In the final part of the series, the Civic Media Lab looks at the most prominent agency under the Ministry of Health in the fight against COVID-19, the National Centre For Disease Control, NCDC, in an independent analysis of its budget, activities and outputs in the last five years.
In December 2018, the President signed the bill giving the NCDC its legal status. This was reflected in the budget he had signed five to six months before.
The centre received an estimated N319.58m for reoccurring spending, it’s overhead stayed same at N3.77m, while its personnel cost soared from N12m to N315.80m.
It appeared the centre received approval for more money than it needed to spend on buffing its diseases response and aiding its partners like the ECOWAS Centre for Regional Surveillance and Diseases Control, the African Field Epidemiological Network (AFENET) and its epidemiology training programme.
The CML makes this claim because the centre extended N187.50m of its N1.63bn capital envelope on revamping three health centres in Ehime Mbano/Ihite Uboma/Obowo Federal Constituency in Imo State and two general hospitals in Abia State.
The centre’s capital fund was divided between 41 projects. 10 of these were copied from 2017 and pasted in 2018, six others were improvements on 2017 projects and another two were simply modifications.
In the previous budgeting cycle, a project described as: “Purchase of lab reagents and PPES for Lassa, Ebola, Zika and other public health emergencies; support funding to NFELTP, AFENET and Convocation of Epidemiology summit,” received an estimate of N42m. The second appendage to that description was removed in the 2018 budget and the modified line item received an approval to draw down on N43m.
In the prior fiscal year as well, the NCDC had budgeted N10.70m for “Building workforce Capacity and Support to Nigerian Field Epidemiology and Field Laboratory Training Programme (NFELTP) and African Epidemiology Network (AFENET).”
The vaguely described “Training Capacity Building and Awareness Campaign,” from 2017 was modified in 2018 to read: “Capacity Building for Effectiveness in Disease Management Control” and given N100m, whose capacity was to be built or where the skills upgrade was to take place was not stated.
Aside from the N120m shared equitably among the labs in the health care centres in Amuzi, Amaniyi and Umualumaku, all in Ehime Mbano/Ihite Uboma/Obowo Federal Constituency in Imo State, as well as the N67.50m allocated to two general hospitals in Umunnato and Arochukwu, in Abia State, the NCDC also received an approval of N200m for an unspecified number of Hilux vehicles to help it work ‘effectively’ in Obowo and Abia North and another N100m for the procurement of an unspecified number of ambulances in Zamfara Central, Imo East and Abia North – a reoccurring project from 2017.
The centre’s mandate is to support states response to small outbreaks and lead the response to large ones, not have an operational presence in constituencies and senatorial districts.
This mandate was offered to states for the handling of six diseases according to its situational reports, between June 2018 and May 2019, when the budget for the next fiscal year was signed.
From June 2018 to December 2018, there were 52 deaths caused by Lassa fever from 195 confirmed cases. Like in the first half of the year, all the probable cases – another ten, lost their lives.
From January to June 2, 2019, 581 Nigerians were infected with Lassa fever in 22 states around the country. The centre said 130 of them succumbed to the virus, two of the health workers.
From the Meningitis belt, 905 suspect cases were reported with 65 deaths across 15 states, between October 1, 2018, and May 12 2019. The death to case ratio is 7.2 per cent.
The NCDC also responded to a measles outbreak across the country. From January 1, 2019, to May 18 2019, 28,796 cases and 89 deaths were reported to the centre from all states in the country. It was able to collect 6,394 samples, test 5,976 and confirm 1,423 as having the infection.
From January 1, 2019, to May 31, 2019, the centre recorded 1,255 suspected yellow fever cases. The centre successfully collected blood samples from all cases and sent 49 of these to Dakar.
The centre also responded to a cholera outbreak during this period. It said 42,466 cases were reported from 20 states at the end of October 29. Two states in the South East, Anambra and Ebonyi and all the states in the North, except for Benue, were plagued with the disease which killed 803 persons – a fatality rate of 1.95 per cent.
2019 emergency responses
The NCDC was given an improved recurrent spending package of N416.52m from the N319.58m the previous year, its capital funding shrunk from N1.63bn to N1.07bn. The centre prepared a spending plan that included only four new projects in 2019.
From the reduced sum, the NCDC was still able to allocate N70m on purchasing vehicles in Abia and Imo states. The centre also made spending plans for another N40m for the general hospital in Arochukwu, Abia State – the same price it budgeted for the project in 2018.
Asides from these three Hilux/SUV purchase line items, the other new project this year was a N180m plan to respond to disease outbreaks. CML did not spot this line item in previous years but the centre’s scheduling officers described it as new.
The training capacity building project, which had first appeared in 2017 but was modified in 2018, received N25m this year, just a quarter of the allocation it was given for each of the last two years. The scheduling officers at NCDC also defined it as new.
Every year CML searched, NCDC funded its NFELTP scheme, budgeting N167.10m to the programme between 2015 and 2019. This is asides from merging it with the line item on the purchase of PPE’s in 2017, after voting funds for it in a different description. The centre has also given support funding to the ECOWAS Regional Centre for Disease Surveillance and Control since 2016, its total budgetary provision coming up to N78.70m.
The N180m requested for by the centre for disease response went into responding to the ever-present Lassa fever. Another 229 persons were infected between June and December 2019, increasing the rate of infections for the calendar year from 581 to 810 in 23 states. The number of deaths recorded increased from 130 to 167 as well.
The total number of confirmed cases between January 1 and May 9, 2020, is 190 more than all of 2018, with the centre saying 1,000 cases had been affirmed as positive in 27 states. Of these, 192 have been killed by the ailment, 15 more than In the 12 calendar months of 2019.
The NCDC reckons that 4,288 cases of yellow fever were reported from all 36 states of the country between January and December 2019. A further 139 suspect cases were reported as at the last month of its situational report update for the epidemic. In all, 4,427 persons were infected with the ailment and 231 of them failed to survive.
The centre also reported 341 suspect cases of rubella – a mild version of measles that causes pregnant women to give birth to deformed children, across nine predominantly southern states. There were also 113 suspect cases of monkeypox with one death and eight further cases of meningitis from the 905 cases reported as of June 2, 2019. The total deaths from the disease remained 65 from 914 infections.
Undocumented Strange Deaths
Since the first case of COVID-19 was reported in Kano State, North-West Nigeria on April 11, more than 650 persons, including several prominent persons have lost their lives to a fast-acting ailment. In Hadejia local government of Jigawa State, an area close to Kano, media reports say some 120 graves were counted out in a week, a claim its government officials have made painstaking effort to deny.
They have instead worked with figures ranging from 47 to 51, saying it is a normal occurrence for old persons to die during the Muslim month of Ramadan. In Yobe State, North-East Nigeria, government officials said in the first week of May that 475 unexplained deaths were reported.
With over 1,000 unexplained burials across three Northern states triggering rumours and denials among state governments and onlookers, the NCDC has yet to give a definitive view. It has not tied the deaths to any ailment on its integrated disease surveillance response platform, which it budgeted N150.91m for in three appropriation cycles.
On its NCDC linked webpage, NFELTP said it had trained more than 900 front line health workers in 13 states across 260 local governments. It said one of the aims of its scheme is to: “Improve the ability for timely detection and prompt response to disease outbreaks and other public health threats by building epidemiologic capacity at the LGA and state levels.”
Although the NCDC failed to mention the states that have benefited from the programme, it said the benefiting territories are across the six geopolitical zones. Yet, no preliminary mention of causative factors or action has come from the centre. Disease surveillance note officers and epidemiological heads across the 13 states and 260 LGAs were reported to have been involved in the training.
No NCDC built labs in Ehime Mbano/Ihite Uboma/Obowo Federal Constituency
Civic Media Lab learnt there were no labs in the three comprehensive health care centres in Amuzi, Amainyi and Umualumaku that the NCDC budgeted N40m each for. A source close to two of the health care centres said the National Primary Health Care Development Agency (NPHCDA) budgeted for the construction of the centres and no labs were built. In the NPHCDA’s capital budget of over N23bn, there were six projects related to these three health centres, one for construction and another for the supply of 100 KVA generators. The total cost of the two projects for each centre was estimated at N29m each.
A resident of one of the communities in the Ihite Uboma axis of the constituency, said there are no functional labs in the area. He said in all the local government provinces that make up the House of Representatives seat, the general hospitals do not have functional labs either.
“The only hospital with a lab around here is Mercy Hospital, a missionary owned facility for training nurses,” he said.
Vehicles Versus Disease Control
The NCDC had, between 2017 and 2019, budgeted N470m for ambulances, Hilux and SUV. Except for Zamfara central senatorial district, the locations for these vehicles have been in Imo and Abia States.
CML observed that the centre’s objectives have nothing to do with responding to diseases and having areas of operation in senatorial districts and federal constituencies. Their focus is instead on states and local governments.
In the last five years, Nigeria has reported thousands of suspect cases of meningitis, Lassa fever, cholera, measles, yellow fever and now, COVID-19. Lassa fever and Meningitis have been the chief killers. The centre needs every kobo available to respond to these ailments, not to help National Assembly members buff up their constituency envelopes.
When the COVID-19 ailment broke out in Kano State, the disease surveillance system in the North came under a heavy strain, despite yearly polio and meningitis responses in the regions. The centre and its partners were reported to have vaccinated more than 2.1m persons in response to the meningitis Type C outbreak that tapered off in June 2017, still, disease surveillance in the region appears weak.
The weight of the samples that required testing, forced Chikwe Ihekweazu, the Director-General of the NCDC, to go on his Twitter handle to announce the nature of testing kits Nigeria was in desperate need of.
The NCDC is the youngest of the agencies whose budget and activities were surveyed by the lab. Yet, it was found to be the lead ship in the ministry of health’s disease surveillance and research fleet, with clear channels for different fields of reporting.
Of the five, it is the only agency with its annual reports updated as of 2018 and available for download on its site. Although its research link was empty, the centre has been busy putting out epidemiological fires. It would have been better then, if the centre-left research to NIMR and NAVRC, than budgeting just N10m for a study of Dengue, Yellow and Lassa fever across the country in 2018.
When CML shared its findings with the NCDC, a source in the agency said it had been escalated to the budget department, no feedback was received ever since.