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: Summer 2019


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 implemented 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 also implemented a mystery client survey in non-networked private facilities and public clinical facilities.

Objectives/research questions

This study had two main objectives. The first was to evaluate the quality of TB screening and referral for diagnosis and treatment services provided by SHOPS Plus network facilities. This occurred 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 was to 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 supported 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?


To answer these questions, SHOPS Plus implemented a mystery client survey in private and public health facilities. We surveyed four cadres of private providers: patent and proprietary medicine vendors (PPMVs), community pharmacies, stand-alone laboratories, and clinical facilities. Private providers were sampled from inside and outside of the SHOPS Plus PPM networks. The public facilities we surveyed included clinical facilities that were actively engaged by the state TB programs and those that were not engaged. The mystery client survey assessed 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 conducted a face-to-face survey in SHOPS Plus network facilities to evaluate the provider’s knowledge and examine if there was a know-do gap.


Status: Completed
Last updated: August 2020

Learn more about our work in Nigeria and tuberculosis, mystery client, quality of care, and public-private mix.

See other SHOPS plus studies. 




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.

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