Improving Program Outcomes Through Responsive Feedback: A Case Study of a Leadership Development Academy in Nigeria.

BACKGROUND: In 2018, the National Primary Health Care Development Agency (NPHCDA), under the Nigeria Federal Ministry of Health, recognized that inadequate personnel competencies limited its ability to provide technical assistance to state primary health care development boards (SPHCBs). In response, NPHCDA instituted a cohort-based leadership development academy (LDA) to develop its staff's leadership and management skills. NPHCDA LEADERSHIP DEVELOPMENT ACADEMY PROGRAM: A baseline assessment identified critical gaps in leadership and management competencies. Agency leaders and midlevel staff aligned on the gaps and approaches to bridge them. Participants in the LDA were selected across headquarters and zones to ensure equitable spread. The NPHCDA adopted a mix of capacity-building approaches that prioritized 6 core leadership and management skills with the application of the 70-20-10 learning philosophy to ensure participants learn and apply skills. Responsive feedback (RF) mechanisms were key in program design and implementation. NPHCDA collaborated with development partners through an iterative cocreation process to design and revise for implementation. The program embraced information and communication technology to collate qualitative and quantitative data across activities in real-time and used insights to drive continuous improvement. RESULTS: Incorporating feedback from the first cohort led to an increase in the proportion of trainees acquiring intermediate to advanced competencies in target skill areas from 41% to 57% in the second cohort. The trainees have taken on more challenging roles at NPHCDA, delivering technical assistance to SPHCBs and bolstering the agency's ability to independently execute activities such as the COVID-19 vaccine introduction. The agency continues to adopt RF mechanisms in the coordination and delivery of advanced technical training for staff and institution of a capacity-building and acculturation program for new hires. CONCLUSION: RF has demonstrated that identifying and engaging key stakeholders to participate in continuous learning and adaptation is critical to achieving program effectiveness and sustainability.

Patient and health facility attributes associated with retention and virologic suppression in private for-profit health facilities in Nigeria.

BACKGROUND: In Nigeria, private for-profit health facilities present an opportunity to achieve the UNAIDS 95-95-95 HIV targets because of their reach and patronage. However, little is known about determinants of outcomes in these facilities. This study describes patient outcomes and the patient and health facility characteristics associated with these outcomes in adults receiving HIV treatment in private facilities in the Federal Capital Territory (FCT), Benue and Nasarawa states in north-central Nigeria. METHODS: A retrospective longitudinal analysis of program data collected between 2013 and 2019 was done. Patient attributes and outcomes were compared across the two states and FCT. Incidence rates were determined for all cause exit, mortality and loss to follow up (LTFU). Cox proportional hazard models were used to identify associations between patient and facility attributes and these outcomes. Bivariate and multivariate logistic regression models were used to determine the factors associated with viral suppression among the study participants. RESULTS: Of the 22,010 study subjects, 42.7%, 22.2% and 35.1%, respectively, were in Benue, FCT and Nasarawa. Almost a third (31.8%) had received antiretroviral treatment (ART) for less than a year at censoring. Incidence rates for all-cause exit, mortality and loss to follow up (LTFU) were 17.2 (95% CI 16.8, 17.5), 2.1 (95% CI 2.0, 2.2), and 11.2 (95% CI 10.8, 11.8) per 100 person years respectively. Males had higher risks of death (HR = 1.47, 95% CI 1.25-1.73), and LTFU (HR = 1.08, 95% CI 1.00-1.16). Age at ART start showed a dose-response association with both mortality and LTFU. Care at model facilities (OR = 2.16, p < 0.001), Zidovudine (AZT)-based regimens (OR = 2.00, p < 0.001), and lowest quartile baseline CD4 + count (OR = 2.40, p < 0.001) were associated with regimen switch. 75.6% of subjects were viral suppressed. Male gender (OR = 0.84, p = 0.025); AZT-based regimen (OR = 0.72, p < 0.001), age in the bottom quartile (OR = 0.71, p = 0.002) were associated with virally suppression. CONCLUSION: Private for-profit facilities are a major provider of HIV and other health services in Nigeria. With appropriate technical support and engagement, they can help accelerate efforts to achieve epidemic control of HIV in Nigeria, and contribute to achievement of UNAIDS 95-95-95 target by 2030.