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Politics of Tuberculosis Control Programme in Rivers State, Nigeria, 2001 - 2010

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Politics of Tuberculosis Control Programme in Rivers State, Nigeria, 2001 - 2010 POLITICS OF TUBERCULOSIS CONTROL PROGRAMME IN RIVERS STATE, NIGERIA, 2001 - 2010 BY KOMENE-ABANEE, PROMISE SARO PG/PhD/06/41544 A THESIS PRESENTED TO THE DEPARTMENT OF POLITICAL SCIENCE, UNIVERSITY OF NIGERIA, NSUKKA, IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE DOCTOR OF PHILOSOPHY (PhD) IN POLITICAL SCIENCE (POLITICAL ECONOMY) SUPERVISOR: PROFESSOR OBASI IGWE MARCH, 2015. 1 APPROVAL PAGE This Thesis written by Komene-Abanee, Promise Saro (PG/Ph.D/06/41544), has been approved for the Department of Political Science, University of Nigeria, Nsukka By ……………………. ………………………….. Professor Obasi Igwe Date Supervisor ……………………… ………………………….. Prof. Jonah Onuoha Date Ag. Head of Department ……………………………. ………………………….. External Examiner Date ……………………….. ………………………….. Professor C.O.T. Ugwu Date Dean, Faculty of The Social Sciences 2 DEDICATION This study is dedicated to the Almighty God, who’s infinite Mercy and Grace enabled me to complete this work. And to all tuberculosis patients, especially in my immediate environment; whose circumstances remain a source of concern for me. 3 ACKNOWLEDGEMENTS Having successfully completed this study against all odds, I am eternally thankful to the Most High God, who gave me the strength, wisdom and the enablement for this adventure. I am not only grateful, but highly indebted to the exceptional, unparallel ingenuity and profound display of understanding of my Supervisor, Professor Obasi Igwe for his attention given to me, that made this work to see the light of the day. He has a reputation for thoroughness and love for imparting knowledge in painstaking details and which he availed me. My Supervisor was not alone in this enterprise as Professors Jonah Onuoha (HoD), A.M.N. Okolie, Ken Ifesinachi, E.O. Ezeani, as well as Dr Gerald Ezirim played pivotal role in ensuring that I got the best. I also owe a depth of gratitude and appreciation to Professor Ibaba S. Ibaba and Dr Lucky Legborsi Nwidu for their consistency in asking me “how far”. It was as if my completing this work will certainly give them satisfaction and fulfillment. And to Mr. Kialee Nyiayaana and Dr Kelechi Obi for their exhibition of comradeship towards me. For Happiness Deele, he remains a friend indeed. My gratitude and appreciation also goes to my siblings: Messrs Ledum Komene Abanee, Barikpoa N. Komene Abanee, Monday Komene Abanee and Mrs. Zorkue Legbara. My warmest regard and thanks to my immediate family Mrs. DumBari Joy Komene and my children Messrs. Barisua Hope Komene, GodisAble Legborsi Komene, Joshua LeBari Komene,and Miss Queen-Esther Barinuazor Komene for bearing the pain of this adventure. Finally, to those who assisted in the distribution and retrieval of the questionnaire, Miss Ann Bannen for her assistance in typing the work; and to others that I cannot mention here, I remain grateful. God knows the best. TABLE OF CONTENTS. Title Page ………………………………………………………………………..i Approval Page……………………………………………………………………….ii Dedication…………………………………………………………………………...iii 4 Acknowledgements………………………………………………………………….iv Table of Contents…………………………………………………………………...v-vi List of Tables………………………………………………………………………..vii List of Figures……………………………………………………………………….viii Abbreviations………………………………………………………………………..ix Abstract………………………………………………………………………………x CHAPTER ONE: BACKGROUND TO THE STUDY. 1.1 Introduction…………………………………….....................................................1 1.2 Statement of the Problem………………………………….....................................7 1.3 Objectives of the study…………………………………………………...................12 1.4 Significance of the study……………………………………………..………………13 CHAPTER TWO: LITERATURE REVIEW 2.1 Theoretical Literature…...…………………………………………………………...16 2.2 Empirical Literature………………………………………………………………..18 2.3 Gaps in Literature……………………………………………………………………25 CHAPTER THREE: METHODOLOGY 3.1 Theoretical Framework………………………………………………………………27 3.2 Hypotheses………………………………………………………………………......33 3.3 Research Design ……………………………………..…………………………...…33 3.4 Methods of Data Collection……………………………………………………........36 3.5 Methods of Data Analysis……………………………………………………….......41 3.6 Logical Data Framework..………………………………………………....…………43 CHAPTER FOUR: NATIONAL TUBERCULOSIS AND LEPROSY CONTROL PROGRAMME, AND IMPLEMENTATION IN RIVERS STATE. 4.1 The Geography and People of Rivers State……………………………….………45 4.2 Historical background of Rivers State……..……………………………………...51 4.3 The Economy and Resource Allocation to Health Services in Rivers State ...…..61 4.4 The Political Economy Context of Health Services in Rivers State………………92 CHAPTER FIVE: PROFILE OF THE NATIONAL TUBERCULOSIS CONTROL PROGRAMME. 5.1 Global Context of Tuberculosis Control and its Evolution……………………….96 5.2 Tuberculosis Control and the Nigerian Health Care System……………………..111 5.3 Rivers State Health Care System and Tuberculosis Control……………………. 118 5.4 Tuberculosis Control Programme Objectives and Targets………………………..121 5 CHAPTER SIX: PROGRAMME IMPLEMENTATION AND UTILISATION IN RIVERS STATE TUBERCULOSIS CONTROL SERVICES. 6.1 Government Health Care Facilities in Rivers State……………………………….124 6.2 Functional DOTs and Microscopy Centers by LGA during 2010 ……………….136 6.3 TB Situation in Rivers State LGAs, Nigeria (2001-2010)………………………...141 CHAPTER SEVEN: POLITICS AND HEALTH RELATED IMPLICATIONS FROM THE IMPLEMENTATION OF THE TUBERCULOSIS CONTROL PROGRAMME RIVERS STATE. 7.1 Politics (Political Commitment) and the implementation of the tuberculosis Control Programme in Rivers State………………………………………………..148 7.2 The Health Related implications from the implementation of the tuberculosis Control Programme in Rivers State…...................................................................176 7.3 Test of Hypotheses ………………………………………………………………..185 CHAPTER EIGHT: SUMMARY, CONCLUSION, AND RECOMMENDATIONS 8.1 Summary…………………………………………………………………………..188 8.2 Conclusion…………………………………………………………………………192 8.3 Recommendations…………………………………………………………………192 Bibliography………………………………………………………………………...193 Appendix A………………………………………………………………………….200 B………..…………………………………………………………………..203 6 LIST OF TABLES PAGE Table 7.1 Number of questionnaires administered and retrieved…………149 7.1.1 On the respondents association with TB control………………..150 7.1.2 Number of years working in TB control…………………………151 7.1.3 Knowledge of set standards for TB control……………………...152 7.1.4 About the government policy (Law) for TB control……………..158 7.1.5 Has the control services been provided with the essential Requirements………………………………………………………159 7.1.6 On the percentage of requirements provided by the government..160 7.2.7 If any member of the executive arm has been involved in Advocacy for the tuberculosis control programme………………..161 7.1.8 On who provides the drugs consumables for the TB programme…161 7.1.9 If there has been drug stock-outs in the programme………………162 7.1.10 How frequent has been the drug stock-outs……………………….163 7.1.11 Did the government stepped in to the drug stock-outs……………164 7.1.12 If the State government allocates financial resources to TB………164 7.1.13 If the budgeted financial resources are released to TB programme165 7.1.14 How the released financial resources affects the programme…….166 7.1.15 On the Health Related implications from the implementation of the tuberculosis control services……………………………………166 7.1.16 If the Development Partners has been playing their role………….167 7 LIST OF FIGURES PAGE Figure 4.3.1 Budgetary provisions for health services 2004………….64 4.3.2 Budgetary provisions for health services 2005………….69 4.3.3 Budgetary provisions for health services 2006………… 72 4.3.4 Budgetary provisions for health services 2007………….76 4.3.5 Budgetary provisions for health services 2008………….81 4.3.6 Budgetary provisions for health services 2009………….84 4.3.7 Budgetary provisions for health services 2010………….87 8 LIST OF ABBREVIATIONS AU African Union CIDA Canadian International Development Agency DOTS Directly Observed Treatment Short Course D Ps Development Partners G D P Gross Domestic Product G L R A German Leprosy and TB Relief Association FMOH Federal Ministry of Health HBCs High Burden Countries HIV Human Immune Virus I L E P International Federation of Leprosy Partners I S T C International Standards for Tuberculosis Control IUATLD International Union Against Tuberculosis and Lung Disease MDGs Millennium Development Goals M D P Medium Term Development Plan M DR-TB Multi-Drug Resistance Tuberculosis MoU Memorandum of Understanding NEEDS National Economic Empowerment and Development Strategy NEPAD New Partnership for Africa’s Development N M A Nigerian Medical Association NTBLCP National Tuberculosis and Leprosy Control Programme N T P National Tuberculosis Programme PLWHA People Living With HIV/AIDs P H C Primary Health Care PPM Public Private Mix RSTBLCP Rivers State Tuberculosis and Leprosy Control Programme TB Tuberculosis U N D P United Nations Development Programme UN United Nations USAID United States Agency for International Development WHA World Health Assembly WHO World Health Organisation. XDR-TB Extensively Drug Resistance TB ABSTRACT 9 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;
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