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Godfrey George
The Chief Executive Officer, Resolve to Save Lives and former Commissioner of the New York City Department of Health and Mental Hygiene, Thomas Freiden, tells GODFREY GEORGE in this interview how Nigeria can strengthen its health care system
What is the purpose of your visit to Nigeria?
I met with our country staff and partners to reinforce the need for reducing the burden of cardiovascular disease in the country and strengthening systems to stop and prevent infectious disease threats. Both heart disease and epidemic prevention are serious public health issues in Nigeria.
Right now, 11% of all deaths in the country are from cardiovascular disease, with an estimated 30% of the adult population suffering from high blood pressure and a projected 1,300 deaths in the country from coronary heart disease each year that can be directly linked to trans-fat consumption. The country has made significant progress in addressing the gaps from the 2017 Joint External Evaluation of Nigeria’s preparedness systems, which has helped the country, improve systems to prevent, detect, and stop infectious disease outbreaks such as monkeypox and COVID-19.
What is your assessment of Nigeria’s health sector?
In Nigeria, I was deeply moved by the impact of community-based treatment with assistance from the United States President’s Emergency Plan for AIDS Relief, on progress in treating patients living with HIV.
With community health workers going door-to-door during the COVID-19 pandemic, the country was able to increase the number of people treated for HIV infection by more than one million.
More than 95% of all people estimated to be living with HIV are now on treatment, and 96% of those have their viral load suppressed. This is enormous progress in less than three years, and during a time with many disruptions to care. This is so impressive, with many lessons for better management of hypertension and other conditions.
What health challenges will your NGO, “Resolve to Save Lives,” solve?
Resolve to Save Lives is a not-for-profit organisation partnering with countries, communities, and organisations to prevent 100 million deaths from cardiovascular disease and make the world safer from epidemics.
RTSL partners with the government and civil society to implement scalable, proven strategies. We prioritise working with national and local organisations in low- and middle-income countries to co-create, advocate for, and scale up activities in heart disease prevention and epidemic preparedness.
Resolve to Save Lives celebrates five years of successful programming in Nigeria, partnering to advance epidemic preparedness and prevent cardiovascular disease.
In what ways so far has the RTSL impacted Nigeria’s health sector?
Working with partners and the Government of Nigeria, Resolve to Save Lives has helped Nigeria make significant progress, including contributed to the efforts to increase funding for the NCDC by providing technical and advocacy support; supported the expansion of the COVID-19 molecular network from four to 150 laboratories; facilitated the rigorous assessment of public health laws at the national level and in five states, developed a toolkit for sub-national legal assessments and finalised a template for state public health law for adoption; partnered to support the Government’s plan to go trans-fat free – this would make Nigeria the second country in Africa to take this action, joining all of Europe, most of the Americas, India, Bangladesh, Thailand, and other countries; provided treatment for hypertension to over 30,000 patients enrolled in hypertension treatment programmes in four states; and, developed a treatment protocol for high blood pressure patients and supported the implementation in two states and the FCT.
An estimated one in three Nigerian adults is hypertensive. The RTSL-supported Nigeria Hypertension Control Initiative covers 104 facilities in Kano and Ogun States. Of 350,000 individuals screened, 23,000 were diagnosed with hypertension, and 16,000 started on treatment since implementation began at the end of 2020.
You met with officials of the Federal Ministry of Health, the Nigeria Centre for Disease Control, the WHO Country Representative, the United States Ambassador to Nigeria, and stakeholder bodies including the African Field Epidemiology Network and Public Health Emergency Operations Centre. Kindly describe the outcome of these engagements.
These were productive engagements that provided an opportunity to seek alignment in our work and to share the lessons we are learning from our support of over 60 countries in the world in our two core areas of preventing epidemics and reducing cardiovascular diseases. It was also important to review some of the lessons learned from Nigeria’s impressive response to COVID-19 as well as the opportunities to further support the Government of Nigeria’s priorities as they work to save lives.
I hope that Nigeria will soon finalise its commitment to becoming trans-fat-free. This would be a major win for the country. Trans-fat is an artificial, toxic chemical added to our food supply that kills people. Regulatory action can save lives, without costing the government much in terms of resources to implement.
There has been a massive exodus of doctors out of Nigeria to the West. How exactly can you assess this?
Doctors’ and health care workers’ leaving has implications for the quality of care for Nigerians. We call on the government of Nigeria to expand its support of health care workers, including by increasing pay, benefits, and safety.
At RTSL, we have been supporting a global movement to protect health care workers, and in Nigeria, we’ve helped implement Infection Prevention and Control measures, such as safer patient flow procedures and increased availability of safe water, which are essential to protecting health workers in Nigeria and across the world.
You commended the government for its response to the COVID-19 pandemic. In which areas did Nigeria perform well?
Nigeria was able to leverage systems that had been put in place in response to recent outbreaks of diseases such as Lassa fever, monkeypox, and meningitis.
There is still a lot of vaccine apathy in Nigeria, fueled mainly by misinformation that the West-made-marketed vaccines are “created” to depopulate Africa. How can Nigeria best address this issue?
We need to be more proactive in public health combating disinformation and misinformation. Paramount to this effort is building and cultivating trust in communities and meeting people where they are. It is important to also note that some of the lower vaccination rates that we’ve been finding in Africa, including in Nigeria, are related to lack of access rather than hesitancy.
With the population of the country and the scarcity of accessible primary health care, especially for the vulnerable (women, children and people living with disabilities), how can the country upscale its PHC services to become viable?
Like many other countries, primary health care in Nigeria is often not seen as a priority when it comes to investing resources. But the COVID-19 pandemic has made clear globally that the more robust the primary care services, the better the outcomes in preventing, detecting, and responding to public health threats and the more resilient the citizens are.
Nigeria, through the National Primary Health Care Development Agency, is developing a series of interventions including the revitalisation of PHCs, which we are watching with keen interest.
The country has suffered many health woes, from Lassa fever to Ebola and polio to even COVID-19. How do you think Nigeria should better prepare for health emergencies?
Nigeria has taken great steps towards better preparedness over the past five years, and many countries can learn from your progress.
In terms of what work remains, Nigeria should work to increase financing for health security at the national, state, and local levels by advocating for increased flexible funding for the NCDC and states. It should also improve sub-national health security through legislation and financing, highlighting the vital importance of security at the sub-national level.
Additionally, Nigeria should expand NCDC and relevant partners’ skills to effectively plan and implement activities that will proactively improve their ability to prevent, detect, and respond to new disease threats as soon as they emerge.
Many Nigerian leaders always love going abroad for their medical needs, even though trillions of dollars are spent every year making the National Hospital as well as other government-owned facilities better. Should this be?
Investing in and improving health systems and facilities is an important part of improving patient care and outcomes.
Cardiovascular and kidney-related diseases in Nigeria appear to be on the rise, and many unexplained deaths have been attributed to this ailment. What concrete steps can be taken at the governmental and individual levels to nip this in the bud?
In Nigeria, not only are costs for medications higher than necessary, but treatments are inconvenient to patients, resulting in high rates of treatment discontinuation. The easier it is for patients to get screened for hypertension and get the treatment they need, the fewer people will die from cardiovascular disease.
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