Nigeria facing Covid-19 : how state decentralization helped in fighting the pandemic.

This article follows the publication of our first report on Nigeria and Covid-19, Covid-19 Nigeria Subnational Analysis, February - December 2020. This document, available in the resources section of HERA’s website, is combining charts, maps and governmental measures, from different local, national and international sources.

In December 2019, the Chinese government put 56 million inhabitants on lockdown after the discovery of a new strain of Coronavirus was detected in Wuhan, China. As it spread rapidly to other parts of the world, the World Health Organization (WHO) declared it a pandemic on 11 March 2020.

Nigeria was the first country in sub-Saharan Africa to register a Covid-19 case in Ogun State on February 27th, which transited in Lagos. As the country is already threatened and fragilized by multiple challenges linked with growing insecurities, increasing humanitarian needs and protracted crises, the Covid-19 pandemic has raised multiple difficulties, especially for the Nigerian health system. However, the Government has worked tremendously to support the response at both national and subnational scale bringing international and local actors together. The response of the country was mostly characterized by the decentralization of measures and actions taken by local authorities supported by aid actors. Nigerian states and the Federal Capital Territory (FCT) have been affected by the pandemic differently. The question stands: how they managed an appropriate response to local contexts while also following the measures provided by the government.

Coordination and local adaptation

In 2020, the Nigerian government established a Presidential Task Force to anticipate and strengthen the government capacity to deal with the Coronavirus outbreak. The Taskforce provides overall policy direction and recommendations, coordinates engagement with other countries and international organizations, and manages priorities, such as effective and safe treatment centres, awareness campaigns and diagnostic laboratories. Following the first case, both the emergency operations center and the response plan were launched thanks to the collaboration between the Nigeria Center for Disease Control (NCDC), the World Bank, UNICEF and WHO. To allow regional adaptation, the management of the health crisis was mainly decentralized to Nigerian states and FCT. In February 2020, awareness sessions about the disease were organized in the 36 States and FCT. In March, the lockdown began in Lagos, Ogun, Abuja, FCT and Bauchi, and was extended to Yobe, Jigawa and Kano by April, following different patterns, as the virus spread faster in some parts of Nigeria. In May the easing of restrictions began, as the situation was improving. The first phase of eased lockdown started, followed by a second one in June and the third one in September.

Borno State : dealing with a pandemic among multiple other threats

North-eastern Nigeria is experiencing a major humanitarian crisis due to insecurity and armed conflict. Over 80% of displaced people are located in Borno State and the humanitarian situation is alarming. The conflict prevents humanitarian actors from reaching certain vulnerable areas and affects the quality of humanitarian response.

Borno State registered the first case of Covid-19 on April 19th. From this date onwards until December 2020, 806 cases, 36 deaths and 738 recoveries were registered. Borno State implemented a lockdown from April 22th until May 13th. The largest spike of cases occurred on June 12th followed by a rapid decline, also noticed at the national level.

For internally displaced people, access to health care was already limited by a lack of medical and personal protective equipment. Therefore, humanitarian organizations supported Borno’s local governments in establishing and managing additional isolation centers to fight the pandemic. On October 26th public schools in Borno State reopened. International aid actors supported the government in implementing safety measures, including disinfection of school facilities, installation of handwashing points and training school staff before the reopening. The WHO, along with Borno State authorities have also launched a campaign labelled “Covid-19 Heroes Campaign” to demystify and de-stigmatize Covid-19 survivors.

Despite the relatively low number of Covid-19 cases in Borno compared to Lagos or FCT, the consequences on the fragile local health system have grown enormously.

Overall, the pandemic has affected the States of Nigeria differently as we can see with Lagos or FCT being the most affected. This can be explained by their great connection to other countries, compared to Kogi which has registered only 5 cases since March 2020. As Nigeria undergoes an important increase of Covid-19 cases at the end of the year, what challenges will this pandemic bring in 2021?

A second threatening wave for 2021

In November, the government was worried about a second Covid-19 epidemic wave. This was confirmed by other African countries, facing an increase in Covid-19 infections, which tend to be more violent with higher mortality rates.

At the start of December, Covid-19 cases increased significantly in Nigeria. As The Christmas and New Year period approached, the government and the NCDC issued a public health advisory on the measures that needed to be taken to prevent the spread of Covid-19.

Despite these recommendations, Nigeria entered a difficult phase at the beginning of January, marked by the 100.000 infections registered and became the 8th country in Africa to exceed the 100.000 cases mark. For the first ten days of January 2021, the country recorded around 12.500 new cases, thrice as much as the whole month of November 2020. Osagie Ehanire, Nigerian Minister of Health, explained the increase in cases as the consequence of gatherings within communities and the lack of respect for social distancing. The transmission of the virus has recently been exacerbated even more by further neglect of public health and social distancing measures, a certain relaxation in compliance with governmental measures can be observed in the country. The country registered an increase in deaths during the period of January 12th to 20th 2021. It was particularly deadly with daily death rates ranging from 12 to 23 casualties, compared to November with daily deaths ranging from 1 to 5 deaths at most.

Lagos remains the most affected State of Nigeria, followed by FCT, Plateau and Kaduna. Health infrastructures are starting to be overwhelmed while a large part of its inhabitants ignore health recommendations. On January 30th, Lagos recorded its highest number of infections in one day with approximately 1040 cases. As the number of cases increased exponentially, scientists from the Osun African Centre of Excellence for Genomics of Infectious Diseases (ACEGID) identified a new variant of Covid-19 after analyzing 200 samples. While it remains difficult to tell if this variant could be more violent than the original strain, there is no denying that cases are growing at the national scale.

To cope with this new epidemic wave and the threat of a new variant of the virus, the government ordered the reopening of all isolation and treatment centres that had been closed due to the decreasing number of patients.

According to Osagie Ehanire, the country is already discussing vaccine opportunities and challenges with the World Bank and WHO that supports the Covax programme, aiming at rebalancing the accessibility to Covid vaccine for the most vulnerable countries. The supply of 100,000 vaccination doses has been confirmed and should be shipped to Nigeria in late February. Authorities are convinced they will vaccinate 40% of the population before the end of 2021, which represents around 80 million people. Nigeria aims to start with at least 20 million vaccine doses from the Covax initiative supported by the WHO, The Executive Director of NPHCDA, Dr. Faisal Shuaib said, “We are expecting final confirmation soon from COVAX on when our first doses will arrive through the programme”. But the transportation, storage and vaccination process of a population of 200 million inhabitants remains challenging.

The health crisis persists in 2021. It remains to be seen whether the vaccinations and the management strategies of the government will make it possible to slow down the transmission of the virus. Concluding from our observations, Nigeria will not be able to prevent a second wave, even with strong efforts to control the transmissions and a management model that highlights decentralization.. However, there is no denying that decentralization and consortiums have helped improve the efficiency of the national response and reduced the risk of impact throughout the country.