On February 28, 2020, a 44-year old Italian flew into Lagos from Milan for business and ended up being the first person to test positive for COVID-19 in Nigeria. From one person in February, over 70,669 cases of COVID-19 have been recorded with 1,184 deaths as at December 10, 2020. The country is one epidemic away from disaster and here is how to prevent that.
Despite the fact that states across the country already have an epidemiology unit, COVID-19 spread gradually until none of the states was spared.
The poor preparedness for epidemics at the state level was obvious when many states started making provisions for isolation centers only after positive cases have been confirmed within their vicinity.
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Incidentally, a month before the index case was confirmed, the state epidemiologists throughout the country held a summit in January 2020 to avoid a fast spread of infections and epidemics.
Part of the recommendation at the summit held in Lagos was that State Governments should support State Epidemiologists to expand their scope beyond surveillance for priority diseases to other health events of public importance in their geographical environment.
The need for a budget line for Epidemiology Unit/Division/Department with prompt release of funds was also raised.
Also, in the recommendation was that states should increase health manpower resources through the recruitment of more personnel and provide conducive office accommodation for effective coordination of epidemiological activities and that states should provide dedicated functional utility vehicle(s) and ambulance(s).
They should also have a Health facility designated for highly infectious diseases with isolation wards where Emerging and Re-emerging Infectious Disease cases will be properly managed.
Not all these could be achieved before COVID-19 surfaced, but with the emergence of the disease, these recommendations were addressed.
An October 2019 global health security index ranked Nigeria 67 out of 195 countries in the world, in terms of emergency preparedness and response planning and ranked it 171 for its public health vulnerabilities.
In spite of complaints by the masses, about the budget of the National Assembly, N128 billion was budgeted for NASS in both 2020 and 2021 budgets but was reviewed downwards by 20 percent because of the COVID-19 Pandemic.
Yet, the government did not budget adequately for a pandemic that could kill both the populace and lawmakers.
Only the 2.5 percent allocated to the Nigeria Centre for Disease Control (NCDC) through the Basic Health Care Provision Fund (BHCPF) was last disbursed in 2018.
The allocation was made specifically for public health emergency preparedness and response in the 2018 implementation guidelines.
The total amount released to the NCDC for Q1 implementation was N361.59 million. This has been the only release to NCDC to date.
The BHCPF is funded through the Federal Government annual revenue (at least one percent of the Consolidated Revenue Fund), and grants by international donors and funds from other sources.
In a July 2020 report on the implementation of the BHCPF, it was stated that over the last five years, Nigeria has experienced annual and often concurrent outbreaks of infectious diseases.
This includes outbreaks of Lassa fever, yellow fever, monkey pox, cholera and new serotypes of existing pathogens like Neisseria Meningitis serogroup C.
In 2017, Nigeria recorded its first case of monkey pox, 39 years after the last case was reported in the country.
Similarly, the first yellow fever case in 21 years was reported in Nigeria in 2017.
Since then, monkey pox and yellow fever cases have been reported nearly every week in the last three years. Over 70 people were reportedly killed by yellow fever in November in three states.
NCDC recommends that investing 50 per cent of the 5 per cent of the BHCPF (i.e. 2.5 percent of the fund) on preparedness against the threat of infectious diseases will save Nigerian lives, protect the economy and ensure the sustainability of current investments in our health security architecture.
NCDC’s considered recommendation is for the reintroduction of the 2.5 percent allocation for public health emergencies to the 2020 BHCPF implementation guidelines in order to secure the health security of future generations of Nigerians.
As much as it is important for the federal government to be consistent with the BHCPF to properly manage future epidemics, it is also important for states to have a specific budget annually for its epidemic unit.
The Director General of Nigeria Centre for Disease Control, Dr Chikwe Ihekweazu stressed the importance of all states having a State Epidemiology Unit as part of the State Ministry of Health.
“It is difficult to build a ship while sailing and this is what happens when states do not prepare for outbreaks.
“There is strong evidence that preparedness saves costs and also saves lives.
“Before an outbreak begins, we have to ensure the capacity is in place to detect the outbreak and then respond.
“We continue to encourage State Governments to invest strongly in their State Epidemiology Units so that they have adequate resources for outbreak preparedness, prevention, detection and response,” Ihekweazu said.
An annual budget for epidemics, according to an epidemiologist, Prof Tanimola Akande, will assist in disease surveillance so that cases are picked up early as well as strengthening health information systems to provide accurate, reliable, timely and complete data.
The public health expert at the University of Ilorin Teaching Hospital said that dedicated funds for epidemics preparedness will assist in, “Capacity building of health workers to understand disease case definitions and have high index of suspicion.
The late Dr Stella Adadevoh demonstrated this so well during the Ebola outbreak. Community sensitization and use of community-based volunteers to report suspected cases in the community.
Disease outbreak Response teams at all levels should be provided with adequate resources to respond promptly to prevent spread of cases during epidemics.”
Ihekweazu insisted that whether there is an outbreak or not, both the federal and states have to, “improve our surveillance and early warning systems, strengthen public health laboratory services and networks, train health professionals and rapid response teams.
“The State Public Health Emergency Operations Centres (PHEOCs) are not for response activities only.
“Part of their role is to monitor sudden increase in cases and ensure there is an alert system in place for immediate response.”
The immediate past health commissioner in Lagos State, Dr Jide Idris acknowledged Lagos merely started budgeting for epidemics fully after the Ebola saga as, “it dawned on us that something like this could happen again.”
Idris pointed out that the state’s budget on epidemics should be dedicated to infrastructure, training personnel, building laboratories and disease surveillance.
The permanent secretary of the Lagos State Ministry of Health, Dr Olusegun Ogboye explained that with or without an epidemic, the epidemic directorate still gets funding every year.
The funding is for surveillance, collecting data and following trends. When there is an epidemic, the fund is used in managing the epidemics.
There is no specific percentage in the health budget for epidemics.
Similarly, the Director Public Health/Diseases Control, Anambra State, Dr. Uchechukwu Onyejimbe confirmed that the NCDC established a Public Health Emergency Operational Centre located opposite the government house to address epidemic outbreak in the state.
Budget for the centre, he said depends on the issue at stake.
Things are not so different in Kaduna as an epidemiology unit was created under the Public health department for managing epidemics across the 23 local government areas of the state.
The Commissioner for Health in Kaduna, Aisha Boloni said, “There’s a budgetary line every year for emergencies.
“No particular amount or percentage is budgeted for epidemics. Budget for epidemics depends on the situation at hand.”
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