Nigeria: Where Covid-19 Has Left Nigeria's Health System

Nigerians with face masks (file image).
analysis

Over nine months into COVID-19 outbreak in Nigeria, there are concerns about how well the country has managed the pandemic. Adejuwon Soyinka, from The Conversation Africa, asked Dr Doyin Odubanjo, executive secretary of the Nigerian Academy of Science, to assess the situation and how it might affect the country's ability to manage other equally important diseases.

Where does Nigeria stand as far as COVID-19 is concerned at the moment?

I would say we are in the wilderness. Basically we don't know where we are. I think the only thing that everybody agrees on is that the disease doesn't have the bite in Nigeria that it has in other parts of the world. And that we are really thankful for.

We don't have the capacity to test as we should. Many Nigerians are also not compliant with the regulations and preventive protocols and many state governments are tired of following COVID-19 protocols and spending so much money. We can't tell the burden of the disease in our midst.

What we know is that the positivity rate is lower than it used to be. In a bunch of samples, you get fewer positive cases.

Perhaps we have developed herd immunity. But we don't know. We have to do what we call sero-prevalence studies in communities, to see if people have immunity already against this virus.

What are the implications of COVID-19 for Nigeria's health sector?

I think the impact of COVID-19 in Nigeria is both good and bad. Good in the sense that everybody, from government to the people on the streets, realised the importance of health. A lot of private sector people also recognised that we need our health system to work.

But with the number of strikes, for instance, that we have seen in the health sector and the kind of response we have seen from government, one wonders whether we understand the gravity of the situation.

Secondly, the whole world now realises the importance of health. And that means many countries are beginning to rejig their health systems, which begins with the workforce. Countries will have special visas and visa exceptions to attract health workers and other professionals.

Those countries are repositioning to avoid another situation, like this. But I've not heard of this in Nigeria. That is saddening, because it means our health workers now have more opportunities to leave this country and work elsewhere.

Nigeria does not give health workers a comfortable environment to work in. The pressure of not getting good remuneration, not having equipment to work with, of insecurity in their country, is pushing them out.

If we have ever worried about migration of health workers, we need to worry much more now.

And thirdly, COVID-19 is not just a health pandemic, it is also a "socio-economic pandemic". We have less funds to work with, so we can't finance the health sector. We're talking about good remuneration, fixing hospitals, ensuring they have electricity, running water, the right equipment for diagnosis and treatment and all of that and yet there is economic downturn.

What about other diseases that have been neglected because of the focus that has been given to COVID-19 in the last nine months?

One of the dangers, not just in Nigeria but globally, is that the management of COVID-19 has ensured that all other diseases have been neglected somewhat.

Hospitals were shut down and were only attending to COVID-19 patients because they were afraid of the risk of transmission to anybody else who came in, even for routine surgeries. Women couldn't go to the antenatal clinics, or even have safe delivery in hospital. Those who needed cancer screening couldn't get it.

The amount of money that went into COVID also ensured that we were not spending money on other things. Disease surveillance is a critical part of public health. And there are certain key diseases that are notifiable. If you even see a single case of that disease, you must quickly notify authorities because they must work on it before it becomes a big issue.

Institutions like the Nigeria Centre for Disease Control have different units, for example a yellow fever unit. Those people are meant to have been focused on their diseases, despite COVID-19. However, there is no telling whether some of these workers have been diverted to COVID-19 activity.

We probably neglected a lot of things we should be doing. But yellow fever outbreaks are expected to happen from time to time, especially in places where the vaccination programmes have not been adequate all along. There have been warnings for a few years now that Nigeria needed to do quite a comprehensive yellow fever vaccination programme.

What should be the focus areas for health in 2021? What vaccination programmes are at risk?

In most cases a country has to pay in advance to book the vaccines it needs. As far as I know, Nigeria has not defaulted on those payments, so we should have our vaccines. The National Primary Health Care Development Agency (NPHCDA) is in charge of our routine vaccination programmes. The Nigeria Centre for Disease Control (NCDC) is the one primarily driving the COVID-19 response. So we expect the vaccination to be fine.

The challenge is how to position the health system in the coming year. There will be fewer workers and most likely less funding but greater need. We need to understand the importance of a very strong health system. I think the fact that COVID-19 could take out some very important personalities should send a message home that even if you can afford the best insurance or best healthcare anywhere in the world, you could have outbreaks of diseases here in Nigeria that can still kill you. And there's nothing better than having a health system that can work for you and the rest of us around you. That's the best way to be safe.

What should Nigerians be doing to keep the pandemic at bay until the vaccination arrives?

I think we should follow the known precautions: be careful with contact with people, be careful with crowds because anybody could be a carrier of the disease. Take all the precautions you can, like wearing a mask and washing your hands, just in case you came in contact with the virus. It's important to take the COVID-19 precautions very seriously.

There are certain general things we could fix in our lifestyle to avoid diseases. Significant vaccination for COVID-19 is not likely to happen in Nigeria in less than a year. We must continue with life, but we must continue with caution. If we just take the right precautions, we should be fine.

Doyin Odubanjo, Executive Secretary, Nigerian Academy of Science

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