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COVID-19 pandemic, global
advisories and the imperatives
of strengthening the public
healthcare system: Nigeria
in context
Aliu Oladimeji Shodunke
Department of Criminology and Security Studies, University of Ilorin, Ilorin, Nigeria
Sodiq Abiodun Oladipupo
Department of Economics, Western Michigan University, Kalamazoo, Michigan, USA
Oluwadamisi Toluwalase Tayo-Ladega
School of Medical and Health Sciences, Bangor University, Bangor, UK
Adebusayo Joel Alowolodu
Department of Psychology, University of Ibadan, Ibadan, Nigeria, and
Yusuf Olalekan Adebayo
Department of Criminology and Security Studies, University of Ilorin, Ilorin, Nigeria
Abstract
Purpose –Given the efficacy of a robust public healthcare system in handling public health emergencies, the
rapid rate of COVID-19 pandemic infection in early-hit (advanced) countries with competent healthcare system
is intriguing. The popular public health argument supports the strengthening of the healthcare system as a
significant response strategy to minimize infection. Hence, this paper examines the catalysts that exacerbated
the pandemic’s rapid spread in these countries despite the sound state of their healthcare system. Also, it
assesses the condition of Nigerian public healthcare system in the lights of the novel COVID-19 pandemic and
suggests the need for improvement and effective functioning.
Design/methodology/approach –This paper uses a documentary approach to establish the authors’
opinion on the subject matter under investigation.
Findings –Factors such as climate, temperature, and humidity levels played a key role in infection in the
winter of 2020. These factors facilitated for the pandemic’s rapid spread in advanced countries. In peripheral
countries like Nigeria, the public healthcare system is burdened by a lack of funding, an insufficiency in welfare
and training for healthcare staff and facilities and other operational challenges. Hence, the effective
management of COVID-19 outbreak in Nigeria relative to advanced countries was hindered by the
inadequacies mentioned above.
Originality/value –This paper provides an understanding on the condition of public healthcare system in
peripheral nations in relation to the healthcare system advisories from the World Health Organization (WHO)
in the context of handling the pandemic outbreak. Also, it explains the catalysts that heightened the pandemic’s
rapid spread in advanced countries despite the higher capacity of their healthcare system to manage health
emergencies.
Keywords COVID-19, Climate, Public health, Nigeria, World health organization
Paper type Research paper
Introduction
Manifesting in the form ofmild and self-limiting respiratory tract illness,acute pneumonia and
multiple organ failure, theoutbreak and global spread of Severe Acute Respiratory Syndrome
COVID-19 and
Nigerian
healthcare
system
Declaration of Funding: This research did not receive any specific grant from funding agencies in the
public, commercial, or not-for-profit sector.
The current issue and full text archive of this journal is available on Emerald Insight at:
https://www.emerald.com/insight/2059-4631.htm
Received 12 June 2022
Revised 18 July 2022
Accepted 24 July 2022
International Journal of Health
Governance
© Emerald Publishing Limited
2059-4631
DOI 10.1108/IJHG-06-2022-0053
(SARS-CoV-2) known as coronavirus disease 2019 (COVID-19) pandemic has the potential of
causing human body malfunctioning, burdening public health and overpowering the public
healthcare system. The virus’s incubation period ranges from one to fourteen days, and the
disease can be transmitted by direct contact with a contaminated surface or an infected
person. Droplets produced by coughing and sneezing are also responsible for the transmission
of the disease. As of early June 2022, most mortality cases occurred in the US, Brazil, France,
Germany, UK, Italy, Russia, etc. (see Figure 1). Societies are being shaped by COVID-19
pandemic, an unprecedented public health emergency. Nigerian first index case was
recorded on February 27, 2020, with the arrival of an Italian national into the country. The
country’s number of confirmed cases has now snowballed to more than 250,000 as of early
June, 2022.
Thus, the Emergency Committee of the WHO met on January 30, 2020, under the 2005
International Health Regulations and issued public health advisories on the response,
mitigation and containment of the pandemic; reduction of international travel, the practice of
basic hygiene, the use a facemask while among other people, avoidance of touching one’s face
with unwashed hands, and maintenance of a social distance while in a crowd (Shodunke,
2022). Furthermore, the WHO essentially advised African countries with a weak healthcare
system to focus more on strengthening the healthcare system, increasing testing and tracing
rates, and focusing on other health interventions to catalyze the potential of stringent
lockdown as an effective non-therapeutic measure. However, advanced countries with
improved healthcare facilities, such as the US, UK, China, Italy, Australia, and France,
experienced a surge in the pandemic’s infection and casualty (Pachetti et al., 2020), thereby
raising a question on the effectiveness of an improved healthcare system to manage a
pandemic as catastrophic as COVID-19. Hence, this paper explains why an improved
healthcare system could not reduce the surge of infection in the advanced nations but is
necessary for infection containment in peripheral countries with a focus on Nigeria.
Figure 1.
Total cases of
COVID-19-induced
deaths
IJHG
The COVID-19 in advanced countries and climate
In advanced countries, climatic and weather conditions such as temperature, air quality and
humidity levels engineered the virality of the pandemic. Interestingly, the first few regions
where COVID-19 spread quickly; Italy, Iran, South Korea, and the United States (New York
and Washington, DC), had a climate similar to the origin of SARS-CoV-2 hotspots (Hubei and
Wuhan), with average temperatures ranging from 3 to 10 8C(Bukhari and Jameel, 2020).
Fontal et al. (2021) examined 162 countries spanning five continents on the global and
country-level role of temperature in COVID-19 infection.
The study established that in the 20 days after the first 20 cases in countries of the
Northern Hemisphere experienced a significant uptick in cases in the summer of 2021, a
cooler indoor microclimate during these months could accommodate transmission. The
Northern Hemisphere consists of advanced nations mostly. There was an early spread of
infection in 8 cities (Wuhan, China; Tokyo, Japan; Daegu, South Korea; Qom, Iran; Milan, Italy;
Paris, France; Seattle, US; and Madrid, Spain) in a latitudinal band between 308N and 508N,
with low humidity levels and temperatures between 5 8C and 11 8C(Sajadi et al., 2020). These
cities experienced a higher risk of substantial community spread of the pandemic.
In China, the pandemic’s origin, there was a significant correlation between weather and
infection of the pandemic (Byass, 2020). The two most critical environmental elements
contributing to the pandemic transmission in the early-hit countries are temperature and
humidity. Even throughout the period when the pandemic snowballed from a nascent disease
to a designated pandemic of international concern, locations with higher temperatures
(>20 8C) continued to have a smaller amount of confirmed SARS-CoV-2 cases compared to
those with reduced temperatures. According to Bukhari and Jameel (2020), during the month
of February and March of 2020, temperatures ranging from 3 degrees Celsius to 17 degrees
Celsius were responsible for 90% of SARS-CoV-2 transmissions. The pandemic trend tends to
be influenced by temperature; thus, it is seasonal.
COVID-19 and healthcare system in peripheral nations: Nigeria
Over time, African nations continue to experience weakness in the public healthcare system,
particularly in the increasing outbreaks of epidemics such as Ebola, polio, coronavirus and
monkeypox. As a result of the shortage in the necessary medical supplies in the African
health system, it was projected that between 9 and 11% of infected patients in Africa would
require intensive care (Remuzzi and Remuzzi, 2020). According to Ayebale et al. (2020), Africa
has fewer than one acute care bed for every 100,000 residents. Healthcare across the continent
is underfunded, with fewer hospital beds, critical care units and health professionals.
The current COVID-19 was expected to severely impact Africa, which has the most
vulnerable people to infectious illnesses. According to the 2016 Infectious Disease
Vulnerability Index (IDVI), 22 of the 25 most-susceptible nations to infectious diseases are
in Africa. Twenty-six million people in Africa are infected with HIV, 2.5 million with
Tuberculosis, 71 million with hepatitis B or C, and 213 million with malaria (Lone and Ahmad,
2020). However, in handling COVID-19 cases in (the peripheral nations) Africa, the challenges
have been more of the incapacity of the public healthcare system. Beyond disease profile, the
constrained testing capacity, a scarcity of trained personnel for diagnostics and intensive
care units (ICU), insufficient ventilators and ICU facilities (necessary in extreme COVID-19
cases), a lack of personal protective equipment (PPE) for healthcare workers, and a shortage
of funds for the health sector are some of the continent’s core healthcare issues, making it
more vulnerable to the COVID-19 pandemic.
In Nigeria, the present national health system cannot effectively manage the expanding
demands of vulnerable people and patients who are already infected and require admission
into critical care units to treat COVID-19: isolation facilities and obtainability of diagnostic
COVID-19 and
Nigerian
healthcare
system
supplies (Ohia et al., 2020). The existing facilities are burdened with the vulnerable
population’s common health conditions such as diabetes, cancer, high blood pressure,
meningitis, stroke and tuberculosis, and cardiovascular ailments. According to the World
Health Organisation, Tuberculosis remains a major health issue in Nigeria, ranking 5th
among the 22 excessive tuberculosis-ravaged nations. Additionally, the country’s cases of
death from meningitis, stroke and diabetes reached 2.95%, 3.90% and 1.52%, respectively, in
2020. A projected 72,000 mortalities occur yearly and 102,000 new cases are diagnosed
(Fatiregun et al., 2020). The facilities and equipment (including ventilators and personal
protective equipment) are inadequate to deal with the health emergencies caused by
COVID-19.
As reported by the health authorities, bed spaces for COVID-19 patients are in shortage
while the confirmed cases keep increasing, thus necessitating the use of home care. Although
the number of isolation facilities and intensive care unit (ICU) capacity in the country is
increasing, several states were still struggling to build isolation and treatment facilities
around May 2020. Furthermore, in rural regions, where more than 60% of Nigerians live,
health facilities and staff are in shortage (Amzat and Razum, 2017). Public health
departments are ill-equipped to deal with the COVID-19 epidemic because of inadequate
preparation and funding constraints.
Amidst the surge of COVID-19 confirmed cases, the government attempted to slash the
healthcare budgetary allocation, which could further emasculate the response efforts and
weaken the health system. According to Adebisi et al. (2020), the recent fiscal allocation
showed that only 372.70 billion and 463.80 representing 4.22% and 4.38% of the nation’s
budget in 2019 (8.8 trillion) and 2020 (10.5 trillion), respectively (see Figure 2) as against the
15% minimum target set by the African Union in Abuja in 2001 (The Abuja Declaration).
Even in 2021, the year following the pandemic-hit year when the pandemic should have
triggered the government to invest more in the healthcare system, a budgetary allocation of
592.16 billion (4.52% of the total budget) was still below the Union’s standard. This situation
further amplifies the lack of political leadership to improve the system satisfactorily.
Figure 2.
The annual budgetary
allocation for health
from 2014 to 2020
IJHG
In terms of disease control and prevention (IPC), healthcare workers are not well equipped
with the necessary training and protective tools. There is an inadequacy in personal
protective equipment (PPE), IPC management systems, trauma care and patients’hazard
evaluation actions, low employee morale due to shortage in hazard allowances and
deteriorating infrastructure in health facilities. In addition to IPC, Nigeria still lags due to the
lack of funds to put in place testing facilities. In a country of over 200 million citizens, only
2,180,444 diagnostic tests had been done by the Nigeria Center for Diseases Control (NCDC) as
of June 10 2021, 15 months after recording the national index case (Nigeria Centre for Disease
Control, 2021), thus lending credence to the incapability of the healthcare system to treat the
infected patients.
Furthermore, access to health insurance by Nigerians is another issue facing the
healthcare section. Health insurance is available to just 2.3% of the national population;
private insurance is the most common type for this portion (Barasa et al., 2021). Most
Nigerians pay for their medical treatment, including doctor visits, testing in the lab, and
prescription drugs. There is a 72% out-of-pocket payment component to Nigeria’s overall
healthcare costs (United Nations, 2020). More than 70% of Nigeria’s population comprises
lower-class residents who cannot afford comprehensive healthcare, which hinders their
healthcare-seeking behaviors (Asakitikpi, 2019).
However, the government and relevant health authorities have deployed the resources to
contain and prevent the epidemic. The NCDC, on January 7, 2020, issued a new viral alert,
following reports of coronavirus infection in Wuhan, China, in December 2019 as part of the
country’s preparedness. Additionally, on January 26, 2020, the NCDC instituted the National
Coronavirus Preparedness Group (NCPG) to coordinate the country’s preparedness measures
better. By utilizing and optimizing three existing NCDC molecular laboratory networks, the
NCPG was able to increase in-country diagnostic capacity for the testing of COVID-19, as well
as analyze existing infectious disease treatment centers to identify gaps and establish case
management strategies.
Following the confirmation of the first COVID-19 case in the country on February 27, 2020,
the NCPG transitioned to a national multisectoral Emergency Operations Centre (EOC) at the
NCDC. The EOC was activated at level three, the highest level of response in the country
intended for public health emergencies requiring national coordination and use of all
available resources for the response. The EOC comprises multiple pillars: coordination,
surveillance and epidemiology, case management, laboratory, points of entry (PoE), IPC, risk
communication, logistics, and research. To assist in financially equipping the NCDC and its
facilities, the government intended to set up a 500 billion-naira ($1.39 billion) coronavirus
fund (Africanews, 2020).
In addition, the Tertiary Education Trust Fund, the NCDC and other relevant authorities
instituted the National COVID-19 Research Consortium, which consists of academics and
researchers to research effective prevention and control of the pandemic (Etteh et al., 2020).
From the private sector and international community, Coalition Against COVID-19
(CACOVID) funded the government’s response and containment efforts with $70 million
for establishing isolation centers, providing medical facilities and providing relief materials
to the citizens (Elebesunu et al., 2021). The European Union contributed an amount of 50
million euros. To boost available medical facilities, the WHO supplied 26 ventilators and
3,560 fingertip oxygen pulse oximeters to help Nigeria prepare for the third wave of
COVID-19, which is being triggered by the Delta variant (ReliefWeb, 2021). The World Bank
also donated a credit facility of $400 million to the Nigerian government to facilitate upfront
financing of the procurement and deployment of COVID-19 vaccine (World Bank, 2020). The
NCDC is at the forefront of coordinating the national response to disease outbreaks. As such,
it works with its international partners to enhance capacity building to respond to the disease
outbreak, including rapid case detection and diagnosis and adopting innovative techniques
COVID-19 and
Nigerian
healthcare
system
to educate and sensitize the country. Meanwhile, the WHO, Nigerian governments, health
authorities, non-governmental organizations (NGOs), and the academic community are
needed to find a solution.
Conclusion
Given the virulence and sophistication of the pandemic, which weakened the health system in
advanced and peripheral nations, it becomes imperative to illuminate on the exogenous
factors that worsened infection speed and containment efforts. Previous global and country-
wide studies observed that climate, temperature and humidity levels played a crucial role in
spreading the virus in advanced countries. The air compartment is substantially
instrumental in the transmission of COVID-19 in those developed nations located between
latitudes between 308N and 508N, particularly in terms of climatic parameters, including
weather conditions, temperature, humidity, and air pollution.
Hence, those indices were considered necessary when designing management measures.
However, the public health system inadequacies are responsible for the ineffectiveness of
managing COVID-19 cases in peripheral nations such as Nigeria relative to advanced
countries. These arguments should then serve as a basis for understanding the WHO’s
discourse on the public healthcare system and COVID-19 management. The burden of
managing the epidemic in the public healthcare sector in peripheral nations; Nigeria, includes
a lack of funds and political leadership, lack of coordination in infection prevention and
control, poor health insurance, insufficient welfare and training for healthcare employees,
inadequate healthcare personnel to manage the patients, scarcity in medical resources
(personal protective equipment [PPE], diagnostic kits and ventilators), inadequate facilities
and treatment centers, among others. Nigeria’s relatively weak healthcare system and profile
of previous diseases necessitated the WHO to categorize the country as one of the 13 high-risk
African countries concerning the spread of COVID-19. A country’s ability to handle a disease
outbreak depends on the capacity of its healthcare system.
Although Nigeria maintained a case fatality rate of 1.3%, which is less than half the
regional average, since the past two waves were contained, much needs to be done to address
the deficits in the health sectors. Therefore, strengthening the system remains a significant
preparation for managing, containing and preventing an epidemic. Interestingly, the
automation of COVID-19 management helped the pandemic origin, China, to manage the
response and containment efforts. The epidemic serves as a wake-up call for the Nigerian
government to invest massively and satisfactorily in the healthcare system and address
public health vulnerability drivers. Due to an epidemic’s global dimension, response and
prevention efforts should be international if the reoccurrence of such an epidemic like
COVID-19 is to be avoided. Investment efforts should include a partnership with the private
sector and international bodies such as Africa Centres for Disease Control and Prevention
(Africa CDC) United States Centres for Disease Control and Prevention (US, CDC) and the
WHO to strengthen the health system through information sharing, training and research.
Nationally, the government should focus more on adequate funding, equipment of medical
facilities, digitalization of the health service, national health coverage, surveillance and
provision of medication. There should be measures on strengthening institutional capacity
for detection, prevention, and control, as well as providing crucial infrastructure to enable
heightened monitoring and early identification of suspected cases and provision of facilities
for adequate medical care. In addition, cooperative approaches, high-quality laboratory
systems, and affordable diagnostic services should be priorities as they are essential to
achieving standard healthcare for the citizens. At the same time, the health authorities should
intensify on enlightening the citizenry on the need to obey social distancing regulations,
proper hygienic practices and adherence to other public health safety protocols.
IJHG
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Corresponding author
Aliu Oladimeji Shodunke can be contacted at: oa.shodunke@gmail.com
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