Korede Abdullah 
LAGOS, Nigeria – The clock is ticking, and the stakes could not be higher. Tuberculosis (TB), an ancient killer that refuses to die, still stalks Nigerian communities with devastating impact. Despite decades of global campaigns and billions spent on eradication; Nigeria remains one of the hardest-hit nations. In this feature, Korede Abdullah, Africa Health Report (AHR) Southwest Correspondent unpacks the country’s fragile progress, the human cost behind the statistics, and the urgent reforms needed if Nigeria is to meet the United Nations Sustainable Development Goal (SDG) of ending TB by 2030.
“Nigeria is pivotal,” warns Dr Tereza Kasaeva, Director of WHO’s Global TB Programme. “If Nigeria succeeds, the world succeeds. But if Nigeria falters, the global fight against TB will remain out of reach.”
The message is stark: the world is watching, and time is running out.
Nigeria’s TB Burden: Africa’s Epicentre of Infection
Nigeria carries Africa’s heaviest TB burden and ranks sixth globally, contributing 4.6% of the world’s total cases. In 2022 alone, more than 285,000 new cases were reported. WHO’s 2023 Global TB Report placed Nigeria among just eight countries responsible for over two-thirds of all global infections.
By 2023, TB had overtaken COVID-19 as the world’s deadliest infectious disease, claiming 1.25 million lives and infecting 10.8 million people. Nigeria’s weight in this crisis is undeniable — progress in Abuja, Kano or Lagos has direct implications for Johannesburg, Mumbai and beyond.
Paper Gains, Ground Realities
Between 2015 and 2023, Nigeria joined the ranks of 13 nations that halved TB incidence. Notifications surged from 103,018 in 2018 to 285,561 in 2022, suggesting better surveillance. Treatment coverage improved from 24% to 59%, with a 91% success rate.
Yet these gains mask deep fractures. Rural areas remain underserved, with patients undiagnosed or misdiagnosed. In urban centres, private providers often fail to report cases, skewing the true picture.
Dr Chukwuma Anyaike, Nigeria’s Director of Public Health, concedes: “We have made gains, but underdiagnosis and underreporting remain our biggest challenges.”
Social Drivers: Poverty, Malnutrition and Overcrowding
Experts insist Nigeria’s TB crisis is inseparable from its social conditions. Poverty, malnutrition, overcrowded housing and weak infrastructure create fertile ground for transmission.
“Even with the best diagnostics, if people live in slums with poor nutrition, incidence will fall slowly,” notes Dr Patrick Sunday Adeyemo, UNICEF consultant and academic.
TB is both a cause and a consequence of poverty. Families facing long treatment cycles lose income, sell assets, or withdraw children from school, plunging deeper into hardship. Stigma isolates sufferers further, worsening both health and economic outcomes.
Financing Gaps: Nigeria’s 5% Health Budget
The 2001 Abuja Declaration urged African countries to dedicate 15% of national budgets to health. Yet in 2025, Nigeria earmarked just ₦2.48 trillion — 5.18% of its budget.
“Commitment without matching financing is symbolic,” warns Adeyemo. “Rhetoric can catalyse attention, but measurable progress needs predictable financing, clear implementation plans, and accountability.”
International partners such as WHO and the Global Fund continue to plug gaps, but experts argue that donor aid must remain catalytic, not permanent. Without domestic investment, Nigeria’s TB elimination dream may collapse.
Technology Without Systems: The GeneXpert Paradox
Donations of GeneXpert diagnostic machines, capable of rapid TB detection, made headlines when Nigeria’s First Lady pledged ₦1 billion to expand access. But machines alone are not enough.
“Without sample transport, maintenance, cartridges, and trained staff, they underperform,” Adeyemo cautions.
Indeed, reports confirm many machines gather dust in under-resourced hospitals. Technology without systems is, at best, a bandage on a gaping wound.
Manpower: The Missing Link
Even more critical than machines are manpower. Rural clinics often lack clinicians, laboratory scientists and community workers who can conduct outreach, trace contacts, and ensure adherence.
“Investment in health workers, recruitment, training, and retention is arguably the single most important reform,” Adeyemo stresses.
Community health workers — the backbone of case-finding and adherence — remain underfunded and undervalued. Without a retention strategy, Nigeria’s health system risks buckling under the TB burden, regardless of equipment.
Lessons from India and South Africa
Global parallels offer a roadmap. India scaled up diagnostics, community detection and social support, backed by significant financing. South Africa integrated TB into HIV programmes and offered social grants to TB patients, reducing treatment abandonment.
Both nations invested heavily in drug-resistant TB programmes, avoiding the catastrophic costs of uncontrolled spread. Nigeria, experts say, must replicate these lessons with urgency.
The Cost of Missing 2030
Failure to meet the 2030 TB target would be catastrophic. Health-wise, TB will remain a leading killer, drug-resistant strains will surge, and TB/HIV co-infections will rise. Economically, productivity losses will deepen poverty while expensive second-line treatments drain public and household finances.
Reputationally, failure would undermine Nigeria’s credibility in global health leadership. “TB is both a cause and consequence of poverty,” Adeyemo warns. “Missing targets perpetuates that cycle.”
Poverty Trap: Breaking the Vicious Cycle
For families, TB is more than a disease — it is a poverty trap. Treatment cycles, stigma, and the inability to work drag households into deeper debt. WHO’s Africa office insists TB elimination is impossible without tackling housing, nutrition, and poverty.
Integrating TB care into nutrition schemes, housing support, and social protection programmes may hold the key to breaking the cycle. Without such holistic reforms, elimination remains a mirage.
Policy and Implementation: The Missing Middle
Nigeria’s challenge is not lack of policies but weak execution. The Basic Health Care Provision Fund (BHCPF), launched with much promise, has suffered from delayed disbursement and inconsistent state-level buy-in.
Where implemented well, it boosts case detection. Where mismanaged, it leaves frontline workers stranded. Without accountability, political promises risk fading into hollow rhetoric.
Can Nigeria End TB by 2030?
The race is finely poised. Nigeria has shown flashes of progress — halving incidence, expanding treatment — yet systemic weaknesses threaten to derail the 2030 goal.
Experts call for urgent reforms: domestic financing, universal diagnostics, community engagement, stronger surveillance, and integration with poverty-reduction strategies.
“If I had to pick one urgent reform,” Adeyemo concludes, “it would be financing and scaling the diagnostic-to-treatment cascade. Early detection breaks transmission fastest.”
Whether Nigeria emerges as a global success story or a sobering case of missed opportunity will be decided in the next five years.
About the Author
Mirian Gom 
Hussaini Ibrahim 
