How well has Nigeria responded to COVID-19?

This blog was first published in Brookings Future Development Blog. The authors are Siddharth Dixit, Yewande Kofoworola Ogundeji, and Obinna Onwujekwe.

On January 23, 2020, the World Health Organization’s International Health Regulations (IHR) Emergency Committee advised that “all countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of 2019-nCoV infection, and to share full data with WHO.” On January 30, 2020, the WHO declared COVID-19 to be a public health emergency of international concern.

Is Nigeria prepared to respond effectively to pandemics?

In 2017, during the WHO’s Joint External Evaluation (JEE) of IHR core capacities (an independent, collaborative multi-sectoral effort to assess a country’s capacity to prevent, detect, and respond to public health risks), Nigeria scored poorly both in prevention and response.

  • Nigeria’s average score of 1.9 across the 15 JEE indicators in the prevent category suggested that overall there was limited capacity to prevent biological, chemical, or radiation health risk.
  • The country was better prepared in the detect category, with an average score of 2.6 across the 13 indicators in this category. This score shows that the country has developed some capabilities to detect new health risks through real-time surveillance, and laboratory capabilities to test the diseases. However, the sustainability of these capabilities is still in doubt. (Figure 1)
  • The country performed badly in the respond category, with an average score of just 1.5 across the 20 indicators in this category, suggesting that Nigeria has limited capacity to respond to a sudden health risk.

Figure 1. Nigeria’s average score on preparedness to tackle public health risks

Figure 1. Nigeria’s average score on preparedness to tackle public health risks

Source: Authors, using data from World Health Organization (2017).

These scores suggest that Nigeria is not prepared to respond to the current COVID-19 pandemic. This is most obviously evident from the low testing rates for COVID-19 in the country. Nigeria currently has the capacity to test only 2,500 samples a day, and just half of these are actually administered each day because of the shortage of human resources, testing kits, and laboratories, and case definition for testing that prioritizes symptomatic cases and their contacts. As of June 30, only 138,462 samples had been tested in Nigeria for a population of 200 million; in contrast, South Africa—a country of 58 million people—has already conducted 1,630,008 tests.

Nigeria had just 350 ventilators and 350 ICU beds for its entire population before the outbreak. In April 2020, the country acquired 100 more ventilators, but given the growing caseload, this will not be enough. There has been a continuous rise in the number of cases and deaths in Nigeria, and no flattening of the curve has yet been observed. (Figure 2)

Figure 2. Total confirmed cases in Nigeria as of June 22, 2020

Figure 2. Total confirmed COVID-19 cases in Nigeria as of June 22, 2020

Source: Worldometer.

The three states with the highest number of confirmed COVID-19 cases are Lagos (10,510 cases, 128 deaths), the Federal Capital Territory (1,870 cases, 33 deaths), and Oyo (1,380 cases, 12 deaths). These states account for about 54 percent of total confirmed cases, and 29 percent of deaths. However, many of the northern, southwestern, and southeastern states are now seeing an increase in the number of cases, and as of June 30, 2020 there are more than 100 reported COVID-19 cases in each of the states of Ebonyi, Enugu, Imo, Oyo, Ogun, Kwara, Edo, Delta, Sokoto, Katsina, Kaduna Kano, Jigawa, Bauchi, Gombe, and Borno.

What has the government done?

The Nigerian government has taken numerous health, social, and economic measures to cushion the impact of COVID-19 (Figure 3). However, some of the policy responses have weaknesses and, taken together, are not commensurate with the magnitude of the problem.

Figure 3. Timeline of important policy steps taken by the government of Nigeria
Green circles indicate public health policies; blue circle indicate social and economic policies

Figure 3. Timeline of important policy steps taken by the government of Nigeria

Note: FCT: Federal Capital Territory, FMHADMSD: Federal Ministry of Humanitarian Affairs, Disaster Management and Social Development, SMEs: Small and medium enterprises, NSR: National Social Register.

The major strategic responses by the federal government, their main shortcomings, and some ways to improve their effectiveness include:

  • The Economic Stimulus Bill 2020. The House of Representatives passed the Emergency Economic Stimulus Bill 2020 on March 24 to provide support to businesses and individual citizens of Nigeria. The proposed law aims to provide 50 percent tax rebates to businesses that are registered under the Companies and Allied Matters Act so they can use this saving to continue employing their current workers. However, while the bill focuses on providing relief to formal sector businesses, 65 percent of Nigeria’s total GDP comes from the informal sector, which also employs more than 90 percent of the workforce, and these workers need support to survive. Many businesses in the informal sector are unregistered so it will be difficult for them to get these benefits. These businesses are often supported by microfinance facilities. For the government to help, it will have to use small interest-free loans or small grants to these enterprises through microfinance facilities and other community-based channels. This will be even more important now that the country is considering a second wave of targeted lockdown.
  • Cash transfers. On April 1, 2020, the government announced that it will make transfers of 20,000 Naira ($52) to poor and vulnerable households registered in the National Social Register (NSR). Currently, the NSR has only 2.6 million households (about 11 million people) registered on its platform. The government hopes to increase this to 3.6 million households during the COVID-19 crisis. However, 87 million Nigerians live on less than $1.90 a day. Therefore, the cash payments by the federal government will reach only a fraction of poor. Besides, Nigeria does not have a robust national information management system, making electronic payments difficult. This has resulted in many people in the NSR not receiving the money promised by the government. An immediate solution the government can explore is to provide prepaid debit cards to the poor. This can be done at the community/ward level to ensure that the cards reach the poorest. Of course, this is a stopgap solution, and more effective measures like direct bank transfers need be strengthened. But people need a Bank Verification Number (BVN) to open a bank account, and obtaining a BVN requires a valid national ID or international passport, which many Nigerians do not have. Currently, only about 40 percent of the Nigerian population have bank accounts.
  • Central Bank of Nigeria stimulus package. The CBN’s stimulus package offers a credit of 3 million Naira to poor families impacted by COVID-19. However, the loan requires collateral and is not interest-free. The loans could be made available free of collateral to poor households or just require signed guarantees by community leaders. The loans should be available at a low interest rate with long moratorium and repayment period. Moreover, not many poor households and businesses in the informal sector know about the available economic packages and policies implemented by the government.
  • Food assistance. After President Buhari imposed the lockdown in Lagos, FCT, and Ogun states on April 1, 2020, the Federal Ministry of Humanitarian Affairs Disaster Management and Social Development announced that it will provide food rations to vulnerable households in these states. The extended lockdown has led to people facing hunger in many regions of the country. The government has not been able to provide food support to everyone who needs it, as the distribution system is marred by corruption and opaque accountability. The government has to improve transparency and accountability in the food ration distribution system. It should also make sure that middlemen do not have excessive control. The government could use the system of house marking used in the polio campaign (in which houses visited by vaccinators are marked) during food distribution, i.e., putting a mark on those houses where food has been distributed. The Ward Development Committees can also be used for distributing the food rations. The government could also better use technology to plug leakages, track rations, and reduce corruption.

Funding the COVID-19 response

According to the federal government of Nigeria, it will require $330 million to procure medical equipment, personal protective equipment, and medicines for COVID-19 control. The government has committed to investing some of this amount, and financial commitments were also made by private, bilateral, and multilateral institutions to raise the remaining funds. The Nigerian state oil company has pledged $30 million for the government’s COVID-19 efforts. The European Union has contributed 50 million euros to the basket fund to strengthen the Nigerian COVID-19 response. In addition, the private sector in Nigeria, after being called upon by the governor of the Central Bank of Nigeria, established The Coalition Against COVID-19 (CACOVID). It was launched on March 26, 2020 to help the government to control COVID-19 in Nigeria. CACOVID has raised over $72 million, which will be used for the purchase of food relief materials and to provide medical facilities and equipment in different regions of the country.

The IMF approved $3.4 billion of emergency support to Nigeria to tackle the economic impact of the pandemic. In addition, in order to alleviate the macroeconomic situation triggered by the sudden fall in oil prices, the Nigerian government has borrowed $4.34 billion from the domestic stock market to finance its budget. The Nigerian government also plans to borrow another $2.5 billion from the World Bank and $1 billion from the African Development Bank.

In addition to mobilizing additional funding, the government should also increase the efficiency of its response to the pandemic. Making sure that regular health programs remain well-funded is even more important. For example, immunization financing must be maintained; drops in immunization will have profound long-term impacts. The crisis is also an opportunity for overall integration of health programs.

Nigeria will need more international assistance

At the federal level and in most states, evidence-based policies such as social distancing and “test and trace” approaches have been implemented. However, implementation has happened on a base of weak health systems, sluggish emergency response, weak accountability systems, and fragmented data and information monitoring systems. These weaknesses have led to implementation gaps. The federal government and the Central Bank of Nigeria have initiated programs to mitigate economic shocks. But, the financial packages rolled out will mostly provide relief to workers only in the formal sector. Similarly, social welfare schemes—such as food assistance and cash transfers—have been inadequate and inefficient.

The combined effects of COVID-19 and low oil prices have put Nigeria in a precarious financial situation. Given the low oil prices, the brakes put on economic activity due to the lockdown, and a weak global macroeconomic situation, the economic condition in the country could worsen and Nigeria will almost certainly require more efficient, equitable, and accountable use of domestic resources. There is also a potential scope for more international support than currently envisioned.

About the Authors:

Siddharth Dixit (tweets @sid_dix) is a Policy Associate at the Center for Policy Impact in Global Health, Duke Global Health Institute.

Yewande Kofoworola Ogundeji is Associate Director, Health Strategy and Delivery Foundation.

Obinna Onwujekwe is Coordinator, Health Policy Research Group, College of Medicine – University of Nigeria, Nsukka.