FG needs N46.2bn yearly to detect, prevent, treat epidemics

*Experts want special fund for national preparedness against disease outbreaks
To be prepared to prevent, detect and treat any epidemic of infectious diseases such as Ebola, Lassa fever, meningitis, Yellow fever and monkey pox, Nigeria needs to spend at least N46.2 billion yearly for the next five years.

Also, medical experts have called for the establishment of a national preparedness fund for not just Ebola but against outbreak of diseases especially those that are endemic in the country like Lassa fever, meningitis and Yellow fever. The experts include: the immediate past Minister of Health, Prof. Isaac Adewole; a foremost virologist and consultant to the World Health Organisation (WHO), Prof. Oyewale Tomori; immediate past Commissioner for Health in Lagos State, Dr. Jide Idris; a consultant public health physician, epidemiologist and former Chief Medical Director of the Lagos University Teaching Hospital (LUTH), Prof. Akin Osibogun; and President, National Association of Resident Doctors (NARD), Dr. Segun Olaopa.

However, the President, Pharmaceutical Society of Nigeria (PSN), Sam Ohuabunwa, disagrees. The pharmacist said there is no need for any special fund but more emphasis on prevention and primary health care.

Meanwhile, analysis from The Guardian on what the country needs at least N46.2 billion yearly to prevent, detect and treat epidemics. According to the National Action Plan for Health Security (NAPHS), launched in November 2018, the country needs N134 billion over five years – that is N27 billion per year. This is about 0.3 per cent of the 2018 federal budget.

Chief Executive Officer of the Nigeria Centre for Disease Control (NCDC), Dr. Chikwe Ihekweazu, told The Guardian that, in 2018, the centre budgeted approximately N1.5 billion on epidemic preparedness and response activities and in addition to this, development partners provided, in addition, support worth approximately N10 billion. “These activities included simulation exercises, rapid response team deployments, establishment and operations of EOCs at sub-national level, training and capacity building at national and sub-national level, roll-out of SORMAS for digital surveillance and other related activities,” he said.

He said there is also a $90 million five-year credit through the Regional Disease Surveillance Systems Enhancement (REDISSE), which was established in response to the 2014-2015 West African Ebola crisis by the World Bank established to cover all countries in the ECOWAS sub-region, including Nigeria. So for one year, Nigeria should get $18 million, which amounts to N6.3 billion.

The Guardian investigation revealed that five per cent from the one per cent of the Consolidated Revenue Fund (CRF) appropriated for the Basic Health Care Provision Fund (BHCPF) is for emergency preparedness fund and 50 per cent of the five per cent that is 2.5 per cent of the BHCPF goes to the NCDC. N55.1 billion was appropriated in the 2018 budget for the BHCPF, so five per cent of N55.1 billion is N2.755 billion and 50 per cent of the sum or rather 2.5 per cent of the BHCPF is N1.3775.

Do we need a special fund to contain Ebola? Adewole, who is also a professor of Obstetrics & Gynaecology, College of Medicine, University of Ibadan, Oyo State, told The Guardian: “We need a Public Health Emergency Fund and not just Ebola Fund. The Chief Executive Officer of the NCDC should be able to tell you what would be required.”

Adewole further explained: “The Joint External Evaluation conducted on the state of our preparedness is an indicator of our ability to predict, detect and respond to public health challenges. The result indicated those areas where we needed to beef up our national preparedness.

“The development within NCDC over the last three years is a cause for celebration. The Gadua Laboratory in the Federal Capital Territory (FCT) Abuja is now functional while the Lagos Public Health Laboratory is receiving attention. More staffs have been recruited and trained and we are much more better prepared than we were in 2014.”

On the financial implication of containing an epidemic, the former minister said: “The NCDC is also receiving 2.5 per cent of the Basic HealthCare Provision Fund (BHCPF). The Federal Government of Nigeria (FGN) has released about N27 billion so far for the BHCPF.”Adewole insisted that Nigerians were luck that the index case did not go to a public health facility. “Dr. Stella Adedevoh suspected Ebola Virus Disease (EVD) and there was robust collaboration between FGN, Lagos and River States Governments as well as our international partners.”

Tomori, who was also a former Vice Chancellor of Redeemers University and Chairman Expert Review Committee on Polio Eradication in Nigeria, told The Guardian: “We need a special fund not just for Ebola but for national preparedness against outbreaks of known and unknown diseases. I wish to commend the federal government for its efforts in this regard. However, it must be stressed that not enough is being done in this regard.”

The virologist condemned many of the states that have abandoned their role in disease surveillance and preparedness. He said these states are depending unashamedly on the federal government and donor agencies. “Yet we know that epidemics will not start from Abuja, but from rural locations in the various states. Now that we have old governors completing their terms or new governors or returnee governors staring their terms, the message must be clearly provided for them to do their duties to their citizens and see the health security of their people as of the highest priority.

Each state must re-build her disease surveillance capacity to the level that will prevent outbreaks or rapidly contain them,” Tomori said.On the financial implication of containing an epidemic, Tomori said: “It is difficult to come up with any figures as to the cost of containing an epidemic. It depends on the disease, the spread and how long it takes to control or contain it. No matter the disease, the cost of preventing will be ‘chicken feed’ compared to the cost of controlling or containing the outbreak.”

Osibogu said by establishing the NCDC and funding it, the country are already providing funds for the prevention and control of epidemics as that is the core mandate of that agency. “We can argue on the level of funding depending on activities and structures that the agency is able to outline. States can also be encouraged to strengthen their disease prevention and control organs. Some States may also establish State Disease Control Centres of Agencies. These agencies or units must intensify their disease surveillance and investigation efforts. The States are closer to the citizens and must be encouraged to maintain a state of watchfulness,” he said.

Osibogu, however, said it is difficult to respond to the question on how much the country needs to fund the prevention, detection and control of epidemics yearly. “It will depend on our national economy, our set national priorities and the level of tolerance we have for epidemics. The lower our level of tolerance for epidemics, the more we will prioritise and fund our prevention activities at all levels,” he added.

Idris said Nigeria needs a special fund for Ebola and other epidemics of known and unknown diseases for now because of the huge deficit and urgent need to build necessary infrastructure and as a contingency or emergency fund.He, however, said the health system should be comprehensive; therefore such funding should also be part of the government’s increased investment in health

On how much the country needs to prevent, detect and treat epidemics yearly, the former Lagos commissioner said: “I cannot give you real figures. But it’s likely to be very huge because each of those issues has very wide dimensions and are things that would be continuous and also technology based. Health is not cheap but is necessary for our security and economic development.”

But the PSN President said disagrees on the need for a special fund for emergency preparedness. Ohuabunwa told The Guardian: “I do not think that there is the need to talk for a special fund for Ebola or any other epidemic. What we need is simple but often difficult in a fatalistic country like Nigeria. Deploy the one per cent Consolidated Federal Revenue Health fund to funding primary healthcare.

“We should just adopt preventive measures on an ongoing basis and have a readiness to confront any epidemic that overcomes our preventive mechanism. Prevention is what we do not do well in Nigeria. Ordinarily Nigerians are lax with their healthcare and that attitude is carried on even among our healthcare institutions. Diagnostic equipment breakdown in our hospitals and everybody carry’s on until a crisis develops.

“Often, we only wake up to treat or confront full blown disease or epidemic. If only we can take prevention seriously, we can prevent most epidemics. If I were the Health Minister, the moment we had one case in Democratic Republic of Congo (DRC) or anywhere in Africa, I would put Nigeria on red alert and deploy measures as if DRC was next door. Money to do this is not much and is already provided in the budget.”

The pharmacist said prevention will cost some money but it is several times cheaper than dealing with a full-blown epidemic. “Nigeria’s health budget can conveniently cover prevention all over the Nation. What is required is presence of mind and diligence,” he said.