Nigeria is Africa’s most populous nation, with 190 million people, and no less than 21 million are carrying hepatitis B (HBV). A further 4 million have hepatitis C (HCV), according to national statistics. These figures indicate a prevalence of 11% for HBV and 2.2% for HCV but the reality on the ground tells us that the situation is even more dire than they reveal.
Where I live, in Taraba state of North-East Nigeria, the prevalence is as high as 15-16% for HBV and 11% for HCV. In fact, in some communities the HCV prevalence seems to be on the increase. The national study which produced the official figures was done many years ago with a cohort of a very small sample of people and is no longer relevant.
In my own organisation, Chagro-Care Trust (CCT),we run free hepatitis screenings and the prevalence we estimate is quite alarming and far higher than the official national figures. To further compound this problem, less than 4% of the infected population know their status and less than 2% have access to treatment.
In 2016, the government of Nigeria developed a strategic plan to eliminate hepatitis by 2020. In the paper,national goals are for50% of persons infected with Hepatitis B & C virus to know their statusand for50% of all eligible persons infected with either virus to receive treatment by 2020.It’s a beautiful policy but it’s not being fullyimplemented, except for the birth-dose vaccination and screening of blood for donations and blood banks.Unfortunately, the allocationof healthcare resources, including workforce,is skewed towards secondary and tertiary health institutions, where only a negligible number of people access services.
Over 65% of the population reside in semi-urban or rural communities where they can only access primary healthcare institutions such as clinics but over 80% of hepatitis healthcare is provided at secondary and tertiary institutions.Even in terms of equipment, there is a need for good diagnostic technology at the primary healthcare centres. There is also a need for highly-trained specialists as these are the people that have the highest level of training and knowledge on hepatitis.
Due to the lack of access to quality healthcare at the primary level, approximately70% of the health spend in Nigeria is through private institutions and the majority of it comes from out of pocket spending. There is no freegovernment testing or treatment for hepatitis, except in a few states, where pregnant women are tested.Only 4-5% of healthcare spending in Nigeria is covered by health insurance, and there is limited allocation of that to hepatitis.
Advocating for change
As an advocate in the fight against hepatitis, I play roles at the state andnational levels. At the state level, I engage policy makers on why they need to put their feet on the ground and make hepatitis healthcare a priority. Now, I’m glad to say, out of the 36 states in Nigeria, my state Taraba is the only one that has implemented policy on fighting hepatitis. This was directly influenced by the collective advocacy work we did. It’s the only state in Nigeria where the government has put money into providing testing and treatment for citizens.
At the national level, I am privileged to be the National Coordinator of the Civil Society working group on hepatitis; this consistsof all the NGOs working on hepatitis in Nigeria. I’m also privileged to sit on the national working group of the federal ministry of health for the control of hepatitis. That group comprises of clinicians, academia, and civil society groups that produce policy documentation on hepatitis.
We had thehonourof hosting the 1st NigeriaHepatitis Summit in December 2018 in Abuja. We had over 27 states in attendance and biotechnology company Gilead Sciences was the major sponsor of the event. It was the first time we brought together policy makers, directors of public health, civil society groups and academia to look at the extent of the hepatitis problem in Nigeria so as to drive advocacy at the state level.
We wanted to replicate what we had achieved in Taraba and get other state governments to understand why they should invest in hepatitis care. I am glad to say we had commissioners, permanent secretaries and public directors of health from over 27 states. In May this year, we had a follow-up meeting with the federal minister of health and some state governments are beginning to see the urgent need to act on hepatitis.
Another thing we did at the summit in Abuja was to invite the private sector to discuss the possibility of establishing public-private partnerships. In the past we have been able to engage certain companies in providing hepatitis screening and treatment to employees so the private sector has a huge role to play in investing to stimulate action in the fight against hepatitis through corporate social responsibility.
I lost my mother to hepatitis in 2007 and I am also dealing with hepatitis myself soI know what it means to lose someone close to you to this disease, and I know what it means to be a patient. This is the main reason I am determined to see a hepatitis-free Nigeria within my lifetime.
As CCT, we go out and provide free testing to people in remote areas but there is only so much we can do. I have a register of more than 10,000 people in rural communities who have tested positive for hepatitis B & C but are not able to access treatment.
The disconnect between the communities and where the services are available is the main challenge we need to overcome as Nigerian society if we are to defeat hepatitis B & C.If we work together, the elimination of these diseases can become a reality.
- As part of a Pan-African awareness campaign for viral hepatitis B and C — in partnership with the TOTAL African Cup of Nations — Gilead Sciences has asked leading African experts to share their opinions on the disease. The opinions in this editorial are those of the author and do not necessarily reflect the views of Gilead Sciences. To learn more about the campaign, visit kickthevirus.com.
Danjuma K. Adda
Adda is the Executive Director and Founder of Chagro-Care Trust (CCT), a non-profit dedicated to helping hepatitis patients in Nigeria. He is also a viral hepatitis patient group and CFID HIV/AIDS prevention expert. The views expressed are his own.
