Health Care System In Nigeria Research Articles

Physician-Patient Interactions in Nigeria: A Critical-Cultural Perspective on the Role of Power

ABSTRACT Healthcare system in Nigeria has suffered many structural problems, which have impacted healthcare access and delivery. In this study, I explore physician-patient interactions in Nigerian hospitals, with the goal of unveiling its impact of healthcare processes. Using a qualitative narrative framework and in-depth interviews with 22 Nigerians, the study attended to communication dynamics and challenges present in physician-patient relationship in Nigeria. Findings reveal Physicians’ low communication efficacy as characterized by lack of interpersonal relations, empathy, and depth of information disclosure. Additional findings reveal the culture of power as a major influence in this kind of relationship.

Universal healthcare coverage and medical tourism: Challenges and best practice options to access quality healthcare and reduce outward medical tourism in Nigeria

Background: Universal healthcare coverage (UHC) leads to access to quality healthcare. Improved quality healthcare can stem outward medical tourism (MT). This review examined challenges and best practice policy options to implement UHC and how it can reduce outward MT in Nigeria. Methodology: The designed search terms used were “universal health coverage,” “quality healthcare” “medical tourism,” “access to healthcare,” “primary health care,” “healthcare financing,” “private health insurance,” “social health insurance,” and “Nigeria healthcare system.” Peer-reviewed research articles and institutional reports published between January 2000 and March 2020 were searched using four databases: PubMed, National Library of Medicine, Web of Science, and Library of Congress. EndNote X9 software and Google search engine were used to access these databases and documents, and 124 publications were retrieved and 106 were reviewed. Results: Majority of publications reviewed emphasized building health infrastructure, developing skills and human resources for health, and funding for equipment and drugs. Expanding healthcare coverage through social health insurance, developing a financial system to protect the poor, access to quality healthcare, and reinvigoration of primary healthcare (PHC) were common themes. About 50% of the studies identified unavailability of quality healthcare services, inequalities in the supply side of healthcare services, issue of human resources, and health sector implementation shortfall as challenges to UHC. Another 50% of the studies reviewed identified poverty and poorly funded PHC as a barrier to UHC. Almost all the studies (100%) identified cost-effectiveness, safety, and quality of healthcare services as drivers of MT in all countries. Conclusion: Improving the quality of healthcare delivery, increasing accessibility, affordability, and timeliness of access by the population through UHC can stem MT.

Critically Ill Children Admitted into the Paediatric Emergency Unit of a Tertiary Hospital in a Developing Country and the Causes of Delayed Presentation

Decades of advancement in health care delivery and clinical practice may have massively impacted the efficiency of health delivery and patient outcome in high-income countries, but its effect is still minimal in the low-income countries who are still dealing with poorly equipped and inadequate health facilities low insurance coverage and poor education. This study set out to evaluate the clinical profiles of critically ill admitted into the paediatric emergency unit and causes delay presentation. A prospective review of children admitted into the children emergency room between January 2018 to December 2019. A total of 8087 emergency room visits were attended to over the two years out of which 4039 were admitted. The majority of participants (63.5%) are less than 5 years, there was a male to female ratio of 1.6:1 and 1458 (36.1%) had emergency signs necessitating resuscitation at presentation. 74% of participants have been self-medicated by parent/caregiver before presenting in the hospital (50% antibiotics, 44% antimalaria). The most frequent symptoms include fever, vomiting, breathlessness and seizures, majority (73%) of those with emergency sign presented 48 hours after onset of symptoms and the major reason for the delay was the fear of the cost of treatment. Children that had significant odd of dying include those that: were self-medicated, had emergency signs and under- 5 children. The high dependence of out-of-pocket financing in Nigeria health care system remains a major cause of delayed presentation among critically ill children. There is an urgent need for the government to improve on the universal health coverage by improving the number of the population with health insurance coverage.

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.

Influence of a Teaching Session on Breast Self-Examination and Adherence Among Pregnant and Lactating Women in Ibadan, Nigeria

PURPOSE Educating women on how to examine their breasts can raise breast cancer awareness and early detection rates, especially in low- and middle-income countries. In this study, the influence of a teaching session on breast self-examination (BSE) during pregnancy was evaluated. METHODS A quasi-experimental study design was used. A total of 1,248 pregnant women whose pregnancies had a gestational age of 26 weeks or less were recruited from three antenatal clinics representing three tiers of the health care system in Nigeria. They were interviewed using a structured questionnaire, including BSE practice, and taught how to perform BSE using the MammaCare technique at recruitment. At 6 months postpartum, 729 participants were available for phone interview on BSE practice. Adherence to BSE was measured as a binary outcome comparing BSE performances at recruitment with follow-up. Conditional logistic regression analysis was used to determine the differences in BSE practices pre- and postintervention. Multiple logistic regression was used to identify predictors for adherence to BSE training at α = 0.05. RESULTS Participants’ mean age was 30.4 ± 4.9 years, 401 (55.0%) attended a secondary health facility for antenatal care, and 78 (10.7%) had breast disorders at recruitment. Two hundred fifty-three (34.7%) said they practiced BSE before recruitment, and 380 (52.1%) did so at follow-up (odds ratio, 1.91; CI, 1.51 to 2.42). Women less likely to adhere were those with breast disorders detected at recruitment (adjusted odds ratio [aOR], 0.55; CI, 0.32 to 0.95) and women recruited from primary and secondary health facilities compared with those from a tertiary health facility (aOR, 0.41; CI, 0.17 to 0.98; aOR, 0.18; CI, 0.11 to 0.29, respectively). CONCLUSION Educational interventions can significantly improve screening practices, even if only one session, and should serve as an integral control for breast cancer.

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.

Health Outcomes and Agricultural Output in Nigeria

Attaining sustainable agricultural development in any economy indubitably points towards ensuring improved quality of life and enough food for both present and future generations. The need to understand the links between agricultural output and health outcomes necessitates an inquiry to ascertain the extent the changes in health outcomes can influence agricultural output. This study using the dynamic error correction built an econometric model such that mortality rate and life expectancy are proxies for health outcomes while agricultural output is the dependent variable; HIV/AIDS is the dummy. Results showed that HIV/AIDS has lethal effects on health outcomes and aggregate output. It revealed that health outcomes also have significant impact on agricultural output potentials; and there is a causal relationship between health outcomes and agricultural output in Nigeria. This implies that if the healthcare system in Nigeria can be taken as a policy priority, a tremendous increase in the agricultural sector is unarguably expected. A simultaneous front involving both the public and private sectors in extending the healthcare services is necessary to enable workers and prospective workers access to healthcare delivery; this will invariably boost the agricultural output.

Evaluation of the Roles of Physicians and the Functionality of the Healthcare System in Nigeria

Background: A comprehensive medical care system is required for effective healthcare delivery to people who need it. Even though exact configuration of healthcare services varies from country to country, a sturdy mechanism comprising of a robust financing, a well-trained and adequately paid workforce; research, policy recommendation and implementation is needed for a well-maintained system to deliver effective healthcare services.
 Methods: This is a descriptive study conducted on 100 Nigerian trained physicians with at least 1-year practice experience. The online questionnaire was administered to participants through social media platforms such as WhatsApp, Facebook and twitter using purposive sampling method. Data analysis was done using Microsoft excel 2010 version.
 Results: The response rate was 100%. Ninety six percent (96%) and 99% of surveyed physicians think their monthly salary and the amount of money budgeted to the health sector is grossly inadequate. It was also noted that poor enumeration and/or low income 82/330 (25%) and poor medical facilities 70/330 (21%) are the commonest reasons they believe physicians emigrate from Nigeria while problem identification (20.2%), provision of leadership, healthcare service delivery (13.5%), policy making and implementation (12.9%) and research and development (10.4%) are the commonest roles for physicians identified by study participants.
 Conclusion: The Nigerian physician is poorly enumerated, and the healthcare budget is poor. This accounts to large part why leave Nigeria. There is need for better funding of the healthcare system in Nigeria and more involvement of physicians in leadership, research and policy development.

Maternal Mortality and Maternal Health Care in Nigeria: Implications for Socio-Economic Development.

BACKGROUND:Even though maternal mortality, which is a pregnancy-related death is preventable, it has continued to increase in many nations of the world, especially in the African countries of the sub-Saharan regions caused by factors which include a low level of socioeconomic development.AIM:This paper focuses on cogent issues affecting maternal mortality by unpacking its precipitating factors and examining the maternal health care system in Nigeria.METHODS:Contemporary works of literature were reviewed, and the functionalist perspective served as a theoretical guide to examine the interrelated functions of several sectors of the society to the outcome of maternal mortality.RESULTS:It was noted that apart from the medical related causes (direct and indirect) of maternal mortality, certain socio-cultural and socioeconomic factors influence the outcome of pregnancy. Also, a poor health care system, which is a consequent of weak social structure, is a contributing factor.CONCLUSION:As a result, maternal mortality has debilitating effects on the socioeconomic development of any nation. It is therefore pertinent for the government to improve maternal health and eradicate poverty to ensure sustainable development.

The Challenges of Psychiatric Nursing Specialty: Education and Practice in Nigeria

The current mental health care system in Nigeria continues to struggle with providing adequate care and services to all that require it due to limited resources, stigma of persons and families living with mental illness, biases from other professional team members and the complexities of treatment of many of those individuals that suffer from mental illness. Mental health nurses, also referred to as psychiatric nurses, are impacted by these same biases, limited resources, and complexities in their role. This paper highlights the challenges of psychiatric nursing as a profession, and societal perception of both those who have mental illness and those who provide treatment. It is imperative that psychiatric nurses should continue to educate other health care professionals as well as the general public of the role of the psychiatric nurse and those who suffer from mental illness. Unfortunately, the biases of the pre-colonia era are still upheld in the 21st century.

Levels of neonatal care services in Kaduna state

Introduction: Neonatal medicine is a specialized aspect of pediatrics. The availability and accessibility of efficient newborn units are essential for improved newborn health and survival. In the structure of our healthcare system in Nigeria, neonatal units are meant to be the component units of secondary and tertiary healthcare facilities. Aims: The study aimed at determining the availability of neonatal units and the levels of care services in Kaduna state, Northwestern Nigeria. Settings and Design: This was a cross-sectional, descriptive study. Materials and Methods: The study was a survey of all hospitals in Kaduna state including public and nongovernment healthcare facilities. Information on the availability of newborn unit, staffing, and equipment was obtained and units were categorized into the levels of care. Statistical Analysis Used: Data obtained were summarized and presented in proportions and simple percentages. Results: A total of 33 public nonprimary healthcare facilities and 25 nongovernment specialist facilities operated in the state. Only two (one each state and federal owned) of these 33 public facilities, both of which were tertiary healthcare facilities, had an operational neonatal unit while 15 of the 25 specialist nongovernment facilities operated a neonatal unit. All the neonatal units were of level I category except for the state-owned tertiary facility, which was of level II category and the federal-owned tertiary facility, which was of level III category. Conclusions: The number of neonatal units and levels of care in both public and private health facilities in the state are grossly inadequate. Improving these may result in improved neonatal care in the state.

Medical Dominance and Resistance in Nigeria's Health Care System.

The health care system in Nigeria remains topical because of concerns over unremitting health outcomes, such as maternal and infant mortalities and frequent epidemic outbreaks, and more recently because of regular strikes by health workers. The strikes arise mostly from disputes between medical doctors and other health workers over a range of issues, including salary levels and emoluments, leadership of teaching hospitals, and appointment of the Minister of Health. Other health workers, who allege that doctors are favored in the system, have formed Joint Health Sector Unions to confront the doctors. Both groups have frequently engaged in strikes such that, within the past decade, there has always been a strike or the threat of a strike, a situation that causes disruption of health care services. Two presidential commissions have been instituted, to no avail. With the allegations of favoritism, only government even-handedness in more carefully delineating the areas of inclusion and exclusion in accordance with available legislations may stem the rising tide. Until solutions agreeable to both parties are found, the health system and the Nigerian people will continue to suffer frustrations of avoidable disruption of services.

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.

Strategies for Managing Information Flow in Nigeria Healthcare System

Strategies for Managing Information Flow in Nigeria Healthcare System

Knowledge and practice of primary eye care among primary healthcare workers in northern Nigeria.

To assess knowledge and practice of primary eye care among primary healthcare workers known as community health extension workers in Funtua district of Nigeria. Cross-sectional mixed method study among health workers employed in government-owned primary healthcare facilities. Quantitative data were obtained using self-administered questionnaires and checklists, while qualitative data by modified Delphi technique, role plays and observation. A score of 1 was given for each correct answer, while a total score of ≥60% was considered 'good'. Eighty three of 88 health workers participated (94%) in the questionnaire survey; while 16 of them were selected for the qualitative survey. Good scores regarding the knowledge of common eye diseases were obtained by 68.7%, but only 26.4% of them could identify their most important features. Participants could undertake 3 of 5 steps in visual acuity testing. Skills in recognising common eye diseases and their management were weak; while practice was often not according to the guidelines. Community health extension workers displayed good knowledge of common eye diseases. Areas of weakness are recognition and interpretation of eye signs, and practice rarely follows the guidelines. Preventive medicine was neglected; community health extension workers require practical retraining and supervision to achieve integration of primary eye care into primary healthcare services.

Knowledge of Causes of Maternal Deaths and Maternal Health Seeking Behaviour in Nigeria

Nigeria has one of the highest maternal mortality rates in the world. The aim of this study is to examine the influence of women’s knowledge of maternal death on their health seeking behaviour during pregnancy and childbirth. The study extracted and utilized respondents who had childbirth within three years prior to 2013 Nigeria Demographic and Health Survey. Bivariate analysis and logistic regressions were used to assess the association between knowledge of maternal death, selected socio-economic factors and health seeking behaviour. The results reveal that 34% did not attend antenatal visits, 27% of the respondents initiated antenatal care in the first trimester of pregnancy and 63% had birth deliveries outside the health facility. This confirms that non-use of health facilities during pregnancy and delivery contributes to the high maternal mortality in Nigeria. The multivariate analysis indicates that the odds ratio of good health-seeking behaviour is significantly generally low among women who had poor knowledge about the causes of maternal death than those who had good knowledge. Other factors influencing maternal-health seeking behaviour are region, education and wealth status. Poor maternal health-seeking behaviour was high among women in the Northern region, the poor women and women who had low educational background. Emphasis should be placed on these factors in considering strategies to improve the maternal health care system in Nigeria.

Iatrogenic scald injuries in Nigerian babies with perinatal asphyxia: A re-awakening call to strengthen primary health care services

Birth asphyxia is a major cause of neonatal morbidity and mortality in developing countries. Majority of pregnant women in Nigeria still deliver their babies in places where there are no personnel skilled in essential obstetric care and neonatal resuscitation. Consequently newborns are poorly handled at delivery with resultant poor outcome. We report two cases of iatrogenic burns injuries from hot water formentation in an attempt to resuscitate two neonates at peripheral health care facilities in Ilesa, Nigeria. These babies needlessly sustained burns injuries coupled with hypoxic-ischaemic injuries and poor perinatal outcome. These unfortunate cases of insults upon injuries underscore the need to strengthen the primary health care system in Nigeria by training and retraining health workers at these facilities. Proper antenatal care, adequate screening of high risk pregnancy for delivery at adequately equipped centres and making efficient referral system available will go a long way in reducing these needless injuries and morbidities.

ICT knowledge, Utilization and Perception among Healthcare Providers at National Hospital Abuja, Nigeria

Background: Healthcare system in Nigeria is moving towards digitalization especially in the management of patients’ health information, with a view to harmonizing medical care practice for improved healthcare quality. Information and communication technology (ICT) has transformed the way people collaborate, identify potential collaborators or friends, communicate with each other, and identify information that is relevant to their practice. Rationale: Thus, ICT has been identified as one measure to ensure these emerging trends in the Nation’s healthcare systems. Design/objectives: This study deployed a cross-sectional structured questionnaire to determine ICT knowledge and utilization among healthcare providers at National Hospital Abuja (n=271). Methods: We devised stratified random sampling in the recruitment of participants. Result: It was found that profession, possession of a laptop computer, age and sex were associated with knowledge, utilization and perception of ICT. Most participants were advanced in the use of electronic mail (51.8%) and the Internet (47.1%) mostly acquired through self-efforts (46.5%). However, a greater portion of the participants exhibited poor knowledge of database management (47.8%) and statistical analysis package (46.3%). The vast majority have used computer (95.0%) and the Internet (93.6%) for more than 3 years and many (86.2 percent) expressed a desire for further ICT training. Virtually, all participants in this study opined that ICT will improve medical care quality but some anticipated concerns over medical confidentiality as ICT becomes widely adopted in the country’s healthcare systems. Aside their poor skill in database design and statistical analysis software, healthcare providers at National Hospital, Abuja possessed good knowledge and disposition towards ICT especially for the enhancement of their professional practice and for public health quality improvement. They indicated interest in further ICT training in order to enhance their information sources for an improved practice. It would be worthwhile to enrich their sources of information in order to improve public health.

Challenges of Clinical Leadership in Nigeria

Nigeria like the rest of the world is facing a universal health work force 'crunch' that is epitomized by widespread shortages of medical practitioners in positions of authority and consultation, this variance have led to inadequate distribution of healthcare professionals between and within healthcare institutions with poor working conditions and paucity of information and knowledge on best practice due to poor management of the health sector by politicians instead of medical professionals who take care of patients and who holds the best interest of the patients they care for (Conference of African Ministers of Health, 2005). Trending in Nigeria is the conventional view that medical practitioners should look after patients, while administrators look after organizations. Yet several pioneering healthcare institutions have turned this assumption on its head and achieved outstanding performance in the UK and in central Europe. This can be replicated in Nigeria through the adoption of clinical leadership practices and the restructuring of the healthcare system in Nigeria, which has been characterized by strike actions from medical practioners.Clinical leadership still, has a long road to travel in its expansion in healthcare management. To achieve the best and most sustainable quality of care, however, a commitment to building high-performing organizations must complement traditional values. All the evidence suggests that patients will see the benefit.

Building a Solid Health Care System in Nigeria: Challenges and Prospects

The most significant ingredient of life is health. No wonder the oft–spoken slogan: “Health is wealth”, has remained evergreen in our memory. This is why inasmuch as life is the greatest gift of God to man, the provision of health care facilities is needed in superfluity in order that life may be sustained on earth. Unfortunately, in Nigeria today, the provision of health care facilities seems to be at low ebb as many Nigerian are vulnerably exposed to the danger of death. This situation gives the ugly impression that the political office holders appear to be paying lip service to their dauntless statements that health care facilities would be made available at every nook and cranny of the polity. Worried by this perplexing situation, the paper attempts to investigate the decays in the Nigeria’s health system and seeks to proffer ways which the populace can enjoy a healthier and longer life. DOI: 10.5901/ajis.2014.v3n6p501