ABSTRACT

This study interrogates the role of politics in tuberculosis (TB) control services in Rivers State, Nigeria. It raises questions about how the exercise of political power through the nature of the allocation and distribution of resources affects the effective implementation of the tuberculosis control programme in Rivers State, and its attendant implications for the populace. It draws on both qualitative and quantitative methods such as content analysis of documents and questionnaire for data collection; and a combination of qualitative and quantitative descriptive approach for data analysis. Adopting the Marxian Political Economy theory as a guide, the main finding is that there is very weak political commitment to the tuberculosis control programme, such that financial resources was allocated to the tuberculosis control services only once for the study period. The study equally uncovers that no legislative framework exists for the tuberculosis control services. The findings also indicate that the government has not embarked on any form of advocacy that will contribute to improve on the services of the programme, as well as that there are health implications from the implementation of the tuberculosis control services. Thus, it is recommended that government should improve on her political commitment to the programme, take proper ownership of the programme through the enactment of a legislative framework for it, provide adequate financial resources in her annual budget and release it for the programme; embark on advocacy for the programme to attract support for it, as well as forge partnerships (local and international) to enhance effective implementation of the programme, in order to change its fortune and mitigate the impacts on the society.

CHAPTER ONE INTRODUCTION

Politics is an inevitable activity confronting human existence from the smallest unit which is the family to the highest level-the State, and above all, between the States. To ensure not only effective but also sustained tuberculosis control services, the World Health Organization (WHO) recommended Directly Observed Treatment shortcourse (DOTS) broad policy strategy listed “Political Committment with increased and sustained financing as the first element”. This policy strategy was adopted by Nigeria in 1993. This study examined how politics (political commitment) impacts on the implementation of the tuberculosis control programme in Rivers State, Nigeria. Tuberculosis (TB) is a highly infectious disease that is curable with modern efficacious drugs and appropriate treatment. The upsurge in the incidence of tuberculosis is certainly one of the greatest public health challenges that confront nation states of the world today. Despite increased attention and considerable progress toward containing it in recent years, tuberculosis continues to be of serious public health importance. Tuberculosis was perceived to have been eliminated before now such that it was described as the 17th century’s “Captain of all these men of death” and the 19th century’s “white plaque” (Fairchild, 1998:1105). However, according to Kritski et al., (2007:1) “TB remains even in this millennium, the leading killer infectious disease in the world, with 1.6 million deaths in 2005”. Its incidence has thus waned and peaked overtime such that tuberculosis was decleared by the World Health Organisation (WHO) in 1993 as a “global emergency” adding that the disease will claim over 30million lives in the next decade unless immediate action is taken to curb its spread”. From the above, it is evidenced that it remains a major public health problem of inestimable magnitude. For example, the World Health Organisation (WHO) 2009 report on Global TB Control indicates the following: Globally, there were an estimated 9.27 million incident of cases in 2007, 8.3million cases in 2000 and 6.6 million cases in 1990. Most of the estimated numbers of cases in 2007 were in Asia (55%) and Africa (31%) with small proportion of cases in the Eastern Mediterranean Region (6%), the European Region (5%) and the Region of the America’s (3%). The five countries that rank first to fifth in terms of total numbers of cases were India (2.0million), China (1.3million), Indonesia (0.52million) Nigeria (0.46million) and South Africa (0.46 million)” (WHO Global TB Control Report, 2009:11). It is pertinent to state here that these countries incidentally are in the forfront of those that fall within the category of High Burden Countries (HBCs) as identified listed and categorized by the World Health Organisation (WHO).