The Nigerian Medical Association has reviewed the policies, programs and activities implemented so far in the management of the COVID-19 outbreak in Nigeria makes the following observations and proffers solutions:
The Impedance of NCDC:
The Association notes that the Nigerian Centre for Disease Control and Prevention (NCDC) (Establishment) Act 2018 empowers the NCDC to lead the national response in disease outbreaks and public health emergencies. It is also to coordinate diverse kinds of feedback thereof. However, the NCDC has been unable to discharge these functions in some states of the Federation. Apart from threats and in some instances, prevention from collecting and testing samples of suspected cases of COVID-19; the pronouncements of some political leaders constitute outright interference in NCDC’s coordination of case treatment for effectiveness and learning lessons. The NMA vehemently decries the stance of the Governments of Kogi and Cross River states to NCDC’s advisory. While it would be welcome news for a ‘no-positive-case’ status in any state or FCT, every state must ensure that it is following the testing guideline issued by the NCDC. That way, no cases are missed, as that would seriously imperil the whole national response to controlling COVID-19 pandemic. NMA, therefore, appeals to the Federal Government to direct through the Presidential Task Force (PTF) to investigate the claims of the two state governments in the interest of safeguarding Nigeria’s Public Health, and to recommend appropriate remedial intervention (s) if necessary to Mr President.
Challenges with Testing: specimen collection, transport, and inadequate testing kits and testing centres
NMA review revealed verifiable difficulties in collecting samples, transporting them in the proper media and dearth of test kits by the Coordinating authorities. This development is coming a few days after being told of the markedly increased capacity of 50,000 samples per day in 21 laboratories to ramp up testing nationwide. NMA blames this on poor coordination, poor planning, poor forecasting and slow response to developments. This depressing development saddens NMA because it will wipe away the efforts made so far by the Government, PTF and Nigerians in the public reaction against COVID-19 pandemic. The Association places the responsibility on the PTF and the NCDC to find the fastest workable solutions to fix this challenge, including incorporating the approved private sector laboratories that already have established specimen pick up and transport modalities.
Inadequate PPE and Healthcare workers abandoning their duty posts:
The NMA is dismayed that doctors and other health workers still do not have adequate PPEs. Therefore, she has unequivocally advised her members and other healthcare workers in the country to avoid attending to suspected or confirmed cases of COVD-19 if they do not wear the appropriate PPE in the interest of the personnel and their families, and the wider society. The PTF must direct the FMOH and NCDC and other employers of doctors and health workers, to make arrangements for the provision of an adequate supply of PPEs at the point and time of need in the campaign against COVID-19. The Out of stocks is preventable. To this end, NMA opts for the local production of PPEs in a nation where textile materials are not in short supply.
Easing the lockdown amidst fears of an exponential increase in infection rates
The Association recently expressed her misgivings about the premature easing of the lockdown being that the numbers of infected persons are still on the increase, and so is the death toll across the country from CIVID-19. This spike is clear evidence that the peak has not been reached, not to talk of ‘flattening the curve’. The NMA is not oblivious of the socio-political and economic implications of continued lockdown, and the attendant hunger and acute deprivation in the population. But the NMA maintains the firm view that the solution is not to loosen the lockdown prematurely, for that assures more catastrophic worsening of the infection and deaths from coronavirus. Instead, The NMA proffers that the solution lies in a more robust and widened palliatives’ policy and its practical and urgent implementation. The public education and awareness campaign about COVID-19 must go beyond the state capitals the rural areas. The NMA also proffers that government uses the period of the lockdown to increase capacity and capability of doctors and health workers, and ramp up population testing which is the only reliable barometer to predict community transmission and prevalence. When there is evidence that the infection has peaked, and the curve is flattening, the NMA recommends a phased and a slow approach to the loosening of the lockdown, as experience from other climes demonstrates that such approach is the best practice.
Special Risk Allowance and Insurance for Healthcare Workers
NMA welcomes the announcement of Special Risk Allowance and Insurance for Healthcare Workers and has stated as much already. While the NMA has concerns about the implementation, she is cognizant of the agreements on salaries and emoluments of civil/public servants as official circulars. It is not clear to the Association why this has not been done up till date, even when the relevant statutory body the National Salaries Income and Wages Commission (NSIWC) was present during the deliberations. NMA therefore strongly demands that there should be no further delay in commencement of the payment of the announced sums or contemplation of effective date of implementation as it was of common knowledge when COVID-19 became a public health emergency in Nigeria. The NMA uses this medium to appeal to the Federal Government once more to call on the State governments to make public the incentives in the form of Risk/Hazard/inducement allowances and life insurance policies they are offering their healthcare employees. There must be no weak point in the chain of the federal response. This incentive will in no small way, uplift the spirit of the HCWs and ginger them to do more to defeat COVID-19.
Tax Exemption on Allowances during COVID-19
In rounding up the review, the NMA joins the Lagos Chamber of Commerce and Industries in asking for an exemption from PAYE Tax. Exception in taxing the newly introduced allowances as long as COVID-19 lasts, as any taxation at this time would contradict the government’s laudable spirit of incentivising healthcare workers to deliver service needed to defeat COVID-19pandemic in Nigeria.
Infectious Diseases Control Bill 2020
NMA appreciates the sense of urgency and purpose of the House of Representatives in enacting strong legislation to fill the void in the existing ones. The Association is thankful to the leadership of the House and the Health-related Committees but instead opt for broader consultation with relevant stakeholders to have a law that will be implementable and not in conflict with the Constitution. NMA is not embarrassed by the public outcry against specific provisions of the Bill as such is one of the hallmarks of democracy and welcomes the resolve of the House to subject the Bill to a Public Hearing. We further urge that the withdrawal of the Bill entirely and redrafting to remove any existing and future doubts in the people.