preferences are care facilities is one of the defining characteristics of
not necessary to design value propositions. And as a functioning health system (Evans and Stoddart
posited by Castano, (2014), value created in 1990). And as opined by Lawal and Anyim (2019),
healthcare is not so obvious to patients, as only to measure geographic access, consideration should
doctors and healthcare professionals are traditional be given distance to facilities, ease of transportation,
designers of solutions to patients which gives them travel time and costs. In less-developed countries, it is
the privilege to create the structures and processes the inequalities in geographic access to health care
that are expected to result in the possible best that constituted greater challenges in achieving the
outcomes. It is based on this premise that Arrow third Sustainable Development Goal set by the United
(1963) predicated the healthcare industry’s inability Nations (UN, 2015). For regions with huge
to create value for money. He proposed that population and population density, as obtained in
uncertainty in the diagnosis and treatment of disease most less-developed countries, the pattern of access,
makes it difficult for doctors to achieve predictable both within the rural and urban areas, are usually
outcomes. Furthermore, that recovery from diseases inadequate. This was said to be responsible for the
is as unpredictable as its incidence due to the outbreak and easy spread of Ebola as an infected
complications in medical knowledge where the individual possesses the capacity to transmit the
doctor possesses more information on the disease to hundreds of people within short period
consequences of the treatment than the patient. because of the proximity and inadequate access to
Advancement in technology notwithstanding, costs health facilities (Alexander et al., 2015; Heymann et
of medical care is always on the increase as novel al., 2015). Thus, in a good and efficient health care
medical technologies generates negligible benefits at system every individual should have easy access to
increasing costs as against happenings in other appropriate quality health care in a timely, acceptable
industries (Berwick et al., 2008; Castano, 2014; and affordable manner (Lawal and Anyim, 2019).
Smith et al., 2009).
Finding Appropriate Business Model for Health Care
Fundamentally, healthcare affordability critically Delivery in the Frontier Countries
depends on patient’s income, propensity to spend on The theory of disruptive innovation, as propounded
unforeseen contingencies, and personal/societal by Christensen (1997), is a process by which a new
judgements about the value of health facilities entrant into an established industry directs its efforts
available. As posited by Weiner and Glickman towards satisfying the needs of neglected, resource-
(2018), it is a sentiment, involving a qualitative ability constrained, bottom of the pyramids customers. The
and willingness to pay. Unlike most economic new entrant gains traction through quality but low-
measures, health care spending is usually skewed cost offerings and moving up market by offering
with customer needs and demand largely varying attractive solutions to the most profitable segment of
from one individual to the other, and that with time the target market. The process continues until when
health status of individual changes. Factors affecting the new entrant efforts gather enough momentum to
health care affordability have been classified into dislodge market leaders with its new innovations
three by the American Hospital Association to (novel products and services). Uber, Bolt, Airtel,
include: societal, systematic, and operational (Bathija, MTN, to mention but a few, have succeeded in
2019). Social determinants of health with respect to revolutionising transport and telecommunication
variables like education, housing, transportation, industries for example. Having established the fact

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that traditional business models that have been must be imported coupled with the unattractiveness
successful in the advanced countries have been of the rural and urban slums to qualified health
grossly ineffective in these climes (Angeli and Jaiswal, professionals. The scarcity of qualified medical
2016; George et al., 2015; Hubley, 1986; Kim et doctors in Nigeria stems from the limited number
al., 2013; Marmot, 2000), appropriate business produced yearly from Nigerian universities. The
models must be cognisance of the identified WHO Study on Medical Doctors in each country by
peculiarities of the resource-constrained populations. every 1000 people revealed that Nigeria produces
370 doctors in every 10,000 (Motolani, 2019). With
That a large proportion of the population in rural as little as less than 80,000 population to serve about
Nigeria have very limited health literacy and do find 200 million people. Nigerian doctors are leaving its
it very difficult to identify their health problems or that shores in droves, to seek greener pastures, same as
they may not be able to describe them properly is a their Nurses, Mid-wives, and other counterparts from
major challenge. The World Health Report of 2014 the medical field (Medic West Africa, 2019). An
estimated that, world-wide, some 2.5 billion people appropriate business model must necessarily try to
do not have access to basic sanitations, which results overcome these menaces, either by leveraging on
in loss of some 600,000 lives through bacteria- medical professionals’ intrinsic motivations, as
induced diarrheal infections annually. In most rural suggested by Christensen et al. (2000). This can be
and urban slums, the report confirm that dwellers are done by invoking the spirit of volunteerism
not favourably disposed to the idea of using toilets, (encouraging well-placed medics to be socially
especially the ones under the same roof where they responsible), patriotism (by offering them opportunity
eat and sleep. This is because they lack the to contribute or give back to the community from
understanding that from their open defecation where they grow up). Most Non-Governmental
practices come contaminations from human wastes Hospitals in Nigeria are currently benefiting from
which is dangerous to their health. In the same vein, volunteers, as posited by Adele (2014), Pathfinders
the OBG (2019), while commenting on the 2017 International, Amen Healthcare Foundation, Breast
National Health Policy, as amended, describe the Cancer Association of Nigeria, Association for
Nigerian health care services as fraught with Reproductive and Family Health, to mention but few.
inequities that manifests greatly in socioeconomic
and geographic lines. To the extent that only 11% of To address the scarcity of qualified medics, Niezen
births to illiterate women occur in certified health and Mathisjssen (2014), suggested the use of task
facilities as against 91% of educated mothers, and reallocation practices. This involves organising
some 86% of women in urban cities receive prenatal training for young people, with flair for medical
care compared with 48% in the rural areas. Similarly, practices to handle simple tasks, as support staff and
the World Health Statistics reported an estimated 63 nurses. They assist in routine activities of preparing a
million Nigerians lack access to potable water while patient for major operations and effect management
one-third of rural and 12% of urban population still of post-operations. Thus, doctors spent very little
practise open defecation (WHO, 2018). It is on this time per patient, to perform just the critical
basis we conclude that a business model that will operation. In which case allowing the doctor to
describe the resources, processes and cost attend to as many patients as possible. Example is the
assumptions capable of leading to an appropriate assembly line operational model adopted by Aravind
value propositions in this clime must first and Eye Hospital in India. As reported by Rosenberg
foremost ensure that patients are aware of their (2013), by devoting their time to only the core
health needs, especially practices that are injurious to surgical operation, an ophthalmologist performs an
their health, and believe in the efficacy of the average of 2000 cataracts operation annually with
proposed solutions. Thus, we formulated the first little defect precision, and at very lower costs.
proposition that:
Furthermore, efforts must be made to ensure the
A dynamic interaction between patients and deployment of appropriate, locally sourced
healthcare providers that engender trusts is sophisticated medical equipment that are not as
associated with appropriate business model. expensive to increase costs of health. For instance,
an incubator is a very expensive medical equipment
Persistence high costs of health care delivery across usually employed to maintain environmental
contexts, as affirmed by Christensen et al. (2000), is conditions for a neonate, not many hospitals can
usually explained away in the ever-increasing afford it, especially in the less-developed world.
personnel costs (especially in the area of specialised
knowledge required in most phases of care and It is on these pretexts, as reported by Dana (2008), a
treatment). And in the rural areas, this is further group of students, rising from a class in Engineering
compounded by the costs of medical equipment that for Extreme affordability at Stanford University

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devised a little sleeping bag attached with a space- redundant facilities as a result of non-consideration of
aged wax technology inserted in the back pouch. spatial access at the planning stage (Otu, 2018). A
Once heated over boiling water, it can keep the baby large proportion of subscribers to the NHIS are
at proper temperature for four (4) hours. This locally presently unable to access it due to geographic
produced sleeping bag is at a cost of $25 instead of distance. Most of the facilities are in urban centres
$2500 for a standard incubator (Dana, 2008). In the that are difficult for rural dwellers to access in time of
same vein, as reported by Express Healthcare (2008), needs.
the popular medical equipment manufacturer, GE –
with India markets in view, rolled out series of low- However, advancement in technology and easily
costs, battery-powered, easy to use devises like Tejas available spatial data have reduced the burden of
XR 6000, an X-Ray machine that provides high travel as well as the friction of distance to the extent
resolution digital images at half the cost of its networking, partnership and telemedicine has ensure
imported counterpart. The MAC 400, lightweight delivering quality medical services by experts
with rechargeable lithium-ion battery, an ECG irrespective of location. A good business model must
machine that produces ECG Reports at less than $1, leverage partnership, networking and collabourate
and with capacity to produce more than 100 reports with appropriate resource owners with a view to
on a single battery charge. It was manufactured by simplify the delivery of quality care. With a mission to
GE at a cost of less than one-fifth of the conventional provide cardiac care to all and sundry in India, Dr.
machines (Express Healthcare, 2008). Thus, we Shetty, as reported by Madhavan (2014), established
formulated the second proposition that: Narayana Hrudalayala Hospital (NHH) in Bangalore
in 2001. To circumvent delivery hurdles, he
Leveraging medical professionals’ intrinsic established small Cardiac Care Camps (CCC) across
motivations while deploying low-cost but rural settlements and with the aids of networking,
appropriate technology are prelude to partnership, and video conferencing he linked them
fostering appropriate business model up to the main hospital. Each CCC was equipped
with medical supplies, facilities and ECG machines
Globally, the health care facilities distribution usually that were operated by locally trained medical staff.
follows the rich-poor line divide that tends toward a And on the account of Suresh (2012), through these
negative relationship. Thus, as observed by Hart camps, NHH was able to analyse some 144000 ECG
(1971), health facilities are likely to cluster in the outputs as well as 33000 angiograms, being the
high-income neighbourhood where health needs are largest telemedicine platform as at 2008. The feat by
low and car ownership is high to the detriment of the Dr. Shetty was made more outstanding when
low-income areas. While the spatial dimension of consideration is given to the achievement of zero-
access to healthcare includes accessibility and defect precision as against 8 – 40% post-surgery bed
affordability of health care services, geographic sore world-wide (Madhavan, 2014). Furthermore,
accessibility, as posited by Delamater et al. (2012) is Dr. Shetty’s NH Hospital forged strategic
a measure of the friction of distance or burden of partnerships with the Indian Space Research
travel between potential users’ residents and hospital Organisation (ISRO) to leverage on its internet
facilities. Access to health care becomes complex and connectivity for the extensive telemedicine across the
multifaceted as a result of the complexities in the CCCs, and the Indira Ghandi Open University,
characteristics of the population in need of health providing training grounds for first Diploma in cardiac
services as well as the health care delivery mechanism care (Angeli and Jaizwal, 2016). Thus, with the aids
that serves them. And as opined by Delamater et al. of medical technology innovation, networking,
(2012), the inequalities in geographic access to strategic partnerships, and collabouration,
health care is a function of the population inequalities in geographic access to health care can
distribution, configuration of facilities and the be reduced to the barest minimum. Thus, we
available transportation infrastructure within a formulated the third proposition that:
community. The closeness of health care services to
the people, irrespective of their personal A good business model must leverage
circumstance, is bound to improve healthy living and technology, strategic partnership, and
this implies adequacy and timely reach to health networking to circumvent inequality in
services when necessary in order to improve physical geographic access to health care
and mental wellbeing. In Nigeria, lots of efforts on
improving health care by policy makers, health Methodology
experts and administrators are usually focused on The study was conducted on five (5) purposively
financing, increasing human resources and other selected hospitals operating in the southwestern part
interventions at the expense of attention to spatial of Nigeria. Simple random sampling technique was
access. These often results in abandoned, unused, or employed to select 25 senior officials from each

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hospital (including Professionals, Doctors, Nurses, that ensure good quality healthcare is made generally
Administrative staffs) to give equal representation to available to the people at very affordable rate and at
each segment of the hospital management. their easily accessible convenience. Three
propositions were formulated to identify the study
Primary data for the study were gathered through the variables, and which form the kernel upon which our
instrumentality of structured questionnaire structured questionnaire and personal interviews
administered on 25 senior officials and 25 patients were based. The results of descriptive statistical tools
from the selected hospitals with a set of multiple items deployed to analyse data obtained through
reflecting a 5-point Likert-scale to measure each administered questionnaire, on both hospital officials
identified variable, and personal interviews conducted and their patients, and the qualitative data gathered
on the Chief Medical Director of each hospital. Of from personal interviews were compared for the
the 250 questionnaires administered, a total of 234, purposes of literal and analytical generalisation.
representing 93.6% response rate were retrieved and
utilised for data analysis after screening and Results obtained, as shown in Table 1. indicated that
evaluation. Data obtained were analysed with the aids most sampled hospital official respondents (74.45%)
of descriptive statistical tools to describe the agreed that they render fast and convenient
necessary attributes of a business model suitable for healthcare services to their patients irrespective of
inclusive healthcare delivery, most especially in the status, and that their structure is such that affords a
frontier countries. patient to see a doctor, get examined and undergo
diagnostics, if required, on the first visit to the
Results hospital. Corroborating this view as obtained from
This study examined the effects of deploying the Table 2, most sampled patients (69.5%) agreed
innovative business model in healthcare delivery that the hospital services are fast and convenient.
system as a prelude to achieving all important These opinions were also corroborated by the
inclusiveness on the part of the general populace with analysis of the data from the interviewees, as the
a view to ensure healthy living for all and sundry. This textual descriptions from three of the participants
is an attempt to identify attributes of a business model summarised their responses as presented:

Table 1: Responses of Sampled Hospital Officials on Accessibility, Affordability and Geographic access to health
care delivery Services (%)
Particulars Strongly Disagree Undecided Agree Strongly
Disagree Agree
We render convenient and fast health care 3.25 15.05 7.25 34.40 40.05
services
Our facility can offer medical exams and 5.25 7.05 10.20 37.00 40.50
diagnostics to patient on the first day
We have speed in arranging medical 11.35 12.25 14.40 28.02 33.98
appointment and doctor consultation
We offer high quality healthcare services at 6.75 10.20 12.25 30.40 40.40
very affordable prices
Some of our partners sometimes offset 7.30 7.65 15.70 29.30 40.05
medical bills of low-income patients
We get supply of drugs mostly directly from 10.00 12.30 18.15 29.05 30.50
our partners - pharmaceutical firms that
produce them
Our hospitals are strategically located close to 4.55 6.75 11.10 35.2 44.4
the people
We consider areas easily accessible to public 3.35 5.05 12.20 35.0 44.4
transport in citing our facilities
We network other medical facilities to bring 11.15 8.35 14.65 30.05 35.80
our services closer to the people
Source: field survey, 2019

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Table 2: Responses of Sampled Hospital Patients on Accessibility, Affordability and Geographic access to health
care delivery Services (%)
Particulars Strongly Disagree Undecided Agree Strongly
Disagree Agree
This hospital renders convenient and fast 10.05 7.20 13.25 30.30 39.20
health care services

This facility can offer medical exams and 12.25 8.10 15.75 30.40 33.50
diagnostics to patient on the first day
Patient do seek appointment and meet a 12.80 10.00 15.65 28.05 9.60
doctor same day
The hospital offers high quality services at 32.85 30.05 14.45 13.05 9.60
affordable prices
The hospital sometimes renders free 22.00 25.50 15.20 18.85 13.45
medical services
Prescription drugs from the hospital are 32.50 44.50 10.00 7.85 5.15
usually of good standard and cheaper
Hospital facilities appear to be carefully 40.05 36.80 11.25 6.35 5.55
located closer to the people
Hospital facilities are easily accessible 30.50 33.05 14.25 12.75 9.45
through public transport
The hospital has arrangements with other 28.30 40.00 22.35 5.35 4.00
medical facilities to bring services closer to
their patients
Source: field survey, 2019

Participant 1: agreed that they offer high quality healthcare services

This is a strategy to give assurance that we have at very affordable prices. However, Table 2, indicated
solutions to their heath challenges, and it is a high proportion of sampled hospital patients
psychological. Our facility is designed to provide (62.90%) disagreed that their hospital services are
quality care through speed in arranging medical relatively cheap and affordable, while some (22.65%)
appointment with patients and for them to see a agreed to the hospital services affordability. This is
doctor on their first visit to our facility. expected as the question of affordability is very
subjective and relative, while healthcare providers
Participant 2: believe they are fair enough in their charges most
We understand that access is the most convenient low-income patients may not agree to their claims.
and fast possibility to provide healthcare, hence, we As expected, the analysis of data from the
always ensure our patients see a Doctor for interviewees corroborated the position of sampled
examination, receive the diagnostics results on their hospital officials, and that the textual descriptions
first day in our facility. from three participants summarised their responses
as presented:
Participant 3:
Access is very important, and to us it means speed in Participant 1:
attending to each patient. The outpatient unit is well To us in this hospital, we believe in offering good
structured to ensure dignified examinations are quality services, with respect, dignity, and affection.
conducted with high quality and agility, and that gives Our clients do acknowledge our services and that we
assurance to patients that they are in good hands and offer all these at affordable prices to the satisfaction
that psychologically the solution to their ill-health is of a large proportion of our patients.
near, and, with us.
Participant 4:
This agrees with the WHO (2018) report that the Our strategy is simple, with good quality services
health and wellness of people around the world offered at our clients convenience, we have endeared
depend on the healthcare system that serves them. ourselves to a crop of donors, including big
And that psychological solution to ill-health is pharmaceutical industries who supply us standard
obtainable by the nature of attention a patient drugs and equipment, most times for free, hence, we
receives on the first visit to a hospital. are able to reduce costs of treatment and drugs to our
clients.
Results obtained from Table 1, also revealed that
most sampled hospital official respondents (70.8%)

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Participant 5: even make good arrangement to always give them

Here, we believe in aligning quality and excellent rapid attention as the case demands, including
healthcare services with financial availability. Our ambulance services where required.
innovation differential is to provide quality services at
very affordable prices, even to those without access The result is in tandem with the submission of Hart
to health insurance. (1971) that health facilities, as a marketing strategy,
are likely to cluster in the high-income
This result is in consonance with the position of neighbourhood where car ownership is high and the
Castano (2014), that costs of medical services is health needs of the people are relatively low at the
always on the increase as advancement in technology detriment of the low-income areas. The result also
which usually reduces costs in other industries does agrees with the opinion of Delamater et al. (2012),
not apply, as novel medical technologies bring that the inequalities in geographic access to
negligible improvement at higher costs. It also healthcare facilities is a function of the population
corroborates the report of Weiner and Glickman distribution characteristics, configuration of facilities
(2018) that expresses healthcare affordability as a and the availability of transportation infrastructure
sentiment involving patients’ qualitative ability and within a community. The facility location as a
willingness to pay. Thus, to hospital patient’s marketing strategy can only favour high-income
healthcare affordability is a question of relativity, to communities, where patronages of the rich is
the high-income people the prices are generally assured, not the other way around.
affordable, not so to the low-income earners and the
poor. Conclusion
Human desire, irrespective of status, is to enjoy better
To the question whether health facilities are quality of life and better functional capacity to
geographically accessible to the general people, command appropriate healthcare resources,
Table 1. Revealed that a large proportion of sampled juxtaposed with the philosophy of care giver with
hospital official respondents (77.6%) agreed that respect to accessibility, affordability and geographical
their hospital complex is strategically located very access have been examined in this study.
close to the general people. This is to reduce the
burden and stress of distance; it is one marketing The study employed qualitative approach to compare
strategy that management need to adopt to ensure perceptions of both the care givers and their patients
robust patronage. However, a large proportion of vis-à-vis the business model of the care givers as it
sampled hospital patients (63.55%) disagreed that currently captures the yearnings and aspirations of
hospital facilities are easily accessible through public the general people from the identified variables in the
transport. Most rural dwellers who must seek medical Nigerian context.
attention are not finding it easy to visit the hospital The study results revealed a wide gap between the
complexes located in the urban centres. The analysis aspirations, yearnings and expectations of a large
of the data of interviewees also agrees with the proportion of hospital patients and what the hospital
sampled hospital officials view as the textual managements are offering them as services. While a
descriptions from three participants summarised their high proportion of sampled officials and their patients
responses as presented: acknowledged fast availability of most hospital
services in the manner of prompt doctor attention,
Participant 2: diagnostics and sometimes obtaining medical results
To buttress our philosophy of guaranteeing good on first day at the hospital, there appear wide
quality healthcare to the general people, our facility disparities in their responses to questions on other
is located in areas easily accessible through public variables.
transport. This is a marketing strategy to ensure good
patronage from all and sundry. Findings revealed that healthcare affordability
portends the greatest point of disagreement between
Participant 3: sampled health officials and their patients. While
Yes, our facility must be easily accessible to our health management officials-based pricing of their
clients, we are opened to serve the people, so we services on the quality of their offerings, thereby
consider location very important. As you can see, we believing they are very reasonable in their pricing, the
are really in the centre of the city. fact that healthcare is a must for all and sundry
irrespective of income status make the pricing system
Participant 5: of the hospitals exclusive. To the extent not many
As a public health facility, we have a robust poor people and low-income earners can
relationship with several primary healthcare centres comfortably afford their services. Perhaps this
in our rural areas and with superb referral system. We explains why a large number of the disadvantaged,

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LAUTECH Journal of Nursing Vol. 9, May, 2021

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