The Nigerian health information system policy review of 2014 : the need, content, expectations and progress.

BACKGROUND: Nigeria's national health information system (HIS) data sources are grouped into institutional and population based data that traverse many government institutions. Communication and collaboration between these institutions are limited, fraught with fragmentation and challenges national HIS functionality. OBJECTIVES: The objective of this paper was to share insights from and the implications of a recent review of Nigeria's HIS policy in 2014 that resulted in its substantial revision. We also highlight some subsequent enactments. REVIEW PROCESS AND OUTCOMES: In 2013, Nigeria's Federal Ministry of Health launched an inter-ministerial and multi-departmental review of the National Health Management Information System policy of 2006. The review was guided by World Health Organization's 'Framework and Standards for Country Health Information Systems'. The key finding was a lack of governance mechanisms in the execution of the policy, including an absent data management governance process. The review also found a multiplicity of duplicative, parallel reporting tools and platforms. CONCLUSION: Recommendations for HIS Policy revisions were proposed to and implemented by the Federal Government of Nigeria. The revised HIS policy now provides for a strong framework for the leadership and governance of the HIS with early results.

Technical quality of delivery care in private- and public-sector health facilities in Enugu and Lagos States, Nigeria.

Private-sector providers are increasingly being recognized as important contributors to the delivery of healthcare. Countries with high disease burdens and limited public-sector resources are considering using the private sector to achieve universal health coverage. However, evidence for the technical quality of private-sector care is lacking. This study assesses the technical quality of maternal healthcare during delivery in public- and private-sector facilities in resource-limited settings, from a systems and programmatic perspective. A summary index (the skilled attendance index, SAI), was used. Two-staged cluster sampling with stratification was used to select representative samples of case records in public- and private-sector facilities in Enugu and Lagos States, Nigeria. Information to assess criteria was extracted, and the SAI calculated. Linear regression models examined the relationship between SAI and the private and public sectors, controlling for confounders. The median SAI was 54.8% in Enugu and 85.7% in Lagos. The private for-profit sector's SAI was lower than and the private not-for-profit sector's SAI was higher than the public sector in Enugu [coefficient = -3.6 (P = 0.018) and 12.6 (P < 0.001), respectively]. In Lagos, the private for-profit sector's SAI was higher and the private not-for-profit sector's SAI was lower than the public sector [3.71 (P = 0.005) and -3.92 (P < 0.001)]. Results indicate that the technical quality of private for-profit providers' care was poorer than public providers where the public provision of care was weak, while private for-profit facilities provided better technical quality care than public facilities where the public sector was strong and there was a relatively strong regulatory body. Our findings raise important considerations relating to the quality of maternity care, the public-private mix and needs for regulation in global efforts to achieve universal healthcare.

Reducing Maternal Mortality by Strengthening Community Maternal Support Systems: Findings from a Qualitative Baseline Study in Northern Nigeria.

The "three delays model" illustrates how issues around obstetric emergency can lead to maternal deaths. This study applied in-depth interviews of key community gatekeepers in 16 rural communities across two states in northern Nigeria to evaluate the presence and functionality of key community maternal support systems for reducing maternal mortality. Findings show that only one out of the 16 communities had all the key support systems. Five rural communities reported that pregnant women have standing permission to visit health facilities during obstetric emergencies. A quarter of the communities reported the presence of transport for maternal emergencies. One rural community each reported the existence of community savings for obstetric emergencies and the presence of blood donor groups. Establishing and/or strengthening community support systems, ensuring citizens are well-informed about maternal danger signs and preparing for safe pregnancies can enable communities overcome the delays and reduce maternal mortality especially in low resource settings.

An innovation for improving maternal, newborn and child health (MNCH) service delivery in Jigawa State, northern Nigeria: a qualitative study of stakeholders' perceptions about clinical mentoring.

BACKGROUND: An effective capacity building process for healthcare workers is required for the delivery of quality health care services. Work-based training can be applied for the capacity building of health care workers while causing minimum disruption to service delivery within health facilities. In 2012, clinical mentoring was introduced into the Jigawa State Health System through collaboration between the Jigawa State Ministry of Health and the Partnership for Transforming Health Systems Phase 2 (PATHS2). This study evaluates the perceptions of different stakeholders about clinical mentoring as a strategy for improving maternal, newborn and child health service delivery in Jigawa State, northern Nigeria. METHODS: Interviews were conducted in February 2013 with different stakeholders within Jigawa State in Northern Nigeria. There were semi-structured interviews with 33 mentored health care workers as well as the health facility departmental heads for Obstetrics and Pediatrics in the selected clinical mentoring health facilities. In-depth interviews were also conducted with the clinical mentors and two senior government health officials working within the Jigawa State Ministry of Health. The qualitative data were audio-recorded; transcribed and thematically analysed. RESULTS: The study findings suggest that clinical mentoring improved service delivery within the clinical mentoring health facilities. Significant improvements in the professional capacity of mentored health workers were observed by clinical mentors, heads of departments and the mentored health workers. Best practices were introduced with the support of the clinical mentors such as appropriate baseline investigations for pediatric patients, the use of magnesium sulphate and misoprostol for the management of eclampsia and post-partum hemorrhage respectively. Government health officials indicate that clinical mentoring has led to more emphasis on the need for the provision of better quality health services. CONCLUSION: Stakeholders report that the introduction of clinical mentoring into the Jigawa State health system gave rise to an improved capacity of the mentored health care workers to deliver better quality maternal, newborn and child health services. It is anticipated that with a scale up of clinical mentoring, health outcomes will also significantly improve across northern Nigeria.

Knowledge of obstetric danger signs amongst women of reproductive age in PATHS2 Zaria cluster, Kaduna Nigeria.

BACKGROUND: The Partnership for Transforming Health Systems 2 (PATHS2) in Nigeria is implementing selected Behavior Change Communication (BCC) models to increase the knowledge of obstetric danger signs amongst women of reproductive age in Kaduna, Nigeria. The objective of this survey was to establish baseline proportions for knowledge of at least four danger signs of pregnancy, delivery and postpartum period respectively amongst women age 15-49, residing within 25 selected communities in Zaria. METHOD: A cross-sectional survey was carried out amongst the eligible women within the communities. A pre-tested structured questionnaire was used for interview. RESULTS: 617 (94.5% response) eligible women participated in the study. Only 113 (18.31%) knew at least four danger signs during pregnancy. 61 (9.89%) knew at least four danger signs that can occur during labor and delivery and only 57 (9.24%) knew at least four danger signs that can occur during the postpartum period. CONCLUSION: A high proportion of the respondents are unaware of obstetric danger signs. It is recommended that radio broadcast be used as part of efforts towards increasing the proportion of women with knowledge of four or more obstetric danger signs in the study population.

Knowledge of safe motherhood among women in rural communities in northern Nigeria: implications for maternal mortality reduction.

BACKGROUND: Most developed countries have made considerable progress in addressing maternal mortality, but it appears that countries with high maternal mortality burdens like Nigeria have made little progress in improving maternal health outcomes despite emphasis by the Millennium Development Goals (MDGs). Knowledge about safe motherhood practices could help reduce pregnancy related health risks. This study examines knowledge of safe motherhood among women in selected rural communities in northern Nigeria. METHODS: This was a cross-sectional study carried out in two states (Kaduna and Kano States) within northern Nigeria. Pretested, interviewer-administered questionnaires were applied by female data collectors to 540 randomly selected women who had recently delivered within the study site. Chi-square tests were used to determine possible association between variables during bivariate analysis. Variables significant in the bivariate analysis were subsequently entered into a multivariate logistic regression analysis. The degree of association was estimated by odds ratio (OR) and 95% confidence interval (CI) between knowledge of maternal danger signs and independent socio-demographic as well as obstetric history variables which indicated significance at p < 0.05. RESULTS: Over 90% of respondents in both states showed poor knowledge of the benefits of health facility delivery by a skilled birth attendant. More than 80% of respondents in both states displayed poor knowledge of the benefits of ANC visits. More than half of the respondents across both states had poor knowledge of maternal danger signs. According to multivariate regression analysis, ever attending school by a respondent increased the likelihood of knowing maternal danger signs by threefold (OR 2.63, 95% CI: 1.2-5.8) among respondents in Kaduna State. While attendance at ANC visits during most recent pregnancy increased the likelihood of knowing maternal danger signs by twofold among respondents in Kano State (OR 2.05, 95% CI: 1.1-3.9) and threefold among respondents in Kaduna State (OR 3.33, 95% CI: 1.6-7.2). CONCLUSION: This study found generally poor knowledge about safe motherhood practices among female respondents within selected rural communities in northern Nigeria. Knowledge of safe pregnancy practices among some women in rural communities is strongly associated with attendance at ANC visits, being employed or acquiring some level of education. Increasing knowledge about safe motherhood practices should translate into safer pregnancy outcomes and subsequently lead to lower maternal mortality across the developing world.

Pattern of substance use among senior students of command secondary schools in Ibadan, Nigeria.

BACKGROUND: The aim of this study was to assess the pattern of drug use among senior secondary school students within military locations in Ibadan, Nigeria. METHODS: A cross-sectional survey was carried out in 2006. RESULTS: Five hundred ten students participated with a mean age of 15.0 +/- 1.2 years. The prevalence of lifetime use of any substance was 15.3%. Alcohol (33.9%), solvents (17.3%), and tobacco (10.6%) were the most commonly used substances. Only gender and age were associated with the lifetime use of tobacco and solvents (p < 0.05). CONCLUSION: The information provided a useful baseline on which subsequent interventions could be based and evaluated.

Utilization and costs of medical services at military health facilities in Ibadan, Nigeria.

The Nigerian Army introduced user charges in its health care services in 1994. This study attempts to assess possible impact of user charges on the utilization of army health services in Ibadan, Nigeria. This is a descriptive, retrospective study and it involved the review of hospital records from 1992 to 1996 in military health facilities in Ibadan. Yearly consultation rate increased from 339 per 1,000 population in 1992 to 581 per 1,000 population in 1996. While cost of care significantly increased over the years in the army health facilities, services were offered at lower costs when compared with the cost of similar services from non-military medical centers. Utilization of health services is not deterred in spite of the introduction of user charges. Further study was suggested to assess impact.