The National Strategic Plan for Tuberculosis 2015 – 2020
The new information and new technology now available to the NTBLCP call for a major rethinking of the approaches the programme is using to control TB in Nigeria. The mid-term review of the national strategic plan for TB 2010 – 2015 underscored one key performance challenge that has the highest priority in this new NSP-TB: case notification. The prevalence survey results reinforced the need to strengthen case finding and diagnostic capacity to bring down the backlog of prevalent cases and prevent ongoing transmission and mortality. Many national strategies and assessments have enumerated the key health systems weaknesses that must be addressed to improve health programme performance.
This NSP-TB presents an ambitious agenda for rapid scale-up of services to achieve universal access to TB prevention, diagnosis and treatment, with an emphasis on quality, accountability, linkages between the different levels of the health system and partnerships that leverage the resources and efforts of other disease programmes and initiatives to have a greater impact for TB control.
The NTBLCP will prioritise the following approaches as part of this NSP-TB, based on a thorough analysis of available evidence:
1. Maintain and expand basic diagnostic and treatment services, with a focus on quality implementation and expand screening and referral activities to all PHC facilities to provide universal access to basic services;
2. Integrate TB screening and referral/case-finding into the routine activities of public non-TB service providers, military and paramilitary providers, private providers, faith-based organizations, community providers and community-based organizations to increase case notification at low cost;
3. Shift from passive to active case-finding in key affected populations, including PLHIV, urban slum dwellers, men, prisoners, migrants and internally displaced people, nomadic populations, children, people with diabetes and facility-based health care workers, to target those most at risk for TB;
4. Scale up use of rapid TB diagnostic technologies to serve groups at risk for missed or delayed diagnosis, including PLHIV, children, people with smear-negative TB, extra-pulmonary TB or presumptive drug-resistant TB;
5. Work with NACA and NASCP to scale up integrated TB and HIV services at the local level in the areas with the highest burden of co-infection;
6. Concentrate community-based treatment support in poor-performing areas to reduce loss to follow-up and creation of drug resistance;
7. Expand services for DR-TB based on an ambulatory model, with rigorous supervision and community-based patient support;
8. Seek cost-savings in routine activities such as training and supervision by partnering with NACA, NASCP and others;
9. Improve the procurement and supply management system to assure an adequate stock of drugs and supplies where and when they are needed and integrate the system with other disease programmes as possible to realize cost savings;
10. Design and implement an electronic reporting system that captures and analyses TB data for use in timely programme monitoring and improvement and assure its compatibility with the DHIS2;
11. Establish linkages with and coordinate stakeholders to advocate for domestic resource mobilization at federal, state and local levels; and
12. Leverage existing resources through other government agencies and initiatives to strengthen the health delivery infrastructure at the primary health care level, where TB services should be available.
While basic TB services will be expanded to cover all the country, the NTBLCP analysed existing epidemiological and performance data and has prioritized geographic regions for intensified interventions to increase case-finding in 13 states and the FCT, representing an estimated 50% of the missing cases in Nigeria. The analysis was conducted based on burden of HIV, current case notification rates and current population coverage of TB diagnostic and treatment services. Priority was given to states with a high burden of TB, a large gap in actual versus expected case notification and low coverage of services, based on a weighted ranking (see Annex 2 for a detailed description). FCT was added because of the high concentration of key affected populations within the FCT area.
The intensified intervention package will include community outreach for demand creation; active case-finding in key affected populations; public-public- and public-private mix strategies to engage key care providers in case-finding activities; scale-up of rapid diagnostic technologies; and expansion of treatment capacity to meet the increased need. States targeted for this intensified package of services include Akwa Ibom, Anambra, Bauchi, Borno, Imo, Jigawa, Kaduna, Kano, Katsina, Lagos, Oyo, Rivers and Sokoto as well as the FCT.