Primary Health Care In Nigeria Research Articles

Cultural adaptation of the brain health assessment for early detection of cognitive impairment in Southeast Nigeria.

The aging population in developing countries demands parallel improvements in brain health assessment services to mitigate stigma, promote healthy aging, and diagnose cognitive impairments including dementia in primary health care (PHC) facilities. The lack of culturally appropriate cognitive assessment tools in PHC facilities delays early detection. This study aims to culturally adapt a brief digital cognitive assessment tool for PHC professionals in Southeast Nigeria. A total of 30 participants (15 healthcare workers HCW and 15 community members) were selected to be culturally representative of the community. We completed focus groups and pilot testing to evaluate and refine the Brain Health Assessment (BHA) a subset of tools from the Tablet-based Cognitive Assessment Tool (TabCAT) known to be sensitive to cognitive impairment in other settings. We examined BHA subtests across local languages (Pidgin and Igbo) spoken at two geriatric clinics in Anambra State Southeast Nigeria. Following structured approaches in focus groups, adaptations were made to the Favorites (memory) and Line Length (visuospatial) subtests based on their input. Participants found the new adaptations to have good construct validity for the region. The BHA subtests showed content validity for future work needed to validate the tool for detecting early cognitive changes associated with dementia and Alzheimer's disease in PHC settings. The use of culturally adapted and concise digital cognitive assessment tools relevant to healthcare professionals in Southeast Nigeria's PHCs is advocated.

Primary Healthcare Under One Roof: Way Out of Primary Healthcare Dilemma

The adoption of the Primary Health Care Under One Roof (PHCUOR) initiative serves as a crucial approach to tackle the complex challenges encountered by primary healthcare systems worldwide. This paper explores the historical background, present difficulties, and possible remedies related to primary healthcare in Nigeria, with a particular emphasis on the PHCUOR model. By referencing important papers like the Alma Ata Declaration and current research, we highlight the importance of Primary Health Care (PHC) in public health systems. This emphasis how PHC helps to promote health equity and achieve universal health coverage. The PHCUOR model is a progressive approach to healthcare delivery that promotes the consolidation of different services under a single administrative entity in order to enhance the coordination and comprehensiveness of care. The effectiveness of the strategy in improving access, boosting coordination, and delivering cost-effective treatment is demonstrated by several case studies from Anambra and Lagos States. In order to fully harness the potential of PHCUOR (Primary Health Care Under One Roof) in Nigeria, it is crucial for policymakers, healthcare providers, and stakeholders to give utmost importance to the establishment of policy frameworks that are supportive, the development of infrastructure, the enhancement of capacity, and the implementation of sustainable finance mechanisms. Nigeria may enhance its primary healthcare system, enhance health outcomes, and promote health equity for all its residents by adopting these initiatives and proposals.

Assessing interprofessional and integrated care in providing sexual and reproductive health services to adolescents at primary healthcare level in Nigeria

PurposeSexual and reproductive health (SRH) interventions demand diverse services, encompassing medical, social and psychological care to ensure the overall wellbeing of service users. In the absence of multidisciplinary response to SRH interventions, service users could be deprived of crucial SRH services, which could undermine their safety and wellbeing. Based on this knowledge, our study was designed to map the interprofessional space in primary healthcare (PHC) facilities in Ebonyi State, Nigeria that deliver SRH services.Design/methodology/approachInterviews with 20 health workers and group discussions with 72 young people aged 15–24 years provided the data for the study. We analyzed data deductively, focusing on the assessments of the presence or absence of specific professionals that are typically expected to provide different aspects of SRH services.FindingsWe found conspicuous absence of laboratory diagnostic, social care, psycho-cognitive and some medical services expected of primary care. These absences necessitated unnecessary referrals, encouraged breaches in confidentiality, undermined social care and justice, increased cost of care and discouraged young clients from utilizing SRH services provided in PHCs. Our study, therefore, emphasizes the need for integrated care in the delivery of SRH services, which would involve relevant diverse professionals contributing their expertise toward comprehensive care for SRH service users.Originality/valueThe study provides human resource insights toward strengthening primary healthcare in Nigeria vis-à-vis efficient delivery of SRH services to guarantee the health security of service users.

AN OVERVIEW OF THE PRIMARY HEALTHCARE SYSTEM IN NIGERIA

This paper describes the structure and operation of the primary healthcare system in Nigeria, the sequence of its evolution from inception to what is obtainable now and the effectiveness of the system. Prior to that, a detailed description of the WHO targets through its Alma-Ata declaration in 1978 was explained and evaluated in comparison with the Nigerian healthcare system. Emphasis was laid on the concept, principle and element of the primary healthcare system as well as the challenges and the current state of the system. In conclusion, Primary healthcare in Nigeria, particularly in rural areas, has come a long way, but more work is undoubtedly still needed to realize the objective of universal health now and in the future. Priority should be given to improving people's living conditions beyond the current poverty level in order to promote healthier living. Local governments, as well as all other levels of government, must increase their allocations to the health sector among other things.

Safety and upscaling of remote consulting for long-term conditions in primary health care in Nigeria and Tanzania (REaCH trials): stepped-wedge trials of training, mobile data allowance, and implementation

In-person health care poses risks to health workers and patients during pandemics. Remote consultations can mitigate these risks. The REaCH intervention comprised training and mobile data allowance provision for mobile phones to support remotely delivered primary care in Africa compared with no training and mobile data allowance. The aim of this study was to estimate the effects of REaCH among adults with non-communicable diseases on remote and face-to-face consultation rates, patient safety, and trustworthiness of consultations. In these two independent stepped-wedge cluster randomised controlled trials, we enrolled 20 primary care clusters in each of two settings (Oyo State, Nigeria, and Morogoro Region, Tanzania). Eligible clusters had 100 or more patients with diabetes, hypertension, and cardiovascular or pulmonary disease employing five health workers. Clusters were computer-randomised to one of ten (Nigeria) or one of seven (Tanzania) sequences to receive the REaCH intervention. Only outcome assessors were masked. Primary outcomes were consultation, prescription, and investigation rates, and trustworthiness collected monthly for 12 months (Nigeria) and 9 months (Tanzania) from open cohorts. Ten randomly sampled consulting patients per cluster-month completed patient reported outcome measures. This trial was registered with ISRCTN, ISRCTN17941313. Overall, 40 clusters comprising 8776 (Nigeria) and 3246 (Tanzania) patients' open cohort data were analysed (6377 [72·7%] of 8776 females in Nigeria, and 2235 [68·9%] of 3246 females in Tanzania). The mean age of the participants was 55·3 years (SD 13·9) in Nigeria and 59·2 years (14·2) in Tanzania. In Nigeria, no evidence of change in face-to-face consulting rate was observed (rate ratio [RR] 1·06, 95% CI 0·98 to 1·09; p=0·16); however, remote consultations increased four-fold (4·44, 1·34 to >10; p=0·01). In Tanzania, face-to-face (0·94, 0·61 to 1·67; p=0·99) and remote consulting rates (1·17, 0·56 to 5·57; p=0·39) were unchanged. There was no evidence of difference in prescribing rates (Nigeria: 1·05, 0·60 to 1·14; p=0·23; Tanzania: 0·92, 0·60 to 1·67; p=0·97), investigation rates (Nigeria: 1·06, 0·23 to 2·12; p=0·49; Tanzania: 1·15, 0·35 to 1·64; 0·58) or trustworthiness scores (Nigeria: mean difference 0·05, 95% CI -0·45 to 0·42; p=0·89; Tanzania: 0·07, -0·15 to 0·76; p=0·70). REaCH can be implemented and could improve intervention versus control health-care access. Remote consultations appear safe and trustworthy, supporting universal health coverage. The UK Research and Innovation Collective Fund. For the Swahili and Yoruba translations of the abstract see Supplementary Materials section.

Exploration of the Need for Integration of Cervical Cancer Information into Postnatal Services at Primary Health Care Centers in Ibadan Nigeria

Background: Cervical cancer (CC) is a preventable disease yet it is one of the leading causes of death, especially in low-income countries. In Nigeria, information on CC is yet to be part of routine health talk at Postnatal Clinics (PNC) at the Primary Health Care (PHC) level. The PNC would however have been a good avenue to reach women at risk of CC. This study explored health care workers (HCWs)’ willingness to integrate CCS services (CCSS), and women’s readiness to uptake the services at PHCs in Ibadan, Nigeria. Method: A qualitative study design was employed in this study. Data were collected through four sessions of Focus Group Discussions (FGDs) among the women attending PNC, and 20 Key Informant Interviews (KIIs) for health workers in PHC facilities. The Atlas.ti software, version 8 was used for the analysis. Thematic contents from the study were presented as quotes and streams of thoughts. Results: Information on CCS is currently excluded from the list of PNC activities such that most women have never heard of the need for CCS. They were interested in receiving CCS information and services. Women pleaded for the integration of CCS information in PHC clinic activities but preferably in a free or subsidized format in order to encourage utilization of the services. Challenges identified were mainly a shortage of manpower and a lack of training on CCS. Conclusion: Health workers were willing to integrate CCS services in PHC activities, however, recommended recruitment of more hands to ensure effective service delivery in line with National health policy on PHC in Nigeria.

Evidence for "Whole Family Approach" in accelerating uptake of COVID-19 and routine immunizations among integrated primary health services in Nigeria.

The family is the simplest unit but possesses the strongest bond in society. These qualities - bond and proximity - that exist both within and across neighboring families, according to our research, can be instrumental in shaping a new kind of health promotion strategy that can transform health behaviors in communities. The Whole Family Approach (WFA) is a government-sanctioned approach to increase uptake of COVID-19 vaccines in Nigeria. The approach entails leveraging the high family-based demand for some primary health services, such as malaria, diabetes, hypertension, and reproductive services, to generate demand for COVID-19 and routine immunizations. However, since the announcement in 2021, there has been no available evidence to show the impact of the approach on COVID-19 vaccine uptake, though global literature generally favors family-centered health approaches. This study tests the effectiveness of the approach in increasing the utilization of target services in a Nigerian community and further provides a theoretical framework for the strategy. Two primary healthcare facilities were selected in two communities located in Abuja in a quasi-experimental design. After a small-sample landscape assessment of the communities and the facilities, family-targeting health promotion activities were facilitated in the intervention community (integrated health education by trained community health influencers) and facility (opportunistic health promotion through in-facility referrals) for one month. Anonymized service utilization data were acquired from both facilities over a period of four months to analyze their respective month-by-month service utilization trends. Time trend analysis was conducted and revealed that WFA significantly increased service utilization (N = 5870; p < 0.001, α = 0.01, 99% CI) across all the package services provided at the intervention facility. A supplementary Pearson's correlation analysis further presented a positive relationship (r = 0.432-0.996) among the services which favored the result. It can therefore be concluded that the "Whole Family Approach" of health promotion is efficacious in accelerating uptake of priority health services such as COVID-19 and routine immunizations. While there is more to be understood about this interesting approach, we recommend the improvement of communication and capacity gaps in Nigeria's primary healthcare system to ensure that promising strategies such as the WFA are adequately implemented at the community and facility levels.

Ward Health System in Nigeria: An Assessment of the Awareness and Role of Community Members

Ward Health System is an implementation strategy of Primary Health Care in Nigeria. It was introduced in 2001 and is aimed at promoting community mobilization and participation in health care, thereby enhancing an effective, efficient and sustainable health care system. This study assessed the awareness and role of community members in the Ward Health System. A semi-structured interviewer administered questionnaire was used to conduct an exit poll of 240 Primary Health Care facility clients. Approximately 12%, 13% and 29% of the respondents had ever heard of the terms Ward Health System, Village Development Committee and Ward Development committee respectively, while up to 73% have no idea of the role of any of the stakeholders. Inadequate knowledge and involvement of the community members in the Ward Health System constitutes a big challenge to the effective and efficient implementation of Primary Health Care in Nigeria. Efforts towards community education on Ward Health System should be intensified.

Integrating physiotherapy into primary health care in Nigeria: Perceptions of primary health care practitioners

ABSTRACT The perception of Primary Health Care (PHC) practitioners about integrating physiotherapy into PHC in Nigeria is still unknown. The aim of this study was to examine the knowledge and attitude of PHC practitioners in Nigeria regarding the integration of physiotherapy into PHC. The participants in this cross-sectional study were 183 PHC practitioners (physicians, nurses, and community health workers). A content-validated, semi-structured questionnaire was used to obtain information about history of exposure to physiotherapy, knowledge, and attitudes toward integrating physiotherapy into PHC. Data was analyzed using Pearson’s product moment correlation and Analysis of Variance at α = 0.05. Participants were mostly females (n = 154; 84.2%) and aged 39.97 ± 9.38 years. The mean years of work experience was 14.41 ± 8.68 years. Participants had limited knowledge about the role and scope of physiotherapy but were willing to learn more about physiotherapy. Less than half of the participants however, had favorable attitude toward integrating physiotherapy into PHC. Knowledge differed significantly across healthcare professions (p < .05) and was significantly correlated with attitude (p < .01). Our findings underscore the importance of interprofessional education and teamwork among healthcare providers. This might enhance understanding, modify attitudes and facilitate the inclusion of physiotherapy into PHC in Nigeria. Additionally, this could improve access to physiotherapy services for Nigerians.

Integrated Primary Palliative Care in Nigeria- Perspectives of Patients, Families and Providers.

Palliative care should be integrated into primary healthcare systems within low- and middle-income countries to achieve Universal Health Coverage goals. We aimed to identify preferences and expectations for primary palliative care among people living with serious illness and their families and the readiness of primary healthcare providers to deliver primary palliative care in Nigeria. Qualitative descriptive interview study with 48 participants: people living with serious illness (n=21) and their family caregivers (n=15), healthcare providers (n=12). Data were analysed using thematic analysis. Three major themes were identified. 1.) Engaging patients and families. 2.) Managing patients and families' expectations and preferences. 3.) Addressing staffing-related issues. Patients and families have existing trust and bonds from using primary healthcare but lack individual agency necessary for person-centered care decisions. They expect an easily accessible service, opportunities for social interaction and adequate communication. Development of healthcare providers is needed to ensure an appropriate clinical response, manage interprofessional trust and ensure clear role delineation. Our findings have identified specific approaches to implement the WHO policy on integrated primary palliative care. Palliative care integration within primary healthcare in Nigeria can be achieved through building information and communication skills of healthcare providers, engaging and empowering patients to exercise their agency in care decisions, and adequately delineating healthcare providers' roles to ensure staff work within their competencies and training.

Bridging the gap by strengthening the MHGAP: Integrating mental health care into primary health care in Nigeria

Bridging the gap by strengthening the MHGAP: Integrating mental health care into primary health care in Nigeria

Assessing the capacity of primary health care centres to provide tuberculosis services in Kaduna State, North-Western Nigeria

Background: Despite earlier successes achieved in combating it, cases of tuberculosis in Nigeria are now on the increase, affecting more people and communities. Primary health care in Nigeria is through ward health system, designed to provide minimum health package to the communities including TB services. This study aimed to ascertain the capacity of PHC centres to provide TB services in Kaduna North senatorial district, Kaduna State, Nigeria.Methods: Four out of eight local Government areas in the district were randomly selected and one PHC per ward was recruited in the study. In each facility, questionnaires developed from the TB tracer items of the WHO service availability and readiness assessment tool were administered to the facility in-charges and TB/DOTS focal persons.Results: Forty four facilities were selected from Zaria, Sabon Gari, Makarfi and Kudan LGAs. Almost all facilities (98%) diagnosed TB clinically and 39 (90%) had anti-TB drugs available. National TB guidelines were lacking in 23 (52%) facilities and only 5 (11%) had additional capacity for sputum microscopy. While 35 (80%) TB/DOTS focal persons had received training on TB diagnosis and treatment, only 24 (55%)received training on TB/HIV co-infection and only 8 (18%) received training on multi-drug resistant TB.Conclusions: While TB services are widely available in the district, urgent need exists for all stakeholders to work together towards equipping those facilities with critical infrastructure that will improve their overall capacity, particularly with regards to comprehensive TB guidelines, laboratory diagnosis and personnel training for effective TB management.

Factors Affecting the Knowledge and Practice of Drug Management among Healthcare Workers in Primary Health Centers in South-East, Nigeria

The knowledge of health workers regarding their management of drugs is very important in ensuring good health. One of the major indices of the performance of primary health care (PHC) remains improved access to essential drugs as they are the link between patients and health services. Consequently, their availability or absence will contribute to a positive or negative impact on health. This was a quasi-experimental study, carried out in Anambra state, which compared the intervention and control groups following the training and provision of drug management tools to PHC workers in the intervention group. A multi-stage sampling technique was used to select 264 health workers from 132 health centers from two senatorial zones in the State, one acting as a control group and the other as an intervention group. Data was collected using a pre-tested in-depth interview guide and semi-structured interviewer administered questionnaire. Statistical analysis was conducted using SPSS at a statistical significance level of p value less than 0.05, while qualitative data was analyzed using N-Vivo. Several factors such as age, sex, educational qualification, cadre of staff, years of practice and PHC workers’ previous training were identified as affecting the knowledge and practice of drug management. The majority (72.0% and 71.2%) in intervention and control groups respectively said inadequate information or lack of knowledge was the main reason for poor practices while the proportion with low interest of health workers for drug management was (38.5%) for intervention and (59.8%) for the control group and the difference between the groups was statistically significant (p = 0.034). In conclusion, this study has shown that age, sex, educational qualification, cadre of staff, years of practice and PHC workers’ previous training were factors associated with health workers’ knowledge and practice of drug management. The study recommends the development of Aide Memoire and conduct of training and retraining on drug management to improve both knowledge and practice of drug management in PHCs in Nigeria.

PRIMARY HEALTH CARE IN NIGERIA: AN APPRAISAL OF THE EFFECT OF FOREIGN DONATIONS

Primary Health Care (PHC) provides the most viable route towards achieving health related sustainable development goals (SDGs) and is crucial to the achievement of other SDGs. Given the importance of primary health care, nations across the world devote considerable effort and resources towards establishing and maintaining effective PHC systems. In Nigeria, domestic spending on the health sector has been declining while foreign donations towards improving primary health care have been on the increase. However, recent global trends and the imminent expiry of deadlines for a number of foreign donations point toward a not too distant future without foreign donations for health care system improvements. This constitutes a development challenge. Even though foreign donations have yielded some positive health outcomes, the effect of foreign donations on the primary health care system is unclear. The study set out to examine the amount and effect of foreign donations on the primary health care system in Nigeria. The paper combined qualitative methodology and analysis of literature to investigate the present state of primary healthcare, identify the setbacks to full development of primary healthcare in Nigeria and examined the effects of foreign donations on the primary health care system in Nigeria. The paper found that foreign donations have been increasing but have also led to the perpetuation of a non-committal attitude towards increasing domestic spending on health and the neglect of health system strengthening. Therefore, the paper recommends timely and steady increase in domestic funding for health along with the strengthening of the health system towards creating an effective primary health care system with or without foreign donations.

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.

Private money-making indulgence and inefficiency of primary healthcare in Nigeria: a qualitative study of health workers\u2019 absenteeism

ObjectivesGenerating additional personal income is common with primary healthcare (PHC) workforce in Nigeria, which could be because of the inconsistencies marring their monthly salaries. Therefore, this study investigates the drivers of private economic activities of PHC providers in the public sector, and the links to absenteeism, as well as inefficiency of PHC facilities in Nigeria.MethodsA qualitative study design was used to collect data from 30 key-informants using in-depth interviews. They were selected from 5 PHC facilities across three local government areas in Enugu state, south-eastern Nigeria. Data were analysed thematically, and guided by phenomenology.ResultsFindings showed that majority of the health workers were involved in different private money-making activities. A main driver was inconsistencies in salaries, which makes it difficult for them to routinely meet their personal and household needs. As a result, PHC facilities were found less functional.ConclusionsAbsenteeism of PHC providers can be addressed if efforts are made to close justifiable gaps that cause health workers to struggle informally. Such lesson can be instructive to low- and middle-income countries in strengthening their health systems.

The Myth and Reality of Government Expenditure on Primary Health Care in Nigeria: Way Forward to Inclusive Growth

The health sector remains a vital tool for sustainable development of any nation and therefore investment in this sector cannot be overemphasized. The present state of Primary Health Care (PHC) system in Nigeria is alarming, with only about 20% out of the 30,000 PHC facilities relatively distributed throughout the 774 Local Government Areas (LGAs) across Nigeria working partially. This study examines government expenditure on primary health care in Nigeria as well as its relations to real national output within the period 1980 to 2015 using secondary data and the Ordinary Least Square (OLS) econometric technique. The results of the model used revealed government health expenditure to be efficacious for economic growth, and for the well-functioning of primary health care in Nigeria. Nonetheless, such efficacy duly was also understood to be limited in three select aspects: funding/financing strategy, personnel/manpower quality and mobilization, and implementation framework. The paper, in conclusion, attests to the rationale that money spent wisely on capital health expenditure pays off well in both short-run and long-run for individuals, the society and nation at large.

Reviving Healthcare Delivery: Context-Based Issues for Revamping Primary Healthcare in Nigeria

The relationship between health and sustainable development have long been established. Hence the need to rigorously pursue strategies to improve the health status of a nation’s citizenry through functionally effective and efficient delivery systems. However, health and healthcare delivery is a major problem confronting developing nations like Nigeria. In August 1987, Primary healthcare (PHC) was adopted as the cornerstone of health care and health policy in Nigeria. About three decades after, studies have shown that health and healthcare in Nigeria have not significantly improved; and the delivery of health services have become a perennial problem, defying the various solutions that had been advanced to solving it over time. In the face of dwindling economic reality in Nigeria, reviving primary healthcare becomes a viable alternative that will not only produce healthy and productive citizens, thereby generating national wealth; but will also reduce the cost of health care delivery to the average Nigerian. This paper presents a theoretical diagnosis of the state of affairs of healthcare delivery in Nigeria focusing on PHC as the hub of health policy. It examines the problems of PHC, identifying gaps within it that militates against successful implementation and outcomes. The paper concluded that certain deficits in the scope and policy process of PHC in Nigeria accounted for the programme’s incapacitation. It however recommended a thorough situation analysis as a prelude to a bottom-up policy approach, inclusion of the informal health sub-sector especially the traditional health care practitioners as a viable as well as cost effective strategy for the revamping of primary health care in Nigeria. Keywords: Health, primary, context-based healthcare, policy, revamping DOI : 10.7176/JHMN/58-10

Reviving Healthcare Delivery: Context-Based Issues for Revamping Primary Healthcare in Nigeria

Reviving Healthcare Delivery: Context-Based Issues for Revamping Primary Healthcare in Nigeria

Accountability mechanisms for implementing a health financing option: the case of the basic health care provision fund (BHCPF) in Nigeria

BackgroundThe Nigerian National Health Act proposes a radical shift in health financing in Nigeria through the establishment of a fund – Basic Healthcare Provision Fund, (BHCPF). This Fund is intended to improve the functioning of primary health care in Nigeria. Key stakeholders at national, sub-national and local levels have raised concerns over the management of the BHCPF with respect to the roles of various stakeholders in ensuring accountability for its use, and the readiness of the implementers to manage this fund and achieve its objectives. This study explores the governance and accountability readiness of the different layers of implementation of the Fund; and it contributes to the generation of policy implementation guidelines around governance and accountability for the Fund.MethodsNational, state and LGA level respondents were interviewed using a semi structured tool. Respondents were purposively selected to reflect the different layers of implementation of primary health care and the levels of accountability. Different accountability layers and key stakeholders expected to implement the BHCPF are the Federal government (Federal Ministry of Health, NPHCDA, NHIS, Federal Ministry of Finance); the State government (State Ministry of Health, SPHCB, State Ministry of Finance, Ministry of Local Government); the Local government (Local Government Health Authorities); Health facilities (Health workers, Health facility committees (HFC) and External actors (Development partners and donors, CSOs, Community members).ResultsIn general, the strategies for accountability encompass planning mechanisms, strong and transparent monitoring and supervision systems, and systematic reporting at different levels of the healthcare system. Non-state actors, particularly communities, must be empowered and engaged as instruments for ensuring external accountability at lower levels of implementation. New accountability strategies such as result-based or performance-based financing could be very valuable.ConclusionThe key challenges to accountability identified should be addressed and these included trust, transparency and corruption in the health system, political interference at higher levels of government, poor data management, lack of political commitment from the State in relation to release of funds for health activities, poor motivation, mentorship, monitoring and supervision, weak financial management and accountability systems and weak capacity to implement suggested accountability mechanisms due to political interference with accountability structures.