In 2016, NLR Nigeria successfully applied for a new round of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) programs in Nigeria. Besides, NLR has continued to explore new avenues to design more innovative approaches in both leprosy control and disability, focusing on quality health and disability programs and the promotion of Nigerian ownership.
NLR Nigeria has developed several approaches to increase (cost) efficiency and effectiveness in low leprosy endemic areas.
The referral system was further strengthened with instruments such as the involvement of traditional healers and patent medicine vendors (PMVs) in recognition and referral. 181 of them have been trained.
In Jigawa state, NLR Nigeria has been active in a project for the identification of leprosy clusters and the involvement of community volunteer teams in leprosy control activities in these clusters. One year after the pilot started it is clear that the project has great potential: these teams contributed 85% of the new cases in their areas; teams with relatively more female volunteers referred more women and children; and only 3% of the referred cases had grade-2 disabilities, so detection has been relatively early.
Number of new cases detected2,687
Proportion of new cases presenting with grade-2 disabilities14%
Number of new cases detected in the area where we work946
Number of people receiving leprosy-training328
Number of people informed/educated (awareness raising) on leprosy4,307
Number of people from communities informed/educated (awareness raising) on general disabilities 372
Number of self-care groups supported/formed:
a) Existing groups (formed before 2016) supported in 2016 60
b) New groups formed and supported in 2016 0
Number of persons disabled by leprosy and other diseases trained in self-care 534
Number of people provided with reconstructive surgery 77
Number of people provided with septic surgery 236
Number of people provided with assistive devices (wheelchairs + crutches + sunglasses + protective/ orthopaedic footwear + prostheses) 919
Number of eye cased treated 282
Number of eye cases operated 110
Number of ulcer cases treated 453
Number of household contacts (family) of patients examined 1,964
Number of new tuberculosis cases diagnosed and treated 33,176
In Nigeria the Leprosy Control Program is being implemented in a combined program with tuberculosis (TB). Recently, Buruli Ulcer (BU) was added. NLR Nigeria has been involved in the implementation of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) in conjunction with other members of the International Federation of Anti-Leprosy Associations (ILEP). Principal recipients of the TB component of GFATM in Nigeria are the Association for Reproductive and Family Health (ARFH) and the Institute of Human Virology Nigeria (IHVN). NLR has been a sub-recipient and implements the combined TB and leprosy activities in the 13 states it previously solely ran its leprosy program.
The GFATM program financially (partly) facilitates the NLR Nigeria involvement in leprosy, as Medical Advisors will also address leprosy activities while on GFATM supervision missions.
NLR Nigeria supported the government State TB and Leprosy Control Programs (STBLCPs) in 13 states in the form of training, coaching and advisory practices to strengthen capacities. NLR Nigeria supported training geared towards the current major challenges in leprosy control in a low endemic situation such as in Nigeria: to support a ‘slimmer and smarter’ system to maintain leprosy know-how at essential locations in the health system.
The Disability Inclusive Development (DID) program focused on the participatory identification of the extent of disability in (rural) communities, its causes and implications for people with disabilities (PWDs) and their families, as well as the community. To identify all barriers to inclusion it covers both how PWDs and families perceive their situation and how the community perceives PWDs and the problems they are facing. It was the first time that such a participatory assessment was done in Nigeria.
During the focused group discussions (FGD), some people with disabilities (PWDs) had a first-time opportunity to sit together, express themselves and be treated as equals in a community discussion process. The initial stages of the DID process had a deep impact on several PWDs, as the following comments demonstrate:
‘We are very happy today. Until now, we have lived our lives alone and no one has ever cared or called us like this to discuss our situation and listen to us. We feel part of a society now that some people are caring about us for the first time. Thank you very much and may God bless you.’
‘As a person with disabilities I was not aware that I could sit with fellow-sufferers to discuss our problems and to find solutions. I am so happy today and looking forward to more opportunities where the whole community, irrespective of who, can also accept us and listen to us like this; and we can contribute our ideas towards the development of our community into a community where everyone like us will be respected.’
As a person with disabilities I was not aware that I could sit with fellow-sufferers to discuss our problems and to find solutions. I am so happy today
The approaches that NLR Nigeria developed over the last few years to detect cases in a low endemic disease situation proved effective. The involvement of traditional healers and patent medicine vendors (PMVs) in recognition and referral practices has led to successful referrals and an increase in the number of cases found in the areas where we work. The involvement of community volunteers showed a significant increase in case detection too. In 2017, studies are planned to document these findings, so other parties can benefit.
The NLR investment in a ‘smarter and slimmer’ Leprosy Control Program also showed its effects and has been adopted by the government. It means that leprosy services increasingly focus on fewer health clinics where multi-drug therapy (MDT) is provided, with better-trained General Health Workers in the General Hospitals and a few Primary Health Centers (PHCs). This approach has contributed to a more cost-efficient and effective leprosy control organizational set-up, as identified in an external evaluation of the program.
At the end of October 2016 NLR decided that due to decreased revenues our funding of NLR Nigeria will have to be discontinued in 2017. A phase-out plan with the purpose to document and exchange the innovative approaches in situations of low(er) level leprosy endemicity will guide the work in 2017.
In 2017, NLR Nigeria will:
The report with the results will be presented to the NTBLCP early 2018.
The GFATM programs for TB and MDR TB will be continued in 2017. To secure future involvement of the experienced team for TB control in North East Nigeria, NLR seeks to involve another eligible organization to continue the TB work and take over the team involved. As from 2018 NLR will terminate its direct involvement in leprosy and TB work in Nigeria.