On February 28, the day after the first Covid-19 case was detected in Nigeria, the Nigerian Centre for Disease Control (NCDC) established an incident action plan that was estimated to cost N1.6bn ($4.2m). The NCDC sent the plan and a request for funds to donors and development partners such as the ADF; the World Bank; the UK’s Foreign, Commonwealth and Development Office; the US Agency for International Development; and the Bill and Melinda Gates Foundation.
Various partners made commitments based on the most urgent needs. The ADF, for instance, provided N200m ($520,000) for point-of-entry, surveillance and case management responses. Due to the country’s previous experience with Ebola, Nigeria already had materials, strategies and plans that could be activated
at all points of entry, including the use of body temperature scanners at airports and the surveillance outbreak response management and analysis system (SORMAS), which was scaled up to provide the NCDC with a clear overview of epidemiological developments.
Soon after this initial response, private sector leaders realised that more funds were necessary to mount a full response to Covid-19. Early on the private sector was well aware of the potential of the virus to cause major disruptions, and individual companies activated response plans. With a shared sense of responsibility and the common interest to ensure the pandemic was managed as well as possible to ensure a quick return to business, the private sector-led CACOVID initiative was launched on March 26, 2020.
How did CACOVID respond to the early stages of the outbreak?
YOUSSOUFOU: With all major banks and most other large companies in the country contributing funds, we quickly had N25bn ($65m) available. In addition to raising funds, CACOVID needed an intelligent way to disburse them. To this end, we convened a technical group that consisted of some of the most knowledgeable public health experts in the country.
Equipped with medical expertise, funds and organisational capacity, the coalition was able to focus on acquiring and distributing urgent supplies across the country. This included scaling up testing capacity from 38,000 to 600,000 tests – an important achievement since, at that time, most globally available testing material was already dedicated to countries that were facing a much bigger caseload and disease burden.
We also spent a lot on advocacy, communication and outreach, as well as physical health infrastructure. Nigeria needed isolation centres across the country, so CACOVID supported 39 to ensure a minimum capacity of 100 beds in every state and the Federal Capital Territory. There is one in each state, and two each in Abuja and Kano.
When the lockdown was implemented, shutting down Lagos and Abuja and restricting interstate movement, the most urgent crisis became the threat to people’s livelihoods. We knew that people would starve without immediate relief, so we arranged for food for the most vulnerable 5% of the population – approximately 10m people across 1.7m households. We are still in the process of distributing hot food, bread and other essentials. At the same time, with Nigerians returning from abroad, there is a need to test and trace everyone at points of entry, so our efforts continue in that realm as well.
In light of Covid-19, what are the most pressing areas for investment in Nigeria’s health care system?
YOUSSOUFOU: The pandemic has exposed a large number of gaps in our health infrastructure and organisational culture, and underscored the urgency for Nigeria to become more deliberate and self-reliant. At the moment, the country is very dependent on imports for even basic drugs and personal protective equipment. There are not enough local pharmaceutical factories or manufacturing facilities to provide medical essentials such as saline solution, gloves and surgical masks. With international shortages and supply chain disruptions, combined with an economic crisis and pressure on the US dollar-naira exchange rate, it has become very apparent that we need to reduce our dependence on external goods.
However, the biggest gap in health care remains the lack of human capacity. The number of nurses, doctors and health care professionals available in the country is limited. Even if we are able to source enough equipment, we need to invest in personnel capable of operating it.
This has provided a major opportunity to reset: an opportunity to rethink the areas in which we as a country can invest that were less appreciated before – not just in the health space, but also in food security and domestic industry. The twin challenges of the oil price crash and Covid-19 have made it obvious that we need to do things differently. The effective response of our private sector alliance, which also collaborated extensively with the public sector, can provide a blueprint for a future where private sector entities work more directly with government. Natural partnerships between the government and private companies could help provide solutions across many sectors including infrastructure, power, health and agriculture.