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.
Ayunuku Health Education Center
Saturday 3 September 2011
Monday 29 August 2011
PRE- TEST FOR HIV, ASK YOUR SELF THE FOLLOWING QUESTIONS.
1. What is the difference between HIV and AIDS(write the answer below
2. Name 2 things that people can do with People Living with HIV/AIDS(PLWHA that will not spread HIV
For multiple choice questions below, circle the correct answer. Some questions have more than one correct answer.
3. What are 3 ways that HIV can be spread?
a) Mosquito bites
b) Unprotected sex
c) A mother to her baby
d) Using the same toilet as someone with HIV
e) Sharing needles with someone
4. Three major signs of AIDS in adults and children are;-
a) Weight loss, or slim’s disease
b) Yeast infections in the body
c) Bad diarrhea for more than one month
d) Fever for more than one month
5. Voluntary Counseling and Testing (VCT) includes;-
a) Going to get an HIV test because you to and not because anyone force you.
b) Getting counseling before the HIV test
c) Having your test result results shared with your partner or family
d) Getting counseling after the test
e) Getting medicine to treat HIV
6. What are 3 ways to prevent the spread of HIV from mother to child?
a) Giving ARVs to the mother during labor and the baby shortly after the birth
b) Preventing Malaria and STIs during pregnancy
c) Mixed feeding (giving the baby breast milk and other foods or liquids)
d) Exclusive breast feeding
e) Giving the mother antibiotics during labor
7. What are 3 common Sexually Transmitted Infections (STI)
a) Gonorrhea
b) Yeast infections
c) HIV
d) Herpes
e) Malaria
8. Which statement about condoms is FALSE?
a) Condom can be used for sex in the Vagina, anus and mouth
b) Condoms are not good for preventing unplanned pregnancy (family planning)
c) Condoms can be used as protection from HIV and other Sexually Transmitted Infected.
9. What are 3 important task of the CHW in Community Home – Based Care (CHBC)?
a) Prevention
b) Nursing Care
C) Helping the client with housework
d) Skill transfer to caregivers
e) Buying food for PLWHA
10. What are 3 ways that CHWs can work in the community to prevent the spread of HIV/AIDS?
a) Talking to people and encouraging them to go for VCT
b) Telling people to wear gloves before touching people with HIV
c) Getting community leaders and groups to join in the prevention and support actions.
d) Identifying and referring pregnant women for Prevention form mother to child Transmission (PMTCT)
11. Name 2 common nutrition and eating problems of People Living with HIV/AIDS (PLWHA). Write the answer below)
12. Which is the correct way to make Oral Rehydration Solution (ORS)?
a) 8 tea spoons of sugar, ½ teaspoon of salt, and bolt water
b) 12 tea spoon of sugar, 18 teaspoon of salt, and water.
c) 8 tea spoon of cereal, and boiled water.
13. `What are 2 common AIDS related infections or conditions?
a) TB
b) Too much energy and trouble falling asleep
c) Diarrhea
d) Weight gain
14. What are 2 ways that Malaria can be avoided?
a) Using bed nets treated with insecticide.
b) Getting rid of standing water (like puddle) around the house, compound and community
c) Using cold water to cool the body
d) Taking bitter medicines.
15 what are the three reasons to keep records in CHBC programs?
a) You know what you have done over the past month.
b) You keep busy
c) You are able to plan what materials and time is needed in the next month or year.
d) You can compare the goals you had for the month with what actually happened so you can improve next month.
e) You can help with research on HIV.
16 all people with HIV should take anti – retroviral drug (ARVs).
True
False
17 All babies born to HIV+ mothers get HIV
True
False
18 All pregnant women should be offered voluntary counseling and testing (VCT)
True
False
19 HIV+ women have the right to children
True
False
20 When an HIV+ person has unprotected sex with someone, that person will get infected.
True
False
Magnitude of the Orphans and Vulnerable Children OVC Crisis
The magnitude and severity of the OVC crisis in Nigeria is largely undetermined. It is evident that Nigeria is facing an OVC crisis with more than 7 million orphans due to AIDS and other causes, apart from millions of vulnerable children from several causes. There is a deepening and widening exclusion and invisibility of children in Nigeria. The information available paints a depressing picture of neglect, exploitation and abuse facing a large percentage of children today. It is estimated that 39% of children aged between 5 – 14 years are engaged in child labour; 43% of women aged 20 – 24 were married or in union before they were 18 years old between 1986 and 2004 (SWC, UNICEF 2006). A large proportion (40%) of street children may have been trafficked (ILO-IPEC 2001), estimated 40% do not attend primary school (NPC/ORC 2004) and the rights of most children in Nigeria are being denied.
HIV and AIDS became a national challenge over the past two decades when the first case was identified in a 13 year old street hawker. Since then, about one-quarter of the orphans population in Nigeria are due to HIV and AIDS. The situation of children is further compounded by the worsening vulnerability of children through high maternal mortality, poverty, diseases, armed conflicts, socio-political and ecological problems, and communal clashes leading to family dislocation and instability in family income.
Without taking determined steps to address the specific needs of children, there will be no chance of meeting the MDGs and NEEDS. Each of the MDGs is connected to the well-being of children. Failure to achieve these goals would have devastating consequences for the children of this generation and the adults they will become if they survive their childhood.
ADOLESCENT SEXUAL REPRODUCTIVE HEALTH BACKGROUND IN NIGERIA
Nigeria is the most populous country in Africa. Its population is one of its most significant and distinctive features. With an estimated population of 140 million, Nigeria represents about 20% of the total population of sub- Saharan Africa.
The country’s adolescent sexual and reproductive health profile reveals that Nigerian women give birth to an average of nearly 6 children in a life time. With an annual population growth rate of 2.8%, Nigeria’s population is expected to double by 2015 (to nearly 260 million) requiring a doubling of all infrastructures to maintain the present low standard of living. The current modern contraceptive prevalence rate (CPR) is just 9.8% with little change. Women and girls are the most vulnerable through unintended pregnancy, unsafe abortion, and complications of pregnancy and childbirth (a Nigerian woman’s lifetime chance of dying from pregnancy or childbirth is 1in 13). Low educational attainment further compounds the picture for women and children. Higher education levels often correlate with higher levels of contraceptive use and lower mortality rates, contraceptive use and lower mortality rates among children.
It was estimated that a one year increment in mother’s education leads to a 7-9 % decline in less than five mortality providing incentive for higher contraceptive use. While 78% of Nigeria’s children age 6-12 attend primary school, at least 1.5 million fewer girls than boys enroll in Nigeria’s primary schools. Just 39% of primary 6 school pupils made it to JSS1 in 2002. Adolescent account for a large proportion of the population, up to 23%. By age 19, 70% of all adolescents are sexually active, and most encounters are unprotected. Thus, there is a high rate of teenage pregnancy and a correspondingly high level of unsafe abortion. About 80% of all abortion complications reported in hospitals is with adolescents.
In the last 23 years, since the first AIDS case was reported in 1986 estimates now indicate that the HIV sero-prevalence in Nigeria has increased by more than 3.0% to 5.0% in 2003, with much higher rates reported among high- risk groups. HIV and AIDS epidemic is poised to expand rapidly with women more vulnerable than men, while young women between 15-24 years are the most vulnerable group. The bulk of HIV infections in Nigeria are primarily transmitted through heterosexual sex. Several social, economic, and cultural factors contribute to the spread of HIV and AIDS in Nigeria. Some of these socio-cultural norms and values around sex, sexuality and gender relations. Most communities define a set of ideals that drive norms, through unwritten policies. In most instances, these “policies” are very powerful in shaping the sexual and health seeking behavior or lack of it among the community members.
Other determinants driving the epidemic are poverty, livelihood choices, inadequate access to quality prevention information, skills and care products /services and finally the failure of Nigeria’s leadership (though with few exceptions,) to recognize the seriousness of adolescent sexual reproductive health problem and make it a priority issues, it needs to be in terms of attention and investment.
POLITICAL CONTEXT
Nigeria operates a federal system of government modeled more after American model. The federal government is responsible for giving overall policy direction in key sectors including SRH, HIV and AIDS. They are expected to do this with the active participation of the state. Nigeria has 36 autonomous states that are technically responsible for conceptualizing the policy direction of sectors like SRH and HIV and AIDS thematic areas in their states. In an ideal setting, this conceptualization should be fed upfront into the federal government such that the final product reflects the heterogeneity of the 36 states. Evidence however suggests that this has been a challenge. The approach tends to be one forcing the conceptualization after the policy has been agree and signed off at the centre. This is one of the critical bottlenecks why ASRH are poorly implemented at state levels. The political arena is further complicated in that the Nigeria constitution recognizes 774 local government units. There is ongoing debate on whether local government is a constituent part of the state or whether it represents a 3rd tier of government. As presently constituted they are semi-independent elected structures like the states; they also agree their priorities and state; they also agree their priorities and invest in them, as they deem appropriate. This has a major implication in the efficiency of policy formulation and implication process.
LEADERSHIP & ASRH ISSUES
Despite Nigeria are signatories to different declarations such as UNESCO which states that states should allocate 26% to education, MDG’6 states that state should combat hiv, even the declaration done in the land of the self acclaim giant of Africa; the Abuja + 5 which states that African states should allocate 15% of the national budgetary allocation to health, Nigeria has never allocated up to 10%, though other states are counting down to 2001 UNGASS declaration to universal access to prevention, treatment care and support we are not exceptional to evaluate areas our leaders has done excellently well and were needs improvement A key area where leadership has not been displayed at all is in verbal commitment. Most leaders shy away from talking openly about the root cause of ASRH problem and behavior modification needed to scale down infection rates. There are little resources allocated to ASRH at all levels, especially at state and local government levels. There is a lack of distinct ASRH lines in their appropriation budget, and in general, the state & local government depend on donor funding for most of their activities in the ASRH sector. This is responsible for the slow build up of the response all over the country. Experience of some NGO’s working with government as partners indicates that even where fund is budgeted by government for ASRH bureaucratic process makes the actually allocated fund very difficult to be release.
ECONOMIC CONTEXT
Nigeria presents a paradox in terms of poverty; it is an oil producing country that is wealthy in human and natural capital, but is widely agreed that the incidence of multiple forms of poverty and deprivation are high. Nigeria is the 8th largest oil producing country in the world. The Nigerian economy lacks diversification and is dependent on the export of oil and other raw materials whose prices are low and determined from outside. The most commonly quoted statistics suggests that there has been a rising proportion of the population living below the poverty line. In addition, income inequality has increased. Nigeria is among the 20 countries in the world with the widest gap between the rich and poor.
It is a worldwide phenomenon and particularly so in most of the third world countries that women constitute the larger percentage of poor people, they however remain seriously disadvantaged in terms of access health, education, financial and agricultural extension services owing to legal, use of regulatory, cultural and structural barriers. Gender inequity in access to resources contributes to the rising problem of commercial sex work in the country. Studies done in Nigeria indicate that FSW are in the trade mainly because of poverty; requiring income to meet basic needs. This is compounded by the fact that many also lack needed skills to find alternative employment.
National Response to OVC Programme
The Federal Government has demonstrated its commitment through the inauguration of the OVC National Steering Committee, National Stakeholders’ Forum and National Technical Coordination Group. OVC Coordination Units was also established at Federal and State Ministries of Women Affairs. The OVC National Plan of Action, 2006 – 2010, received the personal approval of the former President’s (His Excellency, Chief Olusegun Obasanjo), the approval of the Federal Executive Council and the National Council of State before it was launched. With financial support from the Round 5 of the Global Fund, advocacy tool kits have been developed and used in advocacy visits to states, capacity of CSOs have been built to respond to the psychosocial needs of OVC. Funds are being disbursed for educational and health needs of OVC through the state ministries of women affairs.
Currently, the response to the OVC crisis is mainly by CSOs, which is largely donor driven, and lacks effective coordination. The scale of the response is not commensurate with the magnitude of the situation. There is high political commitment at the national level, but this is yet to translate to other levels of governance with implementation lacking across board. There are challenges that must be addressed in order to accelerate the national response to the problem. These include the need for effective coordination at all levels, mobilization of resources, capacity building for public sector, CSOs, communities and families to deliver essential services.
1.3 Summary of the OVC National Plan of Action 2006 - 2010
The five-year costed National Plan of Action 2006-2010 addresses, in clear terms, the survival, protection, participatory, developmental ,care and support needs of the most vulnerable children in Nigeria. It was developed through consultative and participatory approaches among all stakeholders, involving adults and children. The Plan adopts gender and rights-based approaches in the development of the framework that will accelerate and provide guidance for the national response on orphans and vulnerable children.
The Plan addresses the following key elements; protection, psychosocial care and support, education, health, household care and economic strengthening, advocacy and social mobilisation, legal and policy environment, children’s perspective, coordination structure monitoring, and evaluation. These are integral to the advancement of child’s rights and the achievement of the UNGASS, Millennium Development Goals and NEEDS. The NPA also sets out roles, responsibilities as well as legal and institutional framework for implementation which includes the strengthening of coordination, partnership and implementation structures. It defines program strategies which includes advocacy and social mobilization, scaling up the campaign on Children and AIDS, resource mobilization, engagement of civil society organizations, participatory rights of children and gender inequality and inequity.
Nigeria has the highest TB burden in Africa and is 4th among the 22 countries with high TB burden globally.
Nigeria has the highest TB burden in Africa and is 4th among the 22 countries with high TB burden globally. Estimated incidence for all cases is 311per 100,000 pop (460,000) and estimated incidence for smear positive (SM+) cases is 131 per 100,000 pop (195,000).
It has an estimated TB prevalence of 521/100,000 (772,000) and estimated Mortality rate of 93/100,000 (138,000). The estimated prevalence of MDR-TB among new TB cases is 1.8% and 9.4% among previously treated TB with a prevalence of HIV in adult TB patients (15-49yrs) 27%.
The Nigerian government formally launched its National TB and Leprosy Control
Programme (NTBLCP) in 1991 and adopted the World Health Organization (WHO)–recommended
DOTS strategy in 1993. Although detection of smear-positive TB cases has tripled
over the past eight years, the overall case detection rate of 27 percent is far short of the WHO target of 70 percent. And while the treatment success rate hovered between 71 and 74 percent from 1996 to 2002—slightly below the global target of 85 percent—the latest annual treatment success rate was only 59 percent.
The NTBLCP provides technical and strategic support for TB control activities to
Nigeria’s 36 autonomous states and this include effective and systematic data collection.
However, planning and implementation of TB services is largely decentralized to highly
autonomous State TB and Leprosy Control Officers (STBLCOs) and Regional National TB
Professional Officers. NTBLP efforts to raise awareness about TB and the requirements of the DOTS strategy and to increase political commitment to high-quality TB control programming must therefore focus on the state level as much as on the federal government.
Due to past patterns of donor involvement, states in the north still have far fewer
TB services than those in the south. Donors, the NTBLCP, and regional and state officials must devote particular attention to expanding TB control activities in the northern states. In addition, states must develop targeted services to address the higher concentrations of TB among vulnerable groups, including the urban poor, people living in remote areas, prisoners, migrant laborers, and people living with HIV.
The Priority Plan for OVC Programme in Nigeria
The Priority Plan (PP) was developed in line with the recommendations of the OVC National Technical Coordination Group (NTCG) after the launch of the OVC NPA in May 2007. This is to provide a platform for effective coordination and implementation of the NPA. The PP takes into account the National HIV AND AIDS Strategic Framework, 2005 – 2009.
All stakeholders are expected to support the implementation of the national response through their organizational plans focusing on the aim, objectives, and lines of action of the PP outlined below. Emphasis will also be placed on supporting the operationalisation of the three ones: National Strategic Framework, coordinating mechanism, monitoring and evaluation.
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