This out going year leaves so much bitter tastes in the mouths of millions of Nigerians, not to talk of the whole world. ROYAL IBEH relieves some sordid memories that are still very fresh with us
Too Many Blame On COVID-19
The COVID-19 pandemic was the global story for 2020. The outbreak of COVID-19 pandemic that claimed millions of lives worldwide, disrupted businesses and nearly crippled the Nigerian health sector, made the year an unforgettable one.
Many Nigerians, faced unprecedented challenges from the pandemic. The strain on the Nigerian government is extreme, and the impact on Nigerians all over the country kept growing. The shock from the effects of COVID-19 is somewhat unusual, as it affects significant elements of both supply and demand. How long the impact would be is still difficult to predict.
Prior to COVID-19 pandemic, the health system in Nigeria was already in a deplorable state, as the outbreak of the virus in the country further worsen access to affordable health services. The challenges were mostly of the infectious diseases with emerging viral illnesses such as hemorrhagic fever and Lassa hemorrhagic fever in addition to the “priority infections” HIV, malaria, and tuberculosis, Oyewale Tomori, a professor of virology tells LEADERSHIP Weekend.
Tomori said the virus which causes COVID-19 disease came to bulldoze the Nigerian health system; rendered its health services impotent and decimated facilities. “The virus also shifted our focus from the routine healthcare delivery activities, such as immunization, surveillance, child feeding programme, etc. It rolled back the gains we made in other areas and when it will finally goes away, with the help of the vaccine, we may have to begin from the scratch to rebuild the system,” he adds.
In addition to all of these, COVID-19 also destroyed the gains made in the prevention of diabetes, HIV/AIDS treatment, tuberculosis and malnutrition etc.
In the wake of COVID-19 in Nigeria, there were severe disruptions to Insecticide-Treated Net (ITN) campaigns and access to antimalarial medicines.
Due to the lockdown and movement restrictions, ITN campaigns were suspended and there was a 75 per cent reduction in access to effective antimalarial medicines, according to the World Health Organization (WHO) report.
The report shows that the estimated tally of malaria deaths in Sub-Saharan Africa (SSA) in 2020 would reach 769 000, twice the number of deaths reported in the region in 2018. This would represent a return to malaria mortality levels last seen 20 years ago.
Part of the recommendations by WHO to avert deaths was for governments to accelerate mass vector control campaigns, ensure the protection for both health workers and communities against COVID-19 transmission and maintain preventive therapies for pregnant women and children.
“The provision of prompt diagnostic testing and effective antimalarial medicines are also essential to prevent a mild case of malaria from progressing to severe illness and death,” WHO added.
Access to basic equipment for diagnosis and monitoring of diabetes was a challenge, especially in public and remote health facilities. There were limited supplies of insulin and oral hypoglycaemic medicines for diabetes in Nigeria, while health workers are not sufficiently trained in diabetes diagnosis and care for patients.
In the wake of the COVID-19, the plight of people living with diabetes worsened, as a study by WHO shows that nearly one in five COVID-19 deaths in Africa was linked to diabetes. It states that 18.3 per cent of COVID-19 deaths on the continent are among people with diabetes, one of the conditions that global studies have found to increase the risk of severe illness and death among patients infected with the virus.
According to the WHO Regional Director for Africa, Dr Matshidiso Moeti, far too many people are in the dark as to whether they have diabetes and people with this chronic condition suffer a double blow if they are also infected with COVID-19. “We must turn this around by investing in early detection, prevention and treatment of diabetes,” he adds.
He said “at the onset and the peak months of the COVID-19 pandemic, health services for diabetes were particularly disrupted. Only about a third of reporting countries in a WHO survey of 41 countries in SSA indicated that services were fully functional. We must not lose sight of other health challenges as we combat COVID-19,” Moeti said.
The chairman, Diabetes Control Media Advocacy Group (DICOMAG), Dr. Afoke Isiavwe told LEADERSHIP Weekend that the situation of people living with diabetes, has been particularly tough for them as the emergence of COVID-19 further reduced their access to care.
This is a disease that affects virtually all organs of the body, resulting in loss of vision, dental problem, kidney failure, cardiovascular disease, lower limb amputation, sexual dysfunction, among others, when not properly controlled, sadly a situation faced by Nigerians living with diabetes today.
“DICOMAG therefore calls on the government, to go beyond flowery speeches and initiate practical measures to control the upsurge of diabetes and also assist Nigerians living with diabetes to achieve good control through access to affordable medicines and monitoring devices, she adds.
It is a known fact that lives would be lost, and public health, safety and economic growth would be threatened, without a strong immunisation systems which are critical to equipping populations with the capacity to withstand public health shocks. This fact become glaring with the outbreak of COVID-19.
However, WHO and the United Nations Children’s Fund (UNICEF) recently warned of an alarming decline in the number of children receiving life-saving vaccines worldwide, due to COVID-19 lockdowns and the disruption of essential health services.
Every year, millions of lives are saved due to Routine Immunization which is widely recognized as one of the most successful and cost-effective public health interventions. Despite the huge benefits of routine immunization it is sad that at least 21 countries, including Nigeria, are experiencing vaccine shortages as a result of the pandemic, while vaccination campaigns for diseases such as polio, cholera, yellow fever and meningitis, among others, have been postponed, already affecting more than 13.5 million people, including children.
In Nigeria, the director general, National Primary Healthcare Development Agency (NPHCDA), Dr Faisal Shuaib told LEADERSHIP Weekend that though the agency faced many challenges like insecurity in the north and the recent outbreak of COVID-19, the agency is working with critical stakeholders to surmount those challenges.
He said “one of the greatest challenges we faced in the polio eradication programme, for instance, was insecurity, especially in the northern and eastern Nigeria. So, it is very important to note that the problem of insecurity slowed our achieving polio eradication. This was why we suffered a setback in 2016 when we had the outbreak of four Wild Polio Virus (WPV) cases in Borno State.”
However, the agency has worked with the Nigerian Army, and the Civilian Joint Task Force, which created access to some of these inaccessible areas and vaccinated children. “We deployed a lot of innovative technology to reach children amidst insecurity. These include setting up the Borno State emergency operations centre in Maiduguri,” Dr. Shuaib Said
As for the COVID-19 pandemic that nearly crippled primary health care services, including immunisation, Shuaib said empowering the PHC workers and the community through a massive unprecedented training of health care workers and community mobilizers across the country on COVID-19 preparedness and response at the health facility and community, helped in ensuring that routine immunization was sustained despite the pandemic.
“The fact is that the pandemic has affected all primary health care services and activities, especially in the first few months of the COVID-19 outbreak. Then there was lockdown and it was difficult for people to move around and primary health care workers had no personal protective equipment, coupled with the fact that little was known about the epidemiology of the virus, we experienced a decline in healthcare services.
“We had to suspend polio campaigns that we scheduled for those months. What we did as an Agency with the mandate to support the Nigeria Centre of Disease Control (NCDC) in reducing community transmission of the virus, was to empower the PHC workers and the community through a massive unprecedented training of health care workers and community mobilizers across the country on COVID-19 preparedness and response at the health facility and community.
COVID-19 interrupted vital HIV treatment and prevention services globally, putting countless more lives at risk. According to a UNICEF report, in April and May 2020, coinciding with partial and full lockdowns, pediatric HIV treatment and viral load testing in children declined between 50 and 70 per cent, and new treatment initiation fell from 25 to 50 per cent.
“Similarly, health facility deliveries and maternal treatment were also reported to have reduced by 20 to 60 per cent, maternal HIV testing and ART initiation declined by 25 to 50 per cent, and infant testing services declined by approximately 10 per cent. Though the easing of control measures and the strategic targeting of children and pregnant mothers have successfully led to a rebound of services in recent months, challenges remain, and the world is still far from achieving the global 2020 pediatric HIV targets,” the report stated.
In his response to the report, UNICEF Nigeria Representative, Peter Hawkins said the world is still struggling with the ongoing global COVID-19 pandemic, but there is now hope for a vaccine. But we must remember that there is no vaccine for HIV.
“Hundreds of thousands of children continue to suffer the impacts of the HIV epidemic. Children are still getting infected at alarming rates, and they are still dying from AIDS. Even with improvements in recent years, HIV treatment access for children and adolescents is unacceptably low, and much more needs to be done to ensure children get the treatment they need and deserve,” Hawkins said.
The report, however, called on all governments to protect, sustain and accelerate progress in fighting childhood HIV by maintaining essential health services and strengthening health systems.
While Tuberculosis is claiming millions of lives yearly, the Senior Disease Coordinator at the Global Fund, Dr. Eliud Wanerdwalo, said the impact of COVID-19 pandemic in the fight against TB, was enormous in 2020.
Wanerdwalo said “COVID-19 pandemic has jeopardised global efforts to save millions of lives and provide access to essential TB care and prevention. Health systems are overstretched due to the unprecedented global health emergency, leading to serious restrictions in access to TB diagnosis, treatment, and prevention services.
“Globally, these disruptions could result in an additional 6.3 million people developing TB and 1.4 million additional deaths resulting from TB between 2020 and 2025.
The minister of health, Dr. Osage Ehanire has said efforts to control COVID-19 must not be at the expense of allowing other diseases that are equally life threatening to begin to thrive and increase mortality. “It would be a serious setback, if medical services, especially emergency medical service, begin to deteriorate in the wake of fighting COVID-19,” he adds.
Ehanire said, “There are places today, where we suspect that needless mortality from other diseases has overtaken the threat of COVID-19. We are beginning to see that fear of, or focus on corona virus are making some health institutions lose sight of other health hazards in our communities.
“I therefore appeal to stakeholders that you all shall hold one another accountable for the outcomes emanating from your hospitals. No emergency should be denied attention, even if it means admitting on a stretcher or examination couch to give life-saving oxygen.”
One of such plans, was the commitment by the Nigerian government in committing more of its resources for the health sector on vaccines and immunization efforts.
Out of the nearly N91 billion capital allocation for the health ministry, N44.5 billion is for the the Basic Health Care Provision Fund (BHCPF), leaving N46.5 billion for other activities. According to the list of the major capital expenditures reflected in the budget, a significant proportion is for the prevention of vaccine-preventable diseases.
Specifically, N22.73 billion was budgeted for GAVI/Immunization, N4.8 billion for Polio Eradication Initiatives and N815 million for the procurement Of Non-Polio SIA Vaccine and N4 billion for Procurement of Routine Immunization (RI) Vaccines and devices.
With all these in place, it was supposed to be a beautiful year, but then, the unexpected broke out; COVID-19 broke out. Some thing Nigerians would not like to remember as they have to wash hands several times not for the food – though scarce – but to keep the dreadful variant of this flu at bay.