Feasibility of implementing formal long-distance mentorship for public health physicians: a case study of Association of Public Health Physicians of Nigeria.

BACKGROUND: Conflicting schedules and geographic access limit prospects for mutually beneficial relationships between experts and early career professionals. A formal long-distance mentorship program could address these barriers and potentially bridge the gap of traditional face-to-face mentorship. This study was done to determine the feasibility of implementing a formal long-distance mentorship program amongst public health physicians of Nigeria. METHOD: A mixed-method study comprising of in-depth interviews and surveys was used to collect information from members of the Association of Public Health Physicians in Nigeria. A total of 134 survey participants were recruited consecutively during an annual scientific meeting of the association. In-depth interviewees were purposively selected to ensure diversity in expertise, experience, and social stratifiers such as age. Quantitative data were analyzed using descriptive and inferential statistics, while qualitative data were analyzed using thematic content analysis. RESULTS: Public health physicians of Nigeria are willing to participate in a formal Long-Distance Mentorship Program, and four elements of feasibility were highlighted as necessary for implementing the program. Namely i) capacity to coordinate LDMP, ii) technical expertise and individual competence to provide mentorship, iii) financial capacity to implement and sustain LDMP, and iv) demand for mentorship by mentees. There is a consensus that the organizational structure of the National Postgraduate Medical College of Nigeria and West African College of Physicians provide an enabling environment to initiate a LDMP for public health physicians of Nigeria. The vast human resources with various expertise and the annual National conferences can be leveraged upon to champion and administer the program. However, there is a need for an administrative structure and technical expertise to enable proper coordination. More so, the need for demand creation and the financial requirement was considered gaps that need to be filled to be able to ensure feasibility. Bivariate analysis showed a significant relationship between the dependent variable (preferred role- mentor/mentee) and independent variables (age, year of graduation, and the number of years of practice), while the binary logistic regression model showed that physicians are more likely to participate as mentors with each unit increase in the number of years of practice. This further buttressed the need to commence the mentoring process as soon as trainees gain entrance into the program, as mentorship does not just prepare them for excellent public health practice, but also builds their capacity to mentor the younger and upcoming public health physicians. CONCLUSION: There are enabling structures to incorporate a formal long-distance mentorship program for public health physicians in Nigeria, and physicians are willing to participate in such a program. However, the feasibility of establishing a successful and sustainable program will require robust coordination, technical expertise, demand creation, and financial commitment at both institutional and college levels.

Progress in the face of cuts: a qualitative Nigerian case study of maintaining progress towards universal health coverage after losing donor assistance.

In the coming years, about a dozen middle-income countries are excepted to transition out of development assistance for health (DAH) based on their economic growth. This anticipated loss of external funds at a time when there is a need for accelerated progress towards universal health coverage (UHC) is a source of concern. Evaluating country readiness for transition towards country ownership of health programmes is a crucial step in making progress towards UHC. We used in-depth interviews to explore: (1) the preparedness of the Nigerian health system to transition out of DAH, (2) transition policies and strategies that are in place in Nigeria, (3) the road map for the implementation of these policies and (4) challenges and recommendations for making progress on such policies. We applied Vogus and Graff's expanded transition readiness framework within the Nigerian context to synthesize preparedness plans, gaps, challenges and stakeholders' recommendations for sustaining the gains of donor-funded programmes and reaching UHC. Some steps have been taken to integrate and institutionalize service delivery processes toward sustainable immunization and responsive primary healthcare in line with UHC. There are ongoing discussions on integrating human immunodeficiency virus (HIV) services with other services and the possibility of covering HIV services under the National Health Insurance Scheme (NHIS). We identified more transition preparedness plans within immunization programme compared with HIV programme. However, we identified gaps in all the nine components of the framework that must be filled to be able to sustain gains and make significant progress towards country ownership and UHC. Nigeria needs to focus on building the overall health system by identifying systematic gaps instead of continuing to invest in parallel programmes. Programmes need to be consolidated within the overall health system, health financing priorities and policies. A comprehensive and functional structure will provide continuity even in the event of decreasing external funds or donor exits.