Coronavirus: How Ready Is Nigeria’s Health Sector?

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Coronavirus is slowly but steadily gaining a foothold in Nigeria, bringing to reality fears the country’s weak health systems cannot withstand a larger outbreak.

In less than three weeks, the virus has overloaded hospitals in northern Italy, offering a glimpse of what awaits countries if they cannot slow the contagion.

Doctors from China and Cuba were sent to Italy, Europe’s worst-hit nation when the surge became overbearing.

Nigeria is now rushing to reinforce containment measures and considering several emergency options knowing that her fragile health system will be swiftly overwhelmed if the disease spreads beyond a small number of cases.

Red alert

Africa’s most populous nation within the past few days saw a surge of confirmed cases of Covid-19, a strain of coronavirus which has sent the whole world in panic after it killed over 15, 000 people globally.

In the past seven days, confirmed cases rose from five to 46. One death was recorded and Health Minister, Osagie Ehanire, said on Tuesday that retired health workers could be reabsorbed in states if the spread escalates.

The minister was not specific on how this would happen, like countries with similar ambition. More than 65,000 retired workers have been contacted and sent letters by senior officials to join frontline workers at UK hospitals to battle coronavirus.

Health experts believe recalling retired health workers should be the last option, considering statistical flaws of Nigeria’s health workforce.

It took the Medical and Dental Council of Nigeria (MDCN) eight months to respond to PREMIUM TIMES’ request for official statistics of active and retired medical practitioners in the country.

Even when it did after three freedom of information (FOI) requests, the council only provided data on practising members without that of those who have left.

‘Train, equip active hands first’

The president of the Nigerian Doctor’s Association, (NMA), Francis Faduyile, said active health workers should be trained, equipped and utilised first as the treatment and handling of coronavirus is different from conventional treatments.

“How well have you utilised doctors and nurses? How many have you trained that you are now considering to bring people out of retirement?” he said.

“How many isolation centres are fully active as of today? He (the minister) should first show that to the Nigerian public before considering bringing back those who have retired.”

Roland Aigbovo, the president of resident doctors, Abuja chapter, said there are “several underpaid and unemployed health workers that can easily be co-opted if the health workforce becomes overwhelmed”.

He said recalling retired health workers, though a good plan, should not yet be considered.

The president who recently called off an indefinite strike by doctors in Abuja over unpaid salaries said an unfortunate rise in cases of coronavirus will further expose the ordeal of health workers in the country.

Officially, Nigeria gravely lacks sufficient professional hands to render health services to its teeming population.

Nigeria’s ratio of doctors to patients is about eight times below the World Health Organisation (WHO)’s recommendation of one doctor to 600 patients.

The available ones are overworked and poorly paid and work in facilities that lack basic equipment that will enable effective service delivery.

Measures

Chikwe Ihekweazu, the head of Nigeria’s Centre for Disease Control (NCDC), did not take calls seeking clarifications on the containment measures and preparation of the health workforce.

But Chris Isokpunuw, a senior technical adviser to the health minister, who had directed this reporter to the NCDC boss, spoke.

He said though reabsorbing retired health workers was one of the options considered, “we have not reached that level yet”.

“We have isolation facilities across the nation and they have not been stretched yet.

“As we speak, the NCDC is conducting training on treatment protocols and state governments are also stepping with control measures,” he said.

NCDC, the agency leading government’s intervention against coronavirus had launched training for health workers for Infection Prevention and Control (IPC) to strengthen preparedness in February in response to a potential spread.

PREMIUM TIMES understands that hundreds of medical personnel are being trained in Lagos – Nigeria’s worst-hit city by coronavirus – as first-level emergency responders in 20 local governments areas of the state.

Are we prepared?

Meanwhile, Mr Faduyile said so far, Nigeria has shown it is not prepared to contain the virus.

“If we had closed our borders on time, we would have limited the spread of the disease,” he said. “Almost all the cases we have now are people coming from outside.”

Of the 46 cases, about 31 had a travel history to high-risk countries in the last two weeks.

The NMA president said Nigeria should lock down states with active cases so as to limit the spread or “we will be facing a bigger problem”.

Though lockdown measures are generally considered effective, Mr Faduyile believes they are not enough if frontline health workers, patients, staff and visitors visiting hospitals are left unprotected.

“Doors that will surely remain open even in the event of a wider spread and tighter lockdowns are those of hospitals.”

A random observation in Abuja, Nigeria’s capital bared the level of unpreparedness of health facilities across the city. Most hospitals have not put in place several precautionary measures such as temperature checks and adequate cleaning products.

A recent study suggested that the risk of hospital-related transmissions of coronavirus are very high, Washington post reported.

Coronavirus in Africa

Understanding how the COVID-19 pandemic will evolve in Africa is still a work in progress but regional experts say a widespread pandemic could cripple the continent’s fragile health-care systems and be devastating economically.

Only a fraction of health facilities can deal with a widespread outbreak whilst still handling patients with several other ailments needing care.

For instance, South Africa, which has one of Africa’s best public health systems, has fewer than 1,000 intensive care unit (ICU) beds, of which 160 are in the private sector, for a population of 56 million.

Nigeria, Africa’s most populous state, is scrambling to add isolation beds and provide more specialised medical training and equipment in state hospitals.

“Our health system is not as strong as we’d like it to be,” said Chikwe Ihekweazu, the head of Nigeria’s Centre for Disease Control. “It is because we are a bit worried about our capacity to deal with a large outbreak that we are focused so intensively on prevention and early detection.”

PREMIUM TIMES

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