Leveraging COVID-19 tools to fund Nigeria’s epidemic preparedness

The ongoing experience from the COVID-19 pandemic should provide a solid ground for the Nigerian government to change its attitude to the funding of epidemic preparedness in the country. The government and indeed the citizens have felt the devastation that COVID-19 visited on the economy and the response to it presents an opportunity for the country to improve on the funding of its healthcare and epidemic preparedness.

The government and some financiers are investing substantial amounts of money in new molecular centers and delivery methods, spurring private-sector engagement and innovation. However, Nigeria must take these chances to leverage current investments beyond COVID-19. Following these experiences, it is quite clear now that funding should not just be used to combat COVID-19, but also to prepare the health system for future epidemics.

Before now, the Nigerian government deemed it fit to budget an insignificant eight naira (2.1 cents) for prevention, diagnosis and management of communicable diseases of each citizen in 2020. Data show that only N1, 673, 486, 127 was allocated to the Nigeria Centre for Disease Control (NCDC), the country’s national public health institute, responsible for epidemic preparedness, detection, and response to infectious disease outbreaks and public health emergencies for over 200 million Nigerians.

This implies that the Nigerian government will spend eight naira per person a year, which amounts to 66 kobo per month. Meanwhile, NCDC’s counterpart in the United States, the Centre for Disease Control (CDC) will spend $6.594 billion on epidemic preparedness this year, which is about N2.34 trillion, an amount that exceeds Nigeria’s entire Federal Ministry of Health allocation for five years.

This means that if the CDC’s budget is spread across the population, the centre will spend at least 20 dollars (N7, 200) on the epidemic preparedness for every American resident, while Nigeria, will spend eight naira on the same disease prevention and management in a full year per citizen.

“In 2018 NCDC worked with different partners to produce a document which is called the National Action Plan for Health Security (NAPHS), based on the plan, what it will cost to prevent a pandemic from happening in Nigeria every year is about 40 cent per- capital for a person.” said Ifeanyi Nsofor , chief executive officer CEO of EpiAFRIC and Director of Policy and Advocacy at Nigeria Health Watch.

According to Nsofor, with Nigeria’s estimated populations of about 200million, that comes to about $80 million dollars every year and with the introduced exchange rate that is probably about #35 billion every year for epidemic preparedness, detection of diseases and responses through epidemics.

“looking at the NCDC’s budget, it is definitely not enough. We need to look at three different things to get the real picture, the NCDC budget, budget that state and local government has allocated for epidemics preparedness in doing this funds can be made available,” he said.

Meanwhile, Nigeria’s health budget for 2018 stood at N340.46bn, which was 3.96 percent of its N8.6tn proposed national spending. A breakdown of the health budget shows that Nigeria then estimated to have a population of 186 million, allocated approximately N1, 832.62 for each citizen.

Of the total N9.45tn budgeted for 2020 by the Federal Government, N427.3bn (4.5 percent) was allocated to health.

The budget for 2021 proposes N547 billion for healthcare, about seven percent of the budget’s total of N13.08 trillion.

The amount comprises N380.21 billion for recurrent expenditure and N132 billion for capital projects. There is also N35.03 billion Basic Health Provision Fund, which includes funds for managing emergencies and infectious diseases such as the COVID-19.

On average, the amount translates to about N2, 735 per Nigerian, given the country’s population of about 200 million people.

Now that we have experienced COVID-19, this should change. The country should appreciate the importance of epidemic preparedness because the lack of it can actually cripple the country. It should be taken just as seriously as the government has taken national security and human capital development, or the way the government is pumping money into the fight against Boko Haram insurgency.

For instance, the 2020 budget for the Ministry of Defence was put at N878.4 billion, with N121 billion earmarked for capital projects. This is the same way we should budget for National health security in order to enhance and provide this healthcare to prevent Nigerians from contracting or dying from the host of epidemics.

“UK spends over 200 billion dollars on health for its 60 million populations yearly and this has reflected in the quality of lives and health of the people. Going forward, especially as seen with the present pandemic, Nigeria must improve its healthcare spending. There should be compulsory taxation for health, as this will improve funding,” said Ola Brown, the Founder of Flying Doctors Nigeria.

“It is hard to say that you are 100 percent prepared for the challenges an outbreak like this would bring; however, being able to make plans while things were relatively calm and prepare as much as possible for the inevitable outbreak helped them keep operating and supporting states,” Brown added.

Nigeria has continued to battle with diseases that threaten public health security. These include diseases such as cholera, meningitis, and hemorrhagic fevers, especially Lassa fever for which Nigeria reports considerable morbidity and mortality annually.

Nigeria has responded to and contained these outbreaks, but further steps must be taken to detect them earlier to prevent illness and death. Preparedness for epidemics and health emergencies has a high return on investment, estimated at $2 -7 for every $1 committed.

According to Doyin Odubanjo, former chairman, Association of Public Health Physicians of Nigeria, Lagos Chapter, the only certain thing is that when this epidemic is brought under control, another will eventually take its place.

“Epidemic threats are inevitable. To better prepare for the next crisis, and future epidemics, Nigeria will need to devote considerable political capital and economic resources to reducing the domestic and global vulnerabilities that jeopardize individual, national, and global health security,” he said.

For Odubanjo, epidemic preparedness is funding, especially funding to help the health sector prepare before any outbreaks occur. The important thing that funding epidemic preparedness helps countries do is that with proper research and analysis of trends, it can help them predict, prepare for, and even prevent the next epidemic.

“This is more lesson learned for the country intended to ensure that in future of any epidemic or when the next epidemic threat occurs, Nigeria would be better prepared to avoid at least some of the missteps that have cost humanity so dearly.”

“If the COVID-19 pandemic has revealed anything, it is that there is a need for a political will in disease preparedness,” he said.

However, Nigeria’s health experts say epidemic preparedness is one area of healthcare which represents the process of doing things in advance, preventing, preparing for, detecting, responding, and controlling epidemics in order that the health and economic impacts are minimised. They add that it is an all-embracing term that describes all that needs to be done before, during, and after epidemics, and that it is the core of health security of a nation and its people.

World health experts also advised that, heads of government must commit to preparedness by implementing the International Health Regulations, and increasing investment in preparedness as an integral part of national and international security and the G-7, G-20, G-77 member countries and regional intergovernmental organisations should follow through on their funding and political commitments for preparedness and monitor progress at annual meetings.

They added that all countries should build strong preparedness systems, with heads of government appointing a high-level coordinator to lead efforts across all government departments and sectors, to prioritise community involvement and to routinely conduct multi-sectoral simulation exercises.

“It is a big factor when you are thinking about the response to an epidemic, where the national response is necessary for Nigerians for correlation. There are a lot of lessons that we can learn about how little, tiny microscopic organisms can cause a global pandemic and bring nations to an economic halt,” said Chikwe Ihekweazu, chief executive officer, Nigeria Centre for Disease Control, while speaking recently at the Omnia Health live Africa.

According to Ihekweazu, the Nigerian government’s poor financial allocation for the health of its citizens is not limited to the budget for epidemic preparedness alone. The entire health sector is also battling with poor government funding, a decision that has played out in the health indices of the country.

The Heads of State of African Union member countries in April 2001 met in Nigeria and pledged to set a target of allocating at least 15 percent of their annual budget to improve the health sector. The resolution is known as the Abuja Declaration.

However, since then, the country’s budgets for health have been falling below 10 percent, to the chagrin of stakeholders in the sector.