While disease prevention and management models are, on many occasions, understood by ministers and commissioners of health, director generals of agencies like the NCDC, NIPRD, NHIS and NIMR, and heads of other organisations with capacities to save Nigerians from disease outbreaks, the people with the real political will to provide enviable disease preparedness are the presidents, governors, and federal and state lawmakers, who unfortunately may not know the importance of prioritising healthcare. Martins Ifijeh writes
Ever wondered why many political appointees in both federal and state levels resume their jobs with high hopes only to end up finishing with minimal impact? Wonder no further. Majority of them know what to do to leave a lasting mark, but their bosses do not support their works with the deserved priority. They do not throw their political weight behind templates and recommendations laid down by these professionals.
This is especially true for Nigeria’s health sector, as many otherwise brilliant federal and state appointees, including ministers of health, director generals of agencies, as well as commissioners of health, do not make the desired mark they had hoped they would make because the president and governors who oversee them do not give the health sector the priority it deserves. To these bosses, achievements in health are only human capital and may not be visible in a short time for their voters to see.
One area of healthcare in Nigeria most hit by this lack of political will is epidemic preparedness; an area which represents the process of anticipating, preventing, preparing for, detecting, responding, and controlling epidemics in order that the health and economic impacts are minimised. Health experts say it is an all-embracing term that described all that needs to be done before, during, and after epidemics, and that it is the core of health security of a nation and its people.
THISDAY investigations have shown that the low attention given to disease prevention and management among Nigerian states and the federal government is due to myriads of factors, including the leaders’ poor understanding of the link between epidemic preparedness and economic prosperity, the habit of reacting to disease outbreaks rather than preparing for it, among others. And this is regardless of the direction their health experts may have proposed.
For instance, a breakdown of the 2019 Lagos State budget of N873.53billion showed that even though some healthcare areas got some lifts, there was no clear allocation for epidemic preparedness. This is despite the state in 2014 being the epicenter of Ebola outbreak in the country that gulped over $180 million and eight human lives, according to data from the World Bank. On specifics, Lagos State allocated N1.9 billion for recurrent expenditure on health insurance scheme for 2019 while nothing was set aside for epidemic preparedness.
The former Commissioner for Health, Lagos Health, Dr. Jide Idris had earlier told THISDAY that every year, he usually made case for funding for disease preparedness and healthcare generally but that nothing often changes until when Ebola came in 2014 and the state government was ready to spend all it had to ensure the disease was defeated.
Data obtained by THISDAY showed that other states have not also taken disease preparedness as priority even though it appeared those in charge of disease prevention and management in those states may have made cases for it during their planning.
For instance, a breakdown of Imo State budget of N276 billion in 2019, tagged ‘Budget of Consolidation and Economic Stability’ showed that not no amount was allocated to epidemic preparedness in the entire year. It was not any different in Kogi State for the same year; as most of the allocations went to primary healthcare, recurrent and capital expenditure, among others. This, no doubt has now constituted part of the burden suffered by most state governments managing COVID-19.
Although many states have clearly not given priority to epidemic preparedness as their budget allocation suggests, their ‘big brother’ – Nigeria, who ought to show example and lead the path has also not lived up to expectation. This is even despite the Director General, the Nigeria Centre for Disease Control (NCDC), Dr. Chikwe Ihekweazu on different occasions consistently advocated for attention on national health security as well as increased funding.
Despite the recurrent bouts of disease outbreaks in Nigeria even before the COVID-19 pandemic, the federal government only allocated a paltry sum of eight naira (2.1 cents) for prevention, diagnosis and management of communicable diseases of each citizen in 2020.
It allocated N1, 673, 486, 127 to the NCDC, the country’s national public health institute, responsible for epidemic preparedness, detection and response to infectious disease outbreaks and public health emergencies for over 200 million Nigerians.
This implies that the allocated amount (if entirely released) will be spent on preventing, preparing and managing Lassa fever, Ebola, COVID-19, Yellow fever, Cholera, Meningitis, Measles; building, equipping and maintaining of specialised laboratories; administration and human resource for staff; surveillance and epidemiology; emergency disease response; and a host of other mandates of NCDC.
Obviously, the NCDC DG knows the issues and what is needed to address it, but it is not his call to make. He is not the president. He is not one of the governors. He is not a member of the National Assembly who has the responsibility to ensure favourable healthcare policies are passed into law and made legal.
A public health analyst, Dr. Reuben Okoeboh told THISDAY that leaders, especially presidents, governors and lawmakers must make conscious efforts to listen to health experts, as not everything can be politicized.
“Health is not something to be toyed with. Now we are in the middle of a pandemic and it has brought the world to a standstill. These same governors have lost huge sums in the form of low internally generated revenues. Our nation is losing. No one is talking about development now but how to ensure they survive the outbreak. No other disaster can cause this if not disease outbreaks. This is why they must listen to experts in the field and put their political weight behind them.
“Director generals of the National Institute for Pharmaceutical Research and Development, that of the Nigerian Institute for Medical Research, NCDC, and other related establishments know if governments prioritise their work, they will have results. But what can they do? Theirs is to only recommend,” he said.
The Founder of Flying Doctors Nigeria, Dr. Ola Brown who spoke to THISDAY on how lack of political will was threatening the health of Nigerians in the country, said national debt and budgeting constraints can be restructured to dedicate more resources to healthcare.
She said: “Historically, policy-makers in Nigeria have seen healthcare as a cost rather than an investment. This is evident from the amount of money allocated to healthcare in the budget. According to the World Bank, Nigeria spends less than one per cent of its GDP on healthcare. The United States and Switzerland spent 17 per cent and 12 per cent respectively in 2017.”
“Part of this is lack of political will. Investments in physical infrastructure like roads are easier to see, commission, and photograph, whereas the dividends from investments in human capital are less visible immediately. We need to take a long-term view and see healthcare as an investment,” she added.
She said the co-Founder of Bill and Melinda Gates Foundation, Bill Gates, in 2018 during his visit to Nigeria noted that the country’s lack of investment in human capital development was unhealthy. “Rwanda has invested in human capital development. When the government prioritised building its healthcare system, GDP grew from $754 million in 1994 to $8.4 billion in 2016. Ultimately, a healthy population is more economically productive.
“Health affects economic growth by enhancing worker productivity, increase savings over the individual’s life-cycle, boosting education and encourage foreign direct investment. Each additional year of increase in life expectancy increases economic output by four per cent, even after controlling for work experience and education,” she said.
With COVID-19 as an eye opener, time will tell if Nigerian leaders, including the federal and states’ executives and lawmakers will henceforth give disease prevention, and healthcare generally the attention they deserve.