The NSP (2021-2025) clearly highlights the importance of strengthening the TB Notification information system for improving all the TB service provisions. ^[6]

Nigeria has already developed and deployed the Case based TB notification eTB manager which is used as the real time digital surveillance system in its 370 high burden TB sites. The rest of the low burden sites are also covered with near real time implementation. At the same time, DHIS2 is already functional across the country. The presence of these systems lay a strong foundation for executing the vision of creating a comprehensive and integrated real-time case-based TB surveillance and notification system.

It is recommended that the current eTB manager/DHIS2 infrastructure needs to be scaled up to cover the whole country. The system needs to support integration with external systems like Gen Xperts, Tru-Nat, Digital X-Ray outputs, current National Health management systems and MATS app as visioned by the national TB program with the concept of an integrated Health Information Management System (HMIS).

These data exchanges can be made seamless with API sharing between the platforms and the central repository. ^[6]

Recommended data exchange/ ETL tools like Talend, Informatica ^{[10.1] , [10.2]} makes data management task much easier and simultaneously improves data warehousing. These exchange tools also comply with FHIR , GDPR standards for more secured and seamless data exchange supporting standard data taxonomy and meta data management processes.

Tentative timeline: Month 0-6

The NTPs plan clearly emphasizes on the importance and need for improve data use. This can be made possible by making case-based TB data across systems more real time and useful.

In the existing dashboard there is a strong need to strengthen and expand the data visualization scope and making effective use of data for predictive modelling , data science and for advanced analytics it is also recommended to use best of the breed tools like Tableau , Power BI ^{[11.1] , [11.2]} which offer these features. The current eTB manger platform offers APIs which can connect to these applications and be used as an extended analytical component of the data analysis framework.

Also , To ensure that there is a seamless data exchange from other platforms like MATS app, the data should be extracted, transformed and loaded into the central database.

While eTB supports API other open source ETL tools over My SQL , Post Gres DB and / or WHO powered Xmart ^[12] which can be installed within the current environment can also be considered. These tools also help in upload of historical data to clear backlogs through templates.

Tentative timeline: Month 6-12

One of the challenges reported by the NTP during the data collection processes is inconsistent data connectivity / network issues which delays reporting of cases. In coordination with the National TB and Leprosy Control Programme and other implementing partners, MSH, under the USAID funded Challenge TB (CTB) project, has developed an offline-mode mobile application—an android based local data storage application version of e-TB Manager.

Other advantages for a mobile application include better performance, effective use of device features like in house system updates, usage of location, security measures and tracking user patterns and issue log mechanisms and other analytics measures.

Several mobile solutions for real time case-based notifications can be explored for local adaption and building the mobile counterpart for eTB. Open-source technologies like DHIS2 Mobile App, ODK and KOBO are some notable examples. ^{[13.1] , [13.2]}

Tentative timeline: Month 0-6

Digital training packages to train health professionals on eTB use and workflows

Any national scale roll-out will have its own capacity and training challenges which requires development of a comprehensive eLearning module allowing all health staffs involved in data collection process for training not only on the new eTB tracker-based application but also on the latest manual of procedure and continued medical education on TB care.

To address the challenges with periodic training of facility level staff to orient them on using eTB for direct data reporting, the MOH must engage in development of a comprehensive eLearning module for app training. The C19 RM eLearning system will cover TB management, and the electronic platform training module can be affixed to it.

Training tools like Moodle ^[14] built on standard LMS framework can be reviewed for application rollouts. Additionally for training and updates on the latest manual of procedure and continued medical education on TB care modules can be developed for TB Health providers, administrators at facility and district level.

This will help in developing and enhancing M&E competencies for ensuring a consistent program oversight, specially for the case-based tracker roll out within the existing applications.

Guide TB platform developed by WHO Philippines is a good example of eLearning module for health staffs involved in TB care.

Tentative timeline: Month 1-4

Based on the architecture, the system upgrade would be done with the database, a middleware system, the operating system or the hardware. Additionally, the architecture should be such that it supports the integration layer which would be needed for data exchange with national/external systems.

The technologies that need to be brought in and the areas of inter-connection need special focus. A review of the existing server architecture is advised along with deployment of automated load testing tools like Selenium, Appium ^{[15.1] , [15.2]} which can help in database sizing and monitoring adaptation needs for planning.

Tentative timeline: Month 6-24

Planning for capacity building includes workforce assessment, ranging from ICT professionals to health workers providing care services. Since the application requires regular updates and adaptations, the system support team requires trained personnel on the technology stack in use.

Strengthening the NTP team with trained system administrators will help in reducing costs (in seeking technical support) and improving and expediting the planned implementations.

Tentative timeline: Month 6-24

Establishing a direct and secured mechanism for engaging with patient has potential for drastic improvements in tracking lost to follow-up patients.

Auto generation of notification and messaging by the system through communication channels like Social Media channel, IVRS and SMS outbound messages should be explored. Open-source applications like Open MRS can be used for these activities. ^[16]

Tentative timeline: Month 6-24