Table 1

Emerging elements of governance in Nigerian decision-making during the COVID-19 pandemic and examples of governance approaches

Emerging governance elementsDefinition*Examples of governance approaches in Nigeria
AccountabilityThere are entities responsible for successes and failures in health emergency response, with expectations that decisions are explained and justified, and processes in place to ensure clarity of responsibility and decisions implemented.
  • The Presidential Task Force demonstrated ownership and responsibility of health emergency response through frequent communication with the public and by explaining rationale behind decisions taken.

  • The government demonstrated fiscal transparency by informing citizens how funding for health emergency operations was spent using budget and funding dashboards published on government websites.

  • Civil society organisations (CSOs) played a role in ensuring government accountability by assessing how effectively decisions and measures for COVID-19 response were being implemented.

Adaptive and agileGovernment makes sound and urgent decisions by being flexible or adaptable using existing or modifying, or establishing new structures, processes and arrangements in the face of the complexity and uncertainty associated with health emergencies.
  • Adapting existing pandemic influenza working groups to form COVID-19 working groups.

  • Adapting treatment centres for other diseases (eg, Lassa fever) to COVID-19 treatment and isolation centres.

  • Adapting and updating existing decisions (eg, case management definitions, use of masks) based on emerging data and evidence from local and global sources.

  • Adapting the existing event based management system used for systematic data collection on events to combat misinformation and disinformation by collecting and characterising rumours.

  • Adapting and modifying existing guidelines for other diseases (eg, influenza, viral haemorrhagic fevers) to develop guidelines for COVID-19 management.

  • Agile assembly of incident action plans before identification of index case in Nigeria for early preparedness efforts at national and subnational levels.

  • Agile release of funds and treasury operations by Presidential Task Force for health emergency operationalisation with minimum bureaucratic layers.

Participation and collaborationInvolvement of external actors, community workers, private sector, CSOs, commercial sector and academia in the development of policies, laws, or decisions related to health emergencies, through representation and consultation.
  • Inviting business sector for consultations for their input on business and economic impact of the COVID-19 pandemic and collaboration with the Coalition Against COVID-19, a private sector led organisation.

  • Involvement of community leaders, and local leaders in decisions to halt community transmission.

  • Involvement of religious leaders in decisions regarding places of worship and religious institutions.

  • Use of external independent advisory groups composed of multisectoral technical experts to advise Presidential Task Force and state-level COVID-19 taskforces on measures and decisions.

  • Involvement of CSOs in decisions or measures to take services to people in the community due to CSO expertise in providing such services.

  • Collaboration between government and universities on research efforts to form the Nigeria COVID-19 Research Consortium.

Rule of lawAll actors, including institutions and states, are accountable under the laws and rules that have been established in a manner that is equally enforced, independently adjudicated and consistent, thus ensuring that actions and decisions during health emergency have legal basis.
  • Presence of enabling legal and policy frameworks such as the Nigeria Centre for Disease Control (NCDC) and Prevention (Establishment) Act of 2018 detailing functions and powers of the centre to prevent and control diseases of public health importance.

  • Agencies such as the NCDC and the Nigerian Institute of Medical Research enacted decisions and measures in accordance with their mandates.

  • The inclusion of elected political officials on the Presidential Task Force and state level COVID-19 taskforces aided in enforcement of decisions and measures due to political authority of the body.

  • The inclusion of elected political officials on the Presidential Task Force provided authority and convening power to the body to convene multiministerial meetings which was needed for a cross-sectoral response.

TransparencyThere is open and available information about who makes decisions, how those decisions are made and what data are being relied on to make decisions.
  • After the implementation of decisions and measures, the Presidential Task Force immediately informed the public about these decisions through press conferences or media appearances.

  • Frequent updates to the public about COVID-19 status and burden by NCDC officials through media appearances and press conferences.

  • The government demonstrated fiscal transparency by informing citizens how funding for health emergency operations was spent using budget and funding dashboards published on government websites.

EquityPolicies, laws and decisions are non-discriminatory in their impacts and incorporate the human right to non-discrimination, the right to life and the right to health.CSOs played a role in gauging whether decisions and measures implemented during the COVID-19 pandemic were based on principles of human rights and civil rights.
  • *Definitions adapted from the Global Preparedness Monitoring Board except for ‘adaptive and agile’ which is a newly emerged element of governance in our study- Governance preparedness: Initial lessons from COVID-19.4