HIV/AIDS FUND IS CORRUPT, TB NOT GIVING ADEQUATE ATTENTION IN NIGERIA, MDG 5&6 UNACHIEVABLE

It is good to use this opportunity to appreciate the effort of both the federal, states and local governments for creating an enabling environment for HIV/AIDS since 1999 under the leadership of Chief Olusegun Obasonjo. Let me thank the donor organizations and development partners that deem it fit to support the Nigerian Government on what is supposed to be their sole responsibilities.

Government are supposed to be guardian to the well being of people in the society, Government has to do with the process of being in control, command, regulation, bureaucracy, direction, equity, dominion, polity, ascendancy, supervision, administration, a social contract between the people and those in positions of trust.
75% of HIV/AIDS services in Nigerian is donor driven, I wonder what will happen to PLWHA already on drugs in the next 2 years (some partners are already threatening to pull our their services), some have reduce the number of enrollment on daily basis. The personnel’s employed by these partners will also go at the end of the life time, what happen to the big gap created in times of man power. By September this year, I will be 5 years on uninterrupted ARVs treatment. I was on PEPFAR enrollment register between 2005 to 2006, I later get a transfer later to ICAP supported facility in Kaduna state. This is a clear indication of being on donors support grogram for good five years. What determines my faith in the next 2 years, with the current threats of pulling out of services by most of these partners, what is my country doing to take over from the this partners, can I afford buying this dugs in the open market? Or I should be ready to faced drug resistance and die simple because my government can not afford their sole responsibilities.



NO ADEQUATE ATTENTION FOR TB CONTROL IN NIGERIA
HIV/AIDS is fueling a resurgence of TB in many areas of the world. Global incidence of TB has increased over the past 10 years, killing approximately 2 million people annually. At the same time, TB is a leading cause of death by infectious disease for people living with HIV/AIDS. Yet when contrasted with the extent of social mobilization around HIV/AIDS, the lack of political commitment to TB control is striking. The TB intervention in Nigeria is almost 80% donor driven since inception (government both at federal and states are not committed financially and some of the partners are threatening to pull out), what happen to thousands of people under Directly Observe Treatment Short cause DOTS?.

The federal government formally launched the National TB and Leprosy Control Programme (NTBLCP) in 1991 and adopted the WHO-recommended DOTS strategy in 1993. President Olusegun Obasonjo has demonstrated his political commitment to TB control through his active participation in high-level meetings of the Stop-TB Partnership, the African Heads of State, African Union and World Economic Forum. Including the Abuja declaration, yet public rhetoric has not been translated into funding allocations, either in the federal budget or at the state level (the national assembly approved over 2 billion for HIV/AIDS in 2010 budget and noting was approved for TB intervention).

Nigeria particularly has been one of the countries worst-affected by the TB and HIV epidemic. In the past 15-18 years, the incidence of Tuberculosis (TB) in Nigeria has silently, but steadily increased, posing a huge challenge to public health. Nigeria currently ranks 4th among countries with the highest TB burdens in the world.

Though, a curable disease, TB has now become a leading cause of death in many developing countries, including Nigeria, with statistics growing continually as a result of the huge HIV burden borne by the African continent.

Nigeria also bears a huge TB and HIV burden. Unfortunately when compared to HIV, awareness about TB among the general population is extremely poor. Despite the existence of a free TB treatment programme, information about how TB is spread, signs and symptoms and where to access TB treatment services is still lacking.


There is low political commitment to TB in contrast to what obtain in HIV/AIDS Programmes. Lack of civil society involvement in TB and interaction between TB and HIV among policy makers, care providers and people living with HIV/AIDS (PLWHA). It is my prayer that the current AIDS, Tuberculosis and Malaria (ATM) project on Community System Strengthening under the GFATM will enable the civil society provide effective and comprehensive services that will help Holt TB in our communities, since they are very closer to the community members.

Other factors include the high level stigma surrounding TB, Insufficient Government Funding for TB programmes compared to HIV and Death of health care workers. Nigeria, budgeted over 2 billion in its 2010 appropriation budget and no single kobo was budgeted for TB control, including states and local government which serves as the entering point for health care delivery.

The previous budget on health in the country is nothing to even talk about, 75% of health budget has been on capital expenditures, staff salaries and allowances, how can the remaining 25% cover 150 million Nigerians as service delivery (the entire budget on health, if divided by our population, every citizen is entitled for only N 750.00). If you take out the capital expenditures, salaries and allowances, what is left is 0 percent compare to the Nigerian population.

Though, Hon. Minister of Health, Federal Republic of Nigeria, promised to use the gaps identified in the 2010 Joint International Monitoring Mission (JIMM) on DOTS, TB/HIV to Nigerian report. The Minister who was ably represented by the Permanent Secretary, promised to develop subsequent plans using the 2010 JIMM report. The problem lies with the national assembly, is the issue of health really their concerns? If yes, I see no reason why the health budget can even be tempered with. Instead, they should look at how to ensure that the percentage on service delivery to the people is reasonable. This is the major and important dividend of democracy if properly demonstrated.

Unless our government at all level began to see these as a big threat towards achieving the MDGs 5 and 6 and also remit their promise on 15% annual budget to health, we are in great danger.

Most of the population remains underserved by TB diagnostic and treatment services.
Even within the states and local governments, clients have been reported to travel a distance of about 40 kilometers every day to receive treatment, which may be a contributing factor to relatively high rates of default on treatment. Patient-centered and community-based approaches modeled after support programs for people living with HIV/AIDS represent a promising model for achieving better DOTS coverage in a country as vast as Nigeria, though implementation will have to be adapted to different regional contexts. In addition, expanded partnerships with NGOs and volunteer programs could bring TB services closer to patients’ homes and help address the
Shortage of trained TB workers.

There is the need to bring the CSOs, the media, and community members on board for increase advocacy efforts for the prevention, early diagnosis and treatment of TB in Nigeria, as well as the need to promote interventions to address the TB/HIV co-epidemic. The need to ensure that community TB care CTBC component of the National Tuberculosis and Leprosy Control Program (NTBLCP) strategic plan is captured in the States specific TB plans placing the State Tuberculosis and Leprosy Control Program (STBLCP) in the driving seat, include a budget for the CTBC that includes provision of monetary and non monetary incentives and ensure a standardized systematic approach based on the National CTBC model is adopted for scale up.


CHALLEGES FACED BY PERSONS LIVING WITH HIV/AIDS (PLWHA):

Stigma is frustrating access to TB treatment especially for people living
With HIV/AIDS and the hostile attitude of health care providers is responsible for this. Nobody would want to go to a place where he or she is likely going to be treated like an outcast. No matter how effective the treatment becomes, at the end of the day, you will simply avoid such places. If that is the only place where such treatment exists, so be it; some individuals would rather die than go there.

Although many HIV/AIDS support groups especially those based in urban centers generally provide information and promote discussion on the symptoms of TB along with information on other opportunistic infections, the general public and even members of these support groups often lack basic knowledge about TB such as the location of treatment centers and the linkage between HIV/AIDS and TB.

Lack of accurate information fuels TB-related stigma. Many people continue to harbor
Misconceptions about TB, including the idea that people with the disease have been “poisoned.”

ANTI-STIGMA BILL, YET TO PASS IN TO LAW: NACA & Ministry of Labour need to sensitize other government agencies, including the national assembly that turned a deft ears to the Anti-stigma bill since inception of politics(In the country only Enugu state that has passed the bill into law), they have forgotten that, their brothers and sisters are also denied job opportunities or school admissions directly or indirectly as a result to not having a law that will protect the right of persons living with HIV/AIDS. The dismissal of the police recruits in Kaduna, Maiduguri, Sokoto, and Lagos over their HIV status in 2007, 10 days before passing out is a typical example and the more reason why NACA need and Labour need to sensitize other government agencies. Let them have copies of the National work place policy on HIV/AIDS, our intervention in 2007 during the sacking of police recruits revealed that, these agencies are not aware of the existence of such policy.

We the person living with HIV/AIDS also need to be up and doing. I see no reason why we should publicly say we want government to be feeding us, is the HIV more special than other sickness in the world, what about those with TB, Hepatitis, Diabetics’ etc, are they not also citizens of the this country. We should not become professional beggars, because we are productive, can work for 24 hours and still remain healthy. I urge my fellow brothers and sisters to be up and doing. We have those who are likely to become governors and presidents among us.

MY STATE, KADUNA IS NOT EXCEPTION OF THE ABOVE CHALLENGES

Let me acknowledge the effort of Kaduna State Government for the prompt release of HIV/AIDS counterpart funding. However, Kaduna state ranks the third list of high-burden TB state in Nigeria. There exist so many partners that provide TB/HIV care and support services in the state, but there is no proper way of coordinating the response of these partners. The partners only find their ways to provide TB/HIV services in their programs. There is no state owned program or facility that is implementing the collaborative TB/HIV services. The State TB and Leprosy Control program has not been funded by the state government for over two years now.

Kaduna state TBLCP in collaboration with some development partners established a TB/HIV partners forum with the aim to ensure integration of TB/HIV services at all levels, and coordinate the TB/HIV response but the forum could not succeed due to lack of funding.

TB has remained the major opportunistic infection that claims the lives of people living with HIV/AIDS on daily bases. The non total free treatment of TB in our facilities also contributed to non adherence thereby patients die on the process (Patients still pay for X-Ray at the rate of 800 to 1,000, unlike the treatment of HIV where patients are given full treatment/diagnoses e.g. CD4, Viral load, PVC etc free). In the case of TB, only the drugs and sputum smear test are free, only HIV patients have access to free diagnoses of TB, but generally people pay to access TB test.

Most of the TB/HIV services in the state and even Nigeria at large are donor driven. There is no adequate sustainability plans by the Government, the private sectors also did not find it interesting to support health related services, instead, they support activities such as entertainments and politics forgetting that TB/HIV is a major factor that if care is not taking, they are at risk of losing their well experience staffs and there will be no body to replace such people. They are also likely to lose a high number of customers/consumers, partners/collaborators, which reduces their production and income.

The civil society are either doing little or nothing about the fight against TB, their focus is on HIV/AIDS possibly because there is funding opportunities on HIV/AIDS programs.

Unless both the private and public sector invest largely to Stop TB/HIV in our society if not, our generation is likely to be wipe-out very soon (the current HIV trend in Kaduna state now is 7% based on the 2008 ANC survey as against 5.6% in 2005, most of which have TB related cases, some have died with TB related cases). We don’t need to leave our responsibilities to development partners alone, hence our country is richly blessed with so many resources and investors.

It is very unfortunate that, despite these challenges in Kaduna state, a huge amount of funds was returned to the World Bank due to in ability of the state in utilizing the funds, NGOs, CBOs, and FBOs were asked to apply for the said funds, huge amount of money was used for first review of  proposals, validation of successful candidates and final selection process. It is obvious that, these funds were returned to the World Bank without awarding to the successful candidates. Since the last disbursement in 2006-2007, NGOs are not empowered to scale up activities at the community level.

HIV/AIDS prevalence still on the increase and reason yet unknown, hence stakeholders are not brought together to find out the reason. Activities are not well coordinated, every body seems to be doing what he/she likes in the state, no proper way of reporting to the state, thereby rendering the state vulnerable with under reporting donors, partners, NGOs, CBOs, and FBOs activities.

What is you and I, doing to address the above challenges.