In Nigeria, Coronavirus proves that government healthcare spend needs to increase

Healthcare in Nigeria has been heavily under-prioritized by many Nigerian administrations. Public health experts across the world have frequently expressed fears over the possibility of an epidemic exploding in Lagos and spreading to London, New York, Tokyo or Helsinki because Africa’s most populous country is also its poorest where at least 46% of the population don’t have access to any kind of healthcare. Now, a new pandemic — COVID-19 aka Coronavirus — is in town. Will this finally create the very much needed shift in how the Nigerian government prioritizes healthcare going forward?

No Guarantees

It’s hard to say. Before the world started to deal with the coronavirus pandemic, Nigeria was already dealing with Lassa Fever. Lassa Fever, a severe viral hemorrhagic fever, similar to Ebola, that occurs throughout the year in Nigeria, was declared an “active outbreak” by the Nigerian Center for Disease and Control (NCDC) in February 2020. Just five weeks into the year 2020, there were 365 confirmed cases and 47 deaths as a result of this epidemic. This excessive count, coupled with the fact that this is a long-running issue, is evidence that the NCDC and the Federal Ministry of Health are not quite equipped to deal with that outbreak much less the COVID19 pandemic. But Nigeria’s healthcare problems have run deep for decades.

The NCDC has been around for only nine years and heavily relied on already existing Polio infrastructure (and personnel) to deal with the Ebola outbreak of 2014. Most of that infrastructure was funded by various World Health Organisation, United Nations and other international grants. Furthermore, Nigeria’s success at containing the Ebola outbreak was also possible, in large part, because of the incredible diligence and sacrifice of its underpaid medical professionals. Though Nigeria’s response has been praised, the metaphorical stars also aligned in a lot of places.

Little To No Investment

From an investment and infrastructural standpoint, Nigeria’s public health care system is an absolute disaster. The so-called “Giant of Africa” has the fourth highest rate of maternal mortality in the world, one doctor for every 5100 citizens and only about 24,000 hospitals catering to its estimated population of 200 million people. And these numbers aren’t improving. Since 2001, Nigeria has consistently committed less than 10% of its budget to healthcare — in 2018, Nigeria’s budget allocation for healthcare was 3.91% of its national budget and in 2020, it is 4.5% of its budget. Evidently, there is a big problem here and while it seems like the ongoing coronavirus pandemic is going to exacerbate it, Nigeria’s response so far offered some hope that it can mitigate that.

After the first coronavirus case was confirmed in Nigeria, Chikwe Ihekweazu, Director General of the NCDC, constantly emphasised that the global pandemic is a reminder of how important it is for Nigeria to invest heavily in healthcare and improve on the global indices it has fallen behind on. “We cannot prepare for a war after it has started,” he said. But he can only do so much — in 2018, the NCDC struggled on a government budget that was less than $4 million. In comparison, the US CDC’s budget in the same year was $11 billion. The math comes to less than 0.02 cents per Nigerian per year, compared with the CDC’s $33 per American.

Response To COVID-19 Pandemic

The Nigerian government also refused to initiate a lockdown of its borders until almost three weeks after the first case was confirmed. As at March 22, 2020, flights were still coming in from the UK where more than 5,000 cases and about 281 deaths have been confirmed. While countries like Ghana and South Africa initiated lockdowns and enforced social distancing and self-isolation measures, Nigeria has done none of those. In the past week, at least two government officials have hosted events and President Muhammadu Buhari reportedly attended a Juma’at service on Friday.

Nigeria has little test and treatment infrastructure too. There are only five laboratories in the entire country with capabilities to test for the coronavirus and the majority of hospitals in the country are not equipped with emergency and intensive care equipment. There have also been reports of a lack of test kits alongside a rapidly climbing number of confirmed cases.

“We still have 30 cases but we will be reporting more cases later today. Definitely there will be more cases reported, and we have to brace ourselves for an evolving situation over the next few days as we work very hard to get the situation under control,” NCDC DG Ihekweazu said, during an interview on Channels Television early on Monday.

The Way Forward

There is no better sign for the polity and Nigeria’s leaders to reconsider their position on healthcare and medical tourism. As coronavirus-based travel restrictions now show, you’re only as safe as the healthcare systems you build. Urgent investment in clean water, proper drainage, population control, child and maternal health access to medicines, properly equipped hospitals and effective surveillance systems to track disease outbreaks are required. According to Dr. Olubusuyi Moses Adewumi, a specialist in arenaviruses and virologist at the College of Medicine, University of Ibadan, “In our environment, the vectors continue to have the opportunity to interact with the human population and consequently spread the virus unchecked.”

The World Health Organization (WHO) describes quality care as:

• “Safe. Delivering health care that minimizes risks and harm to service users, including avoiding preventable injuries and reducing medical errors.
• Effective. Providing services based on scientific knowledge and evidence-based guidelines.
• Timely. Reducing delays in providing and receiving health care.
• Efficient. Delivering health care in a manner that maximizes resource use and avoids waste.
• Equitable. Delivering health care that does not differ in quality according to personal characteristics such as gender, race, ethnicity, geographical location or socioeconomic status.
• People-centred. Providing care that takes into account the preferences and aspirations of individual service users and the culture of their community.”

These are the parameters which Nigeria’s leaders and decision makers have to rebuild its healthcare system around. Outbreaks of Ebola, meningitis, Lassa fever, polio and now coronavirus have shown that there is no more time to waste. The time to act is now!

This article was originally published on the Corona Nigeria website.