On this report, PREMIUM TIMES analyses a yr in healthcare – acknowledging the difficulties confronted, highlighting successes achieved, and mentioning the trail forward for a more healthy future.
As we bid farewell to 2023, the healthcare journey has been certainly one of highs and lows. From sudden outbreaks like diphtheria to the affect of already current mind drain within the sector, the yr was peppered with moments that examined Nigeria’s well being programs.
In 2023, the battle in opposition to ailments like cholera, and Lassa fever continued, emphasising the continuing challenges confronted by sure areas in Africa’s most populous nation. But, amidst these struggles, the launch of operational pointers for the Nationwide Well being Insurance coverage Authority (NHIA) Act brings hope for constructive change, pointing in direction of a extra inclusive healthcare system.
On this report, PREMIUM TIMES analyses a yr in healthcare – acknowledging the difficulties confronted, highlighting successes achieved, and mentioning the trail forward for a more healthy future.
Diphtheria outbreak
The resurgence of diphtheria in 2023 emerged as an sudden and formidable foe, difficult well being programs throughout the nation.
Diphtheria is a critical bacterial an infection brought on by the Corynebacterium species that impacts the nostril, throat, and typically, a person’s pores and skin.
The Nigeria Centre for Illness Management and Prevention (NCDC) famous that folks most prone to contracting diphtheria are youngsters and adults who haven’t acquired any or a single dose of the pentavalent vaccine, individuals who dwell in a crowded atmosphere, in areas with poor sanitation and healthcare staff who’re uncovered to suspected or confirmed instances of diphtheria.
Greater than 500 individuals, principally youngsters, have died of diphtheria in Nigeria because the present outbreak started in 2022.
Knowledge revealed by the NCDC spanning Epi-Week 19 2022 to Epi-Week 48 2023 signifies that 20,684 suspected instances have to date been reported from 33 states throughout 280 LGAs.
Kano State, the epicentre of the illness with 13,461, adopted by Yobe with 2,234, Katsina 1,509, Bauchi 1,139, Borno 968, Kaduna 486 and Jigawa 256 accounted for 96.9 of suspected instances reported.
Of the 20,684 suspected instances, 12,086 (58.4 per cent) have been confirmed instances distributed throughout 148 LGAs in 20 states.
The information reveals that 8,393 (69.4 per cent) of the confirmed instances have been amongst youngsters aged 1 – 14 years.
Well being specialists say the resurgence of the bacterial an infection is principally because of low immunisation amongst youngsters, who’re thought-about most weak to the illness.
Alarmingly, solely 3,202 (26.5 per cent) out of the 12086 confirmed instances have been totally vaccinated with a diphtheria toxoid-containing vaccine.
Introduction of HPV vaccine
A major breakthrough within the well being sector in 2023 is the mixing of the Human Papillomavirus (HPV) vaccine into the routine immunisation system.
This strategic transfer is a proactive measure geared toward safeguarding teenage ladies in opposition to cervical most cancers, a prevalent type of most cancers that develops in a girl’s cervix and ranks because the fourth most typical most cancers instances amongst ladies globally.
The Nigerian authorities mentioned it goals to succeed in 7.7 million ladies with the life-saving vaccine, the biggest quantity in a single spherical of HPV vaccination in Africa.
The inclusion of the HPV vaccine is a major victory for Nigeria, the place cervical most cancers stands because the third most prevalent most cancers and the second main reason behind cancer-related deaths amongst ladies aged 15 to 44. Within the newest obtainable knowledge from 2020, the nation reported 12,000 new instances and eight,000 deaths attributed to cervical most cancers.
Whereas the precise causes of most cancers stay unknown, analysis has recognized 14 out of 100 HPV strains as liable for a minimum of 99 per cent of cervical most cancers instances.
Notably, the WHO highlights that HPV varieties 16 and 18 contribute to a minimum of 70 per cent of cervical cancers and pre-cancerous cervical lesions. Moreover, there may be proof linking HPV to cancers of the anus, vulva, vagina, penis, and oropharynx.
However with the existence of vaccines, WHO estimates that cervical most cancers could possibly be the primary most cancers to be eradicated if 90 per cent of ladies are vaccinated in opposition to HPV.
Docs’ strike
The recurring difficulty of healthcare professionals’ strikes persevered in Nigeria all through 2023. Numerous unions inside the sector expressed their discontent, highlighting systemic challenges afflicting the healthcare system.
As an illustration, docs below the umbrella of the Nigerian Affiliation of Resident Docs (NARD) launched into strike at numerous durations in 2023. The docs demanded amongst different points, the instant cost of the 2023 Medical Residency Coaching Fund (MRTF), tangible steps on the “upward overview” of the Consolidated Medical Wage Construction (CONMESS), and cost of all wage arrears owed its members since 2015.
The docs additionally need large recruitment of scientific workers within the hospitals and abolishment of the bureaucratic limitations to the instant alternative of docs and nurses who depart the system. Additionally they need the instant overview of hazard allowance by all of the state governments in addition to non-public tertiary well being establishments the place any type of residency coaching is completed.The affect of those strikes was significantly pronounced as resident docs represent a good portion of medical personnel in Nigeria’s tertiary hospitals. Consequently, the healthcare supply system confronted substantial disruptions throughout their durations of business motion.
Throughout certainly one of their strikes, the federal authorities had threatened to implement the “no work, no pay” coverage in opposition to the hanging resident docs, who remained adamant on their determination.
Lately, the Nigerian Medical Affiliation (NMA) additionally threatened to withdraw their companies throughout well being establishments within the nation ought to the federal authorities fail to implement the upward overview of CONMESS.
Within the upcoming yr, governments in any respect ranges should prioritise the calls for of well being staff and create conducive working environments to maximise their contributions and forestall extra industrial actions.
Psychological well being invoice
The enactment of the Psychological Well being Invoice 2021 stands as a momentous milestone within the well being sector for the yr 2023.
Former President Muhammadu Buhari formally signed the invoice into regulation, marking a major achievement after two earlier unsuccessful makes an attempt in 2003 and 2013.
The invoice, harmonised by each the higher and decrease chambers of the Nationwide Meeting in 2021, represents the inaugural legislative reform within the psychological well being subject because the nation gained independence. Notably, it’s going to supersede the outdated Lunacy Act of 1958.As psychological well being takes centre stage in international conversations, this legislative stride positions Nigeria on the forefront of proactive psychological well being insurance policies.
The enactment of the Psychological Well being Invoice 2021 not solely addresses the gaps within the current authorized framework but in addition units the stage for enhanced psychological well being companies, destigmatisation, and a extra inclusive and supportive strategy to psychological well-being for all residents.
New management
In 2023, a change in management marked a major growth in Nigeria’s well being sector. On 21 August, Muhammad Pate, a professor of Inside Drugs and Infectious Ailments, assumed the function of Coordinating Minister of Well being and Social Welfare. Helping him on this essential place is Tunji Alausa, who takes on the function of Minister of State for Well being and Social Welfare.
They succeeded Osagie Ehanire, who served because the minister from 2019 to 2023, and Olorunnimbe Mamora, the previous Minister of State for Well being.Mr Pate, along with his intensive background, has a singular alternative to make a considerable affect on the nation’s healthcare system for the second time.
The professor stepped into his place with a second alternative to considerably affect the nation’s healthcare system. When he served earlier as Nigeria’s minister of state for well being, he made a notable impression throughout his transient tenure.
He initiated a worldwide coalition geared toward bolstering healthcare programs, at the same time as he noticed to the implementation of progressive programmes devoted to addressing urgent issues, notably the prevention of mother-to-child transmission of HIV.
Moreover, Mr Pate spearheaded a flagship initiative to rejuvenate routine vaccinations and first healthcare. He additionally chaired a presidential process drive centered on eradicating polio whereas introducing new vaccines into the nation’s healthcare routine.
The optimism surrounding the brand new management stems from the wealth of expertise that Mr Pate brings to the place. Expectations are excessive that his strategic strategy and previous expertise will contribute to reshaping and revitalising Nigeria’s well being sector, addressing vital points and making certain a constructive trajectory for the nation’s healthcare.
Launch of operational pointers for the NHIA Act
The disclosing of the operational pointers for the 2022 Nationwide Well being Insurance coverage Authority (NHIA) stands out as a major milestone that resonated all through the well being sector in 2023.
This initiative is a vital element of the federal government’s dedication to making sure that every one Nigerians have entry to cost-effective healthcare companies. On the launch, the Coordinating Minister of Well being and Social Welfare, Mr Pate, emphasised the essential function of offering inexpensive and high-quality healthcare to all Nigerians within the pursuit of Common Well being Protection (UHC).
He famous that the NHIA Act of 2022 has put these pointers into operation, providing a transparent path. This operationalisation goals to facilitate a collective effort by the federal government to reinforce the affordability of healthcare for everybody, with a specific give attention to the poorest and most weak members of the Nigerian inhabitants.
He mentioned the operational pointers have been developed by way of intensive engagement with numerous stakeholders, making certain a complete and inclusive strategy to shaping the way forward for healthcare accessibility within the nation.
Mind drain
The continued development of healthcare professionals, together with medical docs, nurses, and different personnel, migrating to developed nations represents a major and disheartening growth within the well being sector for the yr 2023. Quite a few statistics spotlight the mass exodus of Nigerian docs in pursuit of higher alternatives overseas.
This mass departure has resulted in a major void in Nigeria’s healthcare system, leaving few healthcare staff to handle the wants of the nation’s inhabitants exceeding 200 million.
Whereas the explanations behind this migration are multifaceted, together with the pursuit of higher remuneration, improved working circumstances, {and professional} growth alternatives, the collective affect on the nation’s well being system is undeniably extreme.
For the brand new yr 2024, well being specialists mentioned you will need to recognise the intrinsic worth of healthcare professionals and to create an atmosphere that fosters their development, job satisfaction, and dedication to serving the inhabitants.
Dengue fever outbreak
The sudden emergence of Dengue fever in direction of the shut of 2023 posed a major problem to the well being sector.
As of 16 December, the NCDC reported 13 confirmed instances of Dengue fever in three LGAs in Sokoto State. The World Well being Organisation (WHO) linked the surge in Dengue fever to international warming, characterised by elevated common temperatures, elevated precipitation, and an prolonged interval of drought.
Dengue fever is a viral an infection brought on by the Dengue virus (DENV) and is transmitted to people by way of mosquito bites. Though human-to-human transmission has not been established, people contaminated for the second time face the next threat of extreme Dengue. The virus is prevalent in tropical and sub-tropical climates, significantly in city and semi-urban areas worldwide.
Whereas most individuals with Dengue expertise delicate or no signs and get well inside one to 2 weeks, extreme instances might be life-threatening. Signs could embody excessive fever, intense headache, eye ache, muscle and joint pains, nausea, vomiting, swollen glands, and rashes.
Elevated Lassa Fever instances
Lassa fever continues to pose a major public well being problem in Nigeria, pushed by elements resembling insufficient environmental sanitation, low consciousness, and delayed case shows. The affect of this lethal illness persevered all through 2023, sustaining its grip on the nation.
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As of 10 December, over 200 Nigerians had died from Lassa fever; a illness that’s preventable with good hygiene and treatable if introduced early at hospitals.
The most recent epidemiological report revealed by NCDC for week 49 of 2023, spanning 4 to 10 December, indicated an increase within the variety of suspected instances, reaching 8,707, in comparison with the identical interval in 2022, which recorded 7,907 instances.
The report revealed that from week 1 to week 49 of 2023, 206 deaths have been reported with a case fatality charge (CFR) of 17.3 per cent, which is decrease than the CFR for a similar interval in 2022 of 18.3 per cent.
The nation additionally documented 1,191 confirmed instances of Lassa fever in 2023, surpassing the 1,028 instances reported inside the equal timeframe in 2022.
In response to the report for 2023, 28 states have recorded a minimum of one confirmed case throughout 116 LGAs. Whereas 76 per cent of all confirmed Lassa fever instances have been reported from three states specifically; Ondo, Edo, and Bauchi, 23 per cent have been reported from 25 states with confirmed Lassa fever instances.
Lassa fever is an acute viral haemorrhagic fever brought on by the Lassa virus. The pure reservoir for the virus is the Mastomys natalensis rodent (generally generally known as the multimammate rat or the African rat).
Different rodents can be carriers of the virus. The virus spreads by way of direct contact with the urine, faeces, saliva, or blood of contaminated rats; contact with objects, home goods, and surfaces contaminated with the urine, faeces, saliva, or blood of contaminated rats, and consuming meals or water contaminated with the urine, faeces, saliva, or blood of contaminated rats. Particular person-to-person transmission can even happen by way of direct contact with blood, urine, faeces, vomitus, and different physique fluids of an contaminated individual.
Cholera persists
Whereas there was a lower in cholera instances in 2023 in comparison with the earlier yr, the persistent presence of this acute diarrheal an infection, brought on by the ingestion of meals or water contaminated with the bacterium Vibrio cholera, stays a priority within the nation.
In response to the NCDC epidemiological report for weeks 1-39, as of 1 October, a complete of three,276 suspected instances, together with 102 deaths, have been reported from 27 states.
Comparatively, suspected instances of cholera within the present yr decreased by 79 per cent and cumulative deaths decreased by 77 per cent in comparison with what was reported at Epi-week 39 in 2022.
Notably, age teams under 5 years are predominantly affected adopted by the 5-14 years age group, encompassing each men and women.
Zamfara State, reporting 907 instances, accounts for 28 per cent of all suspected instances among the many 27 states which have reported cholera instances. Obubra Native Authorities Space (LGA) in Cross River State, with 515 instances, contributes to 16 per cent of all suspected instances reported nationwide.
Different states, together with Cross River (718 instances), Bayelsa (341 instances), Katsina (302 instances), Ebonyi (227 instances), Niger (161 instances), and Abia (149 instances), collectively account for 58 per cent of the suspected instances recorded this yr.
