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Why are state governments refusing counterpart funding to fight TB

by Haruna Gimba

By Hassan Zaggi

There is no doubt, Tuberculosis (TB) is a major challenge in Nigeria. Worst still, the funding for the fight against the disease is lean across all levels of government. More shocking is, most of the funds use to fight TB in Nigeria are donor-driven.

Over the years, the political commitment by the Federal and states governments are yet to translate to adequate budgetary allocations for TB control

This, therefore, cripples the efforts and heightens the fears of sustainability of the fight against the disease in the country.

This brings to the fore the need to develop new models of funding where both the federal, states and local governments will be deeply involved in a systematic manner to fight the disease to a stand-still.

Counterpart funding which is a system where a donor partner provides some funds and expects the recipient to bring a particular sum to add up in order to execute a specific developmental project has been a long acceptable model of funding capital intensive projects.

At this critical time of the fight against TB where the figures are not too impressive, Nigeria needs this model.

Truth be told, even though Nigeria is making little progress in the fight against TB, it is clear that Nigeria is losing the war against the disease due to inadequate funding. This is what most government officials will not want to hear. However, it is the truth.

The bitter truth is that Nigeria has 70 per cent funding gap and equally, 70 per cent gap in TB case finding. This further clearly shows that if there are more resources, more missing cases will be uncovered.

Even though the new management of the National Tuberculosis and Leprosy Control Programme (NTBLCP) under the leadership of the current National Coordinator, Dr  Anyaike Chukwuma, is doing considerable work, case detection of TB is still low. The disease is also fast spreading among communities.

The Dr Chukwuma-led management, however, deserve our applause because, for the first time in the history of the country, in 2020, Nigeria recorded 50 per cent increase in TB notification from 138,591 cases to 207,785 cases. This is still not enough.

Another worrisome dimension about TB in Nigeria is that it is fast spreading among pupils in primary and students in secondary schools.

 In Nigeria, an estimated 156,000 people die as a result TB every year. This, therefore, indicates that every hour, an estimated 18 people die of TB. By extension, 432 people die of TB every day. This is unacceptable.

Findings also revealed that Nigeria is among the 30-high burden countries for TB, TB/HIV and Multi Drug Resistant TB (MDR-TB).

Sadly, however, Nigeria is said to rank 6th among the 30-high burden countries globally and number one in Africa.

On the other hand, Nigeria accounts for 11 per cent of the global gap between TB incidence and notified cases and out of the 452,000 estimated new TB cases in Nigeria in 2020, only 138,591 were notified to the NTBLCP with only 30 per cent treatment coverage.

Regrettably, Direct Observation Therapy (DOTs) clinics are only available in 44 per cent of health facilities in Nigeria. Only 9 per cent of them have TB diagnostic services.

In another twist, TB is the leading cause of death of people with HIV and a major contributor to antimicrobial resistance.

This, therefore, calls for serious partnership and collaboration with partners across the globe to get the needed support through counterpart funding to intensify the war against TB.

But the question thus is: Why are most state governments running away from counterpart funding to fight TB?

It is, however, worrisome to note that most states across the federation are not well disposed to counterpart funding to fight the disease even when the opportunity presents itself. Painfully, however, such state governments don’t make budgetary provision for the fight against the disease in their states.

Providing reasons for the foot-dragging by most state governments to contribute to the fight the disease, a top government official who is deeply involved in the fight against TB said: “We all know the mind-set of our leaders. They look at TB as the disease of the poor and them at that level their children, wives and other members of their families are not affected.

“So, because these things are not directly affecting them, they don’t really feel that pain as a result, they are not being pushed to do what they are supposed to do.

“If the state governors had lived up to their expectation, we won’t be where we are as far as the fight against TB is concerned.”

The top government official who pleaded anonymity further disclosed that: “The donors are still open for the governors to key in and access the funds through the payment of the counterpart funding.

“Also, we are still open, whenever we go to them we are still advocating to them to do something. There are some states that are trying and results from such states are also showing that the state governors are actually supporting the programme.”

Counterpart funding, most experts believe can help greatly in the fight against TB in Nigeria as according to them, it will bring more resources to the country because many foreign partners will see the country as being serious, hence, will be encouraged to bring more funding support.

“I think counterpart funding can help immensely in the fight against TB and it can be seen as a way of getting government to commit where the funding agency can say in all the estimated cost, we are going to bring a certain percentage for us to commit that percentage you need to bring yours. I think if that is pushed, it will actually help in bridging the gap in the fight against TB,” says, the Executive Director, KNCV Nigeria, Dr. Bethrand Odume.

Mayowa Joel, Executive Secretary, Stop TB Partnership, however, urged the governments at all levels to take the issue of counterpart funding serious, “because if partners are raising funds for us through the money from tax payers in their countries, I think the least our government can do is to give some agreed amount as a commitment as their own contribution.

“This is very important because it is part of domestic financing to TB. Whatever we give as counterpart funding is counted as part of our domestic resource mobilization.

“In a nut shell, this is what the government should take seriously because if we don’t give our own share of the counterpart funding agreement, what we are saying indirectly is that we don’t care about the health of our people, the donors should take care of them.

“This should not be because the government should be responsible for the health and welfare of its citizens.”

The governments at all levels must rise to the occasion and take responsibility for the health of our people, especially, vulnerable Nigerians.

There is no reason whatsoever, for a government that cannot make budgetary provision for TB to refuse or foot-drag from counterpart funding.

State governors in the country must, as a matter of urgency, act fast, liaise with the TB control programme and assess counterpart funds to fight TB in their state. This is important because the federal government cannot do its part and also take the responsibility of the states.

The vulnerable people reside in the states; hence, the state and local governments must be responsible for their healthcare.

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