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

Background

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 is implementing 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 is also implementing 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 is occurring 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 is 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 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 providers improve over time?

Methods

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. In 2021 we will conduct a follow-up mystery client survey to examine if the quality of care has improved or changed over time, especially as the COVID-19 pandemic has compelled many health facilities globally to screen for COVID-like symptoms, some of which overlap with common pulmonary TB symptoms.

Resources

• Using “Mystery Clients” to Examine TB Care Quality in Lagos and Kano – Key Findings

Status: Ongoing
Last updated: March 2021

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

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