By Laz Ude Eze
A couple of days ago, the co-founder of Bill & Melinda Gates Foundation, Bill Gates, counsel was widely reported in the Nigerian media to have counselled the government of Nigeria to prioritise the development and strengthening of its health sector rather than focusing on the COVID-19 vaccines.
“There is no doubt that the impact of putting money into the health system, particularly the primary healthcare system, will be very high in terms of saving children’s lives. Nigeria should not divert the very limited money that it has for health into trying to pay a high price for COVID-19 vaccines,” Mr. Gates said in response to a question on Nigeria’s plan to invest about N400 billion to vaccinate 70 per cent of Nigeria’s population at $8 per vaccine.
On January 15, 2021, I had written a short piece titled, “Which one kills more? COVID-19 and Dysfunctional Health System?” In the article, I wrote, “Many deaths of influential Nigerians have occurred in the past few months. They were reported to be caused by COVID-19. While they may have COVID-19 infection, the fact is that many of them would have survived it if our hospitals are working optimally. Our dysfunctional hospitals and clinics have been killing many poor people over the years. The rich and influential personalities are becoming victims because the pandemic has essentially halted medical tourism to developed countries. The rich can no longer jet out of the country for medical treatment as they used to. The COVID-19 pandemic has provided an opportunity for us to make our hospital work for everyone everywhere in Nigeria.”
Within the past one month (29th December 2020 to 29th January 2021), an additional 280 Nigerians were reportedly killed by COVID-19, according to the Nigeria Centre for Disease Control (from 1,267 to 1,547 deaths). That’s the highest since the pandemic started. Some of them died because of delayed treatment partially caused by lack of a functional medical emergency management system in most parts of the country. Other possible contributors to the rising deaths include the lack of oxygen in many hospitals and COVID-19 treatment centres, low health literacy among the populace, inadequate personal protection equipment (PPE) for health workers, low hazard allowance and poor welfare of health workers, politicization of the pandemic, etc. One can only imagine the psychological trauma experienced by the families and friends of the deceased failed by our weak health sector. They are in my thoughts and prayers.
One must be honest, I believe the COVID-19 pandemic could have been managed better by the Nigerian authorities. The government at the state and LGA levels should have empowered a virile technical committee led and largely populated by competent public health experts to lead the response. Such a technical team would have liaised with other health administrators to leverage on the pandemic and strengthen the primary health care system. Unfortunately, it has been politicized in some states and allegedly made a conduit pipe for looting of public funds in others. This has eroded the little public confidence that existed hitherto.
Consequently, I agree in toto with Bill Gates. How can we justify spending two-thirda of the total 2021 budget of the Federal Ministry of Health on procurement of COVID-19 vaccines alone? N400 billion is 241% of the N166 billion allocated for the Basic Health Care Provision Fund (BHCPF) between 2018 and 2021, out of which only about N27 billion has been reportedly released. COVID-19 is real and must be contained. However, it is not the only killer disease in Nigeria. It is also not among the top 10 killer diseases in the country, going by the official morbidity and mortality data. Malaria, HIV/AIDS, cancer, pneumonia, diarrhea diseases, pregnancy-related events, severe acute malnutrition, road traffic injuries kill more people. Therefore, a disproportionate use of Nigeria’s scarce resources for the largely ineffective COVID-19 response while the weak health sector keeps claiming more lives is unjustifiable, to say the least.
Rather, the N400b should be used to strengthen primary health care and support local pharmaceutical companies and researchers to manufacture vaccines and other health commodities in Nigeria. This will not only improve the health of the nation but also contribute significantly to national economic growth.
Please, permit me to reiterate as I have consistently done in the recent past that the COVID-19 pandemic provides a golden opportunity for strengthening Nigeria’s health sector. Available resources should be utilized efficiently and an integrated approach must be deployed to make the health sector stronger. It has been alleged in some quarters that some recent decisions in the health sector may have been influenced by parochial interests for the benefit of a few vested interests. I pray it is not true. I believe the Nigerian people can help to change the narrative; we have the responsibility to hold our leaders accountable and drive the change we desire from the community level. The Make Our Hospital Work Campaign, launched on June 15, 2020, provides a platform and template for citizen-led community action to strengthen the health sector from the primary care level. From the Okposi community in Ohaozara LGA of Ebonyi State to the Ogugu community in Olamaboro LGA of Kogi State, citizens are organizing themselves to make their hospitals work. I strongly encourage well-meaning Nigerians to get involved, let’s build from the bottom to the top. We are lucky that COVID-19 is less lethal in Africa compared to the other parts of the world. We may not be that lucky should another epidemic or pandemic occur in the future.
In conclusion, COVID-19 is a major challenge in the health sector that must be tackled but we don’t have to deploy most of the available resources to it and neglect what causes more deaths. When the health sector becomes stronger, many lives shall be saved, not only from COVID-19 but from other infectious diseases, non-communicable diseases and medical emergencies. A strong political will must be demonstrated at all levels of governance to make our hospitals work; and the citizens must help to make this possible through sustainable advocacy and community actions. God bless Nigeria!
•Dr. Eze, a health policy and management expert is founder/CEO of TalkHealth9ja and convener of Make Our Hospitals Work Campaign; @donlaz4u, [email protected]