Stealthily, COVID-19 has caught up on our busy lives, stopped us in our tracks, and meted a blinding punch to the face of human interaction. Its impact continues to increase and sticks like a monkey on the back of civilization. As of 23 April, there were a global total of 2,544,792 confirmed cases and 175,694 deaths (WHO; 23 April).
Although the earliest official case of COVID-19 was recorded in China on 17 November 2019, Nigeria did not document an index case until 27 February. Notwithstanding the three months window, no scenario planning could have armed sufficiently for the impact on Nigeria, a mono-resource economy. As of 23 April, the country had recorded 981 confirmed cases and 31 deaths (NCDC, 23 April).
It is projected that with a change from the current targeted testing approach and the availability of more testing kits and centres, the number of confirmed cases will not only sky-high in Nigeria, so will the causalities. Unfortunately, the longer this takes to happen, the slimmer the opportunity to nip community transmission in the bud. And, it appears Kano State; with a population of about 13.4 million, is at the cusp already. A few days ago, a national newspaper reported that about 150 people died from an ‘unknown’ cause in the State within a couple of days. The Honourable Minister of Health, Ehanire Osagie, had warned a few weeks back that there was early evidence of sustained community transmission. That was upon the identification of 30 per cent of cases with incomplete epidemiological information, which could spiral into widespread community transmission.
There is a lot to be worried about with community transmission, and rightly so for Nigeria with over 205 million people, of which nearly 100 million are multi-dimensionally poor. Little wonder, Melinda Gates, the co-chair of the Bill and Melinda Gates Foundation warned, “I see dead bodies all over Africa”. She could sound this omen upon her Foundation’s experience of the continent’s poor health care systems, inadequate housing arrangements for social distancing, and lack of access to clean water.
The University of Oxford Poverty and Human Development Initiative (OPHI) seems to validate this assertion. Using a 2016-17 household survey, OPHI discovered that of the 100million poor people, about 39million of them are susceptible to contracting COVID-19. Also, its disaggregated projection by states shows that five states are most at risk.
They are Borno (4.1 million), Katsina (4 million), Kano (3.8 million), Kaduna (2.6 million), and Abuja (82 thousand).
The Oxford projection is made on the premise that people are at high risk of contracting COVID-19 when they are multi-dimensionally especially in the indices of access to quality water, nutrition, and what they cook with.
What are the correlations? Access to quality water is crucial, given that unsafe drinking water is linked to heavy disease burden. Likewise, undernutrition is strongly associated with weakened immune systems, morbidity, and mortality – particularly among young children. Lastly, deprivation in clean cooking fuel, relates to indoor air pollution and acute respiratory infection, implying an increased risk to COVID-19.
Given this insight, and as the country gears up for a full-blown outbreak, firm and actionable decisions ought to be taken. The starting point however should be massive grassroots campaign and broadcast to rural communities, where populations still queerly but firmly believe they are immune to the disease. While cultural and religious diversity has been enriching, its relinquishing abandonment to faith may prove fatalistic, rather than serve or save at this time. These are precarious times, requiring trust in God, data and decision. Policies, palliatives and packages should be evidence-based, and data-driven.
“…the vast majority of Nigerians are only one illness away from poverty…”
We know that the virus will be with us for a long time. For this, we need a brave new world; one with bold leadership and resilient humans who are ready to work together for everyone to stay alive. There is no gainsaying it- no progress will be made without audacious policy shifts.
The vast majority of Nigerians are only one illness away from poverty, abject in many cases. This is why any effort made towards inclusive health coverage is worth close to 200million lives. Indeed, pre-COVID-19, barely 20% of the 30,000 primary health care centres (PHCs) in the country was functional.
As we prepare for a post-COVID-19 world, a few ideas are handy for the health sector. They are made in the hope that they reach and influence decision-makers and organs such as the Presidential Task Force (PTF), the Economic Sustainability Committee (ESC) and the Coalition Against COVID-19 (CACOVID).
A two-pronged demand-supply approach will be required to strengthen the health care system and improve health outcomes. This can be achieved through public-private partnerships (PPP), through which states concede the management of primary health care centres (PHCs) to the private sector. Already, this model is being implemented in two states: Delta and Lagos, where PharmAccess, a strategic partner of MSD for Mothers, has been commissioned to identify private healthcare investors, provide accreditation and set standards that define the package of care to be delivered. The private sector actors in turn supply trained community-based health workers (CHWs) as well as provide quality drugs and other medical infrastructure – incentivized medical payment system, and stable electricity supply. This model could be replicated in other states to accelerate universal health coverage nationwide.
At the Federal level, it is imperative for government to review ongoing projects within its social protection interventions in order to incorporate targeted health architecture. For instance, by introducing a school-based health insurance scheme in the National Home-Grown School Feeding Programme (NHGSFP), over 10 million pupils, and 100 thousand cooks in 35 States, could come under health insurance cover. This health cover incentives should be extended to the 500 thousand beneficiaries of Npower, and the additional 2 million, on the conditional cash transfer programme.
The suggestions in this article pertain largely to the health sector. There are a good many well-thought-out ideas coming from other sectors – economic, educational, manufacturing and technology – which are just as valid. Let these suggestions set the tone for post-COVID-19 policy decisions and implementation.