Driving a campaign to get as many COVID-19 shots as possible in the arms of Lagos residents is a preoccupation that has almost usurped previous activities for the Lagos State Primary Healthcare Board since March 2021. The state has had nearly one million fully vaccinated people amid anti-vaccine sentiments. IBRAHIM MUSTAFA, the permanent secretary of the board in this interview with TEMITAYO AYETOTO-OLADEHINDE, sheds light on how the state is faring, estimating it is far ahead of national performance, yet, still having vaccines but fewer people showing interest.
What are the real challenges of primary healthcare that you have observed in the state in recent years?
One of the major challenges of primary healthcare is infrastructure. The government is doing a lot but it can be better. We want a primary healthcare level that the middle class will be able to visit beyond visiting the place for routine immunisation. Everybody wants to have their immunisation at the primary health centres because they are sure they will be getting the right vaccines in the right state. But beyond that, we want people to access other health needs at the primary health centres. One way of achieving that is to have a conducive environment. A number of our primary health centres are quite conducive and welcoming but at the same time, we have those ones that need to upgrade.
Those in need of upgrades would be the majority of the centres?
The majority are good but a significant number will need to be upgraded. We have already earmarked a number of them for upgrading in our budget. We have about six new constructions to be done from scratch and some that will be renovated. We also have those that some of our politicians are assisting with. For instance, in Lagos West, the senator there is renovating 20 primary health centres including one new structure.
The local government chairmen are also doing a lot of renovation in their different areas. The other challenge we face is manpower and we are also working towards that. There is a significant attrition rate in the health sector with doctors, nurses and other cadres leaving for greener pastures. That is affecting the health sector and so we have a dearth of staff and a significant shortage.
We have an exit replacement plan such that as some people are leaving, we replace them immediately. We do it quarterly or bi-quarterly if we don’t have large numbers. We also do fresh recruitments and we have had the approval to recruit about 920 health personnel. All of these are things that we do to mitigate the effect of staff shortage.
How is it that Lagos, the epicentre of the coronavirus disease in Nigeria with 39 percent of infections is performing poorly on the national vaccination chart at 15th position?
What the National Primary Healthcare Development Agency (NPHCDA) is doing is not truly reflective. As of January 1st, the total number vaccinated all over the country was about four million and Lagos did 1.3 million of that. There is no other state that is near that. When we started this last campaign, our plan was to get 50 percent of the target population to reach herd-immunity, which is 50 percent of those above 18 years.
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If you go back and check the national population commission website which is the data that the NPHCDA uses, the population of people above 18 in Lagos is over 8 million and 50 percent of that is four million. The graph you are talking about that is putting Lagos as not doing so well is now basing Lagos on the percentage population of four million from November 17 and not in March when we started vaccination. They have based Lagos on the four million target and are assuming that Lagos has not vaccinated anyone from March to November and that our target is four million.
Indeed, when we started, we had large crowds and most of the people that are very willing to take this vaccine have taken it. And at that point, Lagos was the only centre that had a huge crowd. Most of the other states were not doing as much.
A total of 1, 336, 000 have received first doses and about 800, 000 have been fully vaccinated. So 20 percent of the target population in Lagos have been fully vaccinated.
What we are doing now is sending text to people to come out and take their second doses. That’s the issue. The vaccines are there but they are not coming
Do you think Lagos has done well compared to big-city peers in other countries?
The vaccines are available but the uptake by people is quite slow and the only way is that we continue to mobilise people. In some of these countries, they have a vaccine mandate and probably will be something we will have to decide on in Lagos going forward; that if you are a civil servant, you must have your vaccination to be able to work in a government facility. That will also push people to begin to go to the vaccination centres. Vaccination is still not compulsory in the country and largely voluntary.
Are you doing anything with NPHCDA to harmonise this data?
We have approached NPHCDA. We have regular meetings and we have raised it. The response is that this is what they are doing for now. Up till this morning, I still engaged the people in charge and they said that is the instruction they were given. If the country is doing around four million and Lagos is doing over a million, that’s like 20 percent of what is going on. But when you use percentages like NPHCDA is doing, then you will have what they are depicting.
What we are interested in is to vaccinate as many of our people as possible. We are currently in some of the bus stops. We visit churches and mosques and BRT buses sometimes, just to ensure that we are reaching out to many people.
Early last year, the state was planning to establish direct partnerships with foreign vaccine manufacturers to fix inconsistent supply of vaccines. What happened to that plan and does the state have a sufficient amount for its population?
I may not be competent to give you details about that because I really don’t know much about it. But I know Lagos is keying into what the federal government has to offer in terms of the vaccine. We don’t have scarcity of vaccines now, so there is really no need for Lagos to go out of its way to get vaccines. But at any point we don’t have enough for our people, the government will do the needful.
Do we have sufficient vaccines for the target population?
As of today, we have enough vaccines on the ground. It is for people to come out and get vaccinated.
How has the focus on COVID-19 vaccinations affected other programmes such as cervical cancer, hepatitis B, measles, and yellow fever among others?
When we started the vaccination for COVID-19, other aspects of healthcare delivery were significantly affected because a lot of resources and concentration was on COVID-19.
Even at the beginning of the year, routine immunisation including some of those ones you have mentioned suffered because the staff for routine immunisation are the staff that we are also using for the COVID-19 vaccination campaign. That sort of affected their performance with other diseases.
But about mid last year, we started putting more emphasis on other activities of primary healthcare such as maternal, infant and child health, school health and routine immunisation. We are gradually getting back to where we were. What we have done and what is being done nationally is to routinise the COVID-19 vaccination. This means we will make it as part of the routine exercise of primary healthcare. It will just be like you go in for any other vaccination so that other activities of the health centres will not be affected.
For cervical cancer, is anything going on in terms of the vaccination?
Of course, yes, and we have different programmes targeted at early diagnosis and where possible we also give vaccines. The programmes are free. Most of the primary healthcare centres around have cervical screening services which are free and we even go out to vaccinate people especially school children.
Some disease experts have described the rollout of booster doses as a catalyst for vaccine inequity locally as it could see a fraction of the population overprotected against the coronavirus, leaving the majority unprotected. Has that played out in over a month of administering booster doses?
We need to have people come out for vaccination. The people that have had the first dose are over one million. You will expect that these people should come out for their second doses. Unfortunately, the total who had their second doses are about 800,000. So we have a balance of about 500,000. And then we have some people who have had their second doses and they want a booster. In fact, what we are doing now is sending text to people to come out and take their second doses. That’s the issue. The vaccines are there but they are not coming.
How are you tackling anti-vaccine sentiments among people?
Probably one of the reasons why we are having some hesitancy is because of the negative news they have read on the internet. The main thing is to counter this news. We have to let people know that these vaccines are safe and effective. Some people have a very rigid position and especially when they listen to their religious leaders that they hold in very high esteem saying they shouldn’t take the vaccine. We are also reaching out to these people and have tried to convince them. We are hoping that having done all these, people will be less moved by the negative information they get all around.
Lagos has commercialised COVID-19 vaccination in private hospitals, an idea that was shocking to some and a welcome development for others. What has been the impact of that move on vaccine uptake?
The reason why we did that is to expand the availability of vaccines to the people. We want to increase the number of centres where people can access these vaccines. It was not based on financial interest but on the fact that we wanted people to have access. And as you know, some people will prefer to go to a private hospital any day and we have had people come to us to say they would like to have their vaccine in private hospitals.
It is definitely contributing to our coverage target but it can be better than what we currently have.
What plans are on the board’s agenda this year?
For this year, we want to improve significantly on routine immunisation and do more in terms of school health, maternal infant and child health. We also want to see a situation where we are able to improve on infrastructure. We have a mandate by the governor to improve health and in doing this; we need to have the infrastructure, the manpower and other resources. We are hoping to harness all of the resources around us to improve on the services at the grassroots level.
