9-year old Deborah bewilderedly watched, as her classmates were forcibly withdrawn from school just about 11 am in Akure on Tuesday, October 17, 2017, when the news of an outbreak of Monkey Pox ravaged the city. In the middle of the commotion that greeted the school, she struggled to comprehend why her parents had stormed in to get her before the regular closing time.
Barely a week after ‘a dangerous rumour’ broke across the Southeast region of Nigeria, an exact scenario played out in the South Western city of Akure, Ondo-State. The Nigerian Army was accused of injecting school pupils with the Monkey Pox virus against their will or parents’ consent in order to wipe out citizens in the region. Although the information was immediately dispelled and severally condemned by all parties especially the National Centre for Disease Control (NCDC), palpable fear had already spread and the panic is yet to be cleared. Nigeria has once again failed to manage an information crisis emanating from a potential health epidemic.
Health communication is central to public health and the way the society views healthcare. It also greatly influences the way information is employed thereby impacting critical health decisions. It is an established fact that health communication contributes significantly to health promotion and disease prevention in several ways. However, the disparities in access to health information and technology have resulted in less knowledge about epidemic disease management, poor preventive measures and increased rate of hospitalisation.
The first step towards health communication is data gathering through research and effective monitoring. Unfortunately, a major challenge is the dearth of health-related data required for adequate planning.. A major resultant effect of this is the inability to provide affordable and effective health care services and advocacy content for the general citizenry.
The country has had a number of highs and lows in health communication and crisis management. Prominent of the few successes is the eradication of Ebola in October 2014 and a major failure is the case of Lassa fever epidemic still ravaging the nation.
Barely thirty-nine months ago, the first outbreak of the Ebola virus disease (Ebola) rocked Nigeria. The disease had earlier spread within the West African axis several weeks before it was recognised while these countries, also known for high poverty rates and low technological development, grappled with its peril. Nevertheless, the spread was curtailed before spiralling out of control. The European Centre for Disease Prevention and Control attributed the ability to curtail the epidemic to quick responses which included intense and rapid contact tracing, surveillance of potential contacts and isolation of all contacts, which are all aspects of health communication. Thanks to the Nigerian Centre for Disease Control (NCDC)’s swift declaration of an Ebola emergency and its activation of an emergency team. Moreover, nation-wide sensitisation, massive training, and enlightenment campaigns majorly contributed to containing and managing the panic amongst citizens.
In spite of the laudable success Nigeria recorded with the Ebola virus, it is surprising that the nation has not been able to eradicate Lassa fever within its shores despite an over five-decade experience with its outbreak. The failure to contain Lassa fever is majorly attributed to poor disease control and weak surveillance strategies. These strategies begin with rodent control through environmental health authorities and sanitation agencies. Further, community hygiene and standard infection control practices are central to the eradication of the disease. Arguably, difficulty in containing the outbreak of Lassa fever can also be attributed to poor health system, which can only be managed through adequate health funding.
Another communication failure in Nigeria is the late 2016 breakout of Meningitis. Though Cerebrospinal meningitis (CSM) was at first only reported in Zamfara State, as at March 28 2017, the number of suspected cases reported for the 2016/2017 CSM season stood at 1,966 with the outbreak reaching epidemic proportions in five States.
However, how can these measures be put in place when health statistics have remained appalling – unreliable, uncoordinated, incomplete and untimely over a long period of time?
The Way forward
Currently, the health challenges in Africa are growing at an alarming rate and the health status of Africans still being challenged. Unfortunately, weaknesses in health information systems and limited data collation systems pose another challenge to sound decision-making and effective planning. In general, the dearth of standardised data sets is a great setback in Nigeria which has taken a toll on our healthcare management outcomes.
With the recently discovered Monkey Pox, Nigeria is once again reminded of an urgent need for proactive planning towards the periodic outbreak of diseases. History has it that Monkey pox, with origin from the Democratic Republic of Congo recorded its first outbreak in Nigeria in the 70s, yet, knowledge about it still remains insufficient. As expressed by the World Health Organization (WHO) “doubts persist on the natural history of the virus and further studies are needed to identify the exact reservoir of monkey pox virus and how it is maintained in nature”.
Just as Lassa fever, a disease from the 60s and Ebola from the 70s resurfaced in the 2000s, the return of the Monkey Pox is a clarion call on African nations to strengthen their health warning and response systems against such trends and this can only be developed from data gathering, research and development. This would therefore aid the control, preparedness and eventual eradication of these diseases as they re-emerge.
Hence, despite the success with the Ebola Virus Disease, the Nigerian health sector requires significant improvement in information gathering and dissemination. This will guarantee resilience because failure to curtail an epidemic conveys our inability to manage information, data and mobilise citizens to action through preventive measures. There is however a heightened optimism that the validation of the National Strategic Health Development Plan Framework II (NSHDP II), which includes a National Health Management Information System, will bring about the expected improvement in data gathering for the country. It is also important to stress that the discovery of vaccines is a big part of health communication just as an improvement in a collective capacity to maintain effective health communication systems will guarantee management of epidemics. Training, education, and strategic partnerships are essential tools to capacity building.
Finally, the role of the media is crucial in the race to achieving optimal data gathering and health communication in the Nigerian health system. With the Internet and a proliferation of mobile devices, the narrative is changing and more web users can make better health decisions with the avalanche of information at their fingertips. However, it is important to consider the rural communities whose inhabitants have limited literacy skills and access to technology. In addition, the secondary role of communication, as development partners for collective health and wellbeing cannot be ignored. Apart from media coverage of healthcare development; communication planning and strategy across epidemiology calendars will serve as a preventive action and emphasis on developing relevant, creative messages and materials, which clearly communicate to various audiences and are capable of dispelling rumours even before they are formed. Programs and interventions may also be tailored to the interests of different audiences and their readiness to change.
With the growing complexity in effective and satisfactory healthcare delivery, there is an urgent demand for better communication, diffusion of messaging and desaturation of information. Also, for significant results in the health sector, it is crucial for stakeholders in charge of health care management, to create policies and plans, based on evidence of what is necessary, and what works.
Tina C. Anatsui (2014) Communicating Health Information at Grassroots in Nigeria http://www.transcampus.org/JORINDV12Jun2014/Jorind%20Vol12%20No1%20Jun%20Chapter8.pdf
The Guardian (August 27, 2017) Lassa fever in Nigeria again! https://guardian.ng/opinion/lassa-fever-in-nigeria-again/
International Journal of Infectious Diseases (2013) Containing a Lassa fever epidemic in a resource-limited setting: outbreak description and lessons learned from Abakaliki, Nigeria http://www.sciencedirect.com/science/article/pii/S1201971213002117
Oyewale Tomori (2015) Will Africa’s future epidemic ride on forgotten lessons from the Ebola epidemic? https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0359-7
Tropical Health Matters (2016) Poorly Managed Lassa Fever Outbreak in Nigeria http://malariamatters.org/poorly-managed-lassa-fever-outbreak-in-nigeria/
Scientific American (2014) How Did Nigeria Quash Its Ebola Outbreak So Quickly? https://www.scientificamerican.com/article/how-did-nigeria-quash-its-ebola-outbreak-so-quickly/
The Conversation (2017) Lassa fever will keep ravaging Nigeria unless better surveillance is put in place https://theconversation.com/lassa-fever-will-keep-ravaging-nigeria-unless-better-surveillance-is-put-in-place-83847
Ayodeji Oluwole Odutolu et al (2016) Nigeria’s seven lessons from polio and Ebola response http://blogs.worldbank.org/health/nigeria-s-seven-lessons-polio-and-ebola-response The World Bank Group