Even when the numbers are right in front of you, they can still tell you very little. With over 440,000 new cases in 2025, every day in Nigeria a person with a persistent cough may visit a local health facility and find out they have TB. They are tested, diagnosed, and started on treatment.

TB is far more than a lingering cough, though. An airborne bacterial disease that usually attacks the lungs, TB can also spread to the brain, spine, and other organs, and it remains the world's leading cause of death for people living with HIV. Standard treatment for drug-susceptible TB typically requires a strict six-month course of antibiotics, making long-term patient monitoring and support essential to cure the disease and prevent drug resistance.

Over the months of treatment, each step of a patient’s care generates a data point: a record of the initial test, a note regarding treatment initiation, confirmation of a follow-up visit. Multiply this across hundreds of thousands of patients in hundreds of facilities, across 36 states and the federal capital, and you get millions of data points. The data exists and there has always been a lot of it.

And yet, for too long, those data points sat quietly in Excel sheets, laboratory databases, and quarterly reports, circulating without consequence, reviewed without structure, and rarely translated into action. In short, there were no dedicated mechanisms—either at the local or national level—to ensure that data was used after it was recorded.

A Shift

Nigeria’s TB Situation Room (TBSR) model is a structured performance management platform led by the National Tuberculosis and Leprosy Control Programme (NTBLCP) and supported by the U.S. Government through the Data.FI project. With this model, TB programmes should have a dedicated space to do what data alone cannot do: make decisions.

Currently active in eight states—Akwa Ibom, Anambra, Bauchi, Kano, Lagos, Nasarawa, Osun and Oyo—the TB Situation Rooms bring together state TB programme managers, monitoring and evaluation (M&E) officers, laboratory focal persons, surveillance teams, and implementing partners in routine, disciplined review cycles. Step inside the situation rooms and the spaces are equipped with computers, dashboards, and reliable internet connectivity. But their real value lies not in hardware, but in the habits these situation rooms build: looking at data together, asking hard questions, and committing to act.

At the launch of the initiative, the acting national coordinator of the NTBLCP, Dr. Clement Adesigbin, expressed optimism about its potential impact. “I’m pleased that this initiative is finally underway, and I hope we make the most of it. The purpose of this facility is to advance the TB programme, and there is much to learn.” Drawing on lessons from similar programs and past engagements, he highlighted the importance of simplicity, shared learning, and national ambition in driving the TB response forward.

“Let’s keep things as simple as possible so everyone can benefit. I recall attending a Data.FI-supported meeting in Lagos, where we heard success stories from similar projects. As a country, we should strive to achieve even more—beyond what sub-national levels have accomplished. We have the opportunity to lead and set the pace.”

For Dr. Joseph Kuye, the Data.FI TB M&E/Surveillance Advisor who has worked closely with the TB programme, the problem was never a shortage of information. “Nigeria’s TB programme generates large volumes of routine data,” he explains. The challenge, he says, “has always been converting that information into structured, coordinated response, especially at the sub-national levels.”

That challenge is more consequential than it might appear. An estimated 510,000 people develop TB in Nigeria each year, yet only around 458,534 cases are formally notified, leaving a detection gap of more than 40,000 people who are either undiagnosed or uncaptured by the national system. Behind that gap are delays in testing, breaks in the chain between diagnosis and treatment, and coordination failures between laboratory and surveillance teams that go unnoticed for weeks at a time.

Data without structure, as Kuye puts it, creates the illusion of oversight. Dashboards exist. Reports circulate. But without routine, disciplined review, performance gaps persist, diagnostic backlogs go unresolved, and opportunities for early correction pass quietly.

Interrupting the Silence

Rather than adding another reporting layer, the model consolidates surveillance, laboratory, treatment, commodity, and community data into a unified analytical framework. Priority indicators are visualised through accessible dashboards. Review meetings are held biweekly at the state level and monthly at the national level, giving programme teams a recurring moment to analyze performance, identify root causes, design interventions, assign responsibilities, and set timelines. Progress is tracked between meetings. Follow-up is documented and accountability is visible.

Since launching in March of 2025, the TBSR model is already having a measurable impact on TB outcomes in Nigerian states.

By mid 2025, fewer than half of diagnosed patients in Akwa Ibom were starting treatment. But by the end of the year, that picture had changed dramatically, with initiation rising to 127% as stronger links between diagnosis and care took hold. Lagos tells a similar story of gradual but steady progress. Contact investigation, which stood at just 2.8% in the first quarter of 2025, expanded significantly to 41% by Q3, driven by more deliberate follow-up and tighter coordination across local governments. Across all five states, a pattern is emerging: underperformance is being spotted earlier, responses are more coordinated, and the once-loose connection between laboratory work and field surveillance is becoming far more aligned.

Several lessons have already emerged from the field. States that integrate the Situation Room process into their own routine review structures, rather than treating it as an external, partner-driven activity, show greater continuity and engagement. The value of dedicated M&E leadership has proven equally decisive: states with clearly assigned TB M&E focal persons demonstrate stronger analysis, clearer interpretation of trends, and more consistent follow-up on agreed actions.

Perhaps most importantly, the routine reviews have revealed data quality problems that no one had fully seen. Discrepancies between laboratory-confirmed cases and treatment initiation records, the kind of gaps that can hide for months in static reports, have been identified and corrected through joint review sessions. The situation room improves not just data use, but the quality and integrity of the data itself.

“These are early days, and there are real problems that still need to be addressed,” cautions Kuye. “These include connectivity gaps, infrastructure constraints, and the challenge of sustaining state-led processes beyond the initial implementation timelines. But the model is designed with sustainability at its center — built on existing governance structures, like Emergency Operations Centers, to avoid duplication and reinforce institutional ownership.”

The future of TB control in Nigeria does not depend on generating more data. It depends on disciplined, institutionalised data use: routine reviews, clear accountability, and programme managers empowered to make decisions based on what the numbers actually say.