It has been just over three months since the first COVID-19 case was reported in Nigeria on Feb. 28, 2020.
Now, two lockdowns later and with limited testing capacity (just under 80,000 tests), the number of cases reported in the country has risen to more than 12,400 and the number seems to be trending upwards. Lagos, the country’s commercial capital, is the epicenter of the virus in Nigeria with 5,729 cases, as of June 7.
As the pandemic persists, the health care challenges plaguing Nigeria’s already frail health system have been exacerbated and health care workers are struggling.
There was already an existing shortage of doctors prior to COVID-19, and with the global shortage of personal protective equipment (PPE), health care workers in countries with weak public health systems like Nigeria are at the forefront of it all.
Global Citizen spoke to some health care workers at a public hospital in Lagos to understand the true nature of what they are facing. Here are five major challenges facing health care workers in Nigeria amid the COVID-19 pandemic:
1. Personal Protective Equipment (PPE)
This is one of the areas where health care workers said they are struggling the most. Masks, gloves, and other protective equipment are not readily available, and even though some doctors are able to purchase individually this is not enough.
Private sector organisations (like financial technology company OPay and the Jack Ma Foundation) have contributed over 80,000 masks to Nigeria, but health workers still report a huge gap in availability of PPE.
At some public hospitals, patients are being asked to provide PPE before being treated or diagnosed. At the Randle General Hospital in Lagos, nurses told Global Citizen there’s also a lack of bandages and gauze among other medical items, including PPE.
“For staff, we got PPE,” says Zubair Abdulahi, a doctor at a private hospital in Lagos. “It's not enough as I'd like it personally, but it's available which is a rare thing. My friends cry about this and there was a thread on [Twitter] with many doctors posting what they were given to protect themselves, mostly heinous and laughable items.”
Other private hospitals like Havana Specialist Hospital in Lagos are not taking in new patients of any kind, Global Citizen was told, partly due to the unavailability of PPE for its workers.
2. Personnel & welfare
Nigeria already had a shortage of doctors before COVID-19 hit. According to a TechCabal report, there is just one doctor for every 5,100 Nigerians — and they are not paid very well.
Since the pandemic hit, Nigerian doctors have already gone on strike once and another strike has been announced for June 15. Some of the grievances the doctors have include unclear information around the hazard allowance (50% of basic salary) announced by the Nigerian Minister of Health, Dr. Osagie Ehanire, to support those working in dangerous conditions; non-implementation of any of the promised welfare packages to health care workers; and harassment by the Nigerian Police Force.
“It was stated [that health care workers would be paid an additional] 50% of basic salary plus an extra 20% for frontline workers. But a specific amount of money was not stated in the news by the health minister and nothing has been implemented,” Segun Adediji, a pharmacist at a public hospital in Lagos, told Global Citizen.
Abdulahi further added: “I'm not receiving any special allowances, hazard allowance, or benefits. This is true for many other doctors too. In fact, some hospitals have laid off doctors or implemented pay cuts (for some, it's nearly 50%).”
One reason for this, according to Abdulahi, is the reduced patient load on hospitals as people have stayed home due to restrictions on movement and widespread belief that hospitals are hotspots for the virus.
“At the beginning of the lockdowns, I was paying nearly three times the amount I pay for food and transport to get to work and do work because of the restrictions,” said Abdulahi.. “Yet some people were harassed by the police (I wasn't). It’s also very tasking to be at work for so long and makes you very worn out especially at the end.”
As with PPE and personnel, health care has long been underfunded in Nigeria. Despite a 2001 declaration by African heads of state to allocate at least 15% of their national budgets to health care, successive Nigerian governments since then have consistently allocated under 10% of their budgets to health care.
One consequence of this from a COVID-19 standpoint is that many states in Nigeria are under-equipped to carry out extensive testing and contact tracing as Nigeria continues to battle the pandemic.
“An in-depth analysis of states’ sample collection shows that several states are not collecting adequate samples for testing, including states with high positivity rates,” read an NCDC epidemiology report published in May.
According to the report, the implication of this is that Nigeria’s testing capacity is being underutilised, and there’s an increased risk of cases that don’t develop symptoms going undetected — meaning that the virus is then being spread further.
“One of the major challenges highlighted was inadequate operational funding for community surveillance, active case search, and contact tracing,” the report added.
4. Reduced supply of medication
Due to restrictions in movement, lockdowns, and the various economic implications of COVID-19, drug supply chains are unable to provide much-needed medication at Nigerian hospitals.
“Due to the restrictions on movement, there is a reduction in the supply of medications at hospitals [which can cause an] increased possibility of expired drugs which can [in turn] lead to liabilities for the hospital,” said Adediji.
At Randle General Hospital, the pharmacy only had injections and intravenous medication. All other prescribed medications have to be purchased from external sources, said one nurse, who didn’t want to be named.
“We’ve not been able to give people regular medicines that they always come here for,” she continued. “Since the virus started, we've had to tell people to get the medications doctors prescribe for them outside the hospital, which opens them up to the risk of expired or counterfeit drugs and even re-prescription.”
5. Poor information systems
Despite the fact that the COVID-19 pandemic has been ongoing globally for over five months now, many Nigerians still don’t believe that the coronavirus exists. All over the Lagos metropolis, people can be seen not adhering to social distancing guidelines, not using masks, and not wearing gloves or sanitising their hands.
Yusuf Badru, a businessman in Lagos, told Global Citizen: “It’s the work of the government to continue to keep Nigerians in poverty. Shebi [a pidgin word used similar to, “I mean”]many people, even doctors, that use masks and gloves have died. If it is real and it is as bad as they want us to believe, why aren’t they investing in hospitals and why are doctors going on strike? It’s not that serious, that’s why.”
Adediji says this disbelief is a huge problem. “[The information flow has been really bad and people have not been properly educated about this virus.] Sensitisation of the populace has been poor as some do not believe COVID exists and do not follow standard precautions, thereby increasing risk in their communities.”
Despite these challenges, health care workers across Nigeria continue to show up to work to treat patients and fight the pandemic, but they need all the support they can get.
To put an end to the COVID-19 pandemic globally, we need to urgently develop tests, treatments, and vaccines, and we have also got to ensure that these anti-COVID-19 tools reach everyone, everywhere, equally.
Join the movement to fight COVID-19 by taking action here to support our Global Goal: Unite for Our Future campaign, to urge world leaders to step up funding to deliver and distribute tests, treatments, and vaccines, in a way that’s equitable and ensures no one is left behind.
You can also learn more about COVID-19, its impact on the world’s most vulnerable people, and what we can all do to help stop it through our COVID-19 coverage here.