COVID-19 testing and the ethics of charging students for services, By Isaac N. Obasi

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Although this column has not really focused on Ogun state per se as it did for states such as Lagos – epicentre of coronavirus (COVID-19) in Nigeria, – Kano, Rivers and Cross River states, Governor Dapo Abiodun of Ogun state has been one of the governors known for their pro-activeness in the fight against the coronavirus pandemic. His government has consistently maintained its verve in fighting COVID-19 pandemic. Consequently, the news that his government has made COVID-19 and malaria tests mandatory for returning SS3 boarding students, should be a welcome one, as it also confirms the government’s pro-activeness in stopping the spread of the virus, and keeping the students healthy as they prepare for their terminal examinations. However, the policy is ill-timed, and secondly, the charging of money for COVID-19 test, also surprisingly applied discriminatorily between students in public and private schools, raises serious ethical questions to be addressed later in this piece.

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News report by Premium Times (August 1, 2020 as reported by Alfred Olufemi) indicates that the students are expected to resume on August 4, 2020. Giving further details of the mandatory testing for the two diseases, the Premium Times quoted a statement released on Saturday, August 1, 2020 by Ronke Soyombo, (the Special Assistant to the Governor on Primary and Secondary education) as saying that: ‘the ministry of health has made provision for a COVID-19 and MALARIA TEST for all SS3 BOARDING students in Ogun State as part of the conditions for the reopening of schools in the under listed Public Health Care facilities between Friday 31st July & Monday 3rd August, 2020’. 

The three facilities listed are Ogun State General Hospital, Ota, the 250 MTR Okemosan, Abeokuta, and Olabisi Onabanjo University Teaching Hospital, Sagamu. Mrs. Soyombo also said that part of the strong condition of admittance to school for boarding students is the COVID-19 certificate showing ‘Negative’. Consequently, all Principals were ‘therefore directed to immediately disseminate the above important information to all SS3 learners in the State and to ensure that the above instructions are strictly adhered to as sanctions will be meted out to any defaulting school’ (See https://www.premiumtimesng.com/regional/south-west/406352-school-reopening-ogun-begins-mandatory-covid-19-malaria-tests-for-ss3-students.html).  .

Furthermore, in its follow-up report (2 August 2020 by the same reporter) it was revealed that the COVID-19 test would cost twenty-five thousand naira (N25,000) per student. More details revealed also that only students in private secondary schools in the state would be charged for the test. This discriminatory policy of charging only a section of the students immediately attracted protects from parents of these students in private schools. Some of the parents who spoke to Premium Times ‘described the fee as insensitive on the part of the state government’. However, government responded to the criticisms through the Special Assistant to the Governor on public communication, Remmy Hassan, saying that ‘private school students were meant to pay N25,000 because the government had subsidized the cost by 50 per cent’. 

Continuing, the government explained that ‘the COVID-19 test costs about N50,000. For the students in public schools, it is free but because the private schools could not provide us with the total number of their students, we could only subsidize the cost by 50 per cent. The reagents for the test have to be made available by NDDC because the students need to resume in the next 48 hours. All these are very important and it will cost money. That was why we decided that private schools should pay half of the cost since they are profit makers’ (See https://www.premiumtimesng.com/news/headlines/406422-schools-reopening-parents-kick-as-schools-levy-n25000-for-covid-19-test-in-ogun.html

The Ogun State Government’s intention to pro-actively stop the spread of the virus through making such a test mandatory cannot be reasonably questioned. Such a massive test programme remains the wish and aspiration of any responsible government all over the world. But have many governments in developed countries have been inspired enough with adequate testing materials to achieve this goal? None so far, as the goal remains more aspirational than practically achievable. This is a major aspirational shortcoming of the policy. 

On a very serious note, as we observed earlier, the adoption of a commercialization policy on COVID-19 test by a government on a particular public health disease currently being treated free of charge, raises crucial ethical questions. First, it is not ethically advisable and defensible to start a commercialization policy on COVID-19 testing on students whose state of mind, could be disoriented by the hassles generated by the policy. We recall that the policy was announced on Saturday evening (1 August 2020) according to news report and parents were given up to Monday, August 3, 2020, to complete the test so as to make it possible for the same students to resume on Tuesday, August 4. This raises the second moral issue. Given the long waiting period for results of tests conducted by the Nigeria Centre for Disease Control (NCDC) to come out, how realistic is the very tight deadline? 

Thirdly, and deriving from the unrealistic deadline, was the policy meant to be implemented properly according to the standard procedures? Or was the N25,000 meant to be paid across the counter in designated health facilities, and in return immediately issued a ‘Negative test result’ certificate without undergoing an actual test, as is the practice in most government hospitals that issue medical reports without actual test? Such reports end up being only a revenue generating activity for the government rather than a good public health maintenance policy.

Fourthly, are the tests designed to be carried out with COVID-19 Rapid Test Kits? The NCDC has been very conservative in this regard, as it has been insisting that COVID-19 tests should be conducted in its molecular laboratories which are highly reliable. For the NCDC, reliability of results cannot be compromised if my understanding of the agency’s position is correct. In any case, the NCDC in reaction to the Ogun State policy of charging fees for the test issued a statement immediately that COVID-19 tests conducted in any of its 61 molecular laboratories are free. This confirms that there is an ethical question about the commercialization of the test for students in either public or private schools.

The fifth question is on the ‘why’ of the discriminatory policy. The reason offered by the government as captured earlier appears not tenable. If the government is offering a public good, there should be no discrimination. Students in private schools in Ogun State are citizens of the state whose parents or guardians pay taxes. And by the way, proprietors of private schools pay registration or licensing fee and perhaps other taxes annually to the government. So why should such a policy of paying N250,000 be targeted at their own students?  

Postscript: This article was almost completed when the news of Governor Dapo Abiodun’s magnanimously ‘stepped down the COVID-19 test as a mandatory requirement for returning students in the exit classes’ (See Punch, August 3, 2020 via https://punchng.com/breaking-school-reopening-ogun-cancels-covid-19-test-requirement/). Some details of the statement read: ‘After reviewing these developments, I have today immediately directed that the Government Laboratories carry out tests for all returning SS3 boarding students at no cost. I have also directed that all those who have paid for tests be refunded. The health of our children remains our utmost priority. However, in view of the total number of boarding students to be tested (5,340 private and 500 public), and bearing in mind the limitation of our installed testing capacity of 500 tests per day, it may not be feasible for all boarding students to get tested and get their results prior to resumption or even exams which commence on 17th August 2020’. This column can only say Thank You Mr. Governor for having a listening ear. This piece is still relevant for other state governments that may contemplate such a policy in future. 

Prof. Isaac N. Obasi, a public policy expert (& former columnist in the Daily Trust, Abuja, March 2003 to October 2006, & Daily Champion, Lagos, April 2005 to December 2008), is of the Department of Public Administration, University of Abuja. Email: nnamdizik@gmail.com      


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