A YSPH alumnus and top health official in Nigeria discusses how Africa’s most populous country became “Ebola free.”
Dr. Olajide “Jide” Idris is the Commissioner for Health for Lagos State, Nigeria’s most populous state with some 22 million residents. When the first cases of Ebola were reported there this summer, it had catastrophic potential. Dr. Idris and others responded rapidly, overcoming numerous challenges, and managed to contain and then eliminate the virus before it spread widely. Recently, Nigeria to declared to be free of the virus.
Dr. Idris earned an M.P.H. degree from the Yale School of Public Health in the early 1990s and credits Yale with giving him a global perspective on health, something that was vital in Nigeria’s response and success against Ebola.
In late October it was declared that Nigeria was free of Ebola. How did the country do this?
Yes, Nigeria was declared “Ebola free” by the World Health Organization. Firstly, we had the good fortune that the index case was managed at a medical institution where astute clinical judgment led to the suspicion that the case was Ebola. Then the fortuitous circumstance that Lagos State had a disease surveillance system in place. Finally, with sheer determination, we established strategic partnerships between the Lagos State Government, the federal government of Nigeria, and international organizations (like the World Health Organization, the U.S. Centers for Disease Control and Prevention, UNICEF, Medicins Sans Frontiers, local governments and other faith/community-based organizations.
Every member of the team brought in specific expertise and resources under a well coordinated and integrated structure and response plan, which included:
- Active surveillance through aggressive contact tracing
- Rapid investigation of suspected cases or deaths including rumors
- Active case management
- Preventive action
- Massive community / public enlightenment
- Continuous capacity building
However, it is pertinent to bring certain things into perspective. Nigeria is a huge country with a population of about 170 million people. Nigeria recorded a total of 20 cases and eight deaths from Ebola, all of which occurred in only two states out of a total of 36 in the country. Lagos State, which is the smallest but most populated with a population of 22 million, recorded 16 of the total cases and six of the deaths. Therefore, a huge proportion of the containment activities occurred in Lagos State. A major factor responsible for the successful containment effort of Ebola is the infrastructure established by the government of Lagos State, in anticipation of the health requirements of a megacity, a status already achieved by Lagos.
What kinds of challenges were overcome to make this happen?
There were many challenges. They include:
1) Population.
The government has the colossal task of catering to its large population (22 million people) with significant resource constraints. As such, the infrastructure, human resources, finances and other logistics required to contain this disease had to be innovatively deployed to contain its spread.
2) Human Resources.
There was an ongoing nationwide strike by medical doctors at the inception of the outbreak. This was compounded by the nationwide fear evoked by Ebola, resulting in a delay in securing the adequate number and mix of health care workers needed (especially doctors, nurses, infection prevention and control experts) at the initial stages.
We created an incentive program comprising life insurance, monetary compensation and encouragement for volunteers who participated in case management, contact tracing and surveillance activities at the ports of entry.
3) Public Awareness Campaigns.
There was panic shortly after the announcement of the index case of Ebola. Our team had to counter misinformation about the presentation, transmission and control by partnering with media organizations, radio and television stations in disseminating relevant information, fact sheets and authentic updates. An important aspect of this enlightenment campaign had to do with community engagement and grassroots mobilization (house-to-house mobilization, motorized campaigns, i.e. road shows and engagement of town announcers, collaboration with the Nollywood (Nigerian cinema) stars and community dialoguing with high risk communities). The aim of these campaigns was to proactively prepare communities for the potential of a widespread outbreak.
4) Stigmatization, Rumors, Cultural Practices and Religious Beliefs.
We also had to deal with the stigmatization of volunteers, their contacts and confirmed cases that eventually recovered. Additionally, there were rumors about deaths, new infections and superstitious ways to prevent the disease circulating and burial practices. All these were dealt with through aggressive public enlightenment using different methods which include advocacy and sensitization of different segments of the community, development of messages in different formats and local languages, development and dissemination of information, education and communication materials, engagement of the print and electronic media, including the social media platforms, and regular press briefings and updates.
5) Knowledge base about Ebola
Regular training and retraining of the different categories of workers and community members on the different aspects of the containment program (infection prevention and control, case management including handling of the personal protective equipment, social mobilization and communication, preventive measures in schools, evacuation and decontamination).
Are Nigeria’s successful strategies being replicated elsewhere?
The Lagos State Government is planning to send volunteers to Sierra Leone to help contain the epidemic that is ravaging the country. This is being coordinated at the federal level.