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Why health facilities need more funding for epidemics – Experts

Few months ago, in Nigeria, COVID-19 cases were recorded in hundreds every day. Gradually, the figures kept reducing. With the thought by both the government…

Few months ago, in Nigeria, COVID-19 cases were recorded in hundreds every day. Gradually, the figures kept reducing.

With the thought by both the government and citizens that COVID-19 is “going away”, is there any need to prepare the health facilities across the country for the next epidemic?

Experts are insisting that Lagos, the epicentre of the diseases and Nigeria as a whole need to prepare for the next epidemics through proper funding to reduce its impact on the population.

Why prepare for epidemics?

In the words of the former Commissioner for health in Lagos, Dr Jide Idris, “No state can ever know what kind of emergencies can befall it and when. It is the duty of every government to protect its citizens from epidemics/disasters.

Preparedness is key in epidemic management because we can never know when the next one will be, sadly, we don’t have resources and political will in this country for epidemic preparedness.”

Patients at LUTH

Dr Idris, who has served under three Governors explained, “It may not be possible to prevent disasters from happening and if they do happen, it is their responsibility (governments) to detect them early enough and protect the people from the epidemics/disaster. This will reduce the chances of the epidemics from killing many people.

“These are processes that require funding. Any government must invest properly in the health sector, build infrastructure, employ health staff and train them as no one knows when these things will happen. Also, the government needs to employ technology. All these things will cost money.”

The Director General of the Nigeria Centre for Disease Control (NCDC), Dr Chikwe Ihekweazu explained the COVID-19 pandemic response is an excellent example that highlights the need for all states in Nigeria to be better prepared for disease outbreaks. At the beginning of the pandemic, he stated, we were able to scale up testing capacity by starting with states that already had molecular laboratories for Lassa fever testing.

The activation of testing took longer in states where there were no existing molecular laboratories.

A health worker attending to a patient at a health facility in Lagos

Stressing the issue further, Ihekweazu noted Nigeria records a significant number of disease outbreaks every year.

“While the NCDC continues to support states in outbreak preparedness and response activities, it is very important for states to take more ownership and increase investment in outbreak preparedness. Many states have shown leadership in this area and we must continue to build on this to be better prepared for the next outbreak.”

The Lagos Chairman of the Medical Guild, Dr Oluwajimi Sodipo acknowledged preparing for epidemics should be an ongoing activity.

 

Admitting that though something is being done in the preparation in Lagos, a whole lot more needs to be done.

Funds needed for epidemic

In 2014, Ebola virus disease was introduced into Nigeria by an infected Liberian man, a total of 19 people were infected and seven died.

In 2020, COVID-19, a global pandemic was confirmed in Nigeria when the first confirmed case, an Italian was announced in Lagos on 27 February 2020.

As at October 2, over 59,000 positive cases were confirmed in Nigeria with 1,112 deaths and over 50,000 recovered cases.

There was a record of over 1,000 cases of Lassa fever as at October 2019 while a total of 714 confirmed cases has been recorded as at September 29, 2020.

Bearing this in mind, the government in all the states across the country need dedicated funds for preparing for epidemics.

However, what are the things experts agreed needed funding in preparation for epidemics?

According to Dr Idris as well as the immediate Past Chairman of Association of general and private medical practitioners of Nigeria (AGPMPN) in Lagos, Dr Tunji Akintade, every state government needs funds to prepare some basic things for epidemics.

In their explanation, in preparing for epidemics/disaster, funds will be needed for infrastructure, recruiting and training of personnel, building laboratories, disease surveillance and technology.

Dr Akintade adds that there is a need to ensure all cadres of health workers in a facility need knowledge of a looming pandemic including doctors, nurses, cleaners, front desk officers, laboratory technicians, and others.

It is important for the government to budget for them. It is not during pandemic that infection prevention and control (IPC) training should be done.

Sounding a note of caution, he stressed the fact that COVID-19 pandemic is gradually ‘going away’, that does not mean the health workers do not need training to prepare them for the next epidemics.

The general practitioner stated that more than 80 percent of the private health facilities in the entire country are not purpose-built for infection control as many hospitals build their facilities in a two to three-bedroom apartment.

A health facility in Eti osa

The former association head of private health facilities points out that although the government cannot give all private health facilities personal protective equipment (PPEs), they can make it available and cheap.

On his part, the Permanent Secretary, Lagos state primary healthcare board (LSPHCB), Dr Olugbenga Aina admitted the government needs to focus more on human resources for health.

At the moment, there are three people employed and trained over time on disease outbreak in each of the 57-local government (LG) and local council development areas (LCDAs).

They are the medical officer of health (MoH), whose job is to run activities in the PHCs under him and also ensure his team is always prepared to contain any outbreak within his LG, the disease notification officer and assistant disease notification officer.

These three people in each LG, he noted are not enough.

He harped on the need for an increase in the percentage of the budget that is allocated to health.

Though the state government is trying, he affirmed, but with the enormity of the population, it is still like a drop in the ocean.

In her contribution, a senior lecturer at the Lagos University Teaching Hospital, Dr Alero Roberts suggested the first and most important basic items which needed funding is a trained and contented healthcare worker.

Health facilities, she noted, are as useful as an abandoned property if there are no staff.

Recruiting such a valuable resource is the prime responsibility of a dependable and sensible civil administration.

Contentment is key and critical to ensuring the retention of trained healthcare workers, she added.

Dr Alero who is the Vice President of the Wellbeing Foundation Africa asserted the most important tool in the epidemic preparedness arsenal is Surveillance.

Either or both active and passive surveillance is the advance warning of any epidemic.

The government needs to focus on strengthening community surveillance. Improving grassroots surveillance through the deployment of Personal Health Records will be a far more cost-effective strategy than trying to just replicate the infectious disease hospital (IDH) around the state.

She confirmed there are opportunities for self-check tools which people can use easily to monitor and assess their disease risk. Strategic partnerships for revitalizing primary health centres must be leveraged on.

Recommendations

In a charter released in September 2020 by the World health organization (WHO) on World Patient Safety Day, it was stressed that, both the government and managers of health facilities regardless of whether it is a public or private facility should ensure the implementation of infection prevention and control and occupational safety standards in all health care facilities across the health system.

The WHO also recommended the managers should ensure availability of PPEs at all times, as relevant to the roles and tasks performed, in adequate quantity and appropriate fit and of acceptable quality.

Ensure an adequate, locally held, buffer stock of PPE. Ensure adequate training on the appropriate use of PPE and safety precautions.

For preventing epidemics in the health facilities, WHO suggested adequate environmental services such as water, sanitation and hygiene, disinfection and adequate ventilation should be ensured at all healthcare facilities.

It is important for policy makers both at the federal and state levels to ensure epidemic preparedness funding is increased in all the health facilities.

At the moment, there was funding only due to COVID-19, beyond the pandemic, epidemic preparedness funding should be a priority.

Another epidemic?

Worried about the likelihood of another epidemic after COVID-19, Dr Idris implied it was Ebola then, today it is COVID, “whether we like it or not, we are still going to have something else in the future.”

Explaining further, he confessed there are lots of risk factors in the environment which can cause epidemics and disasters.

“One, there are emerging infectious diseases, two, the environment is a risk factor that can make people vulnerable to disease development. Three, climate change is another and this is caused by development, which is making us cut down trees for the purpose of building houses. We are disrupting the ecosystem of the animals and this is their own way of fighting back,” Idris stressed.

Sodipo warned, “We are better prepared for the next epidemics, which will definitely come and there has to be a continuous plan for that.”

Implications of not funding?

Dr Idris bluntly explained, “The implication for not investing in health facilities in preparation for epidemics is that, when people fall ill due to an epidemic, diagnosis may not be easy, health workers won’t be able to treat them, isolating them will not also be possible. This will make the epidemic spread more because they won’t be able to leave the community. In all, more people will fall ill and more people will die.”

Beyond this, she continued, “Epidemic preparedness goes beyond just mere funding. It is about universal health coverage, it is about a commitment to health equity and justice, ensuring that the ‘common health goods’ are provided, learning from past successes and failures – both locally and globally. It requires strong commitment from the ‘grassroots’ to the ‘treetops’ to open transparent accountability, honest demand creation, educated realistic expectations and willingness for all round community engagement. The implications of the contrary do not bear thinking about.”

One would wonder, beyond COVID, what next? The Lagos PHC boss, Dr Aina hinted of plans by the government to ensure the PHCs are now built to contain future epidemics and manage IPC.

In her views regarding preparing for the next epidemics, Dr Roberts affirmed, “Asides having trained and contented healthcare workers, it is necessary to have robust supply chains for the drugs and consumables, equipment maintenance and other recurrent expenses that may only deliver a modicum of cost benefit to the general population. At the level of national development where we are presently, we will do much better by ‘cutting our agbada to fit our cloth’.”

This story was produced with the support of Nigeria Health Watch, through the 2nd Prevent Epidemics Naija Fellowship, aimed at raising the profile of epidemic preparedness and generating support for robust epidemic preparedness funding.