A Professor of Community Medicine at Olabisi Onabanjo University (OOU), Ago-Iwoye, Prof. Olusoji James Daniel, has called for adequate investment to address the funding gaps needed for the elimination of tuberculosis in Nigeria. The don, who decried the perpetuation of the disease by society’s social and economic inequality, urged the government and all stakeholders to develop a holistic approach to curb the disease. He noted that implementing strategies that focus on poverty reduction, increasing the minimum wage, generation of employment opportunities and improving general socio-economic conditions will go a long way in reducing the social production of tuberculosis.
The scholar made the submissions on Wednesday, 15th March, 2023 while delivering the 106th OOU Inaugural Lecture at the Otunba Gbenga Daniel Lecture Theatre, Main Campus, Ago-Iwoye. The Lecture entitled, “The Great White Plague: Money, Power, Politics and Public Health” was chaired by the Vice-Chancellor of the University, Prof. Ayodeji Agboola, and attended by eminent personalities within and outside the academia.
Prof. Daniel, who is from the Department of Community Medicine and Primary Care, Faculty of Clinical Sciences, asked government to strengthen the primary health care system in the country and ensure medical services are equitable to reach the country’s poor, vulnerable and marginalised populations. He also called for the inclusion of tuberculosis patients in health insurance schemes to eliminate out-of-pocket expenses and catastrophic costs.
The Inaugural Lecturer, who described tuberculosis as a chronic infectious disease that is transmitted by the airborne inhalation of infectious droplets nuclei, said the disease remains a significant public health problem in the country. While lamenting its prevalence rate, he disclosed that tuberculosis is one of the top 13 causes of death globally, adding that it is now the second leading infectious killer after COVID-19.
with the Vice-Chancellor and other Principal Officers of the University
He said, “In 2021, an estimated 10.6 million people fell ill with TB worldwide, of which 6.0 million were men, 3.4 million were women, and 1.2 million were children. Globally, the estimated number of deaths from TB increased between 2019 and 2021, reversing years of decline between 2005 and 2019. In 2021, 1.6 million people died from TB, including 187,000 people with HIV.” “Tuberculosis primarily affects the lungs in about 80% cases. Still, it can also affect any body organ when the TB bacilli enter the bloodstream and spread to other organs, including bones, skin, brain and vertebral spine which is usually accompanied by fever, weight loss, night sweats, chest pain, shortness of breath, tiredness, loss of appetite and hemoptysis (coughing out blood).”
Quoting the World Health Organization 2019 Global TB Report, Prof. Daniel stated that Nigeria ranks among the 30 high-burden countries where 87 percent of the world’s TB burden resides.
“The WHO estimates a TB incidence of 219 per 100,000 populations, translating to an estimated 429,000 TB cases in 2018. The country notified 106,533 TB cases in 2018, which is about 24 percent of treatment coverage.
However, with the increasing effort of the National Tuberculosis and Leprosy Control Programme (NTBLCP) and partners on TB case-finding, the country notified 120,226 in 2019; 138,591 in 2020 and 207,785 in 2021 despite the impact of the COVID-19 pandemic which brings the treatment coverage rate to 44 percent,” he added.
Prof. Daniel declared that the persistence of poverty as well as social and political factors underlying the epidemiology of the disease have led to the current tuberculosis situation in the country. He bemoaned the poor budgetary provision for the nation’s health sector to be able to adequately finance tuberculosis control, adding that the government’s funding commitment to fighting the scourge of tuberculosis in the country over the years has been limited.
He said, “A nation’s health budget signifies the government’s policy direction and priorities. However, in the last nine years, the allocation to health has been consistently below the 15 percent set by the 2000 Abuja Declaration. In 2019, the health budget accounted for 4.1 percent of the total budget, which does not translate to budget release. In addition, the rising inflation rates, corruption, and the high recurrent expenditure of over 80 percent have adversely affected the development of the health sector.”
“The WHO estimates that 72.9 percent of the country’s current health expenditure is out-of-pocket. These out-of-pocket payments are direct payments made by individuals to Healthcare providers at the time when they make use of health service. This payment constitutes access barriers to needed services and further pushes patients and their families into catastrophic and impoverishing health expenditures.”
The distinguished scholar further observed that the political environments play a crucial role in how the social policies and the health systems affect the successes or otherwise of public health interventions. He posited that the causes of ill-health for millions globally are rooted in political, social and economic injustices, stressing that this is because the political system determines the health policy, resource allocation, workforce policy and the quantity and quality of health services available and accessible by the community.
While proffering solutions to the challenges of tuberculosis, the Inaugural Lecturer emphasised the need to address poverty and social inequality that fuels the disease and provide a better and brighter future for generations unborn. He explained that implementing public health interventions such as economic and social changes, environmental control measures, immunization and health education has been responsible for controlling and eliminating infectious diseases over several centuries.
He said, “The government should embark on programmes targeted at the vulnerable in society, such as women, children and people living with HIV. For example, it could include school meal programmes to boost the nutrition and immunity of children and therefore help them resist TB infection.” “In addition, implementing labour laws that protect workers with increased predisposition to tuberculosis, such as miners and those working with silica dust, will go a long way to reducing the burden of the disease. Furthermore, strengthening social protection initiatives for TB patients through food provision and financial support is desirable to enable the successful treatment of TB patients.”
Prof. Daniel also recommended that patients and community groups should be given a voice and made a part of the decision-making process on issues that concern them. He urged government to provide incentives to private professionals to refer and treat patients and to incorporate tuberculosis notification as a requirement for the renewal of the licence of facilities.
“There is also a need to strengthen a coalition of civil society to demand social accountability and social change from all levels of government and defend the patient’s rights. In addition, all healthcare workers should be encouraged to comply with international and national guidelines such as the international standards for TB care,” he said.
The scholar equally enjoined wealthier nations to support their low-income counterparts struggling with the menace of tuberculosis in the fight against the disease. “The international community needs to close the inequality gap in global trade and provide debt relief to address the structural poverty experienced by low-income countries. The Global Fund and other bilateral and multilateral agencies have invested in TB control in the country over the years to expand TB, strengthen the country’s laboratory capacity and deploy new technologies for diagnosing and treating TB. We call on them to do more to support TB elimination efforts in the country,” he added.
Prof. Daniel, who acknowledged that the Nigerian government had domesticated the End TB Strategy in line with Sustainable Development Goals (SDGs), called for collaboration of stakeholders, the community, civil society and the private sector to eradicate the disease.
“We all know we are good at producing documents and policies in this country, but implementation is usually a challenge primarily because of a lack of political will. Implementing the End TB strategy in Nigeria requires a focus on advocacy and collective action at all levels of government. There is a need for collaboration of stakeholders, the community, civil society and the private sector. We must also implement objective mechanisms to measure progress in implementing the TB programme activities,” he submitted.
