As Nigeria seeks to tackle high rate of Tuberculosis (TB) in the country, medical experts have called for the adoption of integrated community systems strengthening for effective response.
The experts say there is need for Nigeria to be ambitious in community response and ensure that Community Based Organisations (CBOs) is scaled- up at a level to optimize impact, reach key and vulnerable populations affected by TB.
They also urge the country to address human rights and related barriers to services across the case more widely, and integrate community systems and response to ensure resilient and sustainable health systems.
The experts made the call at virtual Civil Society Accountability Forum 2020 TB Pre-Conference in collaboration with Stop TB Partnership Nigeria themed as ‘Integrating Community Systems Strengthening for effective HIV, TB, Malaria and COVID-19 Response in Nigeria’.
“TB is a major public health problem in many parts of the world, one third of people estimated to have it in Nigeria are either not reached for diagnosis and treatment by the current health systems,” said Chijioke Osakwe , national community TB Taskforce.
“For those patients who are identified, TB is often diagnosed and treated late,” he added.
According to Osakwe, the role of communities and community based organisations cannot be overempahsised especially in finding missing TB cases and treatment.
“Lockdown and fear of COVID-19 reduced hospital attendance by almost 50 percent. Some facilities closed down as a result of infection of health workers with COVID-19, while diagnostic efforts reduced significantly.
“It is advisable for a wider range of stakeholders already involved in community-based activities to be engaged in order to reach the unreached and to find TB patients early in the course of their ailment,” he said.
However, ending the TB epidemic by 2030 is among the health targets of the United Nations Sustainable Development Goals (SDGs). Nigeria ranks first in Africa with the highest number of TB , according to the Global Report of 2019, Nigeria is still missing 302,467 TB cases out of over 409,000 cases expected to be identified, which implies a large potential for continuous transmission of the disease in the country.
“Community Based Organisations (CBOs) should be engaged in the local government areas to implement and find missing TB cases and there is therefore the need to strengthen the integration and functioning of community steering committees in the various programs, create enabling environments and advocacy, form community networks, linkages, partnerships and coordination, and improve resources and capacity building,” said Osakwe.
In the need for a change in approach in tackling the prevalence of TB, Bethrand Odume , executive director of KNCV TB Foundation Nigeria said Nigeria need to begin to work with the partners that are already rooted within the community and in TB interventions, we look at hospital attendees, presumptives we are identifying, before we identify the TB cases and roll them in care.
Odume said that COVID-19 actually made us rethink our strategy and now we are focusing more on community-based interventions because due to the outbreak, all the parameters for TB interventions decrease to an average of 60 percent across the entire TB cascade.
“I think that we really need to partner with the CSOs that are already rooted since we started moving into the communities.”
“Various programmes need to be integrated to implement uniform activities in the communities instead of working in silos. CBOs/CSOs are better suited for CSS because they present in the community and interact with community members. They react quickly to community needs and issues and provide direct services to communities and advocate for improved programming and policy environments,” Osakwe added.
On some of the roles and benefits of community involvement in TB projects, Osakwe said that the community played a role in collecting samples from patients and in giving drugs, noting that they can also ensure adherence and help in ensuring initiation of treatment.
“Health interventions by communities are cost effective. Many of the community members have passion for the project and they know the people. They have greater acceptability.’’
He also emphasised on the need to be involved in design and implementation but most important, there must be an agreement with CBOs on what they can actually do in the communities.
Osakwe also advocated that a certain percentage of programme budgeting be reserved to support CSOs and CBOs as this will ensure continued operation.
Emperor Ubochioma, Programme Management Team, NTBLCP/Global Fund, said that CSS was based on community interventions that are critically looking into issues, stating that integrating services with other areas and entities working on malaria, HIV and even those currently working on COVID-19 are essential for us to implement.
According to Ubochioma, if we want to look at health outcomes, we must look at the approach where the communities are involved in issues of designing the programmes, delivering them and also participate in monitoring and evaluating those services and activities.
“It becomes very vital that every person in the community should be engaged. It is imperative that during our planning and strategic process, all entities and all those involved at all levels should participate to ensure that things are carried out appropriately.”
“We are happy that some key civil society organisations are already working at the community level, but we are hoping that there will be a more integrated civil society organisations because we are still not doing well in TB detection at the community level, particularly because of COVID-19 pandemic,” Ayodele Awe, NPO (TB) of the World Health Organization (WHO), and Board Chair of the Stop TB Nigeria.
