When Members of the Nigeria Governors’ Forum (NGF) gather to discuss anything, either physically or virtually, it is mostly an issue of national importance. Last Wednesday, the governors consulted among themselves and came out with a strong statement signed by the forum’s Chairman and Ekiti State Governor, Kayode Fayemi.
The Governors, just like other Nigerians must have been jolted by the statistics that over 150,000 TB deaths are recorded in Nigeria annually even with a free testing and treatment policy. This is ten times more than the number of deaths from insurgency and banditry combined.
The statement from the governor’s forum, which was also in commemoration of World TB Day, expressed strong commitment to push for the targets made at the United Nations High-level Meeting on Tuberculosis held in 2018 to end Tuberculosis globally by 2030.
They want the Federal Government to provide the necessary support to the states to enable them rev up the nation’s capacity to address the challenges posed by the spread of tuberculosis in the country.
Nigeria currently ranks as first in the continent, and sixth globally, among countries with the highest TB burden. Nigeria has about 400,000 estimated TB cases yearly from studies done in 2019, with over 150,000 TB deaths recorded annually. The race now is to treat and prevent the 150,000 annual deaths, and fish out the 400,000 hidden cases mixing with the general population.
Factors behind the high number of TB cases in Nigeria have been identified. According to Nigeria’s Minister of State for Health, Dr Olorunnimbe Mamora, “The main drivers of the TB burden in Nigeria are under-nutrition, HIV, diabetes, smoking, and alcohol use”
To tackle the issue of hidden cases that is responsible for the consistent growth of TB figures in Nigeria, the Federal Government through the National Tuberculosis and Leprosy Control Program (NTBLCP) last Wednesday launched the “Check Am O!” campaign, a new integrated multimedia campaign to promote testing and treatment of Tuberculosis (TB) across the country.
The aim of this campaign is to make every Nigerian take the responsibility of checking up any type of cough or other symptoms, and encouraging friends, family, and neighbours to also check since it is totally free.
In the words of Mrs. Itohowo Uko, Director/Head of ACSM in NTBLCP, the campaign will be on television, radio, and social media, and there would be volunteers working within communities to promote free testing and treatment of tuberculosis across the country.” We need to blow this message into every ear because a TB case might just be that friend, relative or co-worker sitting next to you”, she stressed.
The campaign was developed under the leadership of the NTBLCP through a coalition of international and local partner organisations, with financial and technical support from the United States Agency for International Development (USAID) through the USAID Breakthrough ACTION-Nigeria project.
The Check-Am-O campaign will let everyone know that TB testing and treatment are free and that they should tell anyone with a cough to “Check Am O! Make you dey sure!”
This campaign, public health practitioners believe, will be catalytic in shifting health-seeking behaviours and generating unprecedented demand for the use of both public and private TB diagnostic services.
Preparing grounds for this huge effort, the Federal Government has been engaging private practitioners, health professional associations to work tenaciously at expanding the pool of private sector operators, by scaling up their involvement in the proactive screening, testing, and treatment of TB in their various communities.
The main targets of this goal according to the National Coordinator, National Tuberculosis and Leprosy Control Programme (NTBLCP), Dr Chukwuma are to find the missing cases everywhere, create more up-to-date statistical data on TB cases in Nigeria, and ensure all cases found are adequately treated. These steps he believes will pull Nigeria out of the embarrassing position of being referred always as an epicentre of TB in Africa and the world.
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Speaking recently in Lagos, Chukwumma applauded the efforts of the private sector partners, citing the increase in TB case findings in recent times. He emphasised that there is still a lot of room for improvement.
In her goal of partnering with the private sector, some concrete steps have been taken by the government to ensure that great results are achieved in the war against TB. It started in 2018, when the Minister for Health, acting on the advice of the Guild of Private Medical laboratory Directors, GMLD, donated a 4-module GeneXpert machine to El-lab Laboratories, a private laboratory in Lagos. It was a unique kind of support from government to a private health facility.
El-Lab, with private-sector efficiency and optimised testing with the machine, brought about significant improvement in TB case detection. This is coupled with tremendous support from technical partners like the USAID, SHOPS PLUS, and other program networks.
Seeing the impact of the first donation, The Federal Ministry of Health, Lagos State Government and USAID/SHOPS Plus facilitated another machine, four times higher in capacity than the previous one, a 16-Module GeneXpert Machine, again for EL-Lab.
The machine, which is for molecular diagnosis of tuberculosis (TB), was purchased by the United States Agency for International Development (USAID) through its funded Sustaining Health Outcomes by the Private-Sector Plus project (SHOPS Plus). All partners in the project had agreed that it should still be part of the private sector partnership.
With the involvement of almost 3,000 private indigenous medical diagnostic and research centres in the country, the Federal Government is really taking the anti-TB war into the camp of the enemy. Health commentators believe, closing the gap in TB case detection, notification, and treatment in Nigeria will witness a remarkable change from this year onward, if these efforts are sustained.
The introduction of the Mega 16-Module GeneXpert Machine, at EL-Lab, one of the 118 engaged stand-alone laboratories in Lagos, trained by SHOPS/Plus, is seen as a “milestone”, and the optimal use of the machine will help to fish out all TB cases in the state.
Expanding further on the successes so far and future expectations, Dr. Elochukwu Adibo, CEO of El-Lab Medical Diagnostic Ltd explained that the involvement of the private sector is ensuring that Nigeria’s unenviable ranking as 6th globally among the high burden countries and first in Africa, gradually become a thing of the past.
He noted that the adoption of GeneXpert MTB/RIF test as the entry point diagnostic tool for TB case detection, and Federal Government’s wisdom in actively engaging the private health sector has been the masterstroke that has tremendously helped to increase case detection and treatment.
In Adibo’s words, “with the private sector involvement, we had a 68% increase in first quarter of 2020 compared to 2019. In Lagos state, private sector contribution was less than 3% in 2018 but is now 21% in 2021, which has brought Nigerian case detection rate to 31% up from 24% in 2017. The PPM case notification trend rose from 19% in Q1 2020 to 29% by Q3 2020 compared to 12% in Q1 and 16% in Q3 of 2019. This shows that the engagement of the private sector brought more life into the TB program in Nigeria and we believe with all hands on deck, we can kick TB out of Nigeria in half a decade”.
Ntia Usukuma