As the world commemorates the World Tuberculosis Day, the spotlight has once more been shone on the fight against this deadly disease. The 24th of March every year is a day dedicated to public awareness and to reiterate commitment to efforts to fighting the disease globally. The theme for this year’s Tuberculosis day was “Unite to End TB 2017.”
On this day in 1882, German scientist Dr Robert Koch announced to his colleagues that he had discovered the organism responsible for a disease wreaking havoc on almost all of Europe at that period. The symptoms of the disease included coughing, incessant chest pain, frequent fatigue, fever etc. The name of this disease was Tuberculosis and it was caused by the bacteria, Mycobacterium Tuberculosis.
100 years later, the International Union against Tuberculosis and Lung Disease proclaimed that March 24 will be set aside by international health organisations to commemorate Dr. Koch’s amazing feat. However, the World Health Organisation didn’t officially recognise this day until 1992.
Despite its centuries-old discovery, putting an end to it is another adventure on its own. Tuberculosis (TB) has become one of the deadliest diseases in the world. At least, 9 million people get sick from pneumonia every year. About 10.4 million new cases of tuberculosis were discovered in 2015, making it the highest in recent times and also adding to the existing burden of people infected with the disease. About 1.8 million people also died from tuberculosis in 2015, of whom more than half of them were co-infected with HIV.
Tuberculosis kills more people each year than HIV and Malaria combined. For a country like Nigeria, that makes for grim reading. The HIV endemic numbers in Nigeria is among the highest globally, same as for malaria. Nigeria is also listed among the top 30 countries with high TB burden in the world, coming at number 10. In essence, the top three deadliest diseases in the world are the top three deadliest diseases in Nigeria.
The MDGs/SDGs and eradicating Tuberculosis
How does the world hope to eradicate Tuberculosis?
After the time set for achieving the Millennium Development Goals (or MDGs; they were developed in 2000) expired in 2015, the United Nations developed the Sustainable Development Goals (SDGs) that would be achieved before 2030. While the aim of every target under the MDGs was to “reduce” some of the world’s problems by 2015, the SDGs aim to eradicate some of the world’s problem by 2030.
For tuberculosis, its reduction under the MDGs was achieved. Global tuberculosis deaths reduced by 20 percent between 2000 and 2015, encouraging plans for its total eradication by 2030. This plan is known as the “End TB strategy,” which is to reduce TB cases to about 10 per 100,000 of population per year by 2030. In Nigeria too, under the MDGs, TB death rates reduced by almost half between 2006 and 2015.
However, the new resolution to eliminate tuberculosis before 2030 is suffering a setback. Aside from the increase in new cases of tuberculosis every year, there are other newly developing issues limiting the fight against the disease. New studies have proven that HIV drives “the evolution of new cases of tuberculosis bacterium.” This means there is a new trend of symbiotic relationship between HIV and tuberculosis, making the latter resistant to vaccines especially in patients who were infected with HIV first. That also implies that, apart from some strains of tuberculosis being drug resistant, HIV-positive patients also have a higher tendency of coming down with tuberculosis than HIV-negative individuals, even worse than before.
Eight countries are contributing about 75 percent to this new co-dependent relationship between HIV and Tuberculosis. They include the Democratic Republic of the Congo, India, Indonesia, Mozambique, Nigeria, South Africa, the United Republic of Tanzania and Zambia.
There is anxiety now, caused by the possibility of the world not meeting its target of a 20 percent reduction in TB cases by 2020 (2020 is a marker for the progress of the fight) before the 2030 target.
How Nigeria is fighting Tuberculosis
For Nigeria, the clear question to be asked seems to be, what is its government doing to halt this trend?
The unclear answer is that it increases its health budget, every year, by inches, at snail pace.
In the annual Global Tuberculosis Report of 2016, Nigeria’s status as regarding funding for this deadly disease is embarrassing, to say the least. Nigeria needs about 257 million dollars to eliminate TB from its shores. Right now, there is a funding gap of $141 million to achieving that aim. Most of the available funding is provided by international donors, like the Global Fund, who have now halted donations due to the level of corruption among Nigeria’s health officials.
Meanwhile, Nigeria’s health budget is getting more inadequate every year. Nigeria’s health sector has a 4.17 percent allocation in its 2017 budget, up from about 3 percent in 2016. However, this slight increase is meaningless since the basic commodity on which Nigeria’s economy is based, petroleum, continually loses value, while the Forex required to purchase drugs and vaccines not produced locally also mutes the value of the naira.
304 billion naira was budgeted for Health in 2017 in Nigeria. Using that value, every citizen of the country has about 1,688 naira allocation for health for the year. Absurd, right?
The World Health Organisation reports that for Nigeria to be seen as being serious regarding its health sector, it has to budget at least 6,000 naira per citizen, or at least 1.2 trillion naira for its yearly budget.This implies that Nigeria is a long way off from catering to its citizens’ health.
Nigeria can’t hope to overcome TB, or HIV, or even malaria, with those figures. Hence, it becomes a matter of necessity that high-level discussions be held regarding the state of health in Nigeria. Nigeria has one of the worst indices for health in the world; high maternal mortality, high child mortality, high HIV incidence, and now high TB burden. It also has to battle with the rising costs of tuberculosis vaccines, the multiple drug-resistant strains of TB, the lack of knowledge about the disease among its populace, and the ever present corruption among its health workers.
Fighting HIV alone is a problem; now the country has to battle HIV and TB in individuals. There are no two ways about it; Nigeria simply has to increase its health budget.