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Inadequate funding, low access threaten Nigeria’s TB control programme

By Sola Ogundipe

INSUFFICIENT funding and poor access to proper treament services are hampering Nigeria’s efforts to combat the menace of tuberculosis, a disease that killed an estimated 1.5 million people in 2013 including 360,000 people who were living with HIV.

Although Nigeria has developed a new National Strategic Plan on TB, it documents a relatively weak programme, with poor public awareness and gross insufficient federal, state and local funding. The plan which has charted a bold vision for effectively stopping TB, is, however, bogged down by serious shortage of funds.

Last October, the WHO expressed concern over dire shortage of the tune of an annual shortfall of $2 billion (N320 billion)out of an estimated $8bn (N1.28 trillion) that is required each year, to fully tackle TB in the world.

With an HIV/TB average mortality of 85, 000 deaths in 2013, an average prevalence of 570,000, and TB incidence rate of 81 per 100,000 population, Nigeria is classified as a high TB burden country by the World Health Organisation, WHO. Results of a high quality survey of the TB burden in Nigeria revealed that the country’s TB case detection rate is 16 percent, and not 51 percent as previously reported.

Worse still, many more people are dying of TB than previously anticipated as investigations revealed that Nigeria’s TB prevalence and incidence are actually double and triple, respectively, of previously reported figures.

Data from the Global Fund to fight AIDS, Tuberculosis and Malaria, GFATM, which mobilises and invests nearly US$4 billion (N640 billion) a year to support programmes run by local experts in Nigeria and at least 139 other countries, show that for 2014, TB control in Nigeria (as at November 1) is 53 percent unfunded, translating to about US$73.67 million (N1.178 billion). Out of the total National TB programme budget for the year amounting to US$139 million (N22.24 billion), 38 percent, US$52.82 (N8.45 billion), is internationally funded while just 9 percent or US$12.51 million (N2.02 billion) is funded domestically.

In 2013, a funding shortfall of US$100 million or N16 billion was recorded out of a total US$150 million (N24 billion).
Data for 2013 also showed that the total TB case notifications (including new and relapsed) was 100,401. Among these cases, the male to female ratio was 1:5, while 6 percent (5,776) were aged below 15. Newly confirmed TB cases in 2013 totaled 52,811 for bacteriologically confirmed pulmonary cases, and 33,873 for the pulmonary, clinically diagnosed cases. Also last year, a total of 435,216 HIV positive persons were screened for TB, 10,410 MDR-TB cases were reported out of which 426 were started on treatment.

In the view of the National Coordinator, Civil Society for the Eradication of TB in Nigeria, Dr. Baba-Gana Adam, the development is a wake up call. “TB is to me even more dangerous than HIV/AIDS and Ebola because condoms and hand sanitisers cannot stop it because it is transmitted through the air.” he stated.

Transmission of Ebola

He argued that the poor health-seeking attitude of most TB patients, coupled with with a combination of low quality, inaccessibility of services and preference for traditional healers were challenges.

“Access is an issue because only about 25 percent of the primary health clinics are partially functional with less than 10 percent personnel available to offer services to the grassroots. Where they are available, they are disconnected with the people in the communities.

He said implementation of the six goals of community systems strengthening (CSS) of the GFATM is the only assurance that will increase funding for TB at the local levels though sustained advocacy to the Local, State and National Governments.

Also lamenting the reality of TB burden in Nigeria, ACT Regional Vice President, Chibuike Amaechi, identified stigma and unfriendly attitude of public health workers as well as limited public health facilities offering TB services.
Urging civil society to rise up to the task of advocating for increased domestic funding for overall health, Amaechi lamented the lack of separate national or state budget for TB alone. “Allocation is made to the Ministry of Health, it will take further budget tracking in the ministry to find out specific allocation to TB. Definitely our health system needs increased domestic funding to compliment the Global Fund and other international donors investment in Nigeria.


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