On February 28th, the Nigerian government confirmed the first case of coronavirus in Nigeria — marking the first case in sub-Saharan Africa. While health authorities at state and federal levels are taking action to isolate and contain the virus, this incident is a reminder that diseases do not recognize or respect borders, especially in our interconnected world, and strong, well-resourced healthcare systems are necessary for outbreak preparedness.
Unfortunately, Nigeria’s public health system is under-resourced and overwhelmed, resulting in poor health outcomes and vulnerability to outbreaks.
While the country had a successful response to the 2014 Ebola outbreak in West Africa, it has struggled with ongoing outbreaks of lassa fever and yellow fever, neither of which are contagious like coronavirus. Nigeria saw a nearly a three-fold increase in the number of confirmed cases of yellow fever in 2019 compared to 2018. These struggles further underline the need for urgent action to bolster Nigeria’s public health systems.
As we deal with the entry of coronavirus into Nigeria in the short term, it is vital that we consider how to better protect citizens in the medium to long term. Thankfully, the policy framework for a robust national outbreak response system in Nigeria is in place.
The Nigeria Centre for Disease Control (NCDC) adopted the Integrated Disease Surveillance and Response (IDSR) approach and has developed its capacities since the impressive showing against Ebola in 2014. However, a critical component of IDSR in Nigeria has remained chronically neglected: primary health care. 
Why primary healthcare centers are crucial
Primary healthcare is an essential building block of any successful public health system. Primary healthcare centers (PHCs) are essential for testing and treatment and for sharing and collecting information. With over 30,000 PHCs in Nigeria, they should be invaluable to outbreak response, stretching into rural and urban communities alike.
However, the government estimated in 2017 that only 1 in 5 PHCs are functional. This represents a glaring hole in Nigeria’s IDSR strategy.
We have a fantastic opportunity to rejuvenate PHCs and provide essential primary health services to the poorest Nigerians. Huwe is the new Basic Healthcare Provision Fund (BHCPF) that will provide free healthcare to the poorest and most vulnerable across Nigeria, taking Nigeria one step closer to universal health coverage.
Funded by an annual allocation of 1% of Nigeria’s revenues, Huwe provides a basic minimum package of health services to the poorest Nigerians through designated PHCs across Nigeria. This package of services includes antenatal care, vaccinations, malaria treatments and screening for hypertension and is delivered at no out-of-pocket cost to patients.
Providing primary healthcare would ensure that even remote communities have access to well-staffed and equipped healthcare facilities, meaning essential interventions could cascade down to communities. It would also allow for important information to channel to health policymakers at state and federal levels.
These improvements would not only greatly improve the country’s ability to face the health challenges it currently faces but also greatly enhance its ability to respond to infectious disease outbreaks like coronavirus by providing platforms for rapid interventions, even in the most remote rural communities. 
What comes next
Fortunately, through the efforts of the federal and state governments, as well as civil society and development partners, Huwe is being implemented with Osun state becoming the first state to begin service delivery under the programme.
I visited the state with my colleagues last week and saw first-hand the impact that the programme is having on healthcare delivery in communities around the state.
While this implementation has not been without its hiccups, the early successes show just how much potential for meaningful transformation Huwe holds. As we grapple with the presence of coronavirus within our borders, the potential of Huwe to strengthen PHCs as essential components of Nigeria’s outbreak response strategy is even clearer.
It is essential that Nigeria successfully implements Huwe, to deliver urgently needed primary healthcare and to prepare for the next infectious disease outbreak
