Health System In Nigeria Research Articles

Covid-19 Pandemic and Health Systems in Nigeria

Covid-19 Pandemic and Health Systems in Nigeria

Assessing the impacts of donor support on Nigeria's health system: The global fund in perspective

AbstractFrom 2003 to 2019, the Global Fund to Fight AIDS, Tuberculosis, and Malaria (the “Global Fund”) disbursed a total of US$2.3 billion in grants to Nigeria, mainly for the prevention and treatment of HIV/AIDS, tuberculosis, and malaria. This paper examines the impacts of the Global Fund's interventions on Nigeria's health system. Case study evidence shows that while the Global Fund has been successful in achieving its specific performance targets, its impacts on Nigeria's health system has been minimal at best. Major reasons for its negligible impacts on the country's health system include the Global Fund's ambivalent operational structure, little input from the host country in program design, excessive focus on fiduciary matters as opposed to public health interventions, as well as emphasis on parochial performance targets. Policy implications arising from this study include the need for domestic actors in Nigeria's health sector to have significant input in designing the Global Fund's projects in the country. In addition, the Global Fund's board and major donors should work collaboratively to refocus the institution to enhance its public health impacts.

Determinants of perceived quality of health care among pregnant women in Ifo, Ogun State, Nigeria.

Nigeria's health system is among the weakest globally, characterized by doctors' and nurses' concentration in a few tertiary facilities in the cities. Simultaneously, rural areas that constitute over 70% of the population suffer from acute health personnel and inadequate health facilities. Whether Nigeria can achieve the Sustainable Development Goal 3 (SDG 3) of access to quality essential health care by 2030 if this situation continues. Therefore, this study provides unique insights on socio-demographic and environmental determinants of quality of health care and treatment choice among women in the Ifo Local Government Area (LGA), a predominantly rural area, in Ogun State, Nigeria. It employed the 2018 cross-sectional survey data collected using a multi-stage sampling technique. A total of 1350 pregnant women aged 20-44 who attended antenatal care during the study period were interviewed. Multicollinearity diagnostics of explanatory variables showed that variance inflation factor, eigenvalues, and the condition index values were within accepted thresholds. Findings showed that the predictors of perceived quality of care were the age of respondents, level of education, type of house lived in, the number of persons in the house, type of toilet facility, primary source of water supply, waste disposal practices, and husband's level of education. Statistically significant predictors of treatment choice included husband's occupation, number of living children, type of house respondent lived in, type of toilet facility, and primary water supply source. These predictors are useful for designing policies and program activities for achieving improved quality of maternal health care at the community level and the attainment of SDG 3 for the country by 2030.

Incorporating traditional birth attendants into the mainstream maternal health system in Nigeria - An evaluation of the Ondo State Agbebiye program.

Historically, the roles of traditional birth attendants (TBAs) in maternity care have been contentious. In 2014, Ondo state in response to an 80% proportion of TBA-related maternal deaths launched the Agbebiye program to incorporate TBAs. This study which aimed to evaluate the program involved a retrospective review of maternity records between 2013 and 2016. The results showed that the seven-month pilot phase in the state capital witnessed a reduction in TBA-related deaths when compared to the previous year. Overall, 5,606 TBAs were coopted with resultant 14,124 referrals out of 142,206 facility deliveries (9.9% referral rate). Additionally, there was a 61.8% increase in facility births from 33,077 in 2013 to 53,531 in 2016. During program implementation, there were seven maternal deaths linked to Agbebiye-registered TBAs out of 260 statewide facility deaths (2.7%). Our study confirms the positive role that TBAs' incorporation into the maternal healthcare system can play in reducing maternal deaths in low-resource countries.

Globalisation of Diseases: The Challenges of COVID-19 Pandemic and Public Health System in Nigeria

Globalisation is a process that integrates the world socio-economic system through trade liberalization, the free movement of people, technologies and information. It has equally made the spread of infectious diseases much easier globally. In essence, infectious diseases such as COVID-19, are easily transmitted across the countries of the world through the network created by globalisation poses serious challenges to the world health system, particularly developing countries like Nigeria. Public health system in Nigeria is overwhelmed by the consequences of the COVID-19 pandemic, which further exposes the country to the adverse effects of globalisation such as dependence and unequal relationship between her and the developed countries. Although the challenging situation provides Nigeria an opportunity to overhaul her public health system, the current poor global economy has further worsened the problems. This paper analyses the situation, and recommends that Nigerian government should look inward to develop her Public health system in a more sustainable way, also, the economy should be repositioned to reduce the level of dependence, and resources should be redirected to adequately fund education and research to support the health sector. The analysis is based on the premises of dependency perspective

Physical Activity Level and Factors Affecting Exercise Participation among Nigerian Adults with and Without Diabetes

Background: Diabetes presents a multifaceted challenge to health systems in Nigeria and beyond. Physical activity is a cornerstone of diabetes management but is often underutilised. Despite the positive effects of physical activity on different dimensions of health to patients with diabetes, most fail to maintain long-term adherence to physical activity programmes. Objectives: This study aimed to determine the physical activity level and factors affecting exercise participation among patients with and without diabetes. Methods: This was a cross-sectional study involving 400 participants recruited by convenience sampling. International Physical Activity Questionnaire (IPAQ) and Exercise Benefit and Barrier Scale (EBBS) questionnaires were used to measure physical activity and perceived benefits and barriers to exercise, respectively. The data collected were analysed using descriptive statistics of percentages and frequency, mean and standard deviation, and independent t-test. The level of significance was set at p<0.05. Results: The majority of the patients with diabetes (71%) had low physical activity levels while 52% of the nondiabetic group were moderately active. There was a significant difference between physical activity levels of patients with diabetes and the nondiabetic group (p<0.05). Physical exertion was reported by both patients with and without diabetes as the greatest barrier to exercise participation. Conclusion: Patients with diabetes in Nigeria have a low level of physical activity and are also faced with certain barriers which limit their participation in exercise programmes. Exercise barrier identification and public awareness on the health benefits of exercise and physical activity in the prevention and management of diabetes should thus be encouraged.

Knowledge of electronic medical records system among frontline health care workers in Jos University teaching hospital, Plateau State Nigeria.

Background:Electronic Medical Records system (EMRs) in any healthcare system has the potential to transform healthcare in terms of saving costs, reducing medical errors, improving service quality, increasing patients’ safety, decision-making, saving time, data confidentiality, and sharing medical. Evidence on the current state of EMR system in Nigeria health system particularly its knowledge among health professionals is limited. Hence, this study was conducted to assess the level of knowledge EMRs among frontline health care workers in a tertiary health institution in Jos, Plateau State.Methods:This was a cross-sectional study conducted between April and August 2019 among 228 frontline health care workers in Jos University Teaching Hospital using quantitative method of data collection. SPSS version 20 was used for data analysis and a p-value of ≤ 0.05 considered statistically significant.Results:The mean age of the respondents in this study was 35±8 years with 93 (40.8%) being 36 years and above. The overall level of knowledge of EMRs was adjudged to be good among 163 (71.5%) of the participants. Category (pharmacists) of the respondents was found to influence good knowledge of EMRs (OR=1.37; 95% CI=1.007–1.865; p=0.045).Conclusions:This study has demonstrated a relatively high level of good knowledge of EMRs with variation existing along the categories of health care workers bringing to light the existence of a good knowledge base in the light of future EMRs implementation.

The Technical Feasibility of Integrating Primary Eye Care Into Primary Health Care Systems in Nigeria: Protocol for a Mixed Methods Cross-Sectional Study

BackgroundApproximately 90% of the 253 million blind or visually impaired people worldwide live in low- and middle-income countries. Lack of access to eye care is why most people remain or become blind. The World Health Organization Regional Office for Africa (WHO-AFRO) recently launched a primary eye care (PEC) package for sub-Saharan Africa—the WHO-AFRO PEC package—for integration into the health system at the primary health care (PHC) level. This has the potential to increase access to eye care, but feasibility studies are needed to determine the extent to which the health system has the capacity to deliver the package in PHC facilities.ObjectiveOur objective is to assess the technical feasibility of integrating the WHO-AFRO PEC package in PHC facilities in Nigeria.MethodsThis study has several components, which include (1) a literature review of PEC in sub-Saharan Africa, (2) a Delphi exercise to reach consensus among experts regarding the technical complexity of the WHO-AFRO PEC package and the capacities needed to deliver it in PHC facilities, (3) development of PEC technical capacity assessment tools, and (4) data collection, including facility surveys and semistructured interviews with PHC staff and their supervisors and village health workers to determine the capacities available to deliver PEC in PHC facilities. Analysis will identify opportunities and the capacity gaps that need to be addressed to deliver PEC.ResultsConsensus was reached among experts regarding the technical complexity of the WHO-AFRO PEC package and the capacities needed to deliver it as part of PHC. Quantitative tools (ie, structured questionnaires, in-depth interviews, and observation checklists) and topic guides based on agreed-upon technical capacities have been developed and relevant stakeholders have been identified. Surveys in 48 PHC facilities and interviews with health professionals and supervisors have been undertaken. Capacity gaps are being analyzed.ConclusionsThis study will determine the capacity of PHC centers to deliver the WHO-AFRO PEC package as an integral part of the health system in Nigeria, with identification of capacity gaps. Although capacity assessments have to be context specific, the tools and findings will assist policy makers and health planners in Nigeria and similar settings, who are considering implementing the package, in making informed choices.International Registered Report Identifier (IRRID)DERR1-10.2196/17263

Strategies for mitigating burnout among early career doctors in Nigeria: lessons learnt from the qualitative CHARTING study

Background Early career doctors (ECDs) are faced with many challenges due to their transition from undergraduate medical/dental studentship to being postgraduate doctors and being in an early phase of their career. The specific factors that affect ECDs in their careers and endeavors at the workplace range from poor remuneration, particularly in developing countries, to psychosocial problems (such as burnout [BO] syndrome). There is a dearth of information on BO among ECDs in Nigeria. This qualitative study aims to explore the opinions of ECDs in Nigeria on the causal/predisposing factors of BO, effects of BO, and strategies for mitigating BO among ECDs in Nigeria. Method Using purposive sampling method, two sessions of focus group discussions (FGDs) involving 14 ECDs (key informants) holding key leadership positions and who were delegates of other ECDs in Nigeria were conducted to explore their experiences on psychological issues among ECDs. Data collected were transcribed and analyzed thematically. Results BO is an issue of serious concern among ECDs in Nigeria. The causes of BO are diverse, some of which include low staff strength, prolonged work hours, wrong counseling, lack of job description and specification, and abuse of powers by trainers. In order to mitigate the issue of BO among ECDs, the respondents recommended that work policy review, medical workforce strengthening, stakeholder dialog on ECDs’ welfare, regular psychological review of ECDs, and provision of free yearly medicals need to be looked into. Conclusion: Our findings revealed that the participants considered BO issues among ECDs to be common, and it affected their performance and the overall quality of care in Nigeria health system. Based on our findings, there is an urgent need to mitigate the problem of emotional exhaustion among ECDs in Nigeria.

Integration of eye care into primary healthcare tier in Nigeria health system: A case for Delta State

Primary Eye Care (PEC) provides the essential cares of the eyes and visual pathways at the Primary Health Care (PHC) level in order to prevent avoidable visual impairment and blindness. The aim of this study is to review the need for integration of PEC services into PHC in Nigeria healthcare system – with focus oF Delta State. A narrative review approach was used in evaluation of community needs, government and PHC facilities. Published literatures from around the world including in Sub-Saharan Africa and Nigeria was done through web search and Mendeley reference library. The evaluations show that there is ability and willingness to integrate PEC into PHC. Yet, there is observable mismatch in capacity vs. opportunity or a knowledge and attitude gap. In Delta State on Nigeria, there appears to be specialist Eye-care providers located in just 24% of the local government areas and absolutely none (zero %) at any PHC facility. In the rural communities, there is the barrier of affordances including problem of access, but the PHC staff can be equipped to provide basic services such as educational, preventive and referral services that non-governmental organisations have done. Therefore, integration of PEC into PHC at the community level is possible.

Macroeconomic Determinants of Under-Five Mortality Rate in Nigeria

This paper examined the macroeconomic determinants of under-five mortality rate in Nigeria between 1980 and 2017. The study was predicated on the Grossman analytical framework rooted in the human capital development theory. A macro-econometric model incorporating major macroeconomic variables in explaining under-five mortality health outcomes. ARDL bound test estimation technique that took into consideration error correction mechanism was used. Tests of the model’s reliability were carried out using unit root and co-integration tests. The influences of government health expenditure was significant, however both immunisation initiatives and health workers exerted an insignificant positive influence on under-five mortality rate. Thus, the study recommends policies targeted to improve Nigeria health system both in terms of creation of awareness relating to the service delivery and human capital development of the professionals in the sector to avert brain drain syndrome in the country.JEL Classification: J11, J13 How to Cite:Agbatogun, K. K., & Opeloyeru, O. K. (2020). Macroeconomic Determinants of Under-Five Mortality Rate in Nigeria. Signifikan: Jurnal Ilmu Ekonomi, 9(2), 177-186. https://doi.org/10.15408/sjie.v9i2.13751.

Time to Move from Vertical to Horizontal Approach in our COVID-19 Response in Nigeria

The novel Coronavirus (COVID-19) has adversely affected the already weak health system in Nigeria. The choice of whether to use vertical or integrated approach in solving health problems is determined by the peculiarity of the challenges. Vertical programs imply a variety of specific interventions that have not been fully integrated into the health system. The COVID-19 response in Nigeria still operates almost a vertical approach which is headed by the Federal Government through the Nigeria Centre for Disease Control (NCDC). Vertical healthcare programs address health problems through the application of specific measure(s). However, vertical approach alone has proved insufficient in the containment and control of COVID-19. The health system with the integrated services option is required in the proper management of COVID-19. The development of strategies by policymakers is required in the integration of COVID-19 response into the national health system.

Implementing electronic health system in Nigeria: perspective assessment in a specialist hospital.

Perspectives on the pioneering work of Electronic Health Recording (EHR) system in Nigeria was studied. To determine health workers perception, challenges, motivation and satisfaction with EHR. This was a descriptive cross sectional study using structured questionnaire to assess health workers perspective on EHR system at Kogi State Specialist Hospital. A total of 35 consenting health workers with an mean age of 39.4(± 7.6) years using EHR were assessed. The mean daily work hour was 8.0(± 2.4 hours) and median client load per participant was 20 daily. On perceptions, 74.3%, 52.9%, 45.5% and 60.0% were comfortable, well-motivated, satisfied and competent with EHR. The advantages were reduction in transcription cost (88.5%), Paper work (97.1%), administrative cost (91.4%), errors (82.9%) and it captures, provides more services including timely access and ease research in 94.3%, 74.3%, 94.3% and 82.9% respectively. Challenges were threat to patient privacy, poor internet, information overload, power outages, incomplete and inaccurate information in 17.0%, 65.7%, 31.5%, 62.9%, 37.1% and 22.9% respectively. Health workers were comfortable and satisfied with EHR and it eased their work.Scaling up EHR would reduce administrative cost, transcription errors and paper works to mitigate poor quality data from Nigeria a great contributor to global morbidities/mortalities.

Strategies for mitigating burnout among early career doctors in Nigeria: lessons learnt from the qualitative CHARTING study

Abstract Background Early career doctors (ECDs) are faced with many challenges due to their transition from undergraduate medical/dental studentship to being postgraduate doctors and being in an early phase of their career. The specific factors that affect ECDs in their careers and endeavors at the workplace range from poor remuneration, particularly in developing countries, to psychosocial problems (such as burnout [BO] syndrome). There is a dearth of information on BO among ECDs in Nigeria. This qualitative study aims to explore the opinions of ECDs in Nigeria on the causal/predisposing factors of BO, effects of BO, and strategies for mitigating BO among ECDs in Nigeria. Method Using purposive sampling method, two sessions of focus group discussions (FGDs) involving 14 ECDs (key informants) holding key leadership positions and who were delegates of other ECDs in Nigeria were conducted to explore their experiences on psychological issues among ECDs. Data collected were transcribed and analyzed thematically. Results BO is an issue of serious concern among ECDs in Nigeria. The causes of BO are diverse, some of which include low staff strength, prolonged work hours, wrong counseling, lack of job description and specification, and abuse of powers by trainers. In order to mitigate the issue of BO among ECDs, the respondents recommended that work policy review, medical workforce strengthening, stakeholder dialog on ECDs’ welfare, regular psychological review of ECDs, and provision of free yearly medicals need to be looked into. Conclusion: Our findings revealed that the participants considered BO issues among ECDs to be common, and it affected their performance and the overall quality of care in Nigeria health system. Based on our findings, there is an urgent need to mitigate the problem of emotional exhaustion among ECDs in Nigeria.

COVID-19 pandemic: A global health burden.

Coronavirus disease 2019 (COVID-19) pandemic began in China with a group of severe pneumonia cases, later identified to be caused by the severe acute respiratory syndrome coronavirus 2 in December 2019. Thailand reported the first COVID-19 case outside of China on 13th January 2020, Africa reported its first case in Egypt on 14th February 2020 and Nigeria reported its index case of COVID-19 on 27th February 2020. Virtually, all countries in the world are affected, with over 5 million cases reported globally. A literature search was conducted using publications from academic databases and websites of relevant organisations. The disease is associated with typical and atypical signs and symptoms, mimicking other common illnesses. Nigeria is now in the phase of widespread community transmission as almost all the states have reported confirmed cases. The pandemic has shown a wide range of case-fatality rate (CFR) globally; this is postulated to be related to the demographics, existing health systems and probably other unidentified factors. There has been a steady increase in the burden caused by the disease in Nigeria with a relatively stable CFR, which is lower than the global CFR. Health systems have responded with the guidelines for prevention, management, and surveillance of the disease, while effort is being put in place to find a vaccine and a specific therapy for the cure of the disease. The pandemic has had a severe effect on health systems globally, including an unintended disruption in the service delivery of other diseases. It has the potential to disrupt the weak health system in Nigeria significantly. As such, a combination of non-pharmaceutical preventive measures that are cost-effective needs to be scaled up to prevent it from further weakening the existing health system.

2023. Antimicrobial Resistance and Stewardship Knowledge and Perception among Medical and Pharmacy Students in Nigeria

BackgroundNigeria is the most populous country in Africa and has high rates of antimicrobial resistance (AMR). The practice of antimicrobial stewardship in Nigerian hospitals is very limited and the subject is rarely included in undergraduate medical and pharmacy curriculums. To further acceptance and implementation of antimicrobial stewardship programs (ASP) in Nigeria health system, baseline measurements of the knowledge and perceptions held by graduating medical and pharmacy students was deemed essential. This study evaluated the knowledge and perceptions of a cohort of Nigerian medical and pharmacy students in concepts of AMR and ASP.MethodsThis was a cross-sectional questionnaire-based study of final year medical and pharmacy students from the two largest schools in the southeastern region of Nigeria. A previously published 20-items questionnaire measuring knowledge and perceptions toward AMR and ASP was adopted for the study. Results were expressed as frequencies and percentages.ResultsCompleted questionnaires were received from 79.3% (361 of 455 students), over half (60%) were male, and mostly between 22 and 25 years old (68.7%). More pharmacy students had formal training on ASP compared with medical students (41.3% vs. 27.5%, P < 0.05). Pharmacy students (n = 84.3% and 90.5%) were significantly more knowledgeable of factors that promote the spread of AMR and interventions to combat resistance than medical students (n = 73.9% and 82.3%), P < 0.05, respectively. Interestingly, 23.3% of medical students thought pharmacists should lead ASP teams, while 5.8% of pharmacy students thought doctors should lead ASP. However, both held poor perceptions of each other’s roles in the ASP team.ConclusionKnowledge of AMR and ASP among medical and pharmacy students in Nigeria is lacking. Inter-professional collaboration to change perceptions and drive ASP in urgently needed.Disclosures All authors: No reported disclosures.

The role of National Health Act in Nigeria Health System strenghening

The National health act took a long period of 2004 -2014 before coming to existence, it serves as a legal backing for the regulation, development, and management of our health system. It also sets a standard for delivering health care to all citizens. The NHAct is a way of saying good bye to the era of poor access to health care, stock-out syndrome of essential drugs and vaccines, skewed health manpower distribution, mushroom health facilities, hospitals turned to “mere consulting clinics”, unregulated and unethical health researches, assault on health workers, total paralyzing strikes that leave the nation no option than unnecessary death of the citizens. The 2014 NHAct, therefore sets out a legal framework for the provision of health services which is a strong potential to transforming health care provision in Nigeria through the Basic Health Care Provision Fund (BHCPF) by extending primary health care to all Nigerians. As such, the NHAct can be used as a tool to strengthen the health system which is synonymous to the country as the roadmap to Universal Health Coverage (UHC). It is therefore recommended that all health workforce, health Ministries, Departments and Agencies (MDAs) and the three tiers of government work together harmoniously, so that our health system can be strengthened.Keywords: National Health Act, Basic Health care fund, Legal framework, Health System Strengthening.

Sustainable financing mechanisms for strengthening mental health systems in Nigeria

Background and aimsCurrent coverage of mental health care in low- and middle-income countries is limited, not only in terms of access to services but also in terms of financial protection of persons in need of care and treatment. This is especially pertinent considering the established relationship between mental illness and poverty and the need to ensure the financial risk protection of persons with mental disorders and their families as part of country’s efforts to attain universal health coverage. This study set out to review the health and socio-economic contexts of Nigeria as well as to generate strategies for sustainable mental health financing that will be feasible, within the specific context of the country.MethodsA multi-methods approach was developed and applied, consisting of three steps: a situational analysis of Nigeria’s health system, macro-fiscal economic profile, and socio-political status, including a strengths, weaknesses, opportunities and threats (SWOT) analysis of the Nigerian socio-economic, general and mental health context; key informant interviews with 12 expert stakeholders drawn from state and non-state actors in the health and financial sectors; and a policy analysis of sustainable financing options.ResultsKey challenges identified were: poor funding; reduced access to care, resulting in a huge treatment gap; and out of pocket payment for services—leading to impoverishment. Comprehensive coverage of mental health conditions within the ongoing health insurance reforms was identified as a key strategy for moving towards sustainable mental health financing in Nigeria. Other identified strategies include enhanced integration of mental health into primary care; incorporation of mental health into other strategic and currently funded programmes; adoption of performance-based financing measures; and renewed engagement with stakeholders, including external donor institutions.ConclusionsA suite of feasible and actionable measures can be implemented to increase mental health service financing, reduce health-related financial burden on households, increase help-seeking and access to quality mental health care and, ultimately, reduce the large treatment and financing gap for mental disorders in Nigeria.

Out-of-Pocket Payments, Catastrophic Health Expenditure and Poverty Among Households in Nigeria 2010.

Background: There is high reliance on out-of-pocket (OOP) health payments as a means of financing health system in Nigeria. OOP health payments can make households face catastrophe and become impoverished. The study aims to examine the financial burden of OOP health payments among households in Nigeria. Methods: Secondary data from the Harmonized Nigeria Living Standard Survey (HNLSS) of 2009/2010 was utilized to assess the catastrophic and impoverishing effects of OOP health payments on households in Nigeria. Data analysis was carried out using ADePT 6.0 and STATA 12. Results: We found that a total of 16.4% of households incurred catastrophic health payments at 10% threshold of total consumption expenditure while 13.7% of households incurred catastrophic health payments at 40% threshold of nonfood expenditure. Using the $1.25 a day poverty line, poverty headcount was 97.9% gross of health payments. OOP health payments led to a 0.8% rise in poverty headcount and this means that about 1.3 million Nigerians are being pushed below the poverty line. Better-off households were more likely to incur catastrophic health payments than poor households. Conclusion: Our study shows the urgency with which policy makers need to increase public healthcare funding and provide social health protection plan against informal OOP health payments in order to provide financial risk protection which is currently absent among high percentage of households in Nigeria

Promoting effective tobacco control through advancement of public health systems in Nigeria

Promoting effective tobacco control through advancement of public health systems in Nigeria