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Epidemic preparedness: Leadership, increased funding strengthen health systems

For a country such as Nigeria with deteriorating healthcare system leadership, increase and sustained investments are critical elements in ensuring preparedness against epidemics and pandemics.

This means leveraging funds to increase healthcare budgetary allocation, reinforcing emergency operations centres, training medical personnel, upgrading delivery infrastructure, surveillance, diagnostic, and laboratory capabilities.

Additionally, scaling up research institutes, pharmaceutical manufacturing industries, coordinating rapid epidemic response force, and integrating surveillance, zoonotic monitoring and reserving manufacture capacity for medical security measures, such as producing vaccines will require pre- positioned financing to manage the risk of health threats, and can be deployed during an epidemic outbreak.

Addressing these specific needs in the health system will enable the government to propose a more targeted financing model which could possibly be added to an existing plan.

Over time, the occurrence of epidemic outbreaks has increased in Nigeria and experts have repeatedly expressed concerns that “we are not prepared for the next epidemics.” This necessitates the need for government to strengthen healthcare financing by investing in epidemic preparedness.

Read Also: Why Nigeria must take responsibility for epidemic preparedness

For governments to be successful in epidemic preparedness and response, they have to take on and manage the risk of health threats the way they handle economic or security threats as it is no longer news that government should not ignore what is important in place of what is urgent and make preparedness a priority.

Funding epidemic preparedness by the Nigerian government is no longer an option but a necessity as there has been a reoccurrence of disease outbreaks such as the yet-to-be overcome COVID-19, Lassa fever, cholera, yellow fever, measles, monkey-pox, and meningitis resurgence.

COVID-19 has spotlighted the complexities of how preparedness is governed and that epidemics do happen and can take nations unawares, yet the inheritance of lack of political will intensifies the failure to see the need to invest in epidemic preparedness.

With an emergency comes opportunity. The impact of this ongoing experience of Covid-19, and the lessons learned from responding to it creates an opportunity to reinvent national health security and rebuild Nigeria’s health system. This is pivotal for all levels of governance in the country to focus on identifying the importance of growing finance for epidemic preparedness and ensuring that funds are not diverted from essential services that need continued support in order to build resilience to future shocks.

The level of epidemic preparedness and the response has clear benefits at the local, state, and federal levels. These benefits go beyond health and impact economic stability. This is a broader understanding of security. There are many other positive externalities for funding healthcare.

“When you invest in anything, you tend to pay more attention to it. Preparedness for epidemics can be catastrophic as the epidemics will come, but it’s preparedness that enables you to limit them. The need to develop a strategic mechanism for increasing funds for financing epidemics preparedness in Nigeria cannot be overemphasized,” says Doyin Odubanjo, a public health expert.

According to the public health expert, developing a pool of domestic funds such as how the CACOVID and other organisations supported during the spike of COVID-19 outbreak will help the country to avoid dependence on international bodies. Building a strong collaboration for partnership with private and other parastatals will create options for increasing and earmarking resources for preparedness.

“We simply need to take another look at our budgeting system which is currently just a scam! We must begin with what we have available and then share it according to priorities. Such targets as the Abuja Declaration of 15% may not be feasible sometimes. Just budgeting 15% doesn’t mean it will be judiciously spent and make an appropriate impact,” he said.

“We need to know what our priorities really are and apply what is available to them as best as possible. Absolutely, we need to strengthen the health system by using evidence properly for policymaking,” said Odubanjo.

Similarly, Chikwe Ihekweazu, director-general of Nigeria Centre for Disease Control (NCDC), said increasing financing for epidemic preparedness would benefit the country noting that despite the progress made the government needs to prioritise epidemic preparedness not only in word but also in action.

“COVID-19 has shown how weak the health security is and its challenges of how it affects the populations, there are still, several needs to be met in strengthening Nigeria’s public health laboratory system and capacity.

“This will require not only substantial funding but also stable funding that meets the evolving need to invest in diagnostics, we must not neglect the other aspects of epidemic preparedness including those that are not within the direct control of the health sector,” he said.

Epidemic preparedness requires a more explicit definition of national public good in Nigeria. Other requirements are additional finance as well as technical support to accelerate planning and implementation. To monitor progress should be given to Nigeria Centre for Disease Control (NCDC) as the agency is the country’s national public institution championing the prevention, preparedness for, detection, and response to infectious disease outbreaks.

“Our focus is on strengthening the public health system to protect the health of all Nigerians. What is certain is that investing in public health preparedness is far cheaper than the economic impact of a pandemic,” Ihekweazu said.

He added that infectious disease outbreaks start within a state before spreading; therefore, we must prioritise our subnational health security. This requires sustainable investment by State governments. At the national level, we have continued to support states in strengthening their health security while advocating for increased state-level investment.

According to him, “The response to disease outbreaks is not the responsibility of the health sector alone. One of the most important lessons from Nigeria’s COVID-19 response is the role of a multi-sectoral collaboration platform provided through the PTF, in enabling rapid decision making and response.

“Nigeria needs to co-share responsibility to ensure success in investments and preparedness operations. These financing modalities that integrate affordability, sustainability, and stronger health systems.”

Preparedness (emergency system and supplies for public health emergencies) is one of the major cost drivers and initiatives of the National Action Plan for Health Security (NAPHS), according to the 2018 – 2022 plan suggest #11, 265, 414, 006 is what will be needed to prepare for the most likely and highest risks threats in Nigeria.

Some of the challenges affecting implementation of NAPHS is no immediate availability of domestic funding for outbreak response at all levels, low budgetary allocation to health security, weak commitment of the Ministries, Departments and Agencies (MDAs) directly involved with implementing the NAPHS, this was recently discussed at “A Critical Review of NAPHS as an Effective Budgeting Tool for Epidemic Preparedness in Nigeria”, convened by Nigeria Health Watch in July 2020.

“While the NAPHS provides us with a clear strategic plan that requires significant financing, it also highlights the need for stable and sustainable financing for health security. The COVID-19 pandemic is an important reminder that inadequate financing for epidemic preparedness and response can cripple a country’s economy. We must prioritize sustainable financing for epidemic preparedness and response to protect our country’s economy,” Ihekweazu said.

Significant components of the nation’s health security budget would include increased funding for state and local hospitals, scientific research on emerging and epidemiological surveillance, the Strategic National Supply, a crucial agency like NCDC should be more funded.

This approach and these recommendations will only succeed with leadership from the Nigerian policymakers working in concert with their complements in governments at all levels and collaboration. Without such leadership and partnership, accompanied by formal restructurings and adequate funding, any future epidemic response will be no better than the existing, disarrayed performance, with high human and economic costs.

“Citizens have a significant role to play, too. They must request accountability from their governments for health emergency preparedness, which requires that leaders empower their citizens and strengthen civil society,” said Oyewale Tomori, a professor of virology.

Tomori counseled that “Every Individual should take responsibility for seeking and using accurate information to educate themselves, their families, and their communities on the need to always be prepared against any disease outbreak.”

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