Since the outbreak of the deadly Coronavirus, Several public and private hospitals in Lagos and other parts of Nigeria began to turn away patients, this has accidentally led to a few avoidable deaths. Hospitals want to avoid crowds of people on their premises and also more importantly, avoid any yet to be detected covid-19 cases, since most of them lack testing kits and facilities to carry out testing and the risk of staff exposure is high. The most outrageous fact is that some hospital had no personal protective equipment for its staff and they would be at risk if they unwittingly admitted a covid-19 case. As a result, many people with other illnesses find themselves in a dilemma.
As a result of this development at the hospitals, drug abuse became the order of the day as most people now resort to self medications, buying drugs at pharmacies without a doctor’s prescription. Many also opt for traditional treatments in the form of herbal teas and concoctions. These options may create public health catastrophes on their own, including poisoning from herbal remedies and complications that may arise from taking medications not prescribed by doctors.
For a country that even its leaders lacks confidence in its healthcare services and they are always flown abroad for treatment whenever the need arises. In the same vein Nigerian citizens have expressed fears on the ability of Nigeria’s healthcare system to handle the spread of covid-19 in the nation.
Nigeria’s health sector has been one of the weakest in the world. A country, despite being Africa’s largest economy, was, in 2017, rated 187 out of 190 countries in World Health Systems, only ahead of Democratic Republic of Congo, Central African Republic and Myanmar. Even if some aspects of healthcare delivery have improved since then, I will say that as far as covid-19 is concerned, our country Nigeria has been lucky so far that we were quick to contain the virus at a tender stage. If it had gotten to the level of mass transmission as we had seen in Brazil, Italy and USA, I don’t think we are well prepared and equipped to handle an epidemic at that level. It can’t be for a country where its medical doctors are constantly going on strike and qualified personnel seek employment outside the country always. Even as we speak, rumor has it that Resident Doctors will soon resume their temporarily suspended strike.
In spite of its shortcomings however, the government in Nigeria has responded rather well to covid-19, putting in place several measures to combat the spread of the disease so I really give it to them and applaud their efforts so far. There has been relative success in identifying and tracking suspected cases, and several individuals, including the initial index case, have been treated successfully and discharged.
However, it still doesn’t discredit the fact that all the focus on healthcare has gone to covid-19 while other health needs of the population are being given much less attention. Imagine a typhoid or malaria patient dying at home as a result of lack of attention or fear of covid-19. In fact, healthcare in Nigeria, in the time of coronavirus, seems to be depreciating on several fronts.
As the pandemic persists, the health care challenges plaguing Nigeria’s already frail health system have been exacerbated and health care workers are struggling.
There was already an existing shortage of doctors prior to COVID-19, and with the global shortage of personal protective equipment (PPE), health care workers in countries with weak public health systems like Nigeria are at the forefront of it all.
Speaking to Lagos Post Online, recently was a nurse (name withheld) from one of the most prestigious hospitals on Lagos mainland. She expressed fears concerning the menace poised by Covid-19 as a healthcare worker in Nigeria. She said;
“My greatest challenge in this age and time of the global pandemic is the fear of being infected by this virus. I keep asking myself that if after being infected I become an asymptomatic carrier of the virus and I end up infecting the patients I care for or end up infecting people at work. This fear assailed me.
The fear that my colleagues at work could get careless and get infected by the virus and then unknowingly pass it on to me also gripped me.
Another fear that also got to me was that if the patient I am caring for is infected, then it means that the likelihood of me getting infected is high. I will explain in detail later.
Just at the beginning of the lockdown, we discovered that the number of patients who visit the hospital dropped drastically. Long before the Coronavirus outbreak in Nigeria, in a day we could record like a thousand patients but during the lockdown, people were not allowed to move around and so this affected the inflow of patients.
Following the announcement that says that, if anybody feels unwell, just stay at home and put a call through to the Nigeria Centre for Disease Control (NCDC). The number given out to call were medical experts that will interview you to find out the symptoms you are having and immediately give you instructions on what to do to get relief from the symptoms you are having. So we were not seeing a lot of patients, we were only seeing emergency cases such as life threatening cases.
And before we even admit them fully into the hospital, we have to go through some series of tests just to be sure of what we are dealing with and to also make sure that we the health care workers are well protected.
The Personal Protective Equipment (P.P.E) were there for us to use to guard ourselves against getting infected with the virus. Aside from that, the patient we were seeing during the lockdown when the scare was high had to go through a lot of tests so we are sure to be safe before treatment will commence.
Then most times when we question some patients on the symptoms they are having, you will now realize that the patient has a high index of coronavirus. When issues like this come up, we don’t even allow such cases into the hospital. From the threat point, at the entrance of the hospital, we refer them to the medical isolation center Yaba.
So becoming an asymptomatic carrier was my biggest fear. So I fear not for me but for people around me and this is where members of my family come in.
The fear of getting infected and infecting members of my family was even higher and scarier because while the lockdown was still going on, I was the only one in my household still going to work.
The chances of anybody getting the virus from the house were low because no member of my family was going out except me. Prior to the lockdown, the house was stocked with food stuff and provisions that will last for three months. So I was always living with the constant fear of getting them all infected.
In the hospital, the PPE we were using as at then was enough, but when the virus came, as at that time that the lockdown recently started, the cost of this PPE increased tremendously. E.g gloves, mask gowns, caps, goggles, booths etc
Formerly we used to have 100,000 supplies of PPE but since the virus came and made the cost of this PPE expensive, we now fell short of supplies and availability of PPE which in turn has exposed us in a way.
Everybody at work was suspicious of each other of being a carrier so the relationship at work was constrained due to fear.
Even the so-called emergency cases we were having were on red alert as highly suspicious so we treat them as suspected coronavirus cases. Taking cognizance of the fact that we had no covid-19 test kit, we only question the patients. So the fear of encountering asymptomatic career is high because definitely you will give injections, you will give infusions, others you will have to measure the urine and later discard it, some others that are on bed, you might have to give bedside care and there is no way you can avoid contacting the person’s body fluid and we all know that this disease can be transferred through body fluid as well as their breath or tears, all this are highly contaminable including sneezing.
And like they always say, one can never be too careful because we definitely unconsciously touch our faces and nose for a number of reasons even when wearing a mask. There inside the hospital we are mandated to always wear a mask at all times. You can’t be in the hospital premises without a mask on. But on the other hand, this mask makes breathing difficult because after putting it on for a long time, you will get to realize that the oxygen we breath becomes hot which is oxygen mixed with carbon. This could lead to lightheadedness and dizziness.
In putting on mask in the hospital before covid19 we put on mask on specific purposes like when we care for babies, when we want to do a procedure, when we want to go into a theatre for surgery, or during dressing of wounds and when we are caring for patients that has transmittable diseases but for patients that has diabetes, malaria, typhoid, fever, etc, we don’t need a mask so how to put on the mask all day was also a big challenge.” She concluded.
The reality is that citizens, health workers and international development partners worry that Nigeria’s health system is very weak and may be unable to adequately combat COVID-19
Research has underscored the vulnerability of Nigeria’s health system. A consistently solid and accountable health system has eluded the country. The requisite health resources are also in short supply.
The most worrisome issue here is that some Nigerians do not believe the authenticity of the corona infected figures given by the NCDC. While some see it as propaganda to embezzle funds, others feel it is true but exaggerated. The drivers and potential solutions to these health sector corruption problems were also identified, as well as recommendations on how to mitigate corruption in the sector. In the end we hope to explore and bring to the fore feasible grassroots solutions to the problem of health sector corruption in Nigeria.
Since President Muhammadu Buhari came to power in Nigeria in 2015, anti-corruption has been at the heart of his administration. However, a lot of effort is focused on grand corruption at the higher levels of governance and politics. There is less emphasis on the less talked about but vulnerable areas such as the health sector.
Following recent collapse in the international price of crude oil, the budget has now been revised downward. Nigeria’s health sector appropriation in the 2020 budget is 4.5% of the total federal budget, about N427.3 billion. This is far below the 15% agreed in the 2001 Abuja Declaration, when African Union member countries pledged to improve spending on their health sector and urged donor countries to scale up support.
We can easily identify several corrupt practices in the Nigerian health system. These included absenteeism, procurement related corruption, under the counter payments, health financing-related corruption, and employment-related corruption.
We also found that there were high levels of distrust in the government, poor welfare conditions for health workers and health service users, and a lack of proper equipment.
The rapid spread of COVID-19 in Nigeria calls for sincerity on the parts of the authorities, the health workers and citizens. It also demands vigilance from civil society organizations and the mass media to foster accountability.