Dr. Bethrand Odume is the Country Representative Officer, KNCV Nigeria. In an encounter with our Correspondent at a 2- day brainstorming session with stakeholders on the KNCV TB Foundation Nigeria Local Organisation Network (LON) Grant Application, he explained the challenges bedeviling the successful fight against TB in Nigeria.
Why this meeting and what do you want to achieve?
The KNCV International have actually been in Nigeria since early year 2000. Over these years they have been supporting the National TB Response in over 26 states in the country.
The started with their first project TBCTA, TBCAP,TBCARE1 and the one that ended December last year.
In early 2016, they have actually helped to midwifed the local KNCV, that is KNCV TB Nigeria. In as much as this office is concern, we have the international arm and equally have the local arm that is coming up.
This is because the thinking of most funding agencies is to think home-indigenization. How do we used the people to do the work to ensure sustainability.
You know the TB we are fighting here is in Nigeria. Those affected are our relations, it could even be we ourselves. Since we have been depending on international agencies, people don’t even know that we can look inward.
There are some philanthropists here in Nigeria, government can also support some Non Governmental Organsations (NGOs) to do what some of these international organisations are doing. The funding landscape is changing. People are looking more into working with local organisations to device local mechanisms through which this can be done within those local communities.
Because of that thinking, that is why the international NGO-KNCV actually midwifed the local NGO.
Now opportunities are coming up, there are some funding for TB control that US Agency for International Development (USAID) is looking at how they can engage some local organisations. Not only that, we have interest in other funding opportunities, but what actually matters most is that nobody is an island when it comes to knowledge.
If you look at our meeting here today, you could see health journalists, people affected by TB, Civil Society Organsations (CSOs) and the National TB Programme and people came from local governments (supervisors).
The essence is, let us all brainstorm because there are issues around TB control in Nigeria. The gap in detection has been very enormous about 74-75 per cent over the years.
Now we felt we should come together, tap into knowledge, share experiences and what actually are the best issues.
As a new organisation, we are actually interested in opportunities around and for us to throw in some of these applications, we need to involve some of these stakeholders, get to know some of the issues to help refine some of the issues we have. That is the essence of this meeting.
We are rubbing minds and the outcome of this meeting will actually help us not only now but in any subsequent grant application that we may throw in the area of TB control.
What positive impact will this meeting make to an ordinary Nigeria?
The benefit of this meeting is that we are repositioning ourselves for opportunities. Being an NGO, what you use to do your work is the grants and for you to get the grants, you need to convince the funders that you have the strength to do it, you have the appropriate strategies and the systems to checkmate that if you are given one naira, you will be able to use it for what it is meant to do.
The essence of this meeting is that we are brainstorming what are the key issues around TB, what are the key challenges and the strategies that had worked.
You could see some Professors here from the academia. We are looking at evidence and we are actually gathering these things as an organisations, once we see any grant application we tap in.
You could also see people here from different backgrounds even from the facility level. We are actually building a data base of knowledge that these are the key issues and the strategies to tackle them.
As a local organization, any time we see any opportunity, we tap into it. You could see, we worked in groups and a lot of facts had actually been generated.
Look at these things that actually came from the three groups, they could address the issues around TB. What we are generating here will help us going forward and I have told the team that this thing should be a continuous thing.
Looking at TB control in Nigeria, are we making progress?
We are making progress but we need to do more. Take for instance, one case of TB that is not treated in a space of one year can infect 15 to 20 people. Last year, Nigeria detected over 100,000 cases of TB. Out of estimated 480,000 people. A gap in case detection is still enormous, over 70 per cent. If you look at that, you will say we are not making progress.
But for us to have detected over 100,000 cases and put them under treatment, we have actually helped to limit the transmission if those 100,000 were not treated. But we need to do more because a prevalence survey was done in 2012 that showed us that the gap is very enormous.
The knowledge gap is very wide. If you go to the communities, a lot of people don’t even know that treatment of TB is free.
The health system is not strong, sometimes you get to the health facility, you may not even see who will offer you the care.
When go to the DOTs Centres where people have been trained, but due to the issues around support, salaries, there could be strike and when they move to the private sector, it is profit driven even the drugs that are free are charged in the private sector and we know the level of poverty in this country.
For us to be able to confront this TB, we need multi sectoral approach. The community, the government, some of us working in the NGOs, all of must be on board because the gap is enormous.
We can talk about funding, the level of government commitment is not what actually is expected. When we talk about funding, people think it is only the federal government. We have three tier of government, the federal is doing its best. But what is happening at the states and local governments and the at the community. The issues are actually enormous.
We have seen progress over time, they have increase service delivery points across the country. With the coming of Gene Xpert, now we can make diagnosis of TB within two hours. We have over 400 platforms across majority of the local governments in the country. More need to be done.
Because of the many challenges, in our office, we try to support Gene Xpert optimization funding from USAID over time that has actually shown that when you ensure continuous light supply, provide support for adhoc staff, some of these machines can be optimized.
Gene Xpert is actually the current technology in town, but we actually need more experts.
Have NGOs like KNCV and others been able to let the states and local governments know about the need to intervene in the TB situation?
One thing I am actually seeing in the effort against TB is the role of the Stop TB partnership in Nigeria.
The Stop TB partnership is an NGO in Nigeria that is actually a forum where multi stakeholders meet. KNCV that I represent is a board member. There are some opportunities we have explored recently looking at the Governor’s Forum where they come and we were able to show them TB score card.
Across most of the states, the funding gap ranges from 76-100 per cent. There are some states that what the government brings on board for the control of TB is actually zero.
We think if the states and local governments can bring more money it will go a long way.
Everything about TB, the international agencies through the USAID have provided the drugs free, the reagents are free but you need to support the health system. It is not only the drugs and reagents that will do it, there must be structures.
These are some of the issues the states and local governments need to do more.