ACTIVITY DESCRIPTION:

This activity is linked to TBHIV 3.3.07.

There has been renewed discussion about the prospect of providing effective tuberculosis diagnosis and

treatment to patients in Nigeria; however, these discussions are frequently taking place in the absence of

comprehensive, country-specific information on the cost and resource implications. Nigeria has the highest

TB disease burden in Africa and is ranked 4th among high TB burden countries in the world. Combating TB

and the dual epidemics of TBHIV in the country thus requires taking a new approach that is strategically

informed by evidence. To date the absence of country costs estimates have hindered scale up of TB/HIV

integrated services in Nigeria. The Federal government of Nigeria in collaboration with development

partners is taking serious steps in improving efficiency and effectiveness of TB programs in the country.

Towards achieving the aforementioned, the government has requested a comprehensive costing exercise

to estimate the costs of providing and sustaining TB and TBHIV services. Building on the HIV/AIDS costing

work that was done in 2005, HS20/20 in collaboration with, USG partners, WHO, TBCAP and other

stakeholders proposes to undertake the TBHIV costing activity

The activity is designed to help policymakers and practitioners alike take a "health systems" approach to

TB/HIV provision, by conceptualizing and thinking through all relevant questions including infrastructure

requirements, health care providers, equipment, lab tests, drugs, management, logistics M &E, research

and other critical elements necessary to deliver TB and TBHIV services. The activity will be tailored to

country specific situations using local data from statistical agencies, Federal Ministry of Health, state health

institutions, donor community and public and private health facilities. TB costing data will be collected from

at least 111 sites among the tertiary, secondary and primary levels health care facilities in the 36 states and

FCT of Nigeria. It is envisioned that findings from this study will be used by policy makers, program

planners, and technical working groups to guide planning and implementation of robust TB and TBHIV

services in Nigeria.

The costing activity will provide the much needed information for policy makers at both national and sub-

national levels that allows for better planning, forecasting and budgeting for TBHIV activities in all TB and

HIV control programs. Furthermore, the findings will be necessary to strengthen TB diagnosis, treatment

and training among HIV patients. This activity will benefit all the partners; Government of Nigeria (GON) and

key stakeholders (PEPFAR, GFATM etc) to achieve universal access to care with respect to HIV/AIDS and

TB.

Key questions to be addressed by the TB costing study

1.What is the per-patient cost of providing TB diagnosis and treatment in Nigeria?

2.What would be the resulting total cost associated with achieving PEPFAR or national coverage targets?

3.How many patients can feasibly be treated given existing budget commitments?

4.How do these results compare to a full-coverage scenario?

5.What level of human resource capacity is needed to implement these targets?

6.How much will it cost to provide training for these human resource requirements?

7.How will these financial and human resource requirements evolve over the next 3-5 years?

HS20/20 will be collaborating with FMOH, TBLCP and an indigenous NGO on this study, findings will be

validated by relevant stakeholders through a workshop forum and a final report will be shared at a

dissemination meeting that precedes wider dissemination.

EMPHASIS AREAS:

This activity focuses on training and strategic information.

ACTIVITY DESCRIPTION:

Abt Associates has been providing technical assistance to the Federal Ministry of Health (FMoH) to

strengthen the public health system capacity to scale up HIV/AIDS services in Nigeria. As programs scale

up, the need to build capacity for accurate data reporting and management, and use of strategic information

(SI) for policy and programmatic decision making has become increasingly critical. Sustainability and growth

of the system will require information on the private health sector in addition to the public health sector

capacity. In COP08, through HS 20/20, Abt Associates proposes support for implementation of sustainable

and quality HIV/AIDS services by providing technical support to an anticipated 10 agencies (including NACA

and NASCP) to carry out a comprehensive human resources for health (HRH) assessment of private sector

health services in collaboration with FMoH, the Guild of Medical Directors (GMD), National Medical and

Dental Council (NMDC), and their state level counterparts and affiliates. Abt Associates will build on

collaborative relationships established during FY06 and FY07 activities with National and State level

partners, including FMoH, the HIV/AIDS Division of FMoH (formerly NASCP), National and State Agencies

for the Control of AIDS (NACA and SACA), State Ministries of Health, and African Health Project (a local

nongovernmental organization (NGO)).

The purpose of the HRH assessment is to document the numbers of different cadres of health workers

available in private facilities, their distribution, level of training in HIV/AIDS service provision, type of

continuing education attended, types of in-service training held, and the curricula of in-service trainings.

This assessment will provide policy makers with knowledge of HRH status in the private sector at both state

and national levels in order to build a comprehensive picture of HRH status across both public and private

sectors in Nigeria. The Nigerian private health sector is robust and provides accessible and convenient

health care to citizens seeking care who can afford the fees. As the country expands public-private

partnerships, there will be a greater need for strengthened SI skills and capacity at the national level to

oversee the health care system and make informed policy and programmatic decisions. The proposed

assessment will provide evidence of strengths and needs in human capacity development within the private

sector at state and national level, thereby providing data for accurate human resources forecasting,

reallocation, and training. HRH in the private sector is critical to support the attainment of the expected

PEPFAR targets and millennium development goals (MDG).

The HRH assessment will include data collection from state level facilities, including faith-based

organizations, and training in SI to an anticipated 50 individuals (primarily within NACA and NASCP)

involved in a collaborative effort to collate and analyze the data collected. Data collection instruments will be

adapted to data quality assessment/improvement (DQA/I) standards and reviewed by a national team to

ensure consistency prior to application. HS 20/20 and its collaborating partners will prepare a report of the

current HRH capacity within the private sector for HIV/AIDS service delivery and make national

recommendations that address the unique capacity issues identified at all levels. Following a participatory

validation of the findings by key stakeholders at a workshop, the final report will be shared through a

national dissemination meeting.