Tuberculosis (TB) REACH Consultant

Job Description

Location:
Abuja
Nigeria

TERMS OF REFERENCE (TOR) FOR THE IMPLEMENTATION RESEARCH ON THE TB REACH PROJECT

Research title: Assessing the Barriers to Low Childhood Tuberculosis (TB) Notification in Niger State, Nigeria – An Implementation Research.

Background and Rationale

Nigeria ranks first in Africa and sixth globally among the 30 high burden TB countries with over 400,000 TB cases identified in 2024 (GTB report, 2025). In 2023, Nigeria had the fifth-highest number of childhood TB cases in the world. An estimated 59,000 children develop TB annually in Nigeria. Despite this high burden, many cases are not reached by health services – with only 36,197 children notified to the National TB program in 2023, leaving tens of thousands of children undiagnosed or untreated. (PAN, 2025). Over the years, the proportion of childhood TB cases among newly notified cases has consistently ranged between 7%-8% until 2023 where it rose to 10%—much below the 15% national benchmark.

Niger state is among the band 2 states (25+1 states) that accounts for about 71% of TB burden in the country (NTBLCP Report, 2024). The state is estimated to have approximately 15,792 TB cases annually; however, only about 10,265 cases (65%) were detected in 2024 (NTBLCP Report, 2024). Childhood TB notification is particularly low, constituting only 4–6% of cases (Ugwu, C., et.al., 2023). —far below the 15% national target—indicating missed opportunities for early diagnosis Preliminary broad based desk review conducted indicate that factors such as diagnostic challenges specific to children, health system constraints, financial and accessibility barriers, program and policy limitations, etc. reflect the broader national challenges affecting children’s timely diagnosis and quality of care. However, there is a paucity of evidence specifically examining the barriers to childhood TB notification in Niger State.

This implementation research seeks to generate robust, context-specific evidence on the structural, behavioral, and system-level factors contributing to low childhood TB notification in Niger state. It will also identify feasible, scalable, and programmatically relevant strategies to strengthen childhood TB detection, reporting, and linkage to care within existing TB control platforms. The findings will directly inform state and local TB programming, contribute to adaptive management of the TB REACH project, and support evidence-informed policy and programmatic decision-making.

Objectives of the Consultancy

The overall objective of this consultancy is to conduct a qualitative implementation research study to identify and analyze the barriers to childhood TB notification in Niger State and propose actionable recommendations to improve notification rates.

Specific objectives include:

1. Identify key health system, community, and caregiver-related factors responsible for low childhood TB notification in Niger State.
2. Explore opportunities and resources available to improve childhood TB notification within the existing TB control framework.
3. Document the perspectives of healthcare workers and caregivers regarding childhood TB diagnosis, treatment, and notification.
4. Generate evidence-based recommendations to strengthen childhood TB case finding and notification.

Scope of Work

Under the supervision of the Project Lead/Research Coordinator, the Consultant will be responsible for the end-to-end implementation of the study, including but not limited to the following tasks:

Study Preparation and Design
1. Develop and finalize the activity workplan
2. Identify and review relevant literature, project documents, and national and state TB policies and guidelines related to childhood TB.
3. Develop the study protocol, conceptual framework, and methodology in alignment with implementation research principles and stated objectives.
4. Develop, test and finalize semi-structured interview guides for healthcare workers and caregivers, community actors and TB program managers/policy makers.
5. Support ethical approval processes, where required.

Sampling and Participant Recruitment
1. Conduct purposive selection of study sites (selected Primary Health Care facilities), within the evaluation area. State Ministry of Health State TB Program inclusive
2. Support the identification and recruitment of study participants, including:
3. Healthcare workers with strong TB knowledge (including at least three Local Government TB and Leprosy Supervisors–TBLS).
4. Caregivers of children aged 0–14 years who have previously received or are currently receiving TB treatment.
5. Caregivers of children who are close contacts of persons with TB.

Data Collection
1. Conduct targeted desk review of national and state policies, reports, client journey at the facility level etc.
2. Observation of TB service delivery across selected facilities
3. Conduct face-to-face, in-depth interviews with eligible participants using approved and tested interview guides.
4. Ensure interviews are conducted in private, safe, and culturally appropriate environments.
5. Oversee audio recording and detailed note-taking during interviews, ensuring informed consent is obtained.

Data Management and Analysis
1. Transcribe and, where necessary, translate audio recordings and interview notes.
2. Conduct thematic analysis of qualitative data to identify key themes and patterns related to barriers, opportunities, and perspectives on childhood TB notification.
3. Validate findings through triangulation across participant groups.

Reporting and Dissemination
1. Prepare a comprehensive implementation research report detailing methodology, findings, discussion, conclusions, and recommendations.
2. Develop a concise policy/programmatic brief highlighting actionable recommendations for stakeholders.
3. Develop a draft manuscript for submission to a peer-reviewed journal
4. Present findings to relevant stakeholders, including project teams and TB program managers (if required).

Study Design and Duration

1. Study Design: Qualitative implementation research.
2. Study Duration: Three (3) months from contract signing.
3. Study Area: Selected Primary Health Care facilities and communities in Niger State.

Expected Deliverables

The Consultant will be expected to deliver the following:

1. Inception report, including refined methodology, work plan, and data collection tools.
2. Approved semi-structured interview guides.
3. Clean, anonymized transcripts and coded qualitative data.
4. Draft implementation research report.
5. Final implementation research report incorporating stakeholder feedback.
6. Policy/programmatic brief with clear recommendations to improve childhood TB notification.
7. Draft manuscript for submission to a peer-reviewed journal

Reporting and Supervision

The Consultant will report directly to the TB REACH Program Manager. Regular progress updates (bi-weekly or as agreed) will be required throughout the consultancy period.

Required Qualifications and Experience
1. Advanced degree (master’s or higher) in Public Health, Epidemiology, Social Sciences, or a related field.
2. Demonstrated experience conducting qualitative health research, preferably implementation research.
3. Strong background in TB programming; experience in childhood TB is an added advantage.
4. Proven skills in qualitative data collection, transcription, and thematic analysis.
5. Familiarity with Nigeria’s TB control program and health system, particularly at PHC level.
6. Excellent analytical, report-writing, and communication skills.

Ethical Considerations

1. Strict adherence to ethical research standards, including informed consent, confidentiality, and data protection.
2. All data must be anonymized and securely stored.
3. Ethical approval must be obtained from relevant authorities prior to data collection, where applicable.

Level of Effort and Payment Schedule

The consultancy will span three months, with payment milestones to be finalized in the contract and linked to:

1. Approval of the inception report;
2. Completion of data collection and preliminary analysis;
3. Submission and approval of the final report and policy brief.

Ownership of Data and Outputs

All data, reports, and outputs generated under this consultancy shall remain the property of the commissioning organization and may not be shared or published without prior written approval.