An assessment of perceived prioritisation and resource allocation for health policy and systems research in West Africa.

OBJECTIVES: Globally, adequate funding is a strong underpinning to advance health policy and systems research (HPSR) and ensure its impact on strengthening health systems. This study examined the perceived prioritisation, and resource allocation for HPSR in West Africa. METHODS: A desk review was conducted of literature related to HPSR funding published between January 2010 and December 2019, sourced from various databases and government websites. This was followed by in-depth interviews with senior decision makers and HPSR and non-HPSR research leaders (n = 33) across nine West African countries: Benin, Burkina Faso, Côte d'Ivoire, Gambia, Ghana, Liberia, Nigeria, Senegal and Sierra Leone. RESULTS: The majority of the study participants were from ministries of health in their countries (66.7%). All countries except Sierra Leone had a program dedicated to health policy research and/or health planning/program research. There was no specific funding for health research nor HPSR in most countries and a mixed model (demand and supply led) was employed in most instances. HPSR was only considered a priority in two of the nine countries and specific funding for it was non-existent in all nine countries. In all countries, donor agencies played predominant roles in setting health research priorities and resource allocation decisions. Infectious disease and maternal/child health research were the research categories with the highest level of funding. There was limited capacity for HPSR, with a pronounced gap between researchers and policy makers. Stakeholder advocacy, basket funding for health research, multi-stakeholder institutional and individual HPSR capacity building were the major recommendations for improving the status and funding of HPSR. CONCLUSIONS: This study showed that both health research and HPSR were considered low priorities, with no designated funding (budget line) and inadequacy of funding disbursement in the surveyed countries in West Africa. Health research was largely conducted as prioritised and funded by the donor agencies. Given donor fatigue and the transitioning of donor funding, and the pivotal role of HPSR in strengthening health systems, there is an urgent need for West African states to commit to prioritising and funding HPSR and HPSR capacity development.

Demand for malaria rapid diagnostic test, health care-seeking behaviour, and drug use among rural community members with fever or malaria-like illness in Ebonyi state, Nigeria: a cross-sectional household survey.

BACKGROUND: A good understanding of the demand for malaria rapid diagnostic test (MRDT), malaria health care-seeking behavior, and drug use among community members is crucial to malaria control efforts. The aim of this study was to assess the demand (use and/or request) for MRDT, health care-seeking behavior, and drug use, as well as associated factors, among rural community members (both children and adults) with fever or malaria-like illness in Ebonyi state, Nigeria. METHODS: A cross-sectional household survey was conducted between October 1st and November 7th, 2018, in 18 rural geographical clusters. Data was collected using a structured interviewer-administered questionnaire. Descriptive analysis was done using summary statistics. Associated factors (socio-demographic, knowledge and opinion level) were assessed using bivariate and multivariate binomial logistic regressions while the overall effects of these factors were assessed using the "postestimation test" command in Stata. RESULTS: A total of 1310 children under 5 years of age and 2329 children ages 5 years and above and adults (excluding pregnant women) (3639 overall) participated in the study. Among the 1310 children under 5 years of age: 521 (39.8%) received MRDT of which the caregivers of 82 (15.7%) requested for the MRDT; 931 (71.1%) sought care with public/private sector providers (excluding traditional practitioners/drug hawkers) the same/next day; 495 (37.8%) sought care at government primary health centres, 744 (56.8%) sought care with the patent medicine vendors (PMVs); 136 (10.4%) sought care with traditional practitioners; 1020 (77.9%) took ACTs (=88.2%, 1020/1156 of those who took anti-malarial drugs). Generally, lower values were respectively recorded among the 2329 children ages 5 years and above and adults (excluding pregnant women). The most important overarching predictor of the demand for MRDT and care-seeking behaviour was the knowledge and opinion level of respondent female heads of households about malaria and malaria diagnosis. CONCLUSIONS: Among the rural community members with fever or malaria-like illness in Ebonyi state, Nigeria, while majority did not receive MRDT or diagnostic testing, and sought care with the PMVs, most took anti-malaria drugs, and mostly ACTs. Interventions are needed to improve the knowledge and opinion of the female heads of households about malaria and malaria diagnosis.

Social group and health-care provider interventions to increase the demand for malaria rapid diagnostic tests among community members in Ebonyi state, Nigeria: a cluster-randomised controlled trial.

BACKGROUND: The rate of diagnostic testing for malaria is still very low in Nigeria despite the scale-up of malaria rapid diagnostic test (MRDT) availability, following WHO's recommendation of universal diagnostic testing in 2010. We investigated whether a social group sensitisation and education intervention (social group intervention) and a social group intervention plus health-care provider training intervention would increase the demand (use or request, or both) for MRDTs among community members in Ebonyi state, Nigeria. METHODS: We did a three-arm, parallel, open-label, stratified cluster-randomised controlled trial in Ebonyi state, Nigeria, to evaluate the effects of two interventions compared with a control. We randomly assigned geographical clusters that were accessible (close to a road that was drivable even during the rainy seasons) and had at least one eligible public primary health facility and patent medicine vendor (those that offered MRDT services) in a 1:1:1 allocation to the control arm (receiving no intervention), social group arm (receiving sensitisation and education about MRDT), or social group plus provider arm (receiving the social group intervention plus provider training in health communication about MRDT). Investigators, participants (social groups, providers, respondents), and interviewers could not be masked to group assignments. The primary outcome was the proportion of children younger than 5 years with fever or malaria-like illness, in the 2 weeks preceding a household survey, who received an MRDT, and the coprimary outcome was the same outcome but among children aged 5 years and older (ie, up to and including 17 years) and adults (excluding pregnant women). The outcomes were measured at an individual level via household surveys before the interventions and 3 months after the end of the interventions. All analyses were done using a cluster-level method on an intention-to-treat basis. This trial is registered with ISRCTN, number ISRCTN14046444. FINDINGS: We carried out eligibility screening and recruitment of participants (clusters, social groups, and providers) between July 2 and Sept 27, 2018. 34 clusters met the eligibility criteria and 18 were randomly selected to participate and randomly assigned to arms (six clusters per arm). A mean proportion of 40·6% (SD 14·5) of eligible children younger than 5 years in the control arm received an MRDT, versus 66·7% (11·7) in the social group arm (adjusted risk difference [aRD] 28·8%, 95% CI 21·9-35·7, p<0·0001) and 71·7% (19·8) in the social group plus provider arm (aRD 32·7%, 24·9-40·5, p<0·0001), with no significant difference between the social group arm and the social group plus provider arm. A mean proportion of 36·3% (18·5) of eligible children aged 5 years and older in the control arm received an MRDT, versus 60·7% (14·0) in the social group arm (aRD 25·6%, 16·8-34·4, p=0·0004), and 59·5% (18·3) in the social group plus provider arm (aRD 28·0%, 19·5-36·5, p=0·0002), with no significant difference between the social group arm and the social group plus provider arm. INTERPRETATION: The sensitisation and education of social groups about MRDTs can significantly increase the demand for MRDTs. This intervention is pragmatic and could be applied within malaria control or elimination programmes, in Nigeria and in other high-burden countries, to enhance diagnostic testing for patients suspected of having malaria. FUNDING: There was no funding source for this study.