The dreaded but treatable Tuberculosis (TB) epidemic in Nigeria is something the Federal government is devoted to putting a stop to, according to the Minister of Health Dr. Osagie Ehanire.
In order to increase public awareness of tuberculosis and the efforts being done to prevent and treat the disease, he dropped this hint during a news conference marking the 2023 World TB Day. It gives us a chance to evaluate how well the End TB plan and the Sustainable Development Goals (SDGs) are doing .
He stated that tuberculosis (TB) is a significant public health issue both globally and in Nigeria, represented by Minister of State for Health Hon. Ekumankama Joseph Nkama.
Osagie stated that: “In line with the government’s effort to ensure good health and well-being for all Nigerians as envisioned in SDG 3, the Federal Ministry of Health (FMoH) through the NTBLCP with the support of our committed and dependable partners have initiated a number of laudable TB control interventions.
“The country has in place a number of relevant policy documents to charta strategic direction for the control of the infection. These include the National guidelines for TB prevention, diagnosis and treatment, the National Strategic Plan (NSP-2021-2025), and the compendium of best practices among others.
“We have adopted and are scaling up new global innovations in every sphere of the response. This has ensured improved access and the efficiency of the interventions. For example, the GeneXpert equipment – a rapid molecular test for TB has increased from 32 in 2012 to 503 in 2022. The mobile digital ray with artificial intelligence, for TB screening among key and vulnerable populations, is being strategically scaled up across the country.
“In line with the NSP 2021-2025, active case-finding interventions have been deployed to target key and vulnerable populations as well as clinic/hospital attendees. These interventions are yielding positive results. Routine TB screening among outpatients is being implemented in all tertiary and a good number of secondary health facilities and this intervention is responsible for 8% of the national 2022 TB notification. We have equally expanded TB treatment services (DOTS centres) from 12,606 in 2019 to 20,148 in 2022 – translating to a 50% coverage of total heath facilities in Nigeria.
Implementation of a robust Public-Private Mix DOTS (PPM- DOTS) plan has shown encouraging results as we have been able to expand TB services to 4,038 private facilities in 2022 from 1,451 in 2018. Thus, making PPM-DOTS a key TB control intervention that contributed to 24% of the national 2022 TB notification.
“In order to promote community participation, ownership and to discourage stigmatization of TB, community TB interventions are being implemented through community-based organizations across the country but more actively in 23 states. The community contribution to our national TB case notification rosee from 19% in 2018 to 45% in 2022.
“As encapsulated in the National Strategic Framework for TB/HIV collaborative activities, there have been significant improvements in this direction. Ninety-seven per cent of TB patients were tested for HIV in 2022. Consistent with the report of the 2018 National HIV/AIDS Impact Indicator Survey (NAIIS), the proportion of TB patients co-infected with HIV has dropped significantly from 12% in 2018 to 6% in 2022.
“It is heartwarming to state that these high-impact interventions amongst others have helped in revamping our TB control efforts with our annual TB notification increasing steadily from 138,591 in 2020 to the highest-ever notification of 285,561 in 2022. 1 think we all deserve a round of applause for this achievement” , Ehanire stated.
However, considering the high burden of TB in Nigeria, there are significant gaps in some critical aspects of our National TB response. A key challenge to our control effort has been access to TB services. The TB service coverage for 2022 was 50%, as services were only available in 20,148 out of 40,562 health facilities in the country.
Similarly, WHO Country Representative (WR) Dr Walter Kazadi Mulombo who was represented at the occasion by
Dr Laxmikant Chavan WHO Technical Officer hinted that, Nigeria at the United Nations High Level meeting (UNHLM) on TB in 2018 made a commitment to diagnose and treat 1,109,000 TB cases and place 2,183,890 clients on TB preventive Therapy (TPT) from 2018 to 2022. After the end of 2022, Nigeria has not demonstrated achievements of this commitment as available reports show that the country is trailing behind in all the set targets.
He noted that, TB control budgets in Nigeria continue to be drastically underfunded. About 69% of the TB budget in 2021 was unfunded, this is a major threat to the country’s efforts in achieving the set targets. Too many people are pushed into poverty when they contract TB due to lost income, transport costs and other expenses. 71% of the TB patients in Nigeria and their household are affected by catastrophic cost due to TB.
According to him:” WHO will continue to support Nigeria in developing and implementing guidelines, plans, framework and strategic documents to end TB epidemic in Nigeria. In addition, we will facilitate research to provide evidence-based interventions and innovations for finding the missing TB cases and enhancing the country’s efforts in reaching the set targets.
“We will continue to work with the programme to build capacity of senior and middle-level managers across the states on the needed knowledge and skills for improving quality of care and data analysis towards formulating evidence-based policies for enhancing programme performance at all levels. In addition, we will continue to support monitoring of the programme at all levels, in rea-time, to identify challenges and advise on strategies to address the challenges.
“Finally, let me pledge WHO’s continued support in strengthening partnership and innovations towards the attainment of set targets as well as leveraging on the country’s primary health care strengthening initiatives to end TB epidemic in Nigeria.
TB IS Curable and treatable; I implore anyone coughing for two weeks or more to go for TB test in the nearest health facility. We call on everyone- the donors, private sector, civil society, academia and the press to join forces in solidarity and together, “Yes, we can end TB epidemic in Nigeria”, he stated.
In addition, the Deputy Director, Office of HIV/ AIDS and TB USAID Nigeria, Omosalewa Oyelaran said since 2003, Nigeria remains in the top 10 countries affected by TB, with one of the lowest detection rates globally.
She said to combat this debilitating disease, USAID collaborates with the Government of Nigeria and other national and international partners to support the National Tuberculosis Program. Since 2003, USAID has contributed more than $250 million to TB control efforts in Nigeria. In 2022 alone, USAID programs helped screen over 15 million individuals for TB. USAID’s support also includes the provision of TB screening, diagnostic, treatment, and preventive services in 18 states through community and facility-based interventions.
According to her:” In partnership with the Government of Nigeria, USAID’s ‘TB Accelerator’ model invested in local civil society organizations (CSOs) to increase access to quality TB prevention, diagnosis, and treatment, including multi-drug resistant TB. These local CSOs collaborate with the national and state TB programs to deploy, and scale, state of the art equipment and tools to improve detection of TB. USAID also facilitates multi-sectoral public-private partnerships to increase public awareness and advocate for domestic resources to address the TB epidemic in Nigeria. As a result, Nigeria realized a significant increase in TB case finding and treatment coverage over the past three years.
“Despite the additional challenges posed by the COVID-19 pandemic, we have achieved significant results working together in partnership with GON and Global Fund. We commend the Government of Nigeria’s efforts to sustain the accelerated service delivery that resulted in yearly case notification increases of 160 percent between 2019 and 2022.
“However, much remains to be done if Nigeria is to meet its TB control target of ending the TB epidemic by 2035. We must continue to work together to reach all TB patients and their contacts in Nigeria.
“However, the greatest challenge is the funding gap, which is estimated to be 70 percent of the resources needed to effectively control TB. Therefore, I call on you to mobilize domestic resources to meet this funding gap through budgetary allocations, inclusion of TB services in health insurance schemes, and enhanced private sector engagement”, she said.
In her goodwill message, the Ag. Board Chair, Stop TB Partnership Nigeria, Dr Queen Ogbuji said out of the annual estimate of 479,000 TB cases in Nigeria, only 285,561 were notified. This is good progress in the right direction, and considering the fact that Nigeria was able to increase its notification even when the world was grappling with COVID:19 and many countries of the world had low case notification and more TB deaths.
She added that, “The increase has been consistent since then and Nigeria needs to be applauded for this. However, a lot needs to be done to close the gap.While we commemorate, let it remain top in our minds the picture that Nigeria ranks first in Africa and sixth in the world accounting for about 4.6% of the global TB burden
“TB disease is often more severe in children with higher mortality among those less than 5 years old. The notification of children with active TB disease has remained abysmally low at only 6% of out of the annual notification.
“As the country continues to make progress to find the missing TB cases and put them on treatment, much resources is needed to accomplish this, unfortunately, of the $373 million needed for TB control in Nigeria in 2020, only 31% was available and 24% of this came from the donors, only 7% was from domestic source”, she added.
