Advocating domestic resource mobilisation to strengthen Nigeria’s health security

BY IBUKUN OGUNTOLA 

When the #PreventEpidemicsNaija Campaign was launched in 2018, it was likened to the story of the boy who cried wolf. Why should the country dedicate resources to prepare for an epidemic that might never happen? Today, the project has helped increase awareness and funding – among policymakers and the public – for epidemic preparedness at national and sub-national levels.

In October 2018, four years after the first case of Ebola Virus Disease (EVD) was reported in Nigeria, Nigeria Health Watch, supported by the Global Health Advocacy Incubator (GHAI), launched the #PreventEpidemicsNaija project. The overall goal of the project was to increase public awareness and support for epidemic preparedness and response (EPR), as well as to advocate for increased funding to boost the efforts of the national public health institute, the Nigeria Centre for Disease Control (NCDC).

At the time, the Ebola outbreak was no longer foremost in mind of many Nigerians, therefore initial campaign efforts were likened to the story of the boy who cried wolf. There was also the argument that Nigeria had many pressing health needs which required urgent attention, so why should the country dedicate resources to prepare for an epidemic that might never happen? Well, the Ebola outbreak left a clear message that the COVID-19 pandemic reinforced, which is the vital need to build a strong health system that strengthened surveillance efforts and the country’s ability to detect, respond to and control future disease outbreaks. This is essential in order to prevent and minimise the health and socio-economic consequences of an infectious disease outbreak. For these systems to be established, firm political will is required, and it is critical for the government at all levels to make the financial investments required to develop the national and sub-national capacity for health emergency preparedness and response efforts.

Early campaign activities

The project sought to engage with political decision-makers on the need to prioritise epidemic preparedness; build government, civil society and media capacity to advocate for funding for epidemic preparedness, making the case for investments in epidemic preparedness and tracking budget allocation and spending, to inform advocacy.

The campaign was flagged off with vox pops, media engagement, forums and policy dialogues. Notably, at the ‘Cost of Epidemics’ policy dialogue in May 2019, participants shared strategies on how Nigeria could prepare for infectious disease outbreaks, budget for epidemic prevention, and pool local resources towards epidemic prevention. It was agreed that achieving sustainable financing for epidemic prevention would require including a budget line item for epidemic prevention in national and state budgets.

In addition, in February 2020, Senator Chukwuka Utazi, Chairman of the Senate Committee on Primary Healthcare & Communicable Diseases, and Senator Ibrahim Oloreigbe, Chairman, Senate Committee on Health, discussed the role of the legislature in funding epidemic preparedness at a breakfast meeting themed, ‘Legislating Epidemics’.

The #PreventEpidemicsNaija consortium

These activities contributed to achieving the project’s objectives which were to increase awareness and funding for epidemic preparedness and implementation of the National Action Plan on Health Security (NAPHS) in Nigeria, but it soon became imperative to take the #PreventEpidemicsNaija advocacy to the sub-national level. Therefore, in 2020, the campaign expanded, as Nigeria Health Watch, the Legislative Institute for Sustainable Development (LISDEL) and BudgIT were part of a GHAI-led consortium to intensify budget advocacy toward epidemic preparedness at the federal and state level. It was especially important to take the campaign to the states, because despite Nigeria’s history of infectious disease outbreaks, there were gaps in the epidemic preparedness and response capacities at the sub-national level.

Speaking on the need for a consortium, Dr Gafar Alawode, Project Director, LISDEL said, “The major problem this project was trying to solve was the suboptimal public investments in health security, and limited government responsiveness in terms of having the necessary legal, institutional and policy framework to address health security issues both at the national and subnational levels”.

LISDEL and Nigeria Health Watch also collaborated with the Health Sector Reform Coalition (HSRC), the Legislative Network for Universal Health Coverage and other organisations to create public demand for epidemic preparedness.

Media advocacy

The consortium has garnered media attention and leveraged the voices of highly regarded religious and community leaders at media events, as well as leveraging multimedia platforms to raise awareness and support for the campaign.

The media is an important stakeholder for the Prevent Epidemics programme and it was therefore important to equip journalists who report on health and those interested in health reportage with the professional and technical knowledge to accurately report on epidemic preparedness.  To achieve this, Nigeria Health Watch organised a series of journalism workshops with journalists around the country. As a result, reportage of epidemic preparedness in Nigeria became quite widespread. Since 2020, the #PreventEpidemicsNaija Journalism Awards (PEJA) has recognised and rewarded exceptional reporting of epidemic preparedness stories in Nigeria.

Between 2018 and 2020, online engagement has increased significantly, with the campaign hashtag, #PreventEpidemicsNaija, a prominent hashtag in social media conversations about the COVID-19 pandemic in Nigeria.

Accountability and sustainability

LISDEL collaborated with BudgIT and other civil society organisations, including the Health Sector Reform Coalition (HSRC), to build a Health Security Financing Accountability Framework. This approach can be used to track federal, state, and local government budget allocations, expenditure and outcomes, as well as to identify expenditure constraints and to inform advocacy. Campaign partners are collaborating with political decision-makers to disaggregate expenditure data, as needed to track releases at the federal level and in Kano and Lagos State.

According to Iniobong Usen, Head, Research and Policy Advisory, BudgIT, “One thing the project has enabled us to do is to look at what the resource allocation to epidemic preparedness and response through the budget is, and to try to ensure accountability through the tracking of the budget and implemented projects to which these allocated sums in the budget were trying to address.”

Sub-national advocacy: The Kano State example

In Kano State, LISDEL collaborated with BudgIT to establish the Kano State Health Security Advocacy Team (KSHSAT). LISDEL and GHAI built relationships with epidemic preparedness champions in politics and the media to demonstrate the value of investing in health security. This engagement built trust which led to invitations for LISDEL and KSHSAT members to participate in government-led budget review and planning sessions, as well as meetings to assess the state’s preparedness.

Furthermore, LISDEL, GHAI, and KSHSAT collaborated with the Kano State Ministry of Local Government and Chieftaincy Affairs on budget advocacy efforts which was aimed at getting each of the 44 Local Government Areas (LGA) to allocate funding for epidemic preparedness and response in their budgets. The project recorded successes, as a line item of N300 million was created in the budget for epidemic preparedness, as well as an additional allocation of N2 million per LGA.

Prioritising epidemic preparedness

“The COVID-19 pandemic has given us additional impetus that the work we do in advocacy for epidemic preparedness is extremely important, more so, prioritising Nigeria’s health security has to be front and centre for policymakers, especially as we are in an election year,” said Vivianne Ihekweazu, Managing Director, Nigeria Health Watch.

Clearly, adequate funding, political will, partnerships and increased collaboration will improve Nigeria’s ability to prepare and respond to infectious disease outbreaks and strengthen the country’s health security. The #PreventEpidemicsNaija coalition will continue to advocate for increased funding for Nigeria’s health security at the federal and state level; transparency; accountability; and sustainable government investments in epidemic preparedness must be a priority. As Senator Utazi said at the Legislating Epidemics Breakfast meeting, “It is during the time of peace that you prepare for war…We all have to make epidemic preparedness a culture in Nigeria”.