An assessment of Nigeria's health systems response to COVID-19

Objectives: This study aims to understand and report on selected health system interventions considered nationally and sub-nationally of particular significance both in terms of COVID-19 responses and in strengthening the health system for the future. Design: A review of published and grey literature, including journals, news/ media and official documents, was conducted from 1st December 2019 to 31st December 2020. The reviewers read and extracted relevant data using FACTIVA in a uniform data extraction template. Responses that related to service delivery were captured. Setting: The assessment considered responses at the national and two state levels: Lagos and Enugu, representing the epicentre and a low COVID-19 burden centre. Inclusion criteria: Documents and news that mentioned COVID-19 response, particularly service delivery aspects, were included in this review. Results: The identified interventions were mostly technical support targeted at health workers: including training of about 17,000 health workers, supervising and engaging more health workers, upgrading laboratories and building new ones to improve screening and diagnosis, and motivation of health workforce with incentives. Furthermore, the influx of philanthropic contributions improved the data and information systems supply of medicines, medical products and non-pharmaceutical protective materials through local production. The presence of political will and the government's efforts in health system's response to COVID-19 facilitated these interventions. Conclusions: Interventions of state and non-state actors have strengthened the health systems to some extent. However, more needs to be done to sustain these gains and make the health system resilient to absorb unprecedented shocks.

Spatial Differences in Quality of Maternal Health Service in Primary Health Centers of Enugu State, Nigeria.

Aim: The aim of the study was to determine how adequate were the resources, (equipment and personnel), process (client-provider interaction), and outcome components of quality of maternal health service in urban and rural primary health centers of Enugu state, Nigeria. Study Design: Cross-sectional analytical study design. Place and Duration of Study: Primary health centers in Enugu State, Nigeria, between January and March 2013. Methodology: A three stage sampling method was used to select 540 clients in18 of 440 primary health centers in the state. The clients were women who attended antenatal and postnatal care in the health centers. Outcome measure was clients true satisfaction with maternal health service also denoted as satisfaction index. It was assessed by proportion of clients who were satisfied with antenatal, and postnatal care, were ready to use the health centers again, and willing to recommend them to others for same services. Results: No health center had adequate equipment, 16.7% of health centers had adequate health manpower and 16.7% had good client provider interaction. Only a minor proportion of clients, (urban 7%; rural 24.1%) delivered in the health centers. On part of clients, 64.8% in urban were truly satisfied, as compared to 75.6% in rural. Predictors of clients true satisfaction included being a client in urban, (AOR=0.6, 95% CI: 0.4- 0.9), client unmarried, (AOR=0.3, 95% CI: 0.1- 0.5), and being unemployed/housewife, (AOR=2.0, 95% CI: 1.3- 4.5). Conclusion: The structure and process components of quality of maternal health service in primary health centers in the study area were deficient. Also, utilization of health centers for delivery services was poor. The clients of maternal health service seem to focus more on providers of healthcare and their interactions with them than the health system and its deficiencies hence were easily satisfied with the services received. To reduce the maternal death burden in Nigeria there is need for adequate attention on rural areas, the primary health care system and the provision of client oriented health services at all levels of care. More health workers should be employed, and more equipment supplied in-order to improve the quality of maternal health service in the primary health centers.

Providers’ Perception of Quality of Care and Constraints to Delivery of Quality Maternal Health Services in Primary Health Centers of Enugu State, Nigeria.

Aims: The aim of the study was to assess providers’ perception of quality of care and constraints to delivery of quality maternal health services in urban and rural primary health centers of Enugu state, Nigeria. Study Design: This was a qualitative descriptive study. Methodology: A descriptive study design using qualitative data collection and analysis method. Data was collected through a face to face in-depth interview using an interview guide between May and June 2013. A total of 24 providers participated in the study. They included six heads of department of health of six local government areas and officers-in–charge of eighteen primary health centers in urban and rural areas of Enugu state, Nigeria. Results: Most of the providers perceived the quality of maternal health services in the primary health centers as good and they attributed this to results that were achieved. On measures the providers adopted to ensure clients satisfaction, most of the providers in the urban favoured good work attitude while those in the rural relied on provision of incentives. Inability of the health centers to remain open round the clock was identified as the major constraint to the delivery of quality maternal health care in the health centers and this was attributed to the prevailing security challenges in the study area. Other constraints included inadequate number of health workers, poor amenities, and inadequate equipment. Conclusion: The providers in the study area perceived good quality care to be the same as good utilization of services at the health centers. This has made them to adopt client friendly measures like good work attitude and use of incentives to encourage the clients to utilize the health centers. This may invariably lead to good quality care. Also, they view situations that limit access to services at the health centers as constraints to delivery of quality maternal health care. The providers need adequate support from the local government authorities who are the custodians of primary health care in Nigeria and they should also involve the host communities in the discharge of their duties. The primary health centers should be adequately fenced and personnel employed for security purposes as this will improve access primarily and then good quality care. There is also the need to train the health workers specifically on good quality care.