How has COVID-19 affected the delivery of essential CHILD health services in your health facility or country?(3)

26 May, 2021

Thank you colleagues for this interesting discussion on the impact of COVID-19 pandemic on health care delivery.

Since the on-going thematic discussion started on HIFA forum, I have struggled to compartmentalise or separate the effects of COVID-19 pandemic on the basis of ‘maternal and reproductive care’, or ‘childcare’, or any other forthcoming grouping (s). This is because frankly the health system of Nigeria has been poor for so long, and has resisted various attempts at transforming it, before the COVID-19 pandemic that it had to have only one direction of effect no matter how relatively mild the effect: bad effect and consequences on existing health conditions. Since Covid-19 landed in the country in 2020, the effect has been terrible and terrifying on lives and livelihoods and for the health system the effect is cross-cutting due to the weak structure, processes and poor outcome from all the segments of the system: maternal, reproductive, neonatal, child and others.

I am posting this message to cover both the first and this second week of the discussion.The first COVID-19 virus patient was confirmed on 27 February 2020 in Lagos, and a few weeks after the News broke, the Chairman of the Presidential Task Force on COVID-19 Pandemic (PTF) (now called Presidential Steering Committee ) declared (and was stating what many Nigerian Leaders feel) that, ‘’before assuming office during the on-going deadly COVID-19 pandemic, I never knew how bad our country’s health care system is’!. Most Nigerians wondered why those charged with transforming Nigeria’s health system, directly or indirectly, would not be aware that Nigeria’s health system suffers from multiple chronic failure that accounts for the appalling, mostly avoidable, preventable and treatable conditions that contribute to the high morbidity and mortality of patients, including communicable diseases (CDs), non communicable diseases(NCDs), Neglected tropical diseases (NTDs) for which primary health care should provide the first value-for-resources ‘point of care’ /’entry point to the system’. Programmes such as immunisations, reproductive health, etc suffered from the structural weakness of the whole system before COVID-19 pandemic, and the pandemic has only worsened the challenges.

The dreadful result of the neglected system, before the pandemic, and which has worsened since it started in 2020, is that regrettably Nigeria has 10% of the global disease burden (exacerbated due to its relative large population, current estimate 200 Million), even though the country only accounts for 2% of World population. It also accounts for 10% ofglobal maternal mortality, which means that pregnant women in the country risk 1:13chance of dying during child birth. Broken down further, about 378,000 women die yearly from pregnancy/labour-related complications, i.e. about 1,036 women die daily, which is the equivalent of loading nine airplanes carrying 120 pregnant women and crashing them daily. For Children, 2 out of 10 children do not reach age-5yrs, which translates to about 573,000 Under-5 children die daily, which is equivalent to 13 planes carrying 120 children crashing daily. (citations: i)National strategicHealth Development Plan 2010- 2015. Federal Ministry of Health, Abuja, Nigeria,2010. and ii)WHO. Working together for health; the World Health Report 2006.Geneva: World Health Organization, 2006.: & FMOH/UNICEF REPORTS).

On the Government side, the PTF (now PSC) on itsCovid-19 activities is given credit for doing a fairly good job of mobilizing the population including the non pharmaceutical prevention and control measures, and since the arrival of the covid19-vaccines, educating the public and promoting people accepting to be vaccinated. The population is largely confusedby the fake and misleading information out there, despite the efforts ofgovernment and non government stakeholders to spread accurate information.

Over the decades several Organisations, like HRI West Africa(www.hriwestafrica.org) and its subsidiaries, such as the erstwhile ‘BMJ West Africa Local edition (1995-2018)’ and ’N done’, have been promoting health system strengthening, quality and safety programmes, includingthe Home-grown ‘12-Pillar Clinical Governance programme’, and recently PACK (Practical Approach to Care Kit) Nigeria programme for PHC’, etc to strengthen and improve the resilience of Nigeria’s Health System in all the building blocks and pillars, covering maternal, reproductive, neonatal and child health care. TheseOrganisations missions are driven by the desire to help the country establish a ‘healthsystem that is good enough for the Leaders and all other Nigerians to useproudly, whenever they need to’. Thatis not the case yet as the Leaders actually patronise the medical tourismmarket from which it is estimated Nigeria loses about $2 Billion a year. Money that would have helped the systemperform better before, during and after COVID-19 Pandemic. ( Reference:Ana, J. ‘Whole SYSTEM Change of Failing Health Systems’.2009.ISBN:978-978-49487-0-8).

As in most of Africa, so far, except for a few of the 54 African countries, the pandemic has been very relatively less impactful in Nigeria, when compared to countries in Europe, the Americas and parts of South Asia. The reason(s) for this difference remain unclear for now, but all Africans are prayerfully glad because considering the weak status of its health systems, amore severe impact from COVID-19 pandemic would have been uncontrollable and catastrophic for both lives and livelihoods.

As Africans in Africa watch what is happening with the deaths and untold suffering from COVID-19 pandemic in other countries like Brazil, India, etc, the prayer is that it never arrives the continent with such ferocity. Both government and non government stakeholders are working round the clock to inform, educate and fight misinformation (political, cultural, religious on social media, etc) to get the population to comply with the tried and tested science driven non pharmaceutical measures (Hand washing, Physical and social distancing, wearing face masks, avoiding over crowding, etc). recent statements from the richer countries, gives hope that there may be no vaccine-apartheid, so that richer countries shall share their COVID-19 Vaccine oversupplies with the poorer nations. So that 'no country is left behind'!.

Joseph Ana

CHIFA 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. Joseph is a member of the HIFA Steering Group. Website: www.hriwestafrica.com

jneana AT yahoo.co.uk