Nigeria’s health sector misses opportunity to reform through COVID-19

The Covid-19 pandemic was for the better part of the last three years, the centre of global attention. With the threats it posed, the pandemic pushed virtually every country to seek new ways of strengthening health systems. These upgrades to the health systems were to equip countries in effectively combating the virus which was raging at different times (called waves), and also preparing them for future health challenges.

For some countries, they were driven to embark on research and development; for some others, Covid made them see the need to invest more in their healthcare system. Many, especially in developed countries with relatively good health care services, had to develop even better systems.

In Africa, an all-too-familiar story with a lot of countries, and Nigeria for instance, remained largely the same in terms of suboptimal healthcare service delivery. Recurring decimals from factors such as the shortage of human and material resources, underfunding of the health sector, poor motivation of health workers, weak facilities and infrastructure, health sector budget, and so on have largely remained.

At the peak of the pandemic, bans were placed on international flights as a measure to mitigate the risk of spikes in new cases. However, a message it appears the pandemic failed to pass across to Nigeria and Nigerians is that; decisions to embark on medical tours which are largely as a result of the poor state of Nigeria’s healthcare system, may not always be available even when affordability is not an obstacle.

Suddenly, even people with the means to seek treatment abroad, were stuck in Nigeria, with no choice but to seek care in the health facilities that had been abandoned, and underperforming for decades. This became a lesson in itself that the healthcare sector must be heavily invested into. For some countries, this has been identified as a fact, but not some others.

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Speaking on the documentary, Unmasked: Leadership, Trust and COVID-19 pandemic in Nigeria, Kadaria Ahmed, a Nigerian journalist and co-producer of the documentary had stated, “If covid has become that catalyst that allows us to self-reflect and from these reflections, learn lessons, then the life of all those who have died from covid would not have been in vain.

We are actually thinking that what COVID-19 revealed was not so much about the pandemic itself, but about the dysfunction of the public healthcare system, that it is not really designed to produce average good healthcare for Nigerians.”

A blog post by Julius Mugwagwa, Onyeka Onwuegbunam Vivian and Louise Shaxson on the London School of Economics’ website, “With countries closing their borders and citizens, rich or poor, having to resort to local providers for their treatment needs for COVID-19, and other persistent health challenges, perhaps the silver lining from this pandemic is that African leaders may now be spurred from ‘political will to political action’ towards strengthening local health systems. This could even give new impetus towards the attainment of Sustainable Development Goal 3 on health and well-being for all.”

Though Nigeria was not left behind in tackling the “covid problem”, with regards to the overall improvement of the healthcare sector in Nigeria, Covid19 has been an opportunity missed.

“By the end of January (2020), we had put up a small facility, looked at our biobank, looked at a few other epidemiological teams that we had to put in place. So it was just a waiting game- when is it going to happen?” said Babajide Sanwo Olu.

Suddenly, even people with the means to seek treatment abroad, were stuck in Nigeria, with no choice but to seek care in the health facilities that had been abandoned, and underperforming for decades

In late February 2020 as worldwide cases surpassed 83,000 according to data by the WHO, with at least 2,800 deaths, Abimbola Bowale, medical director at Infectious Diseases Hospital, Lagos, explained in the documentary available on youtube, that Lagos State had set up an incident command system as it was clear that it was only a question of when the pandemic would hit Nigeria, and not if it would.

Chikwe Ihekweazu, NCDC chairman, said a laboratory was set up in LUTH to make diagnoses before Nigeria recorded its first case. Supplies were made for them, and a few training exercises were conducted. A presidential task force on covid 19 was also set up that met daily to go through the entire data side to look at the interventions.

Iorhen Akase, head, Infectious Disease Unit at the College of Medicine, University of Lagos, explained that Nigeria’s response to covid helped to strengthen surveillance and public health approach to predicting outbreaks and illnesses in the community. He said, “the outbreak also helped to strengthen our laboratory capacity to make diagnoses, especially for viral infections that pose threats. We have lots of PCR laboratories that have sprung up all over the country, both government and private-owned.”

From this point of view, we can say Covid helped strengthen the health system, however, Akase continued, “most of the responses were temporary, everything was short-term; reacting. Not much went into thinking long-term. Crucial investment, planning in terms of personnel, capacity, structures were missed.”

He also pointed out that some improvements that have been identified happened at the detriment of other aspects of healthcare. “We had institutions that before now, were able to make diagnoses for some other things we’re dealing with like lassa fever, monkeypox, yellow fever, dengue fever, but all these institutions turned over their machines and personnels into doing Covid work.”

Current realities, despite Covid

Health sector budget: In April 2001, heads of state of African Union (AU) countries reached a consensus to set a target of allocating at least 15 percent of their annual budget to improve the health sector. While goals are important signposts, the real problem is that the absolute level of resources available in relation to health needs is well below demand.

Nigeria’s health sector budget for 2022, according to the Budget Office of the Federation is 5.1 percent of the FGN budget which is N876.38 billion, with N770.87 billion earmarked for the Federal Ministry of Health and its agencies, N49.37 billion for Gavi/Immunization funds and N56.14 billion for Basic Healthcare Provision Fund (BHCPF).

Health workers are pressured to leave the Nigerian health system on account of stiff and less motivating work conditions. Whilst the pandemic raged on, health workers even went on strike at least four times.

Availability of doctors was an issue in Nigeria before COVID 19, but the shortage of personal protective equipment (PPE) made it harder for healthcare professionals (at the forefront in countries with weak public health systems such as Nigeria), to do more.

Some of the grievances expressed by Nigerian doctors include often late and poor remuneration. For them, the risks and the reward are not commensurate. “Production of specialists in the country requires that a young doctor goes through close to 16, sometimes over 20 years of training. The migration of this class of workers is a crisis because in the next 5-10 years when the specialists we have now are starting to retire, our health indices are likely going to worsen,” Akase predicted.

In terms of getting medications for treatment, Nigeria relies heavily on imported drugs. About 70 percent of medications administered in Nigeria are brought in from China and India.

Though there is some manufacturing- as the country accommodates more than 115 pharmaceutical companies, there is little research and development activity in the country. And Nigerian pharmaceutical companies have not been able to completely overcome existential challenges that make their operations in the country more viable.

Nigeria’s pharmaceutical manufacturing industry is struggling to grow, as industry players lament. The main reasons for this are infrastructure challenges such as lack of consistent energy supply and inadequate financial support for budding pharmaceutical professionals.

With COVID-19, building capacity across the entire spectrum of healthcare delivery in Nigeria would have seen the country using the pandemic to build capacities both for the present and future. However, for Nigeria, the pandemic seems to have been a missed opportunity, and the clock is ticking faster to convert the opportunity.