SHOPS Plus program in Nigeria works in the areas of family planning, tuberculosis, and HIV. The country's rapidly increasing population has created pressure on its health system. High birth rates are accompanied by low uptake of family planning services, resulting in high levels of unmet need. Nigeria also has one of the lowest case detection rates among high tuberculosis burden countries and has the second largest HIV epidemic in the world. The private sector is an important source of health care in the country. Although the private sector is the preferred source of contraceptives, it is an underused resource for diagnosis of tuberculosis and providing HIV services.
Nigeria is the seventh most populous country in the world with 193 million people. The most recent national health accounts data estimate that 68 percent of health expenditures occur in the private sector; therefore, it is imperative that facilities in both the private and public sectors provide quality services. The SHOPS Plus program focuses on family planning, tuberculosis, and HIV.
The limited availability of providers trained on the delivery of the full method mix at the community health extension worker level, continues to be a significant barrier to family planning services resulting in the low use of modern contraceptives. Therefore, increasing access to effective training for these providers is essential.
SHOPS Plus has enhanced the existing provider training and supervision systems, trained 931 providers of which 546 are CHEWS (59%) , and reached over 110,000 new users of family planning, including long-acting reversible contraceptives (LARCs) in four states (Federal Capital Territory, Plateau, Akwa Ibom, and Oyo). The project collaborates with other USAID projects (Breakthrough Action and Global Health Supply Chain - Procurement Supply Management) to address social and behavior change, as well as contraceptive commodity security.
Despite its high incidence of tuberculosis, Nigeria has one of the lowest case detection rates among high TB burden countries. With an estimated 429,000 cases in 2018 according to the WHO, less than a quarter of these cases were reported as receiving treatment. Strengthening the private sector’s capacity to detect and treat TB is vital to reducing its incidence rate in the country.
SHOPS Plus’s approach to increasing the availability of and access to TB services in the private sector in Nigeria aligns with both international standards and the country’s national plan for TB control. In Lagos and Kano States, SHOPS Plus has established and supports networks made up of different cadres of private providers to detect, diagnose, follow up, and treat TB. These cadres are not limited to clinical providers but also include proprietary patent medicine vendors, community pharmacists, and private laboratories because these cadres are often the first point of contact for Nigerians seeking care. Since project inception, SHOPS Plus supported providers have screened 2,108,604 clients for TB, detected 8,141 TB cases, and networked 1,719 private providers. SHOPS Plus has also initiated expansion efforts in an additional 14 states to build the capacity of and support private providers to screen, refer, and report TB.
The SHOPS Plus team in Nigeria launched a new Android application for tuberculosis screening and tracking for accelerated referral and reporting: TB STARR.