“A disease outbreak anywhere is a risk everywhere”. – Tom Frieden, Former Director US Centres for Disease Control and Prevention (CDC)
Infectious diseases seem to be featuring increasingly in the news in Nigeria. Either it is meningitis in the north-west, Lassa in the south-west or Monkey pox in the South-south. With its increasing population, tropical climate and challenging socio-economic circumstances, Africa’s most populous country remains at risk of major disease outbreaks. To mitigate this risk, the Federal Government has taken the important proactive step of developing a plan to prevent, detect and respond to public health threats by developing a costed National Action Plan for Health Security (NAPHS). Nigeria is only the fourth country in Africa to do this.
The estimated cost of Nigeria’s NAPHS is N134B over 5 years – i.e. N27 billion per year. This is about 0.3% of the 2018 federal budget. The single biggest cost component is immunisation, while other major initiatives and cost drivers include surveillance, laboratory strengthening, workforce development and emergency preparedness.
In developing the NAPHS, Nigeria adopted a multi-sectoral approach; stakeholders from relevant government ministries and agencies as well as security authorities were closely involved. These included the Office of the National Security Adviser, the Federal Ministries of Health, Agriculture and Rural Development, Environment, Finance, Budget and National Planning, Defence, Science and Technology, Justice and Information. Other participants were the World Bank, Resolve to Save Lives and the World Organisation of Animal Health. The NAPHS development process has created partnerships across sectors both nationally and globally.
The background for the development of the NAPHS, lies within the International Health Regulations (IHR) developed in 2005. The IHR represents a commitment between 196 member states of the World Health Organisation (WHO), to work together for global health security. Through the IHR (2005), member states have agreed to build their capacity to detect, assess and report public health events. The WHO plays the coordinating role in IHR and, together with its partners, helps countries to build these capacities.
The Joint External Evaluation (JEE) is a key component of the IHR Monitoring and Evaluation Framework to assess country capacity to prevent, detect, and rapidly respond to public health threats – naturally occurring, deliberate, or accidental. This external evaluation allows countries to identify the most urgent needs within their health security system, prioritise opportunities for enhanced preparedness, as well as identify specific areas for effective resource mobilisation within government and with partners.
In June 2017, the country conducted a JEE to assess its ability to find, stop and prevent threats of public health significance. The evaluation was conducted in the 19 technical areas which included; preparedness, emergency response operations, real-time surveillance, biosafety and biosecurity and agriculture.
Nigeria’s JEE results revealed that, of the 48 indicators within the 19 technical areas evaluated, 15 indicators had ‘no capacity’, 31 indicators had ‘limited or developed capacity’ and only two indicators had ‘demonstrated capacity’. This revealed many critical gaps in prevention, detection and response in the country. However, these results have now led to better planning and development of the costed blueprint for health security strengthening in Nigeria.
Nigeria’s NAPHS integrates multiple workplans, addressing the major gaps identified by the Joint External Evaluation (2017) and prioritising the plan by national strategies and risks. The NAPHS therefore is an “overarching” plan and can be used to create linkages and monitor progress on major health security initiatives.
The importance of strong country ownership and committed leadership were identified by the Minister of Health, Prof. Isaac Adewole as key to drive the implementation and sustainability of the NAPHS, at the launch of the plan on December 17.
The development of a national action plan for health security is a new process that will re-shape the thinking on health security as a national security issue. Dr. Chikwe Ihekweazu, Director-General of the Nigeria Centre for Disease Control (NCDC), maintained that for the first time Nigeria knows exactly where its areas of strength and weakness are when it comes to outbreak prevention and response, and an understanding of how to improve in these areas. “We have a jointly agreed plan for improving our health security that we can jointly monitor as we move forward,” he said.
Dr Clement Peter-Lasugba, Acting Representative for WHO Nigeria, read a message from the Director-General of the World Health Organisation that commended the Nigerian government for leading and owning the process. “This is a great demonstration that the government considers the health of its people as very important,” he said.
Speaking on what NAPHS means for Nigeria, Richard Garfield, Team Lead of Global Health Security at US CDC said, “It means that the country is going to have a competent system that protects the population health against all kinds of threats that are coming. It doesn’t mean that there won’t be bad things, but it means that we know when it happens, and we will be able to respond much more quickly”.
Now that the plan has been launched, it is imperative that the necessary funding is put in place. Development partners and the government must work together to address the existing funding gaps to enable implementation. Participating Ministries, Departments and Agencies (MDAs) have created their own indicators to monitor progress. Twice a year, they will come together to review progress on implementation and assess the capacity of the country using standard WHO tools. For a plan that bears so much weight on the health security of Nigerians, it is critical that citizens are aware of its importance and demand effective implementation and accountability from the government. Nigeria must continue to ensure maximum protection and full implementation of the IHR (2005).
In a year’s time, we hope to look back and clearly identify the areas where we have improved and the areas where we need support and investment. Christopher Lee, Senior Technical Officer, Resolve to Save Lives who supported the NCDC to coordinate the development of the NAPHS mentioned that, “The real measurement will be in how well functioning the health system is and how strong these capacities are… the improvements are going be less Nigerians with infectious diseases, less health systems that are disrupted by the transmission of these kinds of diseases”. We hope that more African countries will be encouraged to follow the example shown by Tanzania, Liberia and now Nigeria to begin the process of developing their own costed, multisectoral National Action Plan for Health Security.
Great initiative should cover the whole ECOWAS sub-region and become part of the political and economic integration as disease security should be a regional security issue. The Ebola epidemic in Liberia, Sierra Leone and Nigeria is an important lesson to learn from in the ECOWAS space. Congratulations Nigeria for leading the way.