Adewole and Chikwe
By Prof. Isaac Adewole
One of the biggest priorities of the President Muhammadu Buhari’s led government in its first tenure, was to strengthen and revitalise Nigeria’s health sector. This was evident in several ways. Perhaps one of the most valuable long-term investments of this administration is the passage of the Act establishing the Nigeria Centre for Disease Control (NCDC). This agency which was established in 2011 to lead the response to the challenges of public health emergencies and to enhance Nigeria’s preparedness and response to epidemics, had existed for over 10 years without a legislative mandate. This led to some uncertainty about its role and mandate. This has now been resolved by the leadership of His Excellency, President Muhammadu Buhari, providing an unambiguous mandate to NCDC as contained in the new Act.
Across the world, there is a rise in the awareness of people, on the critical importance of science driven national public health institutes, in protecting the health of its citizens. In several global health meetings which I have been privileged to attend and in some cases chair, Nigeria’s national public health institute is often cited as a model for other countries. In recognition of this, the Director General of the World Health Organisation, Dr Tedros Adhanom Ghebreyesus visited the agency in 2018, together with all his regional directors from across the world. They were impressed by the progress made by this nascent but vibrant new centre.
Prior to 2017, the ability of NCDC to completely deliver its mandate was limited by the absence of a legislative mandate. Other factors that limited effective and smooth operationalisation of activities included inadequate funding, limited development partners support, a non-effective incident coordination mechanism, limited laboratory diagnostic capacity, lack of standard operation procedures and guidelines, etc. This had a negative impact on outbreak preparedness and response in the country. However, since the Buhari administration prioritised health security and universal health coverage in the last four years, we have recorded incredible progress across several areas.
In 2017, NCDC on behalf of the Federal Ministry of Health coordinated the Joint External Evaluation (JEE) of International Health Regulations (IHR) for Nigeria. This described the country’s gaps and defined the progress that has been made in health security. Subsequently, this led to the development of a National Action Plan for Health Security which I was privileged to launch in December 2018. This plan has an outline of roles for every player in health security, within and outside the Nigerian health sector. For the first time, we have a concise and well defined plan that speaks to health and ‘non-health’ sector leaders. The plan has helped us interact better, as members of the Federal Executive Council, to assure Nigeria’s health security.
Prior to 2015, Nigeria depended largely on other African and Western countries for laboratory testing. In 2017, the new National Reference Laboratory was operationalised in Abuja, and now leads public health laboratory diagnosis in the country. The laboratory together with its network of laboratories across the country, has the capacity to test for the six epidemic prone diseases in Nigeria; Lassa fever, measles, cholera, yellow fever, cerebrospinal meningitis and monkeypox. This is in addition to leading surveillance on antimicrobial resistance, external quality assessments and other important areas.
The National Reference Laboratory also served as the central laboratory for the National AIDS Impact and Indicator Survey (NAIIS). This is evidence of national ownership in ensuring sustainability of investments in the country. We are now leveraging on outputs from the AIDS survey to improve our knowledge of the burden of other diseases.
In line with President Buhari’s agenda for a digital Nigeria, a new digital surveillance tool- Surveillance and Outbreak Review Management System (SORMAS), was developed and introduced for ease of reporting. This has been fully deployed in 211 Local Government Areas (LGAs) in 16 States in Nigeria. This enables digital reporting of infectious disease data, improved response time and better data management. This new system will position Nigeria as a leader in infectious disease surveillance in Africa.
Following the 2014 Ebola outbreak, several structures were lost after the response. The Emergency Operations Centre (EOC) that was used for the response was shut down. The emergence of NCDC has now changed this landscape. Nigeria now has a new National Emergency Operations Centre, known as the Incident Coordination Centre (ICC) within NCDC. This was set up in 2016 and has led the coordination of over 10 outbreaks till date. In addition, NCDC began a project to establish state level Emergency Operations Centre for coordination. By the end of April 2019, this project had been completed in 14 states with plans for further expansion to cover the entire country. A National First Responders Team (N-FIRST) for highly pathogenic infectious disease outbreak was set up in 2018 in alignment with the Emergency Medical Team (EMT) concept. This includes health workers of different cadre from various health facilities in Nigeria, prepared to respond to highly pathogenic outbreaks with NCDC’s coordination.
As part of the overall mandate of the Federal Ministry of Health, NCDC has contributed significantly to research and development, especially for infectious diseases. Nigeria is now at the forefront of Lassa fever research globally. There is a new national Lassa fever research plan, working with partners to understand and push for the production of new countermeasures such as Lassa fever vaccines. In addition, Nigeria now contributes to the Global Antimicrobial Resistance Surveillance System, one of the new threats to global health.
Given the increased trust and renewed vigor in the health sector and NCDC, there has been an increase in partnerships and support globally. NCDC has built partnerships with other national public health institutes in United Kingdom, Germany, United States of America and other countries. In addition, NCDC receives support from the World Health Organization, Africa CDC, West African Health Organization, UNICEF, Gates Foundation, a credit facility from the World Bank and other international agencies.
Finally, in 2018, the Basic Healthcare Provision Fund (BHCPF) was passed into law for the first time. Of the five per cent earmarked for emergencies, 2.5 per cent is for health emergencies and will be managed by NCDC. Our Government recognises that universal health coverage and health security are two sides of the same coin. Therefore, this sustainable act and several others that we have built will support NCDC in continuing its mandate of protecting the health of all Nigerians.
As the first tenure of President Buhari draws to an end, we celebrate one of its most important achievements. The full operationalisation of NCDC will protect the health of Nigerians for generations yet unborn.
Adewole is the Honourable Minister of Health, and a professor of gynaecology and obstetrics