Partnership at country level the Nigerian Experience By

Partnership at country level; the Nigerian Experience By Dr T. O. Sofola National coordinator NTBLCP Nigeria

OUTLINE OF PRESENTATION l Background Information l Status of Partnership l DOTS Expansion l Data l Challenges l Financial Situation l Conclusion

Nigeria: Background information Population: 126 m. 36 states + FCT 774 LGAs Life expectancy : 48 (02) Economy , mainly on Export of Crude Oil. l 70% below poverty line (2002) l GNP per capita. $280 (1998) l Public Expend. On Health as % of GDP: 0. 3% (’ 98) l l l

Background l l • • • Nigeria 5 th among 22 high burden countries in the world WHO estimates for 2002 were 102 per 100, 000 pop for smear positive cases 235 per 100, 000 for all forms of TB TB burden is further compounded by the worsening HIV/AIDS epidemic. TB Control based on DOTS Nigeria is committed to global targets.

Partners as at 2001 l Damien Foundation of Belgium l Department for International Development l German Leprosy Relief Association l German Bank for Reconstruction l Netherlands Leprosy Relief l World Health Organization

Map of Nigeria showing DOTS States Sokoto Katsina Jigawa Zamfara Yobe Borno Kano Kebbi Bauchi Kaduna Gombe Niger Adamawa Plateau FCT Nasarawa Kwara Oyo Osun Taraba Kogi Ekiti Benue Ogun Lagos Ondo Enugu Edo Anambra Delta Bayeisa Imo Rivers Ebony Abia Akwa Ibom Cross River Non DOTS States Old DOTS states

Expanded Partnership (National Inter. Agency Coordinating Committee) DEVELOPMENT PARTNERS e. g. ILEP, CIDA, WHO, USAID, STOP TB/GDF GOVT AGENCIES, MINISTRIES & DEPTS e. g. FINANCE, NIMR NAFDAC, POLICE NGOs e. g. CHAN, SPETB, PLWHA HIV / AIDS / STD CONTROL PROGRAM, NACA

NICC: TERMS OF REFERENCE l Assist/provide strategic & technical guidance l Explore means of strengthening & expanding participation in TB control l Advocate for & mobilize resources to support TB control

Organogram of the NTBLCP FEDERAL Minister PS DPH Nat Coord. TBLCP STATE Com. for Health DDC LGA State TBLCO Sup. Councillor PHC Coord. HOD Health Facilities LGA TBLS TB inter-agency committee

THE NTBLCP SUPPORT PROJECT l l l Federal Government provides Policies, Strategic Planning, Coordination, Storage and distribution of drugs, Technical support Supervision training Other Support State Government Provides Staff Infrastructure, Running cost, Drugs Other Support Local Government Provides Staff Infrastructure Other Support State TBL: Control Programme TB Services in LGAs Diagnose. Treat and Cure TB. Patients Reduction on TBL Transmission Development Partners Agencies Provides drugs, Equipment, Logistics, Sponsor Training, Technical Support Other Support

Monitoring & Evaluation Plan l Improving utilization of data from routine reporting & recording l Monitoring & supervision by National Experts l Joint International Mission (External/Internal Consultants) l Periodic review and evaluation

Achievements l Improved political commitment l 5 -year Strategic plan in place l Capacity to supervise & monitor is strengthened l DOTS expansion drive on-going l New initiatives & approaches embarked upon (TB/HIV, PPM, Operational research & Community DOTS)

Map of Nigeria showing DOTS States Sokoto Katsina Jigawa Zamfara Yobe Borno Kano Kebbi Bauchi Kaduna Gombe Niger Adamawa Plateau FCT Nasarawa Kwara Oyo Osun Taraba Kogi Ekiti Benue Ogun Lagos Ondo Enugu Edo Anambra Delta Bayeisa Imo Rivers Ebony Abia Akwa Ibom Cross River New DOTS States Old DOTS States

Progress in DOTS expansion States implementing DOTS Jan 2002 21/37 (56%) Present 35/37 (94%) LGAs implementing 350/774 DOTS (45%) 400/774 (52%) Microscopy centres 434/774 (56%) 1, 659/5, 000 (33%) 75 m/126 m (60%) Treatment centres Population covered 417/774 (54%) 1, 605/5, 000 (32%) 69 m/126 m (55%)

Status in DOTS States l l l l Constant supply of drugs and lab. Reagents Reliable laboratory services Free anti-TB drugs and lab services to patients Data collection system in place Supervision and monitoring system in place Trained health staff Treatment of patients according to WHO guidelines (Directly Observing Treatment)

GRAPH SHOWING COMPARISON IN TB CASE NOTIFICATION IN NIGERIA BETWEEN Q 1. 2002 AND Q 1. 2003

Trend of HIV prevalence among PTB, STD and ANC attendees 1991 -2000

Key Challenges l Sustain national & external funding l Sustain anti-TB drugs & lab reagents l Expand TB diagnostic services network and quality assurance l Setting up/running the reference labs l Sustain DOTS expansion drive l Continue human resource development l Managing & coordinating new partnerships

Key activities for implementation in 2004 l l l l Enhance lab performance (equipment, materials & quality assurance) Train existing and pre-service staff Ensure TB allocation/release in Federal, state & LGAs budgets Intensify improved drug management system Implement consistent supervision & monitoring Expand reporting network Get all service providers on board Implement COMBI

Projected financial situation for 2004 Total Reqt Staff Building Activities to increase DOTS coverage (advocacy, identifying MCs) 1, 780, 000 Unknown 92, 494 Govt Grant by partners uncommitted Gap - 50, 000 - 1, 730, 000 To be determined - 9, 460 83, 034 Anti-TB Drugs 2, 588, 740 1, 368, 466 1, 220, 274 Training/Human resource development 3, 471, 610 41, 948 1, 211, 060 2, 218, 602 Programme management, supervision and monitoring 2, 326, 877 419, 479 748, 771 1, 158, 627 Activities to increase case detection( IEC, upgrade of labs) 1, 363, 205 278, 130 526, 498 558, 577 Activities to increase cure rate (Drug distr, defaulter retrieval, recording & reporting) 537, 707 34, 782 277, 571 225, 354 TB-HV activities 100, 307 20, 000 - 80, 307 PPM DOTS 289, 420 20, 000 27, 000 242, 420 12, 550, 360 3, 892, 805 3, 993, 634 4, 374, 501 Total -

CONCLUSION l l l Nigeria is the 5 th highest TB burden nation Inadequate funding hampered the rapid implementation of DOTS nationwide Now at point of rapidly expanding DOTS throughout the country (Improve case finding & cured rate) Therefore the need to continue & forge partnerships is paramount We hope to achieve the global targets set for 2005

Thank You