Most African countries are constantly threatened by the outbreak of epidemics, thanks to absence of proactive investment in healthcare infrastructure
Although all countries of the world contend with the threat of outbreak of diseases, those with advanced mechanism of epidemic preparedness are always at much lower risk of experiencing outbreak of infectious diseases within their borders, compared to countries such as Nigeria, whose weak epidemic preparedness system is responsible for their apparent inability to effectively prevent, detect and respond to such outbreaks.
At no time was Nigeria’s obvious low capacity to prevent, detect and respond to outbreak of infectious diseases so glaring as the period of the devastating outbreak of the Ebola Virus Disease (EVD) epidemic in 2014; the wildly ravaging, highly contagious and dreadfully infectious Ebola began in Guinea around December 2013 before quickly spreading to other countries, mainly Sierra Leone and Liberia – from where it was imported to Nigeria through Lagos, killing eight people including four health workers.
The dramatic way Ebola came into Nigeria in 2014 led to an equally dramatic response to its outbreak from the Nigerian government. It however left an enduring lesson: a sense of awareness among the Nigerian public on the country’s fragile national public health system and hence weak level of epidemic preparedness (capability and infrastructure) which are the major determinants of countries’ capacity to manage outbreaks of epidemics and other public health emergencies.
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Thus, Nigeria’s response to Ebola was “ad-hoc” in the form of a hurriedly established Emergency Operations Centre (EOC) – which only became wholly effective days into the outbreak. Nonetheless, since the Ebola crisis of 2014, Nigeria had continued to consciously evolve various preparedness and response mechanisms for the outbreak of epidemics in the form of deliberate strategies targeted at strengthening the country’s healthcare system particularly its health security infrastructure.
Nigeria is signatory to the International Health Regulations (IHR) , a voluntary agreement signed by all WHO member states to collectively work towards achieving global health security including reporting events of international public health importance. In 2017, Nigeria opened up its public health security infrastructure to a Joint External Evaluation (JEE) led by the World Health Organisation. JEE, which is a collaborative, multi-sectoral measure of countries level of preparedness and response capabilities for epidemics, is meant to help countries find and close gaps in epidemic preparedness.
Nigeria was therefore ranked 19th among the 42 countries of the WHO African region, based on the outcome of the JEE. And on ReadyScore’s scale of 0 to100 based on the same JEE, Nigeria only managed to score 39. According to Resolve to Save Lives, a global nonprofit focused on preventing epidemics, countries with a ReadyScore of above 80 are considered as better prepared for an epidemic while countries with ReadyScore of between 40 and 79 still have work to do. Resolve to Save Lives however believe countries with Ready Score below 40 (including Nigeria) are simply not ready!
Thus, it was in response to Nigeria’s embarrassing epidemic preparedness infrastructure and response capabilities i.e ability to prevent, detect, and respond to the outbreak of epidemics that the country came up with the 2018 -2022 National Action Plan for Health Security (NAPHS) – as a strategic roadmap aimed at filling critical gaps identified by health security assessments such as the JEE. The NAPHS, which was a result of a nationwide consultative and participatory process, covers 19 technical areas across prevention, detection, response as well as other IHR-related hazards.
The estimated cost of the 5-year strategic health security action plan is NGN134 billion ($439 million USD) and its implementation will, amongst others, require the active involvement and contribution of the federal, state and local governments including the establishment of EOCs across all 36 states of the federation as well as the establishment of public health labs across the country. NAPHS aims to strengthen surveillance, preparedness, response, laboratory networks across the three tiers of government as well as strengthen public health workforce across the country.
Indeed Nigeria’s opening of its doors to WHO for the purpose of the JEE and the subsequent development of the NAPHS signifies the country’s renewed commitment to preventing, detecting and responding to disease outbreak. However, this lofty plan will remain a mere plan unless governments (federal, state and local) begin to make budgetary provisions for their respective line items in the NAPHS. An integral aspect of the NAPHS is the Nigeria Strategy on Immunization and Primary Health Care Systems Strengthening (NSIPSS) which came into force in April, 2018.
The NSIPSS whose implementation cost is estimated to be to the tune of 81 billion Naira ($265 million) – representing almost 60% of the total cost of the NAPHS – will be implemented over a 10 year period with funding sources being mainly the national budget and World Bank financing. The Nigerian government is already receiving interim funding for the plan through the World Bank’s Regional Disease Surveillance Systems Enhancement (REDISSE) program, focused on addressing systemic weaknesses within the human and animal health sectors that hinder effective disease surveillance and response in the West African sub-region.
Moreover, the final assent for the bill establishing the Nigeria Centre for Disease Control (NCDC) by President Muhammadu Buhari in November 2018 was a huge boost to Nigeria’s quest for safeguarding the health security of about 200 million Nigerian citizens. The NCDC Act offers an opportunity for Nigeria to begin to proactively prevent and better prepare for the outbreak of epidemics.
However, the NCDC requires sufficient and continued financial, human, and technological resources to be able to achieve its extraordinary mandate of proactively building the needed preparedness infrastructure and response capabilities necessary for preventing, detecting and responding to the outbreaks of epidemics in Nigeria.
The 2014 – 2015 West Africa Ebola epidemic cost each of the trio of the republics of Guinea, Liberia and Sierra Leone $600 million, $300 million and $1.9 billion, respectively, in GDP terms, according to the World Bank. The relatively small Ebola outbreak in Nigeria at the time cost the country $186 million in GDP – thanks to Nigeria’s significantly lower number of Ebola cases, compared to Guinea, Liberia and Sierra Leone.
Nigeria would only need roughly US$0.40 per person per year to establish a preparedness infrastructure capable of protecting all Nigerians, based on the NCDC-costed NAPHS. While the International Working Group on Financing Preparedness valued Nigeria’s economic losses in the event of a pandemic at an annual loss of US9,662,722,821 (3.51 trillion naira).
This clearly explains why Nigeria must ensure the effective implementation of its National Action Plan for Health Security (NAPHS) as well as improving funding for the National Centre for Disease Control (NCDC). For, it is only in committing adequate financial, human and technological resources by relevant Ministries Departments and Agencies (MDAs), state and local governments, that Nigeria can successfully drive the implementation of the NAPHS.
And it is only by effectively driving the implementation of its health security action plan that Nigeria could achieve a truly resilient health security infrastructure, one that is capable of satisfactorily serving as the first line of defense against any potential outbreak of epidemics.