The Health Sector’s response to COVID-19 in Nigeria has built on existing multi-sectoral efforts to address the ongoing humanitarian crisis affecting the north-eastern region. The Joint Support Framework takes a whole-of-society and a whole-of-government approach to bring together all sectors and partners operating in Nigeria’s COVID-19 response from the national governmental authorities, non-governmental organizations, UN agencies, academic and training institutes, donor agencies, and the affected population.
The situation at a glance
The decade-long conflict in the north-eastern region impacting over 7 million people generates a rapidly changing setting for the COVID-19 response. The conflict has damaged health and sanitation infrastructure, displaced and made inaccessible large swathes of the population, and has significant disease control implications. The local government areas (LGAs) most impacted by COVID-19 also have a high prevalence of co-morbidities with other diseases (endemic cholera and malaria, current outbreaks of Lassa fever and measles, chronic malnutrition) and other public health risks (damaged public health facilities, inaccessible populations unable to receive vaccinations and other essential health services, and congested camp and camp-like settings). The population most affected by COVID-19 include Internally Displaced Persons (IDPs), host communities in conflict-afflicted areas, and returning refugees from Cameroon, Chad and Niger. There are approximately 2 million IDPs in the BAY (Borno, Adamawa, and Yobe) states. According to recent estimates from the Health and Shelter sectors, there are nearly 475 000 people in highly congested camps/sites. The compounding effects of these other crises heighten the threat of COVID-19 in north-east Nigeria.
On 31 May 2020, the Operational Humanitarian Country Team (OHCT) in Nigeria released the Joint Support Framework to ensure a coordinated approach to managing the COVID-19 emergency across partners and sectors. This framework aims to formalize the ongoing multi-sectoral work happening to address the protracted humanitarian crisis and leverage these collaborations for an effective response to the COVID-19 pandemic.
The strategic objectives of the Joint Support Framework directly align with those of the COVID-19 Global Humanitarian Response Plan (GHRP) – contain the spread of the COVID-19 pandemic and decrease morbidity and mortality; decrease the deterioration of human assets and rights, social cohesion and livelihoods; and protect, assist and advocate for refugees, internally displaced people, migrants, and host communities particularly vulnerable to the pandemic.
Based on these objectives, the plan prioritizes preventing the spread of COVID-19 in IDP camps and camp-like settings. Although there are very few cases in IDP camps, the density and conditions in camps create a high risk setting for rapid spread so there is a need to work proactively on prevention. Camp Coordination and Camp Management (CCCM) Sector, Water Sanitation and Hygiene (WASH) Sector, and the Shelter Sector came together with the Health Sector to build a response based on their complementary areas of expertise. The first outcome of their collaboration is the Decongestion Strategy targeting the over 400,000 individuals living in highly congested camps or sites. The plan calls for the acquisition of 1 207 hectares of land in order to prioritize decongestion as a precondition to implementing social distancing recommendations. Nigeria Health Sector partners such as the Grassroot Initiative for Strengthening Community Resilience (GISCOR) are already deployed at Point of Entry surveillance locations to screen returnees and refugees prior to transfer to IDP camps.
The Joint Support Framework recognizes the existing assets and resources present in the country, encouraging local-level sector partners to contribute in their areas of expertise for a flexible and decentralized response. "One major priority is to address the misconceptions and stigma around COVID-19, both for patients and healthcare workers," noted Mr Muhammad Shafiq, Nigeria Health Sector Coordinator. "This can only be achieved by leveraging our partnerships and building off existing structures in place." The Health Sector engaged with the OCHA community mobilization working group, community teams in the WASH Sector, and community healthcare workers in the Polio eradication programs to leverage their networks and skills in community outreach. As a result, a public service campaign was produced celebrating discharged COVID-19 patients as heroes for having defeated the disease. Partners are also working closely with local influencers such as community and religious leaders to provide clear messaging on COVID-19 prevention and treatment.
Taking a triple nexus approach, the Joint Strategic Framework allows development, humanitarian, and peace actors to contribute to a coordinated COVID-19 response in Nigeria. Health Sector partner, the Alliance for International Medical Action (ALIMA) collaborated with the Ministry of Health by providing over 15,000 outpatient consultations on COVID-19. ALIMA also continues to offer essential health services in seven IDP camps and provides sexual and reproductive health care in hospital settings, incorporating COVID-19 prevention and treatment into their existing programmes. Following WHO guidelines, ALIMA is working to train both healthcare workers and state burial teams in infection prevention and control (IPC) measures. In this way, ALIMA and other Health Sector partners are able to work towards both the GHRP and the Sustainable Development Goals (SDGs) in a harmonized way.
Coordination at this level brings to light cross-cutting operational challenges in the COVID-19 response that require ongoing collaboration to solve. "The closure of international airports as a result of the lockdown led to uneven access to humanitarian cargo and supplies," said Mr Muhammad Shafiq, Health Sector Coordinator. "This continues to pose challenges for obtaining life-saving medicines and other essential supplies among our partners.” The closures and international market fluctuations have also made personal protective equipment (PPE) procurement difficult and unpredictable in terms of cost. The Health Sector is working with the supply chain coordination cell to identify partners to fill immediate needs for supplies and collaborating with the Logistics Sector to adapt the Humanitarian Cargo Movement Notification Form (HCMNF) process to serve the evolving needs. Shortages due to restricted movement pose a significant operational challenge, so the Heath Sector continues to advocate for longer term solutions to address shortages.
