EHS-COVID (56) Q1 How has COVID-19 affected the delivery of essential health services? (5) Impact of COVID-19 in Nigeria

17 November, 2020

Dreaded and deadly COVID-19 pandemic has affected the health system in Nigeria both ways, very badly with all the terrible deaths and morbidity, destruction of lives and livelihoods as we used to know it, and still unsure as a country, how it will all end, given the second (and maybe third) wave in the temperate countries, in this globalized world with cross-travels, and then on the other hand, some rare positive awareness in the corridors of power, that have left the health system so weak that the country’s health indices has remained appalling for decades: many declarations by highly placed policy makers, saying that ‘I never knew that the health system was so weak’. Whether such declarations will lead to a positive change, that sees funding of healthcare as one of the most productive investments any country can make remains to be seen. And the early signs are not promising, because even while the pandemic is still raging the annual budget for health in 2021 has dropped!!.

All groups (elites, working class, formal sector, informal sector, unemployed, urban, rural, difficult to reach areas, vulnerable and challenged groups (challenged: physical, mental, visual, speech, hearing etc), and every tier of the already weak Nigeria health system is affected and impacted directly or indirectly by COVID-19 pandemic. In the facilities, whether government owned or private facilities, outpatient and inpatient services, across specialties including childbirth conducted by skilled attendants have dropped drastically, because users are afraid to attend for fear of ‘catching’ COVID from hospital workers or the facility. The reverse is also true, as news reports are frequent of ‘health workers turning away patients who have covid-like symptoms’.

Logistics and supply chain disruption has affected facility stocks of medicines, commodities, and already failing utilities like running water and electricity supply, with deadly consequences for patient outcome. The reported rates of new infection seems to have peaked around August 2020, but no one is certain of why that is so, or whether the drop is real, because most states, if not all bar one or two, are not persisting with commitment to testing!. Routine immunization, which at best of times was a struggle to improve the rates, has plummeted, the consequences of which may manifest long after COVID-19 emergency. Mis/dis information/ infodemic, coupled with pre-COVID-19 high levels of superstition, ignorance, poverty, and quackery, has taken root, such that most of the population are in denial at this time (November 2020), even as they read of and watch on TV Cable channels the devastating second / third wave of infections in the Western World, led by the USA. Furthermore, some policy decisions and approaches to the mitigation of the pandemic, have not helped because they have been too concentrated on Urban centers to the neglect of rural population, even though most of the population live and work in rural areas. Distribution of palliatives has also been urban-centred in the main, and therefore has not reached the very poor and unemployed especially those that became unemployed because of COVID Lockdown and restrictions. The failure of palliative schemes has forced most of the population to buy-into the misinformation and to go into denial, preferring to ’die from Covid than by hunger’!!.

Already, Nigeria was facing scarcity of health workers (in numbers and distribution across the zones of the country) exacerbated by acute Brain Drain to the Global North, but COVID-19 has worsened the situation drastically, as staff become infected in the course of treating positive cases, and have to rightly, isolate and quarantine mandatorily. Many have succumbed and died. Running normal shifts in the hospitals has been serious, adversely, and we read of facilities closing down services altogether or scaling down, both of which imperil access and care to patients. It is probably too early to know how this sad situation can be effectively controlled, because the pandemic (even though it appears less burdensome in Africa at this time) has not ended, especially given that a second covid-19 wave is still ravaging Western countries and flights have resumed between Africa and those Hotspots.

The message for now (until there is effective treatment and / or vaccine) must be to sustain and maintain the proven mitigation activities: frequent handwashing with running water and soap; social and physical distancing 2M apart; use of face masks; coughing and sneezing etiquette; rely on only information that comes from reliable sources e.g. the National Centre for Disease Control (CDC) and to Call the Free Toll Number if symptoms develop.

HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: Joseph is a member of the HIFA Steering Group and the HIFA working group on Community Health Workers.

Email: jneana AT