In August 2020, Africa was declared polio-free. That was a significant and ironic milestone — reaching the end of a viral epidemic in the middle of a global viral pandemic. Nigeria had held back the continent from being polio-free. The country was one of the quartet nicknamed PAIN (Pakistan, Afghanistan, India, and Nigeria) that continued to host the virus within their borders. In 2014, India succeeded in its quest to overcome the deadly children’s disease and Nigeria followed many years later.
The quest to exterminate wild polio has been on since 1988, and there has been a 99% success rate thanks to the leadership of the World Health Organisation, UNICEF, the Rotary Foundation, the US CDC, and the Gates Foundation all under the Global Polio Eradication Initiative (GPEI).
Eradicating polio was not the country’s first success at eliminating a disease. Nigeria was part of the global effort to eliminate what has now become the first disease to be eradicated in the world — smallpox. Called Sopona in Yourba (with its own deity whose votaries worship it to escape the scourge), the disease ravaged Nigeria in the early nineties and an outbreak in the western region kickstarted the evolution of a new strategy that employed surveillance and containment to break transmission.
Before the break out of Covid-19, Nigeria had also been in the middle of another disease outbreak — the Ebola virus, a saga that caused heroes to emerge. Ebola was first reported in Nigeria at the First Consultant Medical Centre by Dr. Stella Adadevoh in 2014. Her steadfastness despite pressure from high places saved the country from a full-scale outbreak but unfortunately cost her her life and those of a few hapless colleagues at the hospital. First Consultant Medical Centre is private - public hospitals were on strike at the time, and there have been many more strikes after that episode.
This brings to bear how ready the Nigerian public health system is in addressing outbreaks which are increasingly becoming a pattern of life in today’s highly globalized economy.
While it is praiseworthy that the health system has been able to eventually absorb the shocks of outbreaks, overall, Nigeria’s health system is not battle-ready for disease outbreaks.
In 2017, the Joint External Evaluation (JEE) assessment of WHO scored Nigeria poorly on its capacity to prevent, detect and respond to public health risks: the report suggested that overall the country had a limited capacity to prevent biological, chemical, or radiation health risk with a score of 1.9 across 15 indicators out of a possible 5 points.
Nigeria also fared poorly in the respond category accruing a score of 1.5 across the 20 indicators in this category leading to a conclusion that Nigeria has limited capacity to respond to a sudden health risk — a fact that has played out in the Covid-19 outbreak. There is an acute shortage of critical medical equipment like ventilators, defibrillators, oxygen, oxygen tanks, personal protective equipment and so much more.
Finally, the JEE assessment concluded that Nigeria was better prepared in the detect category with an average score of 2.6 across 13 indicators.
As the coronavirus rages on, Nigeria’s response to it has been a topsy-turvy affair. Testing numbers have been abysmally low: the country has only been able to test slightly over a million people while South Africa with only about a fourth of Nigeria’s population has tested over 3 million people. It is common knowledge that with fewer tests, the reported case will be just as few. This does not give enough confidence in the system.
Luckily for the population, there is a high recovery rate which attests to the hard work of the health care professionals who are perhaps getting the best support ever from the federal and state governments as well as the private sector, a synergy that is quite uncommon in Nigeria.
This synergy is what the Nigerian system requires urgently. To begin with, the federal government must strive against all inherent economic odds to adhere to the Abuja and Maputo declarations of committing 15% of the national budget to health — Nigeria has consistently done less than 7% for many years. Health financing is a critical component for the success of any country’s health system.
National and state governments must also intensify efforts to work with public health professionals, health-focused non-governmental organisations, and international organisations like the WHO to build a really formidable health system that is resilient all-through. This will require circling back to the previous point on financing — massive investments are needed to revitalise the health system: there is a chronic shortage of doctors and nurses, a shortage of hospitals especially at the primary level, and diagnostics and therapeutics are insufficient and very expensive in a country with over 100 million people who cannot afford more than a dollar a day.
Beyond financing, a standard epidemic response mechanism must be established on a national scale to warn, prepare and activate the entire chain when there is a spectre of an outbreak. The success of this mechanism is dependent on a well-financed system, a well-motivated workforce, standard and up-to-date health infrastructure, and a sound leadership structure.
An indispensable condition for building a truly resilient health system is the welfare of health care workers. Nigerian doctors, nurses, midwives, and other health care workers are some of the most overworked personnel in Nigeria. According to the Nigerian Medical Association (NMA), there are 40, 000 registered doctors in Nigeria. That works out to exactly one doctor to 5000 Nigerians instead of the WHO-recommended 1:600 ratio.
Health care professionals are the first line of defence in an outbreak and they must be well-provisioned for at all times so they can meet any emergency head-on. They must be well-paid and provided with all the accoutrements that would make their operations efficient. This is a necessary condition for success.
There is no gainsaying that there would be more epidemics and pandemics in the nearby future — there have been at least four within the last 20 years: SARS, MERS, Ebola, and COVID-19 — each with its own peculiarities and potential destructive capacities. It is incumbent on the Nigerian government to fortify its health system to withstand every emergency. The time to start preparing is now, and the requirements are not out of reach.