No public-health system or country in the world was fully prepared when the Covid-19 pandemic hit in 2020, but Nigeria was lucky to be in an incredibly improved position compared to a few years ago. In 2016, the Nigeria Centre for Disease Control (NCDC) – the country’s national public-health institute, responsible for leading on preparedness, detection and response to infectious disease outbreaks – embarked on a journey of institutional strengthening and capacity building. With a reformist leader at the helm and support from the Tony Blair Institute for Global Change (TBI) and other partners, the NCDC was able to put in place functioning systems and a high-performing workforce prior to the coronavirus crisis. As a result, the agency was much better equipped to handle the Covid-19 pandemic than it had been for previous disease outbreaks, such as Ebola in 2014 or cerebrospinal meningitis in 2017.
When Covid-19 emerged, the NCDC of course needed to respond to this new public-health threat but also still had to devote resources to diseases endemic to Nigeria, such as Lassa fever and cholera, that persisted concurrently. In a country where communicable and infectious diseases are the overall primary cause of death, the outbreak of a new, highly transmissible disease alongside Covid-19 could have led to a tragic mass-casualty event. Yet the NCDC’s transformation made it far more capable of protecting the 206 million people of Nigeria than it had ever been before.
For example, prior to Covid-19, the NCDC had been working to increase the network of labs across Nigeria. Thanks to that groundwork, the country was able to go from just three laboratories at the start of the pandemic to more than 100, with at least one in each of the 36 states and the Federal Capital Territory (FCT), facilitating faster Covid testing and disease research nationwide. This technical accomplishment was only possible because structures had been established steadily over the years, so it was a question of scaling an existing system, rather than building a new one from scratch. The same is true of activating trained rapid-response teams to send surge support to the states in need. In addition, the NCDC was able to ensure all states and the FCT were using the same outbreak-response software to provide centralised, seamless data to the agency. Finally, an effective communications strategy enabled the NCDC to quickly build a Covid-19 website, and utilise social media to share accurate daily dashboards and factual Covid-prevention information to more than 1.1 million followers.
A New Kind of Partnership
Despite the positive outcomes that are now apparent, the NCDC project was a new kind of partnership for TBI and represented a significant departure from its usual way of working. Historically, TBI applied its four Ps (prioritisation, policy, planning and performance management) and three Ss (structures, systems and skills) approach at the centre of government, working directly in the offices of prime ministers and presidents. It was a unique strategy to apply this approach in a public-health context and to work with an agency that fell under the Ministry of Health.
It was a departure for me personally, too. I had not worked in public health before, as my experience was in corporate finance and consulting with SMEs. Yet we knew that if you want to impact an incredibly complex country like Nigeria – a federation encompassing more than 700 local governments and people from more than 300 tribes – we had to work differently. We understood that the problems the NCDC was trying to solve were about organisational transformation, not limited to the specific challenges of public health, so TBI moved forward in applying our delivery model for institutional strengthening and capacity building, taking an institution-wide approach to help the NCDC prioritise, plan, and develop internal structures, systems and monitoring mechanisms to achieve positive change. TBI’s approach differed to traditional capacity-building methods, as it took a holistic view of the strategic needs of the organisation rather than being focused on a specific technical or skill area. With TBI’s staff working shoulder to shoulder with the NCDC and taking a bird’s-eye view of what was needed to move the institution forward, we were able to strengthen it from within. Our hypothesis was that once the organisation was functioning well, the advancement of scientific and technical areas would naturally follow – and with the NCDC, that proved true.
From Ideas Into Action
Despite the NCDC being a unique project for TBI at the time, we knew that one of the key ingredients of a successful project is having a reformist leader with a clear vision of what they are looking to achieve. That quality was apparent in Chikwe Ihekweazu, the director general newly appointed in 2016. He had incredible experience leading national public-health agencies in Germany, the UK and South Africa, and a fresh perspective on what the organisation could achieve. Yet as with many leaders on the continent and beyond, he faced the critical challenge of bridging the gap between vision and tangible impact. His vision meant meeting global standards but it also needed to be calibrated to the realities of the environment. Our role was to ask, and then answer, the critical question: as a leader, how do you translate your ideas into practical and implementable action?
Strategy, with a clear implementation plan, would be the way to anchor the journey, with structures and metrics for measuring success built around the strategy. TBI started by listening. In a six-month scoping period, we focused on building trust and learning about the organisation so we could match the director general’s vision to the reality on the ground. Taking that time was vital because it allowed us to be context-specific, rather than prescribe a one-size-fits-all approach, in designing the strategy. The strategy needed to be flexible and responsive, so we revisited the plan at the end of every year to evaluate and revise. We never strayed from our original vision but we could refocus the NCDC’s projects, identify bottlenecks and challenges, and build new ways around them. It was a dynamic process that started with me doing every presentation to a silent audience – but after a few meetings, teams were motivated by friendly competition to try to get a green-light evaluation (indicating best possible performance on a traffic-light assessment system) and share what would make their jobs more efficient. The workforce became aligned with the vision. A key part of creating this successful strategy was setting appropriate performance indicators to ensure there was not a gulf between where the teams were and where the director general was asking them to be; on the other hand, we also didn’t want to set expectations too low and fail to inspire employees to keep pushing further.
The NCDC listened to the director general, and also to staff across different teams and at different levels of management. In 2016, the workforce was both too small (approximately 70 employees) and siloed, lacking basic things like job descriptions and official email addresses. Within four years, it grew to 300 employees. Investments in human resources led to a robust and consistent onboarding process to ensure new staffers fully understand the wider strategic goals of the NCDC and how their work fits within it. That involved developing the right tools to support staff, communication strategy, performance planning and regular leadership development training on the organisation’s values, including teamwork, effective communications, ethics and working with diverse teams. The NCDC also set regular meetings in which directors from each of the formerly siloed technical workflows could collaborate. What resulted was the transformation of the original top-down strategy into a bottom-up strategy, truly informed by the employees across all departments who are doing the work.
Looking to the Future
While the NCDC’s performance is an incredible accomplishment, there is more work to be done to continue evolving and growing to meet tomorrow’s challenges. TBI and the NCDC are looking at the pandemic as an opportunity to once again revisit the organisation’s strategy, this time through the lens of Covid-19, which exposed strengths as well as a few areas for improvement. We’ll never go “back to normal” – now, it’s about the “normal plus” of managing Nigeria’s Covid response while also furthering the NCDC’s mission to protect public health.
Read more about the Nigeria Centre for Disease Control’s transformation journey here.
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