Lessons learnt from decentralization of COVID-19 response in a southwest state of Nigeria

Abstract

Introduction: This report shows the outcomes and lessons learnt from a 3-month intervention focused on decentralization of COVID-19 coordination, testing and contact tracing activities in three hotspot local government areas (LGAs) of a state in the southwest of Nigeria.

Methods: A description of COVID-19 outbreak response from the occurrence of the index case was documented. A health facility and community-based intervention implemented in three hotspots LGA as part of response to COVID-19 pandemic from 24^th May to 22^nd August, 2021 was described. The interventions implemented focused on integrating COVID-19 testing into routine healthcare services in 103 health facilities, engagement of community-based volunteers to conduct contact tracing, and improving coordination of the response through the conduct of incident management meetings at state and LGA levels.  The COVID-19 dataset from 22^nd February to 22^nd August, was obtained from the State Ministry of Health and analyzed. Data were summarized using charts and maps.

Results: A higher number of cases (3879) were tested between 24^th May to 22^nd August, 2021 (during intervention) compared to 1667 cases tested between 23 February to 23 May, 2021 (before intervention) across the three LGAs. Generally, there was a decline in the cumulative number of contacts traced and line-listed during the intervention (778) compared to the period before the intervention (1170) in two of the three LGAs. The number of weekly incident management meetings held improved by 25% at State level, while 83% of weekly LGA meetings were held at the three hot spot LGAs during the intervention compared to the period before the intervention, where no meeting was held at LGA level.

Conclusions: The decentralization of the COVID-19 outbreak response from a central approach to the LGA level improved only testing numbers and the number of incident management meetings conducted across the three hot spot LGAs. The number of contacts line-listed, positivity rate and reported cases reduced following the interventions. The need to supplement contact tracing activities using information technology for self-report as done in other climes, as well as engaging community, religious leaders and key community groups as integral members of the contact tracing team was emphasized.