Patient satisfaction with the Nigerian National Health Insurance Scheme two decades since establishment: A systematic review and recommendations for improvement

Background: To improve healthcare access and mitigate healthcare costs for its population, Nigeria established a National Health Insurance Scheme (NHIS) in 1999. The NHIS remains Nigeria's leading vehicle for achieving universal health coverage; nonetheless, questions remain regarding its quality and effectiveness. Studies on patient satisfaction have served as a useful strategy to further understand the patient experience and the efficacy of health systems. Aim: To synthesise current knowledge on patient satisfaction with the NHIS. Methods: The authors performed a systematic review of primary literature from 1999 to 2020 reporting on NHIS patient satisfaction in eight databases (including PubMed, Embase, and Africa-wide Information). Results: This search returned 764 unique records of which 21 met criteria for full data extraction. The 21 qualifying studies representing 11 of the 36 Nigerian states, were published from 2011 to 2020, and found moderate overall satisfaction with the NHIS (64%). Further, when disaggregated into specific domains, NHIS enrolees were most satisfied with provider attitudes (77%) and healthcare environments (70%), but less satisfied with laboratories (62%), billings (62%), pharmaceutical services (56%), wait times (55%), and referrals (51%). Importantly, time trends indicate satisfaction with the NHIS is increasing ­ although to differing degrees depending on the domain. Conclusion: The beneficiaries of the NHIS are moderately satisfied with the scheme. They consider it an improvement from being uninsured, but believe that the scheme can be considerably improved. The authors present two main recommendations: (1) shorter wait times may increase patient satisfaction and can be a central focus in improving the overall scheme, and (2) more research is needed across all 36 states to comprehensively understand patient satisfaction towards NHIS in anticipation of potential scheme expansion

Roles of local healthcare workers in the humanitarian response in South Sudan: a literature review

Introduction: Armed conflict is devastating to the health system, is a public health concern and recovery is an enormous challenge. The independence of South Sudan in 2011 brought much hope. However, eight years later, the country is still at conflict with itself. Although rich in resources, it is ranked among the poorest in the world and depends on donor funding for most service delivery, especially health. In an international context, promoting the localisation of humanitarian aid and the integration of health services, there is a lot to learn from the roles being played by healthcare workers (HCWs) throughout the conflict in South Sudan. Method: A literature review was conducted to identify the roles of local HCWs in South Sudan since 2011. Four databases were searched, grey literature sourced, and snowballing done to capture additional documents for a comprehensive analysis. Questions were adapted from the Critical Appraisal Skills Programme for qualitative and systematic reviews guided appraisals of the articles. Results were systematically coded, synthesised and summarised using a priori and emergent themes. Results: The health system in South Sudan is very fragmented with heavy dependence on humanitarian aid. There is serious shortage in health workforce with heavy reliance on unskilled workers to fill in the gaps, mainly in rural settings. Although close collaboration exists among different stakeholders to deliver integrated services, poor infrastructure, insecurity, lack of capacity and donor dependency still poses a challenge towards localisation of aid and sustainability. Conclusions: The literature reviewed for this study indicates that the road towards localisation of health care is possible but will depend highly on continued collaboration between the different contributors, integration of services, building capacity of the nationals, increased government funding and infrastructural development. Local involvement of HCWs by international agencies is paramount in ownership and sustainability of services.

Training family physicians: A qualitative exploration of experiences of registrars in a family medicine training programme in Cape Town, South Africa

Background: The MMed in Family Medicine is a professional Master's qualification spanning 4 years of training. The outcomes were predetermined by national consensus. While these outcomes are measured in the form of a national exit examination, there has been no exploration of the experiences of registrars (residents) in this relatively new programme. To evaluate the experiences of registrars in one of the nine training programmes in South Africa and to identify areas for improvement. Methods: This study used purposive sampling to recruit registrar (n = 9) and supervisor (n = 8) participants into respective groups. Data were collected via semi-structured interviews and analysed thematically, and consensus was built using the nominal group technique. Results: Supervisors identified the strengths and weaknesses of the programme which will impact on further strategic planning. Data from registrar interviews yielded two themes: affirmation, referring to the positive social engagement and facilitation of professional identity formation; and frustrations, referring to structural aspects of the programme which hindered academic progress. Conclusion: Qualitative programme evaluation is a useful tool in understanding the learning environment. The student perspective helped to identify the unintended consequences of the programme. It was also shown that the nominal group consensus building technique worked well in a resource-constrained environment

Kenya nutrition monitoring and evaluation

Kenya is facing a triple burden of malnutrition in the form of under nutrition, micronutrient deficiencies and over-nutrition. The Ministry of Health in collaboration with stakeholders developed the Kenya Nutrition Action Plan (KNAP) 2018-2022. The overarching objective of the plan is accelerating and scaling up efforts towards the elimination of malnutrition in Kenya in line with Kenya's Vision 2030 and Sustainable Development Goals (SDGs) with focus on specific achievements by 2022. The action plan is organized into three category focus areas namely; Nutrition-specific and Nutrition-sensitive Interventions and, Enabling Environment. The Kenya Nutrition Monitoring and Evaluation Framework 2018-2022 has been developed to align with the needs of the Kenya Nutrition Action Plan 2018-2022. A review of the Nutrition Monitoring and Evaluation Framework 2013 and other relevant documents was conducted to inform the development of this framework. The development was conducted through a consultative process involving deliberations by task teams, stakeholder consultations, and online survey and review and validation workshops. The rationale of this framework is to ensure continuous tracking of progress, document lessons learned and replicate best practices of nutrition interventions as outlined in the KNAP 2018-2022. It highlights the goal and the objectives and the guiding principles which are expected to ensure a systematic implementation of the monitoring and evaluation framework. The framework describes the basic principles of Monitoring, Evaluation, Accountability and Learning (MEAL) the sources of nutrition information and data analysis and reporting. In addition, the Nutrition Information System monitoring toolkit repository comprising of a variety of guidelines, training packages, tools for data collection and guidance on data analysis and reporting for different sources of information has been developed to provide ease of accessibility to these tools and documents. The framework also covers the Common Results and Accountability Framework (CRAF) for the 19 Key Result Areas (KRAs) and elaborates the process of Monitoring, Evaluation, Accountability and Learning. The key result areas are categorized into nutrition specific, nutrition sensitive and enabling environment with their indicators, definitions, thresholds, means of verification, frequency of reporting and operational research to be conducted. The indicators will be measured and reported through existing systems such as Kenya Health Information System (KHIS), the National Drought Management Authority (NDMA) early warning system, program reports and population-based surveys. Reporting and communication of results will adhere to standard guidelines and use effective communication channels to ensure improved uptake of findings. Evaluation and operational research will be implemented to provide evidence for informing programme decisions that lead to effective coverage of interventions. Finally, accountability will be mainstreamed to ensure service providers or duty bearers are accountable for resources and results. Learning and application of best practices will contribute to adaptation of approaches that are known to produce results. The actualization of the M&E Framework will help build a chain of evidence that will provide the metrics of change. The burden of proof lies with the various stakeholders whose responsibility is to demonstrate that the commitment made in the KNAP 2018-2022 shall indeed be realized and that there is evidence to back up the claim of progress. The implementation strategy therefore shall be driven by human resource development and system readiness and funding mechanisms that will boost M&E human resource and systems at National and County levels

Controlled impact evaluation of a birth registration intervention, Burkina Faso

Objective To evaluate the impact of the introduction of secondary civil registration centres on birth registrations within 60 days of birth, in Burkina Faso. Methods The faith-based organization Sant'Egidio supported the inauguration of secondary birth registration centres within seven health centres in Réo from July 2015 and four health centres in Godyr from February 2015, at which delivery and vaccination services were available. We calculated the number of timely registrations per 1000 population before and after the launch of the intervention in both the intervention and control municipalities. We used a logistic regression model to evaluate the probability of non-registration as a function of the health centre services used and various demographic and health characteristics, obtained through health registers data and interviews. Findings Compared with the previous 12 months, the number of timely birth registrations in Réo and Godyr rose from 502 to 2094 (317.1%) and from 267 to 793 (197.0%) during the first 12 months of the intervention. In the two control municipalities, the numbers were unchanged. Infants whose mothers attended health centres for delivery, but did not return for vaccinations, had the lowest proportions of birth registration (69.0%; 294/426; in Réo and 70.2%; 40/57 in Godyr). Infants of mothers who were not interviewed were more likely to not having a timely birth registration (in Réo odds ratio, OR: 6.25; 95% confidence interval, CI: 4.10­9.52 and in Godyr OR: 25.64; 95% CI: 4.31­166.67).Conclusion Introduction of secondary registration centres within health centres increased timely birth registrations

Evaluation of the influenza sentinel surveillance system in Madagascar, 2009­2014

Problem:Evaluation of influenza surveillance systems is poor, especially in Africa.ApproachIn 2007, the Institut Pasteur de Madagascar and the Malagasy Ministry of Public Health implemented a countrywide system for the prospective syndromic and virological surveillance of influenza-like illnesses. In assessing this system's performance, we identified gaps and ways to promote the best use of resources. We investigated acceptability, data quality, flexibility, representativeness, simplicity, stability, timeliness and usefulness and developed qualitative and/or quantitative indicators for each of these attributes.Local settingUntil 2007, the influenza surveillance system in Madagascar was only operational in Antananarivo and the observations made could not be extrapolated to the entire country.Relevant changes By 2014, the system covered 34 sentinel sites across the country. At 12 sites, nasopharyngeal and/or oropharyngeal samples were collected and tested for influenza virus. Between 2009 and 2014, 177718 fever cases were detected, 25 809 (14.5%) of these fever cases were classified as cases of influenza-like illness. Of the 9192 samples from patients with influenza-like illness that were tested for influenza viruses, 3573 (38.9%) tested positive. Data quality for all evaluated indicators was categorized as above 90% and the system also appeared to be strong in terms of its acceptability, simplicity and stability. However, sample collection needed improvement.Lessons learnt:The influenza surveillance system in Madagascar performed well and provided reliable and timely data for public health interventions. Given its flexibility and overall moderate cost, this system may become a useful platform for syndromic and laboratory-based surveillance in other low-resource settings

What does Sustainability Mean in the HIV and AIDS Response?

Immense progress has been made in the fight against HIV and AIDS. Achieving and exceeding the AIDS targets for the Millennium Development Goals (MDGs) was accomplished; in large part; due to an unprecedented financial investment from the international community. Following an $800 million dip in donor disbursements in 2010; the discourse has since shifted to the need for greater sustainability of funding. But what does sustainability mean? Current efforts focus heavily on fiscal imperatives such as increasing domestic funding. This is important - needs are increasing at a faster rate than donor funding; especially with increased treatment coverage. The problem is that measures of financial sustainability tell very little about the actual sustainability of specific programmes; disease trajectories or enabling environments. Recognising that current definitions of sustainability lack clarity and depth; we offer a new six-tenet conceptualisation of what sustainability means in the HIV and AIDS response: (1) financial; (2) epidemiological; (3) political; (4) structural; (5) programmatic; and (6) human rights. Based on these; we examine examples of donor transitions for their approach to sustainability; including PEPFAR in South Africa; the Global Fund in Eastern Europe; and the Bill and Melinda Gates Foundation in India (Avahan). We conclude that sustainability must be understood within a broader framework beyond funding stability. We also recommend that certain interventions; such as programming for key populations; may have to continue to receive external support even if affected countries can afford to pay

Evaluation of a reproductive health program to support married adolescent girls in rural Ethiopia

Few reproductive health programs are targeted to married adolescent girls. This study measures changes associated with a program for married adolescent girls and a parallel husbands' program, in rural Ethiopia. The married girls' program provided information on communication, self-esteem, reproductive health and gender through girls' groups. The husbands' program focused on non-violence, support to families, and reproductive health. Population-based surveys were undertaken among married girls, at midterm and end line. Outcomes of interest were husbands' assistance with domestic work, accompaniment to the clinic, family planning use, voluntary counseling and testing (VCT), and domestic violence. Overall, 1,010 married girls were interviewed. Participation in the girls' groups was associated with improvements in help with domestic work, accompaniment to the clinic, family planning and VCT. Further improvements were recorded when both partners participated. For example, participating girls were nearly 8 times more likely to receive VCT (OR 7.7) than nonparticipants, and more than 18 times more likely if both partners participated (OR 18.3). While these results are promising, there were indications of selectivity bias that could have contributed to the positive results. Programs engaging both wives and husbands can result in incremental improvements to the health and well-being of girls married early. Afr J Reprod Health 2014; 18[2]: 68-76)

evaluation du programme de la prevention de la transmission mere-enfant du VIH a l' Hopital General de Reference Hakika de Lubumbashi; Republique Democratique du Congo

Ce travail analyse la qualite du programme de la prevention de la transmission mere-enfant du VIH dans a l'hopital general de reference Hakika (Republique Democratique du Congo) de 2006 a 2007 dans le but d'identifier les faiblesses du programme et proposer des pistes de solutions pour l'ameliorer. Le present travail est une etude longitudinale portant sur le suivi des femmes enceintes enregistrees a l'hopital general de reference de la Ruashi de 2006 a 2007 et de leurs nouveau-nes. L'analyse est adaptee du modele de Piot. Le programme connait des deperditions a toutes les etapes du parcours des femmes enceintes et son efficacite operationnelle est reduite a 20 de son potentiel. Il y a des problemes au niveau de l'accessibilite; de l'organisation des services; des professionnels de sante; de la communaute et meme des partenaires responsables du programme. De plus; le programme n'est pas decentralise dans les services de sante de premier echelon.Les visites a domicile; les causeries educatives et la sensibilisation sont les principales strategies orientees vers la communaute. A l'hopital; la formation; le recyclage du personnel; la supervision; et le monitoring sont les strategies proposees

Service uptake and performance of the prevention of mother-to-child transmission (PMTCT) programme in Ibadan, Nigeria

The Prevention of Mother to Child Transmission (PMTCT) programme in the University College Hospital (UCH); Ibadan has been in existence for more than five years and has scaled up to other sites. The study evaluated the service uptake and performance of the programme using national key indicators. Antenatal and delivery records of women enrolled between July 2002 and June 2007 were reviewed. A total of 51952 women attended first antenatal visits and received HIV pre-test counselling. Of these; 51614 (99.5) accepted HIV test and 49134 (95.2) returned for their results. Out of the tested patients; 2152 (4.2) were identified to be HIV positive. Partners of positive patients accepting HIV testing were 361(16.7) with 87 (18.6) testing positive. There were a total of 942 deliveries out of which 39.2of the mothers and 95.2of the babies respectively received ARV prophylaxis. In all; 85.8(788/918) of the mothers opted for formula as the method of infant feeding. Out of the 303 babies eligible for ELISA testing; 68.3reported for the test and 17(8.7) tested positive. There has been progress in the programme; reflected in the increase in the number of new clients accessing the PMTCT service. However; partner testing and follow up of mother-infant pairs remain formidable challenges that deserve special attention

Using Lot Quality Assurance Sampling Methodology to Evaluate the uThukela District Child Survival Project of KwaZulu-Natal

Health services programmes and interventions require objective measures on coverage and quality to ensure that managers have the evidence to adopt and expand health interventions effectively and efficiently. Over the past 15 years; the uThukela District Child Survival Project of South Africa achieved this through regular two- to three-year project evaluations using cluster sampling. Results of these surveys have improved the ability of Child Survival Projects to identify priorities; define objectives based on data; and measure progress towards these objectives. However; the inability to disaggregate information to composite Supervision Areas (SAs) was a limitation. Lot quality assurance sampling (LQAS) was adopted as an improved method based on its ability to assess performance in disaggregated units within a study population and to reliably compare coverage and health status indicators for routine monitoring of child survival activities. This study assessed the feasibility and reliability of LQAS to evaluate the Child Survival Project and compare the results of a rapid manual analysis with a secondary electronic analysis of the same data. The accuracy of the manual analysis was comparable and provides evidence that LQAS and rapid manual analysis can be used to evaluate intervention programmes; particularly in settings of limited electronic technology and expertise

Poor Quality of Data and Care Cast Doubts on Reported Success of Uganda's TB Programme: a Study of the Unit Tuberculosis Registers of Three Ugandan hospitals

With the global resurgence of TB as a public health threat especially in association with HIV-coinfection; accompanied by mismanagement which has led to the emergence of multi-drug resistant TB disease; it is important that care for patients and record-keeping be enhanced. The objective of this study was to analyze the recording of TB cases in Unit Tuberculosis Registers of three Ugandan hospitals in order to identify and quantify the deficiencies in the data registered; for improvement. The design was a retrospective study of the Unit Tuberculosis Registers; with interviews of the staff responsible for entering the data. The setting was three hospitals in the South-Eastern zone of the National Tuberculosis and Leprosy Programme of Uganda - St Francis Buluba Hospital in Mayuge District; Jinja Regional Referral Hospital in Jinja District and Iganga Hospital in Iganga District. All the patients records of cases of tuberculosis entered in the Unit Tuberculosis Registers during 2002 were analysed for the standard TB programme indicators. The Main outcome measures were errors; misclassifications and missing data for each patient registered. The study identified areas for intervention to improve data accuracy. Many so-called cases were diagnosed clinically and never confirmed by laboratory sputum smear examination. Most cases had pulmonary TB. Despite a highly-rated national TB programme; these key field sites showed a cure rate of only 13; a treatment completion rate of 26and a treatment-defaulter rate of 29. These findings are much worse than the reported national figures at the time and suggest a need for the national level to strengthen lower levels further; in order to improve case management; follow-up and reporting

Evaluation of a safer male circumcision training programme for traditional surgeons and nurses in the Eastern Cape, South Africa

Abstract: Training designed to improve circumcision knowledge, attitude and practice was delivered over 5 days to 34 traditional surgeons and 49 traditional nurses in the Eastern Cape, South Africa. Training included the following topics: initiation rites; statutory regulation of traditional male circumcision and initiation into Manhood (TCIM); structure and function of the male sex organs; procedure of safe circumcision, infection control; sexually transmitted infections (STIs); HIV/AIDS; infection control measures; aftercare of the initiate including after care of the circumcision wound and initiate as a whole; detection and early management of common complications of circumcision; nutrition and fluid management; code of conduct and ethics; and sexual health education. The evaluation of the training consisted of a prospective assessment of knowledge and attitude immediately prior to and after training. Significant improvement in knowledge and/or attitudes was observed in legal aspects, STI, HIV and environmental aspects, attitudes in terms of improved collaboration with biomedical health care providers, normal and abnormal anatomy and physiology, sexually transmitted infections and including HIV, circumcision practice and aftercare of initiates. We concluded that safer circumcision training can be successfully delivered to traditional surgeons and nurses

Quality Standards in Provision of Facility Based HIV Care and Treatment: A Case Study from Dar Es Salaam Region; Tanzania

Objective: A cross- sectional descriptive study was conducted to assess the quality standards of health facilities providing antiretroviral treatment (ART) in Dar es Salaam from May to July 2005. Methods: All ten health facilities (both public and private) already designated by Ministry of Health (MOH) to provide ART; six of them since October 2004 and four since May 2005; were included in the study purposively . The other two not designated were randomly picked and added. A checklist with the MOH required standards was used to assess the availability of infrastructure (equipment and staff) for provision of ART; and noted the number of patient eligible; started on ART and their follow ups. Results: The study findings indicated that there were inadequate trained personnel; inadequate laboratory equipments; inadequate antiretroviral drugs and isoniazed was under utilized. There were inadequate confidential places for counseling and information system was weak. Not all the eligible patients were able to start ART and comprehensive HIV care and treatment was not provided in all the designated facilities. Conclusion: Quality standards for providing ART in eligible health facilities in Dar es Salaam varied from facility to facility with better quality standards in facilities that were designated earlier than those designated later indicating a potential for improvement in future. However fast Improvement in staff training; infrastructure; equipment and drugs supplies; health management information system is needed if we are to treat estimated more than 400;00 HIV/AIDS patients by the year 2010

A Comprehensive Programme Addressing HIV/AIDS and Gender Based Violence

A survey was administered to 304 respondents participating from three areas near Welkom; South Africa. Face-toface interviews were conducted with women from randomly selected households to evaluate the impact of a service provision programme targeting women living with HIV/AIDS and gender based violence. Gender based violence (GBV) awareness and knowledge was high. Respondents had high perceived levels of risk.They reported making various behavioural changes to avoid GBV.The respondents were aware of their legal rights pertaining to GBV. HIV/AIDS knowledge levels and attitudes were acceptable. Behavioural changes included condom use; abstinence and being faithful to one partner. Disclosure of HIV was lower than disclosure of GBV. Awareness and knowledge of female condoms were high; yet usage low. Participants reported that they would be able to introduce condoms to a relationship and negotiate usage with relative ease. Perceived levels of GBV and HIV were high; and stigma levels towards the affected women were also relatively high.The awareness and knowledge levels of GBV and HIV of older respondents were lower than younger respondents.The key findings of this study support the notion of using a holistic approach; targeting more than one issue.There is lower stigma levels associated with combined conditions; which might allow easier access to vulnerable groups. Coordination and collaboration of services are however needed to enable this benefit