Health workforce and governance: the crisis in Nigeria

Telemedicine as a tool to prevent multi-drug resistant tuberculosis in poor resource settings: Lessons from Nigeria

Background

This mini review aims to provide an overview of the role of telemedicine in preventing multi-drug resistant tuberculosis (MDR-TB) in Nigeria. The specific objectives include examining the potential benefits of telemedicine, identifying the challenges associated with its implementation, and highlighting the importance of addressing infrastructure limitations and data privacy concerns.

Methods

This minireview is based on a comprehensive analysis of existing literature, including scholarly articles, and reports,. A systematic search was conducted using electronic databases, such as PubMed and Google Scholar, to identify relevant publications related to telemedicine and MDR-TB prevention in Nigeria. The selected articles were assessed for their relevance, and key findings were synthesized to provide an overview of the role of telemedicine in addressing the challenges of MDR-TB in Nigeria.

Results

The review demonstrates that telemedicine has the potential to significantly contribute to MDR-TB prevention efforts in Nigeria. The benefits of telemedicine include improved access to specialized care, enhanced patient adherence to treatment, and potential cost savings. However, challenges such as infrastructure limitations and data privacy concerns need to be addressed for successful implementation. Integrating telemedicine into the healthcare system has the potential to strengthen MDR-TB prevention, particularly in underserved areas, including within Nigeria. Specifically, the integration of telemedicine into the healthcare system can enhance access to specialized care, improve patient adherence, and potentially reduce costs associated with MDR-TB management.

Conclusions

Addressing infrastructure challenges, ensuring data privacy and security, and fostering trust among healthcare providers and patients are critical for successful implementation of telemedicine. Further research and policy frameworks are needed to guide the effective implementation and scale-up of telemedicine in MDR-TB prevention efforts in Nigeria.

Health workforce strategies during COVID-19 response: insights from 15 countries in the WHO Africa Region

INTRODUCTION

The COVID-19 pandemic unveiled huge challenges in health workforce governance in the context of public health emergencies in Africa. Several countries applied several measures to ensure access to qualified and skilled health workers to respond to the pandemic and provide essential health services. However, there has been limited documentation of these measures. This study was undertaken to examine the health workforce governance strategies applied by 15 countries in the World Health Organization (WHO) Africa Region in responding to the COVID-19 pandemic.

METHODS

We extracted data from country case studies developed from national policy documents, reports and grey literature obtained from the Ministries of Health and other service delivery agencies. This study was conducted from October 2020 to January 2021 in 15 countries - Angola, Burkina Faso, Chad, Eswatini, Ghana, Guinea, Guinea Bissau, Ivory Coast, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal and Togo.

RESULTS

All 15 countries had national multi-sectoral bodies to manage the COVID-19 response and a costed national COVID-19 response plan. All the countries also reflected human resources for health (HRH) activities along the different response pillars. These activities included training for health workers, and budget for the recruitment or mobilization of additional health workers to support the response, and for provision of financial and non-financial incentives for health workers. Nine countries recruited additional 35,812 health workers either on a permanent or temporary basis to respond to the COVID-19 with an abridged process of recruitment implemented to ensure needed health workers are in place on time. Six countries redeployed 3671 health workers to respond to the COVID-19. The redeployment of existing health workers was reported to have impacted negatively on essential health service provision.

CONCLUSION

Strengthening multi-sector engagement in the development of public health emergency plans is critical as this promotes the development of holistic interventions needed to improve health workforce availability, retention, incentivization, and coordination. It also ensures optimized utilization based on competencies, especially for the existing health workers.

Validation of the Donabedian Model of Health Service Quality in Selected States in Nigeria

BACKGROUND

Every citizen of a nation has the basic constitutional right to quality health care. However, there is a dearth of literature on the validity and reliability of the Donabedian conceptual model of health service quality in Nigeria.

AIM

The current paper focused on validating the Donabedian model of quality health service in selected states in Nigeria.

METHODS

This is a prospective study of 479 health workforce consisting of 204 physicians, 180 nurses, and 95 health information management officers in three geopolitical zones in Nigeria. A multistage sampling technique was used to select respondents. Data were collected through a semi-structured questionnaire with a response rate of 87%. The overall reliability test of the variables yielded α =0.938. Data gathered was analyzed descriptively for the socio-demographic characteristics and Relative Importance Index (RII) to rank the criteria according to their relative importance.

RESULTS

Findings from the study reveal that the (RII) of all the items in the study instrument exceeded the universally acceptable threshold of 0.5, indicating a high level of care in Federal Tertiary Hospitals in Nigeria with regards to structure, process, and outcomes.

CONCLUSION

The study underscored the need for the adoption of the Donabedian model in the three other geopolitical zones in Nigeria for a generalized conclusion on the validity and reliability of the Donabedian conceptual model of health service quality. We recommended that research studies on health service quality should be anchored on Donabedian conceptual model as a way to increase awareness of the relevance of the model in improving clinical care in Nigeria.

Enhancing quality healthcare in Nigeria through medical laboratory services: A review

This article explores the pivotal role of medical laboratory services in enhancing the quality of healthcare in Nigeria. Medical laboratory science is a comprehensive field that involves a diverse array of diagnostic and analytical procedures. These procedures are of utmost importance in the provision of patient care, the early diagnosis of diseases, and the promotion of public health. The article elucidates the progression of medical laboratory services in Nigeria, tracing the transformation from the role of laboratory assistants to that of medical laboratory scientists. It underscores the significance of these services in informing healthcare decision-making. The essay also discusses the diverse obstacles encountered by the medical laboratory profession in Nigeria. The issues encompass insufficiencies in infrastructure, obsolescence of equipment, absence of a coherent policy framework, slow workforce expansion, persistent labor strikes, and a scarcity of trained specialists. The aforementioned issues not only impede the effectiveness of laboratory services, but also have extensive ramifications for healthcare provision throughout the nation. In order to address these difficulties and improve the standard of healthcare, the essay presents practical solutions and a thorough strategy. Furthermore, it underscores the significance of augmenting financial resources, mitigating corruption, and tackling wage inequalities in order to effectively retain medical laboratory specialists. The action plan is structured into distinct phases, each delineated by specified dates and delineating the duties of various stakeholders, such as government entities, healthcare establishments, professional associations, and diagnostic enterprises.

Analysis of the availability, effectiveness and equity of deployment of resources in the health system response to COVID-19 in Nigeria

BACKGROUND

Coronavirus disease 2019 (COVID-19) exposed weaknesses in the health systems of countries such as Nigeria, which affected the effectiveness of the health system response to the pandemic. This paper provides new knowledge on the level of the availability, effectiveness and equity of resources in response to COVID-19 in Nigeria. This is valuable information for improving the delivery of countermeasures against future pandemics.

METHODS

The study was conducted at the federal level and in two states in Nigeria. The states were Lagos in the southwest and Enugu in the southeast. In-depth interviews were undertaken with 34 key informants. NVivo version 12 software was used for coding and thematic analysis.

RESULTS

There were inadequate, inequitable and suboptimal resources (human, financial, equipment and materials) for the response. In some of the countermeasures, only people that were employed in the formal sector benefitted from the distribution of welfare materials and financial packages; the informal sector, which constitutes the majority of the poor population in Nigeria, was excluded.

CONCLUSIONS

Inequity and suboptimal availability of resources to control COVID-19 led to reduced effectiveness of the health system response to the disease in Nigeria. Such negative factors must be mitigated in future responses to pandemics in the country.

The Promise of Grassroots Approaches to Solving Absenteeism in Primary Health-Care Facilities in Nigeria: Evidence from a Qualitative Study

Absenteeism among primary health-care (PHC) workers in Nigeria is widespread and is a major obstacle to achieving Universal Health Coverage (UHC). There is increasing research on the forms it takes and what drives them, but limited evidence on how to address it. The dominant approach has involved government-led topdown solutions (vertical approach). However, these have rarely been successful in countries such as Nigeria. This paper explores alternative approaches based on grassroots (horizontal) approaches. Data collected from interviews with 40 PHC stakeholders in Enugu, Nigeria, were organized in thematic clusters that explored the contribution of horizontal interventions to solving absenteeism in primary health-care facilities. We applied phenomenology to analyze the lived (practical) experiences of respondents. Absenteeism by PHC workers was prevalent and is encouraged by the complex configuration of the PHC system and its operating environment, which constrains topdown interventions. We identified several horizontal approaches that may create effective incentives and compulsions to reduce absenteeism, which include leveraging community resources to improve security of facilities, tapping the resources of philanthropic individuals and organizations to provide accommodation for health workers, and engaging trained health workers as volunteers or placeholders to address shortages of health-care staff. Nevertheless, a holistic response to absenteeism must complement horizontal approaches with vertical measures, with the government supporting and encouraging the health system to develop self-enforcing mechanisms to tackle absenteeism.

Lessons learned on data collection for a digital health intervention-insights and challenges from Nigeria

Objectives

This article delves into the challenges of medical data collection during the COVID-19 pandemic in developing countries, using Nigeria as a case study. It emphasizes how data collection impacts research quality, reliability, and validity.

Methods

Qualitative research utilizing purposive sampling was employed to explore experiences in designing a diagnostic tool for febrile diseases in Nigeria. A questionnaire with selectable and open-ended questions was utilized for data collection, and 23 respondents participated.

Results

Among 74 potential participants, 23 valid responses were gathered, revealing significant themes related to experiences and challenges in medical data collection. A multidisciplinary team approach proved beneficial, fostering collaboration, enhancing knowledge, and promoting positive experiences. Despite challenges with paper questionnaires, most participants preferred them for ease of use. Connectivity issues hindered timely data uploading and disrupted virtual meetings.

Conclusion

Innovative and flexible strategies, such as a blended data collection approach and well-coordinated teams, were vital in overcoming challenges. Electronic data collection tools, reminders, and effective communication played key roles, leading to positive outcomes. This study provides valuable insights for researchers and practitioners involved in data collection, particularly in developing countries like Nigeria.

Determinants of the managerial staff's disposition towards e-payment platforms in public tertiary hospitals in Enugu, Nigeria: a cross-sectional study

BACKGROUND

Many Nigerians pay out-of-pocket for their health care, and some hospitals have started utilising e-payment systems to increase transactional efficiency. The study investigated the type and usage of e-payment platforms in public hospitals and the factors that may influence the managerial staff's disposition towards using the e-payment system.

METHODS

We conducted a cross-sectional survey of 300 managerial staff within the four public tertiary hospitals in Enugu, Nigeria, through proportionate quota sampling. The survey obtained participants' demographic characteristics, types of e-payment platforms, managerial staff's technophobia, perception of credibility, and disposition towards e-payment. Data were analysed using descriptive statistics, Spearman correlation, and hierarchical linear regression.

RESULTS

The majority of the respondents (n = 278, 92.7% completion rate) aged 43.4 ± 7.6 years were females (59.0%) with a bachelor's degree (54.7%). Their disposition (80.0%±17.9%), perceptions of the usefulness (85.7 ± 13.9%), and user-friendliness (80.5 ± 18.1%) of e-payment in the hospital were positive, credibility (72.6 ± 20.1%) and technophobia (68.0 ± 20.7%) were moderate. There was a negative correlation between technophobia and disposition toward the use of e-payment (ρ = -0.50, P < 0.001). Significant multivariate predictors of managerial disposition towards e-payment were; being a woman (β = 0.12, P = 0.033), married (β = 0.18, P = 0.003), positive perception of usefulness (β = 0.14, P = 0.025), and credibility (β = 0.15, P = 0.032).

CONCLUSION

Most participants had a positive disposition towards e-payment in public hospitals. However, managers with technophobia, a negative perception of e-payment usefulness, and credibility had a lesser disposition to its use. To ensure the universal implementation of e-payment in Nigerian hospitals, the service providers should make the e-payment platforms more secure and user-friendly to health services consumers and providers.

Polymorphic Analysis of Genes PADI4 (rs2240340, rs1748033) and HLA-DRB1 (rs2395175) in Arthritis Patients in Pakistani Population

Genes are an important factor for the initiation of any disease. Many genes are associated with rheumatoid arthritis (RA) other than environmental factors. The main objective of the study was to evaluate the association of genes PADI4 (peptidylarginine deiminases 14) (rs2240340, rs1748033) and Human leukocyte antigen class II histocompatibility, D-related beta chain (HLA-DRB1) (rs2395175) polymorphisms in RA patients from Punjab, Pakistan. Blood samples of RA patients were collected from different hospitals of Sargodha. DNA was extracted, followed by PCR. Polymorphic analysis was performed in 300 rheumatoid arthritis patients and 300 healthy controls on PADI4 (rs2240340, rs1748033) and HLA-DRB1 (rs2395175). In PADI4 gene, both homozygous mutant genotype (TT) and heterozygous (CT) of SNP rs2240340 showed significant association by increasing the risk of RA up to two fold (OR 2.55; 95% CI 1.57-4.15; p = 0.0002). In case of rs1748033 polymorphism, homozygous mutant genotype (TT) showed significant association with RA by increasing the risk of disease up to three fold (OR 3.46; 95% CI 1.97-6.07; p = 0.0001), while heterozygous genotype (CT) of the same SNP showed significant association with RA by playing a protective role (OR 0.57; 95% CI 0.36-0.91; p = 0.0197). In HLA-DRB1 gene, homozygous mutant genotype (GG) of SNP rs2395175 showed no significant association with RA, while heterozygous genotype (AG) of the same SNP showed significant association with RA by playing a protective role (OR 0.44; 95% CI 0.27-0.71; p = 0.0009). Highly significance association of genes PADI4 (rs2240340, rs1748033) and HLA-DRB1 (rs2395175) polymorphisms with RA was observed in Pakistani population.

The assessment of health system responsiveness from the viewpoints of COVID-19 patients

BACKGROUND

Pandemics such as Corona are currently major health concerns worldwide. Health system responsiveness to the medical and non-medical needs of patients during pandemics is essential. This study aimed to examine hospitals' responsiveness to Corona patients.

METHODS

This descriptive and analytical research had a cross-sectional design. The study population included Corona patients discharged from 17 public hospitals of Mashhad University of Medical Sciences, Iran, in the spring of 2021. WHO questionnaire for health system responsiveness was used to collect data. 413 patients participated in the study who were selected by random classified sampling. To analyze the data, descriptive statistics, including frequency, and deviation, and to examine the relationship between variables, Kruskal-Wallis and Mann-Whitney tests were used.

RESULTS

In this study, one-third participants were in the age range of 31 to 40 (32.6%). The ability of 277 (70.5%) participants to pay treatment costs was very low, and low. 380 (96.7%) of the respondents had basic health insurance and 101 (25.7%) had supplementary insurance. In general, respondents evaluated the responsiveness of hospitals as 75.6. The highest score was related to confidentiality, and the lowest to prompt attention. There was no significant relationship between the total response score with demographic information.

CONCLUSION

The responsiveness of studied hospitals to Corona patients was adequate. However, there was dissatisfaction with the lack of timely treatment and medication. Moreover, the most important dimension of responsiveness was dignity. Healthcare providers need to pay attention to different aspects of responsiveness and improving the quality of and access to health services during pandemics and disasters.

Assessment of hypertension service availability in some primary health centres in Nigeria: a mixed-methods study

OBJECTIVE

Strengthening primary health centre (PHC) systems is a potentially effective strategy to reduce the burden of non-communicable diseases in Nigeria, a low/middle-income country with limited resources. The aim of this study was to assess hypertension service availability in some PHCs in Nigeria and seek recommendations that could facilitate improved services from PHC workers.

DESIGN

Explanatory sequential mixed-methods study.

SETTINGS

PHCs in the six geopolitical zones and Federal Capital City of Nigeria.

PARTICIPANTS

Eighteen PHC workers and 305 PHC facilities.

METHOD

Hypertension service availability and readiness were assessed in PHCs across Nigeria using a pro forma adapted from the WHO Service Readiness and Assessment tool. Eighteen workers in the PHCs were subsequently interviewed for in-depth exploration of hypertension service availability and readiness.

FINDINGS

Among the 305 health facilities assessed, 96 (31.5%) were in urban, 94 (30.8%) in semiurban and 115 (37.7%) in rural local government areas. Majority of the health facilities (43.0%) were manned by community extension workers. Only 1.6% and 19.7% of the health facilities had physicians and pharmacy technicians, respectively. About 22.3% of the providers had training in hypertension in the last 1 year. All the PHCs lacked adequate supply of essential antihypertensive medications. The identified deficiencies were less common in the urban PHCs compared with others. Qualitative analysis showed that the personnel, essential facilities and medicines required to provide hypertension services in the PHCs were inadequate. Suggested recommendations to successfully provide these services were provision of performance-based incentives; adequate staffing and training; supportive supervision of staff; provision of adequate equipment and essential medicines for hypertension management; provision of conducive environment for clients; and community engagement and participation.

CONCLUSION

Majority of the PHCs are currently not adequately equipped to provide hypertension services. Addressing identified gaps and using suggestions provided will guarantee successful provision of effective services.

Influence of well-being and quality of work-life on quality of care among healthcare professionals in southwest, Nigeria

The Nigerian healthcare industry is bedevilled with infrastructural dilapidations and a dysfunctional healthcare system. This study investigated the influence of healthcare professionals' well-being and quality of work-life (QoWL) on the quality of care (QoC) of patients in Nigeria. A multicentre cross-sectional study was conducted at four tertiary healthcare institutions in southwest, Nigeria. Participants' demographic information, well-being, quality of life (QoL), QoWL, and QoC were obtained using four standardised questionnaires. Data were summarised using descriptive statistics. Inferential statistics included Chi-square, Pearson's correlation, independent samples t-test, confirmatory factor analyses and structural equation model. Medical practitioners (n = 609) and nurses (n = 570) constituted 74.6% of all the healthcare professionals with physiotherapists, pharmacists, and medical laboratory scientists constituting 25.4%. The mean (SD) participants' well-being = 71.65% (14.65), QoL = 61.8% (21.31), QoWL = 65.73% (10.52) and QoC = 70.14% (12.77). Participants' QoL had a significant negative correlation with QoC while well-being and quality of work-life had a significant positive correlation with QoC. We concluded that healthcare professionals' well-being and QoWL are important factors that influence the QoC rendered to patients. Healthcare policymakers in Nigeria should ensure improved work-related factors and the well-being of healthcare professionals to ensure good QoC for patients.

Evaluation of healthcare facilities and personnel distribution in Lagos State: implications on universal health coverage

BACKGROUND

Nigeria is considering making Universal Health Coverage (UHC) a common policy goal to ensure that citizens have access to high-quality healthcare services without crippling debt. Globally, there is an acute shortage of human resources for Health (HRH), and the most significant burden is borne by low-income countries, especially in sub-Saharan Africa. This shortage has considerably constrained the achievement of health-related development goals and impeded accelerated progress toward universal health coverage. We examine the existing human resource capacity and the distribution of health facilities in Lagos state in this study, discussing the implications of our findings.

METHODS

The study is descriptive using secondary data analysis. We leverage census-based primary data collected by NOIPoll on health facility assessments in Lagos state. The collected data was analyzed using counts, ratios, rates, and percentages.

RESULTS

We observe a ratio of 5,014 people to 1 general medical doctor, 2,942 people to 1 specialist, 2,165 people to 1 nurse, and 5,117 people to 1 midwife, which are far higher than the WHO recommendation. We also observe that the ratio of nurses to general medical practitioners is 2.2:1 in urban areas and 2.7:1 in rural. In contrast, the ratio of nurses to specialist medical doctors is 1.3:1 in the urban area and 1.5:1 in the rural areas of Lagos state. The overall nurse per general medical practitioner ratio is 2.3:1 and 1.4:1 for specialist medical doctors. 77.2% of the health facilities surveyed were in the urban areas, with private-for-profit facilities accounting for 82.9%, government facilities accounting for 15.4%, and NGOs/faith clinics accounting for 1.7%. Primary healthcare facilities account for 75.3% of the facilities surveyed, secondary and tertiary facilities account for 24.6% and 0.08%, respectively. Alimosho LGA has the most health facilities (77.38% PHCs, and 22.62% SHCs) and staff strength specifically for general medical practitioners, specialists, nurses, and midwives (16.9%, 19.9%, 16.7%, 17.1%, respectively). Eti-Osa LGA has the best density ratio for generalist doctors, specialist doctors, and nurses per 10,000 (4.42, 12.96, and 11.34 respectively), while Ikeja has the best midwife population density ratio 5.46 per 10,000 population.

CONCLUSION

The distribution of health personnel and facilities in Lagos State is not equitable, with evident variation between rural and urban areas. This inequitable distribution could affect the physical distance of health facilities to residents, leading to decreased utilization, ultimately poor health outcomes, and impaired access. Much like child mortality, maternal mortality also exhibits a correlation with healthcare worker density. As the physician density increases linearly, the maternal mortality rate decreases exponentially. However, due to the low number of healthcare workers in Lagos state, doctors, nurses, and midwives are frequently unavailable during childbirth, resulting in increasing infant, neonatal, and maternal death. As such, the government should adopt the UHC strategy in its distribution of facilities and personnel in the state for adequate coverage and optimal performance of the facilities. Also, additional investments are needed in some parts of the state to improve access to tertiary health facilities and leverage private sector capacity.

Risk communication during health emergencies in Nigeria: What are its challenges?

Although globalization has been advantageous in facilitating the free movement of people, goods, and services, the ease of movement of cross-border pathogens has increased the risk of international public health emergencies in recent years. Risk communication is an integral part of every country's response during public health emergencies such as the coronavirus disease (COVID-19) pandemic. To effectively increase adherence to guidelines during health emergencies, it is essential to understand the impact of social, cultural, political, and environmental factors on people's behaviours and lifestyles in any given context, as well as how these factors influence people's perception of risks. During the recent response to the COVID-19 pandemic in Nigeria, the need to comprehend these influences was pronounced, and these influences ultimately shaped risk communication in Nigeria. We have identified risk communication challenges in Nigeria based on sociocultural diversity, the complexity of the health system, the impact of social media on communications, and other contextual factors surrounding multisectoral partnerships. To achieve global health security, these challenges must be addressed in resourceconstrained countries like Nigeria. In this paper, we emphasize the need to contextualize risk communication strategies in order to improve their effectiveness during health emergencies. In addition, we urge increased country commitment to a multi-hazard and multisectoral effort, deliberate investment in subnational risk communication systems, and investments in capacity building for risk communication activities.

Preventing and Mitigating Inter-Professional Conflict Among Healthcare Professionals in Nigeria

Introduction

The primary obligation of healthcare professionals is the well-being of patients. Inter-professional conflict can prevent the achievement of this goal, thereby potentially putting patients in peril. This study aimed at articulating contextual strategies to mitigate and prevent inter-professional conflict among healthcare workers in Nigeria.

Methods

A cross sectional study was undertaken in various health facilities in Nigeria. Questionnaires were administered to healthcare professionals. Completed questionnaires were analysed using Statistical Package for Social Sciences. Descriptive and inferential statistical analyses were undertaken.

Results

A total of 2207 valid responses were included for analysis. Findings revealed that almost all the respondents (92.9%) indicated that the Ministry of Health has a key role in resolving conflict in the healthcare sector. Close to three quarters (70.4%) of the study participants disagreed that leadership of hospitals and health agencies be limited to a particular profession. Almost all the participants (90.15%) indicated that cognate administrative expertise and experience are critical for leadership. A strong majority of the sample (93.5%) opined that reforms are required in the leadership selection process of hospital and other healthcare agencies.

Conclusion

Due to the criticality of this issue to patients' access to healthcare, findings from this study can underpin a proactive evidence based strategy that can comprehensively address inter-professional conflict among healthcare workers in Nigeria.

Scope of health worker migration governance and its impact on emigration intentions among skilled health workers in Nigeria

The growing trends for skilled health worker (SHW) migration in Nigeria has led to increased concerns about achieving universal health coverage in the country. While a lot is known about drivers of SHW migration, including national/sub-national government's inability to address them, not enough is known about its governance. Underpinning good governance systems is a commitment to human rights norms, that is, principles that enshrine non-discrimination, participation, accountability, and transparency. Hence, this study was aimed at deriving a conceptual framework that captures the scope of SHW migration governance in Nigeria and the extent to which it is human rights based. To describe the scope of SHW migration governance, we conducted an exploratory factor analysis and mapped our findings to themes derived from a qualitative analysis. We also did a multivariate analysis, examining how governance items are related to migration intentions of SHWs. The scope of SHW migration governance in Nigeria can be described across three levels: Constitutional-where policies about the economy and the health workforce are made and often poorly implemented; Collective-which responds to the governance vacuum at the constitutional level by promoting SHW migration or trying to mitigate its impact; Operational-individual SHWs who navigate the tension between the right to health, their right to fair remuneration, living/working conditions, and free movement. Examining these levels revealed opportunities for collaboration through stronger commitment to human right norms. In recognising their role as rights holders and duty bearers at various levels, citizens, health advocates, health workers, community groups and policy makers can work collaboratively towards addressing factors related to SHW migration. Further evidence is needed on how human rights norms can play a visible role in Nigeria's governance system for SHW migration.

Identifying challenges in implementing child rights instruments in Nigeria: A nationwide survey of knowledge, perception, and practice of child rights among doctors and nurses

Context

After thirty years of ratifying the child rights convention and nineteen years of the Child Rights Act, implementing child rights instruments remains challenging in Nigeria. Healthcare providers are well positioned to change the current paradigm.

Aim

To examine the knowledge, perception, and practice of child rights and the influence of demographics among Nigerian doctors and nurses.

Materials and Methods

A descriptive, cross-sectional online survey was done using nonprobability sampling. Pretested multiple-choice questionnaire was disseminated across Nigeria's six geopolitical zones. Performance was measured on the frequency and ratio scales. Mean scores were compared with 50% and 75% thresholds.

Results

A total of 821 practitioners were analyzed (doctors, 49.8%; nurses, 50.2%). Female-to-male ratio was 2:1 (doctors, 1.2:1; nurses, 3.6:1). Overall, knowledge score was 45.1%; both groups of health workers had similar scores. Most knowledgeable were holders of fellowship qualification (53.2%, P = 0.000) and pediatric practitioners (50.6%, P = 0.000). Perception score was 58.4% overall, and performances were also similar in both groups; females and southerners performed better (59.2%, P = 0.014 and 59.6%, P = 0.000, respectively). Practice score was 67.0% overall; nurses performed better (68.3% vs. 65.6%, P = 0.005) and postbasic nurses had the best score (70.9%, P = 0.000).

Conclusions

Overall, our respondents' knowledge of child rights was poor. Their performances in perception and practice were good but not sufficient. Even though our findings may not apply to all health workers in Nigeria, we believe teaching child rights at various levels of medical and nursing education will be beneficial. Stakeholder engagements involving medical practitioners are crucial.

Relationship between time of referral for physiotherapy and length of stay after stroke in a Nigerian tertiary hospital: a retrospective study

Background

Despite the known benefits of physiotherapy, the relationship between its time of referral and the length of stay (LOS) of stroke patients in developing countries has been understudied. This relationship was investigated in this study as we determined the relationships between LOS and time of referral and LOS and the number of physiotherapy sessions received.

Methods

Medical records of stroke patients admitted at Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife between January 2007 and December 2016 were retrieved. Descriptive statistics were used to summarize the data, independent samples t test, and one-way analysis of variance were used to determine differences, and Pearson correlation was used to determine relationships.

Results

A total of 585 medical records were retrieved. With an inpatient mortality rate of 40.7%, only 243 case records were included in the study. The mean LOS was 17 ± 13 days, and 63.4% received inpatient physiotherapy. Patients who were referred for physiotherapy (p = 0.019) and those who utilized physiotherapy (p = 0.001) had higher LOS. Also, there were significant correlations between LOS and the time of referral for physiotherapy (r = 0.575, p = 0.001) and LOS and the number of physiotherapy sessions received (r = 0.293, p = 0.001).

Conclusions

Stroke patients who utilized physiotherapy had longer LOS. The longer the time of referral and the higher the number of physiotherapy sessions, the longer the LOS. Early referral and commencement of physiotherapy optimize physiotherapy utilization, which may reduce the LOS of stroke patients.

Retrospective study of COVID-19 outcomes among healthcare workers in Rivers State, Nigeria

OBJECTIVE

To determine the illness severity and mortality among COVID-19-infected healthcare workers (HCWs).

DESIGN

A retrospective cohort study using population-level data. Secondary analysis was conducted on collated data from the Public Health Emergency Operations Centre (PHEOC) at the State Ministry of Health, Rivers State, Nigeria. Data were gathered from the COVID-19 patient database of the PHEOC on demographics, place of work, illness severity and outcome.

PARTICIPANTS

The cohort included all documented HCWs with confirmed COVID-19 infection (diagnosed by PCR).

PRIMARY AND SECONDARY OUTCOME MEASURES

Illness severity defined as 'hospitalisation required' and treatment outcome labelled as 'alive' or 'dead' were the outcomes of interest.

RESULTS

The mean age was 43 years and 50.5% of the cohort were female. Of the 301 HCWs infected, 187 patients were symptomatic with 32 requiring hospitalisation. Seven infected HCWs died of their COVID-19 infection, resulting in a case fatality ratio (CFR) of 2.3%. Population proportions for age groups, case presentation and mortality, would be significantly greater than those seen in the study population. Health professionals made up 79.7% (240) of the study cohort, with 68.8% (165) of them working at the teaching hospitals; the association between HCWs and health facilities they worked in, was significant. Symptomatic cases were more inclined to progress to severe illness ([Formula: see text] adjusted OR (aOR) 10.658, 95% CI 2.494 to 45.552); patients also had greater odds of dying from COVID-19 ([Formula: see text] aOR 1.079, 95% CI 1.02 to 1.141) per year increase in age adjusted for sex, case class and illness severity.

CONCLUSIONS

Frontl-ine HCWs are at an increased risk of exposure to COVID-19 infections. In Nigeria, there is a higher risk of experiencing severe illness if symptomatic while infected with COVID-19. Preventive strategies, proper education and awareness must be put in place to protect HCWs.

OBJECTIVE

To determine the illness severity and mortality among COVID-19-infected HCWs.

Understanding the Nature and Sources of Conflict Among Healthcare Professionals in Nigeria: A Qualitative Study

Introduction

Inter-professional conflict in the Nigerian health sector is a concept that is as old as modern medical practice and has resulted in disruption of health care delivery, with the overall impact bearing down on patients.

Purpose

This study aimed to provide an in-depth understanding and a clearer insight into the causes of conflict in the Nigerian health sector.

Methods

A qualitative strategy was employed using a semi-structured interview approach. Data were obtained from health practitioners from diverse backgrounds in various healthcare facilities.

Results

The phenomenon of conflict was reported as a long existent and trans-generational strain on inter-professional relationships occurring in all sectors of health practice, primarily between the physicians and other health care professionals. Inter-professional conflict was reported to emanate primarily from lapses in leadership, remuneration structure, role description, communication and emotional intelligence. This has affected the effectiveness of the Nigerian healthcare system and has contributed to hindrance in the provision of high-quality care in the country.

Conclusion

Evidence from this study can help in developing contextual policy in addressing inter-professional conflict in the health sector, and this will consequently improve health care delivery in the country.

Challenges and lessons from a school-based human papillomavirus (HPV) vaccination program for adolescent girls in a rural Nigerian community

Background

Over 80% of new cervical cancer cases occur in women living in low- and middle-income countries. It is the second highest cause of female cancer deaths in Nigeria. School based vaccination programs are an effective strategy for delivering the HPV vaccine to adolescent girls. This study aims to understand the challenges to implementing school-based HPV vaccination programs, particularly in a remote rural setting where vaccine hesitancy is high.

Methods

A 22- item interviewer administered questionnaire was used to evaluate HPV knowledge and willingness to get the HPV vaccinate among 100 female secondary school students as part of an HPV vaccination pilot in a rural community in Kebbi State, Nigeria. Additionally, semi-structured interviews were used to assess community knowledge and attitudes on cervical cancer and HPV vaccination. Data collected were analyzed thematically to understand challenges and generate lessons for vaccine delivery in the study setting.

Results

Knowledge of HPV and cervical cancer among junior secondary school aged girls was fair with a mean score of 66.05%. For senior secondary school aged girls, the knowledge score ranged from 70 to 100% with a mean of 96.25% indicating good knowledge of HPV and cervical cancer. All participants (n = 100) received the first vaccine dose but due to COVID-19, 33 participants were not able to complete the vaccine dosage within the recommended 6-month schedule. Of the parents who provided consent, none could afford the vaccine out of pocket. Challenges to vaccine delivery included operational costs exacerbated by lack of adequate health workforce and infrastructure in the study setting.

Conclusion

An exploration of sociocultural perspectives and contextual realities is crucial to understanding the complexities of HPV vaccine introduction from the perspective of the target audience, and the local community. Strategies for introducing the HPV vaccine should address community concerns through effective communication, appropriate delivery, and targeted advocacy to make the vaccination program locally relevant. While school-based HPV immunization programs have been shown to be successful, adequate design, planning and monitoring is important. Additionally, considerations must be made to account for the high operational cost of vaccine delivery in rural, hard to reach areas where human resources and infrastructure are limited.

Assessment of the level and distribution of health system responsiveness in Oyo State, Nigeria

Background

Health systems need to be evaluated to ascertain if they are meeting their objectives. There is an increased interest in health system responsiveness (HSR) as a means to appraise health systems. This becomes vital as we put people at the centre of integrated health systems and put a premium on their rights and perspectives. Thus, this study assessed the levels, distribution and factors associated with HSR in Oyo State.

Methods

The study was a cross-sectional study with 717 adults, who had used an out-patient health facility in the preceding 12 months, interviewed using a semi-structured, interviewer-administered questionnaire. HSR was measured on a multi-domain and multi-item (7 domains and 20 items) 5-point Likert scale that was developed by the WHO to measure HSR globally. Summary scores were computed for level, distribution and the most important domains of HSR. Determinants of poor HSR were determined using binomial logistic regression. The level of statistical significance was set at 5%.

Results

The overall level of HSR was 47%. The highest-rated domains were confidentiality (72%), dignity (64%) and choice (60%), while the least rated were prompt attention (43%) and communication (52%). The overall distribution of HSR was 0.228 (range of 0 to 1) with the domains of prompt attention (0.595) and choice (0.506) being the most unequally distributed. The most important domains were communication, prompt attention and dignity. The least important domains were choice and confidentiality. The factors associated with poor HSR (overall) were no formal education, (OR = 2.81; 95% CI: 1.35–5.86), primary education as the highest level of education (OR = 2.19; 95% CI: 1.28–3.75), poor socioeconomic class (OR = 1.86; 95% CI: 1.23–2.80), using a government-owned facility (OR = 1.56; 95% CI: 1.11–2.19) and not using the usual health facility (OR = 1.69; 95% CI: 1.13–2.53).

Conclusions

The overall level of HSR in Oyo State was low with the domains of prompt attention, communication and autonomy being the least rated domains. Therefore, concerted efforts should be targeted at improving HSR as this will improve wellbeing, health system utilization, and the overall health system.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08276-9.

Improving health workforce governance: the role of multi-stakeholder coordination mechanisms and human resources for health units in ministries of health

BACKGROUND

A cohesive and strategic governance approach is needed to improve the health workforce (HW). To achieve this, the WHO Global Strategy on Human Resources for Health (HRH) promotes mechanisms to coordinate HRH stakeholders, HRH structures and capacity within the health sector to support the development and implementation of a comprehensive HW agenda and regular reporting through WHO's National Health Workforce Accounts (NHWA).

METHODS

Using an adapted HRH governance framework for guidance and analysis, we explored the existence and operation of HRH coordination mechanisms and HRH structures in Malawi, Nepal, Sudan and additionally from a global perspective through 28 key informant interviews and a review of 165 documents.

RESULTS

A unified approach is needed for the coordination of stakeholders who support the timely development and oversight of an appropriate costed HRH strategy subsequently implemented and monitored by an HRH unit. Multiple HRH stakeholder coordination mechanisms co-exist, but the broader, embedded mechanisms seemed more likely to support and sustain a comprehensive intersectoral HW agenda. Including all stakeholders is challenging and the private sector and civil society were noted for their absence. The credibility of coordination mechanisms increases participation. Factors contributing to credibility included: high-level leadership, organisational support and the generation and availability of timely HRH data and clear ownership by the ministry of health. HRH units were identified in two study countries and were reported to exist in many countries, but were not necessarily functional. There is a lack of specialist knowledge needed for the planning and management of the HW amongst staff in HRH units or equivalent structures, coupled with high turnover in many countries. Donor support has helped with provision of technical expertise and HRH data systems, though the benefits may not be sustained.

CONCLUSION

While is it important to monitor the existence of HRH coordination mechanisms and HRH structure through the NHWA, improved 'health workforce literacy' for both stakeholders and operational HRH staff and a deeper understanding of the operation of these functions is needed to strengthen their contribution to HW governance and ultimately, wider health goals.

An exploratory study of outpatient medication knowledge and satisfaction with medication counselling at selected hospital pharmacies in Northwestern Nigeria

Background

Medication counselling is an important activity that improves patient therapeutic outcomes. After this activity has been carried out, patients should be satisfied with counselling, and possess adequate knowledge about their medications.

Objectives

To describe outpatient/caregiver medication knowledge and satisfaction with medication counselling at the main outpatient pharmacies of eight public secondary and tertiary hospitals located in two states in Northwestern Nigeria.

Methods

Exit interviews were conducted from December 2019 to March 2020 with randomly sampled patients/caregivers who had just been dispensed one or more prescription medications from the main pharmacies of the hospitals. The questionnaire used contained 31 questions in three sections. The first section collected demographic information. The second section assessed respondents’ experiences and overall satisfaction with the counselling they had received. The last section evaluated respondents’ knowledge of one randomly selected prescription medication that had been dispensed to them. Data collected were coded and analyzed to generate descriptive statistics. To explore associations between respondent characteristics and overall satisfaction, non-parametric tests were used, and statistical significance set at p<0.05.

Results

A total of 684 patients/caregivers were interviewed. Majority of respondents agreed that the time spent (97.1%) and quantity of information (99.1%) provided during counselling was adequate. However, over 60% of them also agreed that dispensers did not assess their understanding of information provided or invite them to ask questions. Despite this, their average overall satisfaction with counselling on a 10-point scale was 8.6 ± 1.6. Over 90% of them also correctly identified the routes and frequency of administration of the prescribed medication selected for the knowledge assessment. Although, more than 60% of respondents did not know the duration of therapy or names of these medications.

Conclusion

Respondents’ satisfaction with medication counselling was fairly high even though they did not seem to know much about their medication.

Assessing service quality and the perceptual difference between employees and patients of public hospitals in a developing country

Purpose

This study aims to examine service quality in Nigerian general hospitals and determines possible differences in service quality perceptions between employees and patients.

Design/methodology/approach

Using the Servqual scale, data was collected from 328 employees and patients of two government hospitals in Abuja and Delta states. Analysis was carried out using SPSS 26 package for constructs reliability frequency, mean, standard deviation and t-statistics.

Findings

The study found significant differences in the perception of service quality between employees and patients of the Nigerian general hospitals. While employees gave a high rating to empathy, patients rated it low. Also, the patients’ poor perception of tangible did not match the employees’ high perception. Other specific findings are patients’ unfavourable assessment of the physical facilities and judged the staff to lack professional dressing. Patients felt the hospitals could not provide necessary equipment for their procedures and thus considered their services unreliable.

Practical implications

Reliability was perceived as a significant problem in this study; therefore, the hospitals management should ensure correct diagnoses and treatment results of the highest quality and timely services. Also, the management should invoke strong relationships between the employees and patients to earn patients’ trust. Employees should ensure to listen to patients’ complaints and find solutions promptly. Patients need health-care workers’ support and rely on their abilities; Therefore, health-care workers should be highly dependable and show empathic behaviour in discharging their duties. Health-care managers must access employees‘ and patients’ particular perceptual gaps and reconcile the difference before further quality improvement initiatives.

Originality/value

The findings in this study strengthen the clamour for assessing service quality from both employees and patients’ views in public hospitals. Hospital service quality is complex and primarily judged from the patients’ perspective. This study showed that health-care quality means different things to all stakeholders.

Patients' satisfaction with physiotherapy management of chronic mechanical neck pain in physiotherapy departments of public hospitals in Ibadan, Nigeria: A mixed-method study

INTRODUCTION

The study was aimed at determining patients' satisfaction level with physiotherapy in the management of chronic mechanical neck pain (CMNP) in physiotherapy departments of the 3 public hospitals in Ibadan, Nigeria.

METHODS

A mixed-method design that involved 51 and five both purposively selected participants for the cross-sectional survey (CSS) and qualitative study, respectively. For the CSS, data was collected using the MedRisk instrument and analyzed using the Chi-square test at p ≤ .05. For the qualitative study, patients' satisfaction was explored through a focus group discussion (FGD) and analyzed using thematic analysis.

RESULTS

For CSS, 49.0% and 7.8% of the participants reported excellent and fair satisfaction, respectively, with physiotherapy in the management of CMNP. There was no significant association of patients' satisfaction level with: age (p = .588); sex (p = .851); and marital status (p = .409). For the FGD, three themes (patients' experience with physiotherapists; patient satisfaction with physiotherapy services; patient satisfaction with other health care services) that emerged further explained that participants were satisfied with physiotherapy management of their CMNP. However, they were not satisfied with the attitude of the record officers, constancy of the same treating physiotherapists, and unavailability of resources.

CONCLUSION

Patients with CMNP are satisfied with the physiotherapy care they received.

Knowledge, causes, and experience of inter-professional conflict and rivalry among healthcare professionals in Nigeria

Introduction

The healthcare workforce is regarded as an essential component of any functioning health system, and a lack of optimal collaboration among this group can result to poor quality healthcare services to the population. In Nigerian setting, the health sector is faced with challenges of inter-professional conflict and rivalry. This study aimed at understanding knowledge, causes, and experience of inter-professional conflict and rivalry among healthcare professionals in Nigeria.

Methods

A cross sectional study was undertaken to administer questionnaires to healthcare personnel in various healthcare facilities in Nigeria. Data were analysed using Statistical Package for Social Sciences.

Results

A total of 2207 valid responses were received, and male participants were in majority as indicated by 63.7% of the sample. Collectively, doctors and pharmacists represented two-thirds of the sample, and majority of the participants were in the public sector (82.5%). Disparity in salary structure was the highest source of conflict. Whilst almost all the participants indicated that inter-professional rivalry and conflict are prevalent in health sector, about three-quarters of them (73.2%) disagreed that this practice is productive. A considerable number of the respondents had experienced inter-professional conflict and rivalry.

Conclusion

Evidence from this study can help policymakers in developing framework that can be utilised in addressing rivalry and conflict in the healthcare sector.

Perspectives of healthcare professionals in Nigeria about physiotherapists’ scope of practice and skills in ICU patients’ management: a cross-sectional study

Background

There is growing evidence for physiotherapy in the intensive care unit (ICU), but physiotherapy in the ICU and patients’ referral rate remains low in Nigeria. This study assessed the healthcare professionals’ perception of the physiotherapists’ scope of practice and skills in managing patients in the ICU of selected teaching hospitals in Southern Nigeria. The study was a cross-sectional survey that involved seventy healthcare professionals working in the ICU who completed an adapted and validated questionnaire. The data obtained from the cross-sectional study were presented using descriptive statistics of mean, standard deviation, frequency distribution, and percentage.

Results

The mean age of the participants was 39.74 ± 7.08 years. The majority of the participants had a bachelor’s degree and had worked for a minimum of 5 years in the ICU, with all the participants working in a mixed ICU and 46.7% work in ICUs with four to six beds. Physiotherapists (PTs) are not posted exclusively to the ICUs, and PTs were reported to be on call in most of the ICUs during the weekdays and weekends. Patients were referred for physiotherapy by the physicians. Healthcare professionals had negative perceptions about PTs’ scope in airway suctioning, nebulization, weaning, and adjustment of mechanical ventilators, intubation, extubation, and changing tracheostomy tubes for ICU patients. Participants had a positive perception about PTs’ assessment skills in the ICU except for hypoxemia calculation, readiness for weaning, and the need for humidification.

Conclusion

Healthcare professionals working in the ICU in the selected hospitals had both negative and positive perceptions regarding certain areas about the scope of practice and skills of PTs in managing patients in the ICU.

Conceptualizing and implementing a health workforce registry in Nigeria

BACKGROUND

Nigeria's health sector aims to ensure that the right number of health workers that are qualified, skilled, and distributed equitably, are available for quality health service provision at all levels. Achieving this requires accurate and timely health workforce information. This informed the development of the Nigeria Health Workforce Registry (NHWR) based on the global, regional, and national strategies for strengthening the HRH towards achieving universal health coverage. This case study describes the process of conceptualizing and establishing the NHWR, and discusses the strategies for developing sustainable and scalable health workforce registries.

CASE PRESENTATION

In designing the NHWR, a review of existing national HRH policies and guidelines, as well as reports of previous endeavors was done to learn what had been done previously and obtain the views of stakeholders on how to develop a scalable and sustainable registry. The findings indicated the need to review the architecture of the registry to align with other health information systems, develop a standardized data set and guidance documents for the registry including a standard operating procedure to ensure that a holistic process is adopted in data collection, management and use nationally. Learning from the findings, a conceptual framework was developed, a registry managed centrally by the Federal Ministry of Health was developed and decentralized, a standardized tool based on a national minimum data was developed and adopted nationally, a registry prototype was developed using iHRIS Manage and the registry governance functions were integrated into the health information system governance structures. To sustain the functionality of the NHWR, the handbook of the NHWR that comprised of an implementation guide, the standard operating procedure, and the basic user training manual was developed and the capacity of government staff was built on the operations of the registry.

CONCLUSION

In establishing a functional and sustainable registry, learning from experiences is essential in shaping acceptable, sustainable, and scalable approaches. Instituting governance structures that include and involve policymakers, health managers and users is of great importance in the design, planning, implementation, and decentralization stages. In addition, developing standardized tools based on the health system's needs and instituting supportable mechanisms for data flow and use for policy, planning, development, and management is essential.

Consolidating and Upscaling Molecular Research Capacity in Nigeria: On Who's Account?

Molecular research and researchers engage in studies that seek to understand the structures, functions, and interactions of biomolecules as the basis for cellular and systemic effects in living organisms. This research approach was made possible by considerable technological advancements that equip researchers with tools to view biomolecules. Although molecular research holds great promises for improving lives and living, the technological requirements and equipment to undertake molecular research are quite expensive, often requiring a heavy start-up capital or investment. In developing countries such as Nigeria, where the majority of the population lives below the poverty line and research funding is abysmally low, such heavy investments into research that do not provide immediate solutions to societal problems are difficult. This is mostly due to limited resources available to tackle many urgent and pressing needs, and limited perspective and understanding of policymakers, leading to infrastructural and skilled personnel deficit to support molecular research. Despite all these, the field of molecular research continues to grow exponentially globally, hence, funding and investments into this critical life science research area have become imperative. With the rich biodiversity of humans, animals, and plants in Nigeria, and the huge burden of infectious diseases in the country or region, global advances in genomics and proteomics studies will be incomplete without adequate contribution from Nigeria and sub-Saharan Africa region. This paper examines the progression and challenges of undertaking molecular research in Nigeria, and how Nigerian molecular research scientists are tackling these issues, with recommendations for improved molecular research capacity and output in the country or region.

OUP accepted manuscript

Priority setting and health system governance are critical for optimising healthcare interventions and determining how best to allocate limited resources. The COVID-19 pandemic has buttressed the need for these especially now that vaccines are available to curb the spread of the disease. In many low- and middle-income countries (LMICs), vaccine coverage remains low, due in large part to sub-optimal priority setting and health system governance which has led to inequities in access and has fuelled vaccine hesitancy. An analysis of the situation in Nigeria identified key issues that have affected the health system response to COVID-19 and impeded timely access to the vaccine. These include weak vaccine procurement strategies, limited evidence on strategies for prioritising recipients and approaches for rolling out mass vaccination programmes for the entire population, lack of a communication strategy to reduce the incidence of vaccine hesitancy and failures to proactively address vaccine hesitancy through the implementation of vaccination programmes. Nigeria and other many other LMICs are still facing the prospect of subsequent and potentially worsening waves of the COVID-19 pandemic. Without effective priority setting, there is a risk that the country will not accelerate vaccine rollout quickly enough to achieve high coverage rates that will ensure herd immunity. In the context of existing weaknesses in health system governance, there is an urgent need to strengthen priority settings in Nigeria and identify and implement context-specific solutions that can improve vaccine coverage for the population.

Coronavirus disease 2019 (COVID-19) and individuals with intellectual and developmental disabilities in Nigeria

This article chronicles the present situation of coronavirus disease 2019 (COVID-19) on individuals with intellectual and developmental disabilities (IDD) in Nigeria. A systematic search was conducted on three bibliographic databases: MEDLINE Complete, Web of Science and Scopus, and supplemented with grey literature searches to assess studies on the effect of COVID-19 on these individuals in Nigeria with data on this group from December 2019 to July 2020. There were no studies found concerning individuals with IDD in Nigeria. This article argues for an urgent call to action by Nigerian policymakers to make data available to help understand the impact of COVID-19 and to develop and implement appropriate interventions. This article provides steps to support and care for these individuals in Nigeria. Forecasting models are recommended which offer better approaches in yielding accurate predictions and provide valuable decisions in the event of future threats and infectious disease outbreak in Nigeria.

'Making the most of our situation': a qualitative study reporting health providers' perspectives on the challenges of implementing the prevention of mother-to-child transmission of HIV services in Lagos, Nigeria

OBJECTIVES

To investigate the challenges of, and opportunities for, effective delivery of prevention of mother-to-child transmission (PMTCT) services from the perspectives of primary healthcare providers in Lagos, Nigeria.

DESIGN

This qualitative study consisted of nine focus groups with 59 health providers, analysed thematically.

SETTING

Thirty-eight primary health facilities in central and western districts of Lagos, Nigeria.

PARTICIPANTS

Participants included nurses, nursing assistants, community health workers, laboratory workers, pharmacists, pharmacy technicians, monitoring and evaluation staff and medical records personnel.

RESULTS

Health providers' challenges included frustration with the healthcare system where unmet training needs, lack of basic amenities for effective and safe treatment practices, low wages and inefficient workflow were discussed. Providers discussed patient-level challenges, which included the practice of giving fake contact information for fear of HIV-related stigmatisation, and refusal to accept HIV-positive results and to enrol in care. Providers' suggestions for addressing PMTCT service delivery challenges included the provision of adequate supplies and training of healthcare workers. To mitigate stigmatisation, participants suggested home-based care, working with traditional birth attendants and religious institutions and designating a HIV health educator for each neighbourhood.

CONCLUSIONS

Findings illustrate the complex nature of PMTCT service delivery and illuminate issues at the patient and health system levels. These results may be used to inform strategies for addressing identified barriers and to improve the provision of PMTCT services, thus ensuring better outcomes for women and families.

"What Are You Really Doing in This Country?": Emigration Intentions of Nigerian Doctors and Their Policy Implications for Human Resource for Health Management

The emigration of doctors from Nigeria has been on the increase in recent years, with no obvious efforts to manage or mitigate the negative impacts of this growing trend on the already weak health system. This study assessed the emigration intentions of doctors undergoing residency training at the premier tertiary healthcare center in Nigeria and the factors that influence these intentions. This mixed-method study was cross-sectional in design. A semi-structured questionnaire was used to identify the factors that influence the emigration intentions of resident doctors at the University College Hospital, Ibadan, Southwest Nigeria. In-depth interviews (IDIs) were also conducted to further explore the push and pull factors identified from the survey and their migration preferences. A total of 244 resident doctors completed the questionnaires and 10 participated in the IDIs. Overall, 57.4% of the respondents had emigration intentions and 34.8% had made various attempts at emigrating. Major factors that encouraged resident doctors to emigrate to developed countries included better working and living conditions, good salary and the opportunity for career advancement in destination countries. Family ties was the single most important factor that deterred resident doctors from emigrating. The UK was found to be the top preferred destination. Strategic approaches and multisectoral collaborations will be required to address doctors’ emigration from Nigeria. These efforts should be targeted at not just the health sector but should also include the social and economic aspects of the lives of resident doctors, to improve their living conditions.

The views of public service managers on the implementation of National Health Insurance in primary care: a case of Johannesburg Health District, Gauteng Province, Republic of South Africa

Background

The South African government is implementing National Health Insurance (NHI) as a monopsony health care financing mechanism to drive the country towards Universal Health Coverage (UHC). Strategic purchasing, with separation of funder, purchaser and provider, underpins this initiative. The NHI plans Contracting Units for Primary healthcare (PHC) Services (CUPS) to function as either independent sub-district purchasers or public providers and District Health Management Offices (DHMOs) to support and monitor these CUPS. This decentralised operational unit of PHC, the heartbeat of NHI, is critical to the success of NHI. The views of district-level managers, who are responsible for these units, are fundamental to this NHI implementation. This qualitative study aimed to explore district and sub-district managerial views on NHI and their role in its implementation.

Methods

Purposive sampling was used to identify key respondents from a major urban district in Gauteng, South Africa, for participation in in-depth interviews. This study used framework analysis methodology within MaxQDA software.

Results

Three main themes were identified: managerial engagement in NHI policy development (with two sub-themes), managerial views on NHI (with three sub-themes) and perceptions of current NHI implementation (with six sub-themes). The managers viewed NHI as a social and moral imperative but lacked clarity and insight into the NHI Bill as well as the associated implementation strategies. The majority of respondents had not had the opportunity to engage in NHI policy formulation. Managers cited several pitfalls in current organisational operations. The respondents felt that national and provincial governments continue to function in a detached and rigid top-down hierarchy. Managers highlighted the need for their inclusion in NHI policy formulation and training and development for them to oversee the implementation strategies.

Conclusions

It appears that strategic purchasing is not being operationalised in PHC. NHI policy implementation appears to function in a rigid top-down hierarchy that excludes key stakeholders in the NHI implementation strategy. The findings of this study suggest an inadequate decentralisation of healthcare governance within the public sector necessary to attain UHC. District managers need to be engaged and capacitated to operationalise the planned decentralised purchasing-provision function of the DHS within the NHI Bill.

Qualitative exploration of health system response to COVID-19 pandemic applying the WHO health systems framework: Case study of a Nigerian state

Pandemics can result in significantly high rates of morbidity and mortality with higher impact in Lower- and Middle-Income Countries like Nigeria. Health systems have an important role in a multi-sector response to pandemics, as there are already concerns that COVID-19 will significantly divert limited health care resources. This study appraised the readiness and resilience of the Nigerian health system to the COVID-19 pandemic, using Oyo State, southwest Nigeria, as a case study. This study was a cross-sectional qualitative study involving key informant and in-depth interviews. Purposive sampling was used in recruiting participants who were members of the Task Force on COVID-19 in the state and Emergency Operations Centre (EOC) members (physicians, nurses, laboratory scientists, “contact tracers”, logistic managers) and other partners. The state's health system response to COVID 19 was assessed using the WHO health systems framework. Audio recordings of the interviews done in English were transcribed and thematic analysis of these transcripts was carried out using NVIVO software. Results show that the state government responded promptly by putting in place measures to address the COVID-19 pandemic. However, the response was not adequate owing to the fact that the health system has already been weakened by various challenges like poor funding of the health system, shortage of human resources and inadequate infrastructure. These contributed to the health system's sub-optimal response to the pandemic. In order to arm the health system for adequate and appropriate response during major health disasters like pandemics, fundamental pillars of the health system-finance, human resources, information and technology, medical equipment and leadership - need to be addressed in order to have a resilient health system.

Retention and motivation of health workers in remote and rural areas in Cross River State, Nigeria: a discrete choice experiment

BACKGROUND

Cross River State is making investments geared towards ensuring equitable distribution and improved retention of its frontline health workforce in remote and rural areas. This informed the conduct of a discrete choice experiment to determine the motivating factors supporting the retention of healthcare workers.

METHODS

Study participants were 198 final year students of nursing, midwifery and community health and frontline health workers. Eight focus group discussions and 38 key informant interviews were conducted to obtain information about the dimensions of the work conditions that are important to frontline health workers when choosing to take up posting or stay in their rural work locations.

RESULTS

Health workers are 2.7 times more likely to take up a rural posting or continue to stay in their present rural duty posts if they receive a salary increment. They are also four times more likely to take a rural job posting if a basic housing or a housing allowance is provided.

CONCLUSION

Improving working conditions of frontline health workers in terms of adequate staff strength, good skills mix and equipment, etc., as well as improving opportunities for career advancement will support retention in rural health posts.

Confronting power in low places: historical analysis of medical dominance and role-boundary negotiation between health professions in Nigeria

Introduction

Interprofessional interaction is intrinsic to health service delivery and forms the basis of task-shifting and task-sharing policies to address human resources for health challenges. But while interprofessional interaction can be collaborative, professional hierarchies and discipline-specific patterns of socialisation can result in unhealthy rivalry and conflicts which disrupt health system functioning. A better understanding of interprofessional dynamics is necessary to avoid such negative consequences. We, therefore, conducted a historical analysis of interprofessional interactions and role-boundary negotiations between health professions in Nigeria.

Methods

We conducted a review of both published and grey literature to provide historical accounts and enable policy tracing of reforms related to interprofessional interactions. We used Nancarrow and Borthwick’s typology for thematic analysis and used medical dominance and negotiated order theories to offer explanations of the conditions that facilitated or constrained interprofessional collaboration.

Results

Despite an overall context of medical dominance, we found evidence of professional power changes (dynamics) and role-boundary shifts between health professions. These shifts occurred in different directions, but shifts between professions that are at different power gradients were more likely to be non-negotiable or conflictual. Conditions that facilitated consensual role-boundary shifts included the feasibility of simultaneous upward expansion of roles for all professions and the extent to which the delegating profession was in charge of role delegation. While the introduction of new medical diagnostic technology opened up occupational vacancies which facilitated consensual role-boundary change in some cases, it constrained professional collaboration in others.

Conclusions

Health workforce governance can contribute to better functioning of health systems and voiding dysfunctional interprofessional relations if the human resource for health interventions are informed by contextual understanding (informed by comparative institutional and health systems research) of conditions that facilitate or constrain effective interprofessional collaboration.

The COVID-19 pandemic: Stay Home policy and exposure to risks of infection among Nigerians

The global threat which continues to accompany SARS-CoV-2 has led to a global response which adopts lockdown and stays home policy as means of curtailing its spread. This study investigates compliance with the Stay Home policy and exposure to COVID-19 in Nigeria. A survey was conducted from April 4 to May 8, 2020 using a cross-sectional mixed-methods approach to elicit responses from 879 participants across six geopolitical zones of Nigeria. Descriptive, χ 2, and multiple regression tests were used to analyze survey data using SPSS, whereas NVivo v12 was used for thematic analysis of qualitative data. States with complete lockdown had 72.4% of respondents complying fully with the policy compared with 44.2% of respondents in zones with the partial lockdown. Market places, classified as high-risk zones, were the most visited (n = 505; 71.0%). Though compliance was influenced by the nature of lockdown enforced (χ 2 = 70.385, df = 2; p < 0.05), being a female, a widow, and unemployed were associated with increased compliance. Exposure to COVID-19 was associated with being married, unemployed, and having no income. Fear, anxiety, and misperception play major roles in compliance. The authors conclude that compliance is not uniform and a more nuanced and targeted approach is required as the government continues to respond to the COVID-19 global pandemic.

Characterization and distribution of medicine vendors in 2 states in Nigeria: implications for scaling health workforce and family planning services

BACKGROUND

In 2014, Nigeria issued the task-shifting/sharing policy for essential health services, which aimed to fill the human resource gap and improve the delivery of health services across the country. This study focuses on the characteristics, spread, and family planning (FP) stocking practices of medicine vendors in Lagos and Kaduna, assessing the influence of medical training on the provision and stocking of FP services and commodities by vendors.

METHODS

We conducted a census of all Patent Medicines stores (PMS) followed up with a facility assessment among 10% of the mapped shops, utilizing an interviewer-administered questionnaire. Bivariate analysis was conducted using the Chi-square test, and multiple logistic regression was used to estimate the adjusted odds ratio (OR) and confidence intervals (CI) for the test of significance in the study.

RESULTS

A total of 8318 medicine shops were enumerated (76.2% urban). There were 39 shops per 100,000 population in both states on average. About half (50.9%) were manned by a medicine vendor without assistance, 25.7% claimed to provide FP services to > 2 clients per week, and 11.4% were not registered with the regulatory body or any professional association. Also, 28.2% of vendors reported formal medical training, with 56.3% of these medically trained vendors relatively new in the business, opening within the last 5 years. Vendors utilized open drug markets as the major source of supply for FP products. Medical training significantly increased the stocking of FP products and inhibited utilization of open drug markets.

CONCLUSION

Patent and Proprietary Medicines Vendor (PPMVs) have continued to grow progressively in the last 5 years, becoming the most proximal health facility for potential clients for different health services (especially FP services) across both Northern and Southern Nigeria, now comprising a considerable mass of medically trained personnel, able to deliver high-quality health services and complement existing healthcare infrastructure, if trained. However, restrictions on services within the PPMV premise and lack of access to quality drugs and commodities have resulted in poor practices among PPMVs. There is therefore a need to identify, train, and provide innovative means of improving access to quality-assured products for this group of health workers.

Public opinion regarding government response to COVID-19: case study of a large commercial city in Nigeria

INTRODUCTION

government measures to contain the COVID-19 pandemic cannot be effective without widespread compliance by the public. A greater understanding of citizens' perceptions of these measures can help government agencies adapt their strategies to boost compliance. We examined citizens' perceptions of government's measures to contain the COVID-19 pandemic and its implications on compliance using data from Onitsha city, Anambra State Nigeria.

METHODS

data was obtained through in-person interviews of 140 consenting adults in March 2020. Descriptive and inferential statistics were used to summarize the data.

RESULTS

most participants (84.7%) doubted government's ability to manage the COVID-19 outbreak, raising concerns about ineffective governance (25.7%) and inadequate health facilities (20.7%). However, participants expressed a favorable perception of school closures (92.3%) and a ban on large gatherings (83.9%), driven mostly by the need to contain the COVID-19 and avoid its spread. But, they were generally indifferent about the closure of the markets and workplaces due to concerns for food insecurity and lack of government's relief programs. Participants who had a positive perception of the ban on large gatherings were more likely to have high knowledge and to adopt good COVID-19 preventive practices.

CONCLUSION

the study showed a lack of public's confidence in the government's ability to manage the pandemic. This provides an opportunity for the city government and the public to reflect on the existing relationships, build mutual trust, and devise collaborative engagement that will boost compliance and help contain the devastating impact of COVID-19 pandemic.

A qualitative inquiry of access to and quality of primary healthcare in seven communities in East and West Africa (SevenCEWA): perspectives of stakeholders, healthcare providers and users

BACKGROUND

Universal health coverage is one of the Sustainable Development Goal targets known to improve population health and reduce financial burden. There is little qualitative data on access to and quality of primary healthcare in East and West Africa. The aim of this study was to describe the viewpoints of healthcare users, healthcare providers and other stakeholders on health-seeking behaviour, access to and quality of healthcare in seven communities in East and West Africa.

METHODS

A qualitative study was conducted in four communities in Nigeria and one community each in Kenya, Uganda and Tanzania in 2018. Purposive sampling was used to recruit: 155 respondents (mostly healthcare users) for 24 focus group discussions, 25 healthcare users, healthcare providers and stakeholders for in-depth interviews and 11 healthcare providers and stakeholders for key informant interviews. The conceptual framework in this study combined elements of the Health Belief Model, Health Care Utilisation Model, four 'As' of access to care, and pathway model to better understand the a priori themes on access to and quality of primary healthcare as well as health-seeking behaviours of the study respondents. A content analysis of the data was done using MAXQDA 2018 qualitative software to identify these a priori themes and emerging themes.

RESULTS

Access to primary healthcare in the seven communities was limited, especially use of health insurance. Quality of care was perceived to be unacceptable in public facilities whereas cost of care was unaffordable in private facilities. Health providers and users as well as stakeholders highlighted shortage of equipment, frequent drug stock-outs and long waiting times as major issues, but had varying opinions on satisfaction with care. Use of herbal medicines and other traditional treatments delayed or deterred seeking modern healthcare in the Nigerian sites.

CONCLUSIONS

There was a substantial gap in primary healthcare coverage and quality in the selected communities in rural and urban East and West Africa. Alternative models of healthcare delivery that address social and health inequities, through affordable health insurance, can be used to fill this gap and facilitate achieving universal health coverage.

Working towards universal health coverage: a qualitative study to identify strategies for improving student enrolment for the pre-service training of nurses, midwives and community health workers in Nigerian health training institutions

BACKGROUND

Student enrolment processes and practices can affect the quality of pre-service training programmes. These processes and practices may have serious implications for the quality and quantity of students within health training institutions, the quality of education for prospective health workers and consequently health workforce performance. This study assessed current student enrolment processes and practices for nurses, midwives and community health workers within health training institutions in two Nigerian states, so as to identify strategies for improving student enrolment for these key cadres of frontline health workers.

METHODS

This study was carried out in Bauchi and Cross-River States, which are the two Human Resources for Health (HRH) project focal states in Nigeria. Utilizing a qualitative research design, 55 in-depth interviews and 13 focus group discussions were conducted with key stakeholders including students and tutors from pre-service health training institutions as well as policy-makers and public sector decision-makers from Ministries of Health, Government Agencies and Regulatory Bodies. Study participants were purposively sampled and the qualitative data were audio-recorded, transcribed and then thematically analysed.

RESULTS

Study participants broadly described the application process to include the purchase, completion and submission of application forms by prospective students prior to participation in entrance examinations and oral interviews. The use of 'weeding examinations' during the student enrolment process, especially in Bauchi state, was identified as a useful quality assurance mechanism for the pre-service training programmes of frontline health workers. Other strategies identified by stakeholders to address challenges with student enrolment include sustained advocacy to counter-cultural norms and gender stereotypes vis-à-vis certain professions, provision of scholarships for trainee frontline health workers and ultimately the development as well as effective implementation of national and state-specific policy and implementation guidelines for the student enrolment of key frontline health workers.

CONCLUSION

While there are challenges which currently affect student enrolment for nurses, midwives and community health workers in Nigeria, this study has proposed key strategies which if carefully considered and implemented can substantially improve the status quo. These will probably have far-reaching implications for improving health workforce performance, population health outcomes and efforts to achieve universal health coverage.