Confirmed cases of coronavirus are mounting in Nigeria and the queue for those desperate to test for the deadly virus is getting unbearably longer by the day. On Saturday, Nigeria crossed another grim milestone after it reported its single biggest daily total of 553 confirmed cases.
Yet the significantly better-resourced private healthcare capacity in Africa’s most populous country has virtually been shut out of the government’s plan to fight the pandemic.
In the early hours of May 30, a 70-year-old Indian national arrived at the IDH centre in Yaba, Lagos, where he died the following day before he could be tested. It is suspected he had been infected and his case may have turned out differently if he could avoid the suffering he went through by being taken all over the city searching for where he could be tested and cared for. You are not given access to a COVID-19 isolation centre in Nigeria if you have not been tested by a government testing centre.
“You do not need an oracle man to tell you that Nigeria needs to do better to avert the worst possible outcome. This fight against COVID-19 should be about doing the right thing and saving lives,” said a health expert working for an international organisation based in Nigeria.
BusinessDay investigations across the country paint a picture of a fight hampered by the lack of vision and a sense of care for those who are infected and dying. There appears to be greater attention given to defending the turf.
Doctors say government officials are more concerned about who will do the job instead of getting the job done. The whole process is blanketed by secrecy and deliberate misrepresentation in some cases.
Nigeria has about seven private healthcare companies that have nearly 45 standard and well-equipped laboratories across the country and could help in plugging the testing gap.
A number of these private health companies include Synlab (formerly Pathcare), Union Diagnostic, AfriGlobal Medicare, Me Cure Healthcare Limited, Echo Lab, and Lancet.
Since the infection was first reported in Nigeria on February 27, one private hospital, First Cardiology Consultants Hospital, Lagos, has been given licence by the government to manage cases of the virus and this privilege is simply on account of being the preferred caregiver to which the late chief of staff to the president was rushed to when he himself caught the virus.
The government’s own facilities are near the point of being overwhelmed but government officials are stubbornly seeking to maintain their firm grip on the entire process.
Private hospitals that have applied for licences to manage COVID-19 patients have waited for weeks without any sensible response from the government.
It takes on average a wait of four days to get tested in most cities in Nigeria because of the number of those waiting to be tested at the available government testing centres, and even after the sample has been taken, you will have to wait for another three days to receive the result.
In those seven days, a person with the virus is left to infect several others while waiting for a test result before being taken into isolation. Unsurprisingly, Nigeria’s infection rate is galloping on the back of unrestrained community spread that is worsened by a grossly under-resourced track and trace platform.
Saliu Oseni, incoming national deputy secretary, Nigeria Medical Association (NMA), particularly blamed the government’s deviation from the original plan to manage the pandemic, saying that the handling needs more than a one-man show.
The original plan, he said, was to have the isolation centres filled up and manage the overflow in some selected general hospitals, event centres and religious centres.
“But along the line, they deviated. A patient who is asymptomatic and goes for test has to go back home for self-isolation without considering the fact that the patient could be coming from a low socio-economic class. There is no way you can self-isolate a man that lives in face-me-I-face-you with two to four people and expect that the disease will not be spread. The tendency of the spread is even more,” Oseni said.
“Also the turnaround time of the test is below the need and by the time the result is out, patients are either already far gone with their symptoms or are dead. That’s not how to manage a pandemic. The reason why we have not had the result that we expect is because a lot of things have been done one-sided,” he said.
Oseni, who is a consultant general surgeon at the Ikorodu General Hospital, said even if a private health player would come onboard to upscale testing, the responsibility of footing the bills must be on the shoulders of the government, else it would be resisted greatly.
“Private labs can get involved as long as it is at the expense of the government, but that we will have a private lab to ask people to pay to do COVID-19 testing, that we will resist with every ability we have,” he said.
He said a lot of the association’s members have been infected with the virus, hence it would never allow anyone to commercialise the pandemic.
Doyin Odubanjo, executive secretary, Nigerian Academy of Science, said though it was necessary for the private sector to come in to assist in upscaling the testing capacity of the country, there was need for proper scrutiny to ensure that profit motive does not override the need for accuracy.
On March 31, Nigeria announced that it would increase the level of testing to 3,000 daily, but more than a month after, less than that daily level has been achieved, placing the continent’s number one oil exporter far behind less endowed African countries.
Since the virus broke out, Nigeria, a country of 200 million people, has completed only 63,882 tests compared with Ghana’s 197,000, Mauritius (104,000), Uganda (86,000), Kenya (61,000), and South Africa (550,000). More than half the tests done in South Africa are accounted for by the private sector which has been shut down in Nigeria.
In the last week, Nigerian government officials raised an alarm, yet unproven, that the coronavirus test kits circulating in the country are fake or unreliable. BusinessDay learnt from several leading medical practitioners in Lagos and Abuja that the alarm was deliberately sounded by officials to justify the government’s policy of shutting out the private sector.
According to BusinessDay investigation, some proprietors of private hospitals in the country acquired the test kits initially to help protect their own staff and when the waiting time for accessing the test in government centres got longer, wealthy patients are coming to them to undertake the tests which cost the naira equivalent of $30 in Nigeria.
As soon as they got wind of this, government officials threatened to shut down such private medical centres and insisted later on that they be given as many as 100 test kits per batch for validation, instead of the usual 10.
One leading health administrator told BusinessDay that this was not the practice during Nigeria’s globally acclaimed battle against Ebola.
He said government officials today are simply too dogmatic and should see the danger in over-centralisation that has bedevilled the fight against COVID-19 in Nigeria.
“I do not see a basis for the argument over the testing technology and the preference for the PCR method when there is at least another with the same level of efficacy. I also do not see why the government should insist that people should not pay for the tests if they are people or companies that are willing to sponsor tests for other Nigerians. This is creating an unnecessary bottleneck and as a result people are dying at home even before they can access the test. All of this is making people lay accusations of conspiracy. It is the usual Nigerian problem all over again,” the health administrator said.
“During Ebola, Lagos State did win the war before the Goodluck Jonathan government really intervened. And there was no such huge private sector donation as we have seen today. The government in Abuja is centralising everything and see what happened when it gave the Lagos State government N10bn, it led to other states demanding their own share,” he said.
What Nigeria must do now, according to healthcare experts
The reality is that COVID-19 is already in our community and we are in a stretchedout battle to contain it, and eventually to shut it down. Our full capacity for adaptive thinking and a flexible problem-solving approach must be immediately deployed, drawing from the examples of other people, but also from our innate resourcefulness.
It is recommended that the following steps be taken IMMEDIATELY:
1. Private health sector participation: The reality is that COVID-19 is already infesting private sector facilities, and not just the designated Isolation Centres. They are trying their best to screen cases using temperature measurement and clinical evidence. However, they are missing asymptomatic carriers, sometimes at great cost. We are aware of a
Teaching Hospital neurosurgery team that had to be shut down because of a patient they operated on, who showed no sign of COVID-19 but proved to be infected.
Actual testing in the present system takes up to three days to arrange, and up to another three days before results are obtained. This leaves medical staff and other patients at great risk as we speak, and is driving people sick with other illnesses away from hospitals.
ALL PCR RESOURCES IN NIGERIA, PUBLIC OR PRIVATE MUST BE IMMEDIATELY DEPLOYED FOR THE PURPOSE.
2. The technology and pace of testing: We must not be dogmatic by insisting on exclusive use of PCR technology for testing. Our pace is way too low, and our numbers utterly inadequate. The FDA in USA last month licensed an Antigen test for use. This signifies that the sensitivity and reliability are now sufficient for Antigen testing to be deployed at least for frontline use. We are aware such kits are already in Nigeria because many doctors feel it’s necessary to continually protect themselves, their staff and their patients. We must bring this discussion to the surface and create a formal role for the ‘rapid test’. It can only enhance practice and confidence. Government may insist that anybody diagnosed positive by the Antigen test must be ‘confirmed’ by PCR testing before being documented. All ‘negatives’ that show clinical signs or have clear history of contact should still be tested again with PCR.
3. The vexed issue of payment: There is an insistence that ‘people must not pay for tests’. This is obviously a policy matter but it is faulty in our present situation and must be pragmatically modified. One of the ways of doing this is to arrange open-ended private sector sponsorship to cover tests undertaken with the currently dormant PCRS, and perhaps to also cover the use of the Antigen test in designated facilities – PRIVATE AND PUBLIC.
Finally, any private facility that shows a willingness to dedicate part or all of its facility to COVID-19 treatment should be guided along the journey in a quick and safe way, instead of being treated as an intruder.
We believe if these measures are urgently taken, we will, as a society, be able to gain firm control of the situation and build confidence in the generality of our health workforce and our society.
ANTHONIA OBOKOH, MICHAEL ANI & TEMITAYO AYETOTO
