National Primary Health Care Development Research Articles

VP159 Strengthening Primary Health Care In Nigeria By Patient Involvement

INTRODUCTION:The Health system in Nigeria is structured into three tiers which include tertiary health care, secondary health care and primary health care (PHC). The latter forms the grassroots system of delivering basic health services to communities in both rural and urban centers. However PHC in Nigeria have been affected by poor service delivery. This has resulted in underuse of PHC due to the acceptance and utilization of health services delivered through this system. This research seek to bridge the gap of inequality, reaffirm that implementing PHC is a human right/duty and fosters patient and consumer involvement for economic, social and environmental sustainability of PHC.METHODS:A qualitative method of research was adopted using a participatory research model. The relative data was sourced secondarily from recent findings (July 2015) carried out in seventy-three primary health centers across Anambra State, Benue State, Kaduna State, Plateau State and Federal Capital Territory (FCT) of Nigeria. Issues that were examined included: client perspective and community involvement, status of available services, utilization and service delivery, and infrastructure and human resource capacities. The respondent of 294 client/service user population from interview were recorded and analyzed.RESULTS:The assessment showed client dissatisfaction to services being provided. In most centers, National Primary Health Care Development Agency (NPHCDA) requirements like availability of basic functional equipment, well trained health workers, patient record system, and access to water and sanitation were not met. Most of the facilities visited reported to be disconnected from the health system due to supportive supervision.CONCLUSIONS:Conclusively, the interest of the underserved Nigerian could be advocated for through local committees of consumer organizations. Their involvement will have an impact in PHC evaluation, policy making, and implementation of action plans aimed at improving PHC services.

Reorganizing Nigeria's Vaccine Supply Chain Reduces Need For Additional Storage Facilities, But More Storage Is Required.

One of the major problems facing Nigeria's vaccine supply chain is the lack of adequate vaccine storage facilities. Despite the introduction of solar-powered refrigerators and the use of new tools to monitor supply levels, this problem persists. Using data on vaccine supply for 2011-14 from Nigeria's National Primary Health Care Development Agency, we created a simulation model to explore the effects of variance in supply and demand on storage capacity requirements. We focused on the segment of the supply chain that moves vaccines inside Nigeria. Our findings suggest that 55 percent more vaccine storage capacity is needed than is currently available. We found that reorganizing the supply chain as proposed by the National Primary Health Care Development Agency could reduce that need to 30 percent more storage. Storage requirements varied by region of the country and vaccine type. The Nigerian government may want to consider the differences in storage requirements by region and vaccine type in its proposed reorganization efforts.

Impact of Patent and Proprietary Medicine Vendors Training on the Delivery of Malaria, Diarrhoea, and Family Planning Services in Nigeria

This study aimed to investigate the impact of PPMV training on their expertise to deliver quality healthcare services to the Nigerian public. The participants were trained on counseling and dispensing of family planning products diarrhea, and malaria products. The study adopted a multistage sampling method and selected a random sample of 1133 PPMVs trained by SFH between 2011 and 2014 who were interviewed between May and June 2015. Data were analyzed using descriptive statistics and logistic regression methods. Results reveal that training attendance was significantly associated with adequate knowledge of diarrhea treatment and knowledge of family planning counseling services. PPMVs who attended training twice, and those who attended more than twice over the four years preceding the study were more likely to have adequate knowledge of diarrhea treatment than those who attended only once. Similarly, within the same four-year period, PPMVs who attended training twice and those who attended more than twice were more likely to have adequate knowledge of family planning counseling services than those attending once. Significant association between training attendance and knowledge of malaria treatment was not found. Adequate PPMV training program should be streamlined into the national primary healthcare development program.

Job satisfaction and retention of midwives in rural Nigeria

BackgroundNigeria is one of the 57 countries with a critical shortage of human resources for health, especially in remote rural areas and in northern states. The National Midwifery Service Scheme (MSS) is one approach introduced by the Government of Nigeria to address the health workforce shortage in rural areas. Since 2009, unemployed, retired and newly graduated midwives are deployed to primary health care (PHC) facilities in rural areas of Nigeria. These midwives form the mainstay of the health system at the primary health care level especially as it relates to the provision of skilled attendance at birth. This study followed up and explored the job satisfaction and retention of the MSS midwives in three Northern states of Nigeria. Methodsthis was a descriptive study. Data were collected using a mixed method approach which included a job satisfaction survey, focus group discussions (FGDs) and exit interviews to explore job satisfaction and retention factors. All 119 MSS midwives deployed by the National Primary Health Care Development Agency between 2010 and 2012 to the 51 Partnership for Reviving Routine Immunisation- Maternal and Child Health (PRRINN-MNCH) programme targeted PHC facilities were included in the study. ResultsMSS midwives were very satisfied with from the feeling of caring for women and children in the community (4.56), with the chance to help and care for others (Mean 4.50), the feeling of worthwhile accomplishment from doing the job (Mean 4.44) and the degree of respect and fair treatment they received from more senior staff and/or supervisor (Mean 4.39). MSS midwives were least satisfied with the lack of existence of a (established) career ladder (Mean 2.5), availability of promotional opportunities within the scheme (Mean 2.66), safety of accommodation (Mean 3.18), and with ‘the degree to which they were fairly paid for what they contribute to the health facility’ (Mean 3.41). When asked about future career plans, 38% (n=33) of the MSS midwives planned to leave the scheme within two years, of which 16 (18%) wanted to leave within one year. However, 39% of the midwives (n=34) indicated that they would be happy to continue working even after the scheme has ended. Of these 34 participants, 18 would like to continue working in the same facility where they are now whereas the remaining 16 would like to continue working in the north but not in the facility where they are working currently. Eight themes on job satisfaction and retention emerged from the FGDs conducted with current midwives, whereas six themes emerged from the exit interviews from midwives who have left the scheme. Conclusionthe MSS programme is a short-term solution to increase SBA coverage in rural Nigeria. MSS midwives were dissatisfied with the short term contract, lack of career structure, irregular payment, poor working condition, inadequate supervision and poor accommodation being offered by the programme, which all contribute to poor retention of MSS midwives. Implications for policy and practicemidwives׳ job satisfaction and retention are critical to improving the health of mothers and their newborn. Poor job satisfaction and retention therefore requires improvements in financial and non-financial incentives, health systems, supportive supervision, ensuring job security and a career structure for midwives working in rural health facilities. Initiating effective strategies to motivate and increase the retention of rural health workers is important for Nigeria to achieve the Millennium/Sustainable Development Goals.

Strengthening HR for SCM in the immunization supply chain in Nigeria through stakeholder engagement

Background Nigeria is the most populous country in Africa with an estimated population of 176 million people and employs the largest number of health workers on the continent. The availability of human resources is at optimal levels however the human resource capacity remains a challenge in Nigeria’s health sector. National Primary Health Care Development Agency (NPHCDA) leadership has moved ahead in addressing these challenges by engaging international partners, traditional and religious leaders nationwide, and donors to be leaders and change agents in strengthening HR for SCM at all levels. This focus is aimed to improve the efficiency and effectiveness of the immunization supply chain.

Polio eradication in Nigeria and the role of the National Stop Transmission of Polio program, 2012-2013.

To strengthen the Nigeria polio eradication program at the operational level, the National Stop Transmission of Polio (N-STOP) program was established in July 2012 as a collaborative effort of the National Primary Health Care Development Agency, the Nigerian Field Epidemiology and Laboratory Training Program, and the US Centers for Disease Control and Prevention. Since its inception, N-STOP has recruited and trained 125 full-time staff, 50 residents in training, and 50 ad hoc officers. N-STOP officers, working at national, state, and district levels, have conducted enumeration outreaches in 46,437 nomadic and hard-to-reach settlements in 253 districts of 19 states, supported supplementary immunization activities in 236 districts, and strengthened routine immunization in 100 districts. Officers have also conducted surveillance assessments, outbreak response, and applied research as needs evolved. The N-STOP program has successfully enhanced Global Polio Eradication Initiative partnerships and outreach in Nigeria, providing an accessible, flexible, and culturally competent technical workforce at the front lines of public health. N-STOP will continue to respond to polio eradication program needs and remain a model for other healthcare initiatives in Nigeria and elsewhere.

Pneumococcal Infection in Nigeria: Preparing for the vaccine

Background: The Pneumococcus is the most common cause of community-acquired pneumonia (CAP), sporadic bacterial meningitis, and bacteremia worldwide. It is an important public health concern throughout the world with global burden in causing disease and deaths comparable to that of human immunodeficiency virus (HIV), malaria, and tuberculosis. Nigeria accounts for 5% of the total global burden. Many of these morbidity and mortality could be averted with the use of pneumococcal vaccine, which is shown to be highly effective. This review is set out to highlight the burden of pneumococcal infection (PI) in Nigeria, its attendant mortality, antibiotic resistance, and the rational for the need to introduce routine pneumococcal vaccination. Materials and Methods: Relevant literatures were reviewed from medical journals, library search, and internet source. Other relevant websites like Global Alliance for Vaccines and Immunisation (GAVI), WHO were also visited as source for information. The key words employed were: pneumococcal infection, Nigeria, and vaccine. Results: Several studies have shown high burden of PI and high prevalence of antibiotic resistant Pneumococcus in Nigeria. Mortality rate has also been shown to be high and the need for effective implementation of pneumococcal vaccine into routine childhood vaccination program has been underscored. Conclusion: Prevention of pneumococcal disease and death is achievable only if efforts to deliver and implement prevention in regions with the greatest burden of disease are successful. National Primary Healthcare Development Agency (NPHCDA) should introduce either pneumococcal conjugate vaccine (PCV)-13 or PCV-10 through GAVI support to eligible children and at risk adult all over the country. As these new vaccines are introduced, it is imperative that we conduct surveillance to document changes, positive or negative, which occur in disease epidemiology. This entails continuing surveillance pre- and post-vaccine introduction, assessing resistance, changes in invasive PI (IPI), serotypes, and any replacement.

Establishing A Sustainable Ward Health System In Nigeria: Are Key Implementers Well Informed?

In response to World Health Organisation recommendation that “community mobilization would greatly be assisted if the boundaries of the health district are the same as the electoral ward which elects a councilor to the LGA”, the Federal Government of Nigeria re-vitalized the National Primary Health Care Development Agency (NPHCDA) and introduced the Ward Health Service (WHS) system in the Year 2000. This study identified one of the major reasons why the WHS was still not well established. Objective: The objective was to determine and document gaps in the knowledge of the key implementors on WHS. Methodology: A self-administered multiple choice questionnaire was administered to a total of 955 participants including 200 Primary Health Care Coordinators and 200 Zonal Technical Officers (ZTOs) of the NPHCDA in the 6 health zones of the country, 255 final year medical students of the College of Medicine, University of Lagos and 300 Community Development Committee/Association members. Five years after, the same instrument was administered to139 Primary Health Care providers of Lagos State. Result: The medical students were the most informed, 76.5% scoring above the cut-off mark of 50% but only 9.8% above 70%. Of the Medical/Community Health Officers, ZTOs (75.5%) were better informed than the PHC Coordinators (72.3%). Community leaders were the least informed; none of them having adequate knowledge about the WHS and therefore all scoring below the cut-off mark. Conclusion: Inadequate stakeholder mobilization remains a major problem of Nigeria’s primary health care system. For effectiveness and sustainability, rigorous effort directed to this is urgently needed.

Public health care financing in Nigeria: Which way forward?

The way a country finances its health care system is a key determinant of the health of its citizenry. Selection of an adequate and efficient method(s) of financing in addition to organizational delivery structure for health services is essential if a country is set to achieve its national health objective of providing health for all. Health care in Nigeria is financed by tax revenue, out-of-pocket payments, donor funding, and health insurance (social and community). However, achieving successful health care financing system continues to be a challenge in Nigeria. This article examines the different financing mechanisms that have been used in Nigeria, including the National Primary Health Care Development Fund proposed for increasing the resource allocation to primary health care. It draws on available and relevant literature to provide an overview and the state of public health care financing in Nigeria. This article concludes by recommending the need for Nigeria to explore and strengthen other mechanisms of health system and shift focus from out-of-pocket payments, address the issues that have undermined public health care financing in Nigeria, improve on evidence-based planning, and prompt implementation of the National Health Bill when signed into law.

The WPA train-the-trainers workshop on mental health in primary care (Ibadan, Nigeria, January 26-30, 2009).

A 5-day WPA training workshop for the teachers of mental health in community health officers’ training institutions in the southwest of Nigeria took place at the University of Ibadan Conference Centre, Ibadan from 26 to 30 January, 2009. There were 25 participants selected from the 6 southwestern states (Lagos, Ogun, Ondo, Osun, Oyo, and Ekiti) and the two Yoruba speaking north-central states (Kogi and Kwara). The workshop aimed to provide the participants with: – Knowledge, skills and competencies around mental health and mental disorders as well as common neurological disorders, and their contribution to physical health, economic and social outcomes. – Understanding of linkages between mental health and child health, reproductive health, malaria and HIV. – Understanding of the general policy and implementation contexts for primary care. – Understanding of mental health policy and legislation. – Skills about working with the community, and supporting volunteer community health workers. – Skills about disaster management. Selection of participants was made through the National Primary Health Care Development Agency working with the heads of the various institutions. The selected participants were experienced, senior teachers serving in colleges of health technology, community health officers’ training programs in teaching hospitals, and community health officer tutors’ courses in the University College Hospital Ibadan. There were also representatives of the Community Health Officers’ Registration Board (the agency responsible for developing community health officers’ curriculum and licensing of practitioners) and the National Primary Health Care Development Agency. The program ran daily from 8.00 a.m. to 5.00 p.m. using an adapted curriculum, following a general health systems approach and compatible with the World Health Organization Primary Health Care (WHO-PHC) guidelines. The curriculum had been previously developed by R. Jenkins for Kenya, and subsequently adapted for and used in Ghana (V. Doku), Malawi (F. Kauye) and Pakistan (R. Taj and R. Jenkins). Short didactic lectures were augmented with 23 role plays and case vignette discussions. The resource persons were O. Gureje, R. Jenkins and V. Doku. Participants were administered a pre- and post-workshop questionnaire to assess their knowledge of mental health issues and evaluate the changes due to the training. The analysis of the tests will be conducted in due course. An important highlight of the workshop was the requirement for the participants to develop specific plans of action that build on the out-come of the training. The following were the plans collectively agreed upon: – Provision of written report on the workshop to the authorities at their institutions within one week of completion of workshop. – Plan to incorporate the contents of the WHO-PHC guidelines into their lecture notes on mental health within the next academic session. – Plan to improve their teaching skills by employing role plays and discussions by their students. – Having understood the relationship between mental health and reproductive health, malaria, HIV/AIDS and child health, the participants resolved to sensitize teachers of other subjects in their institutions to the relevance of mental health to the other courses and subjects. – Specific plan to forward to Ibadan the academic timetable of their institutions indicating when mental health courses would be taught so as to facilitate monitoring and support visit by O. Gureje and his team in Ibadan. It was agreed to have periodic monitoring, evaluation and boosting of the knowledge already acquired through scheduled visits to the participants in their respective institutions to observe them teaching their students using the skills acquired during the training. This initiative is part of the WPA Action Plan 2008-2011 1.

Essential drugs in primary health centres of north central Nigeria; where is Bamako initiative?

To assess the availability of essential drugs and the perceptions of clients on drugs situation in the primary health centres of Tafa Local Government Area, north central Nigeria. Checklist consisting of minimum drugs expected in a generic primary health centre developed by the National Primary Health Care Development Agency (NPHCDA) was adopted and used to assess drugs availability, while Focus Group Discussions were conducted to determine the perceptions of clients on drugs situation in the health centres. Results show that, all the 3 primary health centres in Tafa LGA do not implement Bamako initiative (BI) and none was operating Drug Revolving Fund (DRF) system. Out of the minimum recommended score of 54 points for the availability and adequacy of drugs and consumables, New Wuse primary health centre in the LGAheadquarters scored highest points of 19, while New Bwari and Iku primary health centres scored 13 points each. All these are far below the minimum requirement. Similarly, the results of the FGDs confirmed poor availability of drugs and clients dissatisfactions with the drugs situation in the primary health centres. This study has revealed that despite Bamako Initiatives put in place in late 80s essentials drugs are still mirages in many of the primary health care facilities in the study area. It is therefore recommended that, any effort aimed at reforming or repositioning primary health care must take into account resuscitating Bamako Initiative by ensuring functional DRF system in all the primary care facilities.

Status equipment in primary health centres of Tafa Lga, North Central Nigeria

Background/Aims : Equipment are veritable tools for proper diagnosis and effective management of clients. Every health care facility must possess a minimum acceptable level of equipment if quality of care is to be assessed and assured. Methodology : This study was conducted in Tafa LGA of Niger state in the North Central Nigeria with a view to assessing the status of equipment in the primary health centres, using minimum equipment standard developed by the National Primary Health Care Development Agency (NPHCDA) and to determine the perception of clients on the level of equipment in the centres. Checklist and Focus Group Discussions guide were used in this regard. Results : Results show that out the 26 minimum equipment requirements, none of the three primary health centres scored a minimum requirement. Conclusion : Equipment supply and maintenance in the primary health centres must be central in realising the objectives of the health sector reform programme of this administration. Keywords : assessment, equipment, status, primary health centres Sahel Medical Journal Vol. 8(4) 2005: 83-87