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Bridging Funding Gaps For Tuberculosis Treatment



As nations strive to meet the sustainable Development Goals (SDGs) on Tuberculosis (TB) elimination by 2030, Nigeria is not left out, giving its present status in global disease prevalence fact sheets. According to the 2017 Global TB Report, Nigeria is among the 14 high burden countries for TB, TB/HIV and Multi-Drug Resistant TB (MDR-TBl). The country is also ranked 7th among the 30 high TB burden countries and 2nd in Africa.
Nigeria is also among the 10 countries that account for 64 percent of the global gap in TB case finding. India, Indonesia and Nigeria account for almost half of the total gap.
The World Health Organisation (WHO) estimates that 210,000 new cases of all forms of TB occurred in the country in 2010, equivalent to 133 per 100,000 population.
The National Strategic Plan (NSP) on tuberculosis shows that Nigeria requires $336m to address TB challenges by 2020.
A breakdown of the funding in Nigeria so far shows that $31m (9 per cent) has been provided domestically, $90m (27 per cent) raised through international donors agencies leaving a $215m (64 per cent) funding gap.
WHO said although the African region has made good progress in controlling TB, it still has the world’s highest levels of the disease, and only half of existing TB cases are being found by its health systems
WHO Regional Director for Africa, Dr Matshidiso Moeti, said “We have the most patients infected with both HIV and TB, and are seeing alarming increases in the forms of TB that resist treatment with common medicines.

“ Finally, governments are contributing only a quarter of the resources needed to provide adequate TB services, and 40% of needs remain unfunded.
“A TB-free world will only be achieved through leaders who champion efforts to end TB at local level”, he stressed.
According to him, leaders have tremendous influence to build strong partnerships and commitment to end the TB epidemic at every level while calling on governments, parliamentarians and policy-makers to drive ambitious plans that will accelerate TB control at national level.
Moeti also called on health workers, nongovernmental organisations and technicians to maximize the use of proven methods to diagnose and successfully treat all types of TB, and for researchers to do the scientific studies needed to inform policies to help improve and monitor TB services.
He urged community leaders, patient advocacy groups and people affected by TB to partner with government to ensure access to treatment for all.
Also calling on governments to push for universal coverage with proven high quality services, Moeti urged it to scale up domestic funding for TB control and take responsibility for essential medicines and laboratory supplies.
He said since TB is found in communities where human rights and dignity are often overlooked, governments should lead actions beyond the health sector to address environmental, economic and other factors which increase the risk of TB.
“The implementation of these actions requires strong leadership. We want leaders for a TB-free world”, he stated.
Stakeholders in the health sector have however expressed the view that the Nigerian government alone is unlikely to increase its funding for TB because the Debt Management Office (DMO) recently reported that Nigeria’s total debt has increased by about 90% in almost three years from N12.6 trillion in December 2015 to about N22.71 trillion as at March 2018.
In addition to the figures reported by the DMO, there is N1.95 trillion deficit in the 2018 budget
Critical stakeholders therefore opined that mobilisation of domestic resources especially from the private sector will address the funding gap for TB.
But the minister of Heath, Prof. Isaac Adewole, said that in 2017, only 36% of the total funding required for TB control was available. This he said, is grossly inadequate to make the desired impact.

According to him, in recent years, donor resources have continued to dwindle thus threatening sustainable TB control financing in the country.
The median cost for patients treated for susceptible TB in 2016 was $1,256 while that of Drug Resistant Tuberculosis is $9,529.
Adewole said: “Thus, it is evident that TB control requires considerable financial outlay. It is important to note too, that the cost of increasing efforts is even much higher.”
He however informed that the Private Sector Engagement for TB is also being vigorously looked into as there is a robust Public-Private Mix (PPM) engagement plan for TB.
“Similarly, during the National Council on Health (NCH) meeting in Abeokuta, Ogun state, a resolution was passed mandating all private health facilities in the country to compulsorily notify TB cases.”
“In view of the enormity of the challenge and paucity of resources, I want to call on all our partners and private individuals not to relent in rendering support to the country,” Adewole stressed.
The minister however informed that “Nigeria currently has 6,753 DOTS centres compared to 3931 in 2010. The total number of microscopy centres has risen from 1,148 in 2010 to 2,650 in 2017. GeneXpert machines installed in the country have increased from 32 in 2012 to 390 in 2017.
“Treatment centres for patients with DR-TB have expanded from 10 in 2013 to 27 in 2017. The number of TB reference laboratories has also increased from 9 in 2013 to 10 in 2018. Over 90% of the TB patients notified in 2016 have documented HIV test results compared to 79% in 2010,” he stated.
Adewole said in addition to this, shorter drug regimen for the treatment of DR-TB was introduced in the country in 2017 to reduce the treatment duration for patients with DR-TB and ensure better treatment outcomes.

Meanwhile, as part of efforts by the private sector at assisting the government in bridging the gap, the CEO, Kleef & Helixor Pharmaceuticals Nigeria Ltd, Dr. Cliff Ogbede, disclosed that plans are underway for YURiA Pharm, a foremost Ukrainian manufacturer of TB treatment and preventive drugs, to support Nigeria in the fight against TB by providing pediatric friendly Isoniazid Syrup/Anti-TB therapy.
According to him, this would be used for the effective and safe treatment and chemical prophylaxis of TB for diseased and infected children with BCG vaccination complications.
He said the syrup will also be useful for those who had come in contact with tuberculosis patients. Adding that his company, in collaboration with Yuria Pharm plans to build a manufacturing plant in the country to help meake TB drugs readily available for patients in the country.
“Through the necessary support from the federal government, the proposed plant will enable us to satisfy the local market, improve the health of TB patients in Nigeria and equally export to the neighbouring countries within the region,” he said.