Operationalizing strategies for expanding UHC for the vulnerable population in Nigeria.

People living in vulnerable conditions have often been neglected or have a low coverage in health insurance which exacerbate poverty, vulnerability and social exclusion. This necessitates building and implementing insurance coverage that fully integrates social protection systems and community-based social care that prioritise the needs of the most vulnerable. To that end, we propose a decentralized system of sustainable financing and management of the vulnerable group fund that is performance driven with multi-stakeholder accountability systems premised on integrated data management. Integrating these elements will ensure that some of the existing gaps in the basic healthcare provision fund implementation in Nigeria are addressed with the following fundamental building blocks for the vulnerable group fund. These recommendations will help governments, resource partners and relevant stakeholders to consider in formulating strategies for operationalizing the vulnerable group funds and decreasing health inequalities among the population. In addition to implementation of this to accelerate universal health coverage and social protection, this will help to mitigate the currents challenges that exacerbate the inequality gaps, and build more resilient health and social protection systems, including the systems within humanitarian crises settings.

A multi-level analysis of prevalence and factors associated with caesarean section in Nigeria.

The choice of caesarean section (CS) plays a significant role in maternal and neonatal health. However, suboptimal CS uptake suggests unmet obstetric care leading to adverse maternal and neonatal health. Considering that maternal health problems in Nigeria remain a public health problem, this present study aims to assess the prevalence and multilevel factors associated with caesarean section among women of reproductive age in Nigeria. Data from the 2018 Nigeria Demographic and Health Survey were analysed. Our analyses included 19,964 women of reproductive age, with their last birth within five years preceding the survey. Multilevel logistic regression analysis was carried out to examine the predictors of the caesarean section in Nigeria. The prevalence of CS among women of reproductive age in Nigeria was 3.11%. Women from the Yoruba ethnic group [aOR = 0.52; 95%(CI = (0.32-0.84)], with two children [aOR = 0.67; 95%(CI = 0.52-0.88)], three children [aOR = 0.49; 95%(CI = 0.36-0.66)], four children and above [aOR = 0.34; 95%(CI = 0.26-0.46)], those who practised Islam [aOR = 0.74; 95%(CI = (0.56-0.99)], and those that had a normal weighted baby [aOR = 0.73; 95%(CI = 0.60-0.99)] were less likely to report having a CS in Nigeria compared to those from Hausa/Fulani ethnic group, those who had one child, those who practised Christianity, and those who had a high weighted baby. Also, women residing in rural areas [aOR = 0.79; 95% (CI = (0.63-0.99)] and the South-South [aOR = 0.65; 95%(CI = (0.46-0.92)] were less likely to have CS compared to those residing in urban areas and North Central. The study concluded that several individual and community-level factors, such as religious belief, number of children, ethnicity, place of residence, and region of residence, were associated with CS utilisation in Nigeria. Our study highlights the need for different regional, local, and cultural contexts for evidence-based policy and programmatic efforts to facilitate equitable access to a caesarean section in Nigeria.

Enablers and barriers to effective HIV self-testing in the private sector among sexually active youths in Nigeria: A qualitative study using journey map methodology.

BACKGROUND: HIV is a public health burden in Nigeria. HIV self-testing is one of the approaches to testing, which is the first of the 95:95:95 cascade of a coherent response to the epidemic. The ability to self-test HIV is influenced by various factors that can either serve as enablers or barriers. Exploring these enablers and barriers to the uptake of HIVST will help achieve optimal HIV self-testing and provide a deeper understanding of the HIVST kits users' journey. OBJECTIVE: The purpose of the study was to identify enablers and barriers to the uptake of HIV self-testing among sexually active youth in Nigeria using journey map methodology. METHODS: We conducted a qualitative exploratory study between January 2021 to October 2021 to understand the journey map for taking up and using HIVST in the private health delivery systems which include the pharmacies and PPMVs. 80 youths in Lagos, Anambra and Kano states were interviewed using IDIs and in-person FGDs. Their responses were audio-recorded, transcribed and analyzed using a qualitative software package (Nvivo software). RESULTS: A journey map for taking up and effectively using HIVST using the private sector among sexually active youths using key enablers and barriers at the attract, purchase, use, confirmation, linkage, and reporting stage was developed. The major enablers among participants were privacy and confidentiality, bundling purchases with other health products, easy-to-use instructions, and past experience with other self-testing kits. The major barriers were fear of discrimination, big packaging, high price, lack of confidence from user error and fear of status disclosure. CONCLUSIONS: Sexually active young people's perspectives enhance our understanding of the barriers and enablers of using HIVST through the private sector. Optimizing the enablers such as improved confidentiality that may be seen in e-pharmacy, reducing barriers and factoring sexually young people's perspectives will enhance the market and the uptake of HIVST towards ensuring sustainability and accelerating progress towards the 95-95-95 targets.

Stakeholders' perception of a total market approach to HIV self-testing (HIVST) for the private sector in Nigeria.

BACKGROUND: The continuous supply of affordable and quality HIV self-test (HIVST) is a key pillar toward achieving the global HIV 95-95-95 target in Nigeria. This was a descriptive qualitative study that explored private sector stakeholders' perceptions of the enablers and barriers of the HIVST market in Nigeria. METHODS: A total of 29 In-depth interviews (IDIs) were conducted with HIVST supply chain stakeholders and private sector providers (PPMVs and Community Pharmacies). Responses were analyzed using Nvivo software and we systematically developed a total market approach analysis for supply chain stakeholders and archetypes for community Pharmacies and PPMVs based on insights gathered from their journey map. RESULTS: Challenges to the supply side dynamics include forecasting, point of care service delivery, the availability of free and subsidized HIVST kits in the market, neglect of private sector providers (Community Pharmacists and PPMVs) in the healthcare delivery system, limited demand for HIVST, and regulatory bottlenecks influences the overall market dynamics. High cost of the HIVST kit, which triggers low availability, accessibility and affordability from the demand side, depicts the need to understand the market dynamics. Addressing the barriers and optimizing the enablers of the three-model pharmacist and PPMV's will change the market dynamic and service delivery to generate demand. CONCLUSION: To address challenges which already exist, the government need to revise the process guidelines for introducing new HIVST products in the Nigerian market, developing contingency plans to ensure the supply of HIVST remains sufficient when experiencing economic shocks, and create a sustainable roadmap toward optimizing the market for HIVST kits.

Assessment of occupational violence towards pharmacists at practice settings in Nigeria.

BACKGROUND: Occupational Violence is prevalent among healthcare workers, including pharmacists, and poses a big threat to their job satisfaction, safety, and social wellbeing. OBJECTIVE: This study seeks to assess the incidents and factors associated with occupational violence towards pharmacists in Nigeria. METHODS: A cross-sectional study was conducted among pharmacists practicing in Nigeria, using an online survey (Google Form™). Occupational violence was assessed using a validated questionnaire. The survey was conducted and reported based on the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Participants were recruited by sharing the survey link via social media platforms including WhatsApp, Facebook, LinkedIn, and Twitter. RESULTS: A total of 263 respondents returned the online questionnaire, with a completion rate of 99.2%. The prevalence of occupational violence was 92.7% (95% CI, 90 to 96). Violent events occurred among 48.7% of pharmacists with at least six years of experience, and 68.4% of hospital pharmacists. The commonly reported factors associated with the violence include long waiting times in the pharmacy (36.5%), refusal to fulfil aggressor's demands (22.1%), and counseling/poor communication (21.7%). Events related to verbal abuse were reported among 95% of the participants. The prevalence of violence was significantly higher among hospital pharmacists, compared with those practicing in administration/regulatory, and in community pharmacies (chi-square=10.213 (2); p=0.006). Similarly, physical aggression was higher among hospital pharmacists (chi-square=10.646 (2), p = 0.005). CONCLUSIONS: The prevalence of occupational violence towards pharmacists practicing in Nigeria appeared to be high. Major factors associated with the violence were refusal to fulfil aggressors' demands and frustrations due to long waiting times at pharmacy. Recommended strategies to slowdown the incidences of violence were improved pharmacists' workforce, interprofessional harmony, and penalties against perpetrators.