In response to Neil's comment on the effect of Covid-19 on the health system/staff, I thought I should comment on Nigeria especially.
With international airports closed all over the world at the first peak in 2020, and the health systems of the high income countries (HICs), which have been the 'healthcare safe havens' of the rich and leadersof LMICs, overwhelmed by their own healthcare needs of their citizens, because of more severe Covid-19 pandemic effects, everyone in Nigeria was forced to stay home in the country especially the leaders and high-networth persons (similar to other LMICs). The consequences of chronic executive negligence had come home to roost!!. Covid-19 ensured that previously ignored calls for attention to reform healthcare in Nigeria may now receive executive appropriate attention and action. These ignored calls in Nigeria include, "Nigeria’s health system is haemorrhaging from health workers brain drain, do something," "Most Nigerian doctors and nurses are seek jobs abroad," "President Buhari’s lamentation about medical tourism during his inauguration in 2015 is still awaiting action," and "President Buhari’s pledge to ban foreign medical treatment for public officials in 2015 is a farce with himself going to UK for treatment", "too many strike action by health workers due to poor conditions in the workplace, do something", etc. At the same time, the fear of being infected with the Covid-19 virus and rampant misinformation about Covid-19 risk was keeping patients away from health facilities, which means that there are huge backlogs of chronic diseases follow-up, and patients are reporting even later than before the pandemic, which makes recovery and prognosis worse still. Anecdotes reveal that stress, depression and other psycho-social and mental illness are on the increase across board without respect for status, employed or not, man, woman, youth or child.
Ironically, there are some positive effects from Covid-19 pandemic on the Nigeria health system which has suffered from longstanding under investment and attention. For instance, all the governments (federal,state / FCT and Local) and private/corporate sector seem to actively want to improve the healthcare system: ‘theFederal Government released about N15 billion and some state governments havereleased hundreds of millions as emergency health sector grants’, ‘rich Nigerians and the organised private sector donated billions of naira to provide essentialmaterials such as PPEs, staff hazard allowances, etc’, healthcare is mentioned as an investment, just like real estate, so that it may be reformed and repositioned through private sector-driven interventions, including setting-up world-class specialist hospitals, supported by health professional organisations including the Nigerian Medical Association, development agencies and health-related not-for-profit organisations, manned by Nigerian health professionals and experts at home (and from diaspora)’. There seems to be wider understanding that ‘facilities alone do not run hospitals, but that the human capacity, capability, skills and the right attitude are essential for quality and safe healthcare delivery, everywhere. The Covid-19 tragedy seems to have motivated governments and other stakeholders in Nigeria to want to invest in research and vaccine production rather that totally depend on external sources and imports. The Federal Government released N10 Billion for a start on vaccine development efforts.
It appears also that government has been woken up by Covid-19 virus and its disastrous consequences on Lives and Livelihoods, to want to finally listen to repeated calls by serious watchers of the weak health system to partner with the private sector to take over selected services /provision of certain items in the failing public hospital and turn them into performing facilities, delivery patient centred, cost-efficient and affordable services. It appears that government, on preventive health, at all levels is seeking to ensure provision and availability of and access to basic necessities such as running water, electricity, basic hygiene and sanitation and other basic equipment and consumables. It appears lessons that were not learnt after the Ebola virus epidemic in 2014 are about to be learnt this this time from the Covid-19 pandemic by continuing the non pharmaceutical prevention and control measures, such as ‘wearing face mask’, ‘physical distancing’, ‘frequent hand washing’, and continuing ongoing fumigation and disinfection of public places’.
It is to be hoped that these positive effects from what is a disaster Covid-19 pandemic, will actually be implemented so that the health system not only conquers this pandemic but is ready for any other one in future.
AFRICA CENTRE FOR CLINICAL GOVERNANCE RESEARCH & PATIENT SAFETY
@Health Resources International (HRI) WA.
National Implementing Organisation: 12-PillarClinical Governance
National Healthcare Standards and Quality Monitor andAssessor
National ImplementingOrganisation: PACK Nigeria Programme for PHC
Publisher:Medical and Health Journals; Books and Periodicals.
Nigeria: 8 Amaku Street, StateHousing & 20 Eta Agbor Road, Calabar.
Tel: +234 (0) 8063600642
Website: www.hriwestafrica.org email: firstname.lastname@example.org ; email@example.com
HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: www.hriwestafrica.com Joseph is a member of the HIFA Steering Group and the HIFA working group on Community Health Workers.
Email: jneana AT yahoo.co.uk