By Adie Vanessa Offiong
The Nigeria Centre for Disease Control (NCDC) has become the country’s most prominent public health institution. It leads the preparedness, detection, and response to infectious disease outbreaks. It responded to Ebola, and for years, it has been responding to Lassa fever, meningitis, cholera, yellow fever—all infectious diseases that rattle the population every year like clockwork. Its last major battle with an infectious disease was with monkey pox, and this February, COVID-19 jumped onto that list.
In the last three months, the NCDC surveillance system used for the collection, analysis and interpretation of data on diseases of public health has been put to test. It has demonstrated leadership by remaining at the forefront of the COVID-19 response strategy development, implementation, and coordination through a multisectoral national emergency operations centre. From a grossly inadequate number of laboratories, the NCDC has significantly expanded the network of reference and molecular laboratories in the country, while working with state (sub-national) governments to strengthen capacity for sample collection and transportation.
Money, money, money
However, the NCDC began the COVID-19 response from a weak, disadvantaged position, particularly considering its low budgetary allocation of over N1 billion (over USD4 million) in the 2020 budget. Once the COVID-19 pandemic reached Nigeria, it was obvious NCDC did not have the budgetary resources to respond. The NCDC required emergency funding to be spent on infection prevention and control, personal protective equipment, surveillance and epidemiology, case management, laboratory diagnosis, logistics, supply as well as risk communication activities.
As it stands, the NCDC sends out millions of texts daily to mobile phone subscribers in Nigeria on its #TakeResponsiblity campaign to get the public involved in COVID-19 prevention, which is being paid for by the US government. Faced with the pandemic, the Nigerian government had to pay N6.5billion emergency intervention fund for the country’s response. The fund is to equip, expand, and provide personnel to its facilities and laboratories across the country. The fund is nearly four times the entire budget of the NCDC for 2020.
Despite the high-level commitment so far demonstrated by government and stakeholders, there remains challenges to be addressed. It is imperative for the country to continue to invest in building resilient health systems. This will safeguard citizens and bolster the much-desired economic transformation of the nation.
The National Action Plan for Health Security (NAPHS), is a comprehensive multisectoral plan that integrates workplans across the health sector, in a bid to address the major gaps identified by the Joint External Evaluation of 2017 and Performance of Veterinary Services (2010) assessments, and prioritizing them by national strategies and risks. The NAPHS reveals 19 technical areas required to effectively prevent, detect, and respond to public health threats like COVID-19 in Nigeria.
Detailed plans for each technical area were developed by multisectoral working groups, to cover the period 2018‒2022 with the NCDC at the very core. The estimated cost to implement all planned activities during 2018‒2022 is N134 billion ($439million). The major cost driver in the plan is the immunizations plan under the Nigeria Strategy on Immunization and Primary Health Care Systems Strengthening (NSIPSS) is N81 billion (USD265 million, or 60 per cent of total cost).
The remaining 18 NAPHS technical areas cost during 2018–2022 is approximately N53billion (USD174 million), or approximately 18 cents per capita (N56) per year. The major cost drivers of the NAPHS come from the laboratory, emergency preparedness, surveillance, and workforce development technical areas, reflecting major initiatives by the agency and other partners to improve health security in these three areas.
The activities presented in the NAPHS represent the minimum needed investments, costing approximately N130 per capita per year, which includes important efforts to strengthen our national immunization programme.
Bearing the cost of outbreaks
The COVID-19 has disrupted political, social, economic, religious, and financial structures around the whole world. The impact on Nigeria, and by extension Africa, brings to the fore the cost of containing diseases of this magnitude. Small strategic investments in our public health systems can prevent major damages.
The experience with SARS, H1N1 and Ebola shows that, while some progress is made after each outbreak, this is often not sustained. The covid-19 pandemic shows that preventing disease outbreaks is critical to the long-term health of global economy. For the future that we seek, it is important to organize our health system around people, institutions, and resources to promote prevention.
This approach will yield broader outcomes, delivering health care in a sustainable, equitable and effective way, accelerating progress toward universal health coverage and helping prepare for emerging threats to national and global health security. As Nigeria’s lead public health institution, the NCDC has already demonstrated its capacity. With increased and sustained funding, it will yet again lead and coordinate the implementation of Nigeria’s NAPHS.