As this year winds down, more than 100,000 would have lost their lives to tuberculosis, according to the global TB statistic from the World Health Organization.
The statistic estimated 157,000 TB deaths for Nigeria in 2019, with about 429,000 new cases, and 302,467 undetected cases.
Experts predicted these deaths and infection could even be much higher with this year’s COVID-19 lockdown and fear reducing hospital attendance, hence the need for urgent intervention.
Based on this, and in a bid to find the huge undetected TB cases, experts are advocating for community involvement in finding missing TB cases and treatment.
The experts made the call at virtual Civil Society Accountability Forum 2020 TB pre-conference in collaboration with Stop TB Partnership Nigeria themed; ‘Integrating Community Systems Strengthening for effective HIV, TB, Malaria and COVID-19 Response in Nigeria’.
According to the chairman of the board of Stop TB Nigeria, Dr. Ayodele Awe, about 75 per cent of these undetected TB cases are found at in communities. Hence, need to integrate a community-based approach to find the missing/undetected TB cases in Nigeria.
“Integrating community system strengthening for effectively controlling HIV, TB, malaria and COVID-19 response is very important,” he said.
“For us in TB, community level is the operational level for TB. It is at this level that we were told In a previous survey carried out in 2012 on TB, that 75 per cent of the TB cases that we are not detecting are in the community and we don’t know them.
“We need to increase our collaborative activities to ensure that we are able to detect cases.
“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,” Dr. Ayodele, said.
“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 other to change the 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.x
According to Odume; “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 decreased 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.”