Global reflections – how Nigeria is building health security resilience from ideas to impact

About the author:

Olukayode Fasominu is a Public Health Physician & Management Consultant. He is currently a student on cohort 2 of the MSc in Global Healthcare Leadership course, jointly run by the Nuffield Department of Primary Care Health Sciences and the Saïd Business School. He currently serves as Principal at Volte Health where he spearheads engagements across Africa. He is a graduate of the University of Ibadan and Cardiff University. Olukayode enjoys football and making scholarly contributions.

The COVID-19 pandemic exposed vulnerabilities within countries' preparedness for infectious disease outbreaks. It also highlighted tendencies toward nationalism during such crises, underscoring the urgent requirement to build resilient health systems. Leaders now face the daunting task of navigating uncertainties in exceptionally turbulent times. There are signs that these outbreaks will persist, driven by the influence of climate change and ongoing strains on formerly stable food chains. These new dynamics present a unique leadership challenge for health security thought leaders like me to grapple with.

As we undertook the second module of our Global Healthcare Leadership course early this year, I reflected on the resilience framework proposed by Teece and colleagues[1] – sensing, organising, capturing and renewing. The framework highlighted provided a guide on how the Nigeria Centre for Disease Control (NCDC) has focused on building health security capacities and resilience. Following the swift and widely surprising response to curtailing the imported case of Ebola Virus Disease into her megacity, Lagos[2], in 2014, it became evident that a National Public Health Institute (NPHI) was required to help harness existing capacities to protect the lives of Nigerians, and indeed the world from the impact of such events of public health importance.

By 2017, the NCDC had taken steps to better understand these health security gaps by partaking in the voluntary peer-led Joint External Evaluation (JEE). The JEE, led by the World Health Organisation (WHO), was one of the tools (out of four) in the refined Internal Health Regulations (IHR) Monitoring and Evaluation framework (IHRMEF) to improving compliance with IHR 2005. The NCDC subsequently conducted a country-led midterm evaluation in 2019[3] to monitor progress against program indicators, and benchmarks.

Nigeria operates under a federal system comprising 36 states (and a federal capital), each serving as a crucial component of the nation's "health security chain." Despite progress, shortcomings were apparent within this chain. Furthermore, the failure to fully implement continental strategies like the Integrated Disease Surveillance and Response (IDSR) Strategy became evident.

To address these deficiencies and enhance efforts to fortify resilience across these chains, the NCDC devised a tailored tool at the sub-national level to gain deeper insights into these health security gaps. This proved crucial given Nigeria's vast geographical expanse, stretching from the Atlantic Ocean and dense rainforests in the South to the arid regions within the Sahara Desert in the North. The shortcomings in IDSR implementation were now more apparent than ever, prompting deliberate steps to bridge these divides. It was evident that the required actions extend beyond health ministries, necessitating collaborative approaches to bolster capacities and safeguard the lives of Nigerians. Notably, this tool represents a pioneering effort globally, exclusively crafted and utilised for this purpose at the sub-national level.

By deploying this tool, all entities are better able to sense – collect critical data on health security gaps; organise – identify needed resources beyond health agencies to implement the IDSR strategy; capture – codify lessons for building better health systems; renew – review and refine existing strategies to sustainably address systemic health security gaps and challenges.

A growing body of evidence underscores the influence of the interplay between environmental, animal, and human health, often referred to as One Health, as well as planetary health, on the spread of infectious diseases. Consequently, nations must consistently enhance health security resilience across all facets of their health systems. These innovative strategies will optimise the allocation of resources, such as those from the Pandemic Fund, and ensure that initiatives like the new Pandemic Accord, spearheaded by the WHO, contribute to a safer, more prosperous world while maintaining environmental sustainability and avoiding the repetition of past errors.

History frequently offers abundant lessons for humanity, yet do we consistently heed them?

For Nigeria, this means efforts at building resilience need to continue. Several sub-national level health departments are now pushing ahead to establish dedicated disease control departments. Through such organisations, it would be essential to continuously seek avenues to lead – leveraging the four key resilience activities – to protect the lives of Nigerians, and the world.