Corruption, Stigmatization, Weak Communication, Others Undermine Nigeria's Ability To Handle Epidemic

In this report, ODIMEGWU ONWUMERE discusses how the lack of preparedness in the Nigerian health system to respond to outbreaks is caused by disparities in capabilities, collaboration among government agencies, healthcare providers, private organizations, community leaders, ineffective leadership, inadequate funding, population diversities, corruption, stigmatization in communities, and a shortage of human resources

Despite efforts to enhance public health infrastructure and response capabilities, there appears to be a lack of awareness among the general populace regarding the importance of readiness for health crises.

Analysts say that the lack of awareness can hinder the timely detection, response, and prevention measures during outbreaks.

Public health experts are troubled by the insufficient understanding of the risks linked with health disasters in Nigeria and stress the significance of increasing public awareness about these risks in a country facing numerous infectious diseases.

They argue that individual actions such as symptom recognition, prompt medical assistance seeking, and adherence to preventive measures play a critical role in epidemic control.

A comprehensive strategy has, however, been devised to educate and engage the populace in epidemic management efforts. This strategy includes disseminating information on financial support and enhancing awareness about communicable diseases. Moreover, it strives to ensure transparency in funding allocated for epidemic preparedness and tackle security challenges that could impede response initiatives.

Possible underestimation of cases recorded?

Noteworthy epidemic diseases prevalent in Nigeria comprise COVID-19, diphtheria, meningitis, measles, cholera, tuberculosis, trypanosomiasis, toxoplasmosis, taeniasis, rabies, lassa fever, yellow fever alongside ongoing humanitarian crises.

Aminu Tsanyawa, the Commissioner for Health in Kano State, officially confirmed on Thursday, January 19, 2023, the occurrence of a Diphtheria outbreak within the state, leading to the unfortunate demise of a minimum of 25 individuals.

Concerns were raised by healthcare professionals saying that Nigeria encountering substantial public health difficulties revolve around particularly in regions with low immunization rates (such as the north-east.)

This situation may precipitate outbreaks and strain already limited resources. The imperative nature of readiness for epidemics is underscored due to their potential rapid global dissemination.

In December 2022, alerts were received by the Nigerian Center for Disease Control and Prevention concerning suspected diphtheria outbreaks in Kano and Lagos States.

From May 14, 2022, to April 9, 2023, a total of 1,439 suspected cases were documented with 557 confirmed cases resulting in 73 fatalities. The reported coverage rate for the third dose of pentavalent vaccine in Nigeria stood at only 57% during 2021 indicating inadequate coverage of diphtheria toxoid-containing vaccines.

The World Health Organisation (WHO) highlighted limited reports regarding diphtheria outbreaks in Nigeria suggesting possible underestimation of cases recorded.

According to the WHO, "the diphtheria outbreak in Nigeria has been particularly severe since December 2022, with a total of 7,400 confirmed cases and 12,000 suspected cases as of September 28, 2023.

“Starting from July 2023, more than a thousand new cases of the disease have been identified each week, marking the highest point of the outbreak.

"The disease has also spread to 19 other states where case discovery, contact tracing, and immunization rates are low.

“The IFRC and its members are aiming to raise CHF 6 million to support the Nigeria Red Cross in expanding their response efforts in 12 states. Since the beginning of 2023, there have been 557 confirmed cases of diphtheria in Nigeria, affecting 21 out of the 36 states."

Numerous challenges in managing epidemics in Nigeria?

A medical practitioner in Port Harcourt, whom the writer contacted online but refused to disclose his name, mentioned that there are numerous challenges in managing epidemics in Nigeria.

He highlighted obstacles in the country's ability to respond effectively to public health emergencies, such as insufficient investments in epidemic preparedness.

“Despite recent increases in funding for the Nigeria Center for Disease Control (NCDC) and the establishment of budget lines for epidemic preparedness at federal and state levels, there are still deficiencies in funding allocation and utilization,” he says.

“The healthcare infrastructure in Nigeria is often inadequate to support strong efforts in preparing for and responding to epidemics, with shortages in medical facilities, equipment, and trained healthcare personnel hindering the country's response to outbreaks.”

There is the issue of diverse population in Nigeria, with over 500 languages spoken, which presents challenges in communicating health information during epidemics, requiring tailored risk communication strategies to address cultural differences and beliefs.

The source lamented the weaknesses in the Nigerian health system, including limited access to healthcare services, inadequate data management systems, and challenges in disease surveillance and reporting, can impede the early detection and containment of outbreaks.

“Issues related to corruption and mismanagement of funds in the healthcare sector can lead to inefficiencies in resource allocation and implementation of epidemic preparedness initiatives, worsened by a lack of transparency,” he says.

“Nigeria's vast geographical size and diverse terrain pose logistical challenges in epidemic responses, such as ensuring timely delivery of medical supplies, deploying healthcare teams to remote areas, and coordinating efforts across different sectors.”

There is the case for insufficient public health education and awareness programs which may result in low community involvement during epidemics, with stigma around infectious diseases like COVID-19 leading to a limited understanding of the disease and poor compliance with infection prevention measures, hindering efforts to control the virus's spread.

“Disparities in capabilities, ineffective leadership, inadequate funding, and a shortage of human resources contribute to the Nigerian health system's lack of preparedness to respond to outbreaks, as indicated by low scores for disease outbreak prevention and response in the 2019 Midterm Joint External Evaluation (JEE) of International Health Regulations (IHR) core capacities,” he said.

According to him, the fragmented nature of health service delivery in Nigeria makes coordination during health emergencies difficult, which hampers effective communication and collaboration among those involved in epidemic preparedness and response.

Weak risk communication?
However, Nigeria's response to health emergencies has been criticized for its weak risk communication, with experts suggesting a need for improved communication strategies that cater to the diverse population and cultural contexts.

“People from vulnerable health systems and poor socioeconomic backgrounds are particularly at risk during epidemics like COVID-19,” says our anonymous source.

“Epidemic preparedness efforts in Nigeria are further complicated by prolonged health system vulnerabilities, civil unrest, corruption, and other socioeconomic factors.”

Analysts are of the view that a successful epidemic preparedness requires collaboration across various sectors beyond healthcare, but coordinating between these sectors in Nigeria presents challenges.

“The impact of social media on communication during public health emergencies offers both opportunities and challenges. The spread of misinformation on social platforms can hinder official risk communication, highlighting the importance of effective strategies to combat false information,” he says.

Further, he adds, “It is crucial to educate the public on preventive measures, disease transmission, and the importance of early intervention for effective epidemic readiness.

“Addressing these challenges demands a comprehensive approach that includes sustained investments in healthcare infrastructure, capacity building for healthcare workers, improved governance and accountability, tailored risk communication strategies, enhanced surveillance systems, and strengthened partnerships with government agencies, civil society organizations, and international partners.

“Stigmatizing infectious diseases like COVID-19 can lead to limited knowledge and low compliance with infection prevention measures, thereby impeding efforts to control the virus's spread in communities.

Infrastructure in many Nigerian communities poses significant challenges?

Checks reveal that limited resources and infrastructure in many Nigerian communities pose significant challenges for preparing for epidemics. Inadequate healthcare facilities, shortages of medical supplies, and insufficient funding for public health initiatives can hinder the ability to respond effectively to outbreaks and provide necessary assistance to affected populations.

Furthermore, collaboration among government agencies, healthcare providers, private organizations, and community leaders is crucial for a coordinated response to epidemics.

However, challenges in establishing effective partnerships across different sectors and ensuring seamless communication between stakeholders can impede preparedness efforts at the community level.

Ensuring accurate information?
The source says that during public health emergencies, it is vital to have effective risk communication to ensure accurate information as shared with the public.

According to him, “In Nigeria, obstacles such as socio-cultural diversity, healthcare system complexity, and the impact of social media on communication can hinder the effectiveness of risk communication strategies, leading to misinformation and confusion among community members.

“The fear of stigma and social rejection for being labeled as a disease carrier can deter individuals from seeking timely healthcare when experiencing symptoms, potentially exacerbating virus spread and hindering early detection and containment efforts.”

Recommendation that ongoing educational initiatives be implemented?

Experts recommend that ongoing educational initiatives be implemented in Nigeria to improve awareness and preparedness for epidemics. These initiatives should target communities, healthcare professionals, policymakers, and other key stakeholders.

The goal is to educate the population on disease transmission, prevention strategies, early symptom recognition, and available healthcare resources. By doing so, Nigeria can enhance its population's ability to effectively handle public health emergencies. Although progress has been made in strengthening infrastructure to combat infectious disease outbreaks, there is still a crucial need to educate individuals from all sectors of society to enhance overall preparedness for managing such situations.

It is believed that in order for a country to effectively handle public health emergencies, it must have clear legal authority to take decisive action and the flexibility to adapt to changing situations. This authority is crucial not only during emergencies, but also in passing laws that promote preparedness and improve national health safety.

The World Health Organization acknowledges the importance of strong legal frameworks in a country's ability to prevent, detect, and address public health risks, as seen in its evaluation of epidemic readiness through Legal Instruments.

Those who are knowledgeable say that Nigeria faces challenges in epidemic preparedness awareness that impact its ability to respond to public health threats effectively. Overcoming these obstacles is vital to improving epidemic preparedness awareness in Nigeria and strengthening the country's response to future health threats.

Odimegwu Onwumere is the Chairman, Advocacy Network On Religious And Cultural Coexistence (ANORACC). He can be reached via: apoet_25 (at) yahoo (dot) com