Health system responses and capacities for COVID-19 in Nigeria: a scoping review

By: Uguru, N., Ojielo, N., Ogu, U., Onah, S., and Ude N

Prior to the index case in 2019, there was no official preparedness plan on the ground of inadequate public awareness of COVID-19 in Nigeria. Health system financing and infrastructural development were at a very low point. This study aimed to find out information and determine the capacity of the Nigerian health system’s responses to COVID-19 in the country.

A scoping review of media and official documents and journals, published from 1st December 2019 to 31st December 2020 was done. Other online news sources that have consistently reported health systems’ responses to COVID-19 in Nigeria, were also reviewed. The geographical scope of the articles were national and sub-national. The search was conducted in English and performed in PubMed, Google Scholar and Scopus.

Nigeria’s International Health Regulations (IHR) score at point of entry (PoE) 1 & 2 was 3 and 1 in 2019. Routine capacities established at points of entry were improved after the index case, however, effective public health response at points of entry, remained the same. After the index case, a presidential task force to organize response to the pandemic and oversee nationwide lockdown measures was inaugurated. However, this brought about poor access to food and income for millions of Nigerians. Non-health responses such as conditional cash transfers and welfare packages were haphazardly done and deemed not to have met the adequate economic response need.

By December 31st, 2020, Nigeria had 70 free laboratories from an initial 13 before the pandemic. Available testing platforms were G-expert, open PCR, Corbas and Abott, with a capacity to test 2500 samples a day, only half of this was achieved due to inadequate human resource supply. Equipment, infrastructure and supplies received a boost after the index case but were still considered inadequate, as there were 350 intensive care unit (ICU) beds prior to the index case, by 31st December there were 450 ventilated ICU beds. Local production and sourcing of materials were encouraged, though this remained below par at 14 mobile testing booths. Health worker infection rose as shortage of PPE’s was cited as a cause.

Nigeria’s health system response and capacity to handle COVID-19 is quite poor and grossly inadequate. There is a need to increase the number of health workforce in the country and institute adequate accountability mechanisms to ensure prudent and focused management of health funds.

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National Responses to COVID-19 in Nigeria: Data and Evidence to Support Health Preparedness and Responses

By: Obinna Onwujekwe and Chinyere Okeke

This presentation explores and compares responses in the two anglophone countries that together make up almost half the population of West Africa, Nigeria and Ghana. Drawing on desk reviews including media reports and policy documents as well as key informant interviews with key national and sub-national health sector decision-makers and implementers in the Covid 19 response timelines of interventions at central and local government level to address the pandemic, and observations as to how and why these interventions worked (or not), intended and unintended effects are presented. A qualitative exploration of whether the timelines of the waves from the epidemiological analysis and of the interventions show any similar patterns or not. Lessons from the analysis for the ongoing management of the present epidemic and any future pandemics are explored.

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A review of Nigeria’s health systems response to COVID-19: lessons for strengthening the health systems for improved service delivery

By: Chinyere Okeke, Chioma Onyedinma, Benjamin Uzochukwu, Obinna Onwujekwe

The COVID-19 pandemic has challenged the health systems of almost all the countries in the world. A strong health system is characterized by its ability to respond to emergencies while remaining resilient in delivering high-quality routine essential services promptly. This is not the case in most low- and middle-income countries, of which Nigeria is one of them, making them very vulnerable to COVID-19 pandemic. Prior to the pandemic, health systems had not received adequate attention. However, with this pandemic, the country’s leadership has made efforts to respond to reduce its spread. These efforts are worth documenting, as they will inform policymakers and other stakeholders in Nigeria to reflect on the ways to adapt and scale up the positive measures identified.

A scoping review of published and grey literature including journals, news/ media documents and official documents that were published from 1st December 2019 to 31st December 2020 was conducted. The reviewers read and extracted relevant data using FACTIVA in a uniform data extraction template. The template was structured in themes using the health system building blocks and service delivery subtheme that captured technical support and interventions targeted at health workers was used for the manual content analysis.

The identified interventions and strategies that have affected health service delivery were mostly technical support and interventions targeted at health workers. These included training of about 17,000 health workers, supervising and engaging more workers, upgrading laboratories and building new ones to improve screening and diagnosis, motivation of health workforce with incentives (financial and non-financial). There was influx of philanthropic gestures and improved data and information systems, supply of medicines, medical products and non-pharmaceutical preventive materials through local production. Overall, the presence of political will and government’s efforts in health systems response to COVID-19 facilitated these interventions.

The interventions of state and non-state actors have to some extent, strengthened the health systems for improved service delivery. However, more needs to be done towards sustaining these gains and towards making the health system strong and resilient to absorb the unprecedented shocks.

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