Preferred approach to performance improvement among stakeholders in the health insurance industry in Southwest Region of Nigeria: Implications for Universal Health Coverage

Background: Population coverage of the National Health Insurance Scheme (NHIS) of Nigeria is low. This study aimed to assess the capacity gaps of personnel in the health insurance industry in southwest Nigeria as well determined the approach to improvement. Methods: This was a cross-sectional survey conducted in the health insurance industry in southwest Nigeria. Survey tool adapted was the World Health Organization adopted Hennessy-Hicks Training Needs Analysis Questionnaire with a set of 30 tasks which are important to the job performance of personnel in the health insurance industry. From the register made available by stakeholders, there were a total of 275 personnel in the industry in the zone. A total population of all available personnel in all the organizations were recruited into the study. Data analysis was done using the guideline provided in the Hennessy-Hicks Training Needs Analysis Questionnaire. Results: Only 32 (13.7%) reported having a training background in health-related degrees, 119 (50.9%) had work-related (actuarial science) training while 148 (63.3%) has had a form of on-the-job actuarial science and related training. The training course approach was generally preferred to organisational change in all items. Conclusion: This study showed that there were gaps in the capacity of personnel in the health insurance industry. Training course was the preferred approach to addressing these. While not neglecting organizational change, stakeholders in Nigeria and in similar settings are advised to pay more attention to personnel training to improve performance

BLOOD TRANSFUSION REQUIREMENT DURING CAESAREAN DELIVERY: RISK FACTORS.

BACKGROUND: Group specific blood is often cross-matched ready for all patients scheduled for caesarean section in anticipation of haemorrhage during the surgery. This study was conducted to determine the risk factors for blood transfusion during anaesthesia for caesarean section. METHODS: This was a prospective cross-sectional study. A total of 706 pregnant patients scheduled for emergency or elective Caesarean section at the University College Hospital, Ibadan, Nigeria between March and August 2011 were recruited. Participants were followed-up from the date of delivery till the end point of the study which could fall into either of the following conditions: satisfactory post-operative clinical status up to 48 hours post-delivery or death. Transfusion rate was determined and Chi-square test was used to determine if there exist an association between blood transfusion status and preoperative haematocrit level, years of experience of obstetrician, indication for Caesarean Section(CS), CS type (primary or repeat) and HIV status. RESULTS: Transfusion rate was 9.1 %; variables found to be significantly associated with blood transfusion were; preoperative haematocrit less than 26%, increasing parity, years of experience of resident obstetrician, indication for CS (bleeding or not bleeding) and estimated blood loss. Being HIV positive does not increase the need for blood transfusion. CONCLUSION: Preoperative anaemia, increasing parity and severe blood loss at surgery significantly contribute to the requirement for blood transfusion in patients undergoing caesarean section.

ASSESSMENT OF THE LIVING CONDITIONS OF RURAL BASED PEOPLE LIVING WITH HIV/AIDS WITH CLINICAL PRESENTATIONS IN NIGERIA.

OBJECTIVE: To describe the living conditions of rural based people living with HIV/AIDS (PLWHA) and their clinical presentations DESIGN: descriptive cross-sectional study, SETTING: University College Hospital, Ibadan. SUBJECTS: PLWHA on anti-retroviral therapy. RESULTS: One hundred and fifty PLWHA participated. The mean age of the respondents was 28.7 ± 8.9 years. Majority of the respondents visited had advanced disease (97%), were poor (75%) and presented with opportunistic infections such as oral candidiasis (92%), chronic diarrhoea (70%) and pulmonary tuberculosis (46%). Majority were treated for malaria (72%) and anaemia (61%). All respondents lived in homes predisposed to these opportunistic infections. They drink unsafe water and had poor disposal of their domestic wastes. CONCLUSION: PLWHA visited lived in homes that predispose them to various opportunistic infections. Improved living conditions and economic empowerment will improve the health conditions of PLWHA.