The health systems of three North-Eastern States in particular, Borno, Taraba and Yobe, have been severely weakened due to the ongoing insurgency and resulting insecurity in these states. “One way to win the battle against COVID-19 is through the effective engagement and training of these surveillance officers and communities,” says Dr Audu Idowu, WHO Borno State Coordinator.

Strategic Planning and Preparedness

In all six States - Adamawa, Bauchi, Borno, Gombe, Taraba and Yobe - WHO is supporting the development of COVID-19 preparedness plans which include eight pillars: epidemiology and surveillance, laboratory services, point of entry, infection prevention and control, case management, risk communication, logistics and supplies, and coordination and research. All States have established isolation centres while preparing for active case finding of suspected COVID-19 cases. In Bauchi State, where six cases of COVID-19 have been confirmed, WHO personnel are also involved in contact tracing. “The Incident Action Plan template we are using provides us with focus and direction to help organize our plans and response in this difficult time,” says Dr Aliyu Maigoro, Commissioner for Health in Bauchi state.

Activation of COVID-19 Task Forces

All six States have set up COVID-19 emergency operation and coordination centres to ensure effective implementation of different parts of their response plans. These are overseen by the Deputy Governors for health who coordinate the activities of the various COVID-19 subcommittees formed for each pillar. The coordination committees meet at least once daily to receive feedback from each subcommittee.

Surveillance and Contact Tracing

To increase case detection and reporting of suspected COVID-19 cases in the North-Eastern States, WHO has trained 13,382 people, ranging from cluster coordinators, LGA facilitators, field volunteers to community informants, and positioned them to support the contacts of confirmed cases. In Bauchi State, the only state with confirmed COVID-19 cases so far, six suspected cases have been identified based on the case definition, with 98 related contacts traced and investigated. "All reported cases have a history of travel from Abuja and Lagos,” confirms Mr Benjamin Gandi, Bauchi State Epidemiologist.

To enhance the quality of surveillance in the States, disease surveillance and notification officers, WHO local government facilitators and clinicians have been trained on case definitions, symptoms, active case searching and contact tracing. Surveillance officer Mafa Bukar in Borno says, “Now that I understand the likely route of transmission and how best to prevent the spread of COVID-19, I am better prepared to effectively implement contact tracing as part of surveillance efforts.”

Logistics support

To help address logistical challenges, WHO has allocated two vehicles to support contact tracing in Bauchi State, while in other States additional vehicles have been directed towards community engagement and surveillance.

Engagement of Traditional Leaders

The role of traditional and religious leaders in public health interventions cannot be over-emphasized. In northern Nigeria, the Northern Traditional Leaders’ Council continues to play a critical role in increasing vaccine acceptance for polio vaccinations and its leaders are credited for the success polio program and that of other public health interventions.

With the announcement of COVID-19, the Nigerian government, with support from WHO has engaged traditional and religious leaders to create awareness around prevention measures and ensure effective community mobilization. Over 50,000 traditional and religious leaders throughout the States are expected to amplify preventive messages. The Emirs of Adamawa, Bauchi, Borno, Gombe, Yobe and Taraba have been sensitized and have in turn engaged other traditional leaders to pass preventive messages to community members.

In a recent meeting facilitated by WHO, Shehu of Borno, His Highness, IBN Mustapha El-Kanemi emphasized and demonstrated key hygienic practices including hand washing. Modelled on hand washing in his palace in Maiduguri, Borno State, the Shehu urged all traditional and religious leaders to amplify their commitment to the COVID-19 response by publicly observing preventive measures including hand washing, social distancing, coughing and sneezing etiquettes, as well as compliance with bans on travel and social gathering.

“As the royal father of Borno,” says Shehu Abubakar, Umar Garba El-Kanemi, “I practice hand washing regularly as recommended by WHO as a way of preventing infection not only from COVID-19 but also other communicable diseases.”

“I urge everyone to observe regular hand washing practices, social distancing, coughing and sneezing etiquettes, and comply with bans on public gathering to help prevent COVID e-19 infection.

Risk Communication

Each state has also activated risk communication teams, with WHO support given for reproduction and distribution of case definition and related information on COVID-19. A surveillance officer of Guzamala says: “Now I have a clearer understanding of the standard case definition of COVID-19 and the use of personal protective equipment I can better support community around preventive measures.”

Further sensitisation has been extended to focal persons for communities in more inaccessible areas of the State. “I think with all the steps we have taken so far, Borno State is prepared for a robust response to the COVID-19 pandemic”, said Dr Sule Mele ,the Executive Director of Borno State Primary Healthcare Agency.