Health Correspondent Scarlett Windmill Last learns about the work of the Clinton Health Access Initiative and the lessons learned during Covid-19
According to the Lowly Institute’s Covid Performance Index, Nigeria has outperformed most of Europe and the Americas in response to the pandemic. The government swiftly enforced a national lockdown and institutionalised testing of entrants to the country, allowing international travel to continue throughout the pandemic.
Mobilisation of the private sector, and cooperation with the government allowed a struggling healthcare system with fragile infrastructure to avoid a state of emergency.
With the support of independent health organisations, the government has been able to roll out an impressive vaccination programme throughout the country, with plans to vaccinate 70 per cent of the population during the course of the next two years. A major player in this scheme has been the Clinton Health Access Initiative (CHAI), which operates throughout Africa and across low-and middle-income countries. CHAI works tirelessly to provide equitable access to healthcare in more than 35 countries worldwide by strengthening the government and private sector to create and sustain high-quality health systems.
CHAI’s innovative oxygen therapy programme was built to tackle the million preventable deaths caused by paediatric pneumonia and hypoxemia in low-income countries. During the Covid crisis, CHAI worked in collaboration with the government and local state actors to provide widespread oxygen access. “When Covid came, we were really prepared,” says Chizoba Fashanu, Deputy Director of Essential Medicines, Sustainable Health Financing and Malaria at CHAI.
New oxygen plants were installed to rapidly expand oxygen supply in the country and oxygen treatment centres were erected in order to provide testing and care in Lagos state – the hardest hit state during the pandemic – covering hard-to-reach areas to support those with limited access to basic primary care services.
Being able to draw on CHAI’s resources and in-depth knowledge during the pandemic enabled the government not only to support wide-reaching testing, but also to produce a comprehensive vaccine programme. From the point of delivery, through the last mile and administration, CHAI has provided unrivalled in-country expertise and support, alongside GAVI and support from others partners such as UNICEF, to deliver Covid-19 vaccinations to the Nigerian population.
“We saw a very unprecedented response from the private sector in Nigeria for Covid,” says Asma’u Abiola, Sustainable Health Financing Associate for CHAI Nigeria.
Global press coverage led to an initial hesitation in the acceptance of a Covid-19 vaccine in every corner of the world. This was acutely felt by Nigerians, who have a history of slow uptake of vaccination programmes, as seen by the polio immunisation campaign in 2003. A risk communication campaign and consistent education championed by CHAI and GAVI is proving particularly successful, with half the population now in support of vaccination.
Collaboration is key
CHAI’s work has been crucial not only in shaping Nigeria’s response to the Covid crisis, but in the future of national immunisation.
Nigeria’s malaria response proved CHAI’s place as a major player in the national healthcare landscape. Through collaborative programmes with both the public and private sectors, CHAI facilitated the increase of diagnostic testing and treatment access to millions of people. Providing the necessary operational support, CHAI has replicated this model and supports more than 20 countries in the global fight against malaria.
CHAI’s history of success in Nigeria doesn’t stop at malaria. Since 2007, CHAI has been spearheading efforts to increase access to vital medications and vaccinations throughout Nigeria, by negotiating sustainable programmes on both a national and state level. CHAI has been providing paediatric and adult HIV treatments, which have contributed to the country cutting their HIV prevalence down by half, according to UNAIDS.
In light of the success of the HIV programme, CHAI developed a wide range of initiatives to address the health concerns of vulnerable sections of society. The focus of these programmes revolves around sexual, reproductive, maternal, newborn and child health. A family planning initiative has worked to empower women to take control of their sexual health.
Chizoba says that “the heart of it is ensuring equitable access to lifesaving commodities, lifesaving interventions for children, women, and their families too.” Chizoba is currently working with the government to provide universal health care, with a focus on primary health care coverage.
Challenges and solutions
However, there is still a long way to go. Across Nigeria, especially in the Northern regions, immunisation programmes are struggling. “The last mile delivery, particularly at the lowest levels of healthcare delivery between local cold stores to health facilities,” causes delay in the delivery of essential medicines, according to Shola Dele-Olowu, Deputy Director of Vaccines Program for CHAI Nigeria.
Part of the problem for CHAI is access to health workers. “There aren’t enough workers being produced,” says Shola, “and getting them to go to some of those difficult areas is problematic.” Before the Covid crisis, CHAI focused on a peer-led initiative to carry out Nigeria’s Expanded Program on Immunization (EPI). This saw the traditional, text-heavy, lectures partially replaced by onsite training and mentorship learning programmes in a bid to increase the skill levels of healthcare workers across the country.
As Covid-19 swept across the globe, this programme had to adapt. A new e-learning system became a crucial part of CHAI’s response to continuing the training of healthcare workers.
The use of technology since February 2020 has laid the foundation for a dramatic increase in the use of digital tools to carry out key immunisation programmes, from malaria to Covid-19. “The pandemic has made us realise how much we need to use digital tools; they are so important in training for the Covid vaccine rollout,” Shola adds.
Not only has the use of technology played a vital role in training, digital tools have also allowed increased surveillance for active cases and detection.
Through community health programmes, digital tools will be able to provide accurate data to support key immunisation initiatives.
Patent and Proprietary Medicine Vendors (PPMV’s) across Nigeria provide 60 per cent of primary care to malaria patients. Through a collaborative effort between the national government and CHAI, simple digital tools are helping provide essential patient records and real time data through PPMVs. “By deploying simple digital tech to these drugstores, we can collect essential information and continuously track the malaria burden,” Chizoba points out.
Although strain has been put on the country as a whole due to the Covid Crisis, CHAI is optimistic that healthcare can become a focal point as a result. “One lesson that we have taken from Covid is how the private sector was able to mobilise in a very organised way,” says Asma’u. “It was a perfect example of how we can collaborate.”
Contact Information:
www.clintonhealthaccess.org/nigeria