• Epidemiologists warn situation leaves Nigeria ‘unprepared’ for emerging epidemics, pandemics
• With only N7.7bn for health security in the 2023 budget proposal, NAPHS fails to mobilise the N134bn targeted in five years cycle
An analysis of the 2023 proposed budget allocation for health security shows, on average, a 13 per cent reduction in allocation from the 2022 approval to the 2023 proposal. In some instances, the reduction is as much as 233 per cent.
The analyses of the National Action Plan on Health Security (NAPS) for Ministries Departments and Agencies (MDAs) budget show deficits in the 2023 proposed budget.
The breakdown of the health security budget for 2021, 2022 and 2023 fiscal years shows an increase in most budget lines from 2021 to 2022 but a decline in over 90 per cent of budget lines from 2022 to 2023.
Thirty-two budget lines relating to health security were examined. Further analysis shows that a total of N5,175,527,623 was approved for health security budget lines in 2021, N8,870,922,330 in 2022 and N7,754,337,084 in 2023. This shows a reduction of 13 per cent (N1,116,585,246) from the 2022 approval to the 2023 proposal.
Epidemiologists and healthcare professionals are worried about the implication of budgeting less for health security despite the obvious threat of emerging epidemics and pandemics. They believe it is a case of when, not if, the world and indeed Nigeria is hit by a global epidemic of a deadly infectious disease, killing millions of people.
Analysis of drug residues in animal products for export under the Nigeria Agricultural Quarantine Service shows N92,000,000 was approved in 2021, N33,250,000 in 2022 and just N2,000,000 proposed in 2023. This shows that the 2023 proposed budget is 94 per cent (N31,250,000) less than that of 2022.
Also, the budget for the national food safety sensitisation workshop, development of food safety manuals and the development of foodborne illness sentinel sites; food safety events preparedness and response (surveillance and detection for foodborne pathogens, contaminants, and diseases); national food safety management committee (NFSMC) activities, and food committee meetings, under the Federal Ministry of Health (FMoH), decreased from N18,550,908 in 2022 to N9,275,454 in 2023. A breakdown shows 50 per cent reduction (N9,275,454) from 2022 to 2023. However, there were zero budgets for food safety in 2021.
On the rehabilitation of port health thermal scanners in the various point of entry, under the FMoH, there was no budget in 2021 but analysis showed a decline from N15,616,836 in 2022 to N7,808,418 in 2023. This also shows there was a 50 per cent reduction (N7,808,418) from 2022.
On the purchases of ambulances and consumables for Public Health Service (PHS), under the FMoH, there were zero budgets in 2021 but a reduction from N85,182,741 in 2022 to N42,591,371 in 2023. This also shows a 50 per cent reduction (N42,591,370) from 2022 to 2023.
On the strengthening of Port Health inspection capacity, under the FMoH, there was no budget for 2021 but there was a reduction from N23,661,872 in 2022 to N11,830,936 in 2023, which is a 50 per cent reduction (N 11,830,936).
On PHS office remodelling/renovation and construction of new port health offices in six geo-political zones, under the FMoH, there was zero budget for 2021 but a reduction from N141,971,235 in 2022 to N70,985,618, which is 50 per cent (N70,985,617) less.
On the establishment of the environmental health and sanitation surveillance system in Nigeria, under the FMoH, N30,932,949 was approved in 2021, N15,000,000 in 2022 and N50,000,000 in 2023. This shows an increase of 233 per cent (N35,000,000) from 2022 to 2023.
On COVID-19 medical waste management, under the FMoH, N50,000,000 was approved for 2021, and N14,000,000 in 2022 and 2023. So, there was no difference between 2022 and 2023.
On establishment and equipment of the nuclear and radiological emergency preparedness response (EPR) coordination center, under the Nigeria Nuclear Regulatory Authority, there was no budget in 2021 and 2023 but N202,594,468 was approved in 2022. This shows a 100 per cent reduction from 2022 to 2023.
On the National Programme for the Control of Transboundary Animal Parasitic and Zoonotic Diseases, under the Federal Ministry of Agriculture and Rural Development, there was no budget in 2021 but a reduction from N364,818,524 in 2022 to N185,790,464 in 2023, which is 49 per cent reduction (N179,028,060).
On the National Programme for the Control of Transboundary Pests and Integrated Pests Surveillance, under the Federal Ministry of Agriculture and Rural Development, there was no budget in 2021, but a reduction from N411,014,063 in 2022 to N152,985,078 in 2023, which is a 63 per cent reduction (N258,028,985).
While for the provision of Internet service for research, vaccine production and disease surveillance, under the National Veterinary Research Institute, there was zero approval in 2021, N22,888,436 in 2022 and N13,700,399, which is a reduction of 40 per cent (N9,188,037).
On surveillance, diagnosis and control of economically important animal diseases in Nigeria (Avian influenza, Newcastle disease, Gumboro, rabies, CBPP, ASF, brucellosis, fowl typhoid, etc.), under the National Veterinary Research Institute, there was no budget in 2021 but a decline from N57,292,496 in 2022 to N26,049,033 in 2023. This shows that the 2022 approval is 55 per cent (N31,243,463) more than the 2023 proposal.
On surveillance of highly pathogenic diseases, under the National Veterinary Research Institute, there was N10,035,391 approval in 2021, N25,199,604 in 2022 and N24,255,529 in 2023. This shows a four per cent reduction (N944,075).
On procurement of reagents, chemicals and consumables, under the National Veterinary Research Institute, there was N129,878,670 approval for 2021, N61,868,333 in 2022 and N28,129,518 in 2023, which is a 55 per cent reduction (N33,738,815).
On strengthening public health emergency preparedness and response and global health security and coordination, under the FMoH, there was no budget in 2021, N56,788,494 in 2022 and N28,394,247 in 2023. This shows a 50 per cent reduction from 2022 to 2023.
On the development of national policies on disease surveillance and response (including notification, laboratory, diagnosis and international health regulations) and emergency preparedness and response to communicable and non-communicable diseases as well as all events of public health concern in Nigeria, under the FMoH, there was no budget in 2021 but a 50 per cent reduction from N23,661,872 in 2022 to N11,830,936 in 2023.
While port health services safe port platform and surveillance activities for prevention and control of pandemics, under the FMoH, there was zero budget in 2021 but a 50 per cent reduction from N37,858,996 in 2022 to N18,929,498 in 2023.
On disease control and operational cost for surveillance activities ongoing, under the National Primary Health Care Development Agency (NPHCDA), there was the approval of N85,618,332 in 2021, N95,112,209 in 2022 and N92,780,000 in 2023. This shows a two per cent reduction (N2,332,209) from 2022 to 2023.
On procurement of routine immunisation (RI) vaccines, devices and operational cost, under the NPHCDA, there was N2,678,333,718 approval in 2021, N4,071,226,161 in 2022 and N3,624,511,869 in 2023. This shows an 11 per cent reduction (N446,714,292).
On procurement of non-polio SIA vaccine, device and operational cost, under the NPHCDA, there was N639,231,362 approval in 2021, N1,457,756,390 in 2022 and N1,319,175,386 in 2023, which is a 10 per cent reduction (N138,581,004).
On procurement of outbreak (emergency) response vaccine, devices and operational costs, under NPHCDA, there is an increase for the first time from 2022 to 2023. While N643,160,069 was approved in 2021, there were N567,548,272 in 2022 and N605,757,111, which is a seven per cent increase (N38,208,839).
On procurement of travellers and pilgrims vaccines, under NPHCDA, there was N286,714,222 approval in 2021, N277,497,911 in 2022 and N320,787,708 in 2023. This shows another increase of 16 per cent (N43,289,797) from 2022 to 2023.
On vaccine distribution and transport (national to states and health facilities), under NPHCDA, there was N393,727,975 approval in 2021, N 144,670,954 in 2022 and N240,172,257. This shows a 66 per cent increase (N95,501,303) from 2022 to 2023.
On immunisation supply chain strengthening at NSCS and zonal cold stores, under NPHCDA, there was the highest increase of 169 per cent from N292,573,895 in 2022 to N757,948,764 in 2023. N106,183,567 was approved for 2021.
On deploy and install 30 DTR in states for real-time monitoring of cold chain equipment functionality, under NPHCDA, there was 100 per cent reduction from N96,775,639 approval in 2022 to zero proposal in 2023. However, there was zero approval in 2021.
The budget line for procurement of freezer and fridge tags for NSCS and the six zonal cold stores, under NPHCDA, also followed the same trend. There was zero approval in 2021 but a 100 per cent reduction from N53,049,918 in 2022 to zero proposal in 2023.
On the development, printing and dissemination of Nigerian vaccine policy, under NPHCDA, there was also a 100 per cent reduction from N14,197,123 in 2022 to zero proposal in 2023. However, N29,711,368 was approved in 2021.
On COVID-19 pandemic response research for health security strengthening the national health research ecosystem to support vaccine and pharmaceutical development, under the FMoH, there was zero approval in 2021, N189,294,980 in 2022 and a reduction of 50 per cent (N94,647,490) in 2023 proposal.
Interestingly, the coordinating body for health security in Nigeria, the Nigeria Centre for Disease Control (NCDC) is affected as well as its capacity to implement NAPS.
There was a 12 per cent decrease in budget approval (N238,315,446) for NCDC from N1,959,715,054 in 2022 to N1,721,399,608 in 2023. This is compared to N1,293,651,516 approved in 2021.
The grand total of the budget for health security including that of NCDC also showed 13 per cent decrease (N1,354,900,692) from N10,830,637,384 in 2022 to N9,475,736,692 in 2023. The grand total for 2021 was N6,469,179,139.
Further analysis shows that Nigeria has failed to meet the target of N134 billion over the next five years (this is from 2018 to 20220) as enshrined in the NAPHS.
The World Health Organisation (WHO) defines global public health security as the activities required, both proactive and reactive, to minimise the danger and impact of acute public health events that endanger people’s health across geographical regions and international boundaries.
Population growth, rapid urbanisation, environmental degradation, and the misuse of antimicrobials are disrupting the equilibrium of the microbial world. New diseases, like COVID-19, are emerging at unprecedented rates disrupting people’s health and causing social and economic impacts. Billions of passengers travel on airplanes each year, increasing the opportunities for the rapid international spread of infectious agents and their vectors.
Dependence on chemicals has increased, as has awareness of the potential hazards for health and the environment, like climate change and air pollution. As the globalisation of food production increases, so does the risk of tainted ingredients and the risk of foodborne diseases. As the world’s population becomes more mobile and increases its economic interdependence, these global health threat increase and traditional defences at national borders cannot protect against the invasion of a disease or vector.
Pandemics, health emergencies and weak health systems not only cost lives but also pose some of the greatest risks to the global economy and security faced today.
Indeed, the world is constantly under threat of emerging and re-emerging diseases. The next big disease outbreak could be triggered by a mutated strain of a known virus or by the release of a biological weapon and examples such as the 1918 Spanish Flu pandemic, which killed up to 100 million people, show the enormity of the danger.
There have been outbreaks of diseases such as cholera, Lassa fever, yellow fever, monkeypox and severe acute respiratory syndrome in the past among other diseases, but many countries soon forget to learn lessons and thus, do not take appropriate actions to prevent a public health crisis.
Nigeria can only respond effectively to disaster and contain disease outbreaks if the health system is viable; besides, functioning healthcare systems are the bedrock of health security.
To address the issues of Emergency Preparedness Response (EPR), Nigerian authorities- two years before COVID-19 arrived in Nigeria and four years after the Ebola outbreak- began developing a NAPHS with the signing of the International Health Regulations (IHR).
The country’s health security plan was developed as an aftermath of the Joint External Evaluation (JEE) of international health regulations core capacities in 2018. The NAPS is a five-year multi-sectoral plan targeted at addressing all the gaps identified in the JEE conducted. NAPS is to be executed from 2018 to 2022.
NAPHS is a comprehensive document that sets out a strategy for strengthening the health security of the country. Developed by the NCDC in collaboration with other relevant government agencies.
During the inauguration of the NAHPS action plan in December 2018, the then NCDC Director General, Dr Chikwe Ihekweazu, said Nigeria needs to mobilise N134 billion over the next five years to enhance national health security in line with global standards.
DG, NCDC, Dr. Ifedayo Adetifa, has identified a paucity of funds as one of the major obstacles to implementing the NAPHS.
Adetifa, in a paper titled, ‘National Action Plan for Health Security: Challenges of Implementation and Potential Areas where Advocacy is needed,’ said: “The NAPHS is poorly funded and as a result, poorly implemented.
“The impact of COVID-19 is huge. The estimated cost to the global economy is 28 trillion dollars by 2025. Having NAPHS is great, effective implementation is a must.” Adetifa said.
He, therefore, called for the creation of a special budget for NAPHS.
Adetifa said the NCDC needed support in the areas of investment in national and sub-national health security by Ministries, Departments and Agencies (MDAs).
Programme director of the PE Project, Gafar Alawode, told journalists that the COVID-19 pandemic had shown that building a strong health security system should be prioritised as epidemics could break out unexpectedly.
He noted that an improved budgetary allocation and sustained preparedness response to epidemics would result in a drastic reduction in mortality during epidemic outbreaks.
“We must strengthen our health system by putting more money into the budget.”
Adetifa said: “Prior to COVID-19, the world was preparing for a possible influenza pandemic, yet the arrival of SARS-CoV-2 highlighted inadequacies in global pandemic preparedness. Given the interconnectedness of the world (now essentially a global village), we are at constant risk of public health emergencies that have the potential to greatly disrupt lives and livelihoods like COVID-19 did.
This makes it critical to learn from lessons taught by this pandemic to strengthen preparedness and response to other diseases in line with our mandate. We have continued to face outbreaks of cholera and Lassa fever concurrently with the COVID-19 pandemic.
“The COVID-19 pandemic response has recorded the largest political commitment in the history of health system development in Nigeria due to its global relevance and impact on our economy. This has provided opportunities for prioritising health on the political agenda and attracting the required future investment in health security. We all have the responsibility to encourage and continue to hold authorities accountable to sustain interest and investment in healthcare in general and particularly for health security.”