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Capacity assessment of Nigeria for health emergencies preparedness and response
Supplement article - Research | Volume 5 (2): 2. 01 Nov 2022 | 10.11604/JIEPH.supp.2022.5.2.1244

Capacity assessment of Nigeria for health emergencies preparedness and response

Womi Eteng Oboma Eteng, Vincent Jessey Ganu, Delia Akosua Bandoh, Gloria Margaretta Chandi, Ernest Kenu, Chikwe Ihekweazu, Virgil Kaussi Lokossou

Corresponding author: Vincent Jessey Ganu, Korle-Bu Teaching Hospital, Accra Ghana

Received: 01 Sep 2021 - Accepted: 22 Jun 2022 - Published: 01 Nov 2022

Domain: Epidemiology,Global health,Public health

Keywords: Nigeria, outbreaks, public health emergencies preparedness and response, NCDC

This articles is published as part of the supplement Overview of Preparedness and Response to public health emergencies in ECOWAS Region, commissioned by AFENET and WAHO.

©Womi Eteng Oboma Eteng et al. Journal of Interventional Epidemiology and Public Health (ISSN: 2664-2824). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this article: Womi Eteng Oboma Eteng et al. Capacity assessment of Nigeria for health emergencies preparedness and response. Journal of Interventional Epidemiology and Public Health. 2022;5(2):2. [doi: 10.11604/JIEPH.supp.2022.5.2.1244]

Available online at: https://www.afenet-journal.net/content/series/5/2/2/full

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Capacity assessment of Nigeria for health emergencies preparedness and response

Capacity assessment of Nigeria for health emergencies preparedness and response

Womi Eteng Oboma Eteng1, Vincent Jessey Ganu2,&, Delia Akosua Bandoh3, Gloria Margaretta Chandi3, Ernest Kenu3, Chikwe Ihekweazu1, Virgil Kaussi Lokossou4

 

1Nigeria Centre for Disease Control, Abuja, Nigeria, 2Korle-Bu Teaching Hospital, Accra, Ghana, 3School of Public Health, University of Ghana, Accra, Ghana, 4ECOWAS Regional Centre for Disease Surveillance and Control, Abuja Nigeria

 

 

&Corresponding author
Vincent Jessey Ganu, Korle-Bu Teaching Hospital, Accra Ghana. vincentjganu@gmail.com

 

 

Abstract

Introduction: Nigeria faces frequent natural and environmental disasters as well as violent conflicts including insurgency and communal clashes. Nigeria's public health challenges continue to grow—rapid population growth, increasing movement of people and destruction of infrastructure in the North East of Nigeria and outbreaks from new and re-emerging pathogens. Objective: We assessed the current status of Nigeria's public health emergencies preparedness and response in order to identify gaps and recommend appropriate measures to be put in place.

 

Methods: A cross-sectional study was conducted from April to September 2018 among key stakeholders in health in the Federal Republic of Nigeria. Data collection was done in 2 phases: desk review and in-country data collection comprising of key informant interviews, in-depth interviews and where appropriate focus group discussions.

 

Results: Nigeria has a public health institute (Nigeria Centre for Disease Control (NCDC)) as a fully established government agency. There is a guidance document for implementation and delivery plans of the NCDC. There is strong leadership support and good collaboration between key state institutions and international partners towards emergency preparedness and response. Coordination between the national level authorities and those at the state levels is usually challenging. One Health collaboration between human, agriculture and toxicology laboratories is poor.

 

Conclusion: The presence of the NCDC which is a full government agency has helped Nigeria with the implementation of preparedness and response strategies. Coordination though smooth at the national and internal stakeholder level remains a challenge at the lower levels (states and LGAs) especially in the areas of health workforce, One Health approach and logistics.

 

 

Introduction    Down

Outbreaks of emerging infectious diseases have been documented as sources of uncertainty and instability [1]. Emergencies such as disease outbreaks and disaster impact the health of population.

 

The Ebola virus disease (EVD) outbreak in 2014 is seen as exceptional due to its geographic scope and its associated significant number of morbidities and mortalities [2]. The extent of the outbreak affected 10 countries (Guinea, Sierra Leone, Liberia, Nigeria, Senegal, Spain, Mali, Italy, United States of America (USA) and the United Kingdom) in 3 continents (Africa, North America and Europe) [3]. The epidemic took considerable time to contain, despite the extensive mobilization of personnel, equipment and resources by both national and international organizations and agencies [4,5].

 

Nigeria is Africa´s most populous country, with an estimated population of over 182 million, including 31 million children below the age of five years and over half the population lives in poverty [6]. It is a nation consisting of more than 250 ethnic groups, 380 languages, and a diverse range of cultural and religious beliefs and practices and also has a high rate of population movement across its borders.

 

Nigeria faces frequent natural and environmental disasters as well as violent conflicts including insurgency and communal clashes. Nigeria´s public health challenges continue to grow—rapid population growth, increasing movement of people and destruction of infrastructure in the North East of Nigeria following the ‘Boko Haram’ insurgency and outbreaks from new and re-emerging pathogens. In 2017, there was an increase in outbreaks of diseases such as Lassa fever [7], yellow fever, monkey pox, cholera and new strains/subtypes/serotypes of existing pathogens like Neisseria meningitidis serogroup C in Nigeria [8].

 

Nigeria´s rapid response to the Ebola Viral Disease (EVD) epidemic in 2014 through intensified efforts at isolation, quarantine, contact tracing, case identification and public education brought the EVD outbreak under control in a little over a month [9].

 

We assessed the current status of Nigeria´s public health emergencies preparedness and response in order to identify gaps and recommend appropriate measures to be put in place.

 

 

Methods Up    Down

Study design

 

A cross-sectional study was conducted from April to September 2018 among key stakeholders in health in the Federal Republic of Nigeria. The study involved desk reviews and qualitative approach comprising of key informant interviews, in-depth interviews and where appropriate focus group discussions. Data collection was done in 2 phases: desk review and in-country data collection conducted from July to September, 2018.

 

Study population

 

The study population were key ministries, parastatal agencies, departments and international organizations and other relevant stakeholders that are involved in the response to health emergencies and disease outbreaks in the country as identified after WAHO´s engagement with the Federal Ministry of Health (FMOH) of Nigeria. Representatives from the Federal Ministry of Health (FMOH), Nigeria Centre for Disease Control (NCDC), Economic Community Of West African States (ECOWAS), World Health Organization (WHO), Médecins Sans Frontières France (MSF-France), United States (US) Centre for Disease Control (CDC) and African Field Epidemiology Network (AFENET) in the country were involved in the study.

 

Data collection and tools

 

Tools

 

The data collection tools used in this study included a data review tool, a structured questionnaire and an interview guide. These tools were developed based on the International Health Regulation (IHR) core capacities. Sixteen major areas of the IHR core capacities were assessed Table 1. The data collection tools were pre-tested and validated by the West Africa Health Organization (WAHO) among ministers of health in the West African Sub-region.

 

Data Collection

 

Desk review was conducted at both the Federal and State levels. Desk review of the following country documents were conducted: latest IHR capacity scores, JEE report, post JEE implemented action reports, surveillance and response assessment reports and national surveillance and response documents (policies, structures, coordination mechanisms, guidelines, procedures and simulation exercises guides).

 

In-country data collection in the form of key informant/in-depth interviews were conducted using an interview guide. These interviews were conducted for representatives the FMOH, NCDC, ECOWAS, WHO, MSF-France, IHR focal person, US CDC and AFENET. All relevant data on the policies, plans, guidelines and relevant literature available were verified during in-country data collection.

 

The structured questionnaire was used to collate specific responses pertaining to various aspects of the country´s surveillance and response to disaster and epidemics. In addition, the strength and gaps were identified from the data and desk review.

 

Strategies adapted to ensure rigor of the study included building a skilled and competent research team, developing data collection guidelines, conducting pilot interviews and testing the interview protocols, regular debriefing sessions held with the project team members and collection of all field notes from interviewers for analysis. We also adapted member checking during the data collection process to determine the normative patterns of responses obtained to achieve reliability.

 

Data Analysis

 

Qualitative data obtained from key informant/in-depth interviews were transcribed and analyzed under the sixteen major areas covered. Dependability of data was ensured by peer rating to ensure transcribed data were in line with questions.

 

Ethical considerations

 

Approval was obtained from FMOH of Nigeria through WAHO. In Nigeria, permission was sought from the head of the NCDC. The purpose of the assessment was explained to participants who were interviewed and their approval was obtained before interviews were conducted. Participants were free to opt out of the assessment at any point.

 

 

Results Up    Down

Findings presented are from record reviews and primary data collected. A total of 28 key informants from the various selected stakeholder organizations were interviewed (Table 1 & Table 2).

 

Summary of Key findings

 

Coordination, Policy and Plans

 

The NCDC is Nigeria´s national public health institute responsible for coordinating response to disease outbreaks.

 

Strengths

 

The NCDC is a fully established agency of the Nigerian government. It was fully recognized by law as a national public health institution after the President signed the bill establishing NCDC as a government agency in November 2018.

 

There is a strong demonstration of leadership support towards emergency preparedness and response in the country at all levels. The NCDC has an organogram which is reflective of the internal structures and linkages in the NCDC at the national level. There is an existence of a national Strategic Plan 2017-2021 as a guidance document in NCDC´s implementation and delivery plans.

 

With regards to the teamwork towards response and preparedness to outbreaks, there is good collaboration between NCDC and key state institutions such as State Ministry of Health, the National Primary Health Care Development Agency (NPHCDA) and State Primary Health Care and Development Agency (SPHCDA). These institutions have personnel such as epidemiologists, health educators, environmental health officers, public health nurses as well as technicians in health facilities who collaborate with NCDC in the implementation of outbreak prevention and response activities.

 

There are varying skills and experience with management of outbreaks in various states as some states experience more outbreaks than others and therefore contribute to the varying coordinated response required during PH emergencies. There is the existence of Rapid Response Teams (RRT) to coordinate responses to tackling the outbreak/epidemic in affected states.

 

The NCDC has a strong partnership with partners such as WHO, CDC, AFENET and MSF who offer support to NCDC in terms of technical assistance, capacity building, resource mobilization, surveillance and provision of skilled personnel before, during and after epidemics/outbreaks.

 

Gaps

 

The existing NCDC organogram is not indicative of linkages to other units/departments at State & Local Government Area (LGA) levels. There is also no available flowchart to show flow of activities or flow of work from the Federal level to the LGA levels. Due to the challenge of lack of technical expertise, the roles indicated on the organogram were created based on the expertise of the available technical staff. There were times when roles had to be collapsed based on availability of technical staff.

 

There is no formal document clearly outlining the coordination between the NCDC, the FMOH, parastatal agencies and partners at the national, state and LGA levels in terms of emergency preparedness and response.

 

The coordination between the national level authorities and those at the state levels is usually challenging due to the autonomous nature of the states and the semi-autonomous nature of the LGAs too.

 

Structure and Function of Disease Surveillance and Epidemic Response and Recovery

 

The NCDC has established the Incident Coordination Centre (ICC) to coordinate preparedness and response activities. The ICC reviews outbreak reports and takes decisions on preparedness and response activities. The ICC is also tasked with daily epidemic intelligence gathering and risk analysis of public health events to identify potential threats. It serves as an Emergency Operations Centre (EOC) during outbreaks, with an incident manager leading the response, bringing together the various pillars of outbreak response working in a command and control structure.

 

Apart from the national EOC located at the NCDC, 20 other EOCs have been established in 20 different States. These state EOCs are being supported by the national EOC.

 

There are post-epidemic -After Action -review meetings between the NCDC and all other relevant stake-holders to share experiences from the epidemic response document key findings or activities for an improved and better response at another time. Most states have isolation facilities routinely used for managing viral hemorrhagic fevers such as Lassa fever.

 

Cross-Border Response

 

Cross border deals with cross-border movements and migration which operates within three (3) core axes (right of entry, residence and establishment). Nigeria established the right of entry from 1980-1985 and the right of residence from 1985-1990.

 

Strengths

 

The department for cross border issues fosters relationship across borders. This department coordinates activities such as combating irregular migrations, human trafficking, drug trafficking, human smuggling, terrorism. There are also migration procedures, migration policies, and lately asylum and refugees´ issues have been given prominent attention because of the experiences from the previous civil wars in Sierra Leone and Liberia.

 

There is a formal contingency plan for designated PoE (airports, sea ports and ground crossings). Simulation exercises are periodically conducted.

 

During an outbreak, screening is intensified at all ports of entry. The cross-border department also sensitized people about compliance to relevant basic hygiene practices after the Ebola outbreak. Education on the avoidance of stigmatization was also carried out to ensure that the free movement plan was not jeopardized thereby worsening the outbreak.

 

Gaps

 

Not all designated PoEs (airports, ports and ground crossings) have a contingency plan in place. In addition, not all PoEs have immediate access to equipment and supplies (PPEs, Infrared thermometers, cleaning and disinfecting products, observation/isolation facilities and ambulance, depending on location).

 

There are no Standard Operating Procedures for implementing exit screening methods in the event a confirmed VHF case is seen.

 

Laboratory

 

The National Public Health Reference Laboratory was established in 2017 and is located in Abuja. This National Reference Laboratory is part of the West Africa Regional Reference Laboratories network. It coordinates the activities of all the laboratories in the country in the event of public health emergencies. The National Public Health Reference Laboratory, based on biological safety Levels is Level two Laboratory with level three practice. The Laboratory has five Polymerase Chain Reaction (PCR) and five Enzyme-linked Immunosorbent Assays (ELISA) machines and Lead care machines for diagnosing lead poisoning.

 

Diagnosis or confirmation with PCR of Cerebrospinal Meningitis (CSM), Cholera, Monkey Pox, Yellow Fever, Lassa fever, influenza are being carried out now at the Reference laboratory.

 

Strengths

 

There is an existing contract with a transport logistics company (Tranex company) to transport samples from State capitals to laboratories. The terms and conditions include a turnaround time for sample transportation to lab of 48 hours.

 

There is distribution and replenishment of triple packaging in the country. The laboratory personnel at national and state levels are trained on safety procedures and Infection Prevention and Control (IPC) for specimen collection, packaging, labelling, referral & shipment, including certification for the handling of infectious substances.

 

There are trained biomedical engineers at NCDC to assist in the management and maintenance of laboratory equipment.

 

Gaps

 

There is lack of information sharing between the veterinary laboratories and other laboratories such as agriculture and toxicology laboratories in this era of One Health concept.

 

Public Health Emergency Communication/ Risk Communication

 

The risk communication team of NCDC employs both traditional and modern methods of communication. Risk assessment outcomes determine information dissemination and the appropriate or preferred channels of communication at all levels (social media, newspapers, state health educators, town announcers).

 

Strengths

 

The NCDC has developed a risk communication plan that is yet to be launched. The NCDC also has a communication tracking tool which is used to track every communication in the State and LGA. The NCDC leverages on existing structures/institutions (the National Orientation Agency, the Ministry of Women Affairs and the National Youth Service Corps (NYSC)) across the country from National to State to LGA levels for risk communication purposes. They work with them as part of their community development programs to do health orientation programmes in the communities.

 

At the Federal level at NCDC, apps such as “tatafoo” are used for monitoring communication activities such as rumours on possible on-going outbreaks. There is a “call centre” where people can call and clarify information and the call centre number is readily available to the general public via the NCDC website and its social media platforms.

 

The team works with United Nations International Children´s Emergency Fund (UNICEF) and WHO and these partners fund most of their communication activities (e.g., jingles, communication materials production and sometimes transportation logistics).

 

Gaps

 

Funding for consistent health promotion programs was reported as inadequate especially in non-crisis times.

 

Although the team at the Federal level works with state health directors (Head of communication at the State level) and LGA health educators, before, during and after an outbreak, it is expected that continuous education of the communities take place but it is not regularly monitored to ensure it is done.

 

Logistics

 

The NCDC has a software that gives information on stock piling. The United Nations Development Programme (UNDP) is assisting with the creation and running of the software. It gives information on the exact available materials, commodities and medications. Information on depleting stocks and the need for restocking is also obtained from the software. For now, the NCDC stores their logistics in rented warehouses.

 

Apart from logistics stored and deployed by the NCDC during an outbreak, various partners also support with logistics depending on the type of epidemic or disaster that occurs.

 

Gaps

 

The cost of renting warehouses for storage of logistics is very high. There is no available inventory of available resources in all the States for potential use in the Public Health emergency response.

 

Infection Prevention and Control (IPC)

 

There are available IPC guidelines and SOPs in health facilities. There are available burial teams. Facilities have been identified for conversion as treatment centers. There have been several trainings on IPC across the countries but not all frontline personnel have benefitted from these trainings.

 

Medical Countermeasures and Personnel Deployment

 

The NCDC is currently developing a medical counter measure document. The NCDC is planning a final workshop where all the stakeholders will agree on this document for it to be launched. The Medical counter measure document will have information on all the stakeholders involved in the procurement, distribution and utilization of all commodities.

 

Gaps

 

There are no existing medical counter measure documents and there is no formal system in place for activating and coordinating medical counter-measures across borders during a public health emergency.

 

Availability of Epidemiology/ Surveillance and Related Institutional Capacity

 

Surveillance carried out are of two types. There is the Event Based Surveillance (EBS) and Indicator Based Surveillance (IBS). The NCDC has a connect centre where this surveillance software is used to track and filter information on what is happening in Nigeria.

 

The IBS is carried out at health facilities and then reported through the local government to the state and finally to NCDC. The information from the IBS is collated and inputted into a platform (surveillance response system) for all supervisory levels to access it.

 

There is another software called SITAware (derived from SITUATIONAL AWARENESS) where actions following initial detection of public health signals are documented and tracked.

 

Strengths

 

The NCDC organizes weekly general meetings known as the National Surveillance meeting. At these meetings, information from the affected states are discussed and decision taken whether there is a need to escalate it to the head of NCDC or solve it at the state level. If there is no need for Federal level input, the responsible technical working group continue monitoring and giving the needed support including surveillance, epidemiology and post communication. There are different cadres of trained personnel at the national, state and LGA levels for surveillance activities.

 

Surveillance softwares exist to intensify surveillance response system. The NCDC carries out what is called After Action review which is a form of post impact epidemic surveillance.

 

There are contact tracing guidelines and SOPs available and disseminated to the national and subnational level and staff of NCDC have had training on the guidelines and SOPs.

 

Gaps

 

There are no policies and guidelines on in-country deployment of experts in the event of a public health emergency.

 

There is also no contingency plan for immediate activation in case of epidemic and health emergency.

 

Health Sector Workforce Development

 

Stakeholders or partners are actively involved in all activities carried out by the NCDC from planning meetings to deployment and After Action reviews. These partners offer assistance in various areas such as technical assistance and training and funding (e.g.: AFENET, WHO, CDC).

 

Gaps

 

There are inadequate trained or skilled personnel needed for Public health emergency planning and response activities. There is high turnover rate of trained workforce due to periodic postings. This results in delays in required response during outbreaks as the ones at post have not been trained whilst the trained ones have been posted elsewhere unrelated to their training.

 

International Health Regulation (IHR) And Joint External Evaluation (JEE)

 

Nigeria´s IHR Focal Point is the NCDC. The last JEE was conducted in June 2017. Nigeria now has a National Action Plan for Health Security. This is in response to the various gaps identified during the last JEE and discussions were being held as to how to bridge these gaps and improve upon the country´s response when it comes to public health emergencies.

 

Stakeholder Engagement

 

The NCDC works with institutions at the state level such as the State Ministry of Health, the National Primary Health Care Development Agency and the State HealthCare and Development Agency. These institutions have personnel such as epidemiologists, health educators, environmental health officers, Public health Nurses as well as technicians in health facilities. Support such as technical assistance, resource mobilization, capacity building and training and provision of skilled personnel are offered by other partners such as the WHO, CDC, AFENET and MSF during outbreaks.

 

Most of these stakeholder engagements actually occurs during and after outbreaks and a few occur before the outbreaks especially for the annual outbreaks.

 

One - Health Approach

 

There is a multi-sectoral, multi-disciplinary One Health coordination platform. A national One Health strategy document has recently been developed and it is publicly available on the NCDC website. Also, there is a risk communication working group that comprises of members from various institutions such as health, agriculture, environment and information. The group meets quarterly to discuss routine activities before outbreaks and also has emergency meetings in the event of an outbreak.

 

Resource Mobilization and Sustainability

 

A yearly budget line for emergency response is controlled by the Director General (DG) of NCDC. This budget line is included in the main budget for the Ministry of Health. So, the NCDC applies for funds for their budget line every year. Funds for deployment to the affected states are released from the office of the Director General. Although some financial support comes from Partners, this is inadequate.

 

Gaps

 

There are no templates for resource mobilization and for country and donor reporting, including mechanisms to monitor and track implementation.

 

Research

 

The NCDC engages in research as one of their activities with respect to PH emergency preparedness and response. However, this is not well structured and formalized as there are issues with research funding. Sometimes, partners provide funding for some research activities during and after an outbreak.

 

Gap

 

Adequate funding for research purposes was reported as lacking and needed to be given much attention.

 

Monitoring and Evaluation

 

The unit responsible for IHR under the NCDC is developing a monitoring and evaluation plan in place to track the progress of activities in assuring the health security of the Nigerian people. However, this is still not ready as they are working to finalize it.

 

There is a weekly national epidemiological bulletin and it is available on the internet and is usually disseminated to all institutions involved in the coordination response both at the national and state levels.

 

Situational Analysis and Evaluation of Nigeria´s Emergency Preparedness and Response

 

The situational analysis of the country has been captured as strengths, weakness, opportunities and threats of epidemic preparedness and response in the country.

 

Strengths

 

-The NCDC has an organogram which is reflective of the internal structures and linkages in the NCDC.

 

-Existence of a national Strategic Plan 2017-2021 as a guidance document in NCDC´s implementation and delivery plans.

 

-There is a strong demonstration of leadership support towards emergency preparedness and response in the country at all levels.

 

-Good collaboration between NCDC and key state institutions such as National and State Ministry of Health, the National and State Primary Health Care Development Agency with regards to response and preparedness to outbreaks.

 

-Support in terms of technical assistance, capacity building and provision of skilled personnel offered by partners such as the WHO, CDC, AFENET and MSF during outbreaks.

 

-Existence of Rapid Response Teams (RRT) to coordinate responses to tackling the outbreak/epidemic in the affected state.

 

-Variable skills and experience with management of outbreaks in various states as some states experience more outbreaks than others and therefore contribute to the varying coordinated response required during PH emergencies.

 

-The NCDC has established the Incident Coordination Centre (ICC) to coordinate preparedness and response activities and is the national public health Emergency Operations Centre.

 

-The department for cross border issues fosters relationship across borders.

 

-There is a National Public Health Reference laboratory and the turnaround time for sample transportation to laboratory and results is 48 hours.

 

-There is distribution and replenishment of triple packaging.

 

-Laboratory personnel are trained on safety procedures and IPC for specimen collection, packaging, labelling, referral & shipment, including certification for the handling of infectious substances.

 

-The NCDC has developed a risk communication plan that is yet to be launched.

 

-The NCDC also has a communication tracking tool which is used to track every communication in the State and LGA.

 

-Leveraging of existing structures/institutions (the National Orientation Agency, the Ministry of Women Affairs and the National Youth Service Corps (NYSC)) across the country from National to State to LGA levels for risk communication purposes.

 

Weaknesses

 

-The existing organogram of the NCDC is not indicative of linkages to other units/departments at State & LGA levels.

 

-There is no formal document clearly outlining the coordination between the NCDC, the FMOH, parastatal agencies and partners at the national, state and LGA levels in terms of emergency preparedness and response.

 

-The coordination between the national level authorities and those at the state levels is usually challenging due to the autonomous nature of the states and the semi-autonomous nature of the LGAs too.

 

-Not all designated PoEs (airports, ports and ground crossings) have a contingency plan in place.

 

-Not all PoEs have immediate access to equipment and supplies (Personal Protective Equipment (PPE), Infrared thermometers, cleaning and disinfecting products, observation/isolation facilities and ambulance, depending on location).

 

-No SOP for implementing exit screening protocols in the event that a confirmed case of Viral Haemorrhagic Fever (VHF) is seen.

 

-Lack of information sharing between the veterinary laboratories and other laboratories such as agriculture and toxicology laboratories in this era of one health concept.

 

-In adequate funding for consistent health promotion programs especially in non-crisis times.

 

-High cost of renting warehouses for storage of logistics.

 

-No available inventory of available resources in all the States for potential use in the Public health emergency response.

 

-No existing medical counter measure document.

 

-No formal system in place for activating and coordinating medical counter-measures across borders during a public health emergency.

 

-Lack of adequate funding for research purposes.

 

Opportunities

 

-There are a lot of partners and the private sector where funds can be sought from to improve on coordination activities of the emergency preparedness response.

 

-Nigeria has huge human resource capacity that can be trained and employed to fill the human resource gaps at the national, state and LGA levels.

 

Threats

 

-Over reliance on donor partner support for most activities for emergency preparedness and response.

 

 

Discussion Up    Down

Local, state and Federal public health agencies and key stakeholders are assuming a growing role in the preparedness and response system with regards to coordination of responses to incidents [10]. A study of this preparedness and response in Nigeria revealed existence of coordination structures, concerted efforts from good collaborations between national and international partners or agencies. Challenges facing this preparedness and coordination response include but not limited to inadequate human resource challenges, inadequate funding as well as One Health concept implementation challenges.

 

Nigeria has a strong emergency preparedness and coordination response spearheaded by the NCDC. Effective collaboration among the NCDC, local and state institutions and international partners was key to curbing the 2014 EVD outbreak [9]. The importance of multi-actor collaboration has been proven as promising when it is structured and effective [11]. Nigeria benefits from support such as technical assistance, capacity building and provision of skilled personnel through effective collaboration with partners such as WHO, CDC, AFENET and MSF during outbreaks. Despite this collaboration, the NCDC and FMOH need to continuously engage stakeholders to identify existing coordination issues and develop interventions for improvement in coordination.

 

Nigeria has a significant number of policies, guidelines and contingency plans especially the national Strategic plan 2017-2021. This is key as they are essential in evidence-based practice in providing direction during a public health emergency and preparedness response [12]. However, lack of coordination flow or network guidance was noted between the NCDC, FMOH, parastatal agencies and partners at the national, state and LGA levels in terms of emergency preparedness and response. This is a threat to emergency response as there will be confusion on who owns a public health emergency and how to respond. This will lead to ineffective, fragmented and poor public health response to an emergency or disaster. There is a need to develop a guiding document to that effect to improve on the coordination and response to epidemics.

 

The interconnected and cross border nature of the threat of infectious disease outbreaks facilitates transmission as evidence from the 2014 EVD outbreak [13]. Nigeria is keen on intensifying screening at their points of entry or exits (PoEs) but lacks a formal contingency plan on emergency preparedness and response at the PoEs. This poses a threat in the event of an emergency such as a disease outbreak as staff at these PoEs do not have a standardized plan to follow and thus response will be disorganized. Development of these plans will help standardize response in terms of coordination and response and also abide by IHR regulations.

 

Significant amount of funding for emergency preparedness and response activities in Nigeria is from international donors. These are heavily relied on especially during an outbreak as funds from governments take time to be released and are usually inadequate. This over reliance on international donors for funding is a threat as withdrawal or inadequate provision of such funds can result in dire consequences during disease outbreaks or disasters. Similar concerns of over reliance on funding from international donors and its impact have been reported in other settings [14,15]. Nigeria needs to deliberate and initiate actions on the issue of social mobilization and sustainable funding to maintain an effective preparedness and response system as revealed in lessons from public health preparedness in California [16].

 

A key aspect of emergency planning is concern for proficient logistics management and the effective provision of relevant items at the appropriate time when needed [17]. Logistics and other resources play a vital role in strategic-level planning in the health care supply chain management´s involvement in emergency preparedness and response [17]. Nigeria has a logistics platform for tracking all supplies received and given out. It is important that Nigeria improves on its logistics platform and ensures its sustainability as it gives an evidence based applied insight into outbreak or disaster mitigation and preparedness. Poor logistic management will result in poor response to emergencies and also result in lack of trust by health workers in the health system.

 

Human resources or workforce is vital in emergency preparedness and response in terms of numbers, training, relevant expertise, availability and deployment [18]. Nigeria has a good workforce including epidemiologists, laboratory personnel, public health specialists, health information experts, clinicians, risk communication experts, nurses and veterinarians although they are inadequate due to the size and population of the country. The Nigeria Field Epidemiology and Laboratory Training Programme (FELTP) which specializes in training field epidemiologists plays a crucial role of providing training for workforce and linking them to the health system. With the large trained workforce available in Nigeria, the NCDC can work closely with the FELTP to train more to address the inadequacy and also to export some of this skilled workforce to assist other countries during public health emergencies.

 

Nigeria is putting in much efforts to ensure effective and efficient coordination when it comes to emergency preparedness and response. However, there are existing threats and gaps that need to be addressed to ensure a stronger and more resilient health system to improve the health security of the people in the country. This will lead to significant mitigation of associated economic, development and social consequences of disease outbreaks and disasters.

 

Limitations

 

Competing interest of stakeholders due to stakeholders´ commitment made it difficult to have ample time to explore in-depth issues on the existing situation during interviews. We tried to minimize this by sharing interview guides with stakeholders ahead of the interview.

 

 

Conclusion Up    Down

Nigeria has a fully functional national public health institute which coordinates all public health emergency and preparedness activities. This has helped with the implementation of preparedness and response strategies through the strategic plan which serves as a guidance document. Coordination, though smooth at the national and international stakeholder level, remains a challenge at the lower levels (states and LGAs). Again, implementation of the One Health Approach in dealing with public health events remains a challenge.

What is known about this topic

  • Nigeria experiences frequent disease outbreaks from new and re-emerging pathogens each year
  • Public health challenges continue to grow in Nigeria due to rapid population growth and existing challenges with infrastructure due to insurgency attacks.

What this study adds

  • This paper highlights the current status of Nigeria's public health emergency preparedness and response
  • It provides critical information on the identified gaps and the opportunities for improvement in relation to emergency preparedness and response
  • It provides information on the relevance of a main coordinating body for emergency preparedness in the country and also the major challenge with implementation of the One Health Approach in dealing with public health events.

 

 

Competing interests Up    Down

The authors declare no competing interests.

 

 

Authors' contributions Up    Down

Conceptualization: WEO, DAB, EK, CI, VKL. Data collection: WEO, VJG, DAB, GMC, EK, CI, VKL. Report writing: WEO, VJG, DAB, GMC, EK, CI, VKL. Manuscript development and finalization: WEO, VJG, DAB, GMC, EK, CI, VKL. All authors read and approved of the final version of the manuscript.

 

 

Acknowledgments Up    Down

We would like to acknowledge all partners and stakeholders who made time out of their busy schedule and granted us the interviews.

 

 

Tables Up    Down

Table 1: International Health Regulation (IHR) core capacity areas assessed in Nigeria, July 2018

Table 2: List of key informants interviewed, Nigeria Country Mission, July, 2018

 

 

References Up    Down

  1. Dingwall R, Hoffman LM, Staniland K. Introduction: why a sociology of pandemics? Sociology of health & illness. 2013 Feb; 35(2):167-73.https://doi.org/10.1111/1467-9566.12019 Google Scholar

  2. World Health Organization. Factors that contributed to undetected spread of the Ebola virus and impeded rapid containment. WHO. 2015. Accessed Oct 2019.

  3. Bali S. Fear Casts a Long Shadow: Zika Virus and the Lessons From Ebola. 2016. Accessed Nov 2020.

  4. Roemer-Mahler A, Rushton S. Introduction: ebola and international relations. Third World Quarterly. 2016 Mar 3; 37(3):373-9.https://doi.org/10.1080/01436597.2015.1118343 Google Scholar

  5. Parmet WE, Sinha MS. A panic foretold: Ebola in the United States. Critical Public Health. 2017 Jan 1; 27(1):148-5. https://doi.org/10.1080/09581596.2016.1159285 Google Scholar

  6. United Nations Development Programme (UNDP). Human Development Report, 2016. UNDP. 2017. Accessed July 2022.

  7. World Health Organization. Epidemic focus. WHO. 2016. Accessed Oct 2019.

  8. World Health Organization. Weekly Epidemiological Record: Zoonotic influenza viruses: antigenic and genetic characteristics and development of candidate vaccine viruses for pandemic preparedness. WHO. 2017. Accessed Oct 2019. Google Scholar

  9. Shuaib F, Gunnala R, Musa EO, Mahoney FJ, Oguntimehin O, Nguku PM, Nyanti SB, Knight N, Gwarzo NS, Idigbe O, Nasidi A, Vertefeuille JF; Centers for Disease Control and Prevention (CDC). Ebola virus disease outbreak - Nigeria, July-September 2014. MMWR Morb Mortal Wkly Rep. 2014 Oct 3; 63(39):867-72. PubMed | Google Scholar

  10. Freedman AM, Mindlin M, Morley C, Griffin M, Wooten W, Miner K. Addressing the gap between public health emergency planning and incident response: Lessons learned from the 2009 H1N1 outbreak in San Diego County. Disaster Health. 2013 Jan 1; 1(1):13-20.https://doi.org/10.4161/dish.21580 PubMed | Google Scholar

  11. de Vries M, Kenis P, Kraaij-Dirkzwager M, Ruitenberg EJ, Raab J, Timen A. Collaborative emergency preparedness and response to cross-institutional outbreaks of multidrug-resistant organisms: a scenario-based approach in two regions of the Netherlands. BMC Public Health. 2019 Jan 11; 19(1):52. https://doi.org/10.1186/s12889-018-6376-7 PubMed | Google Scholar

  12. Carbone EG, Thomas EV. Science as the Basis of Public Health Emergency Preparedness and Response Practice: The Slow but Crucial Evolution. Am J Public Health. 2018 Nov; 108(S5):S383-S386.https://doi.org/10.2105/ajph.2018.304702 PubMed | Google Scholar

  13. Suk JE, Van Cangh T, Beauté J, Bartels C, Tsolova S, Pharris A, Ciotti M, Semenza JC. The interconnected and cross-border nature of risks posed by infectious diseases. Glob Health Action. 2014 Oct 10;7:25287.https://doi.org/10.3402/gha.v7.25287 PubMed | Google Scholar

  14. Legido-Quigley H, Otero L, la Parra D, Alvarez-Dardet C, Martin-Moreno JM, McKee M. Will austerity cuts dismantle the Spanish healthcare system? BMJ. 2013 Jun 13;346.https://doi.org/10.1136/bmj.f2363 Google Scholar

  15. Bevc CA, Simon MC, Montoya TA, Horney JA. Institutional facilitators and barriers to local public health preparedness planning for vulnerable and at-risk populations. Public Health Rep. 2014; 129 Suppl 4(Suppl 4):35-41.https://doi.org/10.1177/00333549141296s406 PubMed | Google Scholar

  16. Lurie N, Wasserman J, Stoto M, Myers S, Namkung P, Fielding J, Valdez RB. Local Variation In Public Health Preparedness: Lessons From California: Even in California–one of the best-prepared states–much work remains to ensure preparedness for a public health emergency. Health Affairs. 2004; 23(Suppl1):W4-341.https://doi.org/10.1377/hlthaff.w4.341 Google Scholar

  17. Van Vactor JD. Strategic health care logistics planning in emergency management. Disaster Prev Manag An Int J. 2012 Jun; 21(3):299-309.http://dx.doi.org/10.1108/09653561211234480 Google Scholar

  18. Kluge H, Martín-Moreno JM, Emiroglu N, Rodier G, Kelley E, Vujnovic M, Permanand G. Strengthening global health security by embedding the International Health Regulations requirements into national health systems. BMJ Glob Health. 2018 Jan 20; 3(Suppl 1):e000656.https://doi.org/10.1136/bmjgh-2017-000656 PubMed | Google Scholar

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Research

Capacity assessment of Nigeria for health emergencies preparedness and response

Research

Capacity assessment of Nigeria for health emergencies preparedness and response

Research

Capacity assessment of Nigeria for health emergencies preparedness and response


The Journal of Interventional Epidemiology and Public Health (ISSN: 2664-2824). The contents of this journal is intended exclusively for public health professionals and allied disciplines.