By Dara Ajala-Damisa & Chibuike Alagboso (Lead Writers)
The COVID-19 pandemic has changed the way people work in Nigeria and the response has required a multi-sectoral approach with all arms of the government keyed into the response. This led to the setting up of the Presidential Taskforce on COVID-19 which brought together the Ministers from different agencies to contribute to the response. Every aspect of Nigeria’s public sector has had to get involved in some way in the fight against the pandemic and its resulting impact.
Two government organisations on seemingly opposite spectrums of Nigeria’s response – the National Orientation Agency (NOA) and the Medical Laboratory Science Council of Nigeria (MLSCN), have made contributions that shaped the Nigerian government’s response.
The National Orientation Agency (NOA) has an established structure for sensitisation, with its 36 offices in every state of the federation. This gives it a broad platform for creating awareness and advocating for behavioral change throughout the country.
According to David Akoji, Special Advisor to the Director General at the NOA, the NOA contends that no other organ of government has the kind of spread and capacity for public enlightenment and sensitisation campaigns as it does. When the COVID-19 pandemic hit Nigeria, the NOA sprung into action, and to ensure that it is broadcasting the right information, the NOA receives messaging from the Nigeria Centre for Disease Control (NCDC).
They also received risk communications training from the NCDC on basic COVID-19 facts and preventive measures for their field staff in the 774 local governments areas of the federation and the Federal Capital Territory. These staff members then go on to disseminate the appropriate messaging on COVID-19 prevention to their communities.
Partnerships and a three-stage response
David Akoji, Special Advisor to the Director General at the NOA said that working hand in hand with NCDC who provided risk communications content helped speed up the information dissemination process, given the need for emergency response that COVID-19 imposed on the country after the first case on February 27, 2020. “What we did was to go to NCDC to get the relevant prevention protocol messaging and build this into our traditional ways of couching our messages. We then sent them out to the field in various languages, to various communities, so that they know how to prevent themselves from contracting the virus,” Akoji said.
Akoji explained that there was a bit of confusion at the beginning of the government’s response, with the emergency set up of what seemed like parallel structures. However, it was not long before the NOA understood that they were included in the risk communications community engagement pillar of the Presidential Task Force (PTF).
Following this clarity at the early stage of the outbreak, NOA complemented their regular information dissemination work with risk communications for COVID-19.
The PTF had committees in each state and the NOA embedded directors in each of these committees despite some push back around sharing control from some states at the beginning. As a result, the committees had instant access to the NOA’s offices in the various local governments in each state. “We gave support in terms of putting at the disposal of these committees our expertise in relating at community level, and then our structures at that level,” Akoji said.
In the initial stage, some states were reluctant to grant NOA access to activities of their task force committees. This delayed the dissemination of information as the NOA was unaware of state government activities.
The pandemic is novel and so it has been challenging on many levels, including the fact that information about the virus has continued to evolve as more evidence is gathered. David Akoji agreed that the NOA has had to adjust its messaging and frequency of dissemination accordingly. He acknowledged that they have had challenges in adapting quickly due to funding constraints and inadequate financial and technical support by state government and local governments.
Looking back – lessons being learnt
One key lesson Akoji says he’s learning from COVID-19 pandemic is that risk communications and community engagement to combat this pandemic and any outbreak is not strictly a health sector affair. Relying on health promotion officers at the NOA alone to sensitise community members proved grossly insufficient. This led to a what he referred to as widespread outcry from Nigerians who felt that the NOA could be more involved in the delivery of risk communications for COVID-19. The NOA must be mainstreamed into the frontline of the strategic planning and tactical implementation on the field, especially with regards to community engagement and sensitisation.
Another lesson for Akoji is the fact that till now, there are prominent and very vocal people who do not believe that COVID-19 is real. Their doubt is fueled by the fact that media reportage of COVID-19, unlike the coverage of Ebola, does not include images of people falling and dying on the streets, admonishing Nigerians to take precaution.. “Let us learn from what we have seen from Italy, from the United States, Britain, Spain, Brazil… these are leading countries in the negative impact of this pandemic. Let us learn from them and then Nigerians should take personal responsibility to protect themselves from contracting the virus” Akoji urged.
Despite harsh criticism, Akoji is proud of aspects of Nigeria’s COVID-19 response and believes that other countries can emulate some of these. He is proud of how swiftly corporate Nigeria responded with the private sector coalition against COVID-19 (CA-COVID), led businessmen businessmen Aliko Dangote, Jim Ovia, Herbert Wigwe and Tony Elumelu, amongst others. He explained that corporate Nigeria was able to raise significant funds which are being strategically deployed in the fight against COVID-19.
“I am very proud also of the way individual Nigerians, civil society organisations, and community based organisations, pulled their resources together, to help their neighbors with palliatives. Nigerians responded in humanity, we saw neighbors who had a little extra to give to neighbors who did not have during the period of the lockdown, and this made life somewhat bearable. Our age-old African tradition of being our brother’s keeper was displayed prominently. I am proud of that and I think it is something to emulate”.
Engendering an evidence-driven response
For Dr Tosan Erhabor who leads the MLSCN as Registrar/CEO, his first reaction after the index case was like every well-meaning Nigerian – concern. “I thought that, as a country, we had a big challenge in our hands. It is no longer a secret that there are inherent weaknesses in our health system, and countries with relatively stronger health systems are still being overwhelmed by the sheer intensity and rapid spread of COVID–19,” Dr Erhabor said.
He said his concern was replaced by confidence in Nigeria’s usual resilience and determination to surmount challenges against all odds, as was the case of the Ebola outbreak in 2014. Working together with other government agencies was vital in the council’s decision to join in the efforts to flatten the COVID-19 curve by contributing to the laboratory component of Nigeria’s response strategy.
Mandated by law to regulate the production, importation, sales and stocking of diagnostic laboratory reagents, kits, and chemicals for use in Nigeria, the MLSCN also proceeded to validate the rapid diagnostic test kits for diagnosing COVID-19. This is done at the MLSCN owned Public Health In-vitro diagnostic Laboratory in Yaba, Lagos state.
While different strategies are being deployed to manage the outbreak, testing helps give a sense of the impact of these strategies by helping to understand the prevalence and spread of the virus. The reliability of results and a quick turn-around time therefore becomes very critical in testing. Rapid diagnostic kits help deliver results quickly, but they must meet minimum diagnostic accuracy requirements of sensitivity and specificity.. Validation therefore becomes very important. “The quality of test kits has a great influence on the quality of test results. It would be counterproductive to fold our hands while all manner of test kits are freely used. Lives would be at risk, and the tireless efforts of the government to flatten the curve would be in vain” Dr Erhabo said.
They started by placing an advert in four national dailies on March 30, 2020, requesting manufacturers or their sales representatives to submit their rapid test kits for validation. Out of the seven antibody-based rapid test kits submitted for validation, only four met the criteria for inclusion in the validation exercise.
Four of the test kits didn’t meet the generally acceptable minimum sensitivity and specificity of 95% for in-vitro diagnostics and this means they are not approved for marketing or use in Nigeria, Dr Erhabo noted.
The validation exercise had its share of challenges around sampling, paucity of funds, and logistics. But these factors did not stop MLSCN from working to safeguard the health of Nigerians, says Dr Erhabo. The council continues to adjust their strategies as the outbreak evolves by scaling up test kit validation efforts in order to help increase testing capacity in Nigeria. They are currently validating another batch of rapid diagnostics test kits.
Dr Erhabo commended Nigeria’s response efforts in the area of quickly scaling molecular laboratory diagnostic capacity, but stated that there are opportunities to learn from other countries and improve on the response. “These pandemics could emerge from time to time. We have to ensure that the health system is prepared in a wholistic sense. The current pandemic offers us the opportunity to also develop considerably robust templates that we could fall back on for future purposes,” he said.
The COVID-19 pandemic will continue to change, just as the Nigerian government and supporting partners continue to learn and respond to it. It will also continue to impact people in different ways as it continues to change the way we live.
But the work done by government agencies such as NOA and MLSCN despite the funding and other challenges they face will remain important as the pandemic evolves. Developing and sharing communication materials with communities requires a good understanding of their context and cultural nuances. This makes NOA’s work very crucial, but it requires funding to sustain their work beyond COVID-19. For instance, around N644 million was appropriated for NOA in the 2018 budget for capital projects but only about N141m was released. For MLSCN, the continuous underfunding of the health sector which has been the focus of numerous advocacies over the years is likely to affect funds appropriated and eventually released to them. If this continues, critical work around regulating medical laboratory science practice, developing laboratory testing guidelines and validating rapid diagnostic test kits will suffer.
The big question now is “How do we then ensure that these organisations have the funding they need to prevent disease outbreaks in Nigeria now and in the future?”
This documentation project is a collaboration between Nigeria Health Watch (NHW) and the Centre for Communication and Social Impact (CCSI). Follow the conversation online with the hashtag #COVID19NaijaResponse.