How data helped Nigeria mitigate the impact of US cuts on TB

Nigeria has diagnosed more people with tuberculosis this year compared to 2024, despite the U.S. funding cuts. Their key weapon? Data. “The people who come to Nigeria will tell you one thing: when you get to TB, you will see that they are on the driving seat when it has to do with their data,” Dr. Obioma Chijioke-Akaniro, monitoring and evaluation manager at the National Tuberculosis, Leprosy and Buruli Ulcer Control Programme in Nigeria, told Devex. There’s no denying that U.S. funding cuts affected many health services across countries. That includes TB programs in Nigeria, where the bulk of funding for TB came from the U.S. government and The Global Fund to Fight AIDS, Tuberculosis and Malaria. But the national TB program was able to mitigate the impact of the cuts. Armed with robust data on what the U.S. government was funding and details per health facility, they were able to make a rapid analysis of the situation and take necessary action to adjust to the new reality, as soon as the USAID stop-work orders came in early 2025. This was critical to ensure the country does not reverse the gains it has made against TB. Chijioke-Akaniro, who initially presented these lessons at the recent Union World Conference on Lung Health 2025, said the country has been able to increase its TB treatment coverage from 24% in 2018 to 79% in 2024. The country has also reduced its TB mortality by 63% since 2015, and is aiming to achieve the WHO End TB Strategy milestone of a 75% reduction by 2025. “If we don’t do something now and this lingers, nothing comes back; in two years, everything we have done will collapse,” she said. One person with TB, if left untreated, can transmit it to 10 to 15 people in a year, she said. How they did it The rapid analysis helped the TB program initiate discussions with the country’s health minister, secure emergency government funding, and prioritize risks. It also helped the program identify some solutions using existing resources, including shuffling health personnel and the reallocation of funding across states. The loss of U.S. government funding led to the termination of ad hoc staff involved in TB screening in several communities and health facilities in the 18 states that were supported by U.S. funding. That risked creating disruptions in the program as Nigeria does not colocate implementation in states, especially for U.S. government and Global Fund resources, Chijioke-Akaniro said. To address the gap, the program first did a rapid assessment on the risk and impact of the U.S. funding cuts. Then they analyzed data to identify how they can distribute resources to ensure states affected by the U.S. funding freeze can still continue some TB case finding activities. One of the things they did was use a formula called maximum yield index. For example, if screening in 20 facilities achieved a 9% case yield, and screening in 25 facilities produced a 10% case yield — a 1% difference — then resources for five facilities were moved to a state that relied on U.S. funding. Doing that allowed the program to maintain screening in all states. The program also transferred specimen samples in batches for cost efficiency, resorted to virtual training for health care workers, and used digital footprint mapping to analyze screening coverage across the country. These measures prevented a significant drop in TB case notifications — the reports sent to national authorities when someone is diagnosed with tuberculosis. This is crucial to ensure people diagnosed with TB get proper treatment and to prevent further transmission of the disease. The program aimed to prevent the case notifications from dropping. But they seem to be doing much better than expected. At the end of the first quarter of 2025, Chijioke-Akaniro said the percentage of TB case notifications in the country increased by 6% when compared to the first quarter of 2024. While this is lower than their usual case notification rate increase — which was usually in double digits — she said, “it would have been worse if we didn’t step up the way we stepped up.” “We’re now 8% in terms of increase. I’m sure by the end of the year, we will close by about a 10% increase. And if we make it back to double figures, it means that we did well,” she said, while being grateful for assistance from the health ministry and many of Nigeria’s implementing and funding partners. “We know we would have done a lot better than this if USG didn’t pull [out], but you won’t count us as a country that has not progressed even amidst USG pulling [out],” she added. Lessons and outstanding challenges The cuts have served as a wake-up call on the dangers of relying on external funding, and some countries have started to put more of their own resources into their health programs. Chijioke-Akaniro said they were able to secure $54 million in government funding that Nigeria is going to use to purchase TB drugs and diagnostics through the Global Drug Facility, as well as funding to continue the TB drug resistance survey that the U.S. government previously supported. With support from the Global Fund, Nigeria is also piloting the expansion of its national health insurance to include TB testing and treatment. Nigeria is one of the African countries currently negotiating bilateral health compacts with the U.S. government. It’s unclear where TB falls in those negotiations. But one valuable lesson she shares for other TB programs: Build your own data system and ensure you’re in control. “So that at any particular time, you would understand that if push comes to shove, I’m still in charge. I might be shaking, but I won’t have a collapse of the system,” she said. Update, Dec. 5, 2025: This piece has been updated to reflect that Dr. Obioma Chijioke-Akaniro initially presented lessons about Nigeria’s TB program at the Union World Conference on Lung Health 2025.