On Wednesday 13th January, the Minister of Health of Nigeria, Prof. Adewole Isaac announced the appointment of Prof. Michael Asuzu as the head of the Ministerial expert committee on Lassa Fever. The committee will embark on a fact-finding mission, assess the current situation, document response and experiences, identify gaps and proffer recommendations on how to prevent future occurrences.
As the Director of the Ibarapa Community & Primary Health Care Programme of the University of Ibadan, Prof. Asuzu has led an integrated teaching, services and developmental research in primary health care, human and community development.
In order to shed light on the governance structure of the current Lassa Fever outbreak in Nigeria, we seek his opinion on the roles of the different stakeholder blocks that surround the control of the outbreak.
In the following paragraphs, we highlight the different stakeholder blocks and how they are expected to function in the process. The stakeholder groups considered ranged from an average citizen to the Federal Government Ministries, Department and Agencies.
ROLE OF INDIVIDUALS & FAMILIES:
- Seek correct information through reliable sources and learn what to do: A lot of information on Lassa Fever are being circulated on social media, radio, television and print media. Citizens must look for these information in order to empower themselves and families on how to respond to outbreaks. This is how to minimize fear.
- Hygiene: Lassa Fever is strongly related to poor hygiene and sanitation. Citizens need to imbibe and sustain good personal hygiene practices through:
- Rat Control: Citizens need to focus on what attracts rats and rodents to the household. From food within the households that attracts them to bush burning that chases them out of their natural habitats. Food should be stored in containers and places that are not easy for rodents to reach. In addition, households should apply covered waste management system in locations far from their houses.
- Hand Hygiene: This was heightened during the Ebola outbreak, this Lassa Fever outbreaks should serve as a prompter to the fact that hand hygiene is important in the prevention of diseases. Proper and regular hand washing should be imbibed.
- Food Hygiene & Storage: Citizens should avoid consuming raw grains, especially meals like garri, while those manufacturing grains should also take more responsibility for the methods they adopt for processing and storage. Farmers in rural communities need to avoid sun-drying farm produces on bear grounds and/or road sides as these are opportunities for rodents to perch on these products that will eventually be processed into food. Families and households should also ensure proper cooking of their grains, Lassa Fever Virus cannot survive at the boiling temperature of water.
- Early Reporting: Households need to get used to the structure of public health facilities designed to serve them. Across all local governments in Nigeria are Primary Healthcare officers that are expected to follow up on citizens concerning Lassa Fever. Citizens must know the contacts of these officers and their locations. In situations where citizens observe fevers that are not responding to anti-malaria and anti-biotics treatment, or fever associated with sore throats or bleeding, they need to report themselves promptly to the local government health officers.
ROLE OF COMMUNITIES:
- Community Enforcement of Appropriate Health Practices
- Community associations or organisations should enforce compliance with roles of families and households stated above. They can enforce reduction of bush burning, improper food process and storage. They should also apply their social capital to drive compliance with better hygiene practices and utilization of health facilities.
ROLE OF LOCAL GOVERNMENTS:
- Improved Primary Healthcare Operations: The primary healthcare system is the beginning of disease surveillance and prevention. By design, local governments are the custodians of primary healthcare and this is the time for them to improve on their responsibility to citizens. They need to support the community development communities, local government health authorities, civil society organisations in their jurisdictions to ensure very strong community response to the outbreak. They must own the health promotions component of our response to this Lassa Fever outbreak, and indeed other communicable diseases control.
- Alert All of Health Workers and Facilities: The Medical officers of health need to take charge at their local government levels. They need to inform all health workers and health facilities, both private and public of the case definition of Lassa Fever, standard precautions and reporting lines.
- Communicate Clear Reporting and Referral Lines: We must differentiate between reporting and referral. Notification doesn’t guarantee that patients will be transferred to the appropriate offices. Local Government Health authorities need to communicate clearly to citizens, health workers and health authorities on the reporting and referral lines.
ROLE OF STATE GOVERNMENT:
- Public Enlightenment: State governments need to take charge of developing health information on Lassa Fever for their citizens. They need to tailor these information down to the local languages and contexts within their states. This will help eliminate the challenges of generalization and language barriers.
- Resuscitate Infectious Diseases Hospitals: One of the reasons Nigeria was able to contain Ebola was the existence of an Infectious Disease Hospital in Lagos. All states of the country need to replicate this. Those that have a non-functional infectious disease hospital need to resuscitate it. Those that do not have one need to look into setting one as soon as possible. The infectious diseases hospitals will serve as the points of treatment of cases.
- Set-Up and strengthen Primary Healthcare Agencies: to support the Local Governments and the primary healthcare centers.
ROLE OF FEDERAL GOVERNMENT:
- Develop protocols for national coordination of Lassa fever control. They must share this protocol to all state ministries of health in order to support the state owned plans.
- Strengthen Public Health Laboratories to serve the whole country. The entire Eastern block of the country, from North to South do not have a public health laboratory.
- Set-Up quality assurance protocols, especially for laboratory results. Dual testing should be encouraged.
- The Federal Ministry of Health must ensure the whole country is updated on the status and the operational details of the Lassa Fever outbreak control.
ROLE OF CORPORATE BODIES:
- Corporate organisations need to look into their daily operations and identify how they can apply themselves to support the government response plans. From sample logistics, to citizens education, there is a lot of room for corporate inclusion into the control plan.
- Re-study standard precaution
- Know how to notify diseases promptly and cultivate the habit of notification.
- Health workers must apply themselves as health educators. They must apply themselves as Lassa Fever educators within their social networks.
Professor Asuzu called for citizens not to panic and also commended the Federal Government for their response so far, he believed they were on the right track.