Strengthening Health Security in Nigeria

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With the Joint External Evaluation of the International Health Regulations placing Nigeria’s capacity to prevent, detect, and respond to public health threats at 46 per cent, Martins Ifijeh writes on the need for the federal government and stakeholders to improve on policies and actions that can strengthen national health security

Imagine this: President Muhammadu Buhari budgets N10.59 trillion ($35 billion) to bring economic prosperity and improved security to Nigerians by the end of 2020. To achieve this, he allocates N262 billion to Works and Housing, N127 billion to Power, N123 billion to Transportation, N100 billion to Defence, N87 billion for Science and Technology, N81 billion to Niger Delta Development Commission (NDDC); and then suddenly, a viral disease emerges from one of the ports, and spreads across borders, infecting people in droves, causing fevers and deaths, with panic, instability and national tremor, and then in no time, begins to have a toll on the economy, security, power, and agriculture of the nation.

By the end of 2020, Nigerians would then refer to the year as the worst ever in the history of the country. Why? Because the federal government only allocated a paltry N41 billion to one of the most important sector, health, with only a small chunk dedicated to strengthening health security, hence unable to adequately prevent or detect viral disease outbreaks despite its plans to make Nigerians happy by the end of the year.

While an average Nigerian will be quick to rebuke the above scenario, which seemed like a plague from the ‘pit of hell’, this unfortunately is the risk the Nigerian government puts its citizens every year when it plans budgetary allocations for the country, with priority given mostly to sectors that have no stronger links to economic prosperity than the health sector. While making these allocations, it often forgets that certain disease outbreaks have the potential to cripple the progress or aspirations of the country even if N1 trillion is allocated to Works and Housing.

For instance, before the last Ebola Virus Disease (EVD) outbreak in Congo; which claimed over 1000 lives, its government said it was going to prioritise human capital development, address maternal and child mortality, and reduce poverty, but with the disease outbreak, it had no choice than to shift its focus to first tackling the epidemic that almost brought the country to its knees.

As at October 2019, its human capital index had fallen to 0.42, which is below the average for middle-income countries. Its maternal and infant mortality rates remain high, with five per cent of children not making it to their fifth birthday, and extreme poverty increased, especially during the Ebola crisis, if figures from the World Bank are to go by.

Although, EVD, which is one of the several diseases capable of shutting down economies of countries, was in 2014 contained in Nigeria when the infected late Patrick Sawyer from Liberia visited the country, stakeholders believed Nigeria was only lucky to manage the situation that claimed eight productive lives and cost the country over $180 million, because the index case landed in Lagos and not in any remote town or village, and that if the country hopes to manage the perceived progress currently noticed in the economy and other sectors in the Buhari-led government, it should not push its luck too far by leaving the health security of the country at the mercy of providence and the usual fire brigade approach.

Strengthening Health Security
Experts believe Nigeria is yet to prioritise health security, which means progresses made or been planned to be made in other sectors may come to nothing if the country experiences another major health crisis. They believe that if health security is prioritised, it will not only ensure government’s overall plans for the citizens in 2020 are achieved, it will help in preventing, detecting and responding to public health threats which are capable of reversing the gains the administration of President Buhari has made or hopes to make by the end of 2020.

Health security, according to the World Health Organisation (WHO) is referred to as the activities required to minimise the danger and impact of acute public health events that endanger the collective health of populations living across geographical regions and international boundaries.
To measure Nigeria’s capacity to prevent, detect, and respond to public health threats, the federal government in November 2019 had a Joint External Evaluation (JEE) of International Health Regulation Capacities which puts the country’s level at 46 per cent. Although this represents seven per cent increase from 2017 score of 39 per cent, it still shows the country ranks below expectation, which therefore means Nigeria remains highly vulnerable to public health threats, especially from other countries, hence the need to give it the priority it deserves.

In 2017, Nigeria, through the Nigeria Centre for Disease Control (NCDC), conducted a JEE of her IHR capacities, which are global standards of countries’ preparedness to tackle public health threats, and are conducted every five years. Last year, the country embarked on a mid-term assessment to review the progress and gaps.

Key stakeholders from 29 Ministries, Departments and Agencies (MDAs) involved in health security used the WHO approved tool with 49 indicators to assess Nigeria’s capacity in the 19 technical areas, validated by a mission Team from the WHO, Public Health England, Resolve to Save Lives, US Centers for Disease Control, Georgetown University, African Field Epidemiology Network, Pro Health International and University of Maryland Baltimore. The findings from the JEE show that Nigeria has made some progress since 2017. This is especially in areas such as legislation, policy and financing; zoonotic disease; biosafety and biosecurity; laboratory system; reporting; emergency preparedness; and response operations; medical countermeasures and risk communication. In other areas, there has been no change or a decrease in capacity.

The Director General, NCDC, Dr. Chikwe Ihekweazu said there was need for improved multi-sectorial effort to protect the health of Nigerians, adding that more needed to be done to achieve a more positive JEE result.

He said: “We are grateful for another opportunity to work collaboratively with our colleagues from other MDAs. It is very important for us to maintain and strengthen our multi-sectorial collaboration for health security. We are only as strong as our weakest link so progress in only one sector alone is not the progress we need. We have to take everyone along.”

NCDC is the government agency with the mandate to lead the prevention, detection, and control of communicable diseases, with functions to prevent, detect, investigate and control communicable diseases of national and international public health importance
Receiving the 2019 results for Nigeria, the Minister of Health, Dr. Osagie Ehanire, reiterated the federal government’s commitment to health security in Nigeria, and thanked Buhari for his commitment.

He said: “Since the first JEE, we have made progress, progress with which I am very pleased. I am impressed with the leadership of the NCDC in their implementation of the IHR in Nigeria. I shall ensure that all relevant agencies and government departments work towards ensuring that the results of this evaluation are discussed with leaders of the ministries and agencies involved, to ensure prioritisation and mobilisation of adequate resources to strengthen Nigeria’s health security.”

Officer in Charge of WHO Nigeria, Dr. Clement Peter-Lasuba, recognised Nigeria’s progress, adding that this was linked to the strong partnerships and increased multi-sectorial approach employed.
“However, more needs to be done to attain full capacities to prevent, detect and respond to public health threats in the country. I encourage even more contributions from the federal and state governments as well as partners to enable Nigeria to achieve the Sustainable Development Goal related targets,” he said.

With most government officials, including Ehanire, Ihekweazu, Peter-Lauba, among others, knowing the importance of health security and at various times pledging to increase efforts towards improving the country’s own, the job is only half done. Political will from President Buhari is now needed to ensure Nigeria strengthens its national health security.