Health Care Services In Nigeria Research Articles

Contributions of family physicians to health care services in Nigeria.

In Nigeria, family physicians are doctors with specialised training to manage a broad range of clinical conditions and pathologies when they first present, considering the psychosocial, economic, cultural and environmental context of the individual and his or her family. In Nigeria, family physicians may be found at district hospitals but are more likely to be located at tertiary health care facilities, where their roles in medical education, research and clinical services cannot be overemphasised. Many patients present to tertiary facilities with primary-care problems, bypassing primary and secondary care. They are often seen initially by family physicians in general outpatient clinics, where 70% of all problems are managed without referral to other specialists. These physicians are also in charge of most of the National Health Insurance Scheme (NHIS) clinics nationwide. They are thus the gatekeepers to the majority of tertiary hospital services.

FACTORS MILITATING AGAINST PUBLIC HEALTH FINANCING IN NIGERIA: AN EMPIRICAL REVIEW

An effective and quality health care service is one of the fundamental visions of every government to its citizenry because it is only the healthy people that can be governed and will value developmental projects. Citizens having access to quality health services translate to significant development in modern society. Therefore, the provision of adequate funds for the sector is essential. However, the Nigeria health care sector is currently confronted with colossal issues that should be surmounted to enhance effective and quality health care delivery to the citizens. This study is rooted in the evidence of appropriate works of literature in the financing of public health care services in Nigeria. From the extant works of the literature surveyed, it was revealed that public health care services in Nigeria are financed by revenue that is accrued from public tax, funding from donors, health insurance, and direct payments made by individuals. Furthermore, public health service is mostly financed by direct payments made by individuals with the government. The most perturbing issues combating public health care financing are direct payments made by individuals, poor government funding, health care policy defects in implementation, and corruption scandals. On this note, the study recommended an effective and robust government funding of public health, implementation of sound health care policies, efficient monitoring of public funds utilization, and discouraging foreign medical trips.
 JEL Classification Codes: A19, B10, B25, C10, C53.

Impact of Strategic Planning on Organizational Performance of Health Care Services in Nigeria

Strategic planning is a concept that has posed so many problems to several organizations in its applicability. However, for any organization to thrive well in this modern contemporary age there is need for such organization to embrace strategic planning in its fullness. This objective of the study aims at examining the influence of strategic processes on organizational development and growth of the public health institution in Nigeria. The strategic plan outlines a plan or strategy to improve the organizational performance, effectiveness as well as overall efficiency of an institution whether public or private. Typically, as an approach to strategy formulation, strategic planning includes elements such as analysis of the organization’s mandate, mission, and values, analysis of the organization’s internal and external environment and the formulation of strategic issues based on these analyses and the formulation of strategies, goals, and plans to address the issues. Numerous research studies show that many institutions are often involved in strategic planning in order to attain and maintain the organizational goals of profit maximization and greater market share. Also these studies in literature show that the development and implementation of it has a direct influence on the efficiency and effectiveness of health institutions with increases in the performance of departments and longevity of the institution. Therefore, the study seeks to investigate the ability of strategic planning to provide similar results as in quality service delivery of the health sector in Nigeria, which is known for inefficiency and underdevelopment. Therefore, this research focuses on examining the systems, types and implications of the strategic approach for institutional performance in the public health sector.

Nigerian Results-Based Financing Fellowship: A Strategic Approach for Sustaining Results-Based Financing in Nigeria.

There is an emergency in the Nigerian primary health care (PHC) system. Majority of PHC facilities are in a sordid and lugubrious state (1). Despite substantial government spending and policy initiatives toward revitalizing the PHC system, it remains largely deplorable across the World Health Organization (WHO) health system building blocks (2). To this end, the government of Nigeria in collaboration with the World Bank launched a Results-Based Financing (RBF) project under the Project Name: Nigeria State Health Investment Project (NSHIP) with the goal of improving service utilization and quality of healthcare services in Nigeria (2, 3). Due lack of in-country capacity, Oxford Policy Management (OPM) was contracted by National Primary Health Care Development Agency (NPHCDA) in 2014 to provide technical assistance to NSHIP for the implementation of RBF in Nigeria. In order to bridge the capacity gap at the exit of OPM in 2018, Nigerian Results-Based Financing Fellowship was conceptualized jointly by OPM and NPHCDA to train 14 Nigerians to a level whereby they are able to take on technical assistance roles in NPHCDA for continued implementation and possible scale-up of RBF in Nigeria (4). This paper describes the 10-months RBF fellowship, the competencies acquired and its usefulness as strategic approach for the sustainability of RBF in Nigeria.

Evaluation of the Participation of Community Pharmacists in Primary Healthcare Services in Nigeria: A Mixed-Method Survey.

Background: Achieving universal health coverage in poorly-resourced settings like Nigeria demands optimal mobilization of all healthcare resources including community pharmacists. Such efforts are hampered by insufficient data on primary healthcare (PHC) contributions by community pharmacists. The study aimed to identify PHC services offered by community pharmacists; assess impact of technologies on PHC service quality; and evaluate factors influencing management of PHC services in Nigeria.Methods: A descriptive cross-sectional survey of 321 community pharmacies and 642 clients was undertaken between April and August, 2019. Semi-structured pre-tested questionnaires were administered on randomly-selected community pharmacists and clients. Interviews were conducted with key informants. Data were summarized using frequency and percentages while weighted averages on 5-point ordinal scales and chi-square tests were used to identify weights and associations between variables respectively at P<.050.Results: Response rates of pharmacists and clients were 74.7% (N=321) and 100% (N=642); while their median ages were 39.41 and 51.20 years respectively. Community pharmacists offered services in all eight domains of PHC, especially supply of medicines for treating of endemic diseases (mean weighted average [MWA]=4.59), and disease prevention (4.54) but least of vaccine administration (2.39). Blood glucose screening devices were the most adopted technology with significant impact on service quality (χ2 6.86, P=.030). Major challenges to management of PHC services were poor awareness of pharmacists’ roles (4.31) and lack of integration with the PHC infrastructure (4.31). Capacity constraints in finances (4.11), technologies (4.09), and human resources (3.99) were significant. However, major facilitators were pharmacists’ managerial skills (4.35), and strong client relationships (4.27). Conclusion: In Nigeria, community pharmacists offered important PHC services. Deploying technologies were associated with improved service quality. If community pharmacists are integrated in the national PHC architecture and financial incentives are provided, their competences and goodwill would enhance the achievement of universal health coverage.

Responsiveness of primary health care services in Nigeria: The patients’ perspective

Responsiveness of primary health care services in Nigeria: The patients’ perspective

Geographical and socioeconomic inequalities in the utilization of maternal healthcare services in Nigeria: 2003\u20132017

BackgroundMaternal mortality has remained a challenge in many low-income countries, especially in Africa and in Nigeria in particular. This study examines the geographical and socioeconomic inequalities in maternal healthcare utilization in Nigeria over the period between 2003 and 2017.MethodsThe study used four rounds of Nigeria Demographic Health Surveys (DHS, 2003, 2008, 2013, and 2018) for women aged 15–49 years old. The rate ratios and differences (RR and RD) were used to measure differences between urban and rural areas in terms of the utilization of the three maternal healthcare services including antenatal care (ANC), facility-based delivery (FBD), and skilled-birth attendance (SBA). The Theil index (T), between-group variance (BGV) were used to measure relative and absolute inequalities in the utilization of maternal healthcare across the six geopolitical zones in Nigeria. The relative and absolute concentration index (RC and AC) were used to measure education-and wealth-related inequalities in the utilization of maternal healthcare services.ResultsThe RD shows that the gap in the utilization of FBD between urban and rural areas significantly increased by 0.3% per year over the study period. The Theil index suggests a decline in relative inequalities in ANC and FBD across the six geopolitical zones by 7, and 1.8% per year, respectively. The BGV results do not suggest any changes in absolute inequalities in ANC, FBD, and SBA utilization across the geopolitical zones over time. The results of the RC and the AC suggest a persistently higher concentration of maternal healthcare use among well-educated and wealthier mothers in Nigeria over the study period.ConclusionWe found that the utilization of maternal healthcare is lower among poorer and less-educated women, as well as those living in rural areas and North West and North East geopolitical zones. Thus, the focus should be on implementing strategies that increase the uptake of maternal healthcare services among these groups.

THE EFFECTS OF ILL-HEALTH AND DISABILITIES ON LABOUR FORCE PARTICIPATION AMONG NIGERIAN HOUSEHOLDS

Nigeria has demeaning health statistics together with declining labour supply despite the large population size. This paper investigated the effect of illness, disability and other socio-demographic factors on labour force participation among Nigerian households. This study is cross-sectional in which secondary data from the General Household Survey (2015/2016) was used for the analysis. A representative sample of 4,200 household heads was used for the analyses. Both predictive and descriptive analyses were undertaken. Binary logistic regression was used to investigate predictors of labour force participation among the household heads. The data revealed that 52.1% of respondents were engaged in labour force. Controlling for other variables, the various forms of disabilities, ill-health, body injury, gender and educational attainment were significant determinants of labour force participation. The result provokes the need for policymakers to articulate policies that improve access to healthcare through the expansion of health insurance coverage. The study concluded that self-assessed health and education attainment influence labour force participation. Policies should be used to expand educational opportunities and improve access to healthcare services in Nigeria. To improve access to healthcare, the Nigeria government should increase the ownership of health insurance policy by broadening the coverage of the formal health insurance and encouraging community-based health insurance in the informal and rural sectors.

Patterns of access to reproductive health services in Ghana and Nigeria: results of a cluster analysis

BackgroundInequalities in access to health care result in systematic health differences between social groups. Interventions to improve health do not always consider these inequalities. To examine access to reproductive health care services in Ghana and Nigeria, the patterns of use of family planning and maternal care by women in these countries are explored.MethodsWe used population-level data from the Ghana and Nigeria Demographic Health Surveys of 2014 and 2013 respectively. We applied a two-step cluster analysis followed by multinomial logistic regression analysis.ResultsThe initial two-step cluster analyses related to family planning identified three clusters of women in Ghana and Nigeria: women with high, medium and poor access to family planning services. The subsequent two-step cluster analyses related to maternal care identified five distinct clusters: higher, high, medium, low and poor access to maternal health services in Ghana and Nigeria. Multinomial logistic regression showed that compared to women with secondary/higher education, women without education have higher odds of poor access to family planning services in Nigeria (OR = 2.54, 95% CI: 1.90–3.39) and in Ghana (OR = 1.257, 95% CI: 0.77–2.03). Compared to white-collar workers, women who are not working have increased odds of poor access to maternal health services in Nigeria (OR = 1.579, 95% CI: 1.081–2.307, p ≤ 0.01). This association is not observed for Ghana. Household wealth is strongly associated with access to family planning services and maternal health care services in Nigeria. Not having insurance in Ghana is associated with low access to family planning services, while this is not the case in Nigeria. In both countries, the absence of insurance is associated with poor access to maternal health services.ConclusionsThese differences confirm the importance of a focused context-specific approach towards reproductive health services, particularly to reduce inequality in access resulting from socio-economic status. Interventions should be focused on the categorization of services and population groups into priority classes based on needs assessment. In this way, they can help expand coverage of quality services bottom up to improve access among these vulnerable groups.

Exploring Issues and Challenges of Leadership among Early Career Doctors in Nigeria Using a Mixed-Method Approach: CHARTING Study.

(1) Background: leadership behaviour is a poorly explored phenomenon among early-career doctors (ECDs). Good leadership is vital in maximising the effective management of patients in a clinical setting. While a good number of studies, though with small sample surveys, have researched the role of leadership in clinical setting quantitatively, qualitative investigations are yet to be done in Nigeria. This study aims to explore the attitudes, skills, and experience of ECDs in Nigeria on issues pertaining to leadership in a medical setting, using a mixed-method approach. (2) Methods: we conducted two sessions of key informant focus group discussion (FGD) that involved 14 ECD leaders in Nigeria, exploring their leadership experience in a clinical setting. Furthermore, we used a self-administered questionnaire to quantitatively survey 474 ECDs from seven Nigerian teaching hospitals to explore their attitudes, skills, and experience on issues pertaining to medical leadership. (3) Results: taking on leadership roles is a common phenomenon (52.7%) among the surveyed ECDs; however, the medical leadership position can be very challenging for ECDs in Nigeria. Despite the fact that many (91.1%) of the surveyed ECDs perceived leadership skills as essential skills needed by a doctr, many (44.1%) of them were yet to be formally trained on medical leadership. About three out of every 10 (23.6%) of surveyed ECDs that have ever held leadership positions in a medical setting experienced major leadership challenges while in such office due to their lack of training on leadership skills. Leadership skill acquisition programmes are highly recommended to become an integral part of medical training programmes in Nigeria. (4) Conclusion: there is a need for a structured leadership skill acquisition programme for ECDs in Nigeria. This programme will help in the robust delivery of highly effective healthcare services in Nigeria, as effective leadership is crucial to patient care services.

An empirical analysis of globalization, oil receipts and health expenditure in Nigeria

This study examined the effect of globalisation and oil revenue on health expenditure in Nigeria. Thestudy used annual time series data spanning from 1980 to 2018. Unit root test was used to check thestationary level of the variables and Unrestricted Error Correction Model (UECM) and Dynamic OrdinaryLeast Square (DOLS) were used to estimate the model. The dependent variable was health expenditurewhile the explanatory variables were globalisation, oil revenue, health care price, per capita income,life expectancy, mortality rate urbanization and corruption. The result showed that oil receipt had a longrun and positive impact on health expenditure in Nigeria. However, globalisation had a negative andsignificant impact in the long-run though not significant in the short run. The implication is that both oilrevenue and globalisation are still very important variables influencing health expenditure in Nigeria. Itis recommended that government should increase allocation to the health sector from oil fiscal revenueso as to improve access to health care services in Nigeria. Also, the government should work on how thecountry can benefit from globalisation through more export and less of import.

Determinants of maternal autonomyin Nigeria

Utilization of health care services by maternal women has been shown to prevent most maternal deaths and health issues faced by women in Nigeria. Therefore, this study examined the level of maternal autonomy and the determinants of maternal autonomy in utilizing health care services in Nigeria. Data on 10193 married women, living in Nigeria were sourced from Nigeria Demographic and Health Survey 2013. Data were disaggregated into six Geo–political zones (North Central, North West, North East, South East, South–South, and South West). Information on socio–economic characteristics, level of maternal autonomy, and factors influencing maternal autonomy were obtained. Data were analysed using descriptive statistics, composite score analysis, ordered probit regression.The mean age was 30 years. 54.61% of the maternal women have low level of autonomy, 42.92% of the respondents have intermediate autonomy and 2.46% of the respondents have high autonomy. Majority of the respondents have low autonomy. About determinants of maternal autonomy, age of respondents was significant and positively related to maternal autonomy at 1% that is, increase in age leads to increase in maternal autonomy. The household size of respondents was significant at 1% and negatively related to maternal autonomy. Respondents who are working have higher autonomy than respondents who are not working. Respondents who have husbands that are working have lower autonomy when compared to those whose husbands are not working. Also, respondents who have husbands with formal education have high autonomy than those whose husbands are not working. Respondents in north–east and north–west have lower autonomy when compared to north–central while respondents in south–east, south–south and south–west have higher autonomy when compared to respondents in north–central. Efforts should be made by governmental and non–governmental organisations to orientate the women and their spouses on the need for women to be autonomous on issues relating to their health.

Cardiovascular diseases in Nigeria: What has happened in the past 20 years?

Cardiovascular diseases (CVDs) are a leading cause of death worldwide with an accelerated increase in CVD-related death in Nigeria and other low-income and middle-income countries. A review of the trend of presentation and management of CVDs in Nigeria over the past 20 years revealed a transition from high incidence of CVDs associated or resulting from poverty and malnutrition (such as rheumatic heart disease) initially to a fall in the prevalence of these poverty-related CVDs occurring subsequently at same time with a rising prevalence of other noncommunicable CVDs (such as hypertension and heart failure). Although some CVDs such as coronary heart disease and cardiomyopathies maintained a steady prevalence within the period in review, this trend was associated with changing availability of healthcare services in Nigeria, with better services and newer treatments becoming more available over time and increasing prevalence of CVD risk factors among Nigerians. Despite these, Nigeria is at a plateau now as a result of poor funding and support of the health sector. This has resulted in most health funding coming from donor agencies, religious bodies, philanthropists, and nongovernment organizations. For progress, there is a need for an increase focus in the health sector with increased funding and support from the government and all players. Increased awareness and education of the general population on the prevention and control of risk factors and training of health professionals on appropriate diagnosis and management of CVDs is advocated.

Assessing the Roles of NGOs in Health Care Services in Nigeria

Assessing the Roles of NGOs in Health Care Services in Nigeria

Mapping and Assessment of Healthcare Facilities Using GIS in a Part of Ikorodu Metropolis, Lagos State

The uneven distribution of health care services in Nigeria had been validated the inequalities in the accessibility and the best of fitness care services rendered to citizens. Basic fitness care offerings continue to be a cardinal responsibility of the authorities for the survival of her citizenry. Mostly in the developing country, the accessibility to these health care centres is poorly understood and underserved by the timing populations. there is a need to apprehend the elements that affect or inhibit health care used and what contributed to the use elements in term of distance from residences to the health care amenities and the thickly populace developed round the facilities. This paper focuses on the acceptable evaluation of spatial distribution of health care facilities and proposed for new health centres in some of catchments location that deserves it primarily based on distance and population figures in Ikorodu Local Community Development Area. It was subdivided into Ibese, Ojubode , Local Govt, Police Post, Ebute , Ogoloto , Tos Benson, Ita Elewa, Sambo , Alagbala and Eyita Area with their two land mass for every the catchment area inside the learn about which covered two Ibese Area, Ojubode Area, Local Govt. Area, Police Post Area, Ebute Area, Ogoloto Area, Tos Benson Area, Ita Elewa, Sambo Area, Alagbala Area and Eyita Area covered 128.585 ha, 59.658 ha, 106.793ha, 99.631ha, 140.803ha, 109.485ha, 131.518 ha, 111.625ha, 155.051 ha, 89.698 ha and 112.907 ha. Based on buffer coverage and population used and it was revealed and proposed new healthcare centres for Ojubode, Local Govt, Ibese, part of Eyita, Sambo,Alagbala and Ogoloto areas maps were produced. The useful geodatabase was created for digital healthcare facility mapping for less difficult replace every time it’s necessary.

Mapping and Assessment of Healthcare Facilities Using GIS in a Part of Ikorodu Metropolis, Lagos State

The uneven distribution of health care services in Nigeria had been validated the inequalities in the accessibility and the best of fitness care services rendered to citizens. Basic fitness care offerings continue to be a cardinal responsibility of the authorities for the survival of her citizenry. Mostly in the developing country, the accessibility to these health care centres is poorly understood and underserved by the timing populations. there is a need to apprehend the elements that affect or inhibit health care used and what contributed to the use elements in term of distance from residences to the health care amenities and the thickly populace developed round the facilities. This paper focuses on the acceptable evaluation of spatial distribution of health care facilities and proposed for new health centres in some of catchments location that deserves it primarily based on distance and population figures in Ikorodu Local Community Development Area. It was subdivided into Ibese, Ojubode , Local Govt, Police Post, Ebute , Ogoloto , Tos Benson, Ita Elewa, Sambo , Alagbala and Eyita Area with their two land mass for every the catchment area inside the learn about which covered two Ibese Area, Ojubode Area, Local Govt. Area, Police Post Area, Ebute Area, Ogoloto Area, Tos Benson Area, Ita Elewa, Sambo Area, Alagbala Area and Eyita Area covered 128.585 ha, 59.658 ha, 106.793ha, 99.631ha, 140.803ha, 109.485ha, 131.518 ha, 111.625ha, 155.051 ha, 89.698 ha and 112.907 ha. Based on buffer coverage and population used and it was revealed and proposed new healthcare centres for Ojubode, Local Govt, Ibese, part of Eyita, Sambo,Alagbala and Ogoloto areas maps were produced. The useful geodatabase was created for digital healthcare facility mapping for less difficult replace every time it’s necessary.

Negotiating access to the Nigerian healthcare system: the experiences of HIV-positive men who have sex with men

Men who have sex with men in sub-Saharan Africa continue to have a disproportionately higher burden of HIV than their counterparts in the general population. In this qualitative study, barriers to participants accessing healthcare services in Nigeria, a country where same-sex relationships are criminalised and considered societally abhorrent, were explored. Four focus group discussions and 21 semi-structured interviews were conducted with HIV-positive men who have sex with men recruited from 3 NGOs in Abuja and Lagos, Nigeria in 2016. Interviews were transcribed verbatim and analysed thematically using NVivo. The findings of this study revealed the numerous barriers these men encounter accessing general (government and private) healthcare facilities. Data were organised into two categories: barriers associated with the wider legal context in relation to HIV-positive men who have sex with men and those with service delivery. There were barriers reported in relation to accessing an emerging service, which had hitherto sought to address some barriers encountered in general healthcare facilities. Findings point to the importance of facilitating a more enabling social and political environment whereby men who have sex with men can freely access healthcare services, potentially through these facilities.

Multilevel analysis of factors associated with assistance during delivery in rural Nigeria: implications for reducing rural-urban inequity in skilled care at delivery

BackgroundStudies have observed rural-urban inequity in the use of skilled delivery in Nigeria. A number of studies have explicitly examined associated factors of assistance during delivery in rural areas. However, the studies so far conducted in rural Nigeria have investigated mainly individual-level characteristics with near exclusion of community-level characteristics. Also, most of the studies that have investigated community-level influence on use of maternal healthcare services in Nigeria did not isolate rural areas for specific research attention. The objective of this study was to investigate the individual-level and community-level characteristics associated with assistance during delivery in rural Nigeria.MethodsThe study analysed women data of 2013 Nigeria Demographic and Health Survey. A weighted sample size of 12,665 rural women was analysed. The outcome variable was assistance during delivery, dichotomised into ‘skilled assistance’ and ‘unskilled assistance’. The explanatory variables are selected individual-level characteristics (maternal education, parity, age at first birth, religion, healthcare decision, employment status, access to mass media, and means of transportation); and selected community-level characteristics (community literacy level, community childcare burden, proportion of women employed outside agriculture, proportion of women who perceived distance to facility as a big problem, community poverty level, and geographical region). The mixed-effects logistic regression was applied.ResultsDuring the most recent deliveries, 23.0% of rural women utilised skilled assistance compared with 77.0% who utilised unskilled assistance. Maternal education, parity, religion, healthcare decision, access to mass media, and means of transportation were the individual-level characteristics that revealed significant effects on the likelihood of utilising skilled assistance during delivery, while community literacy level, community poverty level, community perception of distance to health facility, and geographic region were the community-level characteristics that revealed significant effects on the odds of using skilled assistance during delivery. Results of Intra-Class Correlation (ICC) supported significant community-level effects on the likelihood of using skilled assistance during delivery.ConclusionsAssistance during delivery is influenced by individual-level and community-level characteristics. Health policies and programmes seeking to reduce rural-urban inequity in skilled delivery should endeavour to identify and address important factors at both the individual and community levels of the social environment.

Human Resource Management and Its Impact in Healthcare Services in Nigeria

Human Resource Management and Its Impact in Healthcare Services in Nigeria

Predictors of mortality among older patients in the medical wards of a tertiary hospital in Nigeria.

Older people face the biggest challenges in the overburdened healthcare services in Nigeria especially when hospitalized. There is no reliable data on the predictors of mortality in this population. To determine the predictors of mortality among older patients on admission in the medical wards of University College Hospital, Ibadan. Using a prospective cohort design, we investigated 450 patients (> 60years) from the day of admission to death or discharge. Variables assessed included sociodemographic, family dynamics, lifestyle habits, healthcare utilization, quality of life, frailty, anxiety, depression, cognition, functional disability and anthropometric parameters. Kaplan-Meier method and Log-rank test were used to estimate and compare survival functions, respectively. Cox proportional hazard regression analysis was used to determine the predictors of mortality. The mean age of the subjects was 71.5 ± 8.0years and 234 (52.0%) were females. Overall, there were 99 (22.0%) in-hospital deaths. The median survival time (MST) was 36.0 ± 3.0days [females = 40.0 ± 3.5days vs males = 31.0 ± 4.5days (p < 0.001)]. There was a significant negative correlation between MST and age (r = - 0.931). Predictors of mortality on Cox's proportional hazard regression analyses were male sex HR = 2.03 (95% CI 1.27-3.24), severe frailty HR = 2.07 (1.02-4.20), cognitive impairment HR = 1.90 (1.14-3.17) and having ≥ 5 morbidities HR = 1.94 (1.14-3.30). There was a high mortality among older patients particularly the frail, male or those with multiple morbidities. Prompt and holistic management of morbidities and targeted interventions for cognitive impairment and frailty are needed to improve survival during hospitalization.