TB CARE I - Nigeria Year 1 Annual Report January 1, 2011– December 31, 2011

The NTBLCP is implemented in 36 states of the Federation, including the Federal Capital City (FCT), Abuja. During the first year of the program, TB CARE I provided technical support to strengthen the National program in four technical areas: universal access to TB diagnosis, treatment, and care; scaling up programmatic management of drug-resistant tuberculosis; contributing to health system strengthening; and strengthening the M&E and surveillance system of the NTBLCP. TB CARE I worked with an in-country coalition of partners, including KNCV as the coordinating partner, FHI360, Management Science for Health (MSH), and the World Health Organization (WHO), to implement the planned NTBLCP activities. The coalition partners provided technical assistance in the implementation of the planned activities, and KNCV collaborated with ILEP organizations and other indigenous organizations in the country to implement TB/HIV and some components of the Programmatic Management of Drug-Resistant Tuberculosis (PMDT) in the country. The TB CARE I Nigerian Office is coordinated by KNCV under the leadership of the Country Representative (CR) and supported by technical staff from WHO and MSH. The total buy-in of USD 4.5 million was appropriated for the implementation of activities by the coalition partners. The TB CARE I APA 1 covered a period of 9 months from January 1 to September 30, 2011, but due to delayed commencement of the project, a No-Cost Extension (NCE) was approved for the implementation of the work plan through December 31, 2011. Despite some setbacks during the implementation year, including delayed start-up of activities, competing NTBLCP activities, lack of essential commodities, and insecurity in some parts of the country, significant achievements were attained. Key achievements in the area of universal and early diagnosis and treatment include TB Outreach Campaigns in 77 communities of 17 local government areas (LGAs) of the WHO USAID focus states, community dialogue with 388 community and religious leaders, and training of 364 Government Health Care Workers (GHWs) from 77 communities in 17 LGAs. In the area of laboratory strengthening, capacity development of 42 lab personnel on biosafety measures in BSL 3 culture laboratory and BSL 2 lab with BSL 3 practices was achieved, as well as capacity development of 18 biomedical engineers for the care of medical equipment and infrastructure services in line with Planned Preventive Maintenance (PPM) Standard Operating Procedures (SOP). Additionally, 63 lab personnel were trained on Good Laboratory Practices (GLP), and a draft laboratory TB policy was developed with technical assistance from KNCV lab consultants. In the area of programmatic management of drug-resistant TB (PMDT), the development of National DR-TB guidelines and SOPs for R & R formats was finalized, and 400 copies of the finalized DR-TB guidelines were printed using savings from TBCAP. The National training curriculum and modules for PMDT were also developed, and nine GeneXpert machines were procured and installed, enabling a routine DR-TB surveillance system to be put in place in the country. Key challenges faced during the implementation year include inadequate human resources for health (HRH) at the primary health care level, government support for community-based TB care (CTBC) activities being weak, and trained community volunteers requesting stipends. In the area of laboratory strengthening, majority of the laboratories performing AFB microscopy have no support for EQA activities, and panel testing is not routinely conducted on the national as well as the zonal laboratories. In the area of PMDT, inadequate supply of second-line drugs hindered further registration of diagnosed DR-TB patients for treatment, and inadequate R & R materials for routine DR-TB surveillance were a challenge.