Contributing to interdisciplinary and experiential learning in global health, delegates from all disciplines (not just science/health) were encouraged to participate in this event. They discussed, co-operated, and negotiated with other stakeholders to produce resolution papers addressing the simulation theme, as an important global health priority.
The winning position paper, competing with 70 attendees, was by Dr Shukrat O. Salisu-Olatunji. Shukrat completed her Masters in Clinical Research in ScHARR in 2017.
Delegate name: Dr Shukrat O. Salisu-Olatunji
Region: AFRO (Country: Nigeria)
Role: Member state delegate
Twitter handle: @jumisal25
INTRODUCTIONNigeria is known as the most populous nation in Africa with an estimated population of 196 million in April 2018 and a population growth rate of 2.67%. With globalization, international trade and travel across borders, Nigeria is vulnerable to epidemics and outbreaks of infectious diseases from within and without. It is therefore critical to ensure optimal preparedness and response to this global threat and to empower the health system and its stakeholders appropriately with the goal of preventing pandemics and minimising casualties from such occurrences.
Health funding is key in achieving optimal preparedness and response to outbreaks and epidemics, and Nigeria’s health allocation of 4.17% of its annual spending in 2017 is a far cry from the WHO recommendation of 13% [2,3]. The effects of poor health funding are felt across the three tiers of health care and most especially in primary care which is the foundation of health delivery closest to the people. The majority of patients (71.7%) must pay for health care out-of-pocket at the point of service even as the country puts in efforts to achieve Universal Health Coverage. There is high reliance on foreign aid and NGOs as a source of funding for public health initiatives like childhood immunization, HIV treatment, TB treatment among others.
NIGERIAN EXPERIENCE OF OUTBREAKS/EPIDEMICSIn recent times, Nigeria has experienced outbreaks of public health importance, including the Ebola outbreak in 2014. The strength of local response and collaborations between levels of government greatly influences the outcomes of such outbreaks with respect to acute response and control measures put in place to manage the situation. With the Ebola outbreak which involved several West African countries, the response was highly commendable as Nigeria succeeded in controlling the outbreak within three months and was declared Ebola free by the WHO. The success of the country’s response has been attributed to the Incident management/ Emergency Operation Centre approach which facilitated resource and fund mobilization and coordination of response involving government health facilities, international aid organizations, NGOs and the private sector. This success has however not been replicated with other outbreaks like Lassa fever, cerebrospinal meningitis, cholera and yellow fever which persist in the country. In the country’s experiences, the importance of strengthening health system’s preparedness in terms of personnel, co-ordination of stakeholders and mobilization of resources, provision of needed medications, vaccines and consumables and education of the populace has stood out.
CHALLENGES WITH OUTBREAK PREVENTION AND CONTROLThe health system’s preparedness and response to outbreaks is dependent on coordination of multiple stakeholders and the public. Poor political commitment especially with regards to funding, weak primary health care system, lack of ownership and community involvement are some of the challenges which negatively impact on outbreak/epidemic response. Political crisis and instability especially in Northern Nigeria also further reduce access to healthcare and jeopardises the chances of effective response to an outbreak. Distrust of the authorities and stigma associated with some communicable diseases like Lassa fever, as well as lack of funds to pay for healthcare services may discourage early reporting and identification of cases, thus increasing the likelihood of spread and epidemic potential of such a condition.
- Strengthen the foundation of the healthcare system by improving primary health care. Focus on disease prevention, health promotion and notifiable disease surveillance would provide a better defence against outbreaks at all levels of health care. Public health personnel must be aware of minimum standard operating procedures for potential epidemic prone diseases; e.g. case identification, contact tracing and isolation where required.
- Create regional laboratories to facilitate rapid diagnosis and enhance surveillance and tracking of outbreaks.
- Empower, educate and inform the populace through an effective communication system that enables early identification and reporting of suspected cases at times of outbreaks and minimises anxiety, stigma and harmful practices in the event of an outbreak.
- Train healthcare personnel to enhance case management and optimal infection prevention and control in health facilities and the community.
- Build capacity of Disease Surveillance and Notification Officers in each state. Strengthen Local governments in training DSNOs to use IDSR guidelines and facilitate timely reporting.
- Engage private sector in a focused and coordinated manner.
- Key into global initiatives for outbreak control like the recently launched “Eliminate Yellow fever in Africa by 2026”.
CONCLUSIONSPolicies and interventions to build capacity of personnel, mobilise funds and needed resources and establish a preparedness and response strategy are essential in addressing the threats of outbreaks/epidemics. Improvements in the health system achieved through foreign aid and support must be sustained to empower the healthcare system at primary, secondary and tertiary levels.
- Country meters. Live Nigeria population (2018). Current population of Nigeria — Countrymeters [Internet]. 2018 [cited 2018 Apr 17]. Available from: http://countrymeters.info/en/Nigeria/
- World Health Organization. WHO | Nigeria [Internet]. WHO. World Health Organization; 2018 [cited 2018 Apr 22]. Available from: http://www.who.int/countries/nga/en/
- Nigeria’s Grossly Inadequate 2017 Health Budget [Internet]. THIS DAY. 2017 [cited 2018 Apr 22]. Available from: https://www.thisdaylive.com/index.php/2017/02/09/nigerias-grosslyinadequate-2017-health-budget/
- Centers for Disease Control and Prevention. Ebola Virus Disease Outbreak — Nigeria, July– September 2014 [Internet]. Morbidity and Mortality Weekly Report. 2014 [cited 2018 Apr 22]. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6339a5.htm
- Courage KH. How Did Nigeria Quash Its Ebola Outbreak So Quickly? - Scientific American [Internet]. Scientific American. 2014 [cited 2018 Apr 22]. Available from: https://www.scientificamerican.com/article/how-did-nigeria-quash-its-ebola-outbreak-soquickly/