Towards an effective and coordinated response to COVID-19 in Nigeria - Dr. Gafar Alawode


The Corona virus or COVID-19 that was once tagged China virus is now a pandemic and a global reality. As of last count, more than 190 countries and territories have reported confirmed cases of almost half a million out of which more than twenty-one thousand have succumbed to the deadly viral illness.

The pandemic has affected all aspects of our lives including livelihood, economy, travel, social life, not to mention strain on the health system especially in the worst hit countries. Nigeria is battling with its own share of the pandemic with relatively low number of less than 100 cases confirmed, but when juxtaposed with figure of total number of cases tested which stood at less than 200 at the time of writing this piece, this should cause for serious worry as we might be dealing with a scenario of the  less you search the less you see.  So far, the government at the national level has set up a multi-sectoral response team- the Presidential Task Force on COVID-19 saddled with the responsibility of coordinating the national response to the pandemic.

The National response team is chaired by the Secretary to the Government of the Federation (SGF).  While some erroneously question appropriateness of the SGF as the chair of the committee given the fact the that the problem is primarily health related, being mindful of wider implications of the pandemic beyond health sphere and the role of other sectors in tackling the pandemic including the need for high level political support will give credence to appropriateness of the choice of the SGF.

While the coordinating body has been meeting frequently, releasing updates on the response and issuing advisory where necessary, a major source of worry is perceived inadequate attention to the federal nature of the country in this response.
Design of national level response often treats Nigeria like a unitary state with a single chain of command that can ensure that instruction or policy statement from Abuja is automatically implemented at the state level. We think and do this often and the result is always ineffective response, inefficiency and avoidable loss of lives. Nothing else showcases this concern than wide range of responses that we see from state governments in recent days.

While a state Governor claimed  his state is protected from COVID-19 citing purported spiritual immunity conferred on the state, some have issued statements on efforts geared towards encouraging social distancing by closing down public places, identification  of isolation centres and a couple of other steps. At the same time, many other states are yet to demonstrate any level preparedness.

National response on Pandemic of this nature should clearly reflect the federal nature of the country and have a strong mechanism that will coordinate response among the three tiers of government to ensure that concerted clear and effective measures are designed in terms of planning, implementation, resource mobilization and community mobilization. Nigeria is at risk of exponential increase in number COVID-19 in coming weeks unless governments at all levels adopt clear and effective approach towards tackling the pandemic. The disjointed response so far is manifesting in terms of piece meal approach to lockdown and other responses.  For a lockdown to be effective it has to be total or near total. Even a total lockdown will not achieve much result if we lack the capacity to test those that are exposed or have symptoms. If we are only able to test paltry less than 200 people since the index case was detected, this does not portray a good prognosis for the country of the size of Nigeria. There are increasing cases of number of exposed people that are begging for test but couldn't get tested. It is therefore expedient to increase our ability to test exponentially, isolate confirmed cases and manage them appropriately. We also need  a paradigm shift from passive case finding to active one.

No doubt, expanding response capacity requires more resources and available data from China shows clear correlation between case fatality and available health resources. We should therefore estimate resource gaps, identify potential sources of funds including public funds, private sector resources and external funding. Technical support should be provided to model different scenarios of response ranging from business as usual, mild-moderate and aggressive scenario. This should be presented in simple and clear format that will make the political class and policy makers to understand cost and consequences of different courses of action. This will also form an objective basis for resource mobilization.

Governments at all levels also have important roles to play in the area of assessing local capacity of available health infrastructure to cope during this response. Health workers should be materially and psychologically prepared for the response and isolation centres should be identified and equipped. Available public and private media houses should be well equipped to disseminate correct information among the citizenry. It is well documented that apart from people that are killed by  causative organism itself during a pandemic or epidemic, a number of people also die needlessly due to lack of information or misinformation that encourages them to embrace risky behavior like taking wrong medications for either prevention or treatment of perceived or real symptoms.
As we are highly religious people, religious and other community leaders should play important role in educating their followers about the pandemic and necessary safety precautions. Above all, they should do no harm through propagation of false sense of security and ascribing the pandemic to sins committed by individuals or groups.

As a matter of urgency, the Nigeria Governor Forum should strengthen or establish a robust relationship with the Presidential Task Force on COVID 19 which will ensure that the two bodies are on the same page on vital aspects of the response including lockdown, case finding and contact tracing, isolation of patients, information dissemination and resource mobilization. Henceforth, the 36 state Governors are encouraged to speak with one voice and implement effective measures with the same level of intensity while taking into consideration each state’s peculiarities.

It is also important to emphasize that the notion that our weather offers protection against the spread of COVID-19 pandemic is not yet proven as countries with same weather as ours are not spared from ravaging effect of the pandemic. It's not impossible that our relatively low number of confirmed cases mirrors our weak capacity to diagnose at scale

COVID-19 pandemic is already taking its toll on Nigeria's economy due to its impact on our macro fiscal landscape. As an oil economy, we are inadvertently vulnerable to any shock that brings oil price down, so government revenue is on the downward trend and this is already telling on the value of the Naira. Unemployment rate will skyrocket, and the poor and borderline poor are likely to sink deeper in the hole of poverty – a real threat to Mr. President’s quest to lift one hundred million people out of poverty. The rich are not spared as one newspaper headline has it that Dangote lost 240 billion Naira within a day. The middle class will also see their economic fortune dwindle as productivity declines. The long term implication on our economy and speed of recovery, however, depend on ability of the country to rise up to the challenge and shift from paradigm of disjointed response to embrace a more concerted effort led by the political class and supported by all and sundry.

Each wave of pandemic and epidemic brings to the fore the need to invest in health system strengthening and pay attention to epidemic preparedness and response as the best time to prepare for war is peace time. Public spending on health in Nigeria is less than 1% of Gross Domestic Product (GDP) which is one of the lowest in the world. Poor public spending on health impacts negatively on health system resilience which means minimal ability to stand the test of epidemic or pandemic.

No epidemic or pandemic lasts forever but the impact could make a long-lasting impression on the socio-economic landscape of the nation which could be minimized through effective and well-coordinated preparedness and response.

Source: Dr. Gafar Alawode, An health system strengthening specialist.

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