Health Outcomes In Nigeria Research Articles

Impact of Healthcare Infrastructure on Maternal Mortality in Nigeria

This study investigates the impact of healthcare infrastructure on maternal mortality in Nigeria, focusing on the quality of care, availability of healthcare facilities, and institutional capacity. We employed a cross-sectional survey design, guided by Donabedian's Quality of Care Framework, and targeted 380 healthcare facilities in Lagos, Kano, and Enugu. Data was collected using structured questionnaires and analyzed using multiple regression analysis. The findings reveal that quality of care (β = .643, p < .001) and availability of healthcare facilities (β = .362, p < .001) significantly influence maternal mortality rates, while institutional capacity (β = .003, p = .882) does not have a significant impact. High-quality care and accessible healthcare facilities are crucial in reducing maternal deaths. Recommendations include continuous professional development for healthcare providers, equitable distribution of healthcare resources, and investments in healthcare infrastructure and governance. This research provides valuable insights for policymakers and healthcare stakeholders aiming to improve maternal health outcomes in Nigeria.

Governance, Health Financing and Health Outcomes in Nigeria: A Quantitative Assessment

Good health is essential to achieve sustainable development in any economy. Nigeria is no exception. No wonder it is the third goal in the sustainable development goals of the United Nations. Achieving good health also needs to be well funded with institutional quality, hence this study. This paper examined the effect of health financing and governance quality on health outcomes in Nigeria from 1980 to 2018 using secondary data sourced from World Development Indicators (WDI). A co-integration test and a vector error correction model (VECM) were employed to analyse the data. Short- and long-term results of an analysis based on life expectancy and infant mortality as a measure of health outcomes and dependent variables demonstrate that institutions empowered with good governance could produce positive health outcomes in the country.

Understanding the Factors Promoting Mother to Child Transmission of HIV/AIDS in Nigeria

Mother-to-child transmission (MTCT) of HIV/AIDS remains a significant public health challenge in Nigeria. This review aimed to identify and understand key factors promoting MTCT and assess the effectiveness of current prevention interventions. A systematic literature search was conducted across multiple databases using relevant keywords and approximately 57 individual literatures was reviewed. Studies focusing on MTCT in Nigeria published after 2015 were included. Eligible studies were critically appraised for quality and relevance. Findings indicate significant knowledge gap (such as misconceptions about transmission routes, limited understanding of prevention methods, delay in seeking testing and care and inconsistent adherence to Antiretroviral therapy) among pregnant women regarding HIV transmission, persistent stigma and discrimination hindering access to PMTCT services, and challenges within the healthcare system such as geographical disparities and inadequate provider training. Cultural practices, including breastfeeding and postnatal rituals, further exacerbate MTCT risk. Male partner involvement emerges as a crucial yet often overlooked aspect of PMTCT. Existing interventions showed moderate effectiveness, highlighting the need for tailored approaches. Strengthening multi-level interventions addressing social, economic, and cultural determinants, alongside culturally sensitive approaches and increased male engagement, are crucial to address MTCT and improve maternal and child health outcomes in Nigeria. Future research should focus on developing and evaluating interventions tailored to specific contexts and populations.

Pharmacovigilance in Nigeria: Addressing challenges in ensuring drug safety and monitoring adverse effects

This paper examines the specific challenges faced by Nigeria in implementing pharmacovigilance measures to ensure drug safety and monitor adverse effects. Despite the critical importance of pharmacovigilance in safeguarding public health, Nigeria grapples with several obstacles in its implementation. Through a nuanced exploration of literature and regulatory frameworks, this study sheds light on the unique hurdles encountered in pharmacovigilance practices within the Nigerian context. Challenges in Nigeria's pharmacovigilance landscape include limited awareness and understanding of pharmacovigilance principles among healthcare professionals and consumers, resulting in underreporting of adverse drug reactions. Additionally, there is a lack of robust infrastructure and resources for pharmacovigilance activities, including inadequate funding, shortage of trained personnel, and deficient pharmacovigilance databases. Regulatory enforcement and oversight are also hindered by issues such as weak regulatory frameworks, fragmented reporting systems, and suboptimal collaboration among regulatory agencies. Furthermore, Nigeria's pharmacovigilance efforts are compounded by factors such as the proliferation of counterfeit and substandard medicines, informal drug markets, and cultural beliefs influencing healthcare-seeking behaviors. These challenges pose significant barriers to effective pharmacovigilance implementation and compromise patient safety and public health outcomes in Nigeria. Addressing these challenges requires a multifaceted approach encompassing regulatory reforms, capacity building initiatives, public awareness campaigns, and collaboration with international partners. Strengthening regulatory frameworks, enhancing healthcare professional training on pharmacovigilance, establishing robust reporting systems, and fostering partnerships between regulatory agencies, healthcare institutions, and pharmaceutical companies are essential steps toward improving pharmacovigilance practices in Nigeria. Through a thorough examination of the Nigerian context, this paper aims to raise awareness of the specific challenges hindering pharmacovigilance implementation in the country and stimulate dialogue on potential solutions to enhance drug safety and monitoring of adverse effects in Nigeria's healthcare system.

Artificial Neural Network Prediction Model for Maternal Health Services Quality in Nigeria

This study presents an innovative approach in predicting the quality of maternal health services in Nigeria using artificial neural networks (ANNs). It focuses on a binary classification task in categorizing maternal health services facilities into "High_Quality" and "Low_Quality" classes. Dataset was collected from diverse healthcare facilities in Nigeria through a WHO Health Resources and Services Availability Monitoring System (HeRAMS) cross sectional-survey report. The collected data was preprocessed; the ANN architecture was developed and trained using back-propagation method. The network was modeled using feed-forward modeling approach with 16 variables at the input layer, 2 hidden layers of 65 and 55 neurons each, and an output of 2 neurons. Hence, 87.17% accuracy with only 2.48% deviation at the 50 epoch was achieved. The model's performance was evaluated using standard metrics of accuracy (87%), precision (88%), recall (89%), and F1-score (88%) to assess its ability to accurately classify maternal health services facilities. The findings of the study can have significant implications to policymakers, healthcare providers, and maternal health advocates to optimize healthcare resources and achieve better maternal health outcomes in Nigeria. Data availability, potential biases in the data, and the subjective nature of some quality-related indicators were acknowledged as limitations. However, despite these challenges, the ANN classification model remains a valuable tool for supporting decision-making in maternal healthcare facility delivery service in Nigeria. Artificial neural network, Binary classification, Health services, Maternal health, Predictive modeling

Beyond Community Health Service Provision: Assessing the Knowledge Attitude and Practice of Eye Care among Beneficiaries of an Intervention in an Inner-City Community in Lagos Metropolis

Background: A higher burden of preventable visual impairment has been reported in regions with poor knowledge of eye care, non-availability of or poor uptake of available screening services. This study assessed the knowledge, attitude, and practices as well as factors associated with eyecare among the residents of an inner-city community in Lagos, Nigeria.
 Methods: A cross-sectional study using simple random sampling technique to select 254 consenting participants from a community on Lagos Island. Data was collected electronically using Microsoft office forms and analyzed with SPSS version 23. Frequencies, proportions and tables were used for descriptive analysis. Chi-square test and multivariate logistic regression analysis were done to identify predictors of the outcome variables.
 Results: More of the respondents (52.4% and 61.4%) were middle-aged and female respectively with a mean age of 49.7±16.6 years. About 61.0% of them use prescription eyeglasses, 69.3% had a good knowledge of the importance of routine eye checks. Good attitude and practice of eye care were reported among 78.7% and 68.5% respectively. Respondents with a tertiary level of education were more likely to have a good attitude (OR=2.8; 95% CI=1.115-7.120) and good practice OR=2.7; 95% CI=1.207-5.869) versus lower educational levels.
 Conclusion: This study revealed that efforts to increase access to education, particularly in low-income areas, can contribute to improved attitudes and practices related to eye health care. Addressing gaps in knowledge and promoting regular eye check-ups were seen to be essential steps toward achieving better eye health outcomes in Nigeria and similar settings.

Nutrition knowledge and health vulnerability of mothers of pre-school children in north-central, Nigeria.

This study explores the contribution of nutrition knowledge to the health status of pre-school children's mothers in Niger State, North-Central, Nigeria. The study is a descriptive cross-sectional design using a quantitative data collection method. A multi-stage sampling technique was used to recruit 450 mothers of pre-school children across Niger state, Nigeria. Chi-square and linear regression were used to test the level of statistical significance (at p < 0.05). Socioeconomic and demographic information, anthropometric indices and nutrition knowledge were obtained using semi-structured questionnaires. Feeding patterns were also assessed using a qualitative 7-day dietary recall. The results showed that the majority (63.8%) of the mothers were within 26-35 years, and more than half (51.6%) of the mothers lacked knowledge of a "balanced diet". Fruits, vegetables, and dairy products were the least consumed food group among the mothers (7.1% and 9.1%, respectively). Place of residence, occupation, and method of waste disposal were significantly associated with maternal minimum dietary diversity adequacy (p<0.05). Over half (57.6%) of the mothers were within the normal BMI range, and the mean waist/hip ratio was 0.82± 0.08. Social media/online was the most (36.4%) explored source of nutrition information among the mothers. This study shows no significant association between nutrition knowledge and adequacy of minimum dietary diversity among the mothers of preschool children (p = 0.09, χ2 = 13.682). Dietary diversity among mothers was associated with the socioeconomic status and BMI of the mothers, which were strong determinants of meal quality and health outcomes in Nigeria and other developing countries experiencing food insecurity.

The Effect of Foreign Aid on Health Outcomes in Nigeria: A Case Study of Lagos State Teaching Hospital

The paper examined the effect of foreign aid on health outcomes in the Lagos State Teaching Hospital in Nigeria. The purpose of the study was to uncover the actual effect of foreign aid inflows on health outcomes in Nigeria. The paper employed a quantitative research methodology which explored secondary resources from WHO publications, journals and thesis on foreign aids and their contribution to health outcomes in developing countries especially Nigeria, and other official reports, and statistical bulletins. Qualitative methodology was also applied in this research. A semi-structured questionnaire was administered within the Lagos State Teaching Hospital, with a sample population of 50 healthcare personnel. The qualitative methodology was adopted to give a holistic view of the research study based on the concepts of the literature review, and to fully understand the situation of the topic under study in the country. One of the situation which the paper found out, is that Nigeria have received substantial amount of foreign aid and yet these amount of foreign aid is still considered to be low given the huge healthcare issues in Nigeria. The paper also revealed that, the foreign aid received through the Government in the country have been largely ineffective in addressing the health issues of Nigeria. This could be as a result of the lack of balance between the health challenges in Nigeria and the rate at which these aids are used to fund it. Lack of appropriate policies on disbursement rate of foreign aids to various health cases such as tuberculosis, malaria, HIV/AIDS, and others, could be the case for the perception of how low foreign aids are to the issues of healthcare. This is, without the articulation of the corruption laced on handling of foreign aids in Nigeria. The paper finally revealed foreign aid has a positive impact on the Nigeria health outcomes especially in the area of maternal health, but grossly ineffective in other areas. The study recommended that, the Nigeria government should ensure that foreign aid meant for the health sector is not diverted to other sectors and that; foreign aid dedicated to the health sector should be used judiciously

A systematic review of the evidence on the effectiveness of sexuality education interventions on young people's sexual and reproductive health outcomes in Nigeria

Poor sexual and reproductive health (SRH) outcomes among Nigeria's youth necessitate urgent interventions to meet the country's sustainable development goal (SDG) SRH target by 2030. This review evaluates Nigeria's SRH educational interventions, focusing on their effectiveness in improving young people's (YP) SRH outcomes. It highlights the global implications of these outcomes on achieving the SDG by 2030. The review, following PRISMA standards, analyzed peer-reviewed journals and gray literature (from January 2017-June 2023), using narrative synthesis and Joanna Briggs institute (JBI) quality appraisal checklists for quasi-experimental and cross-sectional studies. The search found 1021 studies, with 6 meeting inclusion criteria (4 quasi-experimental and 2 cross-sectional studies). All reported significant improvements in YPSRH outcomes, including knowledge and attitudes towards SRH themes, uptake of SRH and HIV/STI services, parental and societal support, and reduction in risky sexual behaviors. Quality assessment revealed several methodological flaws such as inadequate blinding and contamination measures. The review offers insights for YP interventions, but methodological flaws limit effectiveness. Further studies with rigorous designs and longer follow-up are needed. The absence of economic evaluation data is a knowledge gap with important implications for decision-makers.

Maternal health literacy and postpartum complication readiness among nursing mothers: Implications for adult literacy educators in Southern Cross River State, Nigeria

This study assessed maternal health literacy and postpartum complication readiness among nursing mothers and identify the implications for adult literacy educators in the Southern Cross River State, Nigeria. This cross-sectional study was conducted with 252 nursing mothers using a structured questionnaire. Data were analysed using descriptive statistics, one-way analysis of variance (ANOVA) and independent sample t-test. The results showed that with an average mean of 2.2, the participants’ level of maternal health literacy was moderate, while the average mean was 2.1 equally indicates that the level of postpartum complication readiness among respondents was equally moderate. The respondents’ education level, household income, and mode of delivery were not significantly associated with health literacy and postpartum complication readiness. Specifically, nursing mothers with higher levels of education and household income were not likely to have adequate health literacy and better postpartum complication readiness than others. The study’s results also indicate that adult literacy educators play a crucial role in improving maternal health literacy levels among nursing mothers. These educators can provide effective health education to nursing mothers to enhance their knowledge of maternal health and postpartum complications. This study highlights the need for adult literacy educators to incorporate maternal health literacy and postpartum complication readiness into their programs. This can be achieved by developing tailored health literacy materials and using interactive teaching methods that promote active participation and discussion among learners. Moreover, community-based interventions targeting vulnerable populations such as low-income mothers and those with limited education are needed to improve maternal health outcomes in Nigeria.

Implementing Health Policy in Nigeria: The Basic Health Care Provision Fund as a Catalyst for Achieving Universal Health Coverage?

ABSTRACTIn 2014, Nigeria adopted a new law for its healthcare system, which mandated the establishment of a novel health‐financing mechanism, the Basic Health Care Provision Fund (BHCPF). The BHCPF was created to provide sustainable funding with a view to fast‐tracking Universal Health Coverage (UHC) and improving health outcomes in Nigeria. This article places Nigeria's UHC reform process in the broader context of social policy implementation in Africa to illustrate the extent to which interactions between different agents, contextual factors such as Nigeria's federal character, as well as changing conceptualizations of social policy at a global level, shape views on how best to implement UHC. The article is based on the careful examination of three different versions of implementation guidelines for the BHCPF combined with qualitative data collected during fieldwork. It argues that there is a discrepancy between the Nigerian government rhetoric of putting into place a system that improves access to healthcare and the actual practice of implementing UHC via the BHCPF. In reality, a range of controversies surround the ongoing operationalization of the BHCPF, contributing to the perpetuation of a social policy environment that allows poor health outcomes and significant health inequities in Nigeria to persist.

PUBLIC HEALTH EXPENDITURE, ENVIROMENTAL POLLUTION AND HEALTH OUTCOMES IN NIGERIA

The study examines public health expenditure, environmental pollution and health outcomes- using infant mortality rate as proxy. Data was sourced from Central Bank of Nigeria and National Bureau of statistics from the period 1981 to 2021. A test of stationarity of the variables using- Unit Root Tests (ADF and P-P Tests) were examined coupled with a test of the existence of a long-run equilibrium relationship using the Johansen Co-integration Test. Afterward, an Error Correction Model (ECM) technique were applied in the study. Other diagnostic tests such as Residual Diagnostic Test, Serial Correlation LM Test and Histogram Normality Test were conducted to further validate the credibility of the model. The findings from the results showed that carbon (iv) oxide and gas flaring do not have significant effect on infant mortality rate as they were not statistically significant at 5% level. HIV showed negative impact on infant mortality which means the variables do not have direct effect on infant mortality. On the other hand, public health expenditure showed positive impact on infant mortality rate due to corrupt practices in the health sector. The study recommends that, expenditure on healthcare should be efficient and accountable. Also, government should create more or intensify public awareness program on pollution and HIV. Overall, the study identified a significant connections between health expenditure and health outcomes, and a weak relationships between environmental pollution and health outcomes in Nigeria.

Greenhouse Gas Emissions and Health Outcomes in Nigeria

This study examined the impact of greenhouse gas emissions on health outcomes in Nigeria covering the period 1990-2021. Data for the study were extracted from the Central Bank of Nigeria (CBN) statistical bulletin and the World Development Index (WDI) 2021. The data are health outcome (life expectancy, greenhouse gas emissions, population and inflation rate). The method of data analysis used is the linear regression with the application of the Vector Error Correction Model (VECM) and the Granger causality statistics. The major findings of the study reveal that Greenhouse gas emissions negatively impact health outcomes in Nigeria and there is a uni-directional granger causality between greenhouse gas emissions and health outcomes in Nigeria. It is therefore the recommendation of the study that more resources should be channeled for research aimed at developing alternatives to greenhouse gas emissions and there is need to carry out a massive reform in our health sector. This reform should include setting up a special committee that ensures any allocated fund to the health-sector is adequately utilized.

Globalization–health outcomes nexus and institutional intermediation in Nigeria

PurposeThe role institutional quality plays in the rising pace of globalization and its associated health effects remain unclear in the literature. This study, therefore, empirically examined the moderating role of institutional quality on the globalization-health outcomes nexus in Nigeria, a country with a relatively weak health system.Design/methodology/approachThe study employed Dynamic Ordinary Least Square (DOLS) to estimate the empirical models. The Fully Modified Ordinary Least Square (FMOLS) and Canonical Cointegration Regression (CCR) techniques were thereafter used to check the consistency and robustness of our results. Annual time-series data spanning from 1984 to 2020 were sourced from the World Development Indicator, KOF Globalization Index, International Countries Risk Guide (ICRG) and Central Bank of Nigeria Statistical Bulletin databases.FindingsThe results revealed that overall globalization and its three dimensional components (economic, political and social globalization) adversely affect life expectancy in their separate models, but increased life expectancy significantly after their interaction with government effectiveness. Also, real GDP, health aids, government recurrent health expenditure are other determinants of life expectancy in Nigeria.Practical implicationsThe Nigerian government should put in place appropriate mechanisms directed toward building and sustaining government effectiveness. This will help mitigate the negative effects of globalization and utilize its net positive benefits to improve life expectancy in Nigeria.Originality/valueThe research is the first to comprehensively examine the moderating impact of institutional quality on the nexus between overall globalization as well as its three dimensional components (economic, political and social) on health outcomes in Nigeria.

A time series analysis of government expenditure and health outcomes in Nigeria.

Despite a significant share of Nigeria's budget in the health sector, the health status has not improved, as reflected by poor health indicators. This study investigates the linkages between government expenditure and health outcomes in Nigeria. The Autoregressive Distributed Lag technique was used to examine the short- and long-run effects of government health expenditure on health outcomes separately. The health outcome was captured by life expectancy at birth and mortality rate. Findings show a negative relationship exists between health expenditure and mortality rate, implying that a rise in health expenditure leads to a decrease in mortality rate, while life expectancy at birth positively responds to the changes in health expenditure. As a policy recommendation from this study, the government should pursue increasing health expenditure and partner with the private sector in the form of Public-Private Partnerships to improve the health sector and outcomes.

Assessing the Impact of Universal Healthcare Coverage on Maternal and Child Health Outcomes in Nigeria

The purpose of this research was to determine how universal healthcare coverage in Nigeria would affect maternal and infant health. 500 households across four states in Nigeria provided information for this cross-sectional research. Data analysis using descriptive statistics revealed that the NHIS has helped increase access to and use of maternal and child healthcare services, leading to a decrease in maternal and child death rates. Inadequate funding, infrastructure, and health workforce were also cited as obstacles to implementing the NHIS in the study. Maximizing the NHIS's effect and achieving further gains in maternal and child health outcomes will require addressing these challenges and social determinants of health, such as poverty, education, and access to clean water and sanitation. These results have substantial implications for healthcare policymakers and providers in Nigeria and other low-income nations. Improving maternal and child health outcomes and decreasing household healthcare expenses are two major goals of universal healthcare coverage initiatives like the NHIS.

Childhood exposure to armed conflict and nutritional health outcomes in Nigeria

BackgroundArmed conflicts are associated with an increased risk of food insecurity, the leading cause of malnutrition in low-and-middle-income countries. Multiple studies have uncovered significant influences of childhood malnutrition on children’s overall health and development. As a result, it is increasingly important to understand how childhood experience of armed conflict intersects with childhood malnutrition in conflict-prone countries like Nigeria. This study examined the association between different measures of childhood experiences of armed conflicts and the nutritional health outcomes of children aged 36–59 months.MethodsWe used data from the Nigeria Demographic and Health Survey linked with Uppsala Conflict Data Program Geo-Referenced Events Dataset using geographic identifiers. Multilevel regression models were fitted on a sample of 4226 children aged 36–59 months.ResultsThe prevalence of stunting, underweight and wasting was 35%, 20% and 3%, respectively. Armed conflicts were mostly recorded in the North-eastern states of Borno (222 episodes) and Adamawa (24 episodes). Exposure to armed conflicts ranged from 0 (no experience of armed conflict) to 3.75 conflicts per month since the child’s birth. An increase in the frequency of armed conflicts is associated with increased odds of childhood stunting [AOR = 2.52, 95%CI: 1.96–3.25] and underweight [AOR = 2.33, 95%CI: 1.19–4.59] but not wasting. The intensity of armed conflict was only marginally associated with stunting and underweight but not wasting. Longer conflicts that occurred in the last year were also associated with the odds of stunting [AOR = 1.25, 95%CI: 1.17–1.33] and underweight [AOR = 1.19, 95%CI: 1.11–1.26] but not wasting.ConclusionChildhood exposure to armed conflict is associated with long-term malnutrition in children aged 36–59 months in Nigeria. Strategies that aim to end childhood malnutrition could target children exposed to armed conflicts.

Overview of Traditional Birth Attendance in Nigeria

Traditional Birth Attendance (TBA) has played a significant role in maternal healthcare in Nigeria for centuries. This paper provides an overview of Traditional Birth Attendance practices in Nigeria, exploring the conceptual analysis, determinants of traditional birth attendance usage, mothers’ reasons for Choosing TBAs for delivery services, and integration into the Health Care System. The paper highlights the essential role of TBAs in preserving cultural heritage, community support, and local knowledge related to childbirth. However, it also identifies numerous challenges associated with TBA practices, including inadequate training, limited medical knowledge, unhygienic birthing conditions, and the potential risks of complications during childbirth. In conclusion, this overview sheds light on the complex landscape of Traditional Birth Attendance in Nigeria. The coexistence of traditional practices and modern healthcare systems presents unique challenges and opportunities. A balanced approach that respects cultural traditions, while prioritizing safe and skilled birth attendance, holds the potential to enhance maternal and child health outcomes in Nigeria. Further research and collaborative efforts are needed to create an integrated and comprehensive healthcare system that caters to the diverse needs of the Nigerian population.

The Effects of Poverty on Health Outcomes in Nigeria: An ARDL Approach

Abstract There is no doubt that individual makes up a nation. Thus, as health is a crucial component of one’s welfare, access to good healthcare is a prerequisite to attaining long-term economic growth that is both sustainable and prosperous. This study looks at the impact of poverty on people’s health in Nigeria. A time series data spanning 29 years, from 1991 to 2021 was used for the study. This data was estimated using Auto Regressive Distributed Lag (ARDL). In order to simulate how poverty affects health outcomes in Nigeria, the study utilized mathematical models to determine whether Nigeria health results (CO2 emission, patients per physician, life expectancy rate, and poverty rate) responds to poverty shock. The study implies that, poverty shock has a big short-term influence on health outcome factors. The study suggested that in order to reduce high mortality rates government should focus more on improvement in health sector, particularly in the areas where there are less hospitals and basic healthcare facilities care is inadequate.

Implications of Performance-based Financing Implementation for Maternal and Child Health Outcomes in Nigeria: A Scoping Review

Background: Performance-based financing (PBF) is seen as an open health system reformtailored to suit the needs of countries, even in a fragile context. It is thought to have the ability to address the strategic challenges of the sustainable development goals. This study explored the implementation of PBF in order to determine whether it improves maternal and child health outcomes in the Nigerian context.&#x0D; Methods: This was a scoping literature review of online multiple databases and programme implementation documents. Six databases and an online library were searched using 30 key words, alone and in combination using Boolean terms. Thirty articles and five implementation documents were screened. At the end, 25 published articles and five implementation documents were reviewed. An adapted World Bank PBF conceptual framework was used for the review.&#x0D; Results: We found mixed results across most of the service indicators consistent with findings in most lower, middle income countries. In both pilot states, the quality of health services, mainly technical, improved remarkably. There was improved utilisation of maternal and child health services, particularly institutional delivery, modern contraceptives and under-five vaccination. However, client dimension of quality was reportedly poor. The study found no impact of PBF on equity.&#x0D; Conclusion: Collaborative partnership to develop policy frameworks for demand-side incentives to ensure equitable access to health services and sustainability of the project is essential. We further recommend that more incentives be paid for client quality dimension.