In Kano, healthcare crisis looms amid COVID-19 pandemic

Although the effect of COVID-19 pandemic could be felt across all sectors of the economy, especially in the area of food security, infrastructure and environment, one major area that has been of concern to many is healthcare.

Just as the pandemic hit global health with enormous tension, efforts were made to flatten the curve. Surprisingly, the battle to end COVID-19 pandemic in Nigeria has gradually reduced attention on other healthcare challenges.

In Kano, the impact of COVID-19 is glaring. Yet, the overriding universal health crisis peculiar to the environment is growing worse by the day. The priority placed on diagnosis and treatment of COVID-19 by governments is exceedingly substantial. This development, stakeholders feel, might lead to more deadly epidemic.

Not leaving any chance for eventuality, Kano State had designated an isolation centre even before the index case on April 11, 2020.  The state government converted five facilities into isolation centers besides the existing four already designated, all fully equipped with the state of art medical equipment to manage active cases. Also, Kano has three laboratories for testing of samples including the Dangote’s modular lab with about 1,500 testing capacity per day.

The facilities are, Abubakar Imam Urology Hospital, Murtala Mohammed Library Complex, Hospitality and Tourism Institute (former Daula Hotel), Kano State Sports Institute at Karfi village and Nigeria Air Force Hospital, Kano. The existing three are Muhammad Buhari Specialist Hospital, Giginyu; Infectious Disease Hospital, Kwanar Dawaki; Sani Abacha Stadium (constructed by Dangote Foundation and Captains of Private Sector); and Isyaka Rabiu Isolation centre at Court road.

Apart from the huge resources spent by governments and private individuals to set up the facilities, billions of naira was expended on procurement of Personal Protective Equipment (PPE) for health workers to curtail the spread of COVID-19 during the period. Expenses running into billions of naira were also incurred on daily running cost in the last six months including allowances of health workers, drugs, testing kits, logistics and miscellaneous.

Although, government has not made official the amount spent on the management of COVID-19 in Kano, The Guardian gathered that the government has spent not less than N10 billion in the last six month, considering the number of confirmed cases in the state. For instance, information available on the twitter handle of Kano State ministry of health, on COVID19 Kano Update, a total of 45,709 samples were so far collected since the index case was recorded on 11th of April, 2020. Out of the total samples, 1,734 confirmed positive, 1,656 cases already discharged while mortality rate stood at 54. For now, only 24 cases are active.

Some, however, believe that COVID-19 pandemic has succeeded in exposing the enormity of challenges bedeviling the healthcare system in the state. They equally emphasized that the persistent health burden facing the sector requires more attention than that which COVID-19 attracted. In their opinion, Kano is losing sufferers of several ailments, which are getting little or no government attention and die on a daily basis in public hospitals.

Barrister Aisha Ali Tijani, founder of a Kano-based women reproductive health foundation, raised concern over the effect of COVID-19 pandemic on women especially those in the rural communities in Kano.

Aisha lamented that government attention has completely shifted from the major predicament women regularly encounter during their reproductive period to the emergence of COVID-19, which incidentally worsen fragile existing conditions.
According to her, “before the advent of COVID-19, our health facilities, especially the primary health centre, which rural women attended more, lacked adequate needs like drugs, medical staff and enabling environment. Now that the issue of COVID-19 done on us or let me say in the last six months we have been battling with the issue, government attention has completely been diverted from other pressing health matters. This is not a welcome development and the people in the authority need to change the narrative in the interest of masses.

“Nobody is saying COVID-19 is not real but what we are saying is there are other health issues relating to women killing women and children, like malaria, maternal and child death, diabetes, hypertension and host of others killing people on a daily basis in Kano. People with this ailment are not getting better care because of COVID-19. Government needs to improve the situation for better wellbeing of people.

Secretary of Partnership with the Promotion of Maternal and Child Health, a non-governmental organisation, Salisu Yusuf, advocated equal funding and attention given to COVID-19 pandemic to the healthcare system in Kano. Again, Salisu wants significant implementation of budget allocation on health to make an intended impact on the health architecture of the common man in the state.

Although Salisu applauded the increase in health allocation from 16.5 percent to 19.5 percent due to COVID-19 pandemic, he strongly hopes the said allocation would be released timely for the intended purposes.

According to him, COVID-19 shouldn’t have shifted government attention from other health matters, if adequate provision was made for exigency needs on the health budget.
“We have seen a situation where many health matters suffered at the expense of COVID-19 in the state. The budget review in Kano has significantly improved funding on health from 16.5 per cent to 19.5 per cent. Incidentally, the upward increase is virtually meant to augment spending on COVID-19. While we commend the government for the increase, we hope they will look into funding of other predicament in the health system. What is more important again is the timely release of this fund.”

Before the pandemic’s coming in the country, maternal mortality remained a major risk for women of childbearing age in Kano. In 2018, Nigeria bore 14 per cent of the global burden of maternal mortality with increasing ratio despite efforts to reduce the impact. Available records indicate that more than 50 per cent cases of maternal and child mortality occur in Kano, despite the free antenatal and maternity care Kano State government operates.

Also, Malaria is another common enemy and public health burden in Kano. According to the World Health Organisation (WHO), Nigeria suffers the world’s greatest Malaria burden, with approximately 57 million cases and 95,844 deaths reported yearly, about 30 per cent of the total malaria burden in Africa. Malaria transmission is meso-endemic in Kano with 32 per cent prevalence of the national figure.

For a cosmopolitan Northern city with population density, Kano is vulnerable to seasonal epidemics that mostly threaten several lives especially the teenagers. In 2019, the Nigeria Centre for Disease Control (NCDC) placed the state as highly prone to cholera outbreak. With the use of new geospatial mapping of cholera hotspots in Nigeria, Kano has 27 council areas on the chart.

Besides, the threat of malnutrition is another critical challenge in Kano. Presently, about two million children in Kano are prone to death as a result of acute malnutrition. According to Multiple Cluster Survey conducted by Civil Society-Scaling Up Nutrition in Nigeria, CS-SUNN recently in Kano, children between six and 23 months lack adequate and basic care to sustain their required nutrient in Kano.

Worse still, the menace of tuberculosis remains major among public health problems in Kano. Statistics have shown Nigeria with an estimated prevalence of 616 cases per 100,000 just as the country ranks first in Africa, and fourth among the 22 high TB burden countries in the world. It is on record that 460,000 cases of TB are reported annually in Nigeria. Worrisome however, Kano ranks second among high burden states with TB in the country, incidentally next to Lagos.

Nevertheless, the prevailing ailments, infrastructural decay and acute shortage of health workers at both secondary and tertiary public health facilities are salient predicaments calling for urgent intervention. For instance, Murtala Mohammed Specialist Hospital Kano, one of the oldest public health facilities in Northern Nigeria, was established over seven decades ago.

Despite the overstretched facilities, limited bed space and old structures, the specialist hospital receives the highest inflow of patients on daily basis.

“Our major problem is manpower apart from infrastructural deficit. It is only in this hospital you find a doctor attending to 40 to 50 patients a day due to shortage of manpower. The patients are coming in their large numbers but the health workers are not adequate enough. It is that bad that you find as few as three or four doctors in some departments. The association of state doctors in Kano raised this matter on several occasions, there was a time the union planned to embark on industrial action due to acute shortage of doctors but I think the government quickly intervened with the promise to employ.

Ehanire

“I am aware that few doctors like five were posted here last week but you can imagine where you require a whole lot of manpower and few people are being engaged. I don’t think this can make any different,” a health worker who does not want to be mentioned for fear of victimisation told The Guardian.

Consultant haematologist with Aminu Kano Teaching Hospital, Kano, Dr. Ibrahim Musa, contended that access and coverage of universal healthcare in the country has always suffered required attention regardless the emergence of COVID-19 pandemic. Musa who believed no amount of dedicated management of COVID-19 would be too much, maintained management of pandemic globally required sufficient human and material resources.

He, however, raised concern on what he considered as perennial neglect and negligence of the government on the universal healthcare sector. Musa worried over the non-performance of budget allocation on health despite the high demand.

“Medical care in Nigeria has not enjoyed considerable resources. If you check our budget on health, it has always been between six and seven per cent and a large percent of this go into recurrent, payment of salaries. We are not thinking of investment on infrastructure and universal access and coverage. At the end of the day, Nigerians will return to normal baseline healthcare, which are not efficient.

Meaning, the Government is not investing on healthcare to expand access and expand coverage. If you look at the ratio of doctor to patient, you will find out that it is very low and unquantifiable. No employment of health personnel. As we have millions of seekers, we also need hundreds of givers. You can say COVID-19 has taken more attention but at the same time, you can also say attention has never been focused on quality universal health coverage in Nigeria before now.

“People need to understand that COVID-19 is a pandemic and may not go any time soon. If the government reduces or shifts attention from COVID-19, the pandemic will eventually destroy other areas of health and economy. I don’t think shifting attention from COVID-19 is the solution. For me, I think the solution is to focus equal attention to other health matters. Now, we have schools closed in the last seven months, where is the budget on education throughout this period? What do you use this reason for? Government can afford to allocate these resources to other areas of health to argue the deficiencies. So the problem is not COVID-19, rather it is our own perennial lack of investment on our health sector. You visit the hospital, you can’t even have a good laboratory system, you can’t do good X-ray, no quality care and that’s the problem. And the problem is not just emerging as a result of COVID-19, it has been around for a long period of no investment in health. What are they doing with the fund and how much was released.

“COVID-19 is a peculiar problem and I am sure it will not be there for life, so if we can endeavor to spend the resources on it to eradicate it completely, the government can continue to channel our resources hundred percent to other areas of concern. Now, the challenge is that people are not seeing the effect and impact of the billions of naira allocated on health even before the advent of COVID-19. The where is the billions of naira allocation on infrastructure in the hospital. If the management is making judicious use of this money, no matter how little, nobody will complain about how much attention is being given to COVID-19.”

Efforts to speak with the commissioner for Health in Kano, Dr Aminu Ibrahim Tsanyawa, were not successful. The commission did not respond to several calls and text messages. A visit to the ministry for the same purpose also proved fruitless because of his absence. However, the commission during one of his public comments on COVID-19 at government house disclosed that the state was adopting home base care management on COVID-19 patients. The major reason, according to the commissioner, was to reduce the burden on other equal pressing health challenges in the state. He said the paradigm shift would enable the health workers concentrate on peculiar health matters in the public facilities.