Stakeholders in Nigeria’s health sector have launched a major strategy to close the yawning funding gap identified in fighting scourge of Turberculosis in the country.
According to the 2017 Global TB Report, Nigeria is among the 14 high burden countries for TB, TB/HIV and Multi-drug-resistant tuberculosis (MDR-TB).
MDR-TB is a form of tuberculosis (TB) infection caused by bacteria that are resistant to treatment with at least two of the most powerful first-line anti-TB medications (drugs), isoniazid and rifampin.
The country is also ranked seventh among the 30 high TB burden countries and second in Africa and Nigeria is among the 10 countries that account for 64 percent of the global gap in TB case finding. India, Indonesia and Nigeria are responsible for almost half of the total gap.
The National Strategic Plan, NSP, on tuberculosis, states that Nigeria requires $336m to address TB challenges by 2020, while a breakdown of the funding in Nigeria so far shows that $31m (approximately nine percent) has been provided domestically, $90m (27 per cent) raised through international donors agencies leaving a $215m (64 per cent) funding gap.
In response to this dire situation, Dr Adebola Lawanson, National Coordinator, National Tuberculosis and Leprosy Control Programme (NTBLCPO), said the agency has commenced discussions with the private sector to raise resources and has developed a platform with which to reach out to them.
According to World Health Organisation(WHO )an estimated 250,000 children died of TB in 2016 including children with HIV associated TB and in 2016 an estimated one million children became ill with TB.
Lawanson said the move is essentially prompted by the concerns that the Nigerian government may not be able to raise the funds to close the gap through direct investments in the production of tuberculosis products and services needed to drive the TB challenge programmes
This is because the Minister of Health, Prof. Isaac Adewole said: “In 2017, only 36 per centof the total funding required for TB control was available, which is grossly inadequate to make the desired impact.
The Minister said that In recent years, donor resources have continued to dwindle thus threatening sustainable TB control financing in the country. “The Median cost for patients treated for susceptible TB in 2016 was $1256 while that of Drug Resistant Tuberculosis is $9529. Thus, it is evident that TB control requires considerable financial outlay; it is important to note too, that the cost of increasing efforts is even much higher.”
Meanwhile stakeholders also noted that Nigerian government alone is unlikely to increase its funding for TB because the Debt Management Office (DMO) recently reported that Nigeria’s total debt has increased by about 90 per cent in almost three years from N12.6 trillion in December 2015 to about N22.71 trillion as at March 2018. In addition to the figures reported by the DMO, there are the N1.95 trillion deficit in the 2018 budget, the $475 million loan agreement recently signed with the French government, and the $328 million agreement with China recently signed by President Muhammadu Buhari. Stakeholders are unanimous in their opinion that mobilisation of domestic resources especially from the private sector will address the funding gap.
Speaking further, Lawanson said, “We are not talking about cash, we want them ( referring to private sector) to affect the lives of the patients on admission, you can go there and pay or whatever the hospital has asked you to do. For the various equipment, you can support us with consumables to do what we have to do. We are not producing TB drugs locally; the drugs we are buying are from global drug facility.
According to her, “if the private sector buys it, it will not be at a negotiated price,and it will be at a high price, we want a negotiated price that will enable us treat more patients with the least amount of resources.
“As the drugs come into the country we apply drugs assurance quality mechanism, as they come in we go to the store where the drugs are stored , check the stores for the quality and efficacy of the medicine, we take their samples and work with NAFDAC so that we know that what we are giving our patients are potent.
We monitor the drugs from the store to the facilities and to the patients because we don’t want anybody to develop drug resistance again or excessive resistant TB, which is more dangerous. That is why we are making sure that whatever medicines we are producing is of the highest quality”.
For her, the essence is to have quality assured medicine as the risk of using medicine from wrong source could lead to drug resistant TB, which has a higher mortality. She revealed that the global drug facility through the store keeping partnership has these drugs at a negotiated price for low income countries like Nigeria .
“TB is treatable, curable and we want the best for our patients” she noted . “If you cure TB for one person you are saving the lives of so many because one TB case has the potential to transmit the infection from ten to fifteen persons”, she concluded.
Also, Dr. Cliff Ogbede , CEO of Kleef & Helixor Pharmaceuticals Nigeria Ltd, said findings have shown that private sector involvement in the TB challenge programme has begun to gather steam.
He revealed that plans are underway for YURiA Pharm, a foremost Ukrainian manufacturer of TB treatment and preventive drugs, to support Nigeria in the fight against TB by providing pediatric friendly Isoniazid Syrup. It is expected that this would be used for the effective and safe treatment and chemical prophylaxis of tuberculosis for diseased and infected children with BCG vaccination complications, as well as for those who had come in contact with tuberculosis patients.
Dr Ogbede , said his company in collaboration with Yuria Pharm plans to build a manufacturing plant in the country which will make their TB drugs readily available for patients, as well as create jobs that will translate into economic growth and development. “Through the necessary support from the Federal Government. The proposed plant will enable us to satisfy the local market, improve the health of TB patients in Nigeria and equally export to the neighbouring countries within the region,” he said.
A recent case in hand revealed that Winner Ihunwo, a seven-year-old promising girl from Obio Akpor Local Government Area in Port Harcourt was diagnosed of Juvenile Tuberculosis.This followed the discovery of a lump on her back.
The swelling grew, and became tender and painful for Winner, who also began having trouble moving her limbs properly. Her mother, Blessing Ihunwo for financial constraints, first took her to a traditional healer, which did little to improve the situation and later sought for more spiritual help rather than taking the girl for medical checkup.
Eventually, Blessing, with the help of the Church sought medical help at the University of Port-Harcourt Teaching Hospital, Rivers state.
The diagnosis was confirmed with a chest X-ray, and Winner was immediately placed on the appropriate anti-TB treatment regimen.
Juvenile tuberculosis is initial (primary) infection with Mycobacterium tuberculosis, characterized by pneumonic lesions in the middle parts of the lungs, rarely cavitary, with rapid spread to lymph nodes in hilar and paratracheal areas; more often seen in childhood, but the pattern is not limited to children.
As childhood tuberculosis (TB) reflects recent transmission, its burden provides an accurate measure of the level of TB control achieved in a particular community. Moreover, infected children represent the main reservoir of Mycobacterium tuberculosis (MTB) as potential future cases. However, childhood TB is neglected by scientists, policy makers, healthcare professionals and product developers.
Anyanwa Beatrice, the health care worker who supervised the girl’s treatment for tuberculosis at the Teaching Hospital noted that she was admitted to the thoracic clinic, where a paediatrician from a USAID program, Challenge TB, immediately recognised the swelling as a symptom of a form of childhood TB known as Pott’s disease.
After two weeks of treatment, she showed significant improvement and her mother’s faith in the efficacy of modern medicine to save her daughter was activated.
Less than two months later, Winner was already showing further signs of improvement. The pain and swelling had diminished almost completely, and function in her legs restored to where she could walk, run and play again. And a slight case of scoliosis, or curvature of the spine, brought on by the TB had straightened.
Her Mother, Ihunwo, was also taught how to adhere to the 12-month treatment regimen that Winner had to complete before being completely rid of the disease and other orthopaedic anomalies.
Timely Intervention played a crucial role in Winner’s recovery. Her story ended well because there was adequate resources for her treatment and support for her family. But could that be said of the over one million other children who are diagnosed with tuberculosis in Nigeria annually, the stakeholders asked.