Private facilities rise to the challenge of improving TB testing and case detection

For a country with the world’s seventh-highest tuberculosis (TB) burden, Nigeria faces a low case detection rate that is a significant barrier to reducing TB prevalence in the population. SHOPS Plus works with private providers to improve detection and treatment outcomes in Nigeria’s Lagos and Kano states, two states with the highest TB burden and high levels of private sector activity.

In efforts to combat low case detection, public and private providers use technology such as GeneXpert machines to determine if a patient has TB through sputum testing. In Nigeria, the majority of the machines are located in public sector health facilities. These facilities often experience challenges in using the machines effectively; irregular machine maintenance, personnel shortages, erratic power supply, and poor air conditioning prevent GeneXpert machines from functioning at maximum capacity.

Facilities may also lack quality assurance policies dedicated to TB testing. El-Lab, a SHOPS Plus-affiliated private testing facility in Lagos, recognized these limitations and set out to make a difference in the fight against TB using its own GeneXpert machine. El Lab’s mission was to demonstrate the potential of the private sector to support public health programs, its effectiveness in doing so, and the willingness of the private sector to work in partnership with the public sector.

Working around technology bottlenecks

In September 2018, El-Lab received the first GeneXpert machine donated from the Nigerian government to the private sector. As a private facility, El-Lab has greater control over its procedures and business management policies than public sector labs and can adapt its operations quickly to reach new goals. Despite not having a memorandum of understanding or formal reimbursement agreement, the lab purchased a larger generator to support a consistent air conditioning system to optimize machine productivity. Laboratory director Elochukwu Adibo decided to run the machine at night to triple its output, so El-Lab modified its HR policies to allow night shifts. El-Lab also purchased motorcycles and hired riders to minimize delays in sample pick up and result turn-around times. Soon, El Lab’s mission became finding TB cases by supporting both the private and public sectors with reliable and fast TB testing.

The GeneXpert machine in El-Lab’s facility exceeded expectations by producing three times the average number of TB tests run in Lagos thanks to its employees’ flexibility, dedication, and vision. In the span of two months, Adibo established a facility that now performs GeneXpert tests twenty-four hours a day, seven days a week. From January to December 2019, with approximately 30 GeneXpert sites, the average output per lab in Lagos was 2,551 samples. El-Lab surpassed the Lagos average by several thousand and tested 8,844 GeneXpert samples within the same period.

Envisioning a TB-free Nigeria

Director Adibo has a clear vision for a TB-free Nigeria. His determination drives El-Lab’s success. He motivates his employees by educating lab staff on Nigeria’s TB burden, urging them to take initiative in their work. He advocates for private sector involvement in the fight against TB, attributing El-Lab’s success to its ability to make procedural changes quickly and efficiently. Adibo believes that Nigeria’s private sector has a duty to fight TB in any way possible and hopes that El-Lab’s success gives other facilities, public or private, the confidence and inspiration to follow their example.