Health Security Needs Healthcare Workers, By Adaeze Oreh
Given how persistent the brain drain has been over the last couple of years, health experts have for a while now feared a time when the country’s health system will grind to an inevitable halt, with barely enough healthcare workers available to provide even the most basic health care services. We certainly hope the new coronavirus doesn’t push us into such a time…
Less than twenty-four hours after the inauguration of the Presidential Task Force for the Control of Coronavirus Disease in Nigeria, five new confirmed cases were announced, sending the country’s total number of confirmed cases to eight and citizens into widespread panic. The burning questions on the mind of so many in Nigeria have varied between, “Are we ready?” and “How ready are we?” Those questions will certainly be answered as events of the coming days and weeks unfold.
When the new coronavirus first hit Italy in February, little did anyone imagine that it would become what has been described as the ground zero of the virus in Europe. Since then, it has rapidly spread across all regions of Italy to infect over 30,000 people and kill more than 2,500, at a nearly 8 per cent death rate – far greater than that observed in Wuhan, China, where the virus was first observed. Additionally, Italy has exported the virus to several countries, including Nigeria, where the first case, an Italian, was reported in February. As the spread of the unrelenting virus ramped up, many Western countries closed their borders and were followed by several African countries who, all in a bid to stop the spread on the continent, suspended visas and deported Europeans to prevent new cases from being imported into their countries.
Now, why is the rampant spread of the new coronavirus in Italy important, one may wonder? So, here’s why.
In 2018, a report on a Lancet-commissioned study on healthcare access and quality, funded by the Bill and Melinda Gates Foundation, ranked Italy 9th out of 195 country health systems. Despite this, when the virus hit the country known for its high-technology health system, hospitals quickly flooded with infected patients and have since reached the breaking point, intensive care spaces have been used up, ventilators are widely unavailable and the country is struggling to find sufficient doctors, nurses and other healthcare workers to attend to the tsunami of patients. This has been so much that the country is rushing 10,000 student doctors into service, forgoing their final exams in a bid to help their struggling health service system. One clear warning that has come from Italian specialists on the ground is that other countries should act early to prevent an occurrence similar to theirs.
The World Health Organisation (WHO) recommends a doctor-patient ratio of 1 doctor to every 1000 patients, and whilst only 45 per cent of WHO member countries have achieved this recommendation, Italy was certainly one of those that even surpassed it. Nigeria, on the other hand, has struggled, averaging 1 doctor to over 6,000 patients, with an incessant brain drain of skilled medical personnel leaving the shores of the country for better lives and more career opportunities abroad. According to the Medical and Dental Council of Nigeria (MDCN), only about 27,000 out of the country’s 72,000 qualified and registered doctors are currently practising in Nigeria. The others work outside the country, with over 2,000 doctors migrating to countries like the United Kingdom, United States of America (USA), Canada, Australia, United Arab Emirates (UAE), Saudi Arabia and South Africa every year. Given that the current national population is approximately 200 million, it doesn’t take a genius to deduce that the present medical workforce in the country is grossly insufficient.
…one of the building blocks of a functional health system is the health workforce; and if Italy, with a large and robust mostly publicly-financed health system and universal health coverage for all citizens can find itself in the desperate situation it is right now, then as a country, Nigeria needs to look more closely at our health security and epidemic preparedness.
On the day of the announcement of Nigeria’s third confirmed case of coronavirus, the National Association of Resident Doctors embarked on an indefinite strike, citing the non-payment of several months’ salaries, pay irregularities and poor working conditions; further stretching an already strained health workforce. According to the World Health Organisation, one of the building blocks of a functional health system is the health workforce; and if Italy, with a large and robust mostly publicly-financed health system and universal health coverage for all citizens can find itself in the desperate situation it is right now, then as a country, Nigeria needs to look more closely at our health security and epidemic preparedness.
It is especially crucial now more than ever, that given what we have observed in China, South Korea, Singapore, USA, Italy, the United Kingdom and Iran, Nigeria takes a firm stand with bold radical steps on curbing the rate of new infections. By placing travel restrictions and pushing self-isolation guidelines on foreigners and citizen arrivals from countries with active community spread and more than 1,000 confirmed cases, we will limit the speed of transmission of the virus, even from asymptomatic individuals, and prevent a ballooning of cases in Nigeria. Failing to do this may see us watch the final collapse of our healthcare system.
It is also vital that we increase the availability of testing across the country, as this is known to not only effectively reduce the risk of transmission but is also being studied as an indicator of higher likelihood of survival from the disease. To buttress this proposition, one may wish to highlight that South Korea, acknowledged to have one of the highest rates of COVID-19 testing in the world, has had one of the lowest death rates among those infected, whereas Italy, on the contrary, has tested less than 20 per cent of South Korea’s total but has a death rate more than ten times higher. Other factors might have also been at play, such as the average age and gender of those infected, but South Korea was able to achieve unprecedented levels of testing by pulling together expertise from across government, private corporations, academia, research and manufacturing, all with a common goal – to increase the availability of coronavirus test kits to most of its population.
…national and state governments should do more to prioritise human resources for health and these resources are the women and men who stand at the frontlines to detect and manage healthcare threats of various kinds. There should be an impatience to enhance domestic financing, through innovative means, for primary healthcare, service delivery at all levels…
Another area of importance for the populace, when it comes to preventing person-to-person spread and a very possible disastrous overwhelming of hospitals by the virus, is improved hand hygiene and social distancing, the latter of which is achievable through cancelled public gatherings, encouraging people to work from home where possible, self-quarantine, self-isolation and crowd avoidance — all critical to preventing the virus from spreading quickly. While considerations for short-term economic losses may lead many to oppose these, the long-term economic losses can completely wipe out any of the considered short term benefits or challenges. Globally, in response to the coronavirus, stock markets have lost over six trillion US dollars, double the figure forecast by Microsoft co-founder and philanthropist Bill Gates in his TED Talk “The Next Outbreak” in 2015, and it looks set to get worse before it gets better. However, despite these unprecedented dynamics which have had varying effects on market psychology, the markets will eventually recover. Therefore, we must focus on strengthening our health systems to manage this challenge.
Finally, national and state governments should do more to prioritise human resources for health and these resources are the women and men who stand at the frontlines to detect and manage healthcare threats of various kinds. There should be an impatience to enhance domestic financing, through innovative means, for primary healthcare, service delivery at all levels, training, research, and also for those factors that enhance working and living conditions such as power, water and sanitation, national security and quality education; as doing this will motivate the much-needed health personnel to remain in-country and deliver uninterrupted service.
Given how persistent the brain drain has been over the last couple of years, health experts have for a while now feared a time when the country’s health system will grind to an inevitable halt, with barely enough healthcare workers available to provide even the most basic health care services. We certainly hope the new coronavirus doesn’t push us into such a time, but we can all come together and take action, buckle down and face this fight. After all, with travel restrictions all over the world, we have nowhere else to go. The good thing is, we are home.
Adaeze Oreh, a family physician, senior health policy advisor and public health expert, is a Senior Aspen New Voices Fellow.