Primary Health Care Development Agency Research Articles

The Paediatric Association of Nigeria (PAN) Guidelines for Childhood Immunisation were first published in 2012 as a follow-up to a position paper submitted to the Nigerian government in 2008. These guidelines are long overdue for updating since their lifespan has exceeded the recommended five years. New evidence and information have accrued, and new vaccines have emerged to prevent old and new diseases. The updated guidelines, while ensuring compliance with international best practices, are intended to guide the use of vaccines in the country as a whole (both within the national guidelines and outside the national guidelines) as well as ensure that the use of vaccines is timely, comprehensive and in tandem with empirical evidence. The updated guideline is intended for use by the Federal Ministry of Health, the Nigerian Immunization Technical Advisory Group (NITAG), the National Primary Health Care Development Agency (NPHCDA), Paediatricians and other healthcare workers in private and public institutions, parents, other key policymakers and vaccine funders.

Moving the needle for COVID-19 vaccinations in Nigeria through leadership, accountability, and transparency.

The first set of vaccines arrived in Nigeria in March 2021. The National Primary Health Care Development Agency (NPHCDA) set out to vaccinate at least 70% percent of Nigeria's eligible population, i.e., 111,776,503 people, by December 2022. As of June 2021, only 3% had received at least one dose of the vaccine. This presented a threat to the achievement of NPHCDA's goal. Nigeria Solidarity Support Fund (NSSF) went into a partnership with NPHCDA to accelerate the uptake of COVID-19 vaccinations across Nigeria over 3 months. Across Nigeria's 6 geopolitical zones, 6 states were selected, namely: Adamawa, Edo, Imo, Katsina, Nasarawa, and Ogun states based on performance, political will, and absence of external resources. A two-pronged approach was implemented: unrestricted funding to the sub-national level and providing technical support at the national level. 5 out of 6 states received unrestricted funding to ramp up vaccination coverage. They also received adequate vaccine supplies. A total of 12,000 healthcare workers were trained on safe immunization practices and multiple communities were engaged across the 133 local government areas (LGAs) through religious and community leaders. After 6 months, there was an average of 35% increase in the uptake of COVID-19 vaccines in the 5 states. An indicator tracker was developed for weekly reviews at the national level and the total population vaccinated in Nigeria increased from 6,186,647 to 11,985,336 at the end of the partnership. Unrestricted funding, though not without its risks, can yield a significant impact on health. The intervention was co-designed with stakeholders and had leadership buy-in, accountability mechanisms, with unrestricted funding. These techniques produced an increase in the vaccination rates in the 5 states and across the country. These elements should be explored for application to other program designs such as routine immunization.

MIDWIVES POPULATION AND ANTENATAL CARE (ANC) SERVICE PROVISION IN CROSS RIVER STATE, NIGERIA: A QUANTITATIVE-QUALITATIVE APPROACH

The main thrust of this study was to assess midwives’ population and service provision at Primary Health Care level in Cross River State, Nigeria. To achieve this objective, two research questions and one hypothesis was postulated to guide the study. The adopted design for this study is a concurrent triangulation mixed method design, which utilizes both quantitative and qualitative approaches. The sample comprised of 70 mid-wives for the quantitative approach and 8 mid-wives for the qualitative approach through the use of census and purposive sampling techniques respectively. A questionnaire developed by the researcher on the type of services provided by mid-wives was used to collect data for the qualitative approach, while a focused group discussion was used to collect data for the qualitative approach. The data gathered were analyzed with descriptive and inferential statistics as well as qualitatively. Results indicated that only forty-four (44) PHCs have midwives while one hundred and fifty-eight PHCs have no midwife at all. The result also indicated that the one PHC that has above 3 midwives render high quality care services to client than the 43 PHC that have below 3 midwives population has the calculated t-value of 17.225 is greater than the critical t-value of 1.980 at 0.05 level of significance and 68 degrees of freedom. This implies that there is a significant relationship between midwives’ population and ANCs service provision in PHCs in Cross River /State, Nigeria. Based on this finding, it was recommended that the presence of midwives in State Primary Health Care Development Agency should be strengthened. Nursing and midwifery council should review the policy to establish community midwifery in Cross River State were more midwives will be trained and automatically employed to PHC level in the State.

Improving Program Outcomes Through Responsive Feedback: A Case Study of a Leadership Development Academy in Nigeria.

In 2018, the National Primary Health Care Development Agency (NPHCDA), under the Nigeria Federal Ministry of Health, recognized that inadequate personnel competencies limited its ability to provide technical assistance to state primary health care development boards (SPHCBs). In response, NPHCDA instituted a cohort-based leadership development academy (LDA) to develop its staff's leadership and management skills. A baseline assessment identified critical gaps in leadership and management competencies. Agency leaders and midlevel staff aligned on the gaps and approaches to bridge them. Participants in the LDA were selected across headquarters and zones to ensure equitable spread. The NPHCDA adopted a mix of capacity-building approaches that prioritized 6 core leadership and management skills with the application of the 70-20-10 learning philosophy to ensure participants learn and apply skills. Responsive feedback (RF) mechanisms were key in program design and implementation. NPHCDA collaborated with development partners through an iterative cocreation process to design and revise for implementation. The program embraced information and communication technology to collate qualitative and quantitative data across activities in real-time and used insights to drive continuous improvement. Incorporating feedback from the first cohort led to an increase in the proportion of trainees acquiring intermediate to advanced competencies in target skill areas from 41% to 57% in the second cohort. The trainees have taken on more challenging roles at NPHCDA, delivering technical assistance to SPHCBs and bolstering the agency's ability to independently execute activities such as the COVID-19 vaccine introduction. The agency continues to adopt RF mechanisms in the coordination and delivery of advanced technical training for staff and institution of a capacity-building and acculturation program for new hires. RF has demonstrated that identifying and engaging key stakeholders to participate in continuous learning and adaptation is critical to achieving program effectiveness and sustainability.

Ward Health System in Nigeria: Are Health Workers in the Local Government Areas Well Informed?

The Ward Health System was introduced in 2001 by the National Primary Health Care Development Agency to enhance community mobilization for health thereby revitalizing the Primary Health Care system. This move was in alignment with the recommendation of the World Health Organization in 1992 that boundaries of the health district should be the same as that of the electoral ward for effective and wholesome community mobilization and ultimately ownership. This study determined the knowledge of the health workers in the Local Government Areas on Ward Health System. A semi-structured questionnaire was administered to a total of 300 Primary Health Care facility workers in Anambra State. Approximately 46% of the health workers had ever heard of the term Ward Health System, while over 94% had no idea of the roles of the three tiers of government in the program. Over 76% of them could not correctly identify the functions of the village and ward development committees. Adequate and on-going education of health workers on Ward Health System is critically needed.

Cause-Effect of Five Child-Killer Diseases on UnderFive Mortality in Adamawa State, Nigeria

This study investigated the Cause-Effect of Five Child-Killer Diseases on Under-Five Mortality (Deaths) in Adamawa State, Nigeria. The study used Ex post facto and quantitative design. A secondary data was obtained from Adamawa State Primary Health Care Development Agency (PHCDA), Yola across the study area for the period of 2001 to 2020.The study used Multiple Regression Analysis to determine the Cause-effect of the Five Childkiller Diseases on Under-Five Mortality in the study area. The study revealed that; Polio needs to be excluded from the Five Child-Killer Disease since there is no death associated with polio disease for the period under review in the study area. The results also revealed that the deaths due to diarrhoea have a significant causal relationship on Under-Five Mortality, while deaths due pneumonia, measles and tetanus has insignificant causal relationship on Under-Five Mortality in the study area. Based on the overall model, the Five Child-Killer Diseases have a Causeeffect of 64% on Under-Five Mortality in the study area. In view of the above, the study recommends that Adamawa State Primary Health Care Development Agency, Yola whose primary responsibility among orders is to curb and reduce the spread of Child-Killer Diseases among vulnerable children of ages; needs to review and strategies their action plans, since the Cause-effect is still high.

Addressing Malnutrition in Children: An Appraisal of the Ondo State Nutrition Program.

BackgroundThe report of the 2013 Nigeria Demographic and Health Survey (NDHS 2013) showed Ondo State had one of the worst indices for stunting and underweight in the southwestern geopolitical zone of the country, a development that was considered "unacceptable" by the state government. In the bid to reverse the ugly trend, the State Primary Health Care Development Agency put in place a comprehensive nutrition program in 2015 tagged "Nutrition Rebirth," aimed at reversing the high prevalence of malnutrition among under-five children in the State.AimsThis study seeks to evaluate the Ondo State comprehensive nutrition program by comparing the children's nutritional status pre- and post-period under review in the implementation of the program. This provides a measure of assessment of the performance of the program as implemented in the period under review.Materials and methodsThis study covered the period between 2015 and 2017 in the implementation of the nutrition rebirth program. Data for the study were obtained from the NDHS (2013) and NDHS (2018) nutrition of children and women data. Analysis of the NDHS (2013) and NDHS (2018) data commenced simultaneously with field work and lasted for about six and eight months, respectively. Analysis of the data obtained from the NDHS for this study spanned through a period of about three weeks. An ecologic time-trend analysis was used to compare the trends in nutritional status indicators among under-five children in all 18 Local Government Areas (LGAs) in Ondo State.ResultsMalnutrition among children less than five years dropped in most of the LGAs in 2018. Malnutrition was not associated with children's gender and maternal age in 2013 and 2018. Prevalence of stunting growth and underweight was associated with maternal education, wealth index, residence type, place of delivery, and LGA in 2013 (p < 0.05) but was not in 2018 (p > 0.05).ConclusionsThe spatial analysis of the Ondo State comprehensive nutrition program showed that the program has a positive impact, reducing malnutrition among children under five years; but critical appraisal of implementation challenges in LGAs with no significant reduction in malnutrition among their children under five years is recommended. The comprehensive and wholistic approach of the program is also recommended for other states and settings with a high prevalence of under-five malnutrition to understudy the possible adaptation, as appropriate.

Web Mapping for Nigeria Covid-19 Testing and Vaccination Site Finder Application

This study aimed to describe the development and implementation of COVID-19 vaccine and testing center’s location finder portal for Nigeria. Names, locations, coordinates, pictures and other relevant information related to the health centers were obtained from the Naational Ccenter for Ddisease Control and the National Primary Healthcare Development Agency. The data was used to create a database which was used to connected to the Google API. The portal contains sections like Nearest Centers, Vaccination Centers, Testing Centers, All Centers, FAQ, Survey and COVID News. The objective of the study is to improve access to COVID-19 testing site, enhance access to COVID-19 vaccination centers across the country and educate Nigerians about COVID-19. The research suggest the active participation of religious and community leaders would improve access and willingness of their subjects to be vaccinated

Effectiveness of an electronic clinical decision support system in improving the management of childhood illness in primary care in rural Nigeria: an observational study

ObjectivesTo evaluate the impact of ALgorithm for the MANAgement of CHildhood illness (‘ALMANACH’), a digital clinical decision support system (CDSS) based on the Integrated Management of Childhood Illness, on health...

Data management needs assessment for the scale-up of district health information system and introduction of routine (essential) immunization module in Bauchi State, Nigeria, 2015.

Introductionthe National Primary Health Care Development Agency, African Field Epidemiology Network, United States Centers for Disease Control and Prevention and the Bill and Melinda Gates Foundation are implementing a Routine Immunization (RI) Module as part of their Routine Health Data Management System based on the 2013 - 2015 Accountability Framework for RI in Nigeria. To inform planning and evidence-based decision making, a data management needs assessment was conducted in Bauchi state which was one of the states selected for the deployment of the DHIS2 RI module.Methodsdesk reviews were conducted, and a semi-structured questionnaire was administered in four Local Government Areas (LGAs) in Bauchi state that were selected based on the initial evaluation of the performance of all 20 Bauchi LGAs. Ganjuwa and Shira were selected as high-performing LGAs and Alkaleri and Bogoro as low-performing LGAs. Four Health Facilities (HF) were selected in each LGA based on rural or urban classification, type of HFs (private or public), security and accessibility.Resultslocal Immunization Officers (LIOs) prepare monthly reports in high-performing LGAs, and Community Health Care workers are mostly (69%) responsible for report compilation at the HFs. Shira and Alkaleri met 77% and 44% of training indicator targets, respectively, in the previous 12 months. Data recording and reporting was the type of training received the most by health facility personnel. Functioning refrigerators were in all visited LGAs, working thermometer and updated temperature monitoring charts were available in all the cold chain stores. However, no health facility reported having available computers for data-related activities.Conclusionthis assessment provided an improved understanding of the Bauchi state Routine Health Data Management System and informed the content of the state-wide scale-up.

Assessment of health-care workers' knowledge regarding COVID-19 in selected local government areas in cross River State

Background: Health-care workers are at the frontline of COVID-19 pandemic response with an increased risk of infection compared to the general population with a significant number losing their lives. It is therefore crucial that HCWs have adequate knowledge about all aspects of the disease to protect themselves and reduce transmission of COVID-19 in populations they serve. Aim: The aim is to determine the level of knowledge of health-care workers (HCWs) regarding COVID-19 in selected local government areas (LGAs) in Cross River State. Materials and Methods: A cross-sectional descriptive study involving a pre- and post-test evaluation was carried out among 47 HCWs in five selected LGAs in Cross River State. A 1-day nonresidential training aimed at improving the knowledge of COVID-19 among HCWs was organized by the Efik Young professionals in collaboration with the State Primary Health Care Development Agency. Data were summarized using proportions and paired t-test to explore associations between quantitative variables. The level of significance was set at P < 0.05. A score of 70 and above represented adequate knowledge. Results: The mean age of participants in the workshop was 36.9 ± 7.23 years. The majority of the respondents were female 38 (80.9%) and health facility heads 20 (42.6%). Before the training, less than a fifth (16.2%) demonstrated adequate knowledge regarding COVID-19 infection. Post-test analysis revealed a marked improvement (83.8%) in the knowledge acquired and this was statistically significant (P < 0.05). Conclusion: Although the training workshop was useful in improving the knowledge of HCWs regarding COVID-19, it is important that these trainings are done periodically to update the HCWs with adequate information particularly frontline HCWs serving in rural areas.

Assessment of service readiness for maternity care in primary health centres in rural Nigeria: implications for service improvement.

Introductionseveral scientific reports from studies across Nigeria revealed a higher incidence of maternal mortality in rural parts of the country as compared to the urban areas. Part of the reasons is the paucity of health care infrastructure and personnel. This study was designed as part of an intervention program with the goal to improve the access of pregnant women to skilled pregnancy care in rural Nigeria. The specific objective of the study was to determine the nature and readiness of Primary Health Centres (PHCs) in two Local Government Areas (LGAs) in rural parts of Edo State, Southern Nigeria to deliver effective maternal and child health services.Methodsthe study was conducted in 12 randomly selected PHCs in the two LGAs. Data were obtained with a semi-structured questionnaire administered on health workers and through direct observation and verification of the facilities in the PHCs. The results obtained were compared with the national standards established for PHCs in Nigeria by the National Primary Health Care Development Agency (NPHCDA). Descriptive statistics were used to analyze the data.Resultsthe results showed severe deficits in buildings and premises, rooms, medical equipment, essential drugs, and personnel. Only 40% of items recommended by the NPHCDA were available for buildings; 41% of the PHCs had facilities available in the labour ward; while less than 30% had the recommended facilities in the antenatal care rooms. Only one PHC had a laboratory space, with only one item (a dipstick for urine analysis) identified in the laboratory. None of the PHCs had ambulances, mobile phones, internet or computers. There was no nurse/midwife in 4 PHCs; only one nurse/midwife each were available in 8 PHCs; while there was no Environmental/Medical Records Officer in any PHC. About 26% of the essential drugs were not available in the PHCs.Conclusionwe conclude that PHCs in Edo State, Nigeria have severe deficits in infrastructural facilities, equipment, essential drugs and personnel for the delivery of maternal and child health care. Efforts to improve these facilities will help increase the quality of delivery of maternal and child health, and therefore reduce maternal and child mortality in the country.

The Effect of Educational Intervention on Rational Prescribing in Public Health Facilities in Selected Local Government Areas of Rivers State: An Interventional Study

Background: Despite progress made so far in identifying intervention models to improve drug use, irrational use of drugs has remained a serious global health problem. The study intends to determine the effectiveness of an educational intervention on rational prescribing among prescribers in selected local government areas of Rivers State.&#x0D; Methods: This was a quasi-experimental study that measured the effect of educational intervention on rational prescribing of drugs among prescribers in public health facilities in two selected Local Government Areas (LGA) of Rivers State: Ikwerre LGA (KELGA) which served as the control and Port Harcourt LGA (PHALGA) which served as the intervention by using cluster sampling with randomization. Paired data were analysed using McNemar’s Chi-square test and the paired t-test. The level of significance was set at P≤ 0.05. The EPI-INFO version 7.02 statistical software was used in the analysis.&#x0D; Results: Findings showed that the largest category of prescribers was nurse/midwives representing 48.61% and 44.4% in the intervention and control LGA respectively. There was an improvement in the knowledge and attitude of respondents in the facilities in the intervention LGA at one month and three months post-intervention (P&lt;0.05). The average number of drugs per encounter (ANDPE), the percentage encounters with an antibiotic (PEA), the percentage encounters with an injection (PEI) were lower for the interventions group compared to the control (P&lt;0.05). Percentage generic drug prescription (PGD) was higher in the intervention group compared to the control (P=0.001).&#x0D; Conclusion: Educational intervention was an effective and sustainable means of improving rational prescribing in the state. Update courses and continuing medical education on rational drug use should be held periodically for health care professionals by the State and National Primary Health Care Development Agency as well as other interested stakeholders.

Implementation strategy of primary health care in Ovia communities

Primary health care is the essential health service provided at the grassroot level. Over the years the implementation of Primary Health Care (PHC) programmes in Edo state are bedeviled with associated challenges such as limited community participation, great communication gap that limit evaluation processes of PHC programme and slow pace collaboration among stakeholders. These challenges need to be averted through effective and people oriented strategies to ensure the implementation of primary health care. A descriptive research design with a population of the study comprised 1,024 primary health care stakeholders in Edo state. Multi-stage sampling technique was used to select 180 respondents for the study. The study found that intersectoral collaboration involving partnerships with community health agencies such as village health committees and ward health committees significantly influenced the implementation of PHC. Intersectoral collaboration, community mobilization strategy and community feedback mechanism are effective and efficient strategies for improved implementation of PHC programmes. The study recommended among others that National Primary Health Care Development Agency (NPHCDA) and State Primary Health Care Development Agency (SPHCDA) should strengthen partnership with international health organizations such as WHO, UNICEF, GAVI, UNDP and boost confidence and trust of these international organizations.

Comparing data Reported Using the National Health Management Information System and data Declared Validated on the PBF Declaration Forms in Funding Health Districts in Nasarawa State

The National Health Management Information System (NHMIS) Was Designed To Provide Timely And Reliable Health Service Delivery Information. The Efficiency And Effectiveness Of Health Service Delivery Is Assessed By The Availability Of Quality, Complete And Timely Data. The NHMIS Policy Review Was Initiated By A Consortium Of Relevant Stake Holders Led By The Department Of Planning, Research And Statistics (DPRS) Of The Federal Ministry Of Health (FMOH) And The National Primary Health Care Development Agency (NPHCDA). The Emphasis Of The NHMIS Is To Strengthen The Health Information System-HIS In The Country And Promote The Use Of Quality Information For Evidence-Based Decision-Making At The Community, LGA, And National Levels. In Spite Of Substantial Investments, The Health Sector In Nigeria Has Made Slow Progress In Improving Its Health Indices. Thus The Nigeria State Health Investment Project(NSHIP), Through Support From WHO, Introduced The Performance-Based Financing –PBF Currently Rolled Out In Three States- Adamawa, Nasarawa, And The Ondo States To Deliver A Result-Based Approach To Improve Quantity And Quality Of Health Services Especially In The Area Of Maternal Health. Health Centers Receive Funds Directly Based On The Number Of Essential Services They Delivered And The Improved Quality Of Care. This Encouraged Health Centers To Focus On Delivering Results, And The New Funds Enabled Them To Improve Their Services. This Study Compared Data Reported Using The NHMIS And Declared Validated On The PBF Declaration Forms In Funding Health Facilities In Nasarawa State For Quarter 1 (Jan.- Mar.)2018 And Quarter 2 (Apr. – June) 2018.

'A seamless transition': how to sustain a community health worker scheme within the health system of Gombe state, northeast Nigeria.

Health interventions introduced as part of donor-funded projects need careful planning if they are to survive when donor funding ends. In northeast Nigeria, the Gombe State Primary Health Care Development Agency and implementing partners recognized this when introducing a Village Health Worker (VHW) Scheme in 2016. VHWs are a new cadre of community health worker, providing maternal, newborn and child health-related messages, basic healthcare and making referrals to health facilities. This paper presents a qualitative study focussing on the VHW Scheme’s sustainability and, hence, contributes to the body of literature on sustaining donor-funded interventions as well as presenting lessons aimed at decision-makers seeking to introduce similar schemes in other Nigerian states and in other low- and middle-income settings. In 2017 and 2018, we conducted 37 semi-structured interviews and 23 focus group discussions with intervention stakeholders and community members. Based on respondents’ accounts, six key actions emerged as essential in promoting the VHW Scheme’s sustainability: government ownership and transition of responsibilities, adapting the scheme for sustainability, motivating VHWs, institutionalizing the scheme within the health system, managing financial uncertainties and fostering community ownership and acceptance. Our study suggests that for a community health worker intervention to be sustainable, reflection and adaption, government and community ownership and a phased transition of responsibilities are crucial.

Improving access, quality and efficiency in health care delivery in Nigeria: a perspective

Providing equitable access to health care for every Nigerian is central in the country´s National Health Act. But the Nigerian Health System ranks poorly in terms of access and quality just as the country also ranks poorly on Transparency International’s Corruption Perception Index. The problem of lack of access to quality health care stems from wasteful use of primary care services at referral centres. In the rural communities where the burden of morbidity and mortality is high, efficient health expenditure and service utilization is plagued by the absence of adequately functioning Primary Health Centers (PHC), cost sharing schemes and corrupt practices in the health sector. In order to curb these issues, policy options such as revamping the PHC and prioritizing the delivery of a basic minimum package of health care are useful to consider. Furthermore, implementation of strong actions to curb corruption in the health sector will improve access to care and health outcomes and it does not incur extra financial investment. This is achievable through improvement in public financial management and limiting corruption by making right choices in resource allocation towards pro-poor interventions. Similarly, well designed package of services and prioritization of primary care making best use of human resource will be beneficial. This is relevant to the Nigerian health system, leveraging on the country´s decentralized administration and strengthening Community Health Committees’ role in ensuring accountability and transparency at the PHCs. Finally, considering the role community health committees play in driving demand at the communities, the National Primary Health Care Development Agency (NPHCDA) can coordinate the development of a joint action plan for health care delivery, between a committee and each respective PHC facility. This will promote efficient use of resources and facilitate access to quality health care at each facility.

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.

Assessing the acceptability of village health workers' roles in improving maternal health care in Gombe State, Nigeria a qualitative exploration from women beneficiaries.

IntroductionMaternal, and under-five mortality rates in Gombe State are disproportionately high. The Society for Family Health (a Non-Governmental Organization) in collaboration with Gombe State Primary Health Care Development Agency implemented the Village Health Worker (VHW) Program in Gombe to address the low uptakes of maternal neonatal and child health (MNCH) services and reduced the impact of healthcare worker insufficiency. VHWs are lay indigenous women trained to educate and encourage women to use MNCH services, provide simple community-based maternal and new-born care through home visits, and facilitate facility linkage. We assessed the acceptability of VHW services among women beneficiaries of the Program.MethodsQualitative data were obtained through six focus group discussions with 58 women beneficiaries of the VHW program who delivered within the last 12 months preceding study period (October–November 2018). Themes explored were roles and acceptability of VHWs, and the influence of VHWs on the uptake of MNCH services. We analyzed data with NVivo 12, using Grounded Theory.ResultsParticipants’ mean age was 25.1 (± 5.3) years old. Most participants 39 (67%), had been in contact with a VHW for at least 10 months. VHWs visited pregnant women at home and registered them for antenatal care, provided them basic maternal healthcare, health education, and facilitated facility linkage. Participants generally accepted the VHW Program because it was community-based, VHWs were indigenous community members, delivered clear messages, and influenced husbands and mothers-in-law to support women’s’ use of MNCH services. VHWs’ interventions were perceived to have improved health literacy and the uptake of MNCH services. Participants generally admired the VHW occupation and recommended VHW program scale-up, and for VHWs to be offered basic obstetric training and employment by health facilities or the government.ConclusionThe general acceptance and positive views of VHWs from beneficiaries of the program demonstrates the feasibility of the program to improve the uptake of MNCH services.

Primary Healthcare on Utilization of Insecticide Treated Nets among Pregnant Mothers and Carers of Children in South –South Nigeria

One of the strategies of Primary Health Care (PHC) is the use of insecticide treated nets (ITNs) against malaria among pregnant mothers and care givers of children under five years. The agency for PHC in Nigeria is the National Primary Health Care Development Agency (NPHCDA). The objective of this narrative review is to identify the role of PHC providers in promoting the use of ITNs among pregnant mothers and care givers of children under five years. Method was by review of 30 published literatures on PHC; as it relates to use of ITNs. Findings indicate that most pregnant mothers and care-givers of children under five years in Nigeria are aware that the best option to prevent malaria infection is by use of ITNs. Healthcare providers participate in mass distribution of ITNs. There is increase nets ownership in households. Supervisory guidance influences use of ITNs. However, there is evidence of slow uptake of ITNs due to resistance to behavioural change. Also, the knowledge of pregnant women concerning ITNs use was good, but the attitudes and practices were poor. The implication is that health promotion need to be enhanced among both PHC workers and community leaders on use of ITNs. Primary healthcare workers may need to be motivated to do their job in terms of promoting the use of ITNs among pregnant mothers and carers of children under five years.