Task 1: Health Promotion Policy in Nigeria
Health promotion is a broad term defined differently over the years. For this report, health promotion is any planned combination of regulatory, educational, political, organisational and community supports for conditions and actions of living which contribute to the health and well-being of individuals, groups and an entire community (Edelman & Kudzma, 2021). Health promotion has been evolving across the globe in the last few decades. Health promotion in the 1970s focused on reducing risk behaviours and preventing disease through health education. The World Health Organisation (WHO), in 1984, through the Ottawa Charter for Health Promotion, defined health promotion as the process of enabling people to control their health improvement and sustenance. The focus switched from the 1970s approach of disease and risk prevention to the impact of lifestyle on people’s health, with more attention directed towards the structural determinants of health in society. The two main factors which have shaped public health in the past century and a half are the growth of scientific knowledge in health to understand the source and means of disease control and the development of public knowledge and acceptance of disease control as a public responsibility and possibility.
Health education has propagated health promotion in Nigeria since the 1940s. As the most populous country in Africa, Nigeria has faced numerous challenges in health promotion, with recent reports indicating poor performance for years. The amended Nigerian 1999 Constitution guarantees the right to health for its citizens, with various frameworks and policies in place to enhance health promotion. The Nigeria Centre for Disease Control (NCDC) is the public institution in charge of health promotion in the country. The country has faced insufficiency in delivering effective and efficient health care as the governmental, non-governmental and donor agencies fail to sustain the population’s health needs. From a global perspective, there have been different accomplishments or milestones in health promotion, as recorded by the World Health Organisation (WHO). The world health body provides various health prerequisites, including peace, food, education, shelter, income, social justice, equity, a stable ecosystem and sustainable resources. These factors enhance full physical, mental and social well-being as the individual or group identifies and realises aspirations and copes appropriately with change and the environment in general.
One milestone in health promotion globally is the declaration of Alma-Ata, implying that health is recognised as a fundamental social objective. It set new dimensions for health promotion policy, emphasising the need for people’s involvement and inter-sectoral cooperation in society with primary health care as the main foundation. The action areas emphasised by the milestone include strengthening community action, building a healthy public policy, creating supportive environments, reorienting health services and developing personal skills, all as interdependent actions. Since 1975, Nigeria has nurtured new plans to improve the national healthcare system. However, the Nigerian primary health sector has been a massive decay. The health sector also lacks the appropriate amalgamation defined by affirmative action on primary health care.
Corruption remains a major hindrance to the efficiency and effectiveness of the Nigerian public health sector. Corruption occurs through the diversion of health resources, theft, improper financial management, fraudulent billing, informal payments, counterfeit medical supplies and absenteeism (Glynn, 2022). The government of Nigeria developed the 2006 National Health Promotion Policy (NHPP) to strengthen the health promotion measures to address the deterioration in public health. Over 30,000 facilities in Nigeria offer public health care services, among them Comprehensive Health Centres and Basic Health Centres. The local government authorities are in charge of oversight. Most of the facilities are placed in rural, underserved areas to promote equity and improved access to health services. In 2019, a World Health Organisation review cited the promotion of health reforms, good governance, enhanced access to programmatic initiatives and strong partnerships between the governmental, non-governmental, private sector and civil societies as the factors for enabling public health implementation.
In Nigeria, the National Primary Health Care Development Agency (NPHCDA) has implemented various policies to improve public health. However, the implementation is still poor due to inadequate financing, poor human resources in health, under-utilisation of facilities and poor governance. Such challenges make Nigeria compare poorly to the milestones set from a global perspective. The public health promotion in Nigeria, which external and international agencies also fund through capacity building, funding health services and equipment, medical supplies and support, is still inadequate for the country’s needs.
Task 2: Approaches and Theories in COVID-19 Pandemic in Nigeria
The recent COVID-19 global pandemic exposed the value of health promotion and the need for health promotion theories. Countries across the globe were making desperate attempts to contain the spread of the coronavirus disease. Governments, including in Nigeria, took unprecedented measures to control the disease and curb its rapid spread. Some of the measures the Nigerian government undertook included travel bans, closure of schools and institutions of higher learning, national and regional lockdowns, and bans on public gatherings, among others. Nigeria undertook risk communication initiatives, collaboration with international health institutions, collaboration with other national sectors and vaccination as measures for health promotion against the COVID-19 disease. The approaches were informed and underpinned by various theories that have been used for years in addressing public health issues. For instance, the World Health Organisation (WHO) provided guidelines to countries on the best measures to protect the public, which were underpinned by public health theories.
One of the health promotion strategies taken by Nigeria was partnering with other international health institutions to prevent COVID-19 through vaccination and health education. For instance, the government partnered with US Centres for Disease Control and Prevention (CDC) to increase vaccination against the virus and restraint public misinformation about the disease (Zuber et al., 2022). The collaborating entities also worked with reputable community leaders to answer questions on preventing the disease and encourage public vaccination to stop the rapid spread. The collaboration between the US CDC and the government of Nigeria, as well as with community leaders, helped make vaccination more convenient to save lives (Zuber et al., 2022). The public uptake of COVID-19 vaccines gradually increased due to authentic reports and public health education on the benefits and deconstruction of the misinformation that misled the Nigerian public.
Nigeria also had a massive collaboration with governmental and non-governmental institutions in response to COVID-19. For instance, the Nigerian military was highly involved in public health response to the disease. Health literacy is critical in such times of the pandemic, which is why the Nigerian government used intersectoral collaboration to prevent COVID-19 disease from spreading further (Abel & McQueen, 2020). Nigeria also implemented an emergency risk communication campaign to respond to the COVID-19 pandemic. This was in line with the WHO recommendation of prioritising risk communication and community engagement in countries as part of response actions (Ihekweazu et al., 2022). The approach was to stop the massive misinformation and the connected risks. Emergency risk communication campaigns were also crucial in promoting non-pharmaceutical interventions, especially when there was no approved vaccine for the virus.
One theory associated with Nigeria’s health promotion action is the Social Cognitive Theory (SCT). The theory factors in environmental factors, individual experiences and the actions of others as the determinants of an individual’s health (Paakkari & Okan, 2020). For instance, lockdowns and bans on gatherings were meant to protect people from each other by preventing physical contact. Based on a culture where the population engages in physical contact when greeting and other actions, this theory was best suited to explaining bans on public gatherings. The environmental influences, such as external factors outside Nigeria, are also linked to this theory based on travel bans. The theory is based on the components of behavioural capability, self-efficacy, expectations, observational earning and self-control, which the government of Nigeria emphasised through public health education on how to protect oneself from contracting the virus.
Social distancing was also implemented in Nigeria as a measure to reduce contact and the risk of contracting the airborne virus. The theory of planned behaviour underpins the approach of social distancing through intention-behaviour relationship moderators’ exploration (Gibson et al., 2021). The Theory of Reasoned Action or Planned Behaviour relates to the health promotion approach taken by Nigeria to control the public tendencies which exposed them to the virus. The health behaviour of the Nigerian public is determined by their willingness to perform a behaviour (Wollast et al., 2021). The willingness to perform a behaviour by an individual is predictable based on their attitude towards the behaviour and the subjective norms that link to the behaviour. The education on vaccination and how the COVID-19 disease spreads is due to the government’s goal to increase awareness and encourage people to be vaccinated. It aimed to change attitudes and improve knowledge of people’s behaviours to be protective, including vaccination (Wang et al., 2020). The concept was informed by the need to understand the psychological determinants of hesitancy against COVID-19 vaccines to increase compliance and uptake.
Task 3: Health Promotion Campaigns in Nigeria
Nigeria played a vital role in the global response to COVID-19, contributing some of the experts led by the World Health Organisation (WHO) to China to examine the extent of the outbreak and the best response action. However, Nigeria’s response to COVID-19 also factored the existing fragile and under-resourced health system. The public health challenges in Nigeria are further exacerbated by complicated political, economic, social and security issues which are rampant across the country. However, with the country ravaged by the 2014 Ebola epidemic 2014, there was more government, community and health system sensitisation on the need for rapid response to the alarming impact of the COVID-19 disease (Gilmore et al., 2020). Among the developments in Nigeria is the enhanced capacity of the Nigeria Centre for Disease Control (NCDC) in diagnostic and surveillance capabilities. NCDC conducted various surveillance and preparedness assessment before the first coronavirus case was reported and notified the public through social and traditional media.
Emergency Risk Communication Campaign
One health promotion campaign adopted by Nigeria was implementing an emergency risk communication about the novel disease. This was in line with the World Health Organisation’s (WHO) recommendation of prioritising risk communication and engagement of communities in response to COVID-19 in countries (Gilmore et al., 2020). The implementation of the campaign on emergency risk communication was ravaged by challenges but had crucial lessons that helped Nigeria respond to the pandemic. The campaign was implemented through interdisciplinary or multisectoral collaboration with national, international, governmental, non-governmental and private health institutions. Multidisciplinary Emergency Operations Centre (EOC), which also constituted NCDC partners and staff, was created to respond through risk communication on the outbreak. After the confirmation of the first coronavirus case in Nigeria, NCDC established the multisectoral National Coronavirus Preparedness Group (NCPG) to effectively and efficiently coordinate the preparedness efforts for the country (Talabi et al., 2022). This was a presidential task force to address the pandemic and take appropriate measures to protect the public from contracting the disease.
The emergency risk communication approach was vital despite the implementational hindrances encountered, as it increased the use of data and actualised participatory engagement in developing campaigns to curb the spread of coronavirus disease (Gilmore et al., 2020). The national health institution, NCDC, issued restrictions on social gatherings, lockdown of activities, internal travel restrictions and physical distancing measures to prevent the spread of COVID-19 (Ibrahim, Ajide & Julius, 2020). This measure required efficient, effective and appropriate communication to prevent public panic, which the emergency risk communication campaign sought to address. To address the growing public mistrust of the government, NCDC partnered with other stakeholders in increasing the intensity and reach of information to influence informed decisions among the public to enhance individual protection and the protection of others. The knowledge shared with the public and the global reports helped change Nigerians’ perspective on the magnitude of the problem.
Publicity campaigns are popular for motivating the public to take action (Ihekweazu et al., 2022). For this reason, they have been utilised in health promotion to achieve goals such as communicating new interventions, such as vaccination for COVID-19, and sensitisation on pandemics due to the urgency of passing information (Curtis et al., 2020). Nigeria encountered poor compliance with the COVID-19 measures, which became a major threat to the national response. However, poor compliance is a problem in many countries and is not unique to Nigeria (Wright et al., 2022). The measures introduced also had adverse effects on many Nigerians, especially the social and economic disruptions, further exacerbated by a lack of safety awareness and public anxiety due to misinformation (Ibrahim, Ajide & Julius, 2020). The growing mistrust of the government was established to be a major challenge by the crisis communication team, hence the need to develop a strategy to encourage individuals to take responsibility for limiting the spread of the virus. The approach was very effective in increasing compliance with the public health recommendations in the country.
Multisectoral Health Education
Nigeria introduced a health education campaign comprising entities from all over the country to enhance public information. Nigeria enhanced public education through support from other institutions, such as UNICEF, which facilitated handwashing campaigns to prevent the spreading of COVID-19. The collaboration between different entities, including local governments, saw motorised public health campaigns run through the densely populated areas in most states across the country. The health education campaign emphasised the importance of proper hygiene practices, majorly handwashing with soap and running water. The approach of this campaign was very effective, especially due to the high value of community engagement. The health education campaign started by informing the public about the coronavirus and its symptoms, transmission methods and how to prevent it. Nigerian institutions, such as the military, played a vital role in health education campaigns to help the government reach more people.
The multidisciplinary task forces introduced a contact tracing protocol and thermal screening at Nigerian points of entry to prevent importing the virus. This was a lesson from the 2014 Ebola pandemic. The National Coronavirus Preparedness Group (NCPG) was to foresee cohesive and effective coordination of the preparedness efforts of the country. Risk communication also entailed crisis communication as a pillar of the Emergency Operations Centre (EOC). As the confirmed coronavirus cases in Nigeria increased, there was also a similar increase in misinformation and poor compliance with measures in place to curb the spread. A non-pharmaceutical intervention approach led to the #TakeResponsibility campaign to educate the public and encourage individual and collective level change in behaviour for effective response to the disease (Reuben et al., 2021). The social media campaign played a vital role in sensitising the public on the disease, how it spreads and how to protect oneself and others. The mass media, community voices, social media and collaborative efforts with community leaders helped contextualise the communication of the messages. Communication resources and empowerment through information were enhanced through training local officers to increase impact at the community level.
The health education campaign also added value to the information through simulations to enhance understanding. The health education campaign was also important in debunking misinformation about the disease, especially with the widespread sharing of rumours and myths through social media. The health education campaign successfully deconstructed myths such as that the coronavirus cannot survive the hot African weather, that taking a high dosage of chloroquine medication protects individuals, and that ginger and garlic consumed in high quantities prevented the virus (Reuben et al., 2021). The mass awareness campaigns helped in changing public attitudes, especially with international support providing resources such as building handwashing stations, distributing protective equipment and encouraging people to disinfect (Talabi et al., 2022). Community engagement through local leaders was also very crucial for the success of health education campaigns.
The health education campaigns, which were conducted in various methods, including media adverts, social media trends and motorised initiatives, helped in addressing the hesitancy, especially among the youth in the country. Every member of society, including children, learnt how to protect themselves and their loved ones due to the health education campaigns, including animated sessions (Talabi et al., 2022). Health education programmes did not work in isolation but in collaboration with other strategies, including vaccination, isolation and social distancing at all levels. The effectiveness of health education campaigns also improved the uptake of COVID-19 vaccines among the public, which helped in lowering the number of reported cases and improving immunity. The collaboration with other countries, such as the United States through the Centres for Disease Prevention and Control (CDC), also helped the Nigerian government to improve its response to the pandemic.
Task 4: Communication of COVID-19 Campaigns
Emergency Risk Communication Campaign
In communicating the emergency risk information to the public, Nigeria’s government used various methods to reach the people. Proper message development and dissemination were done by analysing real-time data from multiple credible sources. Data paucity is a major challenge to the Nigerian government, especially in epidemics, which necessitated a communication strategy for effectiveness. Risk communication is a vital strategy to respond to the devastating effects of a pandemic for governments and related agencies. In Nigeria, an emergency risk communication campaign was vital for examining public interest, perceptions and assurance on the containment of the novel virus.
The Nigerian government used Google Trends (GT) to communicate to the people about the COVID-19 pandemic information. The approach was informed by the use of Google Mobility Reports (GMR), which monitored the restlessness and perception of the COVID-19 disease. It guided the government’s approach to a national emergency risk communication campaign. The COVID-19 pandemic was devastating, but African countries somehow escaped the extreme wrath of the disease. However, the pandemic taught important lessons on the need for emergency preparedness, especially in the management of communicable diseases. Like many other low-income and middle-income countries, Nigeria faced notable challenges in preventing COVID-19 from spreading due to the high burden of both communicable and non-communicable diseases, poor health literacy, infodemic overcrowding, poverty, weak health systems and porous borders (Lucero-Prisno et al., 2020).
In the communication of health information, credibility and knowledge on the particular issue are vital in modifying public perception. The Nigerian government communicated COVID-19 information through reputable organisations and personnel to influence behaviour change for more public safety. Misinformation (infodemic) was rampantly growing, hence the urgent need to address it and regain trust. With most Nigerians being connected to the internet, the government utilised Google to communicate appropriate risk information online, especially with the corona and COVID words having gained massive search engine interest.
The emergency risk communication campaign was communicated through various avenues, including the Nigerian Presidential Task Force (PTF), the Federal Ministry of Health (MoH), and other private and non-governmental organisations in partnership with the government. Through the Local Government Authorities (LGAs), the government reached out to local leaders to sensitise the public at the community level on COVID-19 risk factors and measures for protection. Nigeria communicated the campaign by first collecting community insights for a data-driven response. Polled data through experts from the government of the UK helped communicate the mission of the emergency risk communication campaign.
Nigeria also coordinated communication of the emergency risk communication campaign through its partners. The collaboration was vital to prevent duplication of risk response programmes through technical advice and mapping to identify information gaps and best-suited organisations to take up the responsibility. With an emphasis on community engagement, the technical support of internal and external partners helped in communicating the campaign goals and the role each stakeholder, including individuals, was expected to play. The communication was guided by priority messages such as emerging hotspots for the virus, more capacity building and channelling public feedback for necessary actions to be taken.
Health Education Campaign
Health education is critical for the general public as the relevant health information guides appropriate lifestyle modification. People exhibit behaviour based on the information available regarding the influence on their well-being, and poor knowledge of health information could lead to bad implications on the health behaviour of a population (He et al., 2016). Nigeria communicated the health education campaign in response to the COVID-19 pandemic through liaison with the World Health Organisation (WHO), television channels, social media platforms, the NCDC, newspapers, COVID-19 hotlines and health care workers. The rural and urban populations have different communication needs, which necessitates using myriad channels to reach more people.
The media has been criticised for not effectively communicating the Nigerian health education campaign. The Nigerian context highly depends on the media due to the high population and information-seeking behaviour of the citizens, which is the reason the government optimised the media in health education during the COVID-19 pandemic. The media plays the role of a public educator, programme promoter, supplement and supporter of a public health promotion campaign (Kim & Noriega, 2020). As an educator, the media, both traditional and social media, partnered with the Nigerian government to educate the public on COVID-19 to serve information to be used as a checklist on mental preparedness and behaviour change. The media has the power to combine education and entertainment, which hence favoured the goal of reaching all audiences.
The health education campaign was also communicated through healthcare staff, and the world health organisation (WHO) updates. Community health workers are committed to their role of engaging the public with health education (Olateju et al., 2022). They were pivotal due to establishing public trust in the government’s response to COVID-19. They are also credibly placed to provide recommendations. The World Health Organisation (WHO) empowered the healthcare staff with information which enhanced influence on the public for a change in perception of the disease. They passed the message through social media and community-level engagement in collaboration with local leaders and groups.
The communication on public education could have been made better with the media informing and educating the public on the virus before the first case was confirmed. Educating the public about the virus is similar to preparing them for war (Gever & Ezeah, 2020). The community healthcare workers also provided suggestions to make the campaign and the response effective, such as financial incentives, more staff to handle the high caseloads, adequate protective equipment for healthcare teams, and masks and hygiene items for the general public. In their communication, healthcare staff acted as a crucial link between the government and the public.
Despite the efforts of public education on COVID-19, Nigeria still encountered challenges such as low compliance to set measures and a low workforce to meet the needs that the pandemic demanded. The government of Nigeria, through the ministry of health and the NCDC, needed to hire more healthcare staff to match the needs of the country in educating people and responding to emergencies from the virus infections. There was also a need to lower public anxiety by providing credible national data rather than comparisons to the international world, especially Europe. Also, international input in Nigeria would facilitate a better working environment and better infrastructure and policies to respond to pandemics. There was also a need to arm community healthcare workers with information through education to increase their credibility and relevance to the public on the information they convey through public education.
During the emergency risk communication campaign, there was public panic due to the rumours and misinformation about the pandemic. The government could have communicated better by having printed versions of communication to reach all groups, including the disabled, who felt discriminated against in the communication on the government’s response to the disease. The government could also have partnered with reputable organisations and personalities to communicate the campaign through online trends such as social media. The role of quarantine, lockdowns, restrictions on gatherings and travel bans could also be included in health education to enhance public support and lower anxiety and mistrust of the government. The communication of the two campaigns was, however, effective, especially with the consideration of how unprepared African countries were found by the COVID-19 pandemic.
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