The National TB & Leprosy Control Programme Framework
The Federal Government of Nigeria established the National Tuberculosis and Leprosy Control Programme in 1988 within the Department of Public Health in the Federal Ministry of Health. It is headed by the National Coordinator who is supported by a team of medical officers, laboratory scientists and other support staff. Similarly, the State TB and Leprosy Control Programme (STBLCP) is located within the Department of Public Health or Primary Health Care in the respective State Ministries of Health. Each STBLCP team comprises a State TB/Leprosy Programme Manager and 2-3 Programme staff.
Each of the 774 LGAs has a Local Government TB/Leprosy Supervisor (LGTBLS) who provides technical guidance to the implementation of activities at the peripheral health facilities in the LGA.
Thematic Areas
Administration
Administration
The admin unit of NTBLCP is responsible for carrying out administrative functions of the program such as Secretary to meetings, Responding to Official correspondences, rendering administrative support to the Programme as may be assigned by the National Coordinator, Draft memos/briefs for consideration by the National Coordinator, Prepare personnel budget of the NTBLCP, General maintenance of the Facilities and Render Administrative Support to the NC.
Finance
Finance
The finance unit is responsible for the management of grants and other financial functions of the Programme. The unit reviews all retirements, processes payments, and documents and files all information both electronically and in hard copies.
Programmatic Management of Drug-Resistant Tuberculosis
Programmatic Management of Drug-Resistant Tuberculosis
The PMDT unit of NTBLCP is charged with the goal to control DR-TB to significantly reduce the burden, socio-economic impact, and transmission of DR-TB in Nigeria.
The two objectives of DR-TB control are:
- To provide access to DR-TB diagnosis to all presumptive DR-TB cases
- To enroll 100% of diagnosed DR-TB patients on an appropriate treatment
The strategic interventions (SI) established for DR-TB include:
- Strategically expand DR-TB diagnostic sites
- Institute a standardized specimen transport system from the point of collection from presumptive DR-TB cases to DR-TB diagnostic centres for DR-TB diagnosis and treatment follow up.
- Increase DR-TB case-finding skills among healthcare providers.
- Strengthen the DR-TB surveillance system.
- Provide prompt, appropriate treatment & care to all diagnosed DR-TB cases.
- Assure adequate supplies of second line and ancillary drugs and supplies.
- Institute appropriate infection control measures to prevent transmission of DR-TB in facilities and the community.
The framework for effective DR-TB control is based on the five essential components of DOTS strategy because the underlying principles are basically the same. DR-TB control in the country has been systematically integrated into the DOTS-based TB control strategy of the NTBLCP.
Laboratory
Laboratory
To effectively control TB, there is a need for quality-assured laboratory services that can detect new TB cases using various bacteriological means to diagnose and follow up on the progress of patients during treatment.
Organization of the Laboratory
The NTBLCP laboratory network is organized in a pyramidal fashion consisting of four levels as follows:
Level 1: many peripheral laboratories provide GeneXpert, Truenat, TB lamp and AFB services and are readily accessible to all TB suspects and patients at the LGA. The NTBLCP strives to ensure that a peripheral laboratory serves a population of at least 80,000 – 100,000 population.
Level 2: one laboratory for each state of the country, including the Federal Capital Territory. NTLCP will ensure that 37 such laboratories are in place.
Level 3: 6 zonal reference laboratories to be in tertiary health facilities in each of the zones.
Level 4: two national reference laboratories, located at the Nigerian Institute of Medical Research (NIMR) to serve the southern part of the country and the National TB and Leprosy Training Centre (NTBLTB), Zaria to serve the Northern part of the country.
The NRL is linked to a Supra-National Laboratory for the purpose of technical support and external quality assurance.
Monitoring and Evaluation
Monitoring and Evaluation
Monitoring and Evaluation (M&E) is essential for successful Programme management and coordination. The M&E system of the NTBLCP is established to ensure smooth Programme implementation and management at all levels. The NTBLCP M&E system encompasses the central unit of the NTBLCP, the States and the LGA and focuses on three main aspects: Programme management, monitoring and evaluation.
To ensure the effectiveness of Programme implementation, the NTBLCP has put in place several Programme review exercises to help provide periodic evaluation and objective assessment of Programme progress against intended objectives. These are quarterly Programme review meetings at all levels (Planning cell meeting at the national level, Programme zonal and State level review meetings) with the singular purpose of providing periodic opportunities to review all planned Programme activities, their progress towards set targets and use the result to inform key Programme decisions where necessary. Data from these various review meetings are also an important source of information to aid improvement in Programme management.
Public-Private Mix (PPM)
Public-Private Mix (PPM)
Among the important interventions required to reach global and national targets would be the systematic involvement of all relevant healthcare providers in delivering effective TB services to all segments of the population. Public-Public and Public-Private Mix DOTS (PPM-DOTS), therefore, represent a comprehensive approach to engage a wide variety of healthcare providers currently outside the NTBLCP. The implementation of PPM-DOTS will improve case detection and case management by bringing all patients managed by these diverse healthcare providers under DOTS.
Community TB
Community TB
Community TB Care is TB Care in a community, by community members who may or may not be health workers and implemented within the context of the National Programme. The major aim of CTBC is to strengthen TB case finding and case holding in close partnership with the communities through community participation that will encourage ownership and sustainability of TB control activities at the community level.
The strategies of CTBC include:
- Effective community engagement through situation assessment, advocacy, communication, and social mobilization
- Capacity enhancement through training of community volunteers/treatment supporters for TB care
- Patient empowerment and mobilization for TB care in the community
- Adopt a patient-centered approach to TB care.
- Programme strengthening through the establishment and strengthening of the recording and reporting system, supervision, monitoring and evaluation.
Procurement and Supply Chain Management
Procurement and Supply Chain Management
The purpose of TB health product supply chain management is to make available effective, affordable, safe, and good quality Pharmaceuticals and Health commodities to all TB, Leprosy and Buruli ulcer patients /presumptive at all times. The success of the TBL programme rests mainly in the provision of essential drugs and supplies. A reliable system of logistics (drugs and supplies) support is therefore a necessity for effective programme implementation. The NTBLCP provides all drugs and supplies free of charge to all TBL patients.
The Major objectives of Health Product supply chain Management Include:
- always Maintaining an adequate stock of medicines in the pipeline i.e., within the minimum and maximum stock levels for all TB commodities.
- Prevention of Stock out and wastages due to expiry
- Ensuring rationale dispensing of TB medicines.
- Ensuring patient safety.
- Maintaining the quality of all TB commodities throughout the Supply Chain Pipeline.
- Coordinating the reconstitution of Laboratory Reagents.
- Ensuring that the LMIS tool, Logistic data and reports collected and collated across all levels of the pipeline are transmitted, aggregated, and used to guide quantification, procurement, and supply of TB commodity.
- Support and strengthen the skills of State logistics officers and LGTBLS on TBL commodity management.
The Central logistics team consist of the NTBLCP PSM Team, the PSM Specialist of the PRs, the FCMS TB focal person and Zonal Logistics officers. Their core responsibilities include Product selection, Quantification & Forecasting, Procurement and Supply plan, Warehousing and Distribution, Ensuring Rational Drug Use, Logistics Management Information Systems (LMIS)
Advocacy, Communication and Social Mobilization
Advocacy, Communication and Social Mobilization
Advocacy Communication and Social Mobilization (ACSM) has been identified by WHO as a critical component in TB and leprosy control, thus effective ACSM activities are needed to support NTLP core TB and leprosy control activities.
Advocacy, Communication and Social Mobilization are three distinct sets of activities designed to address challenges and gaps within the continuum of various approaches to TB, Leprosy and BU control. ACSM activities often overlap and can be used to support each other. For example, communication is often a critical component of advocacy and social mobilization activities. Yet each approach has a distinct target audience and purpose.
ACSM can be expressed as follows:
Advocacy aims to secure needed financial resources and change policies, guidelines, or procedures by influencing stakeholders such as politicians, decision-makers, journalists, e.
Advocacy activities that contribute to TB control objectives include educating philanthropists, politicians, and community and religious leaders. In addition, it helps in reforming legislation or policies or influencing media coverage of TB through the dissemination of media packages and training of journalists.
Communication seeks to increase awareness, influence social norms, and create behavior change among selected individuals or sub-populations. It can also improve interpersonal communication and counselling among people with TB, Leprosy and BU families, and health providers. Communication activities include among other media campaigns, the use of SBC materials for patients and community education.
Social mobilization aims to change norms, improve TB, leprosy, and BU services, and expand community support of TB and leprosy services. It often brings groups together to act on TB and leprosy care at a community level. Organizing social mobilization events and community participation can raise TB and leprosy awareness, promote health-seeking behavior, inspire dialogue, and heighten community concern and action for TB and leprosy control.
The ACSM implementation at the national and state and LGA levels are coordinated through the ACSM sub-committees at the various levels. The ACSM Subcommittee serves as an advisory body to the Programme as well as supports the planning, harmonization, and coordination of all ACSM activities.
Advocacy, Communication and Social Mobilization
Advocacy, Communication and Social Mobilization
Advocacy Communication and Social Mobilization (ACSM) has been identified by WHO as a critical component in TB and leprosy control, thus effective ACSM activities are needed to support NTLP core TB and leprosy control activities.
Advocacy, Communication and Social Mobilization are three distinct sets of activities designed to address challenges and gaps within the continuum of various approaches to TB, Leprosy and BU control. ACSM activities often overlap and can be used to support each other. For example, communication is often a critical component of advocacy and social mobilization activities. Yet each approach has a distinct target audience and purpose.
ACSM can be expressed as follows:
Advocacy aims to secure needed financial resources and change policies, guidelines, or procedures by influencing stakeholders such as politicians, decision-makers, journalists, e.
Advocacy activities that contribute to TB control objectives include educating philanthropists, politicians, and community and religious leaders. In addition, it helps in reforming legislation or policies or influencing media coverage of TB through the dissemination of media packages and training of journalists.
Communication seeks to increase awareness, influence social norms, and create behavior change among selected individuals or sub-populations. It can also improve interpersonal communication and counselling among people with TB, Leprosy and BU families, and health providers. Communication activities include among other media campaigns, the use of SBC materials for patients and community education.
Social mobilization aims to change norms, improve TB, leprosy, and BU services, and expand community support of TB and leprosy services. It often brings groups together to act on TB and leprosy care at a community level. Organizing social mobilization events and community participation can raise TB and leprosy awareness, promote health-seeking behavior, inspire dialogue, and heighten community concern and action for TB and leprosy control.
The ACSM implementation at the national and state and LGA levels are coordinated through the ACSM sub-committees at the various levels. The ACSM Subcommittee serves as an advisory body to the Programme as well as supports the planning, harmonization, and coordination of all ACSM activities.
TB/HIV
TB/HIV
Tuberculosis (TB) and the Human Immunodeficiency Virus (HIV) are among the 10 leading causes of death in Nigeria and indeed Africa. While HIV fuels the TB epidemic in immuno-compromised individuals, TB is the most common cause of death among People Living With HIV/AIDS (PLHIV). TB is responsible for around 30% of deaths among PLHIV. The recorded HIV prevalence among TB patients rose from 2.2% in 1991 to about 27.4% in 2008. The TB and HIV Programme at all levels (National, State, LGA and Facility) should collaborate to address the dual epidemic of TB and HIV.
Goals and Objectives of TB/HIV collaborative activities
The Goal for the TB/HIV collaborative activities in Nigeria is to decrease the burden of TB and HIV in people at risk or affected by both diseases.
Objectives of TB/HIV collaboration are:
- To establish and strengthen the mechanisms of collaboration and joint management between HIV programmes and TB-control programmes for delivering integrated TB and HIV services preferably at the same time and location.
- To reduce the burden of TB in people living with HIV, their families, and communities by ensuring the delivery of the Three I’s for HIV/TB and the early initiation of ART in line with the National guidelines.
- To reduce the burden of HIV in patients with presumptive and diagnosed TB, their families, and communities by providing HIV prevention, diagnosis, and treatment.
Integrated TB/HIV Services
Controlling TB/HIV requires collaboration and coordination between the TB and HIV programmes at all levels. Service integration should include full integration of the TB and HIV/AIDS services in a clinic as much as possible, partial provision of joint TB/HIV services and referral of TB cases and presumptive TB cases between TB and HIV services.
To minimize the burden to the patient it is recommended that the patient receives both TB and ARV medicines from one health facility nearest to his/her home or workplace. ARV drug collection should therefore be made accessible in health facilities that also offer TB therapy, or vice versa.
To facilitate the ease of referral between HIV and TB service delivery points, the use of TB/HIV referral coordinator/volunteers is recommended.
The package of services provided in any integrated TB/HIV service point include.
- Provider-initiated HIV testing and counselling (PITC) for presumptive TB and TB patients,
- TB symptoms screening of all PLHIV for active TB at every visit.
- Diagnostic evaluation for all identified PLHIV with presumptive TB using GeneXpert, X-ray etc.
- Provision of TB preventive therapy (TPT) to all PLHIV who are eligible (see section 6.2).
- Provision of co-trimoxazole preventive therapy (CPT) to co-infected patients.
- Early initiation of ART in all PLHIVs with TB.
- Immediate initiation of TB treatment in PLHIV infected with TB.
These services are provided in a setting with optimal TB infection control measures.
Childhood TB
Childhood TB
The childhood TB unit manages the peculiarities of diagnoses, treatment, and management of childhood DSTB and DRTB cases. They are responsible for developing guidelines, SOPs, desk guide and other treatment protocols specific for child Tb case.
The broad DOTS and follow-up strategies are employed for the management of adult and child TB cases with similar regimens. The main aim of the unit is to ensure all strategies employed by the NTBLCP are tailored to ensure accessibility and availability to child TB presumptives and cases.
Childhood TBLeprosy and Buruli Ulcer
Leprosy and Buruli Ulcer
The Leprosy and Buruli ulcer (BU) unit is responsible for the coordination of all Leprosy and BU activities in the country.
Leprosy is a chronic, infectious disease that mainly affects the skin, peripheral nerves, and mucous membrane of the upper respiratory tract. It remains a disease of public health importance. Nigeria achieved the World Health Organization’s (WHO) elimination target of less than 1 case per 10,000 population at the National level in 1998. However, some states are yet to reach the elimination target of Leprosy.
In Nigeria, about 3,000 leprosy cases are reported annually in the last seven years with a relatively high proportion of children and high proportion with visible disabilities. Leprosy services are provided as an integral part of the general health services in all 774 LGAs. The World Health Organization (WHO), the International Federation of Anti–Leprosy Associations (ILEP) and other partners support the government efforts in Leprosy control.
Case detection in Leprosy is mainly passive. However, active methods such as Leprosy Elimination Campaign (LEC) and mini-LECs were introduced by the NTBLCP in collaboration with partners to actively search for leprosy cases in areas with high prevalence of the disease. There are ongoing efforts to integrate leprosy case detection into the activities of community volunteers and community-directed distributors (CDDs) for Ivermectin.
The overall goal of BU control is to reduce the morbidity, disabilities and socio-economic consequences caused by the disease.
STRATEGIES
- Advocacy, social mobilization, and partnership
- Staff training on early identification and diagnosis
- Early and community-based case detection
- Confirmation of cases
- Case management (antibiotics, surgery, and prevention of disabilities)
- Strengthening health structures
- Supervision, monitoring and evaluation.
The National Tuberculosis and Leprosy Control Programme (NTBLCP) was established in 1989 by the Government of Nigeria to coordinate TB and leprosy control efforts in Nigeria.
QUICK LINKS
HEALTH AREAS
CONTACT US
HEADQUARTERS
No 16, Bissau Street, Zone 6,
Wuse, Abuja
Email: ntblcp@yahoo.com
Call/SMS: +234 906 992 2128
Whatsapp: +234 815 418 4624