Effect of Coronavirus Pandemic on Nigeria's Already Fragile Public Healthcare System; Incidence, Approach So Far and Recommended Interventions.

DEBORAH ADEDIGBA

Abstract

The occurrence of the coronavirus pandemic has further exposed the inadequacy and fragility of Nigeria's healthcare system. Major challenges of Nigeria's healthcare system include poor health infrastructure, facilities and equipment, insufficient financial investment and funding, lack of sufficient health workers due to poor remuneration and hence leading to brain drain and emigration of health workers, poor quality of healthcare services, inability of citizens especially the poor and vulnerable populace to afford healthcare, poor dissemination and education of health information to the public such as preventions, health promotion, hygiene, lack of sufficient medications, low rate of universal health coverage and corruption.

The aim of this research paper is to explore the effects of coronavirus on the preexisting challenges of Nigeria's healthcare system, the approaches so far and possible interventions to contain and manage the pandemic. Diverse search terminologies with popular search engines such as Google, Wikipedia and Google Scholarly were used. Reports were gotten from newspapers and webpages of Nigeria Centre for Disease Control. Data was also gotten from articles and journals. This is a desk based research.

It was found out that the Nigeria Healthcare system has only being patched thus far and is in need of a major renovation. If the healthcare system was more functional and better equipped, fighting the pandemic would be a lot easier on the health workers and the nation at large and the risk reduced. The approach so far by the authorities has been helpful but there is still need for more implemented interventions as there seems to be more talk than action. Recommended Interventions include the need for more testing across the 36 States and the FCT with at least a laboratory in each test and more isolation and treatment centres in each state. Strengthening of health centres via trainings and remuneration was also suggested coupled with ensuring availability of promotional and preventive health services available for low-income and vulnerable communities. Transparent, recorded, monitored evaluation of relief aid to citizens was recommended coupled with strategic financial plans to cushion the effect of the pandemic economically.

Often times, it has been said that Nigeria needs restructuring but fact is the structure on ground is enough to address situations if properly followed. A state by state intervention will help the authorities cover more grounds and reach more grassroots communities. Each state has a number of Local Government Area further divided into Wards comprising communities. If testing, distribution of palliatives, strengthening of primary health centres and other recommended interventions will be done along these channels, it will be a faster approach to fighting the coronavirus, more like a divide and rule system. We are a country of 200 million people, the number seems vague and unreachable but broken down into states and local government area it is less ambiguous. A generalised or centre approach will be less effective and will not reach the grassroots. It is my suggestion that a State-Local Government-Ward-Communities-Families-Individual channel be used with proper documentation, high level of transparency, monitoring and evaluation structure is adopted in fighting this virus.

Keywords: Coronavirus pandemic, Public Healthcare System, Nigeria, Recommended Interventions.

Introduction

It's no more news that the world is going through a pandemic, that is the disease is global and spreading across countries of the world. The Coronavirus disease (COVID-19) is an infectious disease caused by a novel virus. Coronavirus disease spreads primarily through contact with an infected person when they cough or sneeze. It also spreads when a person touches a surface or object that has the virus on it, then touches their eyes, nose, or mouth. The coronavirus belongs to a family of viruses that may cause various symptoms such as pneumonia, fever, breathing difficulty, and lung infection (WWHC, 2020). These viruses are common in animals worldwide, but very few cases have been known to affect humans. The World Health Organization (WHO) used the term 2019 novel coronavirus to refer to a coronavirus that affected the lower respiratory tract of patients with pneumonia in Wuhan, China on 29 December 2019. The WHO announced that the official name of the 2019 novel coronavirus is coronavirus disease (COVID-19) (WHO, 2020) And the current reference name for the virus is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was reported that a cluster of patients with pneumonia of unknown cause was linked to a local Huanan South China Seafood Market in Wuhan, Hubei Province, China in December 2019(Zhu et al, 2019)

As of 4pm BST on April 14, there have been 2,182,187 cases of coronavirus across the globe, according to John Hopkins University in the US. The actual number could be even greater, though, as many people haven't been tested. So far 147,357 people have died from the killer bug. The US has the highest number of positive cases with 678,210 and 34,641 deaths. Behind them is Spain, who have seen 184,948 cases, while recording 19,315 deaths. Italy has 168,941 cases, the third highest number of infections - but a higher fatality rate than Italy with a total death toll of 22,170. France is fourth on the list with 165,027 cases and 17,920 deaths. China after a reported flat line in infections, with just 82,692 cases and 4,632 deaths appeared to be emerging on the other side of the crisis, but there has been a fresh spike in cases and deaths in recent days. (Tiplady-Bishop et al, 2020). COVID-19 has now been declared as a Public Health Emergency of International Concern by the WHO (WHO, 2020)

Figure 1: Total number of cases and deaths in 7 countries with highest numbers of incidence. Source: The Sun UK as at April 18th 2020

Public Healthcare System in Nigeria

The state of public healthcare in Nigeria is rather considered poor and this contributes to the already high rate of poverty and diseases. The 2018 Health access quality (HAQ) index, which measures the quality and accessibility of healthcare based on 32 causes of death which is preventable with effective medical care, ranked Nigeria 187 out of 195 countries, beneath Egypt (64th), Kenya (112th) South-Africa (119th) and Rwanda (173rd). Similarly, the 2018 World Health Organisation (WHO) data on life expectancy at birth (total years), which captures how long, on the average, a new-born baby is expected to live given constancy in death rate, ranked Nigeria 178 out of 192 countries. Total life expectancy in Nigeria, according to the data, stood at 55.2 years, below Rwanda (68years), South Africa (63.6 years), Kenya (66.7 years) and Egypt (70.5 years). Nigerias life expectancy is tangibly below the average across the whole continent, which settled at 62.5 years. (Odubola, 2018)

According to the World Health Organization (WHO), Nigeria had the second highest number of annual maternal deaths in the world in 2010 and contributed 14% of all maternal deaths globally(Gilda et al, 2007) Nigeria has a maternal mortality ratio of about 814 per 100,000 live births as at 2015 (WHO, 2015)

The lack of trained health care attended births in Nigeria is compounded by the fact that only six in ten mothers receive antenatal care from a trained medical professional. The consequences of the poor state of pregnant women in Nigeria are numerous and affect maternal as well as child mortality. The under-five mortality ratio in Nigeria is 201 per 1000 live births meaning that one in five Nigerian children never reach the age of 5. Infant deaths, which account for half of child mortality have increased from what they were in 1990. With a 13% immunization rate for children between 12-23 months, Nigeria is the African country with the lowest vaccination rate. (WHO, 2020) All these data show that the Nigeria Public healthcare system is poor and not functioning to its maximal potential.

Nigeria, Health Insurance and Universal Health Coverage

The Nigerian health system has been evolving over the years through various health care reforms aimed at tackling the public health challenges in the country. For instance, the National Health Insurance Scheme (NHIS), the National Immunisation Coverage Scheme (NICS), the Midwives Service Scheme (MSS) and the Nigerian Pay for Performance scheme are some of the reforms which should ordinarily address the health care challenges faced in the country. The NHIS was launched in 2005 however; news reports and statistics have shown that the scheme only covers less than 10 percent of Nigerians. This implies that most of the vulnerable populations are left at the pity of health care services which in most cases are not affordable. (NOIPolls, 2019)

Given the above background, NOIPolls presents findings from its previous poll on health insurance which was conducted in August 2017. The poll gauged the perception of Nigerians regarding health insurance in the country. Findings from the poll revealed that as many as 89% of the population pay for healthcare services out-of-pocket. This finding does not in any way coincide with the main purpose of these National Health Insurance Scheme (NHIS) which is primarily securing universal health coverage and access to adequate and affordable healthcare in order to improve the health status of Nigerians. Further findings from the poll revealed that only 9% claimed they have some form of health insurance, of which 71% indicated NHIS and 21% indicated Private Health Management Organizations (HMOs) as their provider. Interestingly, a substantial proportion of Nigerians (78%) who were not, covered expressed willingness to pay a small amount of money monthly/yearly to get enrolled for health coverage. (NOIPolls, 2019)

So it is safe to say Nigeria has a poor, almost non-existent Universal Health Coverage, which means everyone regardless of location, financial and education status do not have access to quality and affordable healthcare without it posing a risk of financial debts to each individual.

Figure 2: Poor State Of Primary Health Centre In Ogoni, Rivers State (Nairaland, 2018)

Figure 3: A hospital ward in Nigeria (Channels TV, 2019)

Structure of Health Systems in Nigeria

Healthcare provision in Nigeria is a concurrent responsibility of the three tiers of government in the country. (Akhtar, 1991)

All three tiers of government - Federal, State and Local - share responsibilities for providing health services and programmes in Nigeria. The Federal Government is largely responsible for providing policy guidance, planning and technical assistance, and coordinating state-level implementation of the National Health Policy and establishing health management information systems. In addition, the Federal government is responsible for disease surveillance, drug regulation, vaccine management and training health professionals. The Federal Government is also responsible for the management of teaching, psychiatric and orthopaedic hospitals and also runs some medical centres. (WHO, 2002)

The responsibility for management of health facilities and programmes is shared by the State Ministries of Health, State Hospital Management Boards, and the Local Government Areas (LGAs). The states operate the secondary health facilities (general hospitals) and in some cases tertiary hospitals, as well as some primary health care facilities. The training of nurses, midwives, health technicians and the provision of technical assistance to local government health programs and facilities are also the responsibility of the state authorities. The 774 local governments oversee the operations of primary health care facilities within their geographic areas. This includes the provision of basic health services, community health hygiene and sanitation. The inadequacy of the public health system has given increasing prominence to the private health sector, (profit and non-profit) as well as to traditional and spiritual healers. (WHO, 2002)

Some Major Challenges of the Healthcare System in Nigeria

1. Poor health infrastructure, facilities and equipment

2. Insufficient financial investment and funding

3. Lack of sufficient health workers due to poor remuneration and hence leading to brain drain and emigration of health workers

4. Poor quality of healthcare services

5. Inability of citizens especially the poor and vulnerable populace to afford healthcare

6. Poor dissemination and education of health information to the public such as preventions, health promotion, hygiene, etc.

7. Lack of sufficient medications and pharmaceutical materials

8. Low rate of health coverage

9. Corruption

Coronavirus in Nigeria

The first confirmed case of the pandemic of coronavirus disease 2019 in Nigeria was announced on 27 February 2020, when an Italian citizen in Lagos tested positive for the virus, caused by SARS-CoV-2.(NCDC, 2020) On 9 March 2020, a second case of the virus was reported in Ewekoro, Ogun State, a Nigerian citizen who had contact with the Italian citizen.(P.M News, 2020) On 31 January 2020, following the developments of COVID-19 pandemic in mainland China and other countries worldwide, the federal government of Nigeria set up a Coronavirus Preparedness Group to mitigate the impact of the virus if it eventually spreads to the country. (Ifijeh, 2020) On the same day, the World Health Organization listed Nigeria among other 13 African countries identified as high-risk for the spread of the virus. (Ezigbo et al, 2020)

On 26 February 2020, a Chinese citizen presented himself to the Lagos State government on suspicion of being infected with coronavirus. He was admitted at Reddington Hospital and was released the following day after testing negative.(Gesinde, 2020) On 28 January 2020, the Federal government of Nigeria assured citizens of the country of its readiness to strengthen surveillance at five international airports in the country to prevent the spread of coronavirus. The government announced the airports as Enugu, Lagos, Rivers, Kano and the FCT.(Premium Times, 2020) The Nigeria Centre for Disease Control also announced same day that they had already set up coronavirus group and was ready to activate its incident system if any case emerged in Nigeria.(Odunsi, 2020)

Figure 4: Coronavirus curve in Nigeria showing confirmed cases per day since the first case (27th Feb to 21st April 2020)

Figure 5: Lagos Gets New 110-Bed Isolation Centre(Channels TV, 2020)

Recommended Interventions and Conclusion

1. Carry Out More Tests: UN health body urges African countries to urgently increase testing and warns the virus' peak is near. Some African countries could see a peak in coronavirus cases in the coming weeks, and testing should be urgently increased in the region, the World Health Organization (WHO) said. If the trend continues, and also learning from what happened in China and in Europe, some countries may face a huge peak very soon," he said, adding it could arrive in the coming weeks but without naming countries. (Aljazeera, 2020)

The reason why the cases seem still so few in Nigeria and some other African countries is due to inadequate testing. There is a need to equip specially trained team of health workers to take more samples of citizens, test them and for positive persons isolate them and treat them accordingly. These team of health workers will be adequately and cautiously trained to ensure prevention of spread of the virus and to ensure proper labelling of tests to prevent laboratory mix ups. This will ensure a reduced rate of spread of the virus. There will a reduced risk of spread when citizens are being tested and positive patients isolated and treated accordingly. This will also help with the overview data and statistics to monitor the overall progression and regression of the virus in Nigeria. The testing can be done per each state, across different local government areas.

The Honorable Minister of Health, Dr Osagie Ehanire has made known that there are 12 functional COVID- 19 testing laboratories, with a capacity to test 1,500 samples daily. He said, to ensure maximum utilization of increased testing capacity, the case definition and testing criteria had been expanded to include not only contacts of confirmed COVID-19 cases with fever and respiratory tract symptoms, but also persons with fever and respiratory tract symptoms of unknown cause.(African Press News, 2020)

Dr Ehanire informed that, COVID-19 cases are continuously detected and treated to recovery through enhanced surveillance systems and strengthened epidemic intelligence. He added also that 5,000 samples had been tested so far, as targeted approaches are been taken to scale up the capacity. (African Press Office, 2020)

Ideally, there should be a testing laboratory in each of the 36 states and the FCT and not just 12 in the entire federation. Research institutes and University laboratories should be upgraded with the required tools such as test kits, protective gears, basic amenities such as water and electricity, laboratory machines and equipment, training and manpower to test samples. This will help ensure that more tests are done and the risk of potential spread of the virus curbed.

2. Provision of Sufficient Health Equipment and health Facilities: it goes without saying that our healthworkers need all the support they can get for them to function maximally at this time. Hence there is a need for more isolation and treatment centres where suspected cases are kept until tests results are out and treatment centres for mild and severe cases respectively. An adequate supply of protective gears such as gowns, N95 face mask, googles, gloves and pharmaceuticals to treat symptoms, more beds, ventilators(invasive & noninvasive), dietary services for health workers are all needed. It would interest you to know that in a country of over 200 million citizens, Nigeria might have less than 500 ventilators in the entire country. What are ventilators? Simply put, a ventilator takes over the body's breathing process when the infection has caused the lungs to fail, this gives the patient time to fight off the infection and recover. It should be noted that difficulty in breathing is one of the most dangerous and severe symptom of Corona virus.

When the hit of the coronavirus began to wear down the health force in China, a hospital was built within 10 days to create more space, bedding, isolation centres and room for treatments for the cases. We are in a country where new hospitals aren't even erected in years, how much more in a pandemic? So there is need to prepare. In this pandemic, there have been cases of patients refused treatment due to low capacity and overpowered facility in more developed countries with better healthcare than ours. So what does our fate spell if we don't prepare?

In less than three weeks, the coronavirus has overloaded the health care system all over northern Italy. It has turned the hard hit Lombardy region into a grim glimpse of what awaits countries if they cannot slow the spread of the virus and flatten the curve of new cases allowing the sick to be treated without swamping the capacity of hospitals. If not, even hospitals in developed countries with the worlds best health care risk becoming triage wards, forcing ordinary doctors and nurses to make extraordinary decisions about who may live and who may die. Wealthy northern Italy is facing a version of that nightmare already. (Horowitz, 2020)

There is a need for more isolation and treatment centres and preparedness if there's ever an outbreak. And it is no waste of resources as these are basic needs healthcare facilities in Nigeria have been in need of for decades. Data shows that the Africa region is still the least affected territory, though this might be due to low numbers of testing but this can be used to our advantage. How? This has provided us ample time to put measurable structures in place to prevent and prepare interventions to curtail this virus.

3. Strengthening Primary Healthcare Centres and Hospitals (private, state and tertiary hospitals): According to the NCDC website, trainings are expected to have commenced in state hospitals (popularly known as General Hospitals) and PHCs in each state. The question is have they? In order to be able to contain this virus, healthworkers need to be trained adequately in light of the nature of the virus. The virus is a novel one, so experts need to train health workers on best ways to protect themselves as they have a higher risk of exposure and how to prevent the spread of the virus at our health centres. This should be coupled with adequate remunerations to appreciate our health workers who are always at the front line in the midst of the pandemic.

It should also be noted that coronavirus doesn't mean an automatic end to humans way of life, pregnant people still need to give birth, other diseases like malaria, typhoid, cold, diarrhoea, etc. haven't suddenly gone on break. So what happens when someone needs to access healthcare because they are pregnant or because they have malaria? Do we go back to self-medicating which we have been advising against or do we treat locally? Or do pregnant women give birth at home? So essential working structures need to be put in place to enable citizens still have access to healthcare without fear of contracting the virus at our health centres.

4. Establishing Adequate Preventive Measures: preventive health education about the coronavirus should be intensified both traditionally and via digital media encouraging citizens to practice hand washing, social distancing and safe respiratory hygiene. To ensure the preventive health education works, materials such as public apparatuses for hand washing, hand sanitizers, face mask, vitamins to boost the immune system should be given across each local governments in the country. Law enforcement agencies should also work closely with the health agencies to ensure citizens obey all the rules regarding the pandemic such as social distancing and use of hand sanitizers and hand washing with regard for human right laws, especially in states not under lockdown.

5. Ensure Availability of Health Services to Low-income (Rural) and Vulnerable Communities via Community Health Workers:

In every state in Nigeria, there are about 500 to over 800 Primary Healthcare Centres(PHCs) making the total 30,000 PHCs available in Nigeria. These PHCs are located in different wards in each local government area and they consist of Community Health & Health Extension workers(CHWs) who work with these rural communities(house to house, market places, etc) enlightening them on health issues. The government could use the services of the CHWs to enlighten rural citizens in these communities about the symptoms, prevention of the virus, how to self-isolate, what to do if there is a suspected case and many more guidelines. The measures used so far are digital and social media. There is a need to provide adequate information on symptoms, preventions and treatment to rural and low-income communities and also vulnerable communities such as IDPs via traditional means for those who do not have access to digital media. Most of these communities have difficulty practicing social distancing and hygienic conditions due to lack of running water, poverty, etc. And most of them still live in ignorance concerning the virus.

The CHWs will have adequately been trained before dispersal to ensure protection and prevention as they interact with members of the community. All needed equipment such as means of transportation, protective gears such as medical gowns, face mask, gloves, provision of running water equipment, vitamins to boost immune systems of members of community will also be adequately provided. A monitoring and evaluation system will also be developed to ensure the maximal impact of the intervention is reached and every person in each community in each ward in each local government, in each state across the federation are enlightened. The CHWs will promote good hygiene, social distancing, avoidance of large gatherings and also installment of public running water apparatuses to ensure and promote hand washing.

According to Rural Health Information Hub, the roles of community health workers include creating connections between vulnerable populations and healthcare systems, facilitating healthcare and social service system navigation, managing care and care transitions for vulnerable populations, reducing social isolation among patient populations, providing culturally appropriate health education on topics related to chronic disease prevention, physical activity and nutrition, advocating for underserved individuals to receive appropriate services, providing informal counseling, health screenings, and referrals and building capacity to address health issues. CHWs promote access to services, provide health education, support care delivery, and promote advocacy via Outreach and enrollment, Navigation, Education, Health services and Social-emotional support.

5. Transparent and Monitored Distribution of Relief Aid to Citizens: especially the poor and vulnerable members of the populace. In a bid to contain the coronavirus and its spread across the federation, states are on lockdown. But the question is how will citizens survive bearing in mind that about 69% of the Nigerian population lives below poverty level, that is two-third of the entire populace live below the poverty margin. What happens to a large percentage of citizens who are daily earners and can't go out to earn due to the lockdown. There's been massive donations from different quarters.There is a need to engage in a very detailed, highly documented, monitored and evaluated transparent mode of distribution of these relief materials. So far we've seen over the Internet, citizens complaining of limited quantity of these relief materials or disparity in the sharing or not receiving anything at all from the government as aid after over 2weeks of lockdown. It's really disheartening and sad that corruption and greed has once again prevailed even at such devastating times as this. Citizens have asked what you expect from a Nation that doesn't have a detailed data base of its citizens. Monetary aid and materials have been received from diverse ends, the EU, Jack Ma, various Nigeria business moguls. The question is how are these resources being used? It is only right that there is adequate report and documentation of these funds else fraudulent activities will be prevalent.

The Nigerian government has approved a 10 billion Naira grant (about $27 million) to fight the spread of coronavirus, or COVID-19, in the country. According to a statement from President Muhammadu Buhari on Thursday, the money will be released to Lagos State, Nigeria's commercial center, which has the highest number of coronavirus cases in the country. "This grant will enable Lagos increase its capacity to control and contain the outbreak, while also supporting other States with capacity-building," President Buhari said in a tweet. The immediate release of a 10 billion Naira grant to Lagos State, which remains the epicentre of the Covid-19 outbreak in Nigeria. This grant will enable Lagos increase its capacity to control and contain the outbreak, while also supporting other States with capacity-building. The President is also releasing a 5 billion Naira (about $13 million) special intervention fund to the Nigeria Center for Disease Control (NCDC). "The immediate release of a 5 billion Naira special intervention fund to the Nigeria Center for Disease Control to equip, expand and provide personnel to its facilities and laboratories across the country," said President Buhari. Wealthy Nigerians and organizations, including banks, have also donated billions of Naira to help fund medical centers and provide essential materials necessary to curtail the spread of coronavirus in the country. The United Bank for Africa (UBA) announced Thursday a donation of 5 billion Naira (about $13 million) to provide beds for isolation centers, intensive care unit facilities and direct access to medical advice to up to 450,000 citizens every day. Wealthy members of the private sector including Femi Otedola, Abdulsamad Rabiu, Herbert Wigwe, Segun Agbaje and Aliko Dangote, Africa's richest man, all contributed 1 billion Naira (about $2.7 million) each to support the government in curtailing the pandemic in Nigeria.(Salaudeen, 2020)

The European Union (EU) has announced a EUR 50 million (N21 billion) contribution towards the implementation of a coordinated response to the COVID-19 pandemic in Nigeria. The European Union's support will translate into improved delivery of key support to Nigerians, which could include the following:

- Swift procurement of equipment and commodities required to respond to the outbreak, including those required for surveillance, prevention and control as well as clinical management (portable ventilators, surgical masks, examination gloves, protective googles, gowns, PCR test kits amongst others).

- Improved testing capacity for the National Center for Disease Control molecular Lab network currently existing capacity of 1,500 tests per day nationally to be scaled up to 3,000 tests per day.

- Technical support provided to expand communication and community engagement to reach women, persons living with disabilities and marginalized groups, in order to address their unequal access to information on outbreaks and available services.

- Maintenance of essential health services to ensure that the vulnerable do not experience catastrophic health expenditures during this period.

- Cash transfers to mitigate impact of social distancing measures put in place.(European Union, 2020)

Do you also know that the conditional cash transfer is actually money from the recovered Abacha loot of $322.5 million from Switzerland and not the Federal Governments COVID-19 palliative? Each beneficiary is paid N5, 000 each month according to the NCTO payment framework. The whole Social Protection Programme was managed by the office of the Vice President until last year when it was moved to the Ministry of Humanitarian, Disaster and Social Development. The monthly CCT payment was stopped in December. They were to resume payment few weeks ago when the COVID-19 crisis started and the President directed that the poor beneficiaries should be paid four months- January to April- which is #20, 000. Unfortunately, the Federal Government started to assure Nigerians that COVID-19 palliative will be released while the CCT payment was going on and the public could not differentiate COVID-19 and the Conditional Cash Transfer Programme. (Ewepu, 2020)

So the question now is where is the Federal Government's coronavirus palliative?

So far there has been some state by state approach to the distribution of palliatives and I think this will be a very good method to ensure every citizen gets aid from the government. Often times, it has been said that Nigeria needs restructuring but I beg to differ that the structure on ground is enough to address situations if properly followed. A state by state approach intervention will help the authorities cover more grounds and reach more grassroot communities. Each state has a number of local government area governed by a local government chairman and each Ward has councilors who are closer to the grassroots. If testing, distribution of palliatives, strengthening of primary health centres and other above suggested interventions will be done along these channels, it will be a faster approach to fighting the coronavirus, more like a divide and rule system. We are a country of 200 million people, the number seems vague and unreachable but broken down into states it is less ambiguous. A generalised or centre approach will be less effective and will not reach the grassroots. It is my suggestion that a State-Local Government-Ward-Communities-Families-Individual Channel be used with proper documentation, high level of transparency, monitoring and evaluation structures put in place to prevent any fraudulent dealings.

Each State in collaboration with the Federal Government, Ministry of Health and NCDC should set up isolation and treatment centres, laboratories to ensure more testing, get more materials such as test kits, pharmaceuticals, personal protection equipment, utilise the community health workers for traditional methods of health education on the virus and share relief materials via the local government and wards. We can make existing structures work for us.

It would surprise you that hunger and poverty has killed more Nigerians than coronavirus has. So if the authorities will have people stay home it has to be ready to provide aid, to support the people else people will either die of hunger and starvation sooner or later. And that is still death caused by the Coronavirus pandemic, maybe not directly.

6. Ensure Strategic Financial Plans to Cushion the Economy from the Effects of the Pandemic:

There has been a significant drop in global oil prices due the pandemic. What does this spell for Nigeria, a country where 65% of the total government revenue comes from oil.

Because of these price drops, the largest disruption to trade will be for commodity-sensitive economies, with Algeria, Angola, Cameroon, Chad, Equatorial Guinea, Gabon, Ghana, Nigeria, and the Republic of the Congo among the most affected. Oil exports range from 3 percent of GDP in South Africa to as high as 40 percent in Equatorial Guinea and are a key source of foreign exchange earnings. Furthermore, the shock comes at a particularly bad time for three of the largest economiesAngola, Nigeria, and South Africawhich already had weak growth outlooks, with South Africa already in recession. Nigeria is now facing U.S. dollar shortages due to the oil price crash and is expected to devalue its currency by 10 percent by the end of June. We expect similar stresses to surface in some other countries. (Coulilaby & Madden, 2020)

The naira is still a classic petrocurrency whose fate remains intrinsically tied to global oil prices, at least without a seismic shift in economic structure. That shift is not a short-term task. Right now, the stance by Nigerias key economic actors to defend the naira will likely be tested by the expected further decline in Nigerias foreign reserves the Central Bank set a $30bn foreign reserves threshold for devaluation. Nigeria is treacherously close. About about $9tn was wiped off global equities in 9 days into early March as a result of coronavirus. (Akinkugbe-Filani, 2020)

For those not very familiar with financial numbers, what this means is the pandemic has affected nations of the world and the financial situations of every rich economies. And oil which seems to be a huge determinant of most countries revenue as Nigeria can't save us this time. So there's a need for a plan B. What is Nigeria's plan B? There is a need for strategic economic and financial planning to help us get through this period.

And to be very realistic, money is needed by the authorities to set up and implement most of the recommended interventions to curtail the spread of the virus. So there is a need for strategic financial planning by experts to ensure Nigeria is able to fend for herself in the months to come.

The country has a dearth of financial professionals ranging from financial analysts to economists who can come up with strategic economic and financial development techniques to ensure that the Nation is able to keep her head above the waters economically in this trying time. The question is, "Are their services asked for?" Is there a team working with the Ministry of Finance to ensure measures and plans are put in place to help Nigeria's economy stay afloat amidst and after the pandemic? All hands must be on deck to ensure the Nation as a whole survive this pandemic.

As with most public health issues, the pandemic goes beyond the health sector alone but transverse all sectors from finance to power to energy to economic development. So a corporate approach to curtailthe virus has to be implemented with every one playing their significant roles.

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Author's Profile

Deborah Adedigba is a public health enthusiast with interests in Universal Health Coverage, Primary Healthcare System and Reproductive, Maternal, Newborn and Child's Health (MNCH). She believes as a basic human right, every person regardless of location, education or financial status should have access to quality and affordable healthcare without exposure to financial risks or debt. She has experience across Improving Health Systems and Creating Programmes and Interventions to ensure quality and affordable healthcare. Her educational background in Medical Sciences gives her an edge in handling Public Health problems and procuring solutions.

Deborah advocates that sanitary pads be given freely to young females especially at Primary Health Centres in low-income and vulnerable communities as condoms are given for free at health centres as a sexual health precaution which is a choice while menstruation is not.

She is an advocate for social impact and development and the eradication of poverty in Africa and she pioneers Community Development Service projects to this effect. Deborah is a serial volunteer and change maker. You can connect with her professionally via LinkedIn at Deborah Adedigba and email at [email protected]

Deborah is a creative and artist "extracurricularly". Her works can be seen at Dara Africa, an art and creativity hub that connects local artisans across fashion and creativity industry to local and international markets where she is the Creative Director.

Acknowledgement

Special thanks to Victor Adio, Rhenua Adebo, Daniel Sangobowale, Peace Anyio, Femi & Yemi Adedigba and Joshua Matthew for their help during the creation of this work. Appreciation also goes to Dr & Mrs WoleFunmi Adedigba for their consistent support. God bless you.

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