Who benefits from the Obio Community Health Insurance Scheme in Rivers State, Nigeria? A benefit incidence analysis.

BACKGROUND: A key aspect of monitoring and evaluating health programs is ensuring that benefits are reaching their target population. We conducted a benefit incidence analysis (BIA) of a Shell-sponsored community health insurance scheme in Nigeria to determine the extent to which the target group (the poor) was benefitting. METHODS: We examined a sample of 616 patients' hospital attendance, financial and administrative records from 2012-2013. We estimated annual utilization rates and average unit costs for inpatient and outpatient services. We multiplied the two to produce a total cost per patient, then deducted annual out-of-pocket expenditures to estimate the total community-based health insurance scheme benefit per person. Benefits were multiplied by the total number of persons in each socioeconomic group to aggregate benefits. We used concentration curves and dominance tests to determine statistical significance at 5% and 10% levels of significance. RESULTS: Collectively, the poorest 20% of the population received 12% of benefits while the richest quintile received the largest share (23%). Inpatient and outpatient benefits are weakly regressive (pro-rich), statistically significant at a 10% level of significance. CONCLUSIONS: Although the poor were found to benefit, this BIA revealed a tendency towards pro-rich distributions. Removing co-payments for the poorest, reducing long wait and visit times and using community volunteers to help increase access to health services may improve benefits for the poor.

SegWeigh: a mixed-method approach to segmenting potential contraceptive user groups and meeting Family Planning 2020 goals.

OBJECTIVE: To evaluate a low-cost mixed-method research tool (SegWeigh) that informs awareness raising and family planning interventions for potential contraceptive users. METHODS: A pilot study of SegWeigh was conducted in Uganda and Vietnam between September 3, 2012, and February 21, 2013. User archetypes were produced in four steps by triangulating Demographic and Health Survey (DHS) data; a secondary literature review; family planning service provision data; and primary qualitative investigation. RESULTS: Triangulation of DHS analysis, secondary literature and service data revealed three potential user profiles: Ugandan women wanting to space pregnancies; Ugandan men wanting to limit pregnancies; and unmarried Vietnamese women having infrequent sex. Archetypes were subsequently created of "Kibuuka," a 52-year-old semi-literate subsistence farmer in rural Uganda, and "Anh," a 20-year-old student in Hanoi, Vietnam. CONCLUSION: SegWeigh rapidly produced data-rich "real life" user profiles that might help to tailor family planning interventions.

Parental HIV disclosure in Burkina Faso: experiences and challenges in the era of HAART.

Increasingly parents living with HIV will have to confront the dilemmas of concealing their lifelong treatment or disclosing to their children exposed to their daily treatment practices. However, limited data are available regarding parental HIV disclosure to children in Burkina Faso. Do parents on antiretroviral therapy disclose their HIV status to their children? What drives them? How do they proceed and how do children respond? We conducted in-depth interviews with 63 parents of children aged seven and above where the parents had been in treatment for more than 3 years in two major cities of Burkina Faso. Interviews addressed parental disclosure and the children's role in their parents' treatment. The rate of parental HIV status disclosure is as high as that of non-disclosure. Factors associated with parental disclosure include female sex, parent's older age, parent's marital history and number of children. After adjustment, it appears that the only factor remaining associated with parental disclosure was the female gender of the parent. In most of the cases, children suspected, and among non-disclosers many believed their children already knew without formal disclosure. Age of the children and history of divorce or widowhood were associated with parental disclosure. Most parents believed children do not have the necessary emotional skills to understand or that they cannot keep a secret. However, parents who disclosed to their children did not experience blame nor was their secret revealed. Rather, children became treatment supporters. Challenges to parental HIV disclosure to children are neither essential nor specific since disclosure to adults is already difficult because of perceived risk of public disclosure and subsequent stigma. However, whether aware or not of their parents' HIV-positive status, children contribute positively to the care of parents living with HIV. Perceptions about children's vulnerability and will to protect them against stigma lead parents to delay disclosure and not to overwhelm them with their experience of living with HIV. Finally, without institutional counselling support, disclosure to children remains a challenge for both parents and children, which suggests a need for rethinking of current counselling practices.

2014 Nigeria: Impact Evaluation of Water, Sanitation, and Hygiene (WASH) within the UNICEF Country Programme of Cooperation, Government of Nigeria and UNICEF, 2009-2013

The Nigerian situation mirrors the Sub Saharan African situation where out of an estimated population of 160 million, approximately 63 million still lack access to safe water supply and 113 million people lack access to basic sanitation facilities. Wide disparities between the six geopolitical zones and within states also worsen the situation, with the poor and more vulnerable populations at greater risk of WASH related health and non-health (such as time saving, productivity, school enrolment and attendance, gender inequality) human development problems.