Nigeria Health System in the Covid-19 Era

As the world woke up to the news of a novel virus, and the World Health Organization classifying it a pandemic, the Africa continent was projected to be the most hit due to the poor state of our health centers coupled with systemic corruption and increasing migration of health personnels in search of better and sustainable remuneration in developed countries. 

In Nigeria, the state of health centers are lagging, as recent data shows Nigeria as one of the worst places for a woman to birth a child. In fact, a new study by the Economist Intelligence Unit, EIU, ranked Nigeria the least (80th out of the 80 countries considered) with the study with a score of 4.74 out of 10.

In the early days of the pandemic, most organizations folded up and retrenched staff due to lack of funding as most donor agencies withdrew their resources in order to adequately prepare for the unknown and unanticipated impact of the pandemic.

As an activist with multidimensional skills in turning complex problems into fundable projects, I remember the ideation process that led to the creation of the COVID Transparency and Accountability Project- brand. Instead of resorting to fate and hoping that the mandatory COVID 19 lock down order be removed by the federal government, CODE’s CEO Hamzat Lawal, challenged us to either “innovate or die ” and shared some strategies around tracking COVID 19 funds.

At the aim of CODE’s operations in Abuja Nigeria,  HQ staff dribbled in some ideas and so did our Follow the money International chapters. In less than twenty hours, we had two ideas and Immediately, I reviewed the available ideas and confirmed they were novel, fundable and scalable. So I reviewed and a full concept note and innovation was birthed and shared with partners and prospective donors.

Then, an opportunity appeared for a partnership with BudgIT, one of our strong allies in the sector and I quickly finalized on the concept note and shared with BudgIT team for inputs and after series of donor meetings and pitch sessions, we were able to access $500,000 from the Skoll and Conrad Hilton Foundation for the launch of the CTAP project in 7 African Countries (Nigeria, Kenya, Cameroun, Liberia, Sierra Leone, Malawi and Ghana). 

In Nigeria, the CTAP Project under CODE’s deliverables had diverse components including “Tracking the state of Primary Health Care (PHCs) and Vaccine distribution in Nigeria” in order to monitor the state of and vaccine storage in 15 States namely Cross River, Yobe, Bauchi, Gombe, Taraba, Abia, Anambra, Imo, Ebonyi, Benue, Kogi, Nasarawa, Plateau, Kebbi, Osun States across the 6 geopolitical zones of Nigeria, and monitor and advocate for a transparent and inclusive approach on the distribution of COVID-19 Vaccines in Nigeria. The PHC tracking component was crafted to increase citizens participation in advocating for transparency and accountability in the health care sector by monitoring and reporting the state of PHCs across Nigeria.  

Follow The Money team members across the 15 states conducted intense tracking and data gathering using our designed toolkit on the kobotool box. The result of this intense research revealed that only about 20% of PHCs meet the required standards for infrastructure, personnel, service delivery, vaccine storage and vaccine administration. From this analysis, it could be inferred that only two (2) out of every ten (10) PHCs in Nigeria are up to standard. Further discoveries show that 30% of PHCs do not have access to clean and safe water, as some facilities use wells as their source of water and 7% use rain water. However, maternity and ante-natal service showed up as the most readily available and accessed service across Nigeria.

The follow the money team (FTM) teams in each of the 15 States soon after data collection on PHCs commenced Community outreach (CO) in May, 2021. They engaged with community stakeholders such as community head/chiefs, women leaders, men leaders, youth leaders. This activity was targeted at compiling evidence to advocate for the improvement of PHCs by engaging community gatekeepers in garnering community support for the tracking of COVID-19 vaccines, create awareness for the importance of the vaccines, and identify the level of knowledge about services the PHCs render. This activity revealed the disproportionate ratio of PHC to the size of each community and community leaders testified that vaccines were hoarded in some communities by health workers.

The final activity in CTAP tracking was the town hall meeting which held across all project States, it served as a rendezvous for health workers, representatives of local governments area councils, the Executive Secretaries of various States Primary Health Care Development Agency (SPHCDA), traditional heads, community chiefs, women leaders and men leader, to have a dialogue and map out an action plan for the standardization of PHCs to efficiently service the communities that host them as well as foster their preparedness for future COVID-19 vaccine administration. 

To further intensify the campaign and present our findings across these states for policy changes and institutional restructuring across PHC, our team states have further engaged with key stakeholders and partnered with frontline media agencies in amplifying the findings in their states

We reviewed seven cases of COVID-19 related corruption, contacted witnesses, and gathered evidence. We also forwarded petitions to relevant prosecutory bodies. Six petitions were sent to ICPC(Independent Corrupt Practices Commission). ICPC reached out and has opened investigations into some of the cases upon receipt of our petitions. Our team is helping them with relevant facts/evidence in the cases.  

During the course of tracking the state of Primary Healthcare Centers (PHCs), the campaign garnered public and media attention in Osun State, South-West Nigeria, as conversations around the use of torch lights and candles to take delivery of babies in PHCs gathered momentum. According to public sources, the Osun State Government in 2019 received $20.5million from WHO as a grant to revitalize 332 PHCs. Less than two (2) years later, the revitalized PHCs are only visible with painted buildings but not in amenities.

Relying on findings during CTAP, the team influenced Rave 91.7 FM, a radio station with about 5.1 million listenership in Osun State, to carry-out more investigation on two (2) out of the six (6) PHCs we assessed. Find the story here. 

Two weeks after the findings were published, those two PHCs received brand new generators. The reporter who conducted the investigations, Emmanuel Ujiagughele, received the Best Reporter Award during the Nigerian Union of Journalists (NUJ) event in the State. Follow-up investigations were conducted by HumAngle, a notable reporting media in the State. The HumAngle publication of investigations made reference to FollowTheMoney/CTAP investigations uncovering gaps as well as the unresponsiveness of the State Government in being transparent and accountable for COVID-19 funds.

Another outstanding unanticipated success was entering into a formalized partnership with the National Primary Healthcare Development Agency (NPHCDA), a parastatal under Nigeria’s Federal Ministry of Health responsible for the development of the primary health care delivery system, storage and distribution of vaccines in Nigeria. This partnership grants FollowTheMoney/CTAP access to all of the Agency’s data necessary for social accountability in the health sector as well as unfettered access to PHCs for joint monitoring and evaluation of health services, COVID-19 vaccine exercises and health intervention programmes across the Federation.