Governance of tuberculosis control programme in Nigeria

Abstract

Background The role of governance in strengthening tuberculosis (TB) control has received little research attention. This review provides evidence of how institutional designs and organisational practices influence implementation of the national TB control programme (NTP) in Nigeria. Main text We conducted a scoping review using a five-stage framework to review published and grey literature in English, on implementation of Nigeria’s NTP and identified themes related to governance using a health system governance framework. We included articles, of all study designs and methods, which described or analysed the processes of implementing TB control based on relevance to the research question. The review shows a dearth of studies which examined the role of governance in TB control in Nigeria. Although costed plans and policy coordination framework exist, public spending on TB control is low. While stakeholders’ involvement in TB control is increasing, institutional capacity is limited, especially in the private sector. TB-specific legislation is absent. Deployment and transfer of staff to the NTP are not transparent. Health workers are not transparent in communicating service entitlements to users. Despite existence of supportive policies, integration of TB control into the community and general health services have been weak. Willingness to pay for TB services is high, however, transaction cost and stigma among patients limit equity. Effectiveness and efficiency of the NTP was hindered by inadequate human resources, dilapidated service delivery infrastructure and weak drug supply system. Despite adhering to standardized recording and reporting format, regular monitoring and evaluation, revision of reporting formats, and electronic data management system, TB surveillance system was found to be weak. Delay in TB diagnosis and initiation of care, poor staff attitude to patients, lack of privacy, poor management of drug reactions and absence of infection control measures breach ethical standards for TB care. Conclusions This scoping review of governance of TB control in Nigeria highlights two main issues. Governance for strengthening TB control programmes in low-resource, high TB burden settings like Nigeria, is imperative. Secondly, there is a need for empirical studies involving detailed analysis of different dimensions of governance of TB control. Electronic supplementary material The online version of this article (10.1186/s40249-019-0556-2) contains supplementary material, which is available to authorized users.

Through service providers’ eyes: health systems factors affecting implementation of tuberculosis control in Enugu State, South-eastern Nigeria

“…This study also found that government spending on TB control was inadequate, which is similar to evidence from several studies where donors, instead of governments, drive TB control efforts (5)(6)(7)(8)(9)(10)(11)(12)(13).…”

Through service providers’ eyes: health systems factors affecting implementation of tuberculosis control in Enugu State, South-Eastern Nigeria

“…Health systems factors that strengthened TB control include effective national strategies [5][6][7]; strong stewardship from district government [8]; donor funding [5,[8][9][10][11][12][13]; inclusion of TB in social health insurance schemes [14,15]; earmarked funding for TB [16]; medical vouchers and subsidies [17,18]; providers' satisfaction with directly observed treatment short course [19]; incentives to programme staff [20]; patient-centred approaches and intersectoral collaboration [6,16,19]; motivated and dedicated healthcare workers [16,19]; effective supply and drug management system [8,21]; use of dedicated logistics agency to distribute TB drugs [9,22]; and electronic reminders to improve treatment adherence [17].…”

“…Constraints to TB control include perception that TB control is less important than other public health programs [20,23]; weak accountability relationship between provincial/regional and district TB programme management [7,12,24]; insufficient community involvement [25]; and low public spending on TB [5][6][7][9][10][11][12][13]. TB control have been limited by lack of skilled staff [4,10,11,19,22]; lack of incentives for service providers [4,5,10]; lack of utilization of various levels of health staff and health facilities [25]; poor attitude and weak commitment of health workers towards deployment to TB services [22,23], inadequate training [10,11,19], and lack of laboratory staff [5,22,23]. Poor TB data management capacity [22]; frequent revisions of reporting formats [5]; and ineffective electronic recording and reporting system [14].…”

“…TB control have been limited by lack of skilled staff [4,10,11,19,22]; lack of incentives for service providers [4,5,10]; lack of utilization of various levels of health staff and health facilities [25]; poor attitude and weak commitment of health workers towards deployment to TB services [22,23], inadequate training [10,11,19], and lack of laboratory staff [5,22,23]. Poor TB data management capacity [22]; frequent revisions of reporting formats [5]; and ineffective electronic recording and reporting system [14]. Shortages of TB drug [7,22] and unavailability of laboratory supplies and equipment hinder TB service delivery [7,11,22].…”

“…Poor adherence to GeneXpert algorithm, interrupted supply of cartridges, lack of replacement of damaged modules, poor maintenance, and poor recording and reporting limit usefulness of GeneXpert in TB diagnosis [14,26,27]. Poor adherence to national guidelines [11,22,23]; dilapidated infrastructure [5,12,23] weak TB/HIV integration [10,12,14,24,28]; lack of public-private mix [10,12,23] and poor integration into general health services hinder effective TB service delivery [5,29,30].…”