On Combatting Covid-19 and Strengthening the Health Care System
What has been your experience with Covid-19 in Kaduna State?
BALARABE: The Kaduna State government, like most of the country, relies on its public health personnel and facilities to manage not only endemic disease, but also epidemics such as Covid-19. The pandemic has served to reinforce the critical importance of this system. Managing a public health crisis requires collaboration across ministries, departments and agencies, and the Covid-19 task force in Kaduna State is an example of this synergy.
The fragility of the social fabric in a developing country like Nigeria limits the utility of lockdowns as a containment strategy. We imposed quarantine orders to help slow the spread of the infection and set up mobile courts to enforce the regulations. We have noticed gaps in enforcement capacity and are engaging with the institutions that can remedy this.
Such restrictions require palliative measures for citizens whose ability to earn a living had been constrained; however, targeting those in need is difficult in the absence of reliable data. Thus, in addition to other lessons learned, the importance of secure identification systems and a social register is very clear.
To what extent has the private sector been mobilised in the fight against Covid-19?
BALARABE: Many medium and large companies are continuing to adjust to the challenges imposed by this pandemic, taking care not to further compound the existing problem of unemployment. A large number of private organisations have been magnanimous and maintained their workforce.
The state government, via the task force, has received ample support from private firms. Their donations ranged from medical supplies such as test kits, personal protective equipment, hospital beds, ventilator and essential medicine, to food items including rice, maize, flour, gari, noodles, pasta and other products. These essential goods were made available to low-income and vulnerable households across all 23 local government areas in two phases of distribution. We also received substantial cash contributions.
The private sector coalition against Covid-19, known as CaCovid, played a significant role in providing support to Kaduna State and other states across the country. We are sincerely appreciative of all those who contributed to the state at this time of need – their support underscores our common humanity and ability to stand up for one another in times of difficulty.
How can Kaduna strengthen its health care system?
BALARABE: Since 2015 the state government has been putting plans in place to create a resilient health care network. A diagnostic analysis of the system was commissioned, the results of which helped us develop a service delivery plan that detailed strategies, including funding, for a more viable primary health care (PHC) system, which is the bedrock of any health care network.
Over the past four years the state has consistently devoted 16% or more of the annual budget to health. In 2016 we made deliberate attempts to improve routine immunisation, and entered into a partnership with the Bill and Melinda Gates Foundation and the Aliko Dangote Foundation. The following year this collaboration was expanded to other parts of PHC, and partners such as the Global Fund, the World Health Organisation and UNICEF joined in.
Our goal is to increase the capacity of our health facilities, improve the quality of service and expand access to care. Central to this is a programme to upgrade, staff and equip 255 PHC centres. This is now 90% complete, and we have identified another 255 for upgrade. We are also working to address the lack of power in our health facilities through the Kaduna Solar for Health programme, with the support of the UK Department for International Development, commencing with 34 PHC facilities. All facilities that were provided with solar power now offer 24-hour services. We are hopeful that by mid-2021 the remaining 221 facilities will have made similar improvements.
We have reinvigorated data collection, monitoring and evaluation by establishing the Integrated Data Control Room. We have also conducted a training gap analysis and based on the result, are investing in capacity-building for our health care workers.
The Kaduna State government has an emergency and rapid response structure at the state and local level, which has been empowered and strengthened to handle epidemics and pandemics. The state also launched a contributory health insurance scheme to expand access to health care while reducing out-of-pocket expenses.
With these lessons in mind, we are seizing the opportunities afforded by the pandemic to strengthen our health system. Since March 2020 we have expanded capacity to better manage cases. We are building a new 136-bed infectious disease hospital in Kaduna, as well as 20- to 30-bed infectious disease wards at each of our general hospitals. From zero testing capacity, we now have three accredited laboratories, two of which operate in public health facilities.