Nigerian Healthcare System Research Articles

Realist Synthesis of the International Theory and Evidence on Strategies to Improve Childhood Vaccination in Low- and Middle-Income Countries: Developing Strategies for the Nigerian Healthcare System.

Background: Childhood vaccination coverage rates in low- and middle-income countries (LMICs) vary significantly, with some countries achieving higher rates than others. Several attempts have been made in Nigeria to achieve universal vaccination coverage but with limited success. This study aimed to analyse strategies used to improve childhood vaccine access and uptake in LMICs in order to inform strategy development for the Nigerian healthcare system. Methods: A realist synthesis approach was adopted in order to elucidate the contexts and mechanisms wherewith these strategies achieved their aim (or not). Nine databases were searched for relevant articles and 27 articles were included in the study. Programme theories were generated from the included articles, and data extraction was carried out paying particular attention to context, mechanism and outcomes configurations. Results: Interventions used in LMICs to improve vaccination coverage were categorised as follows: communication/ educational, reminder-type, incentives, social mobilisation, provider-directed strategies, health service integration and multi-pronged strategies. The strategies that appeared most likely to be effective in the health contexts of contemporary Nigeria include communication and educational interventions; employing informal change agents, and; monitoring and evaluation to strengthen communication. The programme theories for the use of reminders, social mobilisation, staff training and supportive supervision were observed in practice, and these strategies were generally successful within some contexts. By contrast, the use of monetary incentives in Nigeria is not supported by the evidence, although further research and evaluation is required. The integration of other interventions with routine immunisation (RI) to improve uptake was more effective when the perceived value of the other program was high. Adoption of multipronged interventions for hard to reach communities was beneficial. However, caution should be exercised because of varying levels of published evidence in respect of each intervention type and a relative lack of the rich description required to conduct a full realist analysis. Conclusion: This paper adds to the evidence base on the adaption of strategies to improve vaccine access and uptake to the context of LMICs.

Social and Health System Complexities Impacting on Decision-Making for Utilization of Oncology and Palliative Care in an African Context: A Qualitative Study.

There is a dearth of research focusing on identifying the social complexities impacting on oncology and palliative care (PC), and no study has explored how the health-care system in Nigeria or other African contexts may be influencing utilization of these services. This study explored how social complexities and the organization of health-care influenced the decision-making process for the utilization of oncology and PC in a Nigerian hospital. This qualitative study used an interpretive descriptive design. Data were collected using semistructured interview guides with 40 participants, comprising health-care professionals, patients, and their families. Thematic analysis was conducted to generate and analyze patterns within the data. Three themes were identified: dysfunctional structural organization of the health-care delivery system, service-users' economic status, and the influence of social networks. The interrelationship between the themes result in patients and their family members decisions either to present late to the hospital, miss their clinical appointments, or not to seek oncological health care and PC. This article offers insights into the role of the health-care system, as organized currently in Nigeria, as "autoinhibitory" and not adequately prepared to address the increasing burden of cancer. We therefore argue that there is a need to restructure the Nigerian health-care system to better meet the needs of patients with cancer and their families as failure to do so will strengthen the existing inequalities, discourage usage, and increase mortality.

Reducing maternal and newborn mortality in Nigeria\u2014a qualitative study of stakeholders\u2019 perceptions about the performance of community health workers and the introduction of community midwifery at primary healthcare level

BackgroundRural communities in Nigeria account for high maternal and newborn mortality rates in the country. Thus, there is a need for innovative models of service delivery, possibly with greater community engagement. Introducing and strengthening community midwifery practice within the Nigerian primary healthcare system is a clear policy option. The potential of community midwifery to increase the availability of skilled care during pregnancy, at birth and within postpartum periods in the health systems of developing countries has not been fully explored. This study was designed to assess stakeholders’ perceptions about the performance of community health workers and the feasibility of introducing and using community midwifery to address the high maternal and newborn mortality within the Nigerian healthcare system.MethodsThis study was undertaken in two human resources for health (HRH) project focal states (Bauchi and Cross River States) in Nigeria, utilizing a qualitative research design. Interviews were conducted with 44 purposively selected key informants. Key informants were selected based on their knowledge and experience working with different cadres of frontline health workers at primary healthcare level. The qualitative data were audio-recorded, transcribed and then thematically analysed.ResultsSome study participants felt that introducing community midwifery will increase access to maternal and newborn healthcare services, especially in rural communities. Others felt that applying community midwifery at the primary healthcare level may lead to duplication of duties among the health worker cadres, possibly creating disharmony. Some key informants suggested that there should be concerted efforts to train and retrain the existing cadres of community health workers via the effective implementation of the task shifting policy in Nigeria, in addition to possibly revising the existing training curricula, instead of introducing community midwifery.ConclusionApplying community midwifery within the Nigerian healthcare system has the potential to increase the availability of skilled care during pregnancy, at birth and within postpartum periods, especially in rural communities. However, there needs to be broader stakeholder engagement, more awareness creation and the careful consideration of modalities for introducing and strengthening community midwifery training and practice within the Nigerian health system as well as within the health systems of other developing countries.

English

Nigeria is a country that has stood tall in Africa and features prominently in global affairs, yet her healthcare system has suffered several down-falls. Despite her position as a country with huge human and natural resources, her health facilities are grossly inadequate, especially in rural communities and this robs her citizen of optimum health care. Good health is one of the fundamental human rights and the onus rests on the healthcare system to provide health services for health care consumers. A healthcare system is an organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations. Such a healthcare system must have a good health services, a well-performing health workforce, and well-functioning health information system that ensures equitable access to essential medical products, vaccines and technologies, a good health financing system and good leadership and governance for quality, efficiency, acceptability, and equity. Available evidence posits that the Nigerian healthcare system has failed in all these indices. Nevertheless, nurses by virtue of their education, expertise, numerical strength and position as the first point of contact with patients, are well positioned to champion health care transformations. These reforms are needed for a strong and sustainable healthcare system. This paper discusses the Nigerian healthcare system and the role of the nurse in building a strong and sustainable health care system in Nigeria. Key words: Health care system, nurses, strong and sustainable.

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.

Challenges of residency training and early career doctors in Nigeria study (charting study): A protocol paper

Introduction: Early career doctors (ECDs) make up a significant proportion of the workforce of medical/dental practitioners in Nigeria. ECDs play pivotal roles in the Nigerian healthcare system. However, several factors affect ECDs in their career endeavours, ranging from poor remuneration to psychosocial problems (such as burn out, job dissatisfaction, etc.). While other countries have tried to investigate these factors and their impact, no national inquiry has been done yet in Nigeria. This demonstrates the critical need to conduct a nationally representativestudy exploring these factors, such as demographic, workplace and psychosocial factors, among ECDs in Nigeria. This article is a protocol paper for the challenges of residency training and early career doctors in Nigeria study; charting study to be conducted under the auspices of the Nigerian Association of Resident Doctors of Nigeria(NARD).Methods: The Charting Study would be a mixed study design, utilizing both qualitative and quantitative study designs and access data from structured questionnaire, focus group interview and secondary data available to the association.Conclusion: The outcome of this study will provide great insight into various issues affecting ECDs in Nigeria and make necessary recommendations.Keywords: Nigeria, early career doctors, junior doctors, physicians, dentists, workplace, psychosocial issues

Unregulated drug use and consequences in the Nigerian health sector

Background: The Nigerian health system is bedeviled with poor regulatory services, frequent interruption of services as a result of disharmony among different cadres of health-care providers, inadequate manpower, poor management and leadership, and poor access to care due to non-enrollment in health insurance. Health-care spending is often catastrophic in most cases as payment is usually out of pocket for most service users. This has led to proliferation and patronage of unlicensed and unregulated health-care providers. Some patients are able to afford out of pocket payment but often meet suboptimal functioning services when they present to the hospitals which are also bedeviled by inadequate manpower and health-care facilities. Others who cannot afford the payments first patronize quacks and present later to the hospitals, sometimes with complications and attendant increase in morbidity and mortality. Aims and Objectives: The aim of this study was to highlight some problems that may arise as a result of unregulated drug use in the Nigerian populace and the role of an efficient health system with improved health insurance access, in curbing these problems. Materials and Methods: The reality of the Nigerian Health Care System as it stands today was highlighted and objectives of the National Health Insurance Scheme at inception cited. Three clinical cases of complications arising from poor access to health care and drug use regulation were described. Conclusion: Access to health care in Nigeria has remained poor and mostly out of pocket despite the goal of the National Health Insurance Scheme to provide health care at reduced costs. Patronage of unlicensed health-care providers remains high due to poor access to health care, poverty, and illiteracy with untoward effects on affected individuals. There is an urgent need to scale up access to health insurance across all sectors and ensure efficient service delivery through regular monitoring by appropriate regulatory agencies and constant education of the populace to discourage patronage of quack health-care providers.

Prevalence and determinants of terminated and unintended pregnancies among married women: analysis of pooled cross-sectional surveys in Nigeria

BackgroundInduced pregnancy termination and unintended pregnancy are two commonly occurring phenomena in the discipline of women’s reproductive health. In the present study, we explored cross-sectional data pooled from three rounds...

Factors Affecting the Successful Adoption of e-Health Cloud Based Health System From Healthcare Consumers’ Perspective

Cloud computing in healthcare has witnessed a major development in recent years due to its remote access capabilities among others. Studies have shown that it has attracted great attention in the field of healthcare. However, research studies show a number of healthcare consumers are yet to accept the technology, especially in developing countries due to reasons, such as the data security and the improper utilization of available information and communication technologies (ICTs) in healthcare. This paper therefore aims to identify factors affecting healthcare consumers’ attitude toward the adoption of the cloud-based health center. Questionnaires were administered to 465 respondents in four locations in Benue, Nigeria with 76.9% response rate. The analysis of the data was conducted with statistical package for social science (20.0), factor analysis, and LISREL (9.30), was used to determine the structural path model. Using the social technical design approach, we developed the cloud-based health center which will provide access to healthcare services remotely to rural communities and reduce the cost/time of medical healthcare delivery when implemented into the Nigerian healthcare system. The results show that performance expectancy ( $\beta =0.31$ and $t=5.80$ ), effort expectancy ( $\beta = 0.19$ and $t= 3.90$ ), social influence ( $\beta = 0.21$ and $t=3.95$ ), facilitating conditions ( $\beta = 0.22$ and $t=4.82$ ), data security ( $\beta = 0.15$ and $t=3.07$ ), and information sharing ( $\beta =0.11$ and $t=2.53$ ) had a significant impact on the behavioral intention of healthcare consumers. However, cloud-based health knowledge ( $\beta = 0.09$ and $t=1.49$ ) was found to be statistically not significant. With these findings, healthcare policy makers must think carefully before the implementation of cloud-based health center. Otherwise, the integration will continue to create a challenge.

A model-driven framework for multi-paradigm modeling and holistic simulation of healthcare systems

The domain of healthcare is characterized by a high degree of complexity and a diversity of perspectives, and modelers are often confronted with the challenge of formulating a simulation model that captures this complexity in a systematic and manageable manner. Most often, the diverse perspectives of healthcare systems are studied in isolation and using specific formalisms. As it turns out, answering questions concerning behavioral properties of the overall system becomes difficult and therefore not sufficient for an efficient design and analysis of the system under study. In this article, we propose a framework for multi-paradigm modeling and holistic simulation of healthcare systems. We present a modeling methodology with a plethora of formalisms to allow the modeler to choose an appropriate formalism at a given level of abstraction while model transformation relates the different formalisms. Furthermore, we develop an integrative approach for the interactions between models of different perspectives through dynamic update of model output-to-parameter integration during concurrent simulations. Such an approach provides multiple levels of explanation for the same system, while offering, at the same time, an integrated view of the whole. The framework has successfully been applied to study part of the Nigerian healthcare system.

Abnormalities of the external genitalia and groins among primary school boys in Bida, Nigeria.

Abnormalities of the male external genitalia and groin, a set of lesions which may be congenital or acquired, are rather obscured to many kids and their parents and Nigerian health care system has no formal program to detect them. To identify and determine the prevalence of abnormalities of external genitalia and groin among primary school boys in Bida, Nigeria. This was a cross-sectional study of primary school male pupils in Bida. A detailed clinical examination of the external genitalia and groin was performed on them. Abnormalities were detected in 240 (36.20%) of the 663 boys, with 35 (5.28%) having more than one abnormality. The three most prevalent abnormalities were penile chordee (37, 5.58%), excessive removal of penile skin (37, 5.58%) and retractile testis (34, 5.13%). The prevalence of complications of circumcision was 15.40% and included excessive residual foreskin, excessive removal of skin, skin bridges and meatal stenosis. Undescended testes were seen in 6 (0.90%) boys, with median age of 9 years and 2 were bilateral. Also, micropenis was detected in 27 (4.07%) of the pupils. Inguino-penoscrotal abnormalities are common in our community (36.20%). Screening of pre-school and school children to detect them should be introduced into the school health programs in Nigeria.

ICT Implementation in the Nigerian Healthcare System

In Nigeria, the use of ICT in the healthcare sector has transformed the delivery of care. ICT has had significant effects in terms of the quality of healthcare services delivery. Here, the authors discuss how Nigeria has advanced in its use of ICT for citizen services and examine the widespread application of ICT for healthcare delivery across the country.

Intensive Patient Education Improves Glycaemic Control in Diabetes Compared to Conventional Education: A Randomised Controlled Trial in a Nigerian Tertiary Care Hospital.

BackgroundDiabetes is now a global epidemic, but most cases are now in low- and middle-income countries. Diabetes self-management education (DSME) is key to enabling patients to manage their chronic condition and can reduce the occurrence of costly and devastating complications. However, there is limited evidence on the effectiveness of different DSME programmes in resource limited settings.MethodsWe conducted an unblinded, parallel-group, individually-randomised controlled trial at the University of Calabar Teaching Hospital (Nigeria) to evaluate whether an intensive and systematic DSME programme, using structured guidelines, improved glycaemic control compared to the existing ad hoc patient education (clinical practice was unchanged). Eligible patients (≥18 years, HbA1c > 8.5% and physically able to participate) were randomly allocated by permuted block randomisation to participate for six months in either an intensive or conventional education group. The primary outcome was HbA1c (%) at six-months.ResultsWe randomised 59 participants to each group and obtained six-month HbA1c outcomes from 53 and 51 participants in the intensive and conventional education groups, respectively. Intensive group participants had a mean six-month HbA1c (%) of 8.4 (95% CI: 8 to 8.9), while participants in the conventional education group had a mean six-month HbA1c (%) of 10.2 (95% CI: 9.8 to 10.7). The difference was statistically (P < 0.0001) and clinically significant, with intensive group participants having HbA1c outcomes on average -1.8 (95% CI: -2.4 to -1.2) percentage points lower than conventional group participants. Results were robust to adjustment for a range of covariates and multiple imputation of missing outcome data.ConclusionsThis study demonstrates the effectiveness of a structured, guideline-based DSME intervention in a LMIC setting versus a pragmatic comparator. The intervention is potentially replicable at other levels of the Nigerian healthcare system and in other LMICs, where nurses/diabetes educators can run the programme.Trial RegistrationPan African Clinical Trial Registry PACTR20130200047835

Corruption in the Nigerian healthcare system

Corruption is the use of public resources for private gain. This is common in most countries though reduced in some and alarming in others. It affects all sectors of the economy and the healthcare system is not spared. Medical corruption is increasing in countries with high rates of corruption and all healthcare professionals are affected. This is review article on medical corruption in Nigeria with suggestion on how to reduce itKeywords: Healthcare System, Corruption, Healthcare Professional, Medical Care

Nigerian health care: A quick appraisal

Qualitative health care is a fundamental right of all citizens of a given country. How this health care is delivered depends significantly on the economy, dedication, and quality of the health-care providers and the political will of the government of the country. Health care may be public run or organized by private health-care providers. We can also have an intercalated program where there is public–private partnership. Whichever way this basic fundamental human right is delivered, sustainability, affordability, and accessibility are vital to its success. The Nigerian health-care delivery can be broadly classified into two; the hitherto existing traditional medicine and the modern orthodox medicine which came to our shores with the arrival of the European colonialists. The traditional system is still patronized by most Nigerians and is known by different linguistic terminologies such as the “Wanzami” or Barber in Hausa and the “Babalawo” in Yoruba language. Traditional birth attendants also exist in all communities in Nigeria complemented by herbalist and spiritualists of different shades and callings. It is our aim to give a brief account of our observations on the Nigerian health-care system with a view to correcting the challenges by the government and the public in general.

An Ontology Based Remote Patient Monitoring Framework for Nigerian Healthcare System

An Ontology Based Remote Patient Monitoring Framework for Nigerian Healthcare System

Caring for children born with cleft lip and palate within the Nigerian health care system

Background: Children affected with cleft lip and/or palate often present with difficulties in feeding, hearing, speech, and dental occlusion. Caring for these children starts at birth and aims at providing holistic treatment so that they can live a normal life. Shortcomings of cleft care services in Nigeria have been reported previously and include lack of comprehensive care, shortage of personnel and equipment as well as difficulty in accessing services. Accessing governmental funding may impact greatly on the quality of services being provided and may solve many problems associated with cleft care. One way of accessing governmental funding in Nigeria is through health parastatals and agencies which have resources to fund health care and may possibly fund cleft care if they are well informed. The aim of this study is to discuss the possible ways that cleft care may be integrated into the Nigerian health care system to allow for governmental funding. Materials and Methods: This study employed a narrative literature review method, using key search terms to collect useful information in Nigeria about cleft care, health care system, and funding. Salient points concerning the organization of the Nigerian health care system and the place of cleft care were identified; these have been summarized and reported. Results: The Nigerian health care system operates at three levels: Tertiary, secondary, and primary. Cleft care services are available at the tertiary and secondary levels only, and rarely at the primary level, where majority of affected children are recruited for surgical repair. The Nigerian government does not fund cleft care services; funding is mainly from donor agencies or borne on an out-of-pocket basis. Conclusion: This study has reported useful information on how cleft care can be integrated into the current health care system in Nigeria that may serve as a useful guide when planning health policies.

Nurses' Involvement in HIV Policy Formulation in Nigerian Health Care System

Background of study: Nigerian national policy on HIV stresses the need for the adoption of multi-sectoral and multi-disciplinary approach in policy formulation, with the health sector taking the lead. This calls for collaboration among the various stakeholders including nurses in policy development initiatives to ensure that diverse health care needs and disciplinary perspectives are captured in HIV health policies. Purpose: This paper will present the findings of a recent study which examined nurse’s involvement in policy development in the context of mother-to-child transmission (MTCT) of HIV in Nigeria. Methodology: A qualitative case study design under the guiding tenets of critical social and power theories. The research is a single case study of one state with embedded units. Thirty nurse-leaders from the various embedded units were recruited through purposive and snowball sampling technique. Semi-structured in-depth interviews and document reviews were used for data collection. Focus group discussions were used as a form of member-checking and also to generate data. Data was analysed using thematic analysis. Results: This paper focuses on the major themes that emerged from the study as well as highlight specific interplay of power dynamics in the health care system which hinders nurse’s involvement in policy formulation. Conclusion: The paper concludes with some of the lessons learnt in the study and proffer suggestions for effective integration of nurses into policy arena. It suggests the need for a broad-based educational curriculum which will incorporate strategies to build nurses capacity for leadership and policy development in nursing training schools.

Socio-Economic Status and Overnight Hospital Stays: Evidence from the Panel Component of the Nigerian Household Survey

An individual’s socioeconomic status is one of the most important determinants of health care utilization. Yet, income as an indicator of socio-economic status is often underreported in survey data. This problem is compounded in African countries due to the existence of a large informal sector and cultural practices. To overcome this situation, this paper constructs a five-scale index based on households’ assets. This alternate measure of one’s socio-economic status is included as an explanatory variable in a negative binomial regression that examines the determinants of overnight hospital stays in Nigeria. My analysis suggests overnight hospital stays tend to decrease in both monetary and asset-based measures of socioeconomic status; although income tends to overstate this effect. Since the poor are more likely to stay more nights in a hospital, this may be an indication that the poor generally delay visits to health care facilities due to the predominance of user fees in the Nigerian health care system. To reduce this trend, there is the need for an expanded and affordable primary health care system that takes into account the local socio-economic environment. Finally, the study finds that the severity of ill-health is the single most important determinant of overnight hospital stays.

Health Information Technology in Nigeria: Stakeholders’ Perspectives of Nationwide Implementations and Meaningful Use of the Emerging Technology in the Most Populous Black Nation

Background: Nigeria is witnessing continuing advocacy and increase in number of individuals yearning for computerization of health information and healthcare processes. On the other hand, the Government of this most populous black nation is evolving plans and strategies for the adoption and implementation of health information technology (HIT). However, little is known about opinions of the diverse healthcare providers who would act the script of government in ensuring meaningful use of HIT in the country. Objective: This nationwide, cross-sectional study attempted to determine stakeholders’ perspectives of the emerging HIT in Nigeria. Result: HIT stakeholders who gave consent (n=233) at the two conferences participated in the study, 76% of whom were male professionals, mostly (117, 50.2%) from tertiary healthcare institutions. It worthy of note that three of the participants came from United States of America to attend the 1st National Conference on Health Information Technology in Nigeria. Of all participants, the majority (226, 99.1%) opined that HIT will improve communication among healthcare providers. A similar portion (223, 98.2%) were of the opinion that HIT will facilitate prompt retrieval of patient’s health records on point-of-care (POC). Nearly two-third (139, 62.6%) were optimistic of possible realization of nationwide implementations of HIT in the country by the year 2020. The results also indicate that gender, professional inclination, and place of work were important predictors of positive opinion of HIT. The three factors were associated with stakeholders’ opinion that the evolving HIT is capable of improving medical care quality (p=0.059; 0.000; 0.014) of the Nigerian populace. Most stakeholders (61%) recommended that the paper-based health records should be archived post implementation of HIT. Conclusion: The Nigerian healthcare system is manned by providers and stakeholders who are quite abreast of the benefits of health information technology and are willing to embrace the technology in their workflow. This is quite reassuring and tends to prompt the healthcare decision makers to proactively formulate policies and introduce interventions to encourage nationwide acceptance of the emerging technology. Nonetheless, there is more to be done on appropriate clinical documentation in order to set a friendly pedestal for effective takeoff, successful implementations and meaningful use. Appropriate funding and financial incentives for quality improvement is recommended. In addition, the National Conference on HIT should be convened annually and a technical committee be set up to appraise future implementations.