COVID-19 Nigeria by Mories Atoki & Georgios Radoglou

Mories Atoki
CEO ABCHealth
Georgios Radaglou
Partner Climax-X
COVID Realities in green on white
A tale of a poor African country’s struggles with
a mighty pandemic -
Is the “Happy End” possible and how?
"When health is absent, ‘wisdom’ cannot reveal itself, ‘art’ cannot manifest, ‘strength’ cannot fight, ‘wealth’ becomes
useless, and ‘intelligence’ cannot be applied." – Herophilus

Ever before COVID-19 hit West Africa, Nigeria’s health sector was already facing huge challenges – the country is one of
the biggest contributors to Africa’s disease burden and the more astute have traced this to years of wrong spending priorities
and a cultivated leaders’ attitude of “Dirt can’t kill African man”. Some say financial mismanagement of allocated funds for
the health sector paired with unbridled corruption and incompetence further exacerbate the pursuit of those wrong priorities.
Amidst the Global COVID-19 pandemic, the Federal Government even decided to cut the health budget from N44.4bn to
25.5bn whilst allocating N27bn to the renovation of the Nigerian National Assembly building complex (source: Daily Post
03.06.2020).
Currently being the poverty capital of the world with over 95mn citizens amongst the poorest, unseating India of this dubious
recognition in 2019, Nigeria’s government seem to be at odds on how to tackle the country’s poor health narratives as
political and traditional office holders’ responsive discordant expressions became more audible in light of the uncoordinated
efforts to tackle the pandemic.
It could be time consuming to trace the issues but in order to provide the necessary perspectives, it is essential for one to
understand that Nigeria, at its best of times, has only committed 4.5% of its national budget to health, which is less than a
third of the Abuja Declaration of 2001which committed to 15% of the Annual National Budget. Worse still, after subsequent
A public healthcare facility in Nigeria
years of low budget implementation, it is fair to say that less than this 4.5% gets spent wisely at any given time and even
worse, a substantial portion of the released funds end up being misappropriated. Corruption thus significantly undermines
efforts to achieve UN Sustainable Development Goal 3, which is to “ensure healthy lives and promote well-being for all at
all ages”.
“Extremely poor. The medical facilities are
poor. We operate a predatory, neocolonial
capitalist system, which is founded on
fraud and exploitation, and therefore, you
are bound to have corruption…”
- Falz in his ‘This Is Nigeria’ song released
in May 2018
As if that was not already enough, the COVID-
19 crisis met Nigeria with depleted financial
reserves in addition to a sudden collapse of Oil
prices, cutting the inflow of revenues for the FG
financial apparatus by almost 90%.
Nigeria's 2020 budget breakdown

Graph above: Nigeria Healthcare spending (source: World Bank)
Private admissions by United Nations personnel indicate that Nigeria’s health sector is literally a tale of two cities – on paper,
the sector is vibrant and delivering value for investments but in reality, facilities are simply neglected buildings lacking
competent & qualified staff, functional equipment, basic medication and basic functionalities in general.

Doctors protest poor conditions and health infrastructure
Following the expose of neglect and decadence by COVID-19’s illumination of the sector, it becomes obvious that by far
not enough has been done and, to correct the narrative, an emergency of national proportions must be declared
especially, putting the public and private health sector to the top of national priorities and political agenda and consequently
address the deficits with a national joint effort.
While the current pandemic has revealed its intention of staying around for a long time, th e ugly reality of the immediate
past of our battles with ill-health on multiple fronts including communicable diseases (CDs), non-communicable diseases
(NCDs), tropical diseases (TDs) and neglected tropical diseases (NTDs) keeps haunting us.
COVID-19 is ‘just another day’ as the saying goes, proofs to be a trap that has mislead many parts of the Globe. COVID-
19 is a globally spread aggressive pandemic and shall not be compared to an epidemic which is regionally contained. While
many stakeholders consider this pandemic a turning point for the country using the Ebola crisis as a point of reference, it is
important to layer the dynamics of both situations.
The outbreak of Ebola Virus Disease began in Guinea in December 2013 and quickly spread to Liberia and Sierra Leone,
causing devastation in all three countries. Nigeria responded quickly enough by putting measures in place to ensure its
citizen’s safety. Despite the measures, the country recorded its first EVD case in the form of a Liberian diplomat who, aware
of his infectious status, circumvented the safety measures to enter the country before ending up in a hospital where the
foresight of medical personnel there and their subsequent sacrifice successfully contained the virus in Nigeria.
A total of nineteen (19) Nigerians lost their lives to the virus
– most of them medical personnel of the hospital where
patient zero was quarantined – and the country was
celebrated for its response. However, there are many who
believed the government was taking undue credit and
hyping its capacity to deal with particular problems even if
there is political commitment to mobilize the country and
COVD-19 seems to bear them out.
Consider the measures government put in place to stop
the Coronavirus getting into the country. Reminiscent of
Ebola times, reluctantly screening was set up at the
airports but for many, it was clear that the government had
not updated or even upgraded its pandemic response
playbook – there was no increase in the number of
screening machines and procedures to track passenger
after passing through immigration were not effective,
Passengers being screened at an airport in Lagos

airports continued to operate, receiving flights from countries already hard hit by the pandemic while land and sea borders
continued to function with little or no screening or safety checks.
When the country started to see infections and the attendant rise in cases and subsequently deaths, several guidelines
were issued including ones stating that private hospitals would not be allowed to treat suspected infected cases and that
bodies of COVID-19 fatalities would not be released to their families for burial but these guidelines were flouted with
impunity.
Security agencies enforcing the lockdown in Lagos
Business as usual after lockdown ease in Lagos
Then the lockdown was enforced initially in three Federal states – Abuja, Lagos and Ogun – before the national extension
during which citizens, most of whom depended on the daily revenue generated from an informal economy, were forced to
endure hunger. Insecurity rose as people came to terms with the desperation to survive. Security agencies, seemingly
interested only in enforcing the lockdown, were complicit in the assault and even murder of suffering, innocent citizens while
gangs of hungry youths, armed with primitive weapons, freely harassed communities forcing residents to seek selfprotection.
Now that the lockdown is over and a curfew imposed nationally, cases have leaped and as at May 31, Nigeria has officially
over 10,000 confirmed COVID-19 cases and reached 300 COVID-19 related fatalities (vs. 19 from Ebola in 2014). But let
us not be cheating ourselves and admit that all of us feel that there is a grey zone based on very low number of tests
compared to the total population and there are deaths, like those in Kano, which disregarding the WHO committee jointly
investigating them with NCDC and attributing them to COVID-19, not being accounted for in the National statistics. When
the COVID-19 cases began in March and the statistics showed a flat curve, Nigeria would show the same correlation
between number of tests and identified COVID-19 infection cases as the rest of the world, being 8-9%. Meanwhile and
especially after loosening the lockdown after May 6 th this percentage grew to reach almost 20%. This is a significant indicator
for the ongoing crisis and when projected to the total Nigerian population creates shock and awe for a potentially catastrophic
real situation. COVID-19 cannot be controlled and Nigeria must put up guards to learn to live with it whilst mitigating its
impact.
The difficult situation today could have been prevented, but given the potential of COVID-19 to generate subsequent
infection waves, Nigeria needs to prepare for a “continual management” of the disease and the way forward needs to include
amongst many measures:
one – to put in place effective measures to guarantee food security which, while already a main challenge pre- and during
the pandemic, if achieved would contribute to a mitigation in consequences of the diseases spread and impact;
two – to place priority on extensive rapid response testing focusing on extent, speed and quality in relation to the population.
As at the end of May, Nigeria had tested only about 50,000 citizens in a population of almost 200 million;
three – to ensure the continual protection of exposed professional groups with the provision of PPE, clear orders to security
agencies on the exemption of those providing essential services from movement restrictions and adequate financial
provisions to cater for hazards;
four, to achieve national unity in dealing with the virus especially amongst political and traditional office holders whose
discordant tunes could have the effect of hampering control and mitigation measures;
five, to source transparent and accurate data on the country’s population, health statistics and the vulnerable; and
six, to engage the private sector in a way that resources would be coalesced and optimized to improve health systems
across the country with a post-pandemic outlook.

None of these were necessary to combat the epidemic
Ebola and as such, did not come into play for the dynamics
to be better understood, refined and deployed for the
“global COVID-19 pandemic” hence what is being
witnessed today. As a matter of fact, one key dynamic that
came to play with this global pandemic which was not
present during the Ebola crisis was this – Nigeria’s elites
could not travel out of the country to access quality medical
care. This singular happenstance is the cornerstone that
many believe will alter the mindsets of those charged with
governing Nigeria – the realization that the only medical
Airports across the country shutdown
access that will be available is their country’s own public
healthcare system, a system that is ordinarily debilitated by
poor coordination, a lack of accountability, few incentives to improve performance and a lack of resources at the frontline.
These problems can be traced back to Nigeria’s competitive political settlement where the political elite frequently use state
resources to maintain the support of their allies and to co-opt potential rivals into accepting the status-quo. This situation,
while enabling a semblance of political stability in the short term, only serves to undermine the effectiveness of the public
sector in the long term as seen in the case of the health sector where the average citizen is left without access to quality or
affordable healthcare.
Granted, while the government seems to recognize moments of catastrophic threat and pull together political and technical
resources to head it off, this is not a viable or sustainable approach and cannot be practical. For instance, Nigeria has
recently had Lassa fever and Avian flu epidemics, but these were not addressed with the kind of technical, coordinated and
efficient leadership seen during Ebola or COVID-19 and why should it? Is it not time for the entire healthcare system to be
restructured and reorganized to manage public health efficiently and contribute to the Nigerian Nation’s resilience for the
coming challenges?
Tragically, COVID-19 is affecting Nigerian society much more broadly and deeply than the Ebola outbreak did. To respond
effectively, the country will need to strengthen the capacity of the public sector across the board. Federal State governments,
as well as the overarching Federal Government, must each lead their populations through the health and economic crisis.
The legacies of past governors will be significant, but each state can chart its own course through the pandemic. Some may
generate narratives of unity, such as in Ekiti State, where the governor has announced a 50 percent pay cut for his political
appointees in order to fund the state’s crisis response while others abdicate responsibility laying blame on the Federal
Government for abandoning its responsibility to the States while citizens die in droves as in the case of Kano State. However,
there are also deeply contrary extreme narratives where state governments deny the existence of the disease within their
borders as in the case of Kogi State where the governor has refuted the NCDC’s report of infections in the state and on the
opposite the governor of Benue state seeking economic benefits for his state by inflating the negligible COVID-19 infection
cases and maintaining them at the same level for weeks.
Following the rapid spread of COVID-19 in Nigeria after the lockdown, there are growing calls for sincerity on the parts of
the authorities, the health workers and citizens.
Graves in Kano following the state's government’s slow response

It also demands vigilance from civil society organizations and the mass media to foster accountability. Front line
organizations and institutions tasked with improving health outcomes in the country must commence support to aid the
efforts and mitigate the risks and hazards to the Nigerian society by engaging in continually effective actions including but
not limited to:
1) Campaigning for an opening of the borders for imports of quality food (basically protein), improve customs and import
procedures, eliminate middlemen by finding ways to sell at lower prices to the end consumer. Post COVID-19 there will be
no room for profiteering middlemen who do not contribute anything to the supply chain but holding up their open hands to
collect an unjustified share, while contributing to an unnecessary increase of cost for the end consumer
2) Providing cheap, qualitative and rapid response test kits in abundant quantity and help the quick identification and instant
response to infected persons timely and spatially and only in second level with expensive and rare PCR machines and
tests, which apparently limits Nigeria’s testing ability significantly

3) Providing the necessary personal and collective protective equipment (PPE&CPE), such as face shields, sneeze guards,
quality nose masks, quality disinfectants (sanitizers with above 65% alcohol and medical spirit) and many more at real cost
and in sufficient quality to the “exposed professional groups” and sectors identified, as there are Airports, Banks, Public
transport, Court houses, Educational institutions, Authorities, Shopping malls and retail in general
4) Embarking on a massive and concerted sensitization campaign directed at the public to ensure the imbibing of safe and
best practices towards limiting spread
5) Engaging the heads of public and private sector institutions, organizations and businesses to extend work-from-safe
locations policy in a bit to further reduce citizens’ movement
6) Combat corruption in the Health sector to reduce cost and increase efficiency and quality of service. Nigeria’s healthcare
sector must be supported through adequate funding, incentives for health workers, and healthcare subsidies for the most
vulnerable people.
In a midterm approach, the exposed sectors need to have health & safety concepts and strategies as well as proper
monitoring in regards to COVID-19 mitigation measures and programs while the training of the exposed professionals and
essential service providers must be thoroughly planned and executed on a continually effective basis. This could be
addressed with ‘train the trainer’ systems to achieve a pyramid-like cascading effect of the knowledge needed.
In a long-term approach, a campaign to support the repatriation of “dormant” Nigerian capital, stashed in offshore accounts
by Nigerian entrepreneurs and politicians to be utilized for the public good. This initiative should be supported by FMoF and
CBN incentives (tax - and legal amnesties), documented and channeled to support the restructuring and improvement of
the Nigerian Health Sector whilst in parallel the ability and processes for investments in the Health sector must be optimized
and boosted in combination with a boost in qualification and training of the Health sector workers.
There are organizations which have already started activities in this direction – they should be supported by every
stakeholder in the “Nigeria project”.
There can be no real growth without healthy populations.
No sustainable development without tackling disease and malnutrition.
No international security without assisting crisis-ridden countries…….
..and No hope for the spread of freedom, democracy and human dignity unless we treat HEALTH as a basic human right.
-- Gro Brundtland