Tuesday, April 28, 2020
Sydney, Australia

n Nigeria, we have seen how an uncontrolled COVID-19 pandemic has quickly overwhelmed the Nigerian healthcare system. The Nigerian healthcare system is poorly developed and has suffered several backdrops, especially at the local government levels. No adequate and functional surveillance systems are developed and hence no tracking system to monitor the outbreak of COVID-19. The inability to effectively address Nigeria's numerous public health challenges has contributed to the persistent and high level of poverty and the weakness of the health system. Political instability, corruption, limited institutional capacity, greed; bad leadership and an unstable economy are major factors responsible for the poor development of health services in Nigeria. Households and individuals in Nigeria bear the burden of a dysfunctional and inequitable healthcare system - delaying or not seeking health care and having to pay out of pocket for health care services that are not affordable.

Matters have been made worse when the Nigerian government imposed a lockdown which has led to ordinary Nigerians filling the country's major social welfare gaps amid coronavirus. Many households are now struggling without income during the lockdown given their dependence on small, informal businesses, the need for food and cash relief has grown critical. Though the need for a lockdown was inevitable amid the COVID-19 outbreak, the government abruptness in announcing the lockdown within a 24-hour notice has left millions of low-income households battling with hunger. Criminality and jungle justice are on a steady surge. The Nigerian government claim they have provided cash relief to 3.6 million people living in extreme poverty during the lockdown. The Nigerian government's inability to cater for its citizens in poverty reflects a long-running lack of a functioning, nationwide social welfare and healthcare system. To add to the suffering of Nigerians, the National Human Rights Commission (NHRC) have raised an alarm that the Nigerian security forces have killed 18 people in two weeks while enforcing lockdowns imposed to halt the spread of the new coronavirus. The cases of police brutality are on the rise. The Nigerian police have been known to brutalize communities they are meant to protect. Arbitrary arrests and killings are not uncommon in Nigeria.

The Nigeria Centre for Disease Control (NCDC) has recorded more than 1182 cases, 222 discharged and 35 death since the end of February - most of the people who had been abroad, and those they had interacted with after their return to Nigeria, which has a population of about 200 million. The list of elite Nigerians' who got or have died from COVID-19 includes President Muhammadu Buhari's chief of staff, legislators, politicians, leaders of government agencies, former ambassadors and their aides or relatives. These are class of privileged citizens who normally would fly out of the country to advanced countries such as Canada, UK, Germany, or US at the slightest illness because Nigeria's hospitals are poorly funded, run-down, and lack adequate equipment. The 2020 government budget allocates only about 4.5% of spending on health, less than the 15% target the African Union had set for governments in 2001. Nigeria loses more than $1 billion annually to medical tourism as tens of thousands of Nigerians including President Muhammadu Buhari, travel abroad in search of the best medical treatments.

Early testing is the ideal response to COVID-19 because it will lead to quick identification of cases, quick treatment for those people and immediate isolation to prevent spread. Early testing also helps to identify anyone who came into contact with infected people so they too can be quickly treated. COVID-19 testing remains critical; however, we have seen a slow pace of testing for coronavirus in Nigeria. The Nigerian government have defended the slow pace of testing for the coronavirus amid a lockdown but it's evident that these are all signs that Nigeria's weak healthcare system cannot cope with a larger outbreak. At least four private hospitals in the commercial hub Lagos have been closed temporarily or 'until further notice' because they had to be decontaminated. A laboratory in the northern city of Kano, Nigeria's third-largest, shut after two workers tested positive.

The Nigerian healthcare system is completely broken; it has become a huge money pit, the federal, state and local health system cannot cope with COVID-19 outbreak at the current rate. This comes as many state and local hospitals are turning away patients with COVID-19 symptoms. Many Nigerian doctors and other healthcare workers say they do not have adequate personal protective equipment. The official COVID-19 death toll estimates from the Nigeria Centre for Disease Control (NCDC) are bad enough. But, there are reports that the Nigerian government have been underreporting deaths. There are unconfirmed reports that more than 150 people who have died in Kano state and this have added to fears that the government response is inadequate. In Nigeria, the Nigeria Centre for Disease Control (NCDC), state and local health authorities reported cases and deaths in which the presence of the novel coronavirus is confirmed in a laboratory test. However, many people who died and had COVID-19 symptoms - at home or at a traditional care facility - are not being tested. No death should be a mere statistic. But, it may be worse for a death to be an inaccurate statistic or one that in some sense doesn't exist. Accounting for COVID-19 deaths that happen at home or at a traditional care facility rectifies this issue. Moreover, for future data, research, and model purposes appropriate and accurate tabulating is essential.

There are no medicines or vaccines for COVID-19 at this time. There is a need for the Nigerian government and its State counterparts to revise and implement appropriate and effective interventions to provide social welfare, promote healthy living and prevent and control the spread of COVID-19. The Nigerian government must rely on public health interventions to control the disease. These falls into seven areas: provide social welfare for the people to survive, identifying cases early, isolating cases, tracing and quarantining contacts of cases, improving hygiene, restricting travel and social distancing. The more effective these isolation and distancing measures, the slower the spread of the disease. Evidence suggests engaging all stakeholders in preventing and controlling these and other diseases is the way to go. The Nigerian community and its friends need to be engaged at all levels to mitigate the high burden of COVID-19.