The COVID-19 crisis has highlighted some of the shortcomings of the healthcare system. In this analysis, VICTOR OKEKE writes on how the pandemic presents unique opportunities for the Nigerian healthcare system to innovate in real time.
On January 23, 2020, the World Health Organization’s International Health Regulations (IHR) Emergency Committee advised that “all countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of 2019-nCoV infection, and to share full data with WHO.” On January 30, 2020, the WHO declared COVID-19 to be a public health emergency of international concern.
Then, on February 27, 2020, an Italian man was confirmed as Nigeria’s first coronavirus case after arriving from Milan for almost two days, traveling through Lagos and visiting another state before being isolated.
As of December 23, 2020, Nigeria has recorded 79, 789 confirmed COVID-19 cases. Of this figure, 68, 879 have been discharged and 1,231 deaths have been recorded in the 36 states and the Federal Capital Territory.
Then, suddenly, the #ENDSARS protests erupted across many Nigerian cities denying all coronavirus protocols. In fact, at this point, many Nigerians have moved on with their regular lives numbed by the beclouding fears spread by the pandemic. Beyond the immediate concerns of containing the spread of COVID-19, Nigeria’s greatest challenge at the time a fiscal crisis- job losses, striking university lectures, university students at home and the burden of skyrocketing food prices.
For over two weeks, protests were organised while calling for a complete ban of the Special Anti-Robbery Squad (SARS) of the Nigerian police force. Set up in the mid-1990s to combat incidences of armed robbery, SARS has over the years metamorphosed into a force associated with harassment of innocent citizens, extortion at gunpoint, and extrajudicial killings of suspects.
An overwhelming majority of those participating in the protest are young Nigerians. Across the country, the Nigerian Centre for Disease Control (NCDC) worry that even though many protesters are wearing masks, the risk of new coronavirus cases will increase as thousands gather.
Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open-air settings could mitigate the risk of transmission. In addition, many of the demonstrators were wearing masks, and in some places, they appeared to be avoiding clustering too closely.
Experts say younger adults generally have better outcomes if they become ill with coronavirus, though there is a risk they could transmit the virus to relatives and household members who may be older and more susceptible.
From the index case in Lagos to a nation-wide lockdown and the #ENDSARS protests, year 2020 has been a low point for many Nigerians and COVID-19 has become a sudden specter in our lives. We know now that touching things, being with other people and breathing the air in an enclosed space can be risky.
Memory fades but it can never vanish completely for anyone who lived through this year. It could become second nature to recoil from shaking hands or touching our faces—and we might all find we can’t stop washing our hands.
The comfort of being in the presence of others might be replaced by a greater comfort with absence, especially with those we don’t know intimately. Instead of asking, “Is there a reason to do this online?” we will be asking, “Is there any good reason to do this in person?”—and might need to be reminded and convinced that there is. Unfortunately, if unintendedly, those without easy access to network connectivity will be further disadvantaged. The paradox of online communication will be increased: It creates more distance, yes, but also more connection, as we communicate more often with people who are physically farther and farther away—and who feel safer to us because of that distance.
COVID-19 has swept away many of the artificial barriers to moving more of our lives online. In many areas of our lives, uptake on genuinely useful online tools has been slowed by powerful legacy players, often working in collaboration with overcautious bureaucrats.
Accessing healthcare using telemedicine was a long-overdue change. And while not every job can be done remotely, many people are learning that the difference between having to put on a tie and commute for an hour or working efficiently at home was always just the ability to download one or two apps plus permission from their boss. Once companies sort out their remote work dance steps, it will be harder—and more expensive—to deny employees those options. In other words, it turns out, an awful lot of meetings (and doctors’ appointments) really could have been an email.
In an article- Coronavirus Will Change the World Permanently- published on Politico, Dr Ezekiel Emanuel, who is chair of the department of medical ethics and health policy at the University of Pennsylvania, said the pandemic will shift the paradigm of where our healthcare delivery takes place.
He observed that for years, telemedicine has lingered on the sidelines as a cost-controlling, high convenience system. “Out of necessity, remote office visits could skyrocket in popularity as traditional-care settings are overwhelmed by the pandemic. There would also be containment-related benefits to this shift; staying home for a video call keeps you out of the transit system, out of the waiting room and, most importantly, away from patients who need critical care,” he said.
According to the Chief Executive Officer of DoctorCare247- a telehealth service provider-, Chuks Chibundu, despite the devastating effects of the pandemic across the globe, it propelled tech-enabled virtual healthcare delivery to prominence.
He said “the highly infectious nature of Covid-19 restricted people with other health conditions from accessing in-person healthcare from health facilities. Telehealth therefore became a safe and convenient means of accessing care from the comfort of patients’ location, thus protecting them from potent chances of contracting the virus, or other infectious diseases.
“In like manner, Healthcare providers are equally protected from contracting the virus from sick persons who come for in-person visits. Telehealth has no doubt become a life saver to many, as people can still get effective treatment for their health conditions or concerns, without the fear of contracting any infectious disease.”
Chibundu whose firm is pioneering one of the leading telehealth firms in Nigeria said, Doctorcare247 is an integrated telehealth platform that enables doctors and healthcare specialists diagnose and treat patients online. Under the platform, consultations are done via a secure high-definition video chat, texts or calls with all records held in a secure cloud storage. Consultations are offered for general wellness, child wellness, mental wellness and lifestyle management.
He said “Doctorcare247 has been at the forefront of promoting telehealth services in Nigeria in the last one year. The tempo was raised during the pandemic with social media related activities, such as bi-monthly Instagram live sessions with guest specialist doctors. Other activities include published blog articles, email and SMS health tips dissemination.
“These promotion activities have activated marked increases in new patient subscriptions, month on month growth in patient-doctor consultations via Chats or Video conferencing, as well as remote patient monitoring. “
The company said that within the past four months, patient subscriptions have increased by over 3000, while consultations have more than doubled. “Telehealth is relatively new in Nigeria, so we will continue to aggressively push our awareness campaigns to ensure more and more people take advantage of the immense benefits of the service,” they said.
With the challenging infrastructural deficit in Nigeria, the techpreneur said it will take more than a basic amount of investments to put in place a robust, effective and efficient telehealth solution in Nigeria.
He explained that a fully efficient telehealth solution like ones operated in developed climes, require much more than a robust solution, as the supporting telecommunication, power and logistic infrastructure are already in place.
To provide the same level of service delivery in Nigeria, much more is required beyond the software solution investment. The resource constraints increase the level of investments required to offer quality and effective telehealth service. Chibundu said that Doctorcare247 already has a very robust solution in place and not relenting in delivering top notch service despite the challenges.
“It our hope that the infrastructural challenges will gradually become a thing of the past as the government invests more and more in meeting those needs. With such contributions by the government, the cost of setting up a full-fledged platform will reduce considerably.”
To ensure maximum coordination between providers and tech firms, he explained that a deliberate supportive policy framework should be initiated by the government, to be driven by private sector players.
“The framework which will give birth to a robust policy on telehealth under the national healthcare policy, will make for proper regulation and support for the growth of telehealth in Nigeria,” Chibundu said.
Telehealth in Nigeria is still in its infancy, so now is the time to put together an operating and guiding policy that can be integrated into the national health policy.
To achieve this, the government should put together stakeholders and experts, both locally and internationally to provide a blueprint that will eventually be approved as policy within the next one year, to support the growth of telehealth in Nigeria.
Despite these seemingly dire circumstances, the pandemic offers an opportunity for hospitals across Nigeria and beyond to build resilient healthcare systems that can withstand future disease outbreaks or market disruptions.