We are currently facing a primary healthcare crisis in Nigeria and speedy intervention is needed to enhance access to health care for our ever growing population.

The latest data from the World Health Organization (WHO) reveals that Nigeria’s physician-to-patient ratio is 4 doctors per 10,000 patients and patients often wait hours to be seen. In the US the ratio is 26 doctors per 10,000 people and 28 in the UK.

Nigeria repeatedly falls short on its 2001 commitment to spend at least 15% of its budget on health. Last year just 3.9% was allocated.

The Nigerian Medical Association (NMA) advised there are only 40,000 doctors in an estimated population of 196 million.

A WHO report by Uta Lehmann and David Sanders from the School of Public Health University of the Western Cape, says:

‘The use of community health workers has been identified as one strategy to address the growing shortage of health workers, particularly in low-income countries. Using community members to render certain basic health services to the communities they come from is a concept that has been around for at least 50 years. There have been innumerable experiences throughout the world with programmes ranging from largescale, national programmes to small-scale, community-based initiatives’ (Evidence and Information for Policy, Department of Human Resources for Health Geneva, January 2007)

Community health workers have the potential to enhance primary care access and quality, but remain underutilised in Nigeria.

It is common knowledge that we do not have trained physician associates or assistants in primary care facilities to support medical doctors in providing primary care services; rather what we have in some communities are quacks, people parading themselves as medical doctors with no medical qualification whatsoever.

But I don’t see any reason why we should not welcome the idea of training physician associates or assistants to fill in the gap for medical staff shortage, when other developing and developed countries that have better healthcare systems do have them.

In Nigeria we do not have enough doctors per population or geographical area, This is the time to train more community health care workers as this would help in the much needed awareness creation and community based interventions for  managing long term conditions, reducing childhood illnesses due to lack of immunisation. Trained birth attendants will also help reduce maternal mortality and community nursing care will reduce infant mortality.

In a typical medical centre in the UK for instance, healthcare assistants, advanced nurse practitioners, health trainers, clinical pharmacists or prescribers, work alongside doctors to provide patient centered care. This helps to reduce the work load on the doctors as these other clinicians and allied health workers have enough training and experience to manage long term conditions and participate in triage system.

In the UK, a lot of research has been done and there are calls to increase the health work force in the National Health Service (NHS) through the utilisation of community-based lay workers.

In Brazil, community health workers receive basic training in disease identification and monitoring, immunisation, screening and health promotion. They support patients with medication adherence and chronic disease monitoring and liaise proactively with doctors and practice nurses.

Community healthcare workforce could be utilised effectively in emergency care or first aid. In most public and private settings  in Nigeria, there are no ambulance or paramedic services; having well trained community first aid responders would go a long way to save lives in times of emergency for example; cardiac arrest, collapse, and respiratory distress. Having a health unit manned by well-trained first aid responders in all public places like markets, motor parks etc is highly essential.

Healthcare provision anywhere in the world is capital intensive but we can start from the basics; we can reduce the burden or costs in secondary healthcare provision especially in our public hospitals if we lay more emphasis on health promotion, patient health education and encourage people to engage in healthy living and self-care. 

Another important way we could ensure we have enough medical/healthcare practitioners to address the primary healthcare needs in Nigeria is to reduce the constant brain drain by retaining our health professionals post graduation.

The Federal Government invests a lot of funds in Government owned Universities to train medical/healthcare professionals, only for them to migrate after graduation to practice in other countries. If we are going to invest funds in medical/healthcare education for our doctors, pharmacists, nurses, optometrists etc we should create jobs as well so the Nigerian populace could benefit from their expertise.

Integrated healthcare practice at all levels is an efficient way of providing patient centered care where every member of the healthcare team contributes their own quota. Community healthcare workers are well placed to offer advice on healthy living and self-care in the language people of a specific demographic area would understand. Hypertension, Chronic Kidney Disease, Type 2 diabetes mellitus, malaria, HIV/AIDs are among the diseases that could be prevented or well managed through patient education and lifestyle modification.

The role of health education cannot be overemphasized. For instance, there is still some form of stigma around epilepsy in some areas in the country; where people who are epileptic are believed to be possessed by some sort of evil spirits, in an unfortunate event of epileptic fits in public places, patients are not well cared for and objects like spoon etc. are inserted into their mouths in the believe that it keeps the airways open, this could be a choking hazard and has made recovery time worse for some patient. Community healthcare workers could perfectly fill that gap of providing basic health education and public health enlightenment.

 Addressing the primary healthcare crises in Nigeria is no mean feat, but we need to look at the issue holistically, it involves a multifaceted, public/private partnership, but the Government has to lead on this through enacting relevant laws and provision of training programs, monitoring and evaluation etc.

I strongly believe a systematic integration of community health workers at scale could be an effective and a rapidly implementable approach to the current primary care workload crisis in Nigeria. 

‘Without health, life is not life; it is only a state of languor and suffering’.     

Francois Rabelais

It was jubilation in Kaduna among workers. The Kaduna State Government has become the first state in Nigeria to implement the newly approved minimum wage. The hard won battle has been facing implementation hurdles in the 36 states, until Kaduna set the pace.

Minimum wage in Nigeria has been a mockery of livelihood:Minimum wage in Nigeria has been a mockery of livelihood: a life support system that has yielded economic hardship and income inequality.

The battle to increase the minimum wage from N18, 000 to N30, 000 took so long. And the hope of its implementation by states hangs on uncertainty. The governors had vehemently opposed the increment, stating that they can’t afford it. A true statement evident in their inability to pay N18, 000 wages.

So you know why it’s a cause for jubilation in Kaduna that the State Government has announced its decision to pay workers N30, 000, about $80 monthly. But while the people of Kaduna are rejoicing, workers in other states are salivating in hope. But if at all there is such a hope, it’s going to take a long while.

In 2017, the Federal Government (FG) provided extra-statutory bailout fund to states to the tune of N614 billion, due to the states’ inability to pay workers for long. To recover the loan as it was deemed, the FG adopted a reductionist approach to the states. That means, the fund will be deducted monthly from their Federation Account Allocation Committee (FAAC), quota.

The deduction has started, and some states are kicking that they have little left at their coffers after the deductions. According to the data published by the Nigerian Bureau of statistics (NBS), the deduction rate is so high for some states that they may not afford to pay salaries even at N18, 000.

The August deduction report is as follows:

• Osun: 54%
• Cross River: 30%
• Lagos: 29%
• Ogun: 26%
• Zamfara: 22%
• Plateau: 19%
• Bauchi: 19%
• Gombe: 18%
• Imo: 16%
• Oyo: 15%
• Ekiti: 15%
• Ondo: 13%
• Kwara: 12%
• Abia: 12%
• Kogi: 11%
• Niger: 11%
• Edo: 10%
• Adamawa: 10%

The rest of the states are hanging between 9 and 3 percent. However, it is not a good news to the hope of N30, 000 minimum wage. Some states like Kogi, are still borrowing from the FG to pay workers their N18, 000 salaries. In Abia State, the hope is so thin. Workers and pensioners are wailing in starvation.

So it certainly appears that states governments are sitting on a cliff of financial doom, and workers will continue to take the fall. Most of the states are heavily in debt and have little or no means of revenue generation apart from the FAAC. And the oil downturn has depleted the volume of their respective allocations.

Therefore, the option is to wait on the FAAC and choose what to do with it from the list of “most important” which wages is evidently not on. And you don’t talk about infrastructure yet it is reserved for the days of oil boom.

So the N30, 000 minimum wage remains a dream that may never come true in most states of Nigeria, because the reality depends on high oil prices.

On 1 April 2019, the Federal Government under the Ministry of Health phased replaced the old ‘Yellow Card’ with a new electronic card which they issue to people who have been vaccinated. But on August 31, 2019 thousands of data were leaked! What can the Government learn from this?

The yellow card is an important document which is given to a person after getting a vaccine against yellow fever disease. In its stead, a new electronic yellow card would be issued for people who have been vaccinated.

The new e-Yellow card is also expected to stop the racketeering in fake yellow cards which are issued at point of airports and borders. The yellow card is also meant to forestall the problems of payment to collect the card without getting the vaccination.

The World Health Organisation (WHO) recommends vaccination against yellow fever for all international travelers, nine months of age and older before they come to Nigeria as there is evidence of persistent or periodic yellow fever virus transmission there.

The New System

The new implementation begun when the Ministry of Health said that all registration for getting the Yellow Card would be exclusively online. While this was a great movement in the light of digital sustainability and ease, the Ministry failed to see the critical aspect of securing its citizens.

Here’s an overview on how to get the card using the new system:

The new yellow fever card costs N2000 and will need to be paid online via credit or Debit Card Payment.

STEP BY STEP

• STEP 1:Visit http://www.yellowcardnigeria.com
• STEP 2: click on Register
• STEP 3: Fill in your personal information and click on submit button.
• STEP 4: Click on Payment button, generate your Remita Retrival Receipt (RRR) code and pay the sum of N2,000 online (or go to the bank).
• STEP 5: Take the payment receipt along with your international passport to any Port Health Services Office to get vaccinated and obtain the yellow card.

The Looming Problem

According to Business Day, “a visit to the website on Saturday showed that when a user input their passport number on the ‘Check card Number’ page, rather than take the user to the login page, it opens directly to the data page where the user’s information has been stored. When you increment the number one by one, you are taking to different private information of other users on the website.”

While the Ministry has not yet responded to situation which could (or has) potentially seen millions of private information belonging to travelers fall into the wrong hands, we take a look at the implications of this event.

Implications Observed

1. Loss or compromise of Travelers data. In this infamous Yellow Card data breach, which most likely occurred between late August 2019- and July, personally identifiable information belonging to around least 200,000 Nigerians is believed to have been accessed by cyber-thieves. The scale and consequences of the Yellow Card security faux pas is enough to scare any individual into dealing with sensitive information correctly.
2. Loss of money. The majority of cyber attacks concentrate on the insides of an agency’s wallet. It is forecast that by 2021, cyber-crime damages will cost the world $6 billion.While that is a fact that has begun happening, the current breach will likely cost the Ministry of Health huge junks in fixing.
3. Hurt of Reputation. Most downturns for firms and organizations are usually caused by data breaches and cyber attacks that could have been prevented. According to 90% of CEOs, striving to rebuild commercial trust among stakeholders after a breach is one of the most difficult tasks to achieve for any company?—?regardless of their revenue. Now, with this qualm that has blown to the ways of the Ministry of Health’s Yellow Card website, you can be sure that no Nigerian would feel safe to put their Debit Cards details on their website.
4. Risk of Physical Data loss. Over 70% of businesses involved in a major incident either do not reopen or fail within three years of an incident occurring. Remembering to keep the infrastructure of the Yellow Card website safe at all times to avoid loss of data is something that should have been the mind of the Nigerian authorities, unfortunately we know how the story turned out.

What the Nigerian Government should Learn!

With technology being fundamental to many businesses, it should hardly be seen as a surprise that cyber attacks pose significant threats. The above worst-case scenarios are to encourage businesses, and active participants in the digital economy, to implement protective measures that allow them to comply with data protection regulations. Although there is no “silver bullet” that can protect your business from cyber-crime, putting in place adequate security measures is essential for stability and continuity.

According to Glyn Moody of ARS Technica?—?Extremely personal information will be leaked with terrible consequences for some people. The only question is when. This is an essential thought, the Government should plan for the future, information accessed by hackers now could be used to harm the profile of well meaning innocent individuals in years times considering that hackers will take time to analyze the information gotten from their raids (breach success).

Data breaches can expose personal information, financial information such as credit card numbers from individuals and corporate secrets, their software codes, customers and even intellectual property.

Once the attack has been stopped and eliminated, the next step is to investigate it and assess the damage it has caused to the organization. Knowing how the attack happened is needed to prevent future attackers from the same tactics and succeeding. Also, it’s important to investigate the affected systems so that any malware possibly left by the attacker can be detected.

During the assessment, information that should be dug up includes:

• What was the attack vector?
• Was the attack based on social-engineering tactics or through user accounts?
• How sensitive is the breached data?
• What is the type of that data affected?
• Does the data contain high-risk information?
• Was the data encrypted and can it be restored (did the company backup their data)?

After taking the first steps in recovering from a data breach, a security audit is needed to assess the organization’s current security systems and to help with preparation for future recovery plans.

After an attack and taking all the appropriate steps for recovery, the importance of preparing for the next attack can’t be stressed enough. After being attacked once, the possibilities that you will be attacked again are substantial; it’s possible that the same attacker or group of attackers will try it again since they’ve already succeeded, or other groups will use the same or similar methods.

The security audit and internal investigation are valuable. The information uncovered will help guide you toward your future recovery plan and any vulnerabilities that may be lurking. The new recovery plan may include new privacy policies, security training for all employees, enforcing agreed policies with third-party businesses and more. But one thing every organization needs to do is work on educating their employees in some of the finer points of cyber-security since, as we mentioned, human error is one of the most frequent reasons a data breach occurs.

Featured image – Nigerian Yellow Card (Sahara Reporters)