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Tuberculosis Legal Environment Assessment TUBERCULOSIS LEGAL ENVIRONMENT ASSESSMENT Nigeria Final Report July 2018 This report is, in part, made possible by the support of the American People through the United States Agency for International Development (USAID). Communication for Development Centre … promoting sustainable health and development programs TUBERCULOSIS LEGAL ENVIRONMENT ASSESSMENT | NIGERIA | FINAL REPORT JULY 2018 1 Table of Contents Objective, Scope and Approach ............................................................................................................... 4 Objective ....................................................................................................................................................................... 4 Scope .............................................................................................................................................................................. 4 Human Rights-Based Approach ................................................................................................................................ 4 Recommendations ......................................................................................................................................... 6 To Legislators and Policymakers .............................................................................................................................. 6 To Donors and Development Partners ............................................................................................................... 16 LEA Task Team and Technical Expert Group ................................................................................... 20 Stages and Methodology ............................................................................................................................ 20 Planning ........................................................................................................................................................................ 20 Desk Research ............................................................................................................................................................ 20 In-Country Assessment ............................................................................................................................................ 21 In-Depth Stakeholder Interviews ...................................................................................................................... 21 Site Visits ................................................................................................................................................................. 22 Stakeholder Dialogues—Abuja and Lagos ...................................................................................................... 22 Evaluation and Report Writing ............................................................................................................................... 22 Feedback and Finalization ........................................................................................................................................ 22 TB in Nigeria .................................................................................................................................................. 23 Epidemiological Profile and Program Highlights ................................................................................................. 23 Lagos State ............................................................................................................................................................. 25 In-Country Assessment Key Findings ................................................................................................... 27 Programmatic Challenges ........................................................................................................................................ 27 Barriers to TB Testing and Treatment Services ............................................................................................ 27 TB Treatment Interruptions .............................................................................................................................. 28 Over-the-Counter Sale of TB Drugs ............................................................................................................... 29 Delays in TB Diagnosis ........................................................................................................................................ 29 Public-Private Mix Program Challenges ........................................................................................................... 29 Stigmatization and Discrimination of People with TB ....................................................................................... 30 Stigma and Discrimination in the Community ............................................................................................... 30 Stigmatizing and Discriminatory Treatment in TB Health Facilities .......................................................... 31 Employment Discrimination against People with TB .................................................................................... 32 Low Public Awareness and Lack of Accurate Information about TB ............................................................ 32 Lack of TB Community Mobilization ..................................................................................................................... 34 Need for a Policy on Isolation and Involuntary Isolation of People with TB ............................................... 34 TUBERCULOSIS LEGAL ENVIRONMENT ASSESSMENT | NIGERIA | FINAL REPORT JULY 2018 2 TB Legal and Policy Framework in Nigeria ........................................................................................ 35 International and Regional law ................................................................................................................................ 35 Nigerian Domestic Law and Policy ........................................................................................................................ 38 Constitutional Law and Jurisprudence ............................................................................................................. 39 Right to Health ................................................................................................................................................................... 40 Fundamental Rights (Enforcement Procedure) Rules ................................................................................................ 41 Right to Life ......................................................................................................................................................................... 42 Locus Standi and Access to Justice ................................................................................................................................ 42 Legislation ............................................................................................................................................................... 43 Federal Health Legislation ................................................................................................................................................ 43 Lagos State Health Legislation ........................................................................................................................................ 48 Legislation Protecting Key Populations ......................................................................................................................... 52 Administrative Policies and Regulations .......................................................................................................... 57 Health Policies and Regulations ...................................................................................................................................... 57 TB Policies and Regulations ............................................................................................................................................. 59 HIV/AIDS Policies and Regulations ................................................................................................................................ 62 Prison Policies and Regulations ....................................................................................................................................... 64 Labor and Employment Policies and Regulations ....................................................................................................... 65 Appendix ......................................................................................................................................................... 66 In-Country Assessment Schedule .......................................................................................................................... 66 In-Depth Stakeholder Interview Questionnaires ............................................................................................... 67 Abuja Stakeholder Dialogue .................................................................................................................................... 70 Abuja Stakeholder Dialogue Agenda ................................................................................................................ 70 Abuja Stakeholder Dialogue List of Participants ...........................................................................................
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