Governance of tuberculosis control programme in Nigeria

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. We conducted a scoping rev...

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Bibliographic Details
Published in:	Infectious diseases of poverty 2019-06, Vol.8 (1), p.45-45, Article 45
Main Authors:	Ogbuabor, Daniel Chukwuemeka, Onwujekwe, Obinna Emmanuel
Format:	Article
Language:	eng
Subjects:	Accountability Analysis Control Control programme Delivery of Health Care - economics Delivery of Health Care - organization & administration Delivery of Health Care - standards Disease control Governance Health care policy Health facilities Health Personnel - organization & administration Health Policy Health Workforce - statistics & numerical data Humans Information management Infrastructure (Economics) Leadership Legislation Medical personnel Mortality Nigeria Objectives Patients Public finance Public health Scoping Review Strategic planning Surveillance Tuberculosis Tuberculosis - prevention & control Workers
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Summary:	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. 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. 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.
ISSN:	2049-9957 2095-5162 2049-9957