COVID-19: Re-tooling Nigeria’s public health delivery model

That the ravaging COVID-19 which has since the beginning of the year spread rapidly around the globe could leave a very serious public health crisis in its wake is no longer news. In many parts of the world, attention is shifting to how to concretize local, regional and continental health partnerships that focus on not just how to successfully contain or tackle the virus, but, more importantly, to ensure that life saving and essential health delivery services are sustained and maintained to entrench a robust system that maximizes the learnings gained from the current pandemic.

Like other developing countries, Nigeria now, more than ever before, has to seriously confront the challenge of creating a modern health services delivery system that guarantees efficient, fast and accessible solutions capable of curtailing fatalities associated with common diseases and their devastating impact on families, communities and development.

While speaking recently on the threat of malaria in the country, the Minister of Health, Dr. Osagie Ehanire, revealed that “though fever testing amongst children under 5 has increased consistently from 5% in 2010 to 11% in 2013, to 13% in 2015 and 14% in 2018, it is still very low when compared with the second objective of the Malaria Strategic plan which is to test all care-seeking persons with suspected malaria using RDT or microscopy.”

According to the World Malaria Report, Nigeria still accounts for 25% of the global malaria burden and 19% of global malaria deaths. Nigeria, it is estimated, accounts for 81,640 annual malaria deaths – about 9 deaths per hour – and the situation is worsened by very low levels of investment in malaria elimination at both the sub-national levels and the private sector.

Apart from the frightening mortality and morbidity data on malaria, lack of access to functional health services delivery system has also been responsible for avoidable havoc caused by many other common but potentially deadly illnesses, such as STDs, diarrhea, hypertension, and diabetes on a large segment of the 52% of the country’s population that live in the rural areas. To compound the situation, the country’s rural areas mostly lack good and functional infrastructure while unavailability of competent healthcare personnel, coupled with high levels of poverty and illiteracy continue to make public health a daunting task in the country.

Despite the country’s strategic position in Africa, it is highly underserved in the health care delivery sphere. Health resources such as facilities, personnel, and medical equipment are inadequate, especially in rural areas.

Latest data from a survey of Africa’s 10 largest economies show that only Ethiopia has fewer hospital beds per capita than Nigeria. The most recent WHO data puts the number of hospital beds at only five per 10,000 people in Nigeria.

Beyond hospital beds, however, public healthcare delivery is hampered more by inadequacy of healthcare resources particularly personnel, drugs and other medical equipment needed for holistic patient treatment. For instance, the doctor to patient ratio is currently 1:6000. Most of the available qualified doctors are concentrated in urban cities and towns while the rural areas have next to nothing, thereby leaving room for quacks and other unqualified hands to tend citizens’ health needs. This poor picture makes the healthcare system particularly fragile and always at major risk of being overwhelmed at the breakout or in the aftermath of any pandemic with serious presence in the country.

Yet, as an important element of national security, the need for public health is non-negotiable. Public health not only functions to provide adequate and timely medical care but also tracks, monitors and controls disease outbreak. The Nigerian health care environment has suffered several infectious disease outbreaks year after year. Hence, there is need to tackle the problem decisively now in order to forestall a repeat of the chaotic national response to the COVID-19 pandemic.
While government has regularly come up with reforms to address the wide-ranging issues in the health care system, implementation has sadly been poor.

According to the 2009 communique of the National Health Conference, health care system remains weak as evidenced by lack of coordination, fragmentation of services, dearth of resources, including drug and supplies, inadequate and decaying infrastructure, inequity in resource distribution, lack of access to care and very deplorable quality of care. The communique also pinpointed lack of clarity of roles and responsibilities among the different levels of government to have compounded the situation.

To further underline the fact that the Nigerian health care system is poorly developed, experts have often observed that there are no discernible and well maintained adequate and functional surveillance systems in the sector. A successful modern day health care delivery model requires routine surveillance and medical intelligence as the backbone of the health sector. This is because medical intelligence and surveillance represent a very useful component in the health care system and control of diseases outbreak. Provision of timely information aimed at combating possible health menace among many other things is an important function of public health. Hence, inadequate tracking techniques in the public health sector can lead to huge health insecurity, and thereby endanger national development, peace and security.

There is therefore an increasing role of automated-based medical intelligence and surveillance systems to complement the traditional manual pattern of document retrieval in advanced medical setting as seen in western and European countries.

Given the above prognosis, the primary challenge confronting the country’s public health today could therefore be framed as how to create and sustain an information-rich and patient-focused health care system that reliably delivers high-quality care.

Learning from experience is crucial, both for effective emergency response and to rebuild for the future.

Past experiences have shown that in the wake of health pandemics, government has often been discovered to divert statutory health budget and resources to tackle the immediate challenge of the pandemic. This often leaves the healthcare services delivery sector more fragile, weaker and more overwhelmed, especially in the efforts to contain common citizen health needs.

For instance, in the aftermath of the Ebola crisis, many people died because of the inability of the overwhelmed health systems to treat malaria, HIV, and tuberculosis than from Ebola itself. A similar trend can only be avoided in the aftermath of this fight against COVID-19 if efforts are geared towards putting in place a proactive, revolutionary and easily affordable and accessible health services delivery model that can ride on strong deployment of technology to strengthen healthcare accessibility at the grassroots.

Nigeria needs to urgently come up with an innovative approach to creating different layers of health services delivery model that can deliver effective and efficient medical services to the most vulnerable in the society, to achieve the best health outcomes, such that location and socio-economic status will not be a barrier to accessing quality healthcare services. This needs to also be done as cheaply as possible, given the dwindling economic fortunes of the country.

In this regard, the country needs to look towards the innovative and revolutionary Community health hub idea which is capable of leveraging technology to offer holistic solution to the identified gaps in the existing healthcare delivery systems, particularly in the undeserved areas, as a way of maximizing the scarce human resources for health (HRH). The best of these community health hub ideas is grounded on tele-healthcare model and not the anachronistic brick and mortar community healthcare facility model. The growing popularity, spread, reach and utility value of mobile telephony and other digital devices should challenge health administrators and service providers to think out of the box in coming up with solutions that can deliver efficient health services to majority of Nigerians, especially in the lower socio-economic cadre.

The current pandemic has demonstrated the central importance of health in our national life — without it, we have nothing. It has also shown how we can do things differently as regards to making our public healthcare system truly patient-focused.

We should not expect the world to stand still for us to move at a pedestrian pace when everybody else is sprinting to make their systems better.

Samuel is project coordinator, Telehealth Nigeria Initiative (TENI), wrote from Abuja.