For some health sector stakeholders, it is increasingly unsettling to watch how poor response to early detection fuels and sustains the rise in cases of tuberculosis, a “residual pandemic” that kills an estimated 440,000 people each year in Africa’s most populated country, Nigeria.
The infectious disease that attacks the lungs, leaving affected patients with mainly severe coughs is preventable and curable. But somehow, Nigeria still ranks high among eight countries suffering the highest burden of the disease around the world.
It was at the front line of interest from various support groups and organisations, locally and globally, until the coronavirus pandemic back-benched it, reducing the flow of resources for control in some very vulnerable communities.
Anadach, a health consulting firm has stepped forward to fill these gaps, going after the crucial support that Nigeria’s private sector world can contribute to ending the scourge of the disease.
The Nigerian private sector is believed to have a proven record of supporting disease control as demonstrated in the fight against polio, malaria, and even during the latest COVID-19 pandemic outbreak, where the private sector alliance made significant financial contributions.
Anadach’s theory is that by increasing organised private sector awareness and engagement in TB control, staff screening and detection by occupational physicians can be encouraged. It could also promote coverage of TB care services under private sector insurance plans or medical financing.
Egbe Osifo-Dawodu, founding partner of the Anadach Group said a business-as-usual approach will not yield any positive result, giving her assessment of Nigeria’s TB situation.
She said the country requires transformative actions from all key stakeholders including the private sector and led by government to ensure increased focus on effective advocacy, awareness, early identification and sustainable financing for widespread treatment.
“Given our work, we believe focus on improving the TB Public Private Mix (PPM) is essential to effectively widen access to treatment and diagnosis of TB, in addition to raising additional funding to fill the financing gap to meet the 2030 goals. At this time, the awareness of TB in the private sector is much lower than you would expect given that TB, a treatable infectious disease, is one of the top ten causes of deaths in the country. So we suggest that the government supported by donors in this area, allocate resources to increasing awareness of TB,” Osifo-Dawodu told BusinessDay.
Cases
There were already three million “missing cases” of TB – people with active TB who did not know it and were passing the disease to others while going untreated themselves – before COVID-19 began, according to the 2020 Goalkeepers report by the Bill and Melinda Gates Foundation.
Elsie Ilori, director, Surveillance and Epidemiology Department, Nigeria Centre for Disease Control (NCDC) said Nigeria accounts for 11 percent of the global gaps between TB incidence and notified cases, speaking during an event marking the 2021 World TB Day in September.
With the pandemic outbreak, people either cannot go to health facilities for diagnosis or with the intention to opt out to avoid the risk of exposure, since both diseases share similar symptoms and require an appropriate diagnosis to determine the actual cause.
The foundation raised fears that undiagnosed infections would rise further, leading to a long-term increase in the number of TB cases around the world.
Its projection in 2020 was that countries would have to make case-finding and funding for TB a major priority as they come out of COVID-19. Case finding is a strategy for targeting resources at individuals or groups who are suspected to be at risk for a particular disease.
Data shown in the 2021 edition of the Goalkeepers report indicate that Nigeria saw 344 new cases of tuberculosis per 100, 000 people as of 2018, marking 2.6 percent above the global average.
This spate of new case growth could decline to 265 cases if control efforts remain in the status quo.
But if the country progresses, the figures could drop 18 percent further to 217 new cases per 100, 000 people or otherwise record 33 percent rise to 353 cases in bad incidents of recline.
Part of the federal government’s effort is NCDC’s collaboration with the National Tuberculosis and Leprosy Control Programme to find the missing cases with immediate reporting for TB intervention.
“There is a collaboration to improve surveillance as a case-based outbreak disease using Surveillance Outbreak Response Management and Analysis System (SORMAS),” Ilori said.
SORMAS is a real-time software for outbreak and epidemic surveillance worldwide. It covers infectious diseases from COVID-19 to Ebola and provides the digital infrastructure for timely management and control measures to verify disease cases.
However, recognizing that public intervention alone would not suffice, Anadach Group in partnership with the Institute of Human Virology Nigeria (IHVN) and with support from the USAID/Nigeria Tuberculosis Local Organization Network (TB-LON) is mobilising support to leverage the low hanging fruits of Nigeria’s TB situation, with an end goal of eliminating the disease.
Read also: USAID donates $3.3m to tackle tuberculosis
Apart from improving the financing of TB services in Nigeria, the group expects those private businesses can also play a role to improve knowledge on TB and increase the identification of TB patients.
This can impact the reduction of the TB burden in the workplace, fend off stigma and discrimination against workers with TB and their families through protection and promotion of human rights and dignity.
Olubunmi Ogbodu, Anadach’s team lead, private sector component, USAID TB LON 3 told BusinessDay TB could be ended in Nigeria but will require the concerted efforts of the public and the private sector – with the private sector will complement government’s effort.
“We are not where we should be as Nigeria. We have the highest burden of TB disease on the continent. What we are doing is to mobilise the private sector to improve the detection of TB and get messages out on prevention,” Ogbodu said. “The government alone cannot do this. At Anadach, it is part of our focus to increase the private sector participation in ending TB.”
The consulting firm comes to the fight against TB with 11 years of experience of standing off diseases in different areas of public health intervention. It has worked with the Dangote Group, in the past on malaria eradication and its current response comes under a project that the grant was approved last year.
Interventions
In what speaks to the possibility of support opportunities that can be unlocked with private partnerships, Anadach has raised a total of N30 million on the project, according to a breakdown of achievements provided by the group.
Its advocacy efforts have reached over 2 million people in the formal private sector in the focal states including Lagos, Abeokuta, Ibadan, and Oshogbo.
Over 90 organised private sector stakeholders has been targeted via direct advocacy on getting companies to widen TB screening beyond food handlers to all employees.
Some of the companies engaged in the project tagged TB LON3 include Leadway Assurance and its associated Companies; Unilever Plc; Sterling Bank; GT Bank; Dangote Group; and OLAM.
Others are Animal Care Services Consult; Lafarge Plc; Nigerian Breweries; International Breweries Plc; Sahara Group; GE, Phillips; Honeywell Flour Mills; IHS Towers; and Flutterwave.
It has engaged associations such as the Nigerian Employers Consultative Association (NECA), State Chapters of Manufacturers Association of Nigeria (MAN), and Chambers of Commerce and Industry in Lagos and Ogun states.
Partnerships with some leading health maintenance organisations have resulted in Leadway Health Insurance, for instance, agreeing to expand its TB screening, making it compulsory for all pre-recruitment employees screening from 2021 fourth quarter.
Axa Mansard and Wellness HMO have agreed to integrate TB awareness into quarterly awareness for all enrollees and with their health provider network to ensure TB screening is conducted routinely for employees and enrollees. This is estimated to cover at least 300,000 HMO enrollees and 250 providers. Health Assur HMO has equally keyed into a partnership with Anadach to share TB advocacy messages on their platform.
According to the group’s fact-sheet, advocacy efforts have yielded domestic resources mobilisation, external TB promotion through social media and internal marketing to employees, contractors, and suppliers from partner firms.
About 150 health and safety officers, occupational health physicians and human resources were trained for screening and referral of presumptive TB cases.
As bad as TB might be, Ogbodu said, it is preventable and also curable. She said the group is working to debunk the myth that TB is a death sentence, educating the public that the better part of it is that it is preventable.
“We are working with companies to give advocacy messages and to also train health safety personnel on the risk factors of TB and what to do when suspected individuals are found,” Ogbodu said.
