Gaps In Service Delivery Research Articles

Identifying and addressing extension service delivery gaps: A study on fish farmers of Andhra Pradesh, India

Identifying and addressing extension service delivery gaps: A study on fish farmers of Andhra Pradesh, India

Addressing disparities in the global epidemiology of stroke.

Stroke is the second leading cause of death and the third leading cause of disability worldwide. Though the burden of stroke worldwide seems to have declined in the past three decades, much of this effect reflects decreases in high-income countries (HICs). By contrast, the burden of stroke has grown rapidly in low-income and middle-income countries (LMICs), where epidemiological, socioeconomic and demographic shifts have increased the incidence of stroke and other non-communicable diseases. Furthermore, even in HICs, disparities in stroke epidemiology exist along racial, ethnic, socioeconomic and geographical lines. In this Review, we highlight the under-acknowledged disparities in the burden of stroke. We emphasize the shifting global landscape of stroke risk factors, critical gaps in stroke service delivery, and the need for a more granular analysis of the burden of stroke within and between LMICs and HICs to guide context-appropriate capacity-building. Finally, we review strategies for addressing key inequalities in stroke epidemiology, including improvements in epidemiological surveillance and context-specific research efforts in under-resourced regions, development of the global workforce of stroke care providers, expansion of access to preventive and treatment services through mobile and telehealth platforms, and scaling up of evidence-based strategies and policies that target local, national, regional and global stroke disparities.

Impact of Mobile Medical Units on Anaemia Prevalence and Treatment Adherence in Rural India

Background Anaemia poses a significant health challenge in rural India particularly among women. Limited access to healthcare services exacerbates this issue. Mobile Medical Units MMUs have been introduced to address this gap by providing essential healthcare services to underserved populations. Objective This study investigates the effectiveness of MMUs in reducing anaemia prevalence and improving treatment adherence among women in rural areas of Uttar Pradesh and Jharkhand. Methodology A mixed-methods approach was employed combining quantitative surveys and qualitative interviews. The study surveyed 399 women across four districts Ranchi and Khunti in Jharkhand and Prayagraj and Bahraich in Uttar Pradesh. Data on anaemia prevalence treatment adherence and barriers to accessing MMU services were collected and analyzed. Results The findings revealed a high prevalence of anaemia 88 among the surveyed women with moderate-to-severe anaemia constituting 45. MMUs significantly contributed to treatment adherence with 96 of women following medical advice. However 13.5 of participants received no medication indicating gaps in service delivery. The study also identified barriers such as lack of awareness and inconvenient timing of MMU visits. Conclusion MMUs play a crucial role in addressing anaemia in rural India by improving treatment adherence and reducing anaemia prevalence. However gaps in service delivery and barriers to access need to be addressed. Recommendations include strengthening community engagement improving awareness campaigns and promoting dietary diversification to enhance the effectiveness of MMU interventions.

Sickle cell disease in Cameroon: Taking out the "neglect" and highlighting key opportunities for sustainable control.

Sickle Cell Disease (SCD) is a serious genetic disorder with astounding regional differences in childhood survival. Alarmingly, over 90% of children with SCD in SSA die before their fifth birthday. In Cameroon, approximately 7,000 children are born with SCD annually; however, most of them go undiagnosed until their fourth birthday, resulting into untold pain and suffering. Despite this, little is known about the barriers to optimal care and treatment for SCD in Cameroon. Here, we assess these barriers, and consider opportunities that could be leveraged, for a sustainable control of SCD in Cameroon. We conducted a qualitative study, with documentary analysis of key national and international policy documents related to SCD management in Cameroon; semi-structured interviews; and focus group discussions, used for data collection. Key informants were selected purposively, and met at the central level of the health system (in Yaoundé) and the operational level (Mfou health district). These were policy makers, health workers, parents with SCD children and teenagers with SCD. Several critical gaps exist which hinder SCD control in Cameroon. These include lack of a national sickle cell disease strategy, no proportional allocation of funds for SCD in the national budget, and gaps in service delivery. These are translated into healthcare providers having little knowledge on SCD, absence of SCD-specific indicators in the health information system, challenges accessing essential medicines, and limited awareness raising in communities on SCD. Still, several opportunities exist which could be leveraged for improving SCD care in Cameroon. These include the possibility of integrating SCD screening and care into well-established primary healthcare services like vaccination, antenatal care, and non-communicable disease clinics. In the light of such limited resource settings, considering opportunities for integration in existing health programs could go a long way to reduce morbidities and mortalities from SCD over the coming years.

Inequity of healthcare access for patients with diabetic foot disease: a retrospective study in south-east Queensland

ObjectivesLogan local government area (LGA) in Queensland has the highest diabetes prevalence (6.5%) within Metro South Health (MSH). The study aimed to determine the burden of, and equity of access...

Human Capital and Performance of Kisii and Kakamega County Governments in Kenya

Decentralization in Kenya aimed to reduce bureaucratic delays and improve service delivery by transferring power to sub-national governments. Yet, governance challenges persist mainly due to unqualified staff, nepotism, cronyism, among others. The Kenya Institute for Public Policy Research and Analysis found 32% of county governments staff lack the required qualifications for their roles, leading to inefficiencies and service delivery gaps. Despite these concerns, no empirical research has explored the influence of human capital on the performance of Kisii and Kakamega county governments. This study addresses this gap by assessing the effect of human capital on performance of Kisii and Kakamega counties in Kenya. The study adopts a positivism research philosophy and a cross-sectional survey research design. The target population comprised of Chief officers, Directors and Assistant Director at various ministries, sub-county administrators and Members of County Assembly (N=325). To arrive at a statistically sound sample size, the study adopted the Yamane (1967) formula for sample size determination, which gives a sample size of 136 for Kakamega County and 92 for Kisii County (n=228). Given that the study is quantitative in nature, it adopts structured questionnaires in data collection, which were distributed using online platform (Google Forms). In data analysis, Stata version 17 was used to compute descriptive statistics (mean and standard deviation) and inferential statistics (Pearson correlation and univariate linear regression). Data was presented in prose form and visualized using tables and figures. Findings from the test of hypothesis using simple linear regression indicate that human capital has a statistically significant effect on performance (p<.05). Results revealed that human capital has a moderate positive association with performance, 𝑟 (191) =0.486, 𝑝<.05. It is recommended that the County Governments of Kisii and Kakamega should improve human capital by implementing performance contracting, eliminating political patronage, and investing in innovation infrastructure. Additionally, county governments should develop well-documented SOPs, ensure regular employee training, and embrace public participation to align policies with citizens’ needs.

Bridging the Gap: Oral Health-care Delivery Plan in Tribal Belt of Western India

Abstract Background: India has launched many initiatives to achieve Universal Health Coverage, despite there exist gaps in oral health-care need and service delivery. Especially in tribal areas, due to the prevalence of risk factors as well as the lack of accessibility and affordability for health-care services, oral diseases remain unidentified and untreated. Therefore, the present study aims to assess the needs and design an implementation plan for sustainable and culturally acceptable oral health-care delivery in one of the tribal blocks of Mokhada in the state of Maharashtra, Western India. Methodology: The study included participants above 18 years of age and adopted a co-design approach. Data collection methods consisted of a short-form survey and focused group discussion. Convenient and purposive sampling methods were used to select participants for quantitative and qualitative data collection, respectively. Quantitative data analysis was performed using the STATA 16 tool, whereas thematic analysis was performed for the qualitative data. Need assessment led to the design of implementation by engaging multiple stakeholders. Results: A total of 2008 adults participated in the survey with a mean age being 37.7 years. 52.4% of participants were male. Out of 2008 screened, 83.2% were found to have at least one oral disease and a high prevalence of tobacco consumption (42%). Barriers of oral healthcare-seeking behaviour were addressed in the proposed model of care. Accordingly, a twice-a-week functional comprehensive oral care health-care model was integrated into the already existing health center of a community led development organization and portable mobile dental unit were planned with the support of multiple stakeholders. Conclusion: The study demonstrates the feasibility of delivering oral healthcare through integration into primary healthcare and multiple stakeholder engagement.

“I DON’T KNOW WHO GETS MORE OUT OF IT”: OLDER ADULTS’ EXPERIENCES WITH THE ONLINE INTERGENERATIONAL TUTORING PROGRAM

Abstract Due to pandemic-related academic and social stressors experienced by children and social isolation and loneliness experienced by older adults, a team of school psychologists and gerontologists collaborated with older adults to develop the Online Intergenerational Tutoring Program. Conceived in fall 2020, the program is now in its third year of implementation. The program addresses a service delivery gap in schools because older adult volunteers expand schools’ capacity to implement reading instruction with students in need of support. Older adults share their time and talents with young children and children benefit from the care, attention, and instruction from older adults. Tutors meet with students after school 3-4 times per week over a 6–8-week period over Zoom; each of the 24 sessions last 30 minutes. Evaluation data show the program is socially valid, tutors deliver instruction with accuracy, students have high engagement, and there are literacy gains among students.

The perceived benefits and effectiveness of patient feedback systems in strengthening patient-provider relationships in Rural Tanzania

IntroductionPatient feedback system (PFS) forms an important entry point for the medical personnel and healthcare administrators to identify healthcare service delivery gaps and develop responsive interventions. This may foster patient trust consequently increasing healthcare-seeking, engagement in decision, continuity, and satisfaction. However, research on the PFS in rural primary healthcare settings appears limited.ObjectiveThe paper examines the perceived role and effectiveness of PFS in improving therapeutic relationships building on the recent research on patient-provider relationships in rural Tanzania.MethodsThe paper examines the findings of qualitative descriptive research conducted in the Shinyanga Region which employed a human-centred design (HCD) approach to co-create an intervention package for improving nurse-client relationships between January and September 2022. The study used semi-structured interviews in Swahili to first explore drivers of poor provider-patient relationships with purposefully selected providers, patients, and administrators. The findings guided the co-designing of an intervention package in subsequent HCD steps. Interviews were concurrently translated and transcribed, then systematically coded to facilitate the development of themes using a deductive thematic analysis approach.ResultsPFS emerged as one of the key themes in the deductive analysis when examining factors shaping provider–client relationships. The PFS theme was characterized by three major subthemes, which included perceived benefits, availability and accessibility, and perceived effectiveness. The perceived benefits of PFS cited by most participants included: reducing patients’ confusion around the complaints process, promoting patients’ positivity towards providers and hospitals, and reducing tensions between patients and providers. Suggestion boxes (SBs) were the most frequently cited PFS, but there were widespread concerns and disagreements among participants about their accessibility and effectiveness. Despite the providers (nurses) and administrators describing SBs as widely available, they stated that they had not received feedback or complaints from patients for a very long time. In contrast, most patients stated that SBs were either unavailable or ineffective in many facilities, with concerns about non-user friendliness and lack of responsiveness as the main issues when discussing effectiveness.ConclusionDespite the many benefits of PFS in improving healthcare service quality, their availability, user-friendliness, and responsiveness still pose challenges. A call is made to providers, health administrators and researchers to prioritize the PFS as both a useful entry point to reducing tensions in therapeutic relationships and, a tool for improving patient service uptake, continuity of care and satisfaction.

Developing consensus-based oncology financial advocacy services guidelines.

38 Background: Financial advocacy interventions help patients, and their families address financial hardship experienced through the cancer journey. However, how financial services are offered to patients varies greatly. Across the field of financial advocacy there is a lack of standardization of services, which is needed to accurately evaluate the impact of oncology financial advocacy. The Association of Community Cancer Centers (ACCC) Financial Advocacy Network (FAN) set out to revamp the Financial Advocacy Services Guidelines originally published in 2018, with the goal of providing cancer programs direction in implementing and improving financial advocacy services offered to patients with cancer. Methods: ACCC convened a task force of 7 multidisciplinary financial advocacy experts to guide the process of creating consensus-based financial advocacy services guidelines. The task force assembled a panel of 49 diverse oncology financial advocacy experts. A literature review and input from panelists was used to draft a list of guideline statements. Panelists went through 2 rounds of anonymous voting to inform revisions to the guideline statements. Consensus for the guideline statements was set at 75% agreement. The statements were rated as should not be a guideline, minimum guideline, or enhanced guideline. Cancer program staff completed a questionnaire upon downloading the guidelines. Results: After completion of the 2 rounds, the panel reached consensus that 43 statements should be guidelines. The guidelines are split into three main domains: financial advocacy services & functions; program management functions; and partner engagement functions. The updated Guidelines, which provide cancer organizations with the foundation to implement services to help reduce financial burdens of care, were published in March 2023 and are publicly available. From March 2023 until June 2023, it was downloaded by 93 cancer program staff members, of which 74% stated they will use it to assist in the development, implementation, and/or enhancement of a formal advocacy program at their organization and 58% responded that they have a financial advocacy program already implemented or have a financial advocate on staff. Conclusions: As financial advocacy grows more complex, interventions for patients with cancer are vital. The Guidelines provide expert-developed and consensus-based methods to assist cancer organizations with implementing financial intervention services. Importantly, the newly published guidelines will aid in closing existing gaps in delivery of oncology financial services as 48% of respondents stated they do not have a financial advocacy program or staff member. Further it will promote broader collaboration among partners to aid with assessment tools, creating valid measures and rigorous evaluation of the guidelines to improve cancer patients’ experience and reduce financial barriers to care.

Foreign Aid, Decentralization, Local Governance and Service Delivery in Local Governments: A Case Study of Rumbek Central County South Sudan

The study focused on foreign aid, decentralization, and local administration to examine the gap in service delivery in Rumbek County, South Sudan. The study's goals were to investigate the connections between foreign assistance and service provision, the connections between foreign assistance, local governance, and service provision, and the study factor structure between foreign assistance, decentralization, local governance, and service provision. The study population consisted of 75,000 respondents, and the research style was a case study and descriptive research design. It used both qualitative and quantitative methodologies to gather data from this population. The sample of 382 respondents was chosen using simple random sampling. Only 352 were considered for analysis. The descriptive analysis option of SPSS version 20.0 was used to analyze the data before it was presented using Spearman's correlation, multiple regression, and factor structure loadings to show the relationship and prediction for international aid, decentralization, local governance, and service delivery, respectively. The major findings of the study were that there is a significant positive correlation between; foreign aid and service delivery (r = 0.728, P-value < 0.01), decentralization and service delivery (r = 0.544, P-value < 0.01), local governance and service delivery (r = 0.776, P-value < 0.01) and foreign aid, decentralization and local governance influenced 62.9% the level of service delivery. The study suggests that the county implements control measures to guarantee that funds are used for the proper purposes in the counties because research revealed that services were not worth the district budget. Adequate research should be conducted at the community level to identify services needed by the people to draw sufficient budgets for the implementation of foreign aid, decentralization, and local government.

Crisis center, youth MH program address gaps with key stakeholder support

Fulfilling gaps in mental health service delivery and care, while collaborating with state, payer and stakeholders, are at the heart of a Minneapolis‐based organization's mission to understanding what its community needs and wants and offering creative solutions to address those needs.

Professionalization of Public Service Delivery in the Southern African Region

Background: Public service delivery in Africa has been hijacked by politicians who want to advance their political interests and deploy people, not based on how they can contribute to public service delivery. Most countries in Africa have been classified as corrupt states because of corrupt public officials.
 
 Purpose: The purpose of this article is to show the importance of professionalizing public service delivery by ensuring that the public servants in Africa put the citizens first.
 
 Objective: The objective of this article is to provide suggestions on how African governments can professionalize public service delivery. Public servants should not see their employment as means of their survival to earn a salary but as a calling to serve the people.
 
 Research methodology: The study collected the existing data that is related to public service delivery in the countries of the Southern African region. Secondary data was collected to reach the findings and conclusions of this study.
 
 Results: The study found that the existing gap in public service delivery in Africa is based on public servants themselves not owning up to their responsibilities, they need to offer the services to the public the same way they would expect the public services to be delivered to them.
 
 Conclusion: The focus of this article is not on the processes and documentation required by public servants to be seen as professional individuals but the focus is on the existing gap.

Community health needs in Ukraine in the war context

Abstract The full-scale russia's invasion in Ukraine caused the migration of people, partially destroyed the medical infrastructure, disrupted access to services, so there is a need to connect people tocare. The e-tools allow to monitor the capacities of the healthcare system and utilization of services. However, there is insufficient data on the population's needs. The CHNA was conducted in March-May 2023 in 16 communities across 8 regions of Ukraine. It was based on the adapted methodology of the Philadelphia Healthcare Federation and applied the following research methods: statistical analysis of the operating PHC facilities, availability of medical staff, and current gaps in service delivery; structured survey of the community residents; FGDs with community decision makers and residents; in-depth interviews with heads of PHC facilities. The assessment results demonstrated limited access to healthcare services in remote settlements, and thus the need to develop new formats of healthcare provision. The study showed a difference in the perception of PHC services accessibility between decision makers and the population. The biggest need identified was for MHPSS services for IDPs and local residents. CHNA is critical to inform programming. To improve access to essential services, the USAID Public Health System Recovery & Resilience project will support new approaches to PHC service delivery, including through mobile teams and task shifting to expand the role of nurses. To increase availability of MHPSS services, the project builds the capacity of the workforce and supports the delivery of evidence-based interventions such as mhGAP, CETA, Selfhelp+, CBT. Key messages • The developed CHNA is an effective tool for decision-makers to understand the main gaps in the availability of health services and to develop targeted interventions, especially in times of war. • Community-based MHPSS interventions are critical in time of war.

Corrigendum to: Optimising the delivery of sexual health services in Australia: a qualitative study.

With a rise in sexually transmitted infections in Australia, it is important to evaluate and optimise current sexual health services to reduce barriers to access and increase testing. We aimed to describe the range of sexual health services in Australia, focusing on strategies to improve testing among priority populations, and any future strategies participants believed would improve service delivery. We conducted 20 semi-structured interviews with key informants working in Australian sexual health services from July to December 2020, and collected data on service characteristics and strategies to improve access. We used content analysis, then coded and categorised the data into recurring themes and sub-themes. We identified two major themes: 'Expanding Traditional Service Delivery' and 'Thinking Outside the Box'. The first theme outlines strategies that build upon pre-existing service delivery models, such as express clinics and an increased focus on confidentiality. The second theme outlines new strategies introduced to fill gaps in service delivery, such as self-testing and outreach. To improve access to HIV/STI testing, there is a need for multiple access points to cater for a range of populations and their preferences. Establishing strategies to accomplish this involves utilising a combination of expanding traditional service models and implementing new approaches to service delivery.

Refinement pathway for quality research interview guides: an 8-step process to refine a protocol for a complex multi-country humanitarian study

The protracted conflict in the North West and South West regions of Cameroon, and the North East states of Nigeria, has led to the closure of 29% and 26% of the health facilities, respectively. This has caused the displacement of over 2.21 million persons internally and 350,000 returnees in both countries. In turn, this has created a massive gap in service delivery, prompting humanitarian organisations and the government to use different models of primary health care delivery to affected communities. As part of a larger study, we developed and piloted the interview guides for the qualitative arm of the project since we found none exist for conflict-affected countries to orientate how to navigate the complexities of conducting quality qualitative research in fragile and challenging operating environments. Piloting interviews is important for the reliability of the interview guides to obtain good quality data from interviews. We present an eight-step process for piloting qualitative studies in multiple conflict-affected settings. These includes the development of interview guides, expert consultation, translation of interview guides, risk assessment/mobilisation, recruitment of participants, piloting interviews, modifying interview guides, reflecting on the process and reporting the pilot results.

Health and Social Determinants Associated With Delay of Care Among Community-Dwelling Rural Older Adults.

Delaying health care has the capacity to increase morbidity and premature mortality among individuals with chronic and acute health conditions, particularly for those living in rural areas. The objective of this study was to identify social determinants of health that are associated with delay of care (DOC) among older adults residing in rural areas across the inland northwest. We conducted descriptive, bivariate, and regression analyses using data from a needs assessment designed to identify health needs and service delivery gaps among an economically diverse 8-county region. Most respondents (aged 60+ years) were white, female, with health insurance coverage (n = 1226, mean = 71). Overall, 35% experienced DOC. We used logistic regression to determine the influence of age, sex, health conditions, distance from medical facility, income, and perceived quality of neighborhood on DOC. Individuals with younger age ( P = .017), more chronic conditions ( P < .001), lower income ( P < .001), and lower perceived quality of neighborhood ( P = .008) were more likely to experience DOC. These findings highlight risk factors associated with DOC, which can inform prevention efforts championed by community-based organizations, health care providers, and policy makers. Future research is needed to investigate compounding long-term effects of DOC, especially among individuals living in rural areas.

Balancing Economic Sustainability with Densification: A Case Study of Dhaka

Economically sustainable urban residential neighborhoods are characterized by adequate provision of physical infrastructure including transport facilities and utility services. The built urban fabric of residential areas of Dhaka has been undergoing densification operation over the past decades without considering the physical infrastructure capacity of these areas in terms of accessibility and provision of transportation and utility services. This intervention eventually exerted pressure on the existing infrastructure and caused negative externalities like traffic congestion, pollution, and water clogging. Thus, this paper aims to investigate the impact of densification on residential areas of Dhaka through the lens of economic sustainability. Seven residential areas from Old and New Dhaka that underwent various degreesof densification were selected as the study areas. Primary data was collected through a random sampling household questionnaire survey, fieldwork, and informal qualitative interviews with the residents and officials. Various published literature, newspaper articles, plans, and reports from government archives, Capital Development Authority (RAJUK), Dhaka South City Corporation (DSCC), and Dhaka North City Corporation (DNCC) provided the secondary data. The analysis is carried out in two parts. In the firstpart the impact of densification on accessibility to transportation facilities and utility services is analyzed in terms of availability of the services, distance to the bus stops, average travel time, modal choice, and residents’ satisfaction level. The second part explores the relationship between density and aspects of economic sustainability through Pearson’s correlation test. The findings revealed that public transportation is more accessible in lower-density areas than the higher-density residential areas owing to the road network pattern. A significant service delivery gap except for water supply was observed regarding the provision and quality of gas, electricity, sewerage, and garbage disposal services across all the study areas. Overall, density was found to have a negative association with the accessibility to physical infrastructures indicating that high-density residential areas of Dhaka do not have increased access to public transport and utility services which is contrary to the expected benefits of high-density living. A comprehensive density planning with an integrated sustainable transport plan needs to be formulated where viable public transport like Bus Rapid Transit (BRTs) systems and waterways may mitigate the situation from further worsening.

Successes and challenges of primary health care in Australia: A scoping review and comparative analysis.

Australia has achieved universal health insurance for its population since 1975 - a major step forward for increasing access to primary care (PC). Nevertheless, there are reports of several multi-layered challenges, including inequity, that persist. This analysis aims to undertake a scoping review of the success, explanatory factors, and challenges of Primary Health Care (PHC) in Australia guided by the World Health Organization (WHO)-defined key characteristics of good PC. We searched PubMed, Embase, Scopus and Web of Science using key terms related to PHC principles, attributes, system functioning and health care delivery modalities. We also used key PC terminologies used to assess key characteristics of good PC developed by WHO and key terms and attributes from Australia's health care landscape. We then integrated our search terms with the PHC Search Filters developed by Brown, L., et al. (2014). We restricted the search from 2013 to 2021. Two authors independently assessed study eligibility and performed a quality check on the extracted data. We presented findings according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We identified 112 articles on primary health care (PHC), represented from all Australian states and territories. Overall, Australian PHC has achieved comprehensiveness, access and coverage, quality of care, patient / person centeredness and service coordination indicators with exemplary evidence-base practice/knowledge translation and clinical decision-making practices at the PC settings. Yet, we identified complex and multilayered barriers including geographic and socio-economic berries and inequality, staff dissatisfaction/turn over, low adoption of person-centred care, inadequate sectoral collaboration, and inadequate infrastructure in rural and remote primary care units. Primary health care in Australia, which has evolved through major reforms, has been adapting to the complex health care needs of the socio-culturally diversified nation, and has achieved many of the PC attributes, including service diversity, accessibility, acceptability, and quality of care. Yet, there are persistent gaps in service delivery to socio-economically disadvantaged populations, including indigenous people, culturally and linguistically diverse (CALD) populations, and rural- and remote-residents. These challenges could be mitigated through system-wide and targeted policy-level intervention to further improve service delivery through effective and functional local health service coordination, sectoral integration, and improving health care providers' cultural competence.

Contextual factors influencing the roles of patent medicine vendors in the provision of injectable contraception services in Nigeria

BackgroundPatent medicine vendors (PMVs) play vital roles in the delivery of family planning services in Nigeria and other developing countries. There is a growing recognition of the need to integrate them into the formal health care system as a strategy to increase the contraceptive prevalence rate and achieve universal health coverage. Though promising, the success of this proposition is largely dependent on a critical analysis of the factors which influence their operations. This study was designed to identify the contextual factors influencing the provision of injectable contraceptive services by PMVs and the broader effects of their activities on the health system to inform similar interventions in Nigeria.MethodsThis was a qualitative study guided by the UK Medical Research Council’s Framework for Complex Interventions. Twenty-seven in-depth interviews were conducted among officials of the association of PMVs, health workers, government regulatory officers and programme implementers who participated in a phased 3-year (2015–2018) intervention designed to enhance the capacity of PMVs to deliver injectable contraceptive services. The data were transcribed and analyzed thematically using NVIVO software.ResultsThe contextual factors which had implications on the roles of PMVs were socio-cultural and religious, the failing Nigerian health system coupled with government regulatory policies. Other factors were interprofessional tensions and rivalry between the PMVs and some categories of health care workers and increasing donors’ interest in exploring the potentials of PMVs for expanded healthcare service provision. According to the respondents, the PMVs bridged the Nigerian health system service delivery gaps serving as the first point of contact for injectable contraceptive services and this increased contraceptive uptake in the study sites. A negative effect of their operation is the tendency to exceed their service provision limits, which has spurred a planned tiered PMV accreditation system.ConclusionsThis study has highlighted the contextual factors which define the roles and scope of practice of PMVs involved in injectable contraceptive service provision. Strategies and interventions aimed at expanding the healthcare delivery roles of PMVs must be encompassing to address the broader contextual factors which underpin their capacities and functions.