Submission to The Social Lens: A Social Work Action Blog by Uzoma Odera Okoye, Department of Social Work, University of Nigeria, Nsukka Enugu State, Nigeria.
Introduction
Nigeria received her shipped-in share of the novel coronavirus through an Italian consultant who arrived in Nigeria on February 27, 2020, and reported by the Nigerian Centre for Disease Control (NCDC) on February 28, 2020, being the first reported case of COVID-19 in sub-Saharan Africa. Dealing with the subsequent pandemic underscored the inadequacies and challenges that exist across the health system: inadequate supply of human and material resources; a low belief system in the new healthcare system; poor attitude of health practitioners; non-employment of social workers in Primary Health Centres; zero levels of people’s involvement; and inefficient service provision. Together these factors provide a very dangerous threat (Okoye, 2019) and raise the question of the reality and ability of the Nigerian healthcare system to contain a full-blown coronavirus outbreak in the country, especially in rural areas.
Currently, the containment of COVID-19 in Nigeria faces many logistic, administrative, and social barriers. This includes few testing and isolation centres; a lack of medical equipment and personnel, especially in areas of high infection; non-involvement of social workers; and low motivation of medical personnel. The fight against COVID-19 in Nigeria is also faced with challenges of low public compliance with social distancing, the wearing of facemasks, and constant hand washing. These are important topics that social workers could be involved with in the creation of public education and awareness. An additional layer of challenge lives with traditional religious practitioners and pastors in Nigeria who believe in supernatural and preternatural forces in approaching the pandemic.
Unfortunately, the majority of the social workers in Nigeria are not part of the pandemic response and seem to be unaware of the roles they could be playing (Onalu et al. 2020). The Nigerian government did not encourage their involvement or provide additional support during the pandemic. The lack of social welfare services for vulnerable people, households, and poor individuals caused severe pain and economic hardship to households and poor individuals during the Nigerian lockdown.
The COVID-19 experience and the reality of the Nigerian health care system
The health sector in Nigeria has been historically underfunded, as it only receives 5% of the total budget rather than 15% as recommended by the Abuja Declaration of 2001 (Plan International Nigeria, 2020). Apart from underfunding, other factors such as doctor-to-population ratio, per capita budget, the percentage of budget spent on health, the teeming population of Nigeria’s poor and vulnerable, and the inadequate social welfare system all contribute to poor health conditions in the country. Most importantly, the Primary Health Care (PHC) Centres—which are the most likely port of call for community members—are ill-equipped to cope with the challenges posed by the pandemic. In Nigeria, no Primary Health Care (PHC) Centre has a social worker in its facility and other medical personnel come to work intermittently.
Response to the COVID-19 pandemic by different groups in Nigeria
The Federal Government of Nigeria set up a Presidential Task Force on COVID-19 that is working closely with the Federal Ministry of Health, and Nigeria Centre for Disease Control (NCDC). The NCDC has tried to support many states of the federation to establish Emergency Operation Centres (EOC); to train rapid response teams in all the 36 states; to provide relevant public health advisories to Nigerians; to share the case-definition and preventive information with networks of national and subnational public health workers; to build capacity for contact tracing and case management; and to strengthen five laboratories for diagnostic capacities. Currently, every state in Nigeria now has at least one COVID-19 testing centre. However, social workers were not included in the process.
At the beginning of the pandemic, the government imposed a five-week lockdown from March 30 in Abuja, Lagos, and the neighboring Ogun state. Also, the Control of Infectious Disease Act was passed to further contain the coronavirus pandemic in a country of nearly 200 million (Ayeni, 2020). Additional measures included a mandatory requirement to wear facemasks in public spaces; massive flight cancellations and the suspension of all international flights; work-from-home by civil servants; partial closure of major food markets; a ban on all religious activities; and a ban on all sporting events.
As part of government efforts towards encouraging the citizens to comply with the sit-at-home order and to cushion the harsh effects of COVID-19 economic realities, the federal and state governments provided palliative care in form of food items, hand sanitizers, face masks, and other basic social care (NCDC, 2020). The Federal Government of Nigeria also tried to expand a new social safety net and welfare programme to include more vulnerable households in different states.
In addition, a private sector Coalition Against COVID-19 (CACOVID) Relief Fund of 45 million dollars was set up in April 2020. Churches and other non-governmental organizations provided support to communities. They facilitated distribution of food items to some of the most deprived areas. Dozens of humanitarian organizations also distributed food to ease the pain of the lockdown, but only a small proportion of the population attest to receiving any support.
Non-cash donations including medical items and different varieties of foodstuffs were received from different groups. Both the Christian Association of Nigeria (CAN) and the Nigerian Supreme Council of Islamic Affairs (NSCIA) supported the government lockdowns and worked with some local and state governments to disseminate accurate information and encourage compliance.
Factors that worsened the spread of the pandemic
Regardless of these efforts by both the government and other relevant stakeholders, the country’s economy was overwhelmed by this pandemic as the support and stimulus packages provided were reported to be insufficient and not proportional to the number of poor scattered across the country. In addition, some of the policy responses had weaknesses and loopholes that greatly contributed to the further spread of the virus and worsened the socio-economic impacts on the people.
For example, officials in charge of the distribution of the palliatives were reported to be insincere and corrupt as they allegedly hoarded the food items for their own interests, leaving the poor and vulnerable still hungry. Also, the Ministry of Humanitarian Affairs stated that the Federal Government did not have a comprehensive list of beneficiaries of the palliatives. Most people noted there was a lack of transparency, accountability, and proper planning. The whole process lacked records for spending details of both public funds and private sector donations. As a result, they were unable to provide socio-economic benefits to the country’s poorest and most vulnerable people, including people living with disabilities (PWDs); and they could not provide details of the beneficiaries of any cash payments, cash transfers, food distribution, and other benefits.
The COVID-19 preventive measures in Nigeria became unfeasible and unrealistic due to poverty and vulnerability. For example, the majority of Nigerians depend on making a daily income on a daily basis for survival. Many street hawkers, roadside sellers, menial workers, and all daily earners were left with no means of survival amidst the pandemic. As a result, hunger and starvation kept pushing residents to the streets against the order to stay at home. Many residents felt compelled to violate lockdown orders and risk contracting the virus rather than stay at home to die of hunger and malnutrition.
In addition, many Nigerians regarded the disease as a distant “white man’s” infirmity that could never affect them. Some felt that COVID-19 is a “big man disease” (i.e., disease of highly influential persons) especially given the fact that it killed some high-profile political figures at the onset. The spread of misinformation and tales regarding COVID-19 and the promotion of unscientific traditional treatment within Nigeria further jeopardized the implementation of preventive measures. Some religious leaders with considerable influence created doubt among members of the public about the existence of the virus and shared conspiracy theories on its origins and interventions. Also, unproven cures and interventions were regularly propagated by different groups. Unconcerned attitudes and adherence to false and superstitious beliefs by the public ensued due to inadequate awareness, which further affected the level of preparedness and the proper implementation of COVID-19 protocols. Social media played an important role in the creation of awareness about the COVID-19 pandemic within the Nigerian population. It also aided, however, the spread of exaggerated, unverified, and fake news. Some Nigerians also believed that prayer is warfare against COVID-19 spread, and this resulted in a carefree attitude from the people towards obeying the safety measures.
The Impact of the COVID-19 pandemic on Nigerians
The most devastating impact of the COVID-19 pandemic has been the negative socio-economic impact on the livelihood of the poor, the elderly, persons with disabilities, the homeless, and people working in informal sectors (the majority of Nigerians belong to this group). Despite advocacy for inclusion in the distribution of palliatives, many Nigerians were not factored into the COVID-19 intervention programmes.
Some states across the country do not have state-wide 3G mobile (Internet) access, so students in the final year of secondary school who were about to take their senior school certificate examinations had their lessons through the radio or not at all. Before the COVID-19 outbreak began, Nigeria already had a weak and underdeveloped digital economy and limited Internet capacity; therefore, there were hardly any universities or schools that could offer full educational curriculum online from start to finish. Nigerian schools, universities, and educators could not put coursework online while schools were closed. This affected the students as many of them could not learn during the entire period of the lockdown. The best that many teachers like myself could do was to record notes and send them to students as voice notes on WhatsApp.
There was also an increase in sexual violence against women and children all over the country. Between January and May 2020, Nigeria’s Inspector General of Police reported that the force arrested 799 suspects associated with 717 rape cases (Oludayo, 2020). The restrictions in movement, loss of income, isolation, overcrowding, and high levels of stress all contributed to the increase in sexual violence as the stay-at-home order made it difficult for victims to stay away from the perpetrators. Apart from sexual violence, there was also a reported increase in other forms of domestic and gender-based violence, which was attributed to forced proximity occasioned by the lockdowns.
The Nigerian social welfare system and the place of social work in the COVID-19 pandemic
Nigeria does not have a standard national social welfare programme that offers assistance to all individuals and families in need such as health care assistance, food stamps, unemployment compensation, disaster relief, and educational assistance. The consequence of not having a national social welfare programme became evident during the COVID-19 pandemic.
During the outbreak, people had little to rely on and poor citizens did not have sufficient welfare relief that could help them cope with the economic hardship. The lack of such welfare services for vulnerable people, households, and poor individuals during the pandemic in Nigeria were so glaring that the Ministry for Humanitarian Affairs, Disaster Management, and Social Development saw the need to finally develop a comprehensive welfare programme.
Social workers in Nigeria went on lockdown, unlike their counterparts in other parts of the world who were part of the COVID-19 interventions and response teams (IFSW, 2020). These social work practitioners in other countries played exceptional roles in the fight against COVID-19. Unfortunately, this was not the case in Nigeria as social workers were excluded from multidisciplinary teams fighting the virus. The Nigerian government has yet to pass the legal mandate to professionalize social work in Nigeria. This further contributed to the exclusion of their services at the peak of the pandemic. Social workers could have been actively involved at every point in the fight against COVID-19, ranging from community sensitization, awareness creation, psychosocial counselling, referrals, and other forms of social supports.
Conclusion
The challenges of the COVID-19 response are a reflection of the reality of Nigerian society. In Nigeria and across the world, the services of a team of professionals—including social workers—are required to minimize the debilitating effects of the COVID-19 pandemic. It is against this backdrop that social workers must be at the vanguard of promoting policy change in the context of the challenges brought about by the outbreak of the pandemic.
Social workers are social engineers whose services are highly needed during social upheavals such as this (IFSW, 2020). Social workers can utilize social media platforms to sensitize and educate the public about the pandemic, attend to the psychosocial care of COVID-19 victims and their family members, participate actively in palliative distribution, and join other healthcare practitioners in rendering help and social services to individuals and families who require psychosocial/counselling support, referral, reintegration, and other forms of social support (IFSW, 2020). They can also be involved in maintaining safety-inclined contacts with vulnerable clients (women, elderly, youth, physically challenged, and children), distribution and buying of needed goods, psychosocial counselling for the medically isolated, and the general public (Onalu, et al., 2020).
Social workers in Nigeria should strive to get proper training for the management of pandemics and epidemics in order for them to be well equipped in the area of needs assessment, support for vulnerable citizens, counselling services and other important roles. This is a wake-up call for schools of social work in Nigeria to revise their curricula to reflect the realities of the public health situation in the country. Social workers in Nigeria can be aware of their roles and responsibilities in a period of a pandemic through proper training during their student days; this can be realized through an all-encompassing social work curriculum that would include training on risk management and disaster control (Onalu, et al., 2020). Social workers can assume their education roles by informing the public and policymakers about the plight of the poor and vulnerable which is worsened by the indiscriminate allocation of palliative measures. They can provide health education to the community on the clinical features, route of transmission, and access to care. Social workers can also restate and utilize their expertise in social welfare administration. However, they can only do this if they are equipped with the requisite knowledge and skills necessary for intervention from different schools of social work across the country.
References
Ayeni, T. (2020). Coronavirus: Nigeria’s varied response to controlling COVID-19. The Africa Report. Retrieved from https://www.theafricareport.com/27773/coronavirus-nigerias-varied-responses-to-controlling-covid-19/
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IFSW (2020). Nigeria. COVID 19: Call for sober reflections and calmness. The International Federation of Social Workers. Retrieved from https://www.ifsw.org/nigeria-covid-19-call-for- sober-reflections-and-calmness/
Nigeria Centre for Disease Control (2020). NCDC initiates new measures for pandemic control as COVID-19 spreads to 12 States in Nigeria. Retrieved from https://ncdc.gov.ng/reports/weekly
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Okoye, U. O. (2019). Health care social work in Nigeria. In Winnett, R., Furman, R., Epps, D., and Lamphear, G. (Eds) Health Care Social Work: A Global Perspective. New York: Oxford University Press
Oludayo, T. (2020). A Routine Activity Analysis of Selected Rape Cases during COVID-19 Lockdown in Nigeria. Intechopen Retrieved from https://www.intechopen.com/online-first/a-routine-activity-analysis-of-selected-rape-cases-during-covid-19-lockdown-in-nigeria
Plan International Nigeria (2020). Policy brief COVID-19: The need for an inclusive approach.
World Health Organization (2020). WHO ramps up preparedness for novel coronavirus in the African region. Regional Office for Africa. Retrieved from: https://www.afro.who.int/news/who-ramps-preparedness-novel-coronavirus-african-region
World Health Organization, (2020). Nigeria’s polio infrastructure bolster COVID-19 response. WHO Regional Office for Africa. Retrieved from https://www.afro.who.int/news/nigerias-polio-infrastructure-bolster-covid-19-response
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