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Government at all levels must budget for health emergencies – Nsofor

IFEANYI NSOFOR is the senior new voices fellow at the Aspen Institute in Washington DC. In this interview with JOSEPHINE OKOJIE, he spoke about the state of the Nigerian healthcare industry.

Covid-19 showed us the poor state of the Nigerian healthcare system, as a medical professional, can you tell us specific steps needed to get Nigeria prepared for possible future pandemics?

Governments across Nigeria must have a mindset that infectious diseases can happen anywhere anytime. The current global outbreak of monkeypox in countries that are not endemic to the disease is a wake-up call. The following steps to prepare Nigeria for future pandemics are important: Federal, state, and local governments must have budget lines for pandemic preparedness. State and local governments must take a cue from the federal government and domesticate a plan for health security. The National Action Plan for Health Security per capita budget cost 40 cents (N1,000 ) per person as the amount required to fund pandemic preparedness in Nigeria. Federal, state, and local governments must increase advocacy for the prevention of pandemics. For instance, 46 million Nigerians stool in public. This is a recipe for outbreaks of cholera and other diarrheal diseases. They must build public toilets, and provide clean water and functional sanitation system.

This advocacy should be delivered by individuals and organizations that are respected by our people, such as religious leaders, community leaders, and Nollywood/Kannywood celebrities among others. Social media platforms and radio are important routes to disseminate health information. Universal access to healthcare is a sure way to prepare for pandemics. When people are sick, they should be encouraged to seek healthcare in health facilities. To achieve this, federal, state, and local governments must implement mandatory health insurance schemes available across the nation.

What can Nigeria do to address the mass exodus of healthcare workers to foreign countries?

In 2017, I was co-lead of a survey on the emigration of Nigerian medical doctors. We interviewed more than 700 doctors – most were in Nigeria and a few already in the diaspora. Major reasons for emigration include better facilities and work environment, higher remuneration, career progression and professional advancement, and better quality of life. The majority of survey respondents (87percent) believe the government is unconcerned with mitigating the challenges facing medical doctors in Nigeria. Improved remuneration (18 percent), upgrade hospital facilities and equipment (16percent), increased healthcare funding (13percent), and improved working conditions of health workers were the top suggestions given to mitigate the challenges doctors face. The survey on the emigration of medical doctors unpacks what doctors expect governments across Nigeria to do. It is also important to break down these responsibilities by federal, state and local governments. For instance, state governments can make their states very competitive with different incentives for doctors and other health workers. There have been instances when some state governments employed doctors from north African countries and paid them at international rates. They can do the same for Nigerian doctors.

Q: The trillions of naira spent on fuel subsidy could be re-channeled to provide health insurance for all Nigerians

What is your opinion is the ideal percentage of the national budget that should be allocated to the Nigerian health sector?

The Abuja declaration for health recommends a 15percent of the national budget allocation for health. However, this amount will not adequately fund Nigeria’s health system. Indeed, even if all of Nigeria’s federal budget will not adequately fund healthcare for our people. Health insurance is a sustainable and equitable way to provide healthcare for every Nigerian. Luckily, health insurance is now mandatory at the national level as well as across most states in Nigeria. Federal, state and local governments must increase advocacy to Nigerians outside civil service and the organized private sector to buy health insurance.

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Most state health insurance schemes in Nigeria are less than N12,000 per person per year. This is an amount that most Nigerians can afford when they are convinced of the benefits of health insurance. For the poorest of the poor among us, governments can set up equity funds that would pay for health insurance for them. The trillions of naira spent on fuel subsidy could be re-channeled to provide health insurance for all Nigerians.

The outbreak of monkeypox seems to be a topical issue. How well do you think we can curb the spread of this epidemic?

There are currently more than 25,000 cases of monkeypox globally. Most of these are in countries that are not endemic to monkeypox. From January 1 to July 31, 2022, the Nigeria Centre for Disease Control, Nigeria confirmed 157 cases of monkeypox and 4 deaths. Cases by states are as follows: Lagos (20), Adamawa (13), Delta (12), Bayelsa (12), Rivers (11), Edo (8), Nasarawa (8), Plateau (6), Anambra (6), FCT (5), Taraba (5), Kwara (5), Kano (5), Imo (4), Cross River (3), Borno (3), Oyo (3), Abia (3), Gombe (3), Katsina (2), Kogi (2), Niger (1), Ogun (1), Bauchi (1) and Akwa Ibom (1). Curbing the spread of monkeypox includes good hygiene, washing hands with soap and water, and seeking healthcare when one is suspected of having monkeypox. Some animals consumed as bushmeat in Nigeria can spread monkeypox. Therefore, we must discourage the killing of endangered animal species and ensure that other bushmeats are properly cooked before consumption.

We’ve seen how schools abroad engage in deep research to proffer solutions to scientific challenges. How much collaboration currently exists between universities and the Nigerian health sector?

Universities in Nigeria should be more involved in research. There are some instances where this happens. However, there is so much more to be done in this regard. The Nigeria Centre for Disease Control has created an initiative that provides internship opportunities for community medicine resident doctors to gain more insight into pandemic preparedness. Some of these doctors have gone ahead to conduct research and co-author peer-reviewed articles.

There has been a sharp rise in the number of COVID-19 cases reported in the country within one month. How prepared do you think Nigeria is for this?

The rising Covid-19 cases are worrisome, especially with the laxity of governments and government agencies across Nigeria. Apart from the NCDC, NPHCDA and a few state governments, most others seem to be fatigued and are no longer putting out COVID-19 public health advisories on prevention methods. This has to change. Consequently, most state governments are not prepared. This unpreparedness is not helped by the forthcoming elections in Nigeria. Governance is gradually taking a backseat while politicking is on the rise. However, this election fever also provides an opportunity for the electorate to ask politicians questions on pandemic preparedness. Government agencies across the board must keep encouraging Nigerians to wash their hands with soap and under running water, wear face masks when in crowded places and ensure all eligible people get vaccinated against COVID-19. Currently, only 25 percent of individuals aged 18 years and over in Nigeria are fully vaccinated. The NPHCDA is launching the SCALES 3.0 strategy to increase COVID-19 vaccination coverage in Nigeria. Additionally, The SCALES 3.0 strategy is expected to increase childhood vaccines and other primary health care services at public and private health facilities, and mass vaccination sites nationwide.

Looking away from the government, how critical is the role of private organisations towards strengthening the Nigerian health system?

Already, the private health sector in Nigeria provides the bulk of healthcare in Nigeria. Private sector healthcare providers include private hospitals/clinics, patent medicine vendors, chemists, and pharmacies. Vice President Osinbajo chose a private hospital in Lagos over a public hospital for his recent surgery for recurrent leg pains. Likewise, the private sector coalition against COVID-19 CACOVID has so far supported Nigeria’s COVID-19 response with more than N32 billion. This support is unprecedented and should be leveraged for Nigeria’s pandemic preparedness.

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