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Deploying digital technologies to improve universal health coverage: lessons from TB screening tool MATS

As the Nigerian government launches a strategy for the private healthcare sector to help end tuberculosis, Dr Ademola Ade-Serrano reviews a proven digital tool that can be scaled further through public-private partnerships.

  • Jul 10, 2024

The article was first published on the Health Ethics and Law Consulting website.

Digital technologies have played a crucial role in improving health equity and accelerating Universal Health Coverage by confronting the twin barriers to access, affordability and availability. Such tools have gained wider acceptance following the global pandemic and continue to contribute to timely healthcare delivery.

Digital tools can now support governments to have a greater impact and stretch limited healthcare budgets at a time when climate change, conflict, and economic pressure put them under increased strain.

In Nigeria, one clear example of the growing impact of digital technology is the Mobile Application for Tuberculosis Screening (MATS), developed by PharmAccess with support from the Global Fund. An innovative tool, MATS simplifies the screening and diagnosis of tuberculosis (TB), linking patients to appropriate care and management. The tool helps to overcome Nigeria’s core challenges of low levels of TB diagnosis and hazardously low treatment coverage.

Sixth highest cases in world

One of the top ten causes of death globally, Nigeria accounted for 4.5% of the global TB burden in 2022, contributing the most cases in Africa and the sixth-most worldwide. Nigeria’s TB incidence is estimated at 219 per 100,000 of the population, totaling 479,000 people. Of these, an estimated 59% of cases were being diagnosed and notified to the National Tuberculosis, Leprosy and Buruli Ulcer Control Programme (NTBLCP), as calculated by the WHO in consultation with countries.

TB is detected either by collecting sputum for lab testing or taking a chest X-ray. With the first method, which is free of charge in Nigeria, patients must wait several days for the test outcome, while the second is unaffordable to many.

In addition, testing is unavailable in many health facilities, requiring people to travel long distances for a diagnosis. Often though, healthcare providers do not suspect TB as its symptoms resemble other diseases. All these challenges contribute to delays in detecting TB which further impedes timely care and treatment.

Over 2.5 million Nigerians screened

Developed by PharmAccess in partnership with the NTBLCP and the Institute of Human Virology Nigeria and launched in 2020, MATS employs digital and mobile technologies to expand TB screening and treatment in the private sector. Since almost a third of TB cases are treated privately, healthcare providers in this sector need to be involved to close the gap in TB case identification in Nigeria.

The MATS tool guides providers to screen patients with a series of questions to assess their risk of TB infection. Responses entered into the app help determine if a person is at risk of carrying TB. If this is the case, they are referred to a diagnostic facility to confirm the diagnosis, following which treatment is initiated free of charge.

The use of MATS has resulted in a significant increase in TB screening efficiency and linkages  between the facility and community-based units. Because of its simplicity, MATS requires little training to use. The application has helped improve care for TB patients by providing real-time online information on the progress of case detection, increasing the private sector’s share of TB case notifications from 14% in 2019 to 26% in 2020, the authorities’ last available analysis shows.

Using MATS, over 2.5 million Nigerians have been screened, with nearly 250,000 referred for testing and 5,899 confirmed cases enrolled on treatment. The NTBLCP conducts tuberculosis screening with MATS in all 36 states and the Federal Capital of Nigeria.

Tool offers significant progress

While a comprehensive, independent review of the impact of MATS is pending, there is little doubt it offers significant progress in TB diagnosis and treatment.

Digital technologies – in particular, simple-to-use, relatively inexpensive applications – can help improve detection and screening, and support equity by helping facilities in rural communities provide needed care. The use of MATS needs to be expanded across the country, incorporating more community-based units. Both public and private health facilities can benefit from deploying digital technologies.

Furthermore, broader discussions about including digital technologies in health insurance and budget allocations must take place. The current health sector reform offers an opportunity to incorporate digital and data-driven tools to reduce Nigeria’s health burdens while making efficient use of existing resources and ultimately support universal health coverage across the country.

Dr Ademola Ade-Serrano is the innovation manager of PharmAccess Nigeria. With input from Prof Cheluchi Onyemelukwe, Olawale Bhadmus, Adedeji Olayinka, and Omigbile Olamide from Health Ethics and Law Consulting.