Provision Of Basic Health Care Research Articles

Implementing Health Policy in Nigeria: The Basic Health Care Provision Fund as a Catalyst for Achieving Universal Health Coverage?

ABSTRACTIn 2014, Nigeria adopted a new law for its healthcare system, which mandated the establishment of a novel health‐financing mechanism, the Basic Health Care Provision Fund (BHCPF). The BHCPF was created to provide sustainable funding with a view to fast‐tracking Universal Health Coverage (UHC) and improving health outcomes in Nigeria. This article places Nigeria's UHC reform process in the broader context of social policy implementation in Africa to illustrate the extent to which interactions between different agents, contextual factors such as Nigeria's federal character, as well as changing conceptualizations of social policy at a global level, shape views on how best to implement UHC. The article is based on the careful examination of three different versions of implementation guidelines for the BHCPF combined with qualitative data collected during fieldwork. It argues that there is a discrepancy between the Nigerian government rhetoric of putting into place a system that improves access to healthcare and the actual practice of implementing UHC via the BHCPF. In reality, a range of controversies surround the ongoing operationalization of the BHCPF, contributing to the perpetuation of a social policy environment that allows poor health outcomes and significant health inequities in Nigeria to persist.

Effects of utilization of basic health care provision fund on service delivery in primary health centres in Osun State

Background: One of the daunting challenges militating against the provision of quality healthcare services at the various primary health centres hindering the successive provision of sustainable and equitable PHC services. This study aimed to assess the effects of the utilization of the basic health care provision funds on service delivery in primary health centres in Osun State. Methods: A descriptive cross-sectional study was adopted for this study among 384 respondents selected using multistage sampling methods from different LGAs in Osun State between June 2023 and February 2023. The research instrument was a semi-structured questionnaire analysed with SPSS version 25.0. Univariate and bivariate analysis were done as appropriate and a p value of <0.05 was taken as statistically significant. Results: The study found that the majority (93.2%) of BHCPF-supported PHCs received monthly releases. Most patients (98.2%) were satisfied with service delivery, which influenced patient utilization of PHC facilities, albeit without statistical significance. Conclusions: Most (90%) of the facilities provided most services in the component of PHCs, but less than one-third offered mental and dental health services. Implementing these services in BHCPF-supported PHCs is recommended.

Using the Socioecological Model to Explore Barriers to Health Care Provision in Underserved Communities in the Philippines: Qualitative Study.

The Philippines' primary care is delivered via local health centers called barangay health centers (BHCs). Barangays are the most local government units in the Philippines. Designed to promote and prevent disease via basic health care, these BHCs are staffed mainly by barangay health workers (BHWs). However, there has been limited research on the social and environmental factors affecting underserved communities' access to health care in underserved areas of the Philippines. Given the importance of BHCs in disease prevention and health promotion, it is necessary to identify obstacles to providing their services and initiatives. This study aimed to explore multilevel barriers to accessing and providing basic health care in BHCs. We used a qualitative approach and the socioecological model as a framework to investigate the multilevel barriers affecting basic health care provision. A total of 18 BHWs from 6 BHCs nationwide participated in focus group interviews. Traditional thematic content analysis was used to analyze the focus group data. After that, we conducted individual semistructured interviews with 4 public health nurses who supervised the BHWs to confirm findings from focus groups as a data source triangulation. The final stage of thematic analysis was conducted using the socioecological model as the framework. Findings revealed various barriers at the individual (lack of staff motivation and misperceptions of health care needs), interpersonal (lack of training, unprofessional behaviors, and lack of communication), institutional (lack of human resources for health, lack of accountability of staff, unrealistic expectations, and lack of physical space or supplies), community (lack of community support, lack of availability of appropriate resources, and belief in traditional healers), and policy (lack of uniformity in policies and resources and lack of a functional infrastructure) levels. Examining individual-, interpersonal-, institutional-, community-, and policy-level determinants that affect BHCs can inform community-based health promotion interventions for the country's underserved communities. Given the multidimensional barriers identified, a comprehensive program must be developed and implemented in collaboration with health care providers, community leaders, local and regional health care department representatives, and policy makers.

Influence of Basic Health Care Provision Fund in improving primary Health Care in Kano state, a descriptive cross-sectional study

BackgroundThe Basic Health Care Provision Fund (BHCPF) is a direct financial investment that funds Primary Healthcare (PHC) to improve the quality of services. This study assessed the influence of the BHCPF in improving PHC services.MethodsA descriptive cross-sectional study was conducted among PHC workers in 100 facilities randomly selected from the 484 designated PHCs for implementing the BHCPF project in Kano state. Using multiple sampling methods, 200 healthcare workers in PHC facilities were selected and assisted by trained data collectors to respond to the questionnaires. Chi-square analysis was used to show associated factors, while binary regression analysis was used to determine the relationship between factors influencing the BHCPF implementation in PHC.ResultThe findings showed healthcare workers had higher awareness (61.7%) and good utilization (57.1%) of BHCPF. Challenges of the BHCPF implementation were insufficiently skilled health professionals (85%), lack of data management capacity (52.6%), low community participation and awareness (52.0%), delay in releasing funds (60.7%), poor infrastructure (87.8%), and weak financial management and accountability system (58.2%). Healthcare professionals having a diploma were four times more likely to have the National Health Management Information System (NHMIS) in their facilities (AOR = 4.955, 95% CI = 1.120–21.036; P-value 0.035) than those without. Primary healthcare facilities were two times more likely to have the NHMIS (AOR = 2.549, 95% CI = 1.167–5.566: P-value 0. 019) than health post.ConclusionThe factors that influenced PHC facilities to promote the implementation of BHCPF included: periodic evaluation of the facilities, availability of functional storage facilities, and improving the standard of care in PHC facilities. There is a need for retraining healthcare workers and creating more community awareness of the BHCPF.

Embedding Care in Communities: Mixed-Methods Evaluation of a Community Health Worker Training Initiative in Rural Haiti.

Community Health Workers (CHWs) are valuable members within the communities they serve and increase access to health care by garnering the trust of their fellow neighbors, providing services including facilitating access to care, and improving the quality and cultural competence of service delivery. In Southern Haiti, there is a health care provider shortage with one doctor or nurse per 3,000 persons. CHWs are critical to help close the gap of the lack of access to care and facilitate the provision of basic health care. To describe the CHW training initiative at capra-care, a community-based health care provider in rural Haiti, using survey and focus groups results highlighting key findings and implications for the CHW initiative. A mixed-method approach was used to evaluate capracare's CHW Training program. Focus groups were conducted that documented the lived experience of CHWs following the training program; examined barriers and facilitators to translating the training skills to practice in the community. Pretest and post-test data assessed change in knowledge post the Community Health Worker Training (CHWT) program. Findings included 51 (57%) of the graduates. A significant increase was observed in mean test scores from baseline (n = 51; m = 61.48 ± 1.80) to post-test (m = 76.93 ± 1.73; t-7.69; P < 0.001), indicating that the CHW training was successful in increasing participants' knowledge. Themes that emerged from the qualitative analysis were comprehension of skills learned, community benefit, and empowerment. Results from this CHWT program has implications to increase the health care workforce thus facilitating access to care among community residents in under-resourced regions.

Frequency and risk factors for headache disability: A population-based cross-sectional study in Egypt.

A headache is a very common condition that can have a significant impact on one's quality of life. It is one of the leading causes of years lived with disability worldwide. The objective of the study was to determine the prevalence of primary headache disability, its characteristics, risk factors and its impact on daily life. A cross-sectional study was conducted in Fayoum governorate. The sample size was 1909 participants. A multistage random sample technique was used to select adults aged above 18 years. A self-structured questionnaire solicited information on sociodemographic characteristics, headache characteristics, and the headache disability index. SPSS v 22.0 was used for data analysis. Headaches caused complete disability in 19.5% of the study group, and 76.8% developed severe disability. Participants who reported that they had a headache more than once a week were; 44.5% had moderate pain and 40.2% had more intense pain. About 55% complained of attacks rather than continuous headache and were more likely to have a degree of complete disability, (P = 0.001). A statistically significant association was found between living in urban areas, working in professional occupations, complaining of severe headache in the form of an attack and seeking medical advice, with high scores of headache disability. Headache is a condition that affects the entire population in a way that causes high levels of disability. Good management is necessary for the reduction of the adverse effects of headaches on the health of the population. This should focus on raising public awareness by means of education and on the provision of basic healthcare.

Use of herbal, complementary and alternative medicines among pregnant women in Makoni District, Zimbabwe

Use of herbal, complementary and alternative medicines during pregnancy, labour and delivery is common in Zimbabwe. This study aimed at documenting herbal, complementary and alternative medicines used during pregnancy in Makoni District in Zimbabwe. Snowballing was used to select 66 participants which included herbalists (45.5%), traditional birth attendants (18.2%), traditional healers (15.2%), and assistant traditional healers and herbal medicine vendors (10.6% each). Pregnant women in the study areaused a total of 47 plant species from 27 families, and 14 non-plant products as herbal, complementary and alternative medicines by. A total of 26 medical cases were treated with the majority of medicinal plants and non-plant products,used to dilate or widen the birth canal (55.3%) and to augment labour or speed up the delivery process (46.8%). This study showed that herbal, complementary and alternative medicines play an important role in the provision of basic health care in Zimbabwe.

Basic Health Care Provision Fund Scheme: Assessment of Clients' Satisfaction at Primary Health Care Facilities after Two Years of Implementation in Nigeria's Federal Capital Territory

Basic Health Care Provision Fund Scheme: Assessment of Clients' Satisfaction at Primary Health Care Facilities after Two Years of Implementation in Nigeria's Federal Capital Territory

Assessment of the Progress of the Implementation of the Basic Health Care Provision Fund in South East States of Nigeria

Assessment of the Progress of the Implementation of the Basic Health Care Provision Fund in South East States of Nigeria

Assessment of the Progress of the Implementation of the Basic Health Care Provision Fund in South East States of Nigeria

Assessment of the Progress of the Implementation of the Basic Health Care Provision Fund in South East States of Nigeria

International Aid in Managing IDPs: The Case of United Nations in Nigeria

Human displacement has been a recurring factor in international affairs. This, on one hand is a result of trans-border displacement while on the other hand, is due to the intensity of internal displacement and its attendant need for protection and assistance of internally displaced persons. International aid has remained a constant theme in human displacement in general even when internally displaced persons are basically the responsibility of their government. This research examines the interventions of United Nations in the management of internally displaced persons in Nigeria. It made use of both primary and secondary sources of data. The major instrument of research was oral interview of key respondents. The research found out that the United Nations, through its specialised agencies has been playing significant roles in all facets of protection, relief and development of internally displaced persons in Nigeria. The United Nations interventions were observed in the provision of basic healthcare, education, shelter, security,food and non-food items, orientation, durable solution and psychosocial support. The research concludes that, international aid, especially from the United nations has been strategic to the management of the humanitarian crisis in Nigeria. But despite the volume of the interventions, the high population of the IDPs continue to overshadow it.

Does the socioeconomic status predict health service utilization in persons with enhanced health care needs? Results from a population-based survey in persons with spinal cord lesions from Switzerland

BackgroundEvidence suggests that the socioeconomic status (SES) affects individuals’ health service utilization. Spinal cord injury is a condition that often leads to physical impairments and enhanced health care needs. It therefore presents an informative and yet under-researched case in point to investigate social inequalities in health service utilization. This study aims to describe associations between SES and health service utilization in adults with spinal cord injury from Switzerland.MethodsWe use cross-sectional data from 1,294 participants of the Swiss Spinal Cord Injury Cohort Study community survey 2017. SES was operationalized with education, household income, perceived financial hardship, subjective status, and granting of supplementary financial benefits. Health service utilization was assessed with information on visits to 13 different health care providers and four health care institutions (inpatient stays, outpatient clinics, emergency departments, specialized spinal cord centers) during the past 12 months. The dichotomized outcomes on service utilization (visited vs. not visited) were regressed on SES indicators, including adjustments for sociodemographics, lesion characteristics, and health status.ResultsPersons with higher SES reported higher likelihood for specialist, dentist, and dental hygienist visits and reported utilizing a larger number of different care providers. Further, specific SES indicators were associated with certain care provider visits (i.e., higher education and subjective status: higher odds for pharmacist visits; higher income: higher odds for natural healer visits; higher subjective status: higher odds for chiropractor visits; supplementary benefit granting: higher odds for general practitioner and home care service visits). We found statistically non-significant trends towards lower likelihood for inpatient stays, outpatient clinic and emergency department visits and enhanced likelihood for specialized spinal cord-center visits in higher SES groups.ConclusionsThis study generally supports the claim that basic health care provision is guaranteed for all patients with spinal cord injury in Switzerland, independently of their SES. However, social inequalities were still observed for the utilization of specific providers, such as oral health care providers. Given that oral health is key for health maintenance in persons with spinal cord injury, specific interventions to enhance regular dental check-ups in lower SES groups are highly recommended.

CAMPUS WIDE FLORISTIC DIVERSITY IN NIRMALA COLLEGE FOR WOMEN, COIMBATORE, TAMILNADU

Traditional medicine has remained a focal point for addressing the goals of a greater focus on basic healthcare provision, not only in India but throughout the world. Plants with such medical characteristics are widely employed, either directly as folk medicine or indirectly in modern medication production. Regional biological diversity assessment is widely recognized as a new trend in life sciences. The documentation of the Nirmala campus flora was performed by survey, collection and identification of plant specimens. The study revealed that a total of 105 plant species were documented in the campus belonging to 45 families and 92 genera. Among the 45 families, Apocynaceae and Fabaceae were the dominant families with 7 species each followed by Amranthaceae and Euphorbiaceous with 5 species each. Acanthaceae, Annonaceae, Lamiaceae, Nyctaginaceae and Rubiaceae comprises 4 species each and 3 species were observed in 9 families. 7 Families comprises 2 species each followed by 20 families with single species respectively. Herbaceous plants (46) followed by Trees (34), Shrub (17) and Climber (8) were recorded. The documented plants inside the campus are highly valued for their therapeutic uses and their significant role in the society. Keywords: Campus survey, Floristic diversity, Habit, Medicinal Use and Indigenous knowledge

Antenatal Anemia: Predictor of Poor Maternal and Perinatal Outcome

Objective: To assess the impact of antenatal anemia on maternal and perinatal outcome. Design of the study: Prospective Cohort study Place of Study: was conducted at antenatal clinic of Creek General Hospital, United Medical and Dental College, Karachi, Pakistan. Methodology: One hundred and thirty-five singleton anemic pregnant women who satisfied the inclusion criteria were included in the study. Enrolled patients were analyzed in detail, sociodemographic and obstetric characteristics recorded and followed till delivery after their informed consent. Haemoglobin estimation was done at first visit & anaemia was graded according to WHO criteria and statistical analysis were done. Results: The study population included 135 antenatal anemic women. Mean ± SD of maternal age was 25.8±5.12 years. Mild anemia was found in 31.1%, moderate in 59.2% and 9.6% women were diagnosed with severe anemia. Anemia was diagnosed in 1.5% of antenatal women in 1st trimester, 54.8% in 2nd trimester and 43.7% in 3rd trimester. Majority of patients were booked (87.4%), out of them 25.9% were diagnosed with mild anemia, 55.6% with moderate and 5.9% were severely anemic, while 12.59% were non-booked of those 5.2% were diagnosed with mild, 3.7 % with moderate and severe anemia each (p-value=0.003%). Maternal complications in antenatal and postnatal period included Preterm labour (13.33%), Pregnancy induced hypertension/ Pre-eclampsia (8.88%), Gestational diabetes mellitus (7.40%), oligohydramnios (11.85%) , antepartum hemorrhage (5.92%) and Postpartum hemorrhage (5.18%). 50.37% of pregnant women delivered vaginally while in 49.62 % abdominal delivery was conducted (Emergency-37 %, Elective -12.6%). Regarding Neonatal outcomes, Low Birth weight was found in 80% of cases which was highly significant, 20.7% were delivered by mildly anemic, 52.6% by moderately and 6.7% by severely anemic mothers (p value- 0.009). NICU admission within the first week of birth was needed in 47.40%, Still Birth (0.74%), Low APGAR scores (20.74%) and unfortunately two Neonatal Deaths occurred as well (1.48%). Conclusion: Antenatal anemia is still a prevalent public health issue in developing countries. Provided that anemia is a straightforward predictor of poor maternal and fetal outcome, intensive prophylactic strategies to be implemented for timely diagnosis and management. The authorities should play their active role in refining policies to remediate the principal risk factors, provision of basic health care, reinforce proper antenatal care, maintain regular availability of iron and supplements for correction of anemia and other nutritional deficiencies. Keywords: Anemia, Maternal and fetal outcome, Obstetric

The Political Economy of the Design of the Basic Health Care Provision Fund (BHCPF) in Nigeria: A Retrospective Analysis for Prospective Action

ABSTRACT Nigeria has instituted health financing reforms in the past, yet Universal Health Coverage (UHC) remains elusive and out-of-pocket spending accounts for over 70% of the country’s total health expenditure. A current reform, the Basic Health Care Provision Fund (BHCPF), was established by the National Health Act of 2014 to increase the coverage of quality basic health services and promote UHC in Nigeria. However, there is limited knowledge of the political economy of health financing reforms in Nigeria and the impact on reform outcomes. This study applied the Political Economy Framework for Health Financing Reforms as described by Sparkes et al. in assessing the political economy of the BHCPF design. The study found that the BHCPF design was considerably influenced by the interplay of stakeholders’ interests. The National Assembly was pivotal in ensuring the first BHCPF appropriation in 2018, and the Minister of Health, using donor-funded support, hastened the early BHCPF design. However, certain design elements were opposed by the legislature, bureaucratic and interest groups, which led to the suspension of the BHCPF and its subsequent redesign, led by bureaucratic groups. This produced changes in the BHCPF utilization, governance, pooling and counterpart funding arrangements, some of which increased the influence of bureaucratic groups and diminished the influence of the health ministry and external actors. These changes have implications for BHCPF implementation subsequently, including reduced accountability, potential stakeholders’ conflicts, and fragmentation in external contributions. Understanding and managing these stakeholders’ dynamics can create an accelerated consensus, minimize obstacles, and efficiently mobilize resources for achieving reform objectives.

The State of Internally Displaced Persons Camps in Nigeria: A Case Study of Durumi Camp in the Federal Capital Territory of Nigeria

This Investigation was conducted among a small group of IDP population living at the heart of Abuja, Federal Capital Territory, which is the capital city of Nigeria. The study was conducted to determine the living conditions of Internally Displaced Persons in the Camp and their access to basic amenities as action research. It was conducted through an unstructured interview of the sampled population in the Camp to source relevant information. Data was collected by taking notes and recording of interview sessions. Results revealed that 2830 individuals live in the camp, mostly in family units. IDPs in the camp come from the Northeast geopolitical zone of Nigeria in the states of Borno, Adamawa, and Yobe, with the majority of them from Borno state. They were all displaced as a result of insurgency. This IDP camp is organized with a leadership structure and defined system for the management of amenities such as the health clinic, water supply, allocation of shelter, and sharing of donated items received from philanthropists, the private sector, and other well-wishers. The camp has running water, a clinic for basic health care provision, a borehole, toilet facilities, a store for foodstuff and a security post within 500 metres to 1 kilometre of the Camp.

Strengthening Capacities of Ward Development Committees to Promote Health in Nigeria: A Case Study of Osun State

Unsatisfactory health indices characterize Osun State Nigeria Primary Health Care facilities and poor operational conditions. Residents patronize private health facilities with attendant payment of huge out-of-pocket medical bills. Implementation of the Basic Health Care Provision Fund (BHCPF), a mechanism to increase access to quality health care for all its citizens initiated by the state government, commenced in 2018. The study sought to determine the extent to which capacity building/training of Ward development committees (WDC) in BHCPF supported PHCs has contributed to the provision of quality health services in the BHCPF supported facilities. The study was qualitative in design and used three focus group discussions held in three BHCPF implementing LGAs with thirty-five (27males, 8 females) consenting trained WDC members. Prior to the BHCPF training, the majority of the WDCs were not actively involved in the management of their PHCs, as political appointees and were unclear about their roles and responsibilities to the health facilities in their wards. After the training, most of the trained WDCs engaged with their PHC staff to debrief, review the quality improvement plans for their health facilities, identified immediate needs to address, approached influential people in the community, and mobilized local resources to address identified gaps. Electricity and water supply were restored in most of the facilities, hospital beds and basic equipment for were procured for PHCs, building, and equipping of the laboratory were completed. Building the capacity of the WDC on their roles and responsibilities strengthened them to contribute to the provision of quality health services in their communities. Keywords: Access, capacity building, quality improvement, Universal Health Coverage, Ward development committees.

Impact of government budget deficits on public health sector output in Nigeria

The study examined the impact of government budget deficits on the public health sector output in Nigeria over a period of 1980 to 2018. The specifically study sought to: investigate the impact of government budget deficits affect the public health sector output in Nigeria, ascertain the impact of external borrowing on the public health sector output in Nigeria and evaluate the impact of domestic borrowing budget deficits financing on the public health sector output in Nigeria. The methods of data analysis range from argument dickey fuller unit root test, Johansen co-integration test and finally error correction method. The following results were the basic findings of the study: (1) government budget deficits have positive insignificant impact on public health sector output in Nigeria (t – statistics (0.5663) < t0.05 (1.684); (2) external borrowing of financing budget deficits has negative insignificant impact on Health sector output in Nigeria (t – statistics (-1.2746) < t0.05 (1.684) and (3) domestic borrowing of financing budget deficits has positive significant impact on Health sector output in Nigeria (t – statistics (2.1711) > t0.05 (1.684). This study concludes that the budget deficits of government have positive insignificant impact on Health sector output in Nigeria because more budget allocations are put in health recurrent government expenditure than health capital expenditure whereas health capital expenditure is the engine of growth in health sector output. The study recommended that the Federal Government should commence and continue to execute the National Health Act. Allocation’s map-out for the Basic Health Care Provision Fund (BHCPF) should be drawn directly from the National Health Act, which is not less than 1% of the Consolidated Revenue (CRF) Fund of the Federation and is to flow from the FG's share of revenue.

Basic health care provision fund project implementation: An assessment of a selected technical skill among mid-level managers of a performance-based financing scheme in Southwest Nigeria

Introduction: Knowledge and skills in quantitative/numerical disciplines are some of the essential skills necessary for sustainable and successful administration and management in financing health care. It is not clear whether the personnel across relevant establishments in the health sector of Nigeria have the requisite capacity to implement and manage a performance-based financing project. This survey assessed the availability of certain technical skills among selected mid-level managers in charge of the implementation of the Basic Health Care Provision Fund Project (BHCPFP). Materials and Methods: Data were collected with the aid of a self-administered questionnaire developed from a review of the project document. A total population of mid-level managers from all the respective ministries was studied across the six states in Southwest Nigeria. Data collection was conducted between February and June 2019. Data analysis was done using SPSS version 22. Frequency tables were generated and charts were constructed. Results: A total of 234 eligible participants were studied. Those who had formal training in quantitative/numerical-based skills such as accounting-related courses were about one-third, 77 (32.8%) and those who had acquired formal training in insurance-related disciplines were 91 (38.7%). A little above one-third, 66 (28.2%) had a form of on-the-job health insurance training. Conclusions: This study showed that mid-level managers had poor quantitative-related skills necessary for administrative and technical roles for implementation of BHCPFP. Mid-level managers should be trained and re-trained on those administrative and technical skills for better implementation of BHCPFP.

Universal Health Coverage

Universal Health Coverage has attracted global attention as an ideal vehicle that will drive health care services to the individuals, families, and communities globally. Good health systems are capable of serving the needs of entire populations, including the availability of infrastructure, human resources, health technologies, and medicines. This study seeks to identify the barriers and challenges which have hindered the provision of basic health care to communities and suggest ways of addressing some of them. Literature search reviewed 40 materials which were more relevant. Results revealed that there have been disparities in the provision of healthcare. Challenges in service provision include; lack of political commitment, weak health system resulting from limited financial allocation and poor leadership, lack of adequate number of skilled human resources, equipment and supplies and poor infrastructures. For UHC to be successful, an effective and well-functioning Primary Health Care (PHC) system is essential. Thus health systems can be strengthened through financial allocation; training of skilled and well-motivated healthcare workers. Also provision of right equipment and supplies, equity in resource distribution, improvement of infrastructures to meet the needs of the people is fundamental.