In the final part of the series, the Civic Media Lab examines the most prominent agency under the Ministry of Health in the fight against COVID-19, the National Centre for Disease Control, in an independent analysis of its budget, activities and outputs in the last five years.
The Nigeria Centre for Disease Control swelled its capital budgetary provision with 16 questionable projects worth N1.32bn between 2017 and 2019.
Civic Media Lab observed that 12 of these projects were centred in Imo and Abia states.
Two of these 12 projects were lumped line items repeated in 2017 and 2018.
The scrambled descriptions were for the purchase of ambulances in three senatorial districts in Imo, Abia and Zamfara.
Three of the 12 were for the purchase of Hilux SUVs in Abia and Imo states.
Of the remaining four, one was a project valued at half a billion for the eradication of a non-communicable disease, which the centre does not report on or respond to.
The three other line items were poorly described projects valued at N225m for capacity building and effectiveness in the management of disease control.
The description of the line item, which reoccurred three times, lack details of where the training was to take place or who was to be trained; these crucial points were described in other training proposed by the centre, making these descriptions conspicuously ill-fitting in the NCDC’s 2017, 2018 and 2019 appropriation.
The centre’s spending demands were streamlined in 2015 and 2016, receiving only N472.50m in two years to conduct 12 projects.
2015 emergency responses
The Nigeria Centre for Disease Control received no funding for its personnel in 2015 but obtained the approval of N3.08m for its overhead.
The personnel had to draw down on funds from the Federal Ministry of Health since the bill to establish the centre had not reached the President.
For capital funding, the agency was given N224m.
This sum was apportioned between an emergency operation centre set up to respond to the annual Lassa fever epidemic in Nigeria, the already neutralised Ebola outbreak and other public health emergencies, expanding its labs in Lagos, Ibadan, Kano and Maiduguri, as well as annual support to its field and epidemiology training programme.
Between August 2015 and May 2016, the World Health Organisation said it was informed of 273 confirmed Lassa fever cases across 23 states and 149 deaths, a case fatality rate of 53.9 per cent.
“One of a concern since the onset of Lassa fever outbreaks is the high proportion of deaths among the cases that are still under investigation,” the United Nations agency had stated.
The NCDC could, at this time, call on the support of two national laboratories to deal with testing for the virus; the virology lab in LUTH, as well as the Lassa Fever Research and Control Centre, in Irrua Specialist Teaching Hospital, Edo State.
The agency, which Nigeria’s healthcare system depends on especially in coping with outbreaks, said the Lassa fever epidemic in the country showed ‘a declining trend’ in 2015.
The NCDC was at this time not giving weekly epidemiological updates on outbreaks in the country as it does now, so it was again left to WHO to give its climax report on the Type C meningitis outbreak in Kebbi and Sokoto states.
The UN health ministry said, “The disease can be cured with antibiotics and prevented with vaccines.”
The WHO had been informed of 50 deaths and 652 infections at the time of its report.
A vaccination campaign was done in earnest but the timeline of the programme was not stated.
According to this study done in Kebbi state, 1,992 cases of the contagious bacterial ailment were found in an 18-week long outbreak.
At least 79 lives were lost – a case fatality rate of 4.0 per cent.
2016 emergency responses
The centre was still, at this time, drawing its salary from the envelope of the Federal Ministry of health HQ.
It was still just a centre of necessity unprotected by law. Its overhead was N3.77m. Capital spending was increased by more than N24m to an estimate of N248.50m.
The centre increased its project portfolio to nine projects. Two of the nine projects were askew though.
Under recurrent expenditure, the NCDC received the approval of N1.54m for local travels and training.
It failed to set aside any sum for international travel. In the capital expenditure session, where constructions, purchases, research and development, capacity building, and other such spending are detailed, N21.0m was allotted to local and international travel in the capital spending side.
Again, the centre sought N225,606 for utility bills: electricity, water and sewerage, under recurrent spending. It still sought approval for N1.51m to be disbursed for the payment of utility bills in its offices, describing it as a new project in the capital expenditure column.
The centre received monies for zonal units and labs, NFELTP and the regional CDC for the West African region, with headquarters in Abuja.
Funding for its emergency operation centre was reduced to N35m.
The centre responded to two epidemics: Lassa fever and a meningitis outbreak described by an article in the USA as ‘the largest global Neisseria meningitidis group C epidemic ever reported.’
Between December 2016 and June 2 2017, NCDC said it had recorded 182 confirmed and probable cases in 16 states, with 59 deaths from the confirmed ones and 14 from the possible.
This means four in every 10 persons affected by the rodent-borne virus died.
By September when the outbreak which started in December 2016 ended, 869 cases had been reported – both confirmed and suspected, 119 persons, did not survive the epidemic – a fatality rate of 13.69 per cent.
The NCDC’s N35m funded EOC, also responded to a Meningitis outbreak that, according to it, affected 14,473 persons across 25 states.
The centre’s last meningitis update for this outbreak on June 2, 2017, said in one paragraph, ‘A total of 14,473 cases with 1155 deaths (CFR=8.0%)’ and in another heading reported, ‘Total Deaths 1,158.’
The agency said 6,474 children – 46.90 per cent of the total case profile were infected.
The article, which described the meningitis outbreak in 2016 as the largest globally, said as at June 15, 2017, that 14,518 persons were infected and at list 1,161 failed to survive — a fatality ratio of eight per cent.
The article which was a review of a paper by Nnadi C. et al said the outbreak was two to three months old before the NCDC was informed on December 13 2016.
The centre, in turn, failed to inform its patrons, WHO, the US CDC and its international vaccine alliance partners until April 2017.
Although Type C. Meningitis did a number on Kebbi and Zamfara in 2015, the country was unable to mobilise an immunisation programme until foreign help arrived.
In September 2016, the centre also started a weekly epidemiological report, where it reported on diseases under its surveillance, not all of this ailments required the activation of an emergency operation centre, however.
2017 emergency responses
This year, the NCDC received its first funds for the direct payment of salaries.
This increased its recurrent expenditure from N3.77m to N16.23m.
On the capital axis, there was a huge increase from an approximate of N248.50m to N1.57bn.
The centre had so much more to work with, however, CML was unable to find evidence of what it could have done with N800m of the funds by scanning its 2017 and 2018 annual reports, its information-loaded website and Google searches.
The NCDC responded to outbreaks of monkeypox, yellow fever and cholera, aside from the Lassa fever epidemic which ended in September of this fiscal year.
Between May and July 2, WHO said the country’s Federal Ministry of Health reported the emergence of Acute Hepatitis E in Borno State.
It said 146 persons were infected. WHO did not report any deaths and the NCDC did not give a regular situational report on this.
The hepatitis E outbreak was not on the centre’s epidemiological report for the three weeks in July 2017 as well.
The centre received approval to carry out 24 projects. More than half of these were directly targeted at surveying and responding to epidemics.
One was a national action plan on drug resistance in the country, while there were several other capacity and partnership funded projects.
The centre budgeted N100m for a lumped line item which reads: Strengthening Health Research in Nigeria through Procurement of Research Equipment, Capacity Enhancing and Conduct of Nation Wide study on Diseases Burden.” In other descriptions, the NCDC was more descriptive with what equipment it was purchasing. The Centre went on to budget another N100m for a poorly defined project: “Training Capacity Building and Awareness Campaign.”
CML checked if the NCDC had indeed carried out research on diseases burden across the country and found no report to that effect.
The centre however, has a Surveillance and Epidemiology Directorate, which has a disease working group that may have carried out unpublished studies on ‘diseases burden.’
Outside the hedges of these two-line items, was a constituency-type project, in which the centre received approval to spend N100m on purchasing an unspecified number of ambulances for Imo East, Abia North and Zamfara Central Senatorial Districts.
CML however, found the remaining half a billion budgeted fora ‘malaria eradication programme questionable. As observed by CML, the NCDC was not found to deal directly with malaria.
ts contact with the ailment comes through its surveillance of all diseases in the country and its effort to study drug resistance among all communicable and non-communicable ailments in the country.
Since HIV is one of these, CML wonders why the centre did not budget a dime for its eradication as well.
The agency in a September 22, 2016, post, referred Nigerians and any other visitor to its site seeking more detail on the federal government’s response to malaria, to the Nigeria Malaria Control Programme.
Why the NCDC was allocated more money in one year than the five-year capital expenditure budget of the National Arbovirus and Vector Control Research Centre, for a malaria scheme remains unclear.
Within the budgeting cycle between June 13, 2017, and June 20 2018, the NCDC activated its EOC to monitor and respond to a meningitis outbreak from September 2017.
Between the ninth month of 2017 and January 25 2018, it recorded 481 cases of meningitis and 82 deaths across 12 states. Except for Cross River, the other 11 states were in the North East and West.
The centre was able to at this point test 176 samples – 36.6 per cent of the suspect cases, however, there was no other situational report on the outbreak until December of 2018.
Lassa fever popped up on the monitor of the operating centre again, killing 119 persons in 21 states across the six zones of the country Between January 1, 2018, and June 17 2018.
The deaths came from 109 of 438 confirmed cases and ten of ten probable cases.
Based on the confirmed results, the death rate was 24.33 per cent.
At least nine health workers out of 38 infected front line staff did not survive the epidemic.
Between January and May 19 2018, the centre also monitored a cholera outbreak which it said infected 5,607 persons and killed 59 others in nine states, eight of which are in the three zones of the North.
The state that reported a case outside this region in that period, was Anambra.
The centre also activated its EOC for a monkey pox outbreak, which it said had infected 228 persons and killed six others in 15 states.
On September 12 2017, the NCDC and its partners responded to a yellow fever outbreak in Kwara State as well.
By June 24 2018, four days after the 2018 budget became law, the centre said the country had recorded 2,254 suspect cases and 47 deaths – a fatality ratio of 2.1 per cent.
While stating the number of samples collected and tested in labs it wrote, however, “Of the 2,253 suspected cases, 2,071 (91.9%), had blood samples collected and sent to the Nigerian testing laboratories for confirmation.”
The centre sent 125 of these samples to Institute Pasteur in Dakar Senegal.
Although the NCDC still set-up EOCs for outbreaks as it saw fit, it ditched seeking budgetary approval for this, in favour of funding for strengthening its Integrated Disease Surveillance response.