EHS-COVID (86) Q2. What has been the impact of health service disruptions on the health and wellbeing of people in your health facility or country? (2)

23 November, 2020

I believe that as with Nigeria, many of the views about the impact of the COVID-19 pandemic on lives and livelihoods shall be anecdotal at this point, because the nightmare is still ravaging countries in every continent. Even in warmer African continent, where for yet unexplained reasons, the overall numbers of the infection are much lower for now, the populations must remain alert and compliant with the proven mitigation / prevention messages.

However, some reasonable inferences about the extent and depth of the turbulence/disruption that has hit health systems can be made: every facet of the continuum of the health system is affected, from promotive to preventive, curative, rehabilitative and continuity of care. Dis / Misinformation (infodemic) has blunted and obscured the dissemination of the evidence informed Key messages with the result that majority of the populations are in denial of the existence of covid-19 and would rather believe conspiracy theories, especially in countries like Nigeria, where thankgoodness, the numbers are relatively low for a population of over 200 million people. Global Cable media networks bring the disaster that has befallen even countries with strong health systems to the sitting rooms of homes and offices in Low Income Countries (LICs), therefore many people in the LICs believe the untruth that covid-19 affects only certain races and color. This misinformation has led to drop in routine immunization, accessing of health facilities for non-covid-19 illnesses, and whether only by coincidence, there are more epidemics of vaccine preventable diseases like Yellow Fever, Measles, etc.

Simple messages that cost little to nothing and which individuals should implement are neglected e.g. wearing mask, physical distancing, handwashing, and other infection control measures, etc. The announcement of imminent arrival in health facilities of potentially useful vaccines has compounded the infodemics situation as anti vaccine videos are going viral, and further confusing the population. There is more funding coming to health and social care (even as some countries are reducing their annual budgetary allocations to health), because of Covid-19 support, but that in itself has not helped the campaign for immunization, because the money goes to mainly covid-19 related mandates. Mis-directed application of the existing and new money by concentrating on higher tier health facilities like Teaching Hospitals, and stand-alone isolation centres and COVID-19 treatment centres, has not helped. Many Civil Society Organisations (CSO, NGOs) have called for a more population-wide targeting of support and palliatives, but such calls are not leading to action by national or the States Task Forces, so far.

Perhaps it is ‘goodluck and providence’ that the numbers in LICs like Nigeria has not reached predicted levels, because if it did the terrible news and pictures of the struggles of health systems in the Global North would be a child’s play. This is not to belittle the damage done to lives and livelihoods in the LIC, but rather to really urge governments and development partners to use this seeming low-level in numbers to shore up and strengthen already weak health systems like Nigeria’s should incase (Godforbid) the numbers escalate. International air travel has resumed and movement of people with it, which poses renewed risk after the lockdowns. Already weak health systems means that organization is poor, no clinical governance measures in place, inadequate supply of drugs, tests, equipment including PPEs, 24/7 running water, 24/7 power, etc have all suffered amplification by even the relatively milder incidence of Covid-19, and therefore affected curative care adversely. The extent we are yet to be certain as the pandemic has not ended.

LICs, like Nigeria, must learn from those countries that have shown relatively better results so far in their management of COVID-19 pandemic, both in life-saving and mitigation of its unprecedented effects on the economy and livelihoods. There are countries that are reporting that they have avoided recession, etc, even though they have gone through terrible experiences with the pandemic at some point in this dreadful 2020 year. It appears that better timed national or regional restrictions of human movement when the virus strikes, from the grassroots up, coupled with enforcement of population-wide preventive messages, leads to shorter infection and less damage to lives and livelihoods in the end. But the jury is still out until the pandemic is declared over. Stop and start, half-hearted measures not supported by scientific facts, are only compounding the terrible human disaster around the world, including LICs.

Joseph Ana


@Health Resources International (HRI) WA.

National Implementing Organisation: 12-Pillar Clinical Governance

National Standards and Quality Monitor and Assessor

National Implementing Organisation: PACK Nigeria Programme for PHC

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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