OpenUCT :: Browsing by Subject "Nigeria"

Browsing by Subject "Nigeria"

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Open Access
Accountability mechanisms for implementing a health financing option: the case of the basic health care provision fund (BHCPF) in Nigeria
(BioMed Central, 2018-07-11) Uzochukwu, Benjamin; Onwujekwe, Emmanuel; Mbachu, Chinyere; Okeke, Chinyere; Molyneux, Sassy; Gilson, Lucy
Background The 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. Methods National, 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). Results In 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. Conclusion The 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.
Open Access
Assessing computational genomics skills: Our experience in the H3ABioNet African bioinformatics network
(2017) Jongeneel, C Victor; Bendou, Hocine; Chimusa, Emile; Drnevich, Jenny; Falola, Oluwadamila; Fields, Christopher J; Hazelhurst, Scott; Hendry, Liesl; Isewon, Itunuoluwa; Kimuda, Magambo Phillip; Mainzer, Liudmila Sergeevna; Maslamoney, Suresh; Meintjes, Ayton; Munthali, Richard; Odia, Trust; Pillay, Venesa; Mulder, Nicola
The H3ABioNet pan-African bioinformatics network, which is funded to support the Human Heredity and Health in Africa (H3Africa) program, has developed node-assessment exercises to gauge the ability of its participating research and service groups to analyze typical genome-wide datasets being generated by H3Africa research groups. We describe a framework for the assessment of computational genomics analysis skills, which includes standard operating procedures, training and test datasets, and a process for administering the exercise. We present the experiences of 3 research groups that have taken the exercise and the impact on their ability to manage complex projects. Finally, we discuss the reasons why many H3ABioNet nodes have declined so far to participate and potential strategies to encourage them to do so.
Open Access
Assessing the palliative care needs of elderly patients seen at the University College Hospital, Ibadan, Nigeria
(2020) Omoyeni, Eunice Nkechi; Gwyther, Elizabeth; Soyannwo, Olaitan A
Background Nigeria, with a population growth rate (2000-2005) of 2.5% and with 5% of the total population aged 60 years and above, has the potential for a rapid growth rate of the older population in coming years.1 The implication of this in a country with large population as reported by the National Population Census 2006, limited number of health care professionals and care homes, is difficulty in meeting the various needs of the elderly, hence, the importance of identifying the palliative care needs of the elderly. Aim The study was set out to assess the palliative care needs of and provision of care to elderly patients seen in the selected clinics of the University College Hospital, Ibadan, Oyo state, Nigeria. Objectives 1. To describe characteristics of elderly patients seen in the selected clinics. 2. To explore the current use of the hospital palliative care team in the care of geriatric patient. 3. To explore the current use of the hospital palliative care team in the care of geriatric patient. Methods A descriptive cross-sectional study was conducted over a 3-month period using an interviewer administered questionnaire after full consent was given by participants. The questionnaire was a combination of the Africa Palliative Care Outcome Scale (APCA-POS), the Edmonton Symptom Assessment Scale (ESAS) and Hope Spiritual Assessment Tool. Demographic information regarding gender, age, nationality, abode and referral to the Care Centre was obtained. Scaled questions from selected tools were ticked with respect to physical, psychosocial and spiritual needs and expectations of palliative care. The validated data collection tools (APCA-POS, ESAS, HOPE) were used in the questionnaire. Ethical approval was obtained from the relevant organizations. Data was analysed using IBM SPSS statistics 21. Results 424 participants completed the questionnaire and most patients (330; 77.8%) were recruited from the geriatric wards with a 2:1 female to male ratio. Most participants fell in the 60 -69 year-old age group. The most common symptom was pain in 240 patients with moderate pain in single or multiple areas. A high percentage (45.8%) were moderately worried about their disease condition and only 66 out of 422 freely discussed this feeling with their family members. Other symptoms observed were nausea, vomiting, constipation and loss of appetite. Conclusion The study showed the palliative care needs of the elderly and calls for collaboration between the palliative care team and the physicians in the geriatric unit for better management of the needs of the elderly.
Open Access
Assessing the palliative care needs of end stage kidney disease patients in a tertiary hospital in Nigeria
(2022) Adebayo, Adetayo Jolade; Namane, Mosedi; Samuel Ajayi
Background: Worldwide, end-stage kidney disease (ESKD) is associated with high morbidity and mortality. Currently, the incidence of ESKD in Nigeria is about 1.6% -12.4% and is higher amongst 25-45 year-olds, implying that ESKD indirectly affects the economic productivity of the nation negatively. ESKD is a condition that may progresses rapidly from a chronic to a terminal phase and is responsible for about 2-3% of all hospital admission worldwide while in Nigeria the proportion of admissions is as high as 10%. This high symptom and disease burden of ESKD warrants implementation of a palliative care program that is able to assess and manage the needs of patients with this condition and to support their families. Methods: A descriptive study was undertaken to assess the palliative care needs of patients. A random sample of 110 ESKD patients attending University College Hospital (UCH) Ibadan were interviewed using published standardized and validated questionnaire over a period of 3-months. The questionnaire was a combination of the Integrated Palliative Outcome Scale-Renal Patient Version (IPOS-R) and Hope Spiritual Assessment Tool (HOPE). The socio-demographic characteristics comprising of gender, age, place of residence and knowledge of palliative care were determined. IPOS-R was used to explore the patients' symptom-burden, psychological and social palliative care needs and quality of life while the HOPE was used to explore patients' spiritual needs. Ethical approval was obtained from the relevant organizations. Data was analyzed using the IBM SPSS version 23.0. Results: More than half of the participants (57%) were female, 92% had co-morbidities, 86% had formal education, 60% were self-employed and their median age was 43.5years. Half (51%) reported experiencing severe symptoms and poor quality of life. More than half (50%) of the patients complained of shortness of breath, pain, general body malaise, sore mouth, restless with more than 80% reporting nausea, poor appetite, difficulty in sleeping and weakness. Fifty-three percent reported experiencing anxiety most of the time and reported that their families and friends were worrying about them. The majority (98%) said their source of hope was God. Most patients (93%) said they were not aware of palliative care medicine. Conclusion: There is a huge need for palliative care for patients with ESKD in Nigeria. This study has developed a framework that can be used by a palliative care team, in collaboration with nephrologists, to provide a person-centered care for these patients and their families.
Open Access
Blood pressure gradients and cardiovascular risk factors in urban and rural populations in Abia State South Eastern Nigeria using the WHO STEPwise approach
(Public Library of Science, 2013) Okpechi, Ikechi Gareth; Chukwuonye, Innocent Ijezie; Tiffin, Nicki; Madukwe, Okechukwu Ojoemelam; Onyeonoro, Ugochukwu Uchenna; Umeizudike, Theophilus Ifeanyichukwu; Ogah, Okechukwu Samuel
BACKGROUND: Developing countries of sub-Saharan Africa (SSA) face a double burden of non-communicable diseases (NCDs) and communicable diseases. As high blood pressure (BP) is a common global cardiovascular (CV) disorder associated with high morbidity and mortality, the relationship between gradients of BP and other CV risk factors was assessed in Abia State, Nigeria. METHODS: Using the WHO STEPwise approach to surveillance of chronic disease risk factors, we conducted a population-based cross-sectional survey in Abia state, Nigeria from August 2011 to March 2012. Data collected at various steps included: demographic and behavioral risk factors (Step 1); BP and anthropometric measurements (Step 2), and fasting blood cholesterol and glucose (Step 3). RESULTS: Of the 2983 subjects with complete data for analysis, 52.1% were females and 53.2% were rural dwellers. Overall, the distribution of selected CV disease risk factors was diabetes (3.6%), hypertension (31.4%), cigarette smoking (13.3%), use of smokeless tobacco (4.8%), physical inactivity (64.2%) and being overweight or obese (33.7%). Presence of hypertension, excessive intake of alcohol, smoking (cigarette and smokeless tobacco) and physical inactivity occurred more frequently in males than in females (p<0.05); while low income, lack of any formal education and use of smokeless tobacco were seen more frequently in rural dwellers than in those living in urban areas (p<0.05). The frequency of selected CV risk factors increased as BP was graded from optimal, normal to hypertension; and high BP correlated with age, gender, smokeless tobacco, overweight or obesity, annual income and level of education. CONCLUSION: Given the high prevalence of hypertension in this part of Nigeria, there is an urgent need to focus on the reduction of preventable CV risk factors we have observed to be associated with hypertension, in order to effectively reduce the burden of NCDs in Africa.
Open Access
The challenge of bridging the gap between researchers and policy makers: experiences of a Health Policy Research Group in engaging policy makers to support evidence informed policy making in Nigeria
(BioMed Central, 2016-11-04) Uzochukwu, Benjamin; Onwujekwe, Obinna; Mbachu, Chinyere; Okwuosa, Chinenye; Etiaba, Enyi; Nyström, Monica E; Gilson, Lucy
Background: Getting research into policy and practice (GRIPP) is a process of going from research evidence to decisions and action. To integrate research findings into the policy making process and to communicate research findings to policymakers is a key challenge world-wide. This paper reports the experiences of a research group in a Nigerian university when seeking to ‘do’ GRIPP, and the important features and challenges of this process within the African context. Methods: In-depth interviews were conducted with nine purposively selected policy makers in various organizations and six researchers from the universities and research institute in a Nigerian who had been involved in 15 selected joint studies/projects with Health Policy Research Group (HPRG). The interviews explored their understanding and experience of the methods and processes used by the HPRG to generate research questions and research results; their involvement in the process and whether the methods were perceived as effective in relation to influencing policy and practice and factors that influenced the uptake of research results. Results: The results are represented in a model with the four GRIPP strategies found: i) stakeholders’ request for evidence to support the use of certain strategies or to scale up health interventions; ii) policymakers and stakeholders seeking evidence from researchers; iii) involving stakeholders in designing research objectives and throughout the research process; and iv) facilitating policy maker-researcher engagement in finding best ways of using research findings to influence policy and practice and to actively disseminate research findings to relevant stakeholders and policymakers. The challenges to research utilization in health policy found were to address the capacity of policy makers to demand and to uptake research, the communication gap between researchers, donors and policymakers, the management of the political process of GRIPP, the lack of willingness of some policy makers to use research, the limited research funding and the resistance to change. Conclusions: Country based Health Policy and Systems Research groups can influence domestic policy makers if appropriate strategies are employed. The model presented gives some direction to potential strategies for getting research into policy and practice in the health care sector in Nigeria and elsewhere.
Open Access
Characterization of methicillin-susceptible and -resistant staphylococci in the clinical setting: a multicentre study in Nigeria
(BioMed Central Ltd, 2012) Shittu, Adebayo; Oyedara, Omotayo; Abegunrin, Fadekemi; Okon, Kenneth; Raji, Adeola; Taiwo, Samuel; Ogunsola, Folasade; Onyedibe, Kenneth; Elisha, Gay
BACKGROUND: The staphylococci are implicated in a variety of human infections; however, many clinical microbiology laboratories in Nigeria do not identify staphylococci (in particular coagulase negative staphylococci - CNS) to the species level. Moreover, data from multi-centre assessment on antibiotic resistance and epidemiology of the staphylococci are not available in Nigeria. This study investigated 91 non-duplicate staphylococcal isolates obtained from the microbiology laboratories of eight hospitals in Nigeria during the period January to April 2010. METHODS: Identification and antibiotic susceptibility testing was performed using the VITEK 2 system, detection of resistance genes by PCR, and molecular characterization was determined by SCCmec typing, spa and multilocus sequence typing (MLST). RESULTS: All the isolates were susceptible to mupirocin, tigecycline, vancomycin and linezolid, but 72.5% of CNS and 82.3% of Staphylococcus aureus were resistant to cotrimoxazole, while multiresistance was observed in 37 of the 40 CNS isolates. Untypeable SCCmec types (ccrC/Class A mec and ccr-negative/Class C2 mec gene complex) in two methicillin-resistant S. aureus (MRSA) were identified. Additionally, ccr-negative/Class A mec and ccr type 4/Class C2 mec gene complex was detected in one isolate each of S. sciuri and S. haemolyticus, respectively. The S. aureus isolates were classified into 21 spa types including two new types (t8987, t9008) among the methicillin-susceptible S. aureus (MSSA) isolates. Two (CC8-SCCmecnon-typeable and CC88-SCCmec IV) and four (CC8-SCCmec III/IV/V; CC30-SCCmec II/III; CC88-SCCmec IV; and ST152-SCCmecnon-typeable) MRSA clones were identified in Maiduguri (North-East Nigeria) and South-West Nigeria, respectively. The proportion of Panton-Valentine leukocidin (PVL)-positive MSSA was high (44.4%) and 56.3% of these strains were associated with sequence type (ST) 152. CONCLUSIONS: The identification of multiresistant mecA positive S. haemolyticus and S. sciuri from clinical samples indicates that characterization of CNS is important in providing information on their diversity and importance in Nigeria. There is the need to develop new SCCmec classification methods for non-typeable methicillin-resistant staphylococci, and to curtail the spread and establishment of the S. aureus ST152 clone in Nigeria. The study presents the first report of a PVL-positive ST152-SCCmecnontypeable MRSA and SCCmec typing of methicillin-resistant CNS in Nigeria.
Open Access
Corruption, governance performance and political trust in Nigeria
(2004) Alemika, Etannibi
This paper analyses Nigerian citizen perception of (a) democracy and the economy; (b) the performance of their civilian government, and (c) extent of corruption in public institutions and by elected officials and public officers. It also examines the effects of corruption and governance performance on the approval of and trust in Nigeria’s political institutions. The analysis is based on the round 2 version of the Afrobarometer survey and employs descriptive analysis, factor analysis, scale item reliability analysis as well as OLS multiple regression analysis. Key findings show that one-half of the respondents preferred a market economy while a third preferred a government-run economic system. More than two thirds preferred democratic governance, while more than one-half agreed that the national constitution expresses the values and hopes of the Nigerian people. Generally, findings show that trust in public institutions is low and that political approval and trust are primarily influenced by how government performs in the arenas of socio-economic management and civil rights protection.
Open Access
Economic burden of heart failure: investigating outpatient and inpatient costs in abeokuta, southwest Nigeria
(Public Library of Science, 2014) Ogah, Okechukwu S; Stewart, Simon; Onwujekwe, Obinna E; Falase, Ayodele O; Adebayo, Saheed O; Olunuga, Taiwo; Sliwa, Karen
Background: Heart failure (HF) is a deadly, disabling and often costly syndrome world-wide. Unfortunately, there is a paucity of data describing its economic impact in sub Saharan Africa; a region in which the number of relatively younger cases will inevitably rise. Methods: Heath economic data were extracted from a prospective HF registry in a tertiary hospital situated in Abeokuta, southwest Nigeria. Outpatient and inpatient costs were computed from a representative cohort of 239 HF cases including personnel, diagnostic and treatment resources used for their management over a 12-month period. Indirect costs were also calculated. The annual cost per person was then calculated. Results: Mean age of the cohort was 58.0±15.1 years and 53.1% were men. The total computed cost of care of HF in Abeokuta was 76, 288,845 Nigerian Naira (US$508, 595) translating to 319,200 Naira (US$2,128 US Dollars) per patient per year. The total cost of in-patient care (46% of total health care expenditure) was estimated as 34,996,477 Naira (about 301,230 US dollars). This comprised of 17,899,977 Naira- 50.9% ($US114,600) and 17,806,500 naira −49.1%($US118,710) for direct and in-direct costs respectively. Out-patient cost was estimated as 41,292,368 Naira ($US 275,282). The relatively high cost of outpatient care was largely due to cost of transportation for monthly follow up visits. Payments were mostly made through out-of-pocket spending. Conclusion: The economic burden of HF in Nigeria is particularly high considering, the relatively young age of affected cases, a minimum wage of 18,000 Naira ($US120) per month and considerable component of out-of-pocket spending for those affected. Health reforms designed to mitigate the individual to societal burden imposed by the syndrome are required.
Open Access
Essays on institutional evolution and economic development: evidence from Nigeria
(2015) Fadiran, David Oluwatosin; Sarr, Mare
The important role of institutions is relatively agreed on within the growth literature, with most empirical evidence pointing towards a positive influence of institutions on economic growth. However, empirical analysis of the institutions and growth nexus have faced a few problems, which include: the lack of a clear distinction between the different types of institutions; (i.e. political institutions, economic institutions, and customary institutions); a lack of long-run data measuring institutions for most of sub-Saharan Africa; and the paucity of country specific studies - the majority of the empirical evidence have mainly focused on cross-country analysis. While extensions from cross-country analysis to country specific analysis is growing, empirical studies focused on sub-Saharan Africa remain limited. Within the African context, majority of empirical evidence suggest weak institutions as one of the main causes of its poor economic performance. However, due to the paucity of long-run data on institutions, such an hypothesis has not been empirically tested for specific countries. Motivated by these gaps, this thesis contains three essays that examine three types of institutions and their impact on the economy. The specific issues focused on include: the evolution of institutions; persistence of institutions; interdependence between political and economic institutions; interdependence between institutions and economic development; and the role of institutions in determining resource wealth effects. This thesis uses Nigeria as a case study, because of its standing as one of the larger economies in sub-Saharan Africa, especially in terms of its natural resources. In addition to this, Nigeria has experienced numerous regime and constitutional changes over the past few decades which may lead to interesting institutional dynamics.
Open Access
An evaluation of hospital efficiency in Nigeria : a stochastic frontier approach
(2001) Ikenwilo, Divine; Abraham, Haim; Muheki, Charlotte W
Some people have argued that there is no reason to expect economic efficiency in a government enterprise because the funds allocated to various ends have to be exhausted to meet targets. In a social and welfarist sense, this argument seems valid if in essence, such earmarked targets, to improve societal welfare, are met. However, in the face of rising hospital costs and insufficient government funds, the issue of effectively allocating government funds to alternative uses becomes paramount. The setting for this research paper is Nigeria. This research work aims at investigating how well financial resources are used in government hospitals in Nigeria. It not only explores the resources employed in hospitals, but also how well these hospitals use minimum resources to achieve maximum outpatient and inpatient output. Hospital cost and expenditure data are collected from 40 government cottage and general hospitals in South East Nigeria (Anambra and Enugu states specifically). The data is collected by means of open-ended questionnaires, which are filled in by relevant administrators in the hospitals visited and also by ministry of health personnel at the state levels. The main research question asked is whether hospitals in this part of the country (and indeed Nigeria as a whole) are allocatively inefficient. A second question as to whether hospitals in Anambra State are more efficient than Enugu State is also posed. The major component of the research involves using the cost and expenditure data to build cost functions for the entire hospitals studied. The main thrust of analysis is the stochastic frontier process, which also incorporates an efficiency effects model. The choice of this model, above all else, is because it provides numerical efficiency estimates and thus provides quantifiable proof of how well poorly Nigerian hospitals fare. It is found in the analysis of the data collected that the hospitals studied are generally inefficient, as 70 percent of them operate at costs above the average permissible cost frontier.
Open Access
Health policy and systems research and analysis in Nigeria: examining health policymakers’ and researchers’ capacity assets, needs and perspectives in south-east Nigeria
(BioMed Central, 2016-02-24) Uzochukwu, Benjamin; Mbachu, Chinyere; Onwujekwe, Obinna; Okwuosa, Chinenye; Etiaba, Enyi; Nyström, Monica E; Gilson, Lucy
Background: Health policy and systems research and analysis (HPSR+A) has been noted as central to health systems strengthening, yet the capacity for HPSR+A is limited in low- and middle-income countries. Building the capacity of African institutions, rather than relying on training provided in northern countries, is a more sustainable way of building the field in the continent. Recognising that there is insufficient information on African capacity to produce and use HPSR+A to inform interventions in capacity development, the Consortium for Health Policy and Systems Analysis in Africa (2011–2015) conducted a study with the aim to assess the capacity needs of its African partner institutions, including Nigeria, for HPSR+A. This paper provides new knowledge on health policy and systems research assets and needs of different stakeholders, and their perspectives on HPSR+A in Nigeria. Methods: This was a cross-sectional study conducted in the Enugu state, south-east Nigeria. It involved reviews and content analysis of relevant documents and interviews with organizations’ academic staff, policymakers and HPSR+A practitioners. The College of Medicine, University of Nigeria, Enugu campus (COMUNEC), was used as the case study and the HPSR+A capacity needs were assessed at the individual, unit and organizational levels. The HPSR+A capacity needs of the policy and research networks were also assessed. Results: For academicians, lack of awareness of the HPSR+A field and funding were identified as barriers to strengthening HPSR+A in Nigeria. Policymakers were not aware of the availability of research findings that could inform the policies they make nor where they could find them; they also appeared unwilling to go through the rigors of reading extensive research reports. Conclusion: There is a growing interest in HPSR+A as well as a demand for its teaching and, indeed, opportunities for building the field through research and teaching abound. However, there is a need to incorporate HPSR+A teaching and research at an early stage in student training. The need for capacity building for HPSR+A and teaching includes capacity building for human resources, provision and availability of academic materials and skills development on HPSR+A as well as for teaching. Suggested development concerns course accreditation, development of short courses, development and inclusion of HPSR+A teaching and research-specific training modules in school curricula for young researchers, training of young researchers and improving competence of existing researchers. Finally, we could leverage on existing administrative and financial governance mechanisms when establishing HPSR+A field building initiatives, including staff and organizational capacity developments and course development in HPSR+A.
Open Access
Improving maternal care through a state-wide health insurance program: a cost and cost-effectiveness study in rural Nigeria
(Public Library of Science, 2015) Gomez, Gabriela B; Foster, Nicola; Brals, Daniella; Nelissen, Heleen E; Bolarinwa, Oladimeji A; Hendriks, Marleen E; Boers, Alexander C; Eck, Diederik van; Rosendaal, Nicole; Adenusi, Peju
BACKGROUND: While the Nigerian government has made progress towards the Millennium Development Goals, further investments are needed to achieve the targets of post-2015 Sustainable Development Goals, including Universal Health Coverage. Economic evaluations of innovative interventions can help inform investment decisions in resource-constrained settings. We aim to assess the cost and cost-effectiveness of maternal care provided within the new Kwara State Health Insurance program (KSHI) in rural Nigeria. Methods and FINDINGS: We used a decision analytic model to simulate a cohort of pregnant women. The primary outcome is the incremental cost effectiveness ratio (ICER) of the KSHI scenario compared to the current standard of care. Intervention cost from a healthcare provider perspective included service delivery costs and above-service level costs; these were evaluated in a participating hospital and using financial records from the managing organisations, respectively. Standard of care costs from a provider perspective were derived from the literature using an ingredient approach. We generated 95% credibility intervals around the primary outcome through probabilistic sensitivity analysis (PSA) based on a Monte Carlo simulation. We conducted one-way sensitivity analyses across key model parameters and assessed the sensitivity of our results to the performance of the base case separately through a scenario analysis. Finally, we assessed the sustainability and feasibility of this program’s scale up within the State’s healthcare financing structure through a budget impact analysis. The KSHI scenario results in a health benefit to patients at a higher cost compared to the base case. The mean ICER (US$46.4/disability-adjusted life year averted) is considered very cost-effective compared to a willingness-to-pay threshold of one gross domestic product per capita (Nigeria, US$ 2012, 2,730). Our conclusion was robust to uncertainty in parameters estimates (PSA: median US$49.1, 95% credible interval 21.9-152.3), during one-way sensitivity analyses, and when cost, quality, cost and utilization parameters of the base case scenario were changed. The sustainability of this program’s scale up by the State is dependent on further investments in healthcare. CONCLUSIONS: This study provides evidence that the investment made by the KSHI program in rural Nigeria is likely to have been cost-effective; however, further healthcare investments are needed for this program to be successfully expanded within Kwara State. Policy makers should consider supporting financial initiatives to reduce maternal mortality tackling both supply and demand issues in the access to care.
Open Access
Legal issues in the contextual diffusion of independent regulatory agencies in Nigeria
(2015) Andzenge, Terhemen; Corder, Hugh
In the last three decades, there has been a phenomenon, akin to a revolution sweeping through the world, leaving in its wake major consequences of economic, political, legal and constitutional dimensions. The role of the state as we know it has been reconstructed beyond recognition. From an all-encompassing monolith that owns, manages, and provides various infrastructures, goods and services directly to the public and also serves as a regulator, it has now been reduced to a mere bystander or an enabler. Its footprints in the sands of economic and political times have diminished. In its place has arisen the regulatory state, characterised by a thinning out of the state; and the emergence of an institutional innovation: the Independent Regulatory Agency. Its rise, growth and diffusion across jurisdictions and sectors, and most recently in developing countries including Nigeria have been unprecedented. This thesis centres on the question whether the Independent Regulatory Agency can function in Nigeria in a manner analogous to its counterparts in the developed economies and be able to ensure the provision of safe, affordable and efficient infrastructures and services. The thesis finds institutional fragility, limited capacity, information asymmetry, corruption and insecurity within critical political, economic and supporting institutions that ideally gives life and legitimacy to the IRA; while essential democratic concepts are adhered to more in the breach. These challenges present a difficult climate in which the Independent Regulatory Agency can thrive. As an alternative, the thesis advocates the adoption of two transitory regulatory models: regulatory contracts and contracting out or outsourcing of functions. Their utilisation would achieve the desired regulatory outcomes until maturity is attained in the political economy of Nigeria, while simultaneously mitigating its contextual limitations.
Open Access
Out-of-pocket payments, health care access and utilisation in south-eastern Nigeria: a gender perspective
(Public Library of Science, 2014) Onah, Michael N; Govender, Veloshnee
Out-of-pocket (OOP) payments have severe consequences for health care access and utilisation and are especially catastrophic for the poor. Although women comprise the majority of the poor in Nigeria and globally, the implications of OOP payments for health care access from a gender perspective have received little attention. This study seeks to fill this gap by using a combination of quantitative and qualitative analysis to investigate the gendered impact of OOPs on healthcare utilisation in south-eastern Nigeria. 411 households were surveyed and six single-sex Focus Group Discussions conducted. This study confirmed the socioeconomic and demographic vulnerability of female-headed households (FHHs), which contributed to gender-based inter-household differences in healthcare access, cost burden, choices of healthcare providers, methods of funding healthcare and coping strategies. FHHs had higher cost burdens from seeking care and untreated morbidity than male-headed households (MHHs) with affordability as a reason for not seeking care. There is also a high utilisation of patent medicine vendors (PMVs) by both households (PMVs are drug vendors that are unregulated, likely to offer very low-quality treatment and do not have trained personnel). OOP payment was predominantly the means of healthcare payment for both households, and households spoke of the difficulties associated with repaying health-related debt with implications for the medical poverty trap. It is recommended that the removal of user fees, introduction of prepayment schemes, and regulating PMVs be considered to improve access and provide protection against debt for FHHs and MHHs. The vulnerability of widows is of special concern and efforts to improve their healthcare access and broader efforts to empower should be encouraged for them and other poor households.
Open Access
Simulation-based low-dose, high-frequency plus mobile mentoring versus traditional group-based training approaches on day of birth care among maternal and newborn healthcare providers in Ebonyi and Kogi States, Nigeria; a randomized controlled trial
(BioMed Central, 2018-08-13) Ugwa, Emmanuel; Otolorin, Emmanuel; Kabue, Mark; Ishola, Gbenga; Evans, Cherrie; Oniyire, Adetiloye; Olisaekee, Gladys; Onwe, Boniface; LeFevre, Amnesty E; Bluestone, Julia; Orji, Bright; Yenokyan, Gayane; Okoli, Ugo
Abstract Background There is limited information from low and middle-income countries on learning outcomes, provider satisfaction and cost-effectiveness on the day of birth care among maternal and newborn health workers trained using onsite simulation-based low-dose high frequency (LDHF) plus mentoring approach compared to the commonly employed offsite traditional group-based training (TRAD). The LDHF approach uses in-service learning updates to deliver information based on local needs during short, structured, onsite, interactive learning activities that involve the entire team and are spaced over time to optimize learning. The aim of this study will be to compare the effectiveness and cost of LDHF versus TRAD approaches in improving knowledge and skill in maternal and newborn care and to determine trainees’ satisfaction with the approaches in Ebonyi and Kogi states, Nigeria. Methods This will be a prospective cluster randomized control trial. Sixty health facilities will be randomly assigned for day of birth care health providers training through either LDHF plus mobile mentoring (intervention arm) or TRAD (control arm). There will be 150 trainees in each arm. Multiple choices questionnaires (MCQs), objective structured clinical examinations (OSCEs), cost and satisfaction surveys will be administered before and after the trainings. Quantitative data collection will be done at months 0 (baseline), 3 and 12. Qualitative data will also be collected at 12-month from the LDHF arm only. Descriptive and inferential statistics will be used as appropriate. Composite scores will be computed for selected variables to determine areas where service providers have good skills as against areas where their skills are poor and to compare skills and knowledge outcomes between the two groups at 0.05 level of statistical significance. Discussion There is some evidence that LDHF, simulation and practice-based training approach plus mobile mentoring results in improved skills and health outcomes and is cost-effective. By comparing intervention and control arms the authors hope to replicate similar results, evaluate the approach in Nigeria and provide evidence to Ministry of Health on how and which training approach, frequency and setting will result in the greatest return on investment. Trial registration The trial was retrospectively registered on 24th August, 2017 at ClinicalTrials.Gov: NCT03269240 .
Open Access
Socioeconomic inequalities in maternal health service utilisation: a case of antenatal care in Nigeria using a decomposition approach
(2019-11-08) Nwosu, Chijioke O; Ataguba, John E
Abstract Background Antenatal care (ANC) services are critical for maternal health but Nigeria performs poorly in ANC utilisation compared to other countries in sub-Saharan Africa. This study aimed to assess socioeconomic inequalities in ANC utilisation and the determinants of these inequalities in Nigeria. Methods The 2013 Nigeria Demographic and Health Survey data with 18,559 women was used for analysis. The paper used concentration curves and indices for different measures of ANC utilisation (no ANC visit, 1–3 ANC visits, at least four ANC visits, and the number of ANC visits). A positive (or negative) concentration index means that the measure of ANC utilisation was concentrated on the richer (poorer) population compared to their poorer (richer) counterparts. The concentration indices were also decomposed using standard methodologies to examine the significant determinants of the socioeconomic inequalities in no ANC visit, at least four ANC visits, and the number of ANC visits. Results No ANC visit was disproportionately concentrated among the poor (concentration index (CI) = − 0.573), whereas at least four ANC visits (CI = 0.582) and a higher number of ANC visits (CI = 0.357) were disproportionately concentrated among the rich. While these results were consistent across all the geopolitical zones and rural and urban areas, the inequalities were more prevalent in the northern zones (which also have the highest incidence of poverty in the country) and the rural areas. The significant contributors to inequalities in ANC utilisation were the zone of residence, wealth, women’s education (especially secondary) and employment, urban-rural residence, ethnicity, spousal education, and problems with obtaining permission to seek health care and distance to the clinic. Conclusions Addressing wealth inequalities, enhancing literacy, employment and mitigating spatial impediments to health care use will reduce socioeconomic inequalities in ANC utilisation in Nigeria. These factors are the social determinants of health inequalities. Thus, a social determinants of health approach is needed to address socioeconomic inequalities in ANC coverage in Nigeria.
Open Access
Spousal age difference and associated predictors of intimate partner violence in Nigeria
(BioMed Central, 2018-02-02) Adebowale, Ayo Stephen
Background: The growth in Intimate Partner Violence (IPV) cases among couples in Nigeria has been significant in recent years. Victims, which are often females, face numerous health challenges, including early death. I examined the linkages between spousal age differences and IPV in Nigeria. Method: The couples recode data section of the 2013 Nigeria Demographic Health and Survey was used (n = 6765). Intimate partner violence was measured using 13-item questions. Data were analyzed using the logistic regression model (α = .05). Results: The mean spousal age difference was 8.20 ± 5.0 years. About 23.5, 18.0, 13.5 and 4.7% of couples surveyed had experienced some form of IPV, emotional, physical and sexual violence respectively. Also, IPV prevalence was 27.0, 23.7, 22.0 and 18.7% among couples with age differences of 0–4, 5–9, 10–14 and ≥15 years respectively; this pattern was exhibited across all domains of IPV. Among women who experienced physical violence, 20.5% had only bruises, 8.0% had at least one case of eye injuries, sprains and/or dislocations, and 3.7% had either one or more cases of wounds, broken bones or broken teeth. The identified predictors of IPV were: family size, ethnicity, household wealth, education, number of marital unions and husband drinks alcohol. The unadjusted likelihood of IPV was 1.60 (C.I = 1.30–1.98, p < 0.001) and 1.35 (C.I = 1.10–1.64, p < 0.01) higher in households where the spousal age difference was 0–4 and 5–9 years respectively, than the likelihoods among those with a spousal age difference ≥ 15 years, but the strength of the association weakens when other variables were included in the model. Conclusion: The level of IPV was generally high in Nigeria, but it reduced with increasing spousal age difference. This study underscores the need for men to reach a certain level of maturity before marriage, as this is likely to reduce the level of IPV in Nigeria.
Open Access
Sustainable financing mechanisms for strengthening mental health systems in Nigeria
(2019-05-31) Abdulmalik, Jibril; Olayiwola, Saheed; Docrat, Sumaiyah; Lund, Crick; Chisholm, Dan; Gureje, Oye
Background and aims Current coverage of mental health care in low- and middle-income countries is limited, not only in terms of access to services but also in terms of financial protection of persons in need of care and treatment. This is especially pertinent considering the established relationship between mental illness and poverty and the need to ensure the financial risk protection of persons with mental disorders and their families as part of country’s efforts to attain universal health coverage. This study set out to review the health and socio-economic contexts of Nigeria as well as to generate strategies for sustainable mental health financing that will be feasible, within the specific context of the country. Methods A multi-methods approach was developed and applied, consisting of three steps: a situational analysis of Nigeria’s health system, macro-fiscal economic profile, and socio-political status, including a strengths, weaknesses, opportunities and threats (SWOT) analysis of the Nigerian socio-economic, general and mental health context; key informant interviews with 12 expert stakeholders drawn from state and non-state actors in the health and financial sectors; and a policy analysis of sustainable financing options. Results Key challenges identified were: poor funding; reduced access to care, resulting in a huge treatment gap; and out of pocket payment for services—leading to impoverishment. Comprehensive coverage of mental health conditions within the ongoing health insurance reforms was identified as a key strategy for moving towards sustainable mental health financing in Nigeria. Other identified strategies include enhanced integration of mental health into primary care; incorporation of mental health into other strategic and currently funded programmes; adoption of performance-based financing measures; and renewed engagement with stakeholders, including external donor institutions. Conclusions A suite of feasible and actionable measures can be implemented to increase mental health service financing, reduce health-related financial burden on households, increase help-seeking and access to quality mental health care and, ultimately, reduce the large treatment and financing gap for mental disorders in Nigeria.
Open Access
The challenge of bridging the gap between researchers and policy makers: experiences of a Health Policy Research Group in engaging policy makers to support evidence informed policy making in Nigeria
(2016) Uzochukwu, Benjamin; Onwujekwe, Obinna; Mbachu, Chinyere; Okwuosa, Chinenye; Etiaba, Enyi; Nyström, Monica E; Gilson, Lucy
Abstract Background Getting research into policy and practice (GRIPP) is a process of going from research evidence to decisions and action. To integrate research findings into the policy making process and to communicate research findings to policymakers is a key challenge world-wide. This paper reports the experiences of a research group in a Nigerian university when seeking to ‘do’ GRIPP, and the important features and challenges of this process within the African context. Methods In-depth interviews were conducted with nine purposively selected policy makers in various organizations and six researchers from the universities and research institute in a Nigerian who had been involved in 15 selected joint studies/projects with Health Policy Research Group (HPRG). The interviews explored their understanding and experience of the methods and processes used by the HPRG to generate research questions and research results; their involvement in the process and whether the methods were perceived as effective in relation to influencing policy and practice and factors that influenced the uptake of research results. Results The results are represented in a model with the four GRIPP strategies found: i) stakeholders’ request for evidence to support the use of certain strategies or to scale up health interventions; ii) policymakers and stakeholders seeking evidence from researchers; iii) involving stakeholders in designing research objectives and throughout the research process; and iv) facilitating policy maker-researcher engagement in finding best ways of using research findings to influence policy and practice and to actively disseminate research findings to relevant stakeholders and policymakers. The challenges to research utilization in health policy found were to address the capacity of policy makers to demand and to uptake research, the communication gap between researchers, donors and policymakers, the management of the political process of GRIPP, the lack of willingness of some policy makers to use research, the limited research funding and the resistance to change. Conclusions Country based Health Policy and Systems Research groups can influence domestic policy makers if appropriate strategies are employed. The model presented gives some direction to potential strategies for getting research into policy and practice in the health care sector in Nigeria and elsewhere.