Beti Baiye & Dara Ajala Damisa (Lead Writers)
When Nigeria Health Watch’s #PreventEpidemicsNaija project launched in October 2018 and started advocating for better funding for epidemic preparedness in Nigeria, sceptics may have thought that it was akin to the case of the boy who cried wolf. With the various pressing health needs Nigeria faces, it was difficult for some people to understand why the country should dedicate resources to prepare for an epidemic. But it seems now the project took a look into the future because 15 months later, the world is dealing with the largest pandemic we have faced in the last 100 years.
Countries have struggled with the outbreak, perhaps because many were not as prepared to handle a large-scale epidemic as they thought. One major issue that affects epidemic preparedness is funding, especially funding to help the health sector prepare before any outbreaks occur. The important thing that funding epidemic preparedness helps countries do is that with proper research and analysis of trends, it can help them predict, prepare for and even prevent the next epidemic.
On May 11, 2020, the #PreventEpidemicsNaija project hosted the first in a three-part media webinar series. The first one, held on May 11, 2020, explored various issues around funding approaches to COVID-19 in Nigeria. Speakers were Dr Ola Brown, Founder, Flying Doctors Healthcare Investment Group and Oluseun Onigbinde, co-founder and CEO of BudgIT. The Flying Doctors Healthcare Group invests and operates across the healthcare and wellness value chain in hospital/clinic construction and refurbishment, diagnostics and equipment, health facility management, pharmaceutical retail, air ambulance services and logistics, and consulting/healthcare technology. BudgIT is a civic organization that applies technology to intersect citizen engagement with institutional improvement to facilitate societal change. BudgIT uses an array of tech tools to simplify the budget and matters of public spending for citizens, with the primary aim to raise standards of transparency and accountability in government.
Dr Brown shared that the Flying Doctors team had been preparing for COVID-19 since the beginning of the year because she had anticipated the spread over the holidays of 2019. The team knew that as frontline workers, their operations could not exactly be put on hold due to the pandemic and so they stocked up on personal protective equipment (PPE) before the prices skyrocketed. For Oluseun Onigbinde, once the first COVID-19 case was confirmed in Nigeria, BudgIT immediately re-arranged some of its programmes to enable them focus on the pandemic, tracking the response with focus on funding and analysing the impact of the pandemic on the economy.
The Flying Doctors group had prepared with isolation pods on their airplanes and continued to innovate. Due to logistic and time challenges with door-to-door testing, the team set up testing centres with the biggest centre in Zamfara State. With this, they have been able to make testing faster, cheaper and safer. Some of the challenges they faced include having to get a molecular lab up and running in a few days and ensuring the safety of the team who had to airlift COVID-19 patients.
“It is hard to say that you are 100% prepared for the challenges an outbreak like this would bring; however being able to make plans while things were relatively calm and prepare as much as possible for the inevitable outbreak helped them keep operating and supporting states,” Brown said.
This in a sense, is how epidemic preparedness should work in Nigeria — projecting and preparing for epidemics and strengthening systems before any outbreak.
One of the things that should be in place prior to an outbreak is at the least, funding. Epidemics destabilise systems, economies, processes and industries as we have seen with COVID-19. Adequately funding epidemic preparedness will not only help strengthen health service delivery during outbreaks but may help minimise the impact of some of these other consequences.
Onigbinde shared concerns about the state of healthcare in Nigeria and its capacity to bear the strain of a pandemic. “My biggest worry is that we have underfunded health over the years.” Looking at the budgets of states like Kano, Ogun and Yobe, he revealed that an average state in Nigeria spends less than 10% of its budget on health. The few states like Kwara or Bauchi that have a relatively high health budget are either supplemented by donor funding or by international partners, he said.
For over 12 months, BudgIT has been working with Resolve to Save Lives (RTSL) to track spending on epidemic preparedness in some target states and based on their research, it’s clear that preparedness levels of states in Nigeria is low.
Onigbinde commended the Lagos State government on its management of the COVID-19 pandemic in the state. He applauded the private sector involvement and the efficient handling of the emergency. However, he noted that Lagos State is one of the states that has underfunded healthcare over the years and advised that the government build a robust health system in the state.
Brown shared recommendations to states in Nigeria for funding healthcare in resource constrained contexts. She said that states need to discover innovative ways to do more with less. An example is Taiwan, which is poorer than the US, but seem to have a better #COVID19 response. “We are trying to deliver the same services at similar standards at about 1% of the cost,” she said.
States should have agile plans — that can change according to needs — including leasing instead of buying expensive molecular labs, which is more cost effective. It also means less burden if rapid test kits become the norm.
Speaking on accountability, Onigbinde urged Civil Society Organisations (CSOs) and citizens to learn to hold government accountable by asking questions, publicising pictures and videos of poorly maintained health facilities and advocating to curb wasteful spending because public resources are limited. He said, “Until there is political will, resolve and sustained action from the citizens and the civil society, nothing will change”.
Onigbinde also proposed several short-term creative ways to fund healthcare post COVID-19. First is to develop a citizen register and embed a social contract to it. A social contract is an agreement among the members of a society to be governed by outlined moral and political obligations that provide a valuable framework for harmony in that society. The citizen knows that he has an obligation to the government and the government to the citizen. Second is to establish a contributory health insurance system that effectively captures even the informal worker. Third is to apportion a percentage of state spending directly to improving the welfare of health workers and fixing health infrastructure.
The COVID-19 pandemic has shown the central role that the public and private sector must play when it comes to preparedness. This includes making sure that the health sector receives adequate funding and ensuring that the Nigeria Centre for Disease Control, as Nigeria’s public health institute, with the mandate to lead the preparedness, detection and response to infectious disease outbreaks and public health emergencies, is well funded to carry out its duties effectively.
Eventually, COVID-19 will be managed. The lockdown will be lifted, and people will return to work, school and life may not be as we used to know it. Nigerians must understand that we are in constant danger of emerging and re- emerging infectious diseases outbreaks. There is a guarantee that we will experience another outbreak. We may not know when it will occur but what we can do is to ensure that when it does occur, it finds us better prepared than before and for this, funding is key.
What other innovative ways can state governments fund epidemic preparedness? Share with us on Twitter @nighealthwatch, Facebook and Instagram @nigeriahealthwatch.