Cholera Deaths and Local Government Autonomy

By Alabi Williams / July 25, 2024

Last week’s update by the Nigeria Centre for Disease Control and Prevention (NCDC), reported that 103 Nigerians were officially confirmed dead due to rampaging cholera outbreak across the country. According to the Centre, it recorded a total of 3,623 suspected cases in 34 states and the Federal Capital Territory (FCT). The Director General, Dr. Jide Idris, said the outbreak had spread to 187 local government areas, with a cumulative case fatality rate of 2.8 per cent since January.

Idris added that “the trend analysis from previous outbreaks shows the peak of the outbreak usually coincides with the peak of rainy season, which is still some weeks ahead. Also, some of the northern traditional hotspot states have been reporting fewer number of cases, which may be connected with the delayed onset of the rainy season in this part of the country.”

The implication is that Nigerians should expect more fatalities when rains peak in northern states. Moreso, he said though nearly all states have reported cases of cholera, there appeared a situation of underreporting as required data from states were not forthcoming. That is, states are not reporting sufficiently, either due to lack of capacity, or they are shy to admit failure of their health systems.

“This is largely due to inadequate resources to support surveillance and disease detention activities at the subnational level. Additionally, this may likely be further complicated by the effect of political undertone for reporting cholera, which some see as a stigma or disease proxy indicator for the inability of the affected communities to have access to potable water and other basic amenities of life’’ Dr. Idris said.

The revelation by the DG is useful. From experience, it is known when cholera will strike but the experience Nigerians are conversant with is that very little is done to prevent it. We have lived with it; a few hundred will die this year and we wait for the next outbreak. After all, Boko Haram and terrorists have killed hundreds and thousands in the course of a few years. Cholera deaths are just a little additionnot sufficient to deny people in government their sleep.

In June, after more than 40 cholera deaths, the NCDC confessed that the country did not have enough vaccines to protect citizens and had ordered supplies from donor agencies. The delivery date remains unknown. Maybe soon.

According to a newspaper investigation, not less than 4,364 died out of 139,703 people suspected to have cholera in the country in four years, from 2021. Then the question should be; why wait until you have an emergency before pleading for cholera vaccines? It doesn’t make sense, but that is the way it is here. We don’t make a lot of sense.

Isn’t it a big shame and embarrassment that Africa’s richest and most influential country had to depend on donor vaccines, along with other needy countries? The NCDC boss again speaks truth: “I know that the minister has requested more vaccines. But I don’t know when they will come, because other countries also make requests internationally…we don’t have enough to prevent outbreak, because we need to give these things before that time. The problem is that to get vaccines, we need to plan ahead, and we don’t have the funds. Most countries plan ahead.”

Many will not believe that Nigeria doesn’t have money to fund the health ministry. Out of the over N28 trillion 2024 budget, only N1.48 trillion was allocated to the health sector, representing 4.6 per cent of the total sum. That is a far cry from the 15 per cent recommended for African countries at a 2001 declaration in Abuja. Experts had warned that the allocation was too small to confront the health challenges facing the country.

Clearly, it is more about government’s distorted and selfish priorities. A government that spends tens of billion to support religious pilgrimages, a decoy to curry electoral favour; repeatedly spends tens of billion to buy state-of-the-art vehicles for lawmakers and millions of scarce forex to purchase a plane for Mr. President is certainly not poor but shameless.

In October 2022, the Federal Government announced that Nigeria was set to become a global hub for vaccine production and distribution, after the country was selected alongside five other African countries by the World Health Organisation and the European Union (EU) at a Summit in Brussels, Belgium. That transfer of capacity is yet to arrive and government is not too enthusiastic about building local capacity. It prefers to depend on donor support and importation.

COVID-19 exposed the country to dangers of overreliance on importation and donor vaccines. Every country needed to protect their citizens before reaching out to laggers. It was a bitter experience and government vowed to ramp local efforts that were abandoned in Jos and Yaba.

At that time, the Central Bank of Nigeria (CBN), announced an award of N253.54 million in grants to five researchers under its Healthcare Sector Research and Development Intervention Scheme (HSRDIS). Aprofessor and pharmaceutical scientist, Martins Emeje,had quipped; “That grant is a welcome development, but it will not be enough to produce a vaccine because we are starting from the scratch. The reality is that research and development has been neglected over the years. With the COVID-19 pandemic, there is the realisation that dependency on other countries to produce medicine for Nigeria is not sustainable.”

Yet, nothing has changed in 2024. What’s worse, the Independent and Corrupt Practices Commission (ICPC), is still combing nooks and crannies for some of the intervention monies disbursed by the Central Bank in the COVID days. The Commission just announced it intercepted N10 billion COVID-19 fund lodged in an MDA account. That money was originally meant for vaccines development.

President Tinubu responded to the cholera situation by asking for the establishment of a Cabinet Committee to oversee an emergency operation centre already domiciled in the NCDC. The Committee was to comprise of members from health, finance, water resources, environment, youth, aviation and education ministries.

It might take weeks to put together another bogus federal bureaucracy for a disease the NCDC had scientifically tracked to 187 local government areas. Dr. Jide Idris had also simplified the challenge and explained why cholera keeps recurring. This is a grassroots disease for which local containment at subnational levels had been tepid. It doesn’t require committees and conferences to understand.

First, it must be noted that cholera is majorly water-borne. From the Ajah area of Lagos, where the index cases were recorded before it spread to Ogun State and other areas, there is no steady pipe-borne water for residents. In parts of Lagos, where homeowners have no private boreholes, they rely on mai-ruwa suppliers. But instead of blaming absence of potable water for the outbreak, emphasis was more on local drinks like Zobo and Tiger nut, whose makers patronise itinerant water vendors.

In 2021, according to WASHNORM data, “55 per cent of households in Lagos State have access to safely managed water supplies services, only 15 per cent of households in Lagos have access to safely managed sanitation services and only 35 per cent of people have access to hygiene services.” That left nearly half of the population exposed to recurrent bouts of waterborne ailments.

In March 2024, eight million Lagos residents still don’t have access to safe water, that’s about 60 per cent of the population. The Hague Academy for Local Governance said Lagos needs around 650 million gallons of waterdaily but could only deliver a third of that. The state would therefore need N300 billion investment annually meet sustainable water needs commensurate to its status as a Centre for Excellence.

Lagos is not alone. Residents of many states don’t have access to safe water. Taps in Benin City and in major towns in the three senatorial districts of Edo State have gone dry for decades. The Ojirami Dam that used to service communities in Edo North is in a sorry state. Successive governments have abandoned it. Potable water for citizens is not the priority of civilian administrations in this Fourth Republic. In Kwara, the Asa and Agba dams still manageably supply water three times a week to residents, particularly of the densely populated Idi-Ape, Ajikobi and Alanamu. Kaduna is an eye-sore.

A 2020 ranking of states’ performance in provision of safe water by Kingmakers, in their best run states analysis, showed that more than half of the population of the country had no access to improved drinking water sources. Imo, Abia, Jigawa, Osun and Ekiti ranked high.

Provision of water and sanitation are among the functions of local governments as provided in the Fourth Schedule of the 1999 Constitution. But they are unable to perform as governors prefer to have them as fiefdoms for political hegemony instead of using them for critical development.The financial and electoral freedom promised in the Supreme Court ruling for councils should go a long way to helping them discharge their constitutional responsibilities.

The ruling, as far as one can see does not amount to political freedom for councils. It is more of an opportunity to fast-track development, which governors have imprisoned. In the First Republic and even militaryyears, citizens walked to community dispensaries, otherwise known as primary healthcare centres to get treatment for free.

Today’s primary healthcare centres controlled by the Federal Government are not efficient. They are poorly funded and the system is an avenue for corruption. This is an opportunity for the Federal Government to review its control and managementof primary healthcare systems. With enhanced capacity and funding, councils can return to the days in the 1960s and 70s, when they truly serviced the grassroots.

As the Attorney General of the Federation, Lateef Fagbemi, remarked, the National Assembly will need to review the Constitution to make the local government politically free.
This is the time for experts and well-bred personnel in cities to return home to manage councils.

Note: This article was first published by The Guardian Newspaper.
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