How doctors’ strike, spike in infectious diseases, others shaped Nigeria’s health sector in 2021

How doctors’ strike, spike in infectious diseases, others shaped Nigeria’s health sector in 2021

Apart from security, there may be no other sector of Nigeria’s national economy that has been hard hit in the past two years than the health sector.

Nigeria started 2021 with the second wave of the COVID-19 pandemic, recording over a thousand cases on the first day of the year.

With the second wave having spread virulently, particularly during those first three weeks of January 2021, the spike in infections fed through into fatalities as hospitals and isolation centres increasingly became overwhelmed.

Infections had jumped more than six fold from December 2020, forcing the to reopen isolation centres that closed as the disease appeared to have ebbed.

Unlike its initial clumsy and snail-paced response to the outbreak of the pandemic in early 2020, the Nigerian through the presidential steering committee, the Nigeria Centre for Disease Control (NCDC)<, the National Primary Health Care Development Agency (NPHCDA) as well as agencies in some of the sub-national units, took numerous urgent steps and activated various policies geared towards the containment of the contagion.

But some of the policy responses have weaknesses and, taken together, are not commensurate with the magnitude of the problem, health experts say.

Although daily infections reduced as from early March when Nigeria flagged off its vaccination campaign, the outbreak regained momentum in early July with the discovery of the Delta variant. In August, the nation announced it had drifted into the third wave of the disease, with a spike in cases of Delta variant.

The NCDC announced the fourth wave of the coronavirus pandemic in Nigeria on December 20, 2021. It said the country recorded a 500 per cent increase in the number of confirmed cases within two weeks.

The Director-General of NCDC, Ifedayo Adefila, in a statement noted that the rise in infections has been linked to both the Delta and the recently discovered Omicron variants of the rampaging virus.

Nigeria on December 22 recorded its highest daily infection figure of 4,035 since the outbreak started just 24 hours after more than 2,000 cases were reported. The development simply indicated how fast the fourth wave was spreading.

COVID-19 vaccine. [CREDIT: Duetsche Welle]
COVID-19 vaccine. [CREDIT: Duetsche Welle]

Beyond COVID-19

Nigeria, in 2021, had an unprecedented spate of deaths from infectious diseases as more focus was channelled towards tackling coronavirus.

In fact, cholera alone claimed more lives in Nigeria than the dreaded coronavirus pandemic in 2021.

NCDC director, Mr Adetifa, in an interview during a TV program in December, said the country recorded “a little more than 3,600” deaths from cholera in 11 months in 2021 while the total fatalities recorded from coronavirus since 2020 when the index case was recorded still stands at 3,045 as of January 4, 2022.

Aside COVID-19 and cholera, suspected cases of Yellow fever and Lassa fever also claimed people across the country. For instance, the latest data from the disease centre indicates that 92 persons died of Lassa Fever in 2021, with states such as Ondo and Edo States accounting for most of the cases.

FILE: Doctors dressing up for their shift [PHOTO: THEWILL]
FILE: Doctors dressing up for their shift [PHOTO: THEWILL]

Doctors’ strike

Industrial crisis is a common occurrence within Nigeria’s health and education sectors, and 2021 was not different for the nation’s healthcare providers.

The prolonged strike action embarked upon by the National Association of Resident Doctors, NARD, in August, which lasted 63 days, was another major development that threatened the progress recorded in the fight against the pandemic during the year.

It was the fourth and longest industrial action by doctors since the beginning of the pandemic in 2020.

The complaints of the striking doctors include poor remuneration and poor working conditions.

NARD first protested against the delayed payment of salaries and allowances, the non-implementation of life insurance for doctors treating patients with COVID-19; non-funding of their residency programme, hazard allowances and some other unpaid arrears before finally embarking on the strike action.

During this period, the of Nigeria activated the “no work no pay” policy after failing in its attempts to reach an agreement with the NARD. Not even the decision to approach the National Industrial Court helped to resolve the crisis.

Brain drain

While the disagreement between the doctors and the was still lingering, many health workers heeded the call by the of the Kingdom of Saudi Arabia to migrate to the Arabian land for greener pastures.

Saudi Arabia, in partnership with some recruitment consultants, in August, ran a recruitment exercise in Nigeria.

In a widely circulated ‘Important Notice’ in the media, the Saudi Arabian authorities, declared, “There will be an interview session with the Ministry of Health delegates, Kingdom of Saudi Arabia, for consultants and specialists in all specialities, slated for 24th August 2021 at Sheraton Hotel, Abuja.” Earlier, it had held the Lagos leg of the exercise without much fuss.

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The recruitment exercise saw Nigerian doctors trooping in their hundreds for the opportunity.

It was not the first time authorities of foreign countries would enter Nigeria to hunt for medical professionals.

Aside Saudi Arabia, Nigerian doctors have been migrating to the U.S., Canada, the UK, India and many other nations across the globe.

It is estimated that at least 12 Nigerian doctors leave the shores of this country to practise overseas, weekly.

Sadly, the Nigerian on the other hand, has kept downplaying the crisis of ‘brain drain’ in the country.

The Minister of Labour, Chris Ngige, in 2019 had controversially claimed the country had ‘enough’ medical doctors to attend to the needs of Nigerians but did not provide any evidence to back his claims.

Meanwhile, data from the National Bureau of Statistics (NBS) has revealed that Nigeria currently has one doctor for every 7,690 patients.

This is a far cry from the recommendation of the United Nations and the WHO of one doctor to 600 patients.

Consequently, the spate of medical tourism which reduced due to lockdowns and flight restrictions in 2020 resumed in 2021.

President Muhammadu Buhari during the year resumed his frequent visit to the UK for medical care.

Vector of Lassa fever
Vector of Lassa fever

Other key highlights

One of the key moments of 2021 in the health sector was the appointment of Mr Adetifa to replace Chikwe Ihekweazu as the the head of the NCDC following the appointment of the latter as an assistant director-general of the global health body- WHO.

As NCDC director-general, Mr Ihekweazu had led the response to large outbreaks of infectious diseases such as yellow fever, Lassa fever and monkeypox.

Since the coronavirus outbreak in early 2020, Mr Ihekweazu led Nigeria’s public health response to the pandemic through the NCDC.

So when in September his appointment by WHO and the selection of his replacement was announced, it became a topic in the health sector.

Another key moment in the year was the 2021 National Council on Health (NCH) conference which was held early December in Abuja.

The two-day annual conference concluded with a resolution for a deliberate investment on Nigeria’s health security starting with drawing support for pharmaceutical and research agencies to produce locally developed vaccines.

The minister of health, Osagie Ehanire, in his opening remarks at the meeting, gave an update on various steps the was taking on local vaccine production in the country.

On 13 April, Nigeria joined other African countries in pledging to increase the share of vaccines manufactured in the continent from one per cent to 60 per cent by 2040. This includes building factories and bolstering capacity in research and development.

But for this ambitious goal to succeed, health experts say authorities in Africa must contend with several challenges that hindered the development of vaccines in the continent for decades.

The year also saw a lot of international aid organisations withdrawing their funding for several health issues they initially supported.

PREMIUM TIMES reported how the UK ended its annual three million pounds to fund family planning in Nigeria early in the year.

Experts speak

In a telephone interview with PREMIUM TIMES, the vice-chancellor of Ondo State University of Medical Science (UNIMED), Adesegun Fatusi, said for the year 2022 to be better for the health sector, it is important for the to back its promises with action.

He said, while that is easy to say, it may be misleading to argue that the failure of the to do so automatically amounts to insincerity without taking into consideration the overall macroeconomic dynamics.

“To move forward, the needs to continue to robustly engage with healthcare workers to find common grounds and a greater degree of flexibility from both parties is required for harmonious relationships,” the vice-chancellor said.

Immediate past Chairman, Lagos Medical Guild, Sodipo Oluwajimi, spoke to PREMIUM TIMES on the performance of the health sector in 2021, and some expectations for 2022.

The former chairman listed lack of political will and poor funding as major challenges confronting the sector and which he would want to be tackled head on.

Mr Oluwajimi said there is a need for constant reminder to the Nigerian leadership that health is a critical component that must be given the priority that it deserves.

He said: “So the funding now comes into play because we have seen that funding for health drops year in year out. It dropped in 2021, both at the federal and state levels and for a lot of states, it was abysmally low apart from a few exceptional cases.

“The states had very, very low investment in health and of course, that played out by a lot of challenges that came up with a lot of industrial action and of course, the citizens were the ones that suffered for it.”

On health funding strategies

Continuing, he said Nigeria needs to adopt the World Health Organisation (WHO)’s recommendations for funding of the budget for health and look at all the innovative ways to ensure that healthcare is funded.

“Some of those ways include health insurance. Nigeria is still performing very badly in terms of provision of health insurance for the citizens. Most people still pay out of pocket and we are having an increase in the number of non-communicable diseases.

“When COVID came, the emphasis shifted to infectious diseases. Malaria, HIV, waterborne diseases, which have always been traditionally what we face also suffered because a lot of funding was diverted from there to COVID-19,” Mr Oluwajimi said.

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