Promotion of health sector reforms for health systems strengthening in Nigeria: perceptions of policy makers versus the general public on the Nigeria health systems performance.

The objectives of this cross-sectional intervention study were to improve policy makers' understanding of health sector reforms through a training workshop and to assess the perception of policy makers and the general public about health systems performance in Nigeria. Health systems performance was generally rated low by respondents (< 2.5 out of 4). Health service delivery and health workforce were the lowest rated health systems components (< 2.2 out of 4). Efforts need to be intensified to enhance competencies of policy makers to adopt an evidence-informed process in health reform programs. Inputs from the public must be given adequate consideration in addressing the challenges of health systems.

Assessment of organizational capacity for evidence-based health systems operations in Nigeria.

In Nigeria, health outcomes are unacceptably low largely due to the inability of the health system to function optimally. As part of a strategy to strengthen the health system, an assessment of institutional capacity for use of evidence for health system operations was conducted. The health system operations in terms of stewardship, health administration, service delivery, and access to essential medical products/technologies were fairly adequate. In terms of generation/strategic use of information, health financing, and health workforce, the operations were generally inadequate. There is need to evolve strategies that will guarantee equitable and sustained improvements across health services and health outcomes.

Bridging the divide between research and policy in Nigeria: the role of a health policy advisory committee.

Our research group at Ebonyi State University in Nigeria, with the help of the Alliance for Health Policy and Systems Research, has worked with government and other stakeholders to create a Health Policy Advisory Committee. We describe the key elements of the committee and how it has helped bridge gaps between researchers and policymakers to facilitate the use of research-based evidence in policy and programme development.

Promotion of evidence-informed health policymaking in Nigeria: bridging the gap between researchers and policymakers.

In Nigeria, the lack of adequate understanding of the complex nature of translating research into policy and the incompatibility existing between researchers and policymakers constitute a great challenge to evidence-informed policymaking. To address these challenges a one-day evidence-to-policy training workshop was organised for policymakers, researchers and other major stakeholders in the health sector in southeastern Nigeria. Of the 104 individuals invited to the workshop 87 (83.6%) attended. The workshop training sessions focused on capacity development for evidence-informed health policy-making and building effective linkages/partnerships. The post-workshop assessment indicated significant improvements in participants' knowledge, their understanding of the health policymaking process and the use of evidence compared to their pre-workshop status. Using a focus group discussion, major strategies identified by participants that can bridge the gap between health policymakers and researchers included: involving both parties in planning and execution of health research and health programmes; promoting dialogue between researchers and policymakers; institutionalising research grants and commissioning research in health ministries; and ensuring that researchers are made to focus on the core needs of policymakers. There is need for further discussion and debate on the researchers and policymakers partnership concept in low income settings.

Enhancing leadership and governance competencies to strengthen health systems in Nigeria: assessment of organizational human resources development.

The lack of effective leadership and governance in the health sector has remained a major challenge in Nigeria and contributes to the failure of health systems and poor development of human resources. In this cross-sectional intervention study, leadership and governance competencies of policy makers were enhanced through a training workshop, and an assessment was conducted of organizational activities designed to promote evidence-informed leadership and governance to improve human resources for health (HRH). The training workshop increased the understanding of policy makers with regard to leadership and governance factors that ensure the functionality of health systems and improve human resources development, including policy guidance, intelligence and oversight, collaboration and coalition building, regulation, system design and accountability. Findings indicated that systems for human resources development exist in all participants' organizations, but the functionality of these systems was suboptimal. More systematic and standardized processes are required to improve competencies of leadership and governance for better human resources development in low-income settings.

Le manque de leadership et de gouvernance efficaces dans le secteur de la santé demeure un défi de taille au Nigeria et contribue à l'échec des systèmes de santé et au faible développement des ressources humaines. Cette étude transversale sur le terrain s'est penchée sur le renforcement, grâce à un atelier de formation, des compétences de leadership et de gouvernance chez les responsables de politiques ainsi que sur l'évaluation des activités organisationnelles conçues pour favoriser le leadership et la gouvernance fondés sur les données probantes afin d'améliorer les ressources humaines en santé. L'atelier de formation a permis aux responsables de politiques de mieux comprendre les facteurs du leadership et de la gouvernance qui permettent d'assurer la fonctionnalité des systèmes de santé et d'améliorer le développement des ressources humaines, notamment l'orientation des politiques, le renseignement et la surveillance, la mise en place de collaborations et de coalitions, la réglementation, la conception des systèmes et l'obligation de rendre compte. Les résultats indiquent la présence de systèmes pour le développement des ressources humaines dans toutes les organisations des participants, mais leur fonctionnalité reste sous-optimale. Des processus plus systématiques et normalisés sont nécessaires pour améliorer les compétences de leadership et de gouvernance afin d'assurer un meilleur développement des ressources humaines dans les établissements à faible revenu.

Development of health policy and systems research in Nigeria: lessons for developing countries' evidence-based health policy making process and practice.

Health policy and systems research (HPSR), which aims to produce reliable and rigorous evidence to inform the many critical decisions that must be made about health systems, is a new concept in Nigeria. In this study, policy makers and other stakeholders in the health sector identified the challenges and the potential intervention strategies to HPSR evidence use in policy making in Nigeria. The major challenges identified included capacity constraints at individual and organizational levels, communication gaps and poor networking between policy makers and researchers, and the non-involvement of healthcare recipients in identifying and planning care delivery needs. The main solutions suggested included promotion of strategies to encourage partnership between researchers and policy makers, improvement of staff incentives and facilities for research activities, improved budgetary provision for research, and sustainable institutional capacity development. These strategies have been shown to improve evidence-based policy making in developed countries and are likely to produce better outcomes in the developing world.