Minister of Health Prof Isaac Adewole tells OYEYEMI GBENGA-MUSTAPHA what the government is doing to control TB.
What is the government doing to curtail TB, and not leave out cases?
To control TB in Nigeria, the Federal Ministry of Health (FMOH) established the National TB Control Programme, which developed the National TB Strategy 2015-2020 framework to address the TB burden. The framework is consistent with the End TB Strategy and incorporates the most recent internationally recommended diagnostic and treatment strategies.
The ministry, in collaboration with a broad coalition of partners, namely: USAID and the US Centers for Disease Control and Prevention (CDC), the KNCV Tuberculosis Foundation (KNCV)/Challenge TB (CTB), the Department of Defence (DOD), the Global Fund, the International Federation of Leprosy Associations (ILEP), the Stop TB partnership, Association of Reproductive and family Health (ARFH), Institute of Human Virology (IHVN) and the Civil Societies among others, is providing free TB services in over 7,000 health facilities in the country, where over 100,000 TB cases were notified and treated in 2017. The TB cases notified in 2017 only represent about 25 percent of the estimated TB cases in the country. The remaining 75 percent of the estimated TB cases that are undetected (missing TB cases) remain in the community, leaving a high probability of transmission of the disease to other people. The infectious sources could be our close associates, workers, drivers, teachers etc. thereby putting all of us including our children at risk, and hence the need for all of us to work together to make Nigeria free of TB.
Could you shed more light on this?
We are working hard to address the menace. The country currently delivers TB treatment and care through a network of over 7,000 health facilities accredited by the National TB and Leprosy Control Programme (NTBLCP) up from 3931 in 2010. Similarly, the number of Drug resistant TB (DR-TB) treatment centres has been progressively increased from 10 in 2013 to 28 in 2017. There are on-going efforts by the Ministry to ensure Universal Coverage of TB care and prevention. To achieve this, a resolution was passed at the 60th National Council of Health meeting held last year, to include TB service delivery in the Primary Health Care Minimum Health care package. It is believed that these efforts will increase TB case finding. We have deployed cutting-edged technology to enhance TB diagnosis in the country. A total of 391 GeneXpert machines have so far been installed at 310 sites across the country for this purpose. To ensure universal access, the government targets to have at least one machine per LGA.
Is that all?
In addition, a total of 2,650 microscopy centres exist to support treatment monitoring. The number of TB reference laboratories has also increased from eight in 2013 to 10 in 2018 to support the management of drug resistant TB. In furtherance of the desire of the FMoH to improve access of all presumptive TB cases to Xpert MTB/RIF assay, specimen transport is being fashioned in a hub and spoke model. We have also expanded the capacities in-country to adequately manage Drug Resistant TB, with over 2,000 drug resistant TB cases diagnosed in 2017. In 2017, at the National Council on Health a resolution was passed, which mandates notification of TB cases by all providers including Private Health care practitioners.
This is a bold step taken by the country to address its TB burden and increase TB notification in the country. We are working with the relevant government agencies and organisations to enhance the implementation of the NCH resolution. Furthermore, to ensure active Private Sector participation in Financing TB service provision and demand creation, the FMOH has created this platform to engage the private sector. In addition, we are using the Basic Health Care Provision Fund (BHCPF), to expand coverage of an explicit but guaranteed set of services including TB. This, we believe, will reduce out of pocket spending of patients including those with TB, thereby minimising the catastrophic costs borne by patients and their families.
Why is TB still a public health issue?
In spite of all the progress recorded over the years, the TB control efforts is till challenged in the following areas:Finding an estimated 302,000 missing persons with TB (74 percent of total estimated cases) that are not detected annually; the proportion of undetected TB cases was even higher among children where 87 percent (48,550) of the estimated TB cases in this age group (of 56,000) were undetected; The significant gap in multi-drug resistant/rifampicin-resistant (MDR/RR)-TB case detection as (89 percent or 17,714) of the estimated MDR/RR-TB cases are undetected and only 78 percent of diagnosed MDR-TB cases were enrolled in treatment in 2017; Decentralising TB services to all health facilities (public and private) in the country, as only about 20 percent of health facilities are providing TB services. And about five percent of the private health facilities are providing TB services; optimally funding of the National Strategic Plan for TB.
What is the way forward?
To achieve our goal of ending the TB epidemic by 2030, additional support and effort is required. We must expand our current frontiers of control of TB as TB impacts negatively on the health and welfare of individuals as well as the economy of the nation. We require the active involvement of private health care providers and corporate organisations to make Nigeria free of TB.
We have in the recent times engaged more private health care providers to provide quality TB care to all patients in need of the services. This PPM summit is therefore organised to engage the private sector and mobilise additional resources to end TB in Nigeria. I want to assure you all that the administration of President Muhammadu Buhari places high premium on the health of Nigerians and ending TB is on it’s priority list.
This event is a demonstration of the commitment of this administration. Furthermore, as part of our commitment to this partnership, a GeneXpert machine procured by Federal Ministry of Health will be handed over to one of the private diagnostic centres to support active TB case finding in Lagos State. To scale up this gesture to other centres, we request corporate organisations here present and others to be enlisted to also support in the provision of this diagnostic facility to other health centres across the country for the purpose of increasing case finding and treatment of TB patients.