From new and emerging health challenges occasioned by everchanging socioeconomic conditions, to dynamic shifts in healthcare delivery, 2021 has been a year of new lessons learnt. The shockwaves of the COVID-19 pandemic have continued to resonate around the world, effectively diverting global attention away from other health challenges that countries were facing. By January 31, 2021, the estimated global death toll from the pandemic was just over 2.3 million people. This number is roughly the estimated population of Bayelsa State. In Nigeria, the estimated death toll as reported by the Nigeria Centre for Disease Control (NCDC) was 1,586 by January 31, 2021.
However, it hasn’t all been doom and gloom, the world also witnessed significant innovation in the health sector. From the breakneck speed of COVID-19 vaccines development to the first-ever malaria vaccine, which has brought a new dimension to the fight against a disease that is one of the leading causes of death for young children in Africa. The Africa Centres for Disease Control and Prevention (Africa CDC) led the Africa Pathogen Genomics Initiative (Africa PGI), designed to strengthen public health surveillance and laboratory networks across Africa, creating impressive ways to stay ahead of emerging SARS-CoV-2 variants of concern.
As was seen in 2020, much of the health news around the world was centred on the ongoing COVID-19 pandemic. This doesn’t negate the fact that Nigerians have had to deal with other pressing health issues. As the year winds to a close, our ‘2021 in Review’, far from exhaustive, seeks to highlight some of these health issues.
Preparedness: One of the many important lessons the COVID-19 pandemic taught us
Events this year served as a continuous reminder that our world is more connected than ever. With COVID-19 waves and plateaus, the different ‘variants of concern’ and challenges with vaccine access and uptake, government at all levels must take bold, decisive and sustained steps to make the financial and political investments critical for preparedness in Nigeria.
The return on investment for global health security is immense. Expenditure for prevention and preparedness is measured in billions of dollars, while the cost of the pandemic’s consequences measured in trillions. Given the potential social, economic, and political impact of disease outbreaks, preparedness must be kept squarely on the national political agenda.
Dealing with a twin menace
The need for investments in preparedness cannot be overemphasised as this year, Nigeria also experienced an almost yearlong cholera outbreak which resulted in more deaths than COVID-19. The Nigeria Centre for Disease Control (NCDC) situational report confirmed over 100,000 cases and 3,566 deaths from 32 states across the country.
The COVID-19 pandemic has taught us that we must begin preparing for public health emergencies before they happen. For this to be done effectively, Nigeria must do more than fund preparedness, deliberate steps must be taken to encourage the practice of transparency and accountability with released public funds.
Mental Health: One trigger too many
According to the first global estimates of impacts of the pandemic on mental health, the huge impact the pandemic had on mental health globally cannot be ignored as the fallout may continue long after the physical health consequences have been resolved. The report estimated that about 129 million mental health cases were a direct result of the pandemic.
The insecurity and conflicts happening in different parts of the country, increasing substance abuse and the economic and social effects of the pandemic are all mental health triggers. This year, health-care workers were still providing care in difficult circumstances, going to work fearful of taking COVID-19 home with them; students were still anxious about their futures; worker’s livelihoods were still threatened; and a large number of people faced harsh economic conditions, with limited protection from COVID-19.
All the responsibility can’t be attributed to the pandemic, however, it exacerbated an already existing situation and helped bring mental health to the fore, a condition in Nigeria still widely misunderstood and wrapped up in mystery and stigma. The #EndSARS protest, still fresh in the hearts and minds of people, unveiled a degree of police brutality at such levels that led to negative effects on the mental health of young Nigerians. This brutality is still happening today, and anxiety, trauma, hopelessness, and fear of future police encounters are all stressors that are negatively impacting on the mental health of people who have faced police violence.
Gender Equality: A fundamental human right
The pandemic also increased other forms of violence, particularly violence against women (VAW). A UN Women report titled, ‘Measuring the Shadow Pandemic’, indicated that although VAW was existing before the pandemic, most women believe that COVID-19 made things worse. According to the report, nearly 7 in 10 women think domestic violence increased during the pandemic, and 3 in 5 think sexual harassment in public has increased. Also, 41% of women reported that their mental and emotional health had been negatively affected as a result of the pandemic.
Women and girls represent half of the world’s population and, therefore, half of its potential. Gender inequality robs them of the right to harness their full potential. Gender equality, besides being a fundamental human right, is essential to achieve sustainable development. It has also been shown that empowering women spurs productivity and economic growth.
Gender inequality affects the health-seeking behaviour and healthcare utilisation among women of reproductive age. Primary research has consistently shown a trend in how gender inequality has contributed to poor maternal care and outcomes in low- and middle-income countries.
Unfortunately, there is still a long way to go to achieve equal rights and opportunities between men and women, as globally, women have fewer opportunities for economic participation than men, less access to basic and higher education, greater health and safety risks, and less political representation.
To close the distance and hasten the achievement of equal rights and opportunities for all, the 2021 Future of Health Conference took a deep dive into Gender Equality for Sustainable Development. The conference addressed inequalities and proffered solutions for how gender equality could lead to sustainable development and better quality of care for women who have been historically disadvantaged.
Malnutrition: A silent epidemic
Gender inequality, illiteracy and economic recession are some of the recognised causes of poor nutrition in Nigeria. Undernourished mums, who do not receive the right vitamins and minerals, or sufficient calories often deliver babies who are small for their age and are at a higher risk of neonatal death. Those who survive are at risk of illness throughout their childhood, adolescence and into adulthood.
Extremely undernourished mothers are sometimes unable to produce enough breastmilk to feed their babies leaving those children at a further increased risk of stunting as well as of the long-term effects of childhood malnutrition.
The 2021 edition of the UNICEF-WHO-WB Joint Child Malnutrition Estimates (JME) revealed that in 2020, globally, 149.2 million children under the age of 5 years of age were stunted, 45.4 million wasted, and 38.9 million overweight. Country specific data further indicated that in Nigeria at 35.3%, the percentage of stunted children is very high. Further to this, 2.7% of children are overweight and 6.5% are wasted.
Undernutrition puts children at greater risk of dying from common infections, increases the frequency and severity of infections, and delays recovery. Nigeria has a five-year nutrition action plan to guide the implementation of interventions and programmes against hunger and malnutrition across all sectors. The Plan will run from 2021–2025 and aims to reduce the proportion of people who suffer malnutrition by 50% and increase the exclusive breastfeeding rate to 65%.
Primary Healthcare the Alma-Ata way
Primary healthcare providers can play a key role in delivering promotive, preventive, curative, and rehabilitative nutritional interventions as part of comprehensive care. The contribution of primary health care to improved nutrition was outlined in the Alma-Ata Declaration of 1978.
Unfortunately, most Primary Healthcare Centres (PHCs) in Nigeria have not provided the quality of care they are supposed to, due to historical underfunding. Despite the N35 billion Basic Health Care Provision Fund (BHCPF) allocated to improve basic healthcare delivery in the 2021 budget, primary health care centres across the country continue to face many challenges, some of which are tied to inadequate Water, Sanitation and Hygiene (WASH).
The Community Health Watch project launched by Nigeria Health Watch in August 2021, to monitor and report on healthcare delivery in rural communities revealed the daunting challenges faced by rural community members accessing healthcare from PHCs. Most of the health facilities still grapple with a chronic shortage of health workers, lack of basic and essential medications, poor WASH facilities, dilapidated infrastructure, and poor welfare among others. This has impacted quality of care in PHCs, particularly in rural communities, and has contributed to the added stress on secondary and tertiary health facilities in Nigeria. It is disheartening to note that despite COVID-19 and the intense advocacy regarding hand washing, many health facilities have inadequate WASH facilities.
Primary health care is the gateway to achieving optimal healthcare for all. Deliberate focus on revamping PHCs, including improving WASH, will equip them to operate at peak capacity and provide the quality of care that is a basic human right of all people regardless of socioeconomic status.
Looking ahead in hope
We recognise that the everchanging face of the pandemic brought many health issues to the fore and it is important to look at these health issues in a new light as the world as we know it is changing. As we head towards 2022, it is imperative that we are prepared for what this ‘new normal’ will mean for healthcare delivery across Nigeria. As an organisation, Nigeria Health Watch will continue to highlight these issues, driving the necessary conversations and actions to ensure that healthcare in Nigeria continues to improve.
Finally…please stay safe
The global COVID-19 death toll as of December 27, 2021, is, 5,430,876. In the words of U.N. Secretary General Antonio Guterres: “Behind this terrible number are names and faces — the smile that will now only be a memory, the seat forever empty at the dinner table, the room that echoes with the silence of a loved one.” While we remember the ones we have lost and look ahead into the new year with cautious hope, we urge everyone to stay safe.