10, April 2015 - Geneva / Abuja - The Nigerian government sanctioned US$1.42 million to procure quality assured Second Line Drugs (SLDs) that will be used to provide treatment for 500 multi-drug resistant TB (MDR-TB) patients. The second line drugs ordered by the government will be delivered by Stop TB Partnership’s Global Drug Facility starting June 2015.
The largest economy in Africa, and the country with the third highest TB burden in the world - Nigeria - performed a prevalence survey in 2012 to measure the burden of TB. The survey showed a doubling of the estimated overall prevalence of TB (the total number of people with TB) and a tripling of the estimated incidence (the total number of new cases), compared to previous WHO estimates.
In 2013, Nigeria diagnosed and reported 16% of the estimated TB cases. In 2010, more than 7, 000 cases were reported with MDR-TB and nearly 17 per cent of TB burden were MDR-TB patients among newly infected and re-treated TB patients. Nigeria started MDR-TB treatment in 2010 after a successful pilot in DR-TB treatment centre in University College Hospital, Ibadan, Oyo State. A year later, MDR-TB treatment was scaled up nationwide. In 2013, 2.9% of the TB cases were MDR-TB cases, according to the WHO Global TB Report 2014. There were about 426 patients who were started on MDR-TB treatment in 2013.
The introduction of new molecular diagnostics tools such as GeneXpert machines in 49 facilities in 30 states and Federal Capital Territory as on December 2013, yielded detection of more MDR-TB cases than had been envisaged for treatment under the Global Fund grant.
As a result, the consolidated round nine grant from The Global Fund of US$16 million was not sufficient to support all MDR- TB patients. Therefore, the government of Nigeria had to step in to cover the gap in the number of cases being diagnosed and the number of cases being supported by The Global Fund. The government decided to buy drugs using funds from the domestic budget in order to avoid waiting lists on account of drugs for MDR-TB treatment.
Since the size of the investment is large, Nigeria’s Ministry of Health alone could not sanction the entire amount. It therefore required the National TB Program to work with several government arms including the Federal Executive Council, National Food and Drug Council among others. It was in December 2012 that the decision to buy SLDs was taken, and finally in February 2015, the government sanctioned the purchase of drugs. During this period, the patients were treated with drugs bought using the funds from the Global Fund and TB CARE program (USAID support).
A rising MDR-TB burden is a reality. From 665 DR-TB cases notified in 2013, the number of such cases are estimated climb to 29, 469 cases in 2020. In addition, the ambitious targets as reflected in the country’s national strategic plan to address TB, means that Nigeria will likely continue to buy her own drugs.
The Nigerian government and the NTP decided to use their own funding to carry out direct procurement through GDF. The decision to procure drugs through GDF, ensures that quality-assured drugs will be delivered for people living with MDR-TB in Nigeria. The NTP wanted to ensure that all TB patients whether treated with drugs procured using government funding or Global Fund financing received medicines of the same quality.
Using GDF as a procurement mechanism allows Nigeria to have access to the same kind of drug formulations, strengths and packaging, as the drugs procured through the Global Fund grant in Nigeria.
Dr Gabriel Akang, NTP manager, Nigeria, said, "The Government of Nigeria is poised to support, reach and treat everyone living with TB and will continue to unite against TB."
Further, as a result of dipping into domestic resources to buy SLDs, Nigeria successfully ensures country ownership and fulfills criteria of counterpart financing as required, for example, by some donors, including the Global Fund.
Professor Dr. Onyebuchi Chukwu who was holding the position of Minister of Health when this decision was made said, "We certainly need to take care of our own people. MDR-TB is one of the worst public health threats we are facing and we must ensure that we find, diagnose and treat cases as soon as possible, to avoid the spread. Having people on waiting lists for treatment was not an option for us. We hope to give an example to the entire world and to continue investing our own resources in treatment and care of our own people. We thank Stop TB Partnership, the Global Drug Facility, The Global Fund, USAID, WHO and our other partners for their support."
In 2013, the National TB Programme had a total budget of US$ 139 million of which 9% was funded domestically and 38% was funded internationally according to the WHO World TB Report 2014. However, more than half was unfunded. In the face of rising co-infections and increasing co-morbidities, investment by the government, independent of donor support, is a huge step for the people living with TB in Nigeria.
Dr Lucica Ditiu, Executive Secretary, Stop TB Partnership said, "This is fantastic news! All of us must think about this carefully. It is a great example of leadership by the country’s government to ensure that diagnosed cases of MDR-TB will have access to treatment. It also shows clearly that domestic investments are possible, but country stakeholders need time to create or adjust budget lines, follow in-country regulations and procedures in order to make it happen. We must keep this in mind when thinking about countries that have to step in with their domestic resources to ensure sustainability of donors investments and allow enough transition time."
Joel Keravec, manager, GDF, said, "Nigeria’s commitment in taking over the MDR-TB challenge by increasing its own domestic funding for SLDs procurement is an excellent example of a country working towards more sustainability and making a significant shift away from being solely dependent on a donor funded model. We are happy to promote more financial flexibility and technical support to countries like Nigeria willing to follow this leading example." GDF has recently offered financial flexibilities facilitating direct procurement procedures with countries purchasing drugs using their domestic funding.