Health System In Nigeria Research Articles

Examining the roles and relationships of actors in community health systems in Nigeria through the lens of the expanded health systems framework

BackgroundCommunity health system (CHS) exists through the actions and activities of different actors within and outside communities. However, these actors, their roles and their relationships with one another have not...

Identifying enablers and barriers to the control of multidrug-resistant tuberculosis in Abia State, Nigeria: A qualitative study

ObjectiveDrug-resistant tuberculosis (TB) is a significant public health threat in high-burden TB countries, including Nigeria, constraining the achievement of End TB targets. Nonetheless, Nigeria's health system factors shaping the care of patients with multidrug-resistant tuberculosis (MDR-TB) are understudied. The study assessed the enablers and barriers to implementing MDR-TB care and treatment in Abia State, Nigeria. MethodsThis is a qualitative interview study adopting a phenomenological approach. We interviewed twelve participants comprising health workers and TB policymakers with roles in MDR-TB patient management at the national (n = 2) and state (n = 10) levels in May 2022. We used maximum variation sampling to purposively select participants based on their roles, availability, and consent. The data were analysed thematically. ResultsThe factors enhancing care for patients with MDR-TB include using a certificate of readiness, community involvement, donor financing, availability of treatment centre, effective facility-community linkage, treatment support, multidisciplinary care team, training service providers, availability of oral drugs, expansion of diagnostic facilities, data tool availability, review meetings, and data-focused supervision. In contrast, the factors constraining MDR-TB management are poor implementation of infection control policy, donor dependence, delayed initiation of treatment, poorly motivated health workers, health worker stigma, shortage of personal protective equipment, and role conflict in data management. ConclusionThe findings highlight critical health systems strengths and weaknesses in MDR-TB control. MDR-TB care policies must build on the enablers and address the barriers to strengthen the care for patients with MDR-TB.

Perception of Health Professionals on the National Health Act, 2014, in University College Hospital, Ibadan

Abstract Background: The National Health Bill was the most debated bill from the legislative arm of government since 1999 and yet, many health professionals are largely unaware of its details. There had been insufficient health legislation establishing a unified national health system in Nigeria, such as provided for in the National Health Act (NHA), 2014, leading to duplication of functions and laws. Health professionals, being key policy actors and at the front line of healthcare, easily notice the impact of policies set by actors in the health-care system. Therefore, their knowledge and perception of the NHA as legitimate, will compel obedience with the provisions of the act, and also create a basis for stronger advocacy for its implementation for the overall strengthening of the health-care system that the act intends to provide a legal framework for. Methodology: This is a descriptive cross-sectional study to assess the perception of health professionals at the University College Hospital, Ibadan, on the NHA, 2014. Participants were selected by a multistage (stratified and then systematic) random sampling technique. Data were collected quantitatively using a self-administered semi-structured questionnaire. The quantitative data were entered and analysed using IBM SPSS version 23. Results: Awareness of the respondents about the Act was good, with up to 75% of respondents being aware of the existence of the NHA Act. However, the knowledge of the content of the Act was poor among all the cadres of health professionals. The differences in awareness among the different cadres of health professionals were statistically significant with the doctors being more aware and the nurses least aware, P = 0.001. The majority of health professionals perceive that the NHA is sufficient to regulate health care and set the appropriate standards in Nigeria. However, the health-care professionals also perceive that Nigerian government is incapable of diligently implementing the provisions of the Act. Conclusion: There is a need for sustained remedial action by health-care professional bodies, organised media, and relevant government ministries and agencies, to ensure that stakeholders, including health professionals, are abreast with the provisions of the NHA, through prioritising health laws as key areas in undergraduate school curricula and continuing medical education on health laws for the practicing health professionals. Good knowledge of the Act will increase the advocacy efforts by the health professionals and other stakeholders towards the implementation of the provisions of the Act by the government and other relevant stakeholders. There is also a need for the government to show more commitment in publicising its effort at the implementation of the Act to improve the poor perception by the health professionals on the government’s ability to implement the provisions of the Act, as seen in this study.

Understanding and Bridging Gaps in the Use of Evidence from Modeling for Evidence-Based Policy Making in Nigeria's Health System.

Despite the use of modeling by Nigeria's disease control agency in containing the COVID-19 pandemic, modeling remains poorly used in the country's overall health sector.Although policy makers recognize the importance of evidence in making decisions, there are still pertinent concerns about the poor research culture of policy-making institutions and communication gaps that exist between researchers/modelers and policy makers.Nigeria's health system can be strengthened by improving the value and usage of scientific evidence generation through conscious efforts to institutionalize research culture in the health sector and bridge gaps between researchers/modelers and decision makers.

Push and Pull Factors of Emigration among Physicians in Nigeria

Physician emigration is escalating in developing countries. In Nigeria, this massive brain drain has gained the popular moniker ‘Japa syndrome’. This survey used a cross-sectional design to determined the factors causing physicians’ brain-drain from Nigeria. A convenience and snowball sampling were used, and 295/400 attendees of a cardiovascular symposium responded to comprehensive self-administered questionnaires (73.7% response rate). Most participants (79.4%) were aged 20-39 years (Mean 35 years SD ±10.17); female (58.6%); married (58.4%) and a family size below six (73.6%). About 85.8% were employed, and 55.9% worked in private establishments. The top three attractive destinations were UK (50.5%), Canada (43.3%), and USA (37.9%). The most frequent push factors found were low remuneration (71.2%), insecurity (62.7%), and difficult working environments (55.9%). Postgraduate-training frustrations (38.6%), and limited educational opportunities for oneself (37.6%), children (26.4%), or spouse (19.7%) were the least. High earning potential (76.6%), career growth opportunities (70.8%), and high-level equipment/technology (54.9%) were the most frequent pull factors. This practice threatens Nigeria's health system and should be addressed multi-sectorally. To reverse this ugly trend, we have to boost physicians’ remuneration, improve work environments and security. Providing innovative education and digital technology would also promote physicians’ retention.

Perceived public alarm and comprehension of risk communication messages about Lassa fever in Nigeria: a gauge of the risk communication model

IntroductionLassa fever constitutes a threat to the public health system in Nigeria with the reoccurring annual epidemics and its attendant risk communication intervention challenges.ObjectiveThis study examined the influence of public alarm (if any) on respondents' comprehension of risk communication messages about the most common host of the Lassa virus, modes of transmission, risk factors, and protective measures for Lassa fever. The risk communication model (mental noise hypothesis) served as the benchmark for measuring respondents' perceptions in the most endemic states in Nigeria.MethodThe study adopted a quantitative approach, using the survey method. Data for this study were collected from 653 respondents through a structured questionnaire. Respondents were selected through a multi-stage sampling technique. Frequency tables were used to profile the respondents' characteristics and key variables while regression coefficients were used to draw inferences.ResultsThe study found a high level of perceived public alarm among the respondents but maximum attention was paid to risk communication messages amid the high level of anxiety. Knowledge of the common Lassa virus-host, modes of transmission, risk factors, and risk reduction measures was adequate irrespective of the high level of perceived public alarm. Public alarm significantly influenced audience comprehension of the risk information about Lassa fever in Ebonyi and Ondo at r2 = 0.040 and 0.076, at p < 0.05 but not in Edo state at r2 = 0.010, at p > 0.05.ConclusionThe authors conclude that devoting adequate attention to outbreak communication messages amid a high level of anxiety could lead to improved knowledge of infectious diseases.

Healthcare Financing in Nigeria: A Policy Review.

A good health financing system is crucial for the effective performance of a country's health system. Many health systems around the world, especially in lower- and middle-income countries such as Nigeria, grapple with perennial challenges such as chronic underfunding, wastefulness, and lack of accountability rendering these systems inefficient. Nigeria's health system faces additional extraneous challenges such as a huge and rapidly growing population, a stagnant economy, and worsening insecurity of lives and property. Furthermore, recent disease outbreaks such as the Ebola epidemic and the COVID-19 pandemic and an evolving disease demography evidenced by an increasing prevalence of chronic, noncommunicable diseases asphyxiate an already floundering health system. To address these challenges and to bolster its efforts in attaining universal health coverage (UHC) and meeting the targets of the Sustainable Development Goals, the Nigerian government launched a new health policy in 2017. A review of the health financing section of this policy shows a focus on improving funding for health care by all levels of government and guaranteeing affordable and equitable access to health services by all Nigerians, albeit with insufficient clarity on how these will be achieved. A more critical review of the country's health financing system also reveals deep-seated systemic issues. Its out-of-pocket payments for funding health care are among the highest in the world, with abysmally low government contributions to health. Successive governments seem to lack the political will to address these shortfalls. Critical gaps exist in the country's health laws, making it difficult to implement the strategies proposed in the new policy. Nigeria must strengthen its health laws to, among other things, mandate health insurance and provide adequate funding for the health system by the government. It should also formulate a dedicated, more precise health financing policy with specific, measurable aims targeting identified problems to enable it to attain universal health coverage.

Ward Health System in Nigeria: An Assessment of the Awareness and Role of Community Members

Ward Health System is an implementation strategy of Primary Health Care in Nigeria. It was introduced in 2001 and is aimed at promoting community mobilization and participation in health care, thereby enhancing an effective, efficient and sustainable health care system. This study assessed the awareness and role of community members in the Ward Health System. A semi-structured interviewer administered questionnaire was used to conduct an exit poll of 240 Primary Health Care facility clients. Approximately 12%, 13% and 29% of the respondents had ever heard of the terms Ward Health System, Village Development Committee and Ward Development committee respectively, while up to 73% have no idea of the role of any of the stakeholders. Inadequate knowledge and involvement of the community members in the Ward Health System constitutes a big challenge to the effective and efficient implementation of Primary Health Care in Nigeria. Efforts towards community education on Ward Health System should be intensified.

Ward Health System in Nigeria: Are Health Workers in the Local Government Areas Well Informed?

The Ward Health System was introduced in 2001 by the National Primary Health Care Development Agency to enhance community mobilization for health thereby revitalizing the Primary Health Care system. This move was in alignment with the recommendation of the World Health Organization in 1992 that boundaries of the health district should be the same as that of the electoral ward for effective and wholesome community mobilization and ultimately ownership. This study determined the knowledge of the health workers in the Local Government Areas on Ward Health System. A semi-structured questionnaire was administered to a total of 300 Primary Health Care facility workers in Anambra State. Approximately 46% of the health workers had ever heard of the term Ward Health System, while over 94% had no idea of the roles of the three tiers of government in the program. Over 76% of them could not correctly identify the functions of the village and ward development committees. Adequate and on-going education of health workers on Ward Health System is critically needed.

Economic burden of malaria infection on households: A survey of various households in Port Harcourt, Rivers State, Nigeria

Purpose: This study is aimed at evaluating the economic burden of malaria treatment among households in Port Harcourt, Rivers State Nigeria. Methodology: A correlation survey research design was adopted for this study and a sample size of 338 was determined from a target population of 2,200 using Yamane formula. Findings: There are significant positive relationships between economic burden (direct and indirect costs) of treating malaria infection and the disposable income as well as high rate of poverty of the sampled households in Rivers State, Nigeria. Recommendations: The study identifies and recommends the need for government to intensify efforts in malaria elimination through effective eradication programme, universal health coverage, national health insurance scheme and free malaria treatment. In addition, government is called upon to strengthen the health system in Nigeria and provide effective leadership as avenue to mitigate the huge economic burden of malaria treatment in the country. Originality/value: This study contributes to malarial infection research by providing empirical evidences of the relationships that exist between the direct and the indirect costs of treating the disease and its effects on the disposable income and the living standard of the people.

Physician emigration from Nigeria and the associated factors: the implications to safeguarding the Nigeria health system

BackgroundAdequate Human Resources for Health is indispensable to achieving Universal Health Coverage and physicians play a leading role. Nigeria with low physician–population ratio, is experiencing massive exodus of physicians. This study investigated emigration intention of physicians, the factors influencing it and discussed the implications to guide policy formulation and reforms, curtail the trend and safeguard the country’s health system.MethodsThrough cross-sectional survey, 913 physicians from 37 States were interviewed with semi-structured questionnaire using Google form shared via WhatsApp and Telegram forums of Nigeria Medical Association. Data were analysed with IBM-SPSS version-25 and charts were created with Microsoft-Excel. Chi-square and multiple regression tests were done with p-value set at 0.05.ResultsThe mean age of respondents is 37.6 ± 7.9 years; majority of them are males (63.2%), married (75.5%) with postgraduate qualifications (54.1%) and working in public health facilities (85.4%). Whereas 13% and 19.3% are, respectively, satisfied with their work and willing to continue practice in Nigeria, 43.9% want to emigrate and 36.8% are undecided about future location of their practice. The commonest reasons for emigration are poor remuneration (91.3%), rising insecurity (79.8%) and inadequate diagnostic facilities (61.8%). Physicians working in public health facilities are 2.5 times less satisfied than their counterparts in non-public sector (AOR = 0.4; 95% CI = 0.3–0.8). Physicians in their thirties, forties and fifties are 3.5 (95% CI = 1.5–8.0), 5.5 (95% CI = 2.1–14.5) and 13.8 (95% CI = 3.9–49.3) times, respectively, more willing to retain practice in Nigeria than those younger and those satisfied with their work are 4.7 (AOR = 4.7, 95% CI = 2.9–7.4) times more willing to practice in Nigeria than those not satisfied.ConclusionMajority of Nigerian physicians want to emigrate for professional practice and top among the push factors are poor remuneration, rising insecurity and inadequate diagnostic facilities. The observed trend portends danger to the country’s health system due to the foreseeable negative consequences of physician deficit to the system. We recommend upward review of physician remuneration, a root cause analysis of insecurity to determine workable preventive measures and increased funding of the health sector to improve the diagnostic infrastructure, retain physicians and save the health system from imminent collapse.

Creating a Functional Health System for Nigeria

Background: Health systems are more than static health facilities. The World Health Organization has identified six building blocks of the health system namely: human resources for health, service delivery, medicines, vaccines and technology, health information, health financing and leadership and governance. This paper examines the Nigerian health system and posits that it is not functional.Discussion: The dysfunctional state is a result of chronic neglect of both the building blocks of the health system and the wider determinants of health such as education, sanitation, and food security in addition to the lack of synergy between the health and non-health sectors.Conclusion: Creating a functional health system in Nigeria does not require fresh policies rather the political will and commitment of resources to improve the quality of life of the citizens in the non-health sector and the implementation of the numerous policies and strategies in the health sector. Adequate attention should be paid to primary health care.

The Role of Pharmacists in Strengthening the Health System in Nigeria

The role of Pharmacists in healthcare has changed significantly over the previous half-century, from dispensing to providing direct patient-oriented services unrelated to dispensing. As a result, the pharmacy profession offers unique expertise to members of the profession with a distinct set of abilities that enable them to play a variety of roles in developing the Nigerian health system. Pharmacy and community pharmacists play an important role in the public health system by providing prescription and over-the-counter (OTC) medication with professional counseling, participating in health care programs, and maintaining contact with other healthcare professionals in the health care system. In addition to being open to the public, pharmacists are responsible for the safe and effective administration of pharmaceuticals, participate in health screening and monitoring programs, and are responsive to the requirements and preferences of patients. Unfortunately, there are fewer studies on the roles that pharmacists play in improving the Nigerian health system. As a result, this study highlights some of the roles pharmacists play in strengthening the health system of Nigeria.

Screening and Referral for High Risk Pregnancies Among Primary Health Care Workers in Rural Communities in Abia State, Nigeria

Abstract Introduction Screening for conditions like hypertension, diabetes mellitus and anaemia during antenatal reduces the chances of complications in pregnancy. Health systems in Nigeria are structured such that cases that cannot be managed in a lower health facility are referred to higher hospitals with more expertise and equipment. This study was conducted to determine the screening and referral patterns of high risk pregnancies among health workers in rural communities in Abia state, Nigeria. Materials and Methods This was a descriptive cross-sectional study conducted among 400 staff of Primary Health Care Centres in the three senatorial zones of Abia state, Nigeria from January to June, 2021. Primary health centres were grouped using cluster sampling while selection of the respondents was by simple random sampling by balloting. Quantitative and qualitative methods were used to collect data. Data analysis was done using SPSS version 21.0 and results presented in tables. Results Two hundred and sixty-seven (67.3%) respondents knew that gestational diabetes mellitus was associated with pregnancy while 385 (96.3%) screened for gestational diabetes mellitus on first day of antenatal care visit. Three hundred and forty-three (85.7%) respondents screened for hypertension in pregnancy during antenatal. All respondents, 400 (100.0%) knew that anaemia could lead to abortions. Three hundred and thirty-three (83.3%) respondents referred difficult cases to higher facilities, while 49 (12.2%) invite doctors to their facilities. Challenges with referrals include lack of facility ambulances, lack of access roads and lack of funds. Conclusion Health facilities are not equally equipped to handle high risk pregnancies. Also, health workers are not competent to manage high risk pregnancies. Referral strategies and protocols are lacking in the health facilities studied.

Factors Influencing Outbound Medical Tourism: India as the Preferred Destination for Nigerians

This study explored the factors, responsible for the exodus of Nigerians to India for medical tourism. We employed a qualitative approach and the information was retrieved from 50 participants, using an in-depth interview method. The study found factors that were responsible for this drive are as follows: Cheaper cost of treatments and procedures, referrals of doctors, aggressive marketing of agents, top-notch healthcare services, access to human organs, preference of treatment sponsors, assurance of visas, immediate healthcare services, the expertise of Indians in kidney transplant and quick turnaround time. This was the first qualitative study of its kind on the factors, responsible for the exodus of Nigerians to India for medical tourism, and it provides an insight into what the country stands to lose in terms of income. Additionally, emulating the success story of India may, in turn, assist in turning around the dwindling health system in Nigeria.

Strengthening the oral health system in Nigeria: A health systems building block approach.

The present study aimed to describe the building blocks of the oral health system, including the role that the community plays in strengthening the oral health system in Nigeria. This research was a scoping review of the existing literature retrieved from search engines and databases. Thus, we utilised grey literature, peer-reviewed literature, policy documents and websites. The oral health system was analysed using the World Health Organisation's Health systems framework, and we adapted this framework by introducing a seventh block, community participation. We also inserted the links between the oral health service delivery and oral health workforce blocks of the framework to improve the oral health outcomes. More dental clinics are required to improve the availability and accessibility of oral health services. Dental workforce expansion is imperative. This can be approached by training of junior cadre dental professionals and incorporating community health practitioners to deliver basic oral care. There is an unregulated access to medication to treat dental conditions; hence, oral disease treatments need to be included in the country's treatment guidelines to improve standard of care. The government needs to improve on overall health spending and invariably increase oral health care allocation urgently. Furthermore, the country's stewardship of oral health care is hinged on well disseminated and implemented national policies on oral health. The oral health system can achieve its overall goals with community participation, engagement and ownership. Strengthening the oral health system in Nigeria requires urgent attention on each building block and cross-cutting interventions across the system's building blocks. The role of the community will need to be recognised because it is vital in sustaining any organisational change.

Public Health Risk: Public Views on Panic Reporting and Media Framing of the Covid 19 Pandemic

The study examines public views on panic reporting and media framing on the COVID 19 pandemic. Panic is expected during public health risk reporting. Media coverage and the manner of framing of the COVID 19 pandemics earlier created panics and uncertainties among the public. A measuring scale was designed in accordance with the objectives of the study to ascertained respondents views. Through the administration of copies of questionnaire, views of thirty four persons on the subject were ascertained. Results showed that though media framing and coverage of the pandemic news increases public panic, it however reduces the spread of the virus; the public became conscious of the virus. Media framing of the pandemic not only causes fears but also led to panic buying of food items at home. The outbreak of the pandemic exposes government failed health system in Nigeria. The study also showed that the emotional effects as a result of the manner of framing were more harmful than the virus itself. This is because the pandemic news was not carefully managed by the media at the earlier outbreak. Management of news during public health risk or crisis is important for easing panic. It was established that responsible health attitude is most appropriate to ease panics. Keywords: Covid 19; Framing; Media; Pandemic; Panic; Public; Reporting DOI: 10.7176/NMMC/100-02 Publication date: January 31 st 2022

The Role of Pharmacists in Strengthening the Health System in Nigeria.

The role of Pharmacists in healthcare has changed significantly over the previous half-century, from dispensing to providing direct patient-oriented services unrelated to dispensing. As a result, the pharmacy profession offers unique expertise to members of the profession with a distinct set of abilities that enable them to play a variety of roles in developing the Nigerian health system. Pharmacy and community pharmacists play an important role in the public health system by providing prescription and over-the-counter (OTC) medication with professional counseling, participating in health care programs, and maintaining contact with other healthcare professionals in the health care system. In addition to being open to the public, pharmacists are responsible for the safe and effective administration of pharmaceuticals, participate in health screening and monitoring programs, and are responsive to the requirements and preferences of patients. Unfortunately, there are fewer studies on the roles that pharmacists play in improving the Nigerian health system. As a result, this study highlights some of the roles pharmacists play in strengthening the health system of Nigeria.

Mental health system in Nigeria: Current scenarios and future recommendations

Mental health system in Nigeria: Current scenarios and future recommendations

An Overview of Occupational Safety and Health Systems in Nigeria

An Overview of Occupational Safety and Health Systems in Nigeria