Expert Experience
ASLM recently sat down with Dr Omoniyi Amos, National Professional Officer of Tuberculosis (TB) at the World Health Organization’s Nigeria office, to discuss Nigeria’s experience implementing the WHO TB Standard, which sets benchmarks for countries to increase access to rapid diagnostics, reduce the time to diagnosis, and improve the detection of drug resistance.
ASLM: Dr. what is the TB situation in Nigeria?
Dr. Omoniyi: Nigeria has the highest TB burden in Africa with an estimated 479,000 cases in 2022. Nigeria accounted for 19% of Africa TB burden and 23% of TB death in the continent. In the last five years, Nigeria has recorded significant and consistent increase in TB notification: one of the few countries globally that recorded an increase in TB notification during the pandemic, from 106,533 cases in 2018 to 371,019 cases in 2023. Fortunately, Nigeria has maintained a high treatment success rate of above 87% in the last four years.
ASLM: What was the genesis of Nigeria’s implementation of the WHO TB Standard?
Dr. Omoniyi: In 2023, Nigeria was among the countries collecting the data required for the 12 benchmarks in the WHO standards. After a series of discussion between Nigeria and WHO, it was agreed that the existing system of the programme would be used to collect this information with the support of the WHO Nigeria office. Clear terms of reference and deliverables were agreed upon, and the National Tuberculosis Program kick started the process for the data collection.
ASLM: What have been some of the challenges with implementing the WHO TB Standard and how has Nigeria worked to overcome those challenges?
Dr. Omoniyi: The summary tool that reports on some benchmarks was not available in the program, though the primary data were available in the facility (e.g., benchmark 12), therefore it was difficult to report on this benchmark. There was also suboptimal capacity at the lower level. Information on a few components of some of the benchmarks had to be collected from other programs like the Nutritional and HIV programs and sometimes this information was not readily available. In situations where summary tools were not available, some facilities were visited or contacted via phone to collect the information. Going forward, this summary will be developed and incorporated into the electronic data system being developed by the program. We also put in place a series of orientation meetings, mentorships, and supervision to address the suboptimal capacity at lower level in collecting some of the benchmarks. The program has since leveraged on available funding to strengthen TB/HIV collaboration at the state level, henceforth, the information from the HIV programme will be easier to collect.
ASLM: What were some of the best practices in implementing the WHO TB standard?
Dr. Omoniyi: We found the use of LGA positivity rate to optimize case detection activity. It is also advised to leverage on the routine system to build capacity, monitor and review implementation, which reduces waste of resources and time, and enhance participation of key stakeholders and programme staff. Institute feedback mechanisms to facilitate data collection and enhance its quality. We found that virtual support provided by WHO HQ was key in achieving success. Applying benchmark 3 to facility- rather than district-level (LGA) helps to identify facilities that are performing sub-optimally which would have been masked by using LGA data.
ASLM: What improvements or benefits has Nigeria experienced implementing the WHO TB Standard?
Dr. Omoniyi: Based on the gaps identified, in July 2024, the program developed National Guidelines on the use of digital Xray in TB case detection, with a strong M&E component, which enhances reporting of benchmark 3 and other key indicators. The use of the report from implementation of the standards in distributing mWRD being procured by the programme enhances focus on areas where this is needed and minimizes skewness. We have been able to scale up more LGAs to enhance TB case detection and we have been able to provide more support to states with gaps, enhancing their performance.