Study of the Quality of TB Care in Lagos and Kano States

Title: Study of the Quality of TB Care in Lagos and Kano States
Principal Investigators: Lauren Rosapep, Sophie Faye
Timeline: First round: Summer 2019; Second round: Spring 2020 


The World Health Organization declared Nigeria a high burden country for Tuberculosis (TB), Multidrug resistant TB (MDR-TB) and TB–HIV. Although public-private mix (PPM) interventions using private provider networks have been successfully developed and used to increase tuberculosis (TB) detection and patient flows in India, they have not been used extensively in other settings with a high TB burden, including Nigeria. In Nigeria, SHOPS Plus is adapting the private provider network approach to increase private sector involvement in TB detection and treatment. SHOPS Plus will implement a study to evaluate the quality of care provided by network providers in Lagos and Kano states. Additionally, because little is known about the overall quality of TB screening and diagnosis services outside of the SHOPS Plus networks, SHOPS Plus will also implement a mystery client survey in non-networked private facilities and public clinical facilities.

Objectives/research questions:

This study has two main objectives. The first is to evaluate the quality of TB screening and referral for diagnosis and treatment services provided by SHOPS Plus network facilities. This will occur in two states, Lagos and Kano, over two different points of time serving to facilitate adaptive management and inform the design of future programs with private providers. The second objective will provide a snapshot of the quality of TB screening and referral for diagnostic and treatment services in public and private health facilities that operate outside of SHOPS Plus networks in Lagos and Kano. Six research questions support these objectives:

  1. Are health facilities in alignment with international and national standards for TB screening?
  2. Do health facilities appropriately provide TB services?
  3. What is the range and variation in quality of TB services available in different types of health facilities?
  4. On which topics and skills should future TB support focus in order to improve the quality of TB services in health facilities?
  5. Is there a know-do gap in TB service provision among trained SHOPS Plus facilities?
  6. Does the quality of TB services provided by SHOPS Plus network improve over time?


The study will have two phases. In the first phase of the study SHOPS Plus will implement a mystery client survey in private and public health facilities. We will survey four cadres of private providers: patent and proprietary medicine vendors (PPMVs), community pharmacies, stand-alone laboratories, and clinical facilities. Private providers will be drawn from inside and outside of the SHOPS Plus PPM networks. The public facilities we will survey will include clinical facilities that are actively engaged by the state TB programs and those that are not engaged. The mystery client survey will assess the quality of screening, diagnostic, and treatment initiation services using a set of different presumptive patient scenarios. Shortly after the implementation of the mystery client survey we will conduct a face-to-face survey in SHOPS Plus network facilities to evaluate the provider’s knowledge and examine if there is a know-do gap. In the second phase of the study, data collectors will return to SHOPS Plus network to implement a follow-up mystery client survey. The follow-up survey will assess if there has been an improvement of quality in SHOPS Plus facilities over time.

Status: Phase 1, Complete; Phase 2, Ongoing
Last updated: February 2019

Learn more about our work in Nigeria and tuberculosis.

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Sustaining Health Outcomes through the Private Sector (SHOPS) Plus is a five-year cooperative agreement (AID-OAA-A-15-00067) funded by the United States Agency for International Development (USAID). This website is made possible by the generous support of the American people through USAID. The information provided on this website is not official U.S. government information and does not represent the views or positions of USAID or the U.S. government.