Across Nigeria, young people spend their first year after university engaged in a mandatory community service project. Every year, roughly 400,000 graduates join Nigeria’s National Youth Service Program (NYSC), beginning with a three-week orientation and ending with placements in communities, schools, non-profits and more in every corner of the country.
From 2018 until early this year, the tuberculosis (TB) team at the Johns Hopkins Center for Communication Programs (CCP)-led Breakthrough ACTION-Nigeria project worked with the government to identify, screen for, and treat presumptive cases of the deadly disease in Nigeria. The country has one of the highest TB burdens globally and cases are often under-diagnosed. Early diagnosis is crucial for reducing the spread of TB, ensuring timely treatment, and preventing further transmission.
Always looking for ways to bring TB prevention to more people, especially young people who do not regularly interact with the health system, CCP and its partners, including the National/State Tuberculosis, Buruli Ulcer and Leprosy Control Program and local community groups, suggested bringing TB education to the NYSC program, with its audience hundreds of thousands of members strong.
Together, CCP and its partners worked to incorporate TB orientations and free screening into the NYSC during the state-level camp orientations, that kick off six times each year, creating a cadre of TB champions.
“People generally know about TB, but they don’t have the right knowledge about how they can avoid or cure it,” says Olusola Adeoye, who has served as a senior program officer with CCP since 2022. “There are a lot of myths and misconceptions. There’s still a lot of stigma and discrimination. We wanted to partner with the NYSC to give this huge group of young people an education in tuberculosis – and, in turn, reduce the spread of disease.”
Not only did the young people get an education in TB, but they also took those tools to be advocates for TB testing and treatment when they entered communities in every part of Nigeria as part of their 10-month community development service.
“That’s what makes this intervention so really powerful,” Adeoye says. “It goes beyond just reaching the corps members. They can then interact with communities, some of them in places where TB patients have been hard to reach.”
In 2023, an estimated 10.8 million people fell ill worldwide with TB, and 1.25 million died from the disease; more than 361,000 TB cases were reported in Nigeria that year. Global efforts to combat TB have saved an estimated 79 million lives since 2000.
In the summer of 2024, CCP staff in 12 states and the Federal Capital Territory of Nigeria spoke with new members of the NYSC during their three-week orientations. They spoke not only of the risks and symptoms of TB but offered new corps members a chance to be screened on the spot and hooked up with treatment if they had symptoms that could potentially be TB (a lasting cough, unexplained weight loss, night sweats).
One key to stopping the spread of TB is getting people on treatment – and having them stay on it. Patients take a course of strong antibiotics and must stay on them for many months. Stopping TB antibiotics before the disease is fully treated can lead to drug-resistant tuberculosis, which can have even more devastating impacts on health.
CCP and its partners also brought awareness to the local level, working with interested members of the corps who would highlight TB awareness during NYSC-led community meetings, market visits, and outreaches to share what they had learned.
“The corpers go into the communities, and they render different services in a bid to leave the communities better than they were,” Adeoye says. “They now use that opportunity to talk about tuberculosis. They can reach areas that we might not be able to because corpers are posted to every single ward of the local government areas in the country.”
The seven-year USAID-funded Breakthrough ACTION-Nigeria project ended in 2024, but that doesn’t mean the TB work in the NYSC will end. Officials with the National and State Tuberculosis, Leprosy and Buruli Ulcer Control Programs, as well as community groups, will continue the powerful partnership with the NYSC where CCP left off.
“The TB work has achieved three elements of sustainability: local ownership and leadership, institutionalization, and routinization,” says Shittu Abdu-Aguye, who led the Breakthrough ACTION-Nigeria project. NYSC leaders have now mandated the inclusion of TB prevention and detection activities in ongoing community outreach sessions and institutionalized reporting, despite the end of Breakthrough ACTION-Nigeria.
“Sustainability has already commenced,” says Pascaline David Edim, who until October was the Cross River State Coordinator for Breakthrough ACTION. “This is no longer a Breakthrough ACTION project but a national event. The government likes what it has seen so far and is committed to continuing.”
