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 TB/HIV services in Nigerian is donor driven, I wonder what will happen to persons infected by TB/HIV already on drugs in the next 2 years (some partners are already threatening to pull out 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 project period, what happen to the big gap created in terms of man power? By September this year, I will be 6 years on an uninterrupted Treatment of HIV (ARVs). 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 – six years. What determines my faith in the next 2 - 5 years?, with the current threats of pulling out of services by most of these partners, what is my country or state doing to take over from the these partners?, can I afford buying this dugs in the open market? Or I should be ready to faced drug resistance and die simply 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 millions of people under Directly Observe Treatment Short cause DOTS?.
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 5th 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.
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.
Stigma is frustrating access to TB treatment especially for people living With HIV/AIDS and the hostile attitude of some 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.”
Nonetheless, there is low political commitment to TB in contrast to what is obtain in HIV/AIDS Programmes. Low 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 prayers 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 of 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 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.
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!.
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!.
Let me use this medium to call on the Nigerian government across all levels to ensure adequate budget provision in other to address the above challenges. State government should make more efforts towards the prompt release of TB counterpart funding (Kaduna state including others, did not released the counterpart funding for the past 2 years). This is one of the reasons why the development partners are threatening to pull-out their services in the affected states.
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