Status of Legislation and Factors affecting Disease Surveillance in Nigeria: A qualitative inquiry
Authors: Makinde Olusesan A. , Odimegwu Clifford O. 
Published: October 2019

ObjectiveAssess the legal framework establishing disease surveillance in Nigeria and identify major factors affecting the performance of the surveillance system.IntroductionThe outbreak of infectious diseases with a propensity to spread across international boundaries is on an upward rise. Such outbreaks can be devastating with significant associated morbidity and mortality. The recent Ebola Virus Disease outbreak in West Africa which spread to Nigeria is an example.(1) Nigeria like several other African countries implements the Integrated Disease Surveillance and Response (IDSR) system as its method for achieving the International Health Regulations (IHR). Yet, compliance to the IDSR is questioned. This study seeks to investigate the legal instruments in place and the factors affecting performance of the disease surveillance in the country.MethodsThe study reports the first objective of a larger study to investigate compliance to disease surveillance by private health providers.(2) An investigative search of the literature for legal instruments on disease surveillance in Nigeria was carried out. In addition, key informants were identified and interviewed at the national level and in selected states. The six states in the South-West were identified for an in-depth study. The IHR focal person and the National Health Management Information System officer were interviewed at the national level. The state epidemiologists and the state health management information system (HMIS) officers across the six states were interviewed. Each state has only one state epidemiologist and one HMIS officer as such it was a total sample. In all, 14 key informants were interviewed.ResultsSix legal instruments were identified as seen in table 1. The most recent comprehensive legal instrument on infectious disease control in Nigeria is a 2005 policy on IDSR. This is further supported by the National Health Act of 2014. However, the National Health Act is not detailed for infectious disease control. The substantive law which governs infectious diseases in Nigeria, the Quarantine Act was enacted almost a century ago during the colonial era in 1926. None of the states studied has an active law on infectious disease surveillance as noted by key informants. While all states refer to the IDSR policy, none has formally ratified the document. There are two independent overlapping data collection systems on infectious diseases: the IDSR and the National Health Management Information System (NHMIS). Data on malaria, HIV and tuberculosis are among data collected across the two systems. This was identified by key informants as a problem since the data collection forms differed across systems and almost always result in differing statistics. In addition, this duplication causes overburdening of frontline workers expected to fill the parallel data collection tools and results in inefficiency of the system. Funding of the surveillance system was identified to be inadequate with significant reliance on international partners.ConclusionsA review of the national law on disease surveillance to address emerging global health security challenges is necessary. State legislators need to enact or ratify national laws on infectious disease monitoring and control in their states. The duplication across the NHMIS and the IDSR surveillance system requires harmonization to improve efficiency. Government needs to invest more resources in disease surveillance.References. Makinde OA. As Ebola winds down, Lassa Fever reemerges yet again in West Africa. J Infect Dev Ctries [Internet]. 2016 Feb 28;10(02):199–200. Available from: http://www.jidc.org/index.php/journal/article/view/81482. Makinde OA, Odimegwu CO. Disease Surveillance by Private Health Providers in Nigeria: A Research Proposal. Online J Public Health Inform [Internet]. 2016 Mar 24;8(1). Available from: http://ojphi.org/ojs/index.php/ojphi/article/view/6554