Update on PPM-DOTS in Nigeria Dr. Joshua Obasanya National Coordinator, NTBLCP

Country information

Nigeria a Federal country with 36 states and FCT

774 LGAs

Population – 150million

The private medical sector is estimated to provide health care to up to 60% of the population

Schemes for PPM collaboration

SCHEME 1:Referal of patients suspected of having TB

SCHEME 2: Provision of direct observation of treatment

SCHEME 3A: Microscopy only center

SCHEME 3B: Microscopy and treatment centre

PPM States in Nigeria 3/4

Progress in PPM-DOTS 1/4

Conducted PPM National Situational Assessment (NSA) in January 2007

Developed and implemented 2007 – 2008 PPM Operational Plan

Developed PPM Operational Guidelines

National PPM Implementation Guideline

National HDL Plan

Adapted Training Curriculum on ISTC

Progress in PPM-DOTS 2/4

National PPM Steering Committee Inaugurated in 2008 and operational

State PPM Steering Committee in 12 States and operational

PPM implementation in 32 states Nigeria

A total of 404 PPM Centres collaborating with the programme as at 2009

Number of faith based health facilities collaborating with the NTBLCP increased from 72 in 2005 to 101 in 2009

Number of private for profit health facilities institutions collaborating with the NTBLCP increased from 28 in 2005 to 309 in 2009

Progress in PPM DOTS 3/4

Endorsement of the ISTC by the Nigerian Medical Association

52 tertiary health institutions offering TB treatment services

HDL being implemented in 12 tertiary hospitals.

Over 50 doctors trained on HDL and ISTC

Progress in PPM DOTS 4/4

Over 500 medical officers trained on the DOTS programme

Over 1000 GHWs trained

Over 200 lab personnel trained

PPM facilities

Zone

Private for

Profit

Private not for

Profit Total

North

Central 7 16 23

North East 32 8 40

North West 22 12 34

South East 106 38 144

South South 60 3 63

South West 76 24 100

Total 303 101 404

PPM contribution to case finding in 2010

Total TB cases registered (All forms) - 90447

New smear positive cases – 45416

PPM care providers (including non-NTP public providers such as Teaching hospitals) contributed 35% (31 656 cases) of the cases notified in 2011.

The Nigerian PPM mandate

To scale up PPM services such that it contributes to at least 15% of total TB cases detected by the end of 2015

Specific objectives of PPM-DOTS

To standardize TB case detection and treatment.

To improve TB case detection.

To improve treatment outcomes.

To improve access to TB care for the poor.

To reduce diagnostic delay.

To reduce financial burden of TB on patients.

Planned Activities in the 2011 – 2015 National Strategic Plan

TOT workshop for selected private practitioners (to support scale up of PPM activities)

Strategic Expansion of DOTS services to Private health care facilities.

Establish TB/HIV services in at least 70% of eligible PPM facilities by 2015

Implement HDL in all tertiary health facilities by 2015

Establish DOTS services in at least 85% of Nigerian prison

Challenges

High attrition rate of trained staff

Non-use & dissemination of patient charter

high expectations of incentives and enablers from the programme.

Insufficient health work force

Low coverage of EQA activities in private hospitals & laboratories

Non-disaggregation of PPM data

Challenges

Too few stand-alone labs for PPM activities

Low specialist physician involvement in PPM

Non-involvement of patent medicine vendors

Inadequate linkages & support for private practitioners

Way forward 1/2

Implementation of PPM DOTS activities as contained in the National Strategic Plan

Targeting of big cities and busy private hospitals for PPM instead of trying to reach all states

Implementation of the approved TB CARE COP 2010/2011 PPM activities

Effective linking of PPM facilities with the NTBLCP

Way Forward 2/2

NTBLCP to ensure that all PPM states report disaggregated PPM data per quarter

Introduce quarterly meeting between State programmes and PPM focal persons as an incentive for private providers

NTBLCP partners in PPM implementation

WHO – Technical support

USAID supported TB CARE – driving most PPM DOTS activities

GLRA – Initiated PPM DOTS in the country

Private for profit facilities

Faith Based Organizations (Christian Mission and Islamic Health Institutions)

Military and Para-military Health Facilities

Tertiary Hospitals in HDL

Corporate and Industrial Health Facilities

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Poser

How do we sustain the achievements made

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THANK YOU