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Addressing challenges in health sector exposed by COVID-19

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*Sanwo-Olu, Emefiele, IhekweazuEmefiele, Abayomi, Runsewe, others chart path to better healthcare delivery

A documentary film structured around the incident and management of COVID-19 in Nigeria has further exposed many challenges in the health sector, which became more glaring during the peak of transmission in the country. The documentary also proffered solutions to address the challenges faced by the health sector.

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Top on the list of challenges exposed by the documentary is corruption, poor leadership, non-functional health insurance, weak infrastructure, dependence on donor countries for critical items such as vaccines, poor remuneration for medical and health workers, brain drain, and lack of functional equipment.

Experts, who were interviewed in the documentary, recommended among other things: making the National Health Insurance Scheme (NHIS) mandatory, resuscitating primary health care in the country, more public-private partnerships, increased budgetary allocation to health, local production of essential medical tools such as vaccines and protective personal equipment (PPE), and restructuring of the country, especially the health sector.

The documentary titled “UNMASKED: Leadership, Trust and COVID-19 in Nigeria”, which was formally launched on Friday, May 7 at the Civic Centre, Ozumba Mbadiwe Street, Victoria Island, Lagos, is a collaborative work by Daria Media and Zuri24 Media.

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The 95 minutes documentary was produced/directed by Femi Odugbemi, and co-produced/presented by Kadaria Ahmed. It features a stellar cast of resource persons drawn from medical, political and other relevant sectors of the society, was released in March.

The conversation was designed as a public-private sector collaboration for the development of a robust and effective public health care system.

Lagos State Governor, Babajide Sanwo-Olu, in his remarks at the inauguration of the documentary said: “We have to take the lessons from COVID-19 to galvanise tomorrow. What are we doing differently to ensure it will not happen again? The structure of our governance system is among the things we should look into and change. The change has to be about all of us. People have to come out and vote so that they can elect credible leaders. You cannot sit back and not be part of the process to elect your leaders. It is unfortunate that most things only about 20 per cent of registered voters actually come out to cast their votes. We have to be part of that change that we desire. Indeed, COVID-19 has started it for us

“Tough decisions have to come out. Sometimes some of the decisions have to be tough. How are we going to push this narrative forward? We have to get most of us prepared because another pandemic will come tomorrow, next tomorrow.

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What is our level of resilience?”
Sanwo-Olu said there is a need to change the structure of governance to ensure development in Nigeria and that the lessons from the COVID-19 pandemic would be used to improve the welfare of the people.

“The lessons are certainly not lost on me personally and my government. I know that indeed what COVID brought forward to us, these are things that if indeed we take the positive side of it, we can use to galvanise and create tomorrow,” he said.

“It is really not governance that has failed but people; it is really not religion that failed, it is also the people. So, let us look at ourselves in the face and ask what are the lessons that COVID has indeed passed to our generation.

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“What are we doing differently that will ensure that all of our mistakes known and unknown that COVID has caused us — how are we positioning ourselves to ensure that they do not happen again?

“The truth to be told is that the structure of our government system is the kind of thing that we should look into and change. If it is to say that the cost of governance is heavy and big, those are some realities we need to look up and ask ourselves the sincere truth. And we can only make the change when we have the opportunities to make those changes.

“The change has to be about all of us; that change that we desire. COVID has fast-tracked it for us, that is to say that we are living testimonials to the fact that things can still be better in this country, things should get better, and things have to get better.”

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The governor also said participation by stakeholders in different sectors of the country is required to prepare the nation for another pandemic.

“So, leaving here today is to ask how we are going to push this narrative forward. People in government, media, academia and entertainment need to learn lessons from this and get all of us better prepared before another pandemic will come.

“It is not about medical pandemic alone; it could be hunger pandemic, security pandemic, governance pandemic. Whatever it is, how prepared are we? What is the level of our resilience?”

Also, the Central Bank of Nigeria (CBN) Governor, Mr. Godwin Emefiele, in his remarks at the occasion, urged stakeholders in the public and private sectors to collaborate to build more healthy and robust healthcare infrastructure in Nigeria.

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Emefiele disclosed that it has disbursed N83.9bn loans to pharmaceutical companies and healthcare practitioners to support 26 pharmaceutical and 56 medical projects across the country.

Emefiele said addressing the public health crisis along with the downturn in the economy required strong coordination. He said the measures and interventions put in place by the CBN and private sector to improve the government’s capacity response to the COVID-19 crisis was not enough to build a sustainable healthcare infrastructure.

Emefiele, who was represented by the CBN’s acting Director, Corporate Communications, Mr. Osita Nwanisobi, said: “Let me thank the organisers of this event for their efforts in calling our attention to the need to build a more healthy and robust healthcare infrastructure that can cater to the vast majority of Nigerians.

“This work will require the collaborative efforts of both public and private sector stakeholders.”

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Emefiele said the efforts by the private sector-led Coalition Against COVID-19 (CACOVID) led to the provision of N25 billion relief materials to affected households.

He said: “In this regard, we disbursed over N83.9 billion in loans to pharmaceutical companies and healthcare practitioners which is supporting 26 pharmaceutical and 56 medical projects across the country.

“We were also able to mobilise key stakeholders in the Nigerian economy through the CACOVID alliance, which led to the provision of over N25 billion in relief materials to affected households, and the set-up of 39 isolation centres across the country.

“These measures helped to expand and strengthen the capacity of our healthcare institutions to respond to the COVID-19 pandemic.”

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Emefiele said a study by the World Health Organisation (WHO) revealed that only four per cent of Nigerians had access to healthcare insurance. He said that besides food, healthcare expenses were a significant component of average Nigeria’s personal expenditure. According to him, out-of-pocket expenses on healthcare amounted to close to 76 per cent of total healthcare expenditure. He said at such a level of health spending, individuals, particularly those in rural communities, might be denied access to healthcare services.

Emefiele said that one key aspect, which would address this, was improving access to healthcare for all Nigerians. He said: “A key factor that has impeded access to healthcare for Nigerians is the prevailing cost of healthcare services.”

The CBN governor also advocated expansion of the insurance net to capture Nigerians not covered by existing health insurance schemes. According to him, this can reduce the high out of pocket expenses on healthcare services by Nigerians. He said that it would help to increase the pool of funds that could be invested in building healthcare infrastructure and improving the existing welfare package of healthcare workers.

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Emefiele said that the private sector had a significant role to play in this regard, given the decline in government revenues as occasioned by the drop in commodity prices. The CBN governor also called for support for research and development in healthcare.

“Given the challenges our nation faced as a result of the pandemic, it is indeed vital that all stakeholders work towards building the capacity of our researchers and institutions to address domestic healthcare challenges.

“Strengthening collaboration and partnerships between researchers, public as well as private sector stakeholders across the country is crucial to enabling Nigeria to build a more robust and proactive healthcare infrastructure system,” Emefiele said.

Lagos State Commissioner for Health, Prof. Akin Abayomi, said: “As of now there is a decrease in the number of patients requiring oxygen therapy. This is a result of a decrease in positive cases and decreases in bed occupancy rate in both public and private COVID19 care centres. Bed occupancy rate has reduced drastically to about one per cent.”

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Abayomi, who was one of the panellists, said Lagos ResponseTeam has in spite of the decrease in COVID-19 positive cases put stringent measures in place to track Passengers of Interest (POIs) following recent surge in COVID-19 cases in India and some countries.”

Director-General, Nigeria Centre for Disease Control (NCDC), Dr. Chikwe Ihekweazu, said: Documentaries like this one by Femi Odugbemi and Kadaria Ahmed help us reflect, learn and push harder to prevent future outbreaks.”

Ihekweazu, who was one of the panellists, said NCDC is now better prepared for future epidemics and pandemics.

A consultant medical doctor and former Ogun State commissioner for health, Dr. Olaokun Soyinka, said the greatest challenge faced in the Nigeria health sector is to resurrect primary health care. “It is the crux of healthcare delivery. It is the orphan child because it is not owned by anybody. There is three tiers of government contributing to it, that is the Federal, state and Local Government Area (LGA),” he said.

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Chairman, Evercare Hospital Lekki Limited, Mr. Tosin Runsewe, said to properly address the myriads of challenges in the health sector and ensure universal health coverage, health insurance has to be mandatory. Runsewe, who was one of the panelists, representing the private sector, said if the National Health Insurance Scheme (NHIS) were made mandatory, it would take care of 50 per cent of the 200 million populations in Nigeria. He said social health insurance programme that will take care of the indigent people and those in informal employment will now take care of the remaining 50 per cent of Nigerians. Runsewe also identified shortage of medical personnel as one of the major challenges faced by the health sector. “We don’t have enough medical personnel. We graduate about 3,000 doctors yearly in Nigeria but we probably need 10,000 people,” he said.

Odugbemi said: “The COVID-19 pandemic has turned the world on its head and hit the world’s most populous black nation, Nigeria, with predictable ferocity.

“And with its soft underbelly of corruption, poor healthcare infrastructure, weak systems, and an ever-increasing number of its population below the poverty line, the portent is dire. Could this also be an opportunity for reset?”

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Meanwhile, the international audience from four continents first screened the documentary at the 2021 iREP International Documentary Film Festival to critical acclaim.

The event featured a conversation around the issues thrown up by the extensive research, which led to the production of the documentary.

According to Daria Media, after the Lagos premiere, the screening of the film, and the attendant conversation would also be staged in other major cities of the country, with another set of speakers and discussants.

Co-producer and presenter of the documentary, Kadaria Ahmed, said: “It is the hope of the producers of the documentary that beyond documenting the Nigerian story of COVID-19, Unmasked acts as a catalyst for a conversation on shortcomings in our public health sector that were unmasked by COVID-19.”

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Unmasked… features among other resource persons: Speaker of the House of Representatives, Hon. Femi Gbajabiamila; Governor of Central Bank, Godwin Emefiele; Governor of Lagos State, Babajide Sanwoolu; Governor of Kaduna State, Mallam Nasir El-Rufai; National Coordinator of the Presidential Taskforce on COVID-19, Dr. Sani Aliyu; Director-General of the NCDC, Dr. Chikwe Ihekweazu; Lagos State Commissioner for Health, Prof. Akin Abayomi; and Kaduna State Commissioner for Health, Dr. Amina Mohammed-Baloni; World Health Organisation (WHO) Consultant Virologist, Prof. Oyewale Tomori; Medical Director, Mainland Hospital Yaba, Lagos, Dr. Abimbola Bowale; founder, editor-in-chief of Foundation for Investigative Journalism (FIJ), Fisayo Soyombo; founder The Chair Centre Group, Mrs. Ibukun Awosika; and Chairman/Non-Executive Director of Evercare Hospital Lekki, Lagos, Mr. Tosin Runsewe; and others.

Ahmed said subsequent screening of the documentary would also take place in Kano, Ibadan, Kaduna and Port Harcourt. In those cities, the conversations will revolve around the training and retention of medical personnel in Nigeria and the provisions of basic health care as a prerequisite for the development of robust human resources.

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