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Zanga R. Regulation and participation of the private sector in the pursuit of universal health coverage: Challenges and strategies for health systems. J Family Med Prim Care 2024; 13:2123-2129. [PMID: 38948620 PMCID: PMC11213391 DOI: 10.4103/jfmpc.jfmpc_1697_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 07/02/2024] Open
Abstract
The 1978 Alma Ata Declaration established recommendations for health systems, which significantly impacted low-income countries. These guidelines marked improvements in access to health, coverage and financial equity, especially in Latin American countries. Objectives This paper focuses on the role of the private sector (including for-profit and non-profit organizations) in achieving Universal Health Coverage (UHC). It examines their involvement in the management, service delivery, resource investment and financing of primary health care (PHC) within the sustainable development goals (SDGs). Methods The study covers a review of health systems, emphasizing the influence of private institutions on public health, and evaluates how private sector experiences contribute to system functions and progress towards UHC. Results The findings indicate the crucial role of the private sector in global health systems, notably expanded in several countries. Private actors are essential to improve access and coverage, particularly in countries with low health indicators. The article highlights the importance of primary care physicians understanding these dynamics since their management is vital in implementing public policies for UHC.
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Affiliation(s)
- Rosendo Zanga
- Policies and System of Health Program, School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile
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2
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Ali VE, Asika MO, Elebesunu EE, Agbo C, Antwi MH. Cognizance and mitigation of falsified immunization documentation: Analyzing the consequences for public health in Nigeria, with a focus on counterfeited COVID-19 vaccination cards: A case report. Health Sci Rep 2024; 7:e1885. [PMID: 38410502 PMCID: PMC10894752 DOI: 10.1002/hsr2.1885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/03/2023] [Accepted: 01/10/2024] [Indexed: 02/28/2024] Open
Abstract
Background and Aims The global immunization campaign against COVID-19 has mandated vaccination certificates, leading to a surge in fake documentation. In Nigeria, the proliferation of counterfeit COVID-19 vaccination cards, facilitated by unscrupulous health workers, raises critical public health concerns. This research spotlights various forms of this malpractice, analyzes the factors contributing to the circulation of fake vaccination cards, their implications on public health, and provides recommendations for addressing the issue. Methods Extensive literature review and analysis were conducted to investigate the emergence of fake COVID-19 vaccination cards in Nigeria. Perspectives from health workers and reports from reputable undercover investigations were examined to identify factors contributing to the circulation of fraudulent records. The research also delved into corruption within the health sector and the impact of low salaries on healthcare workers. Additionally, global instances of fake vaccination cards were explored to provide a comprehensive understanding of the issue. Results Healthcare workers' vaccine hesitancy, corruption, and inadequate salaries were identified as key contributors to the circulation of fake vaccination cards in Nigeria. Instances of health workers accepting bribes to issue cards without administering vaccines were uncovered. The implications on public health included threats to herd immunity, compromised disease surveillance, erosion of public trust, and reinforcement of vaccine hesitancy. The research also highlighted global challenges with fake vaccination cards, emphasizing the need for international cooperation. Conclusion Fake vaccination cards in Nigeria poses challenges to public health, affecting the reliability of immunization data and jeopardizing disease control efforts. It is crucial to strengthen healthcare worker engagement, tackle corruption through increased transparency and improved policies, and implement digital vaccination verification systems. International collaboration is essential to establish standardized security measures and verification checkpoints. Addressing flawed vaccination records requires urgent action to enhance vaccination efforts, and safeguard the population from the resurgence of vaccine-preventable diseases.
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Affiliation(s)
- Victor E. Ali
- Department of Medical Laboratory ScienceUniversity of NigeriaEnuguNigeria
| | | | | | - Chioma Agbo
- Department of Medical Laboratory ScienceUniversity of NigeriaEnuguNigeria
| | - Maxwell Hubert Antwi
- Department of Medical Laboratory ScienceKoforidua Technical UniversityKoforiduaGhana
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3
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Onwujekwe O, Agwu P, Roy P, Hutchinson E, Orjiakor C, McKee M, Odii A, Nwokolo C, Khan M, Mayhew S, Balabanova D. The Promise of Grassroots Approaches to Solving Absenteeism in Primary Health-Care Facilities in Nigeria: Evidence from a Qualitative Study. Health Syst Reform 2023; 9:2199515. [PMID: 37105904 DOI: 10.1080/23288604.2023.2199515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Absenteeism among primary health-care (PHC) workers in Nigeria is widespread and is a major obstacle to achieving Universal Health Coverage (UHC). There is increasing research on the forms it takes and what drives them, but limited evidence on how to address it. The dominant approach has involved government-led topdown solutions (vertical approach). However, these have rarely been successful in countries such as Nigeria. This paper explores alternative approaches based on grassroots (horizontal) approaches. Data collected from interviews with 40 PHC stakeholders in Enugu, Nigeria, were organized in thematic clusters that explored the contribution of horizontal interventions to solving absenteeism in primary health-care facilities. We applied phenomenology to analyze the lived (practical) experiences of respondents. Absenteeism by PHC workers was prevalent and is encouraged by the complex configuration of the PHC system and its operating environment, which constrains topdown interventions. We identified several horizontal approaches that may create effective incentives and compulsions to reduce absenteeism, which include leveraging community resources to improve security of facilities, tapping the resources of philanthropic individuals and organizations to provide accommodation for health workers, and engaging trained health workers as volunteers or placeholders to address shortages of health-care staff. Nevertheless, a holistic response to absenteeism must complement horizontal approaches with vertical measures, with the government supporting and encouraging the health system to develop self-enforcing mechanisms to tackle absenteeism.
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Affiliation(s)
- Obinna Onwujekwe
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria
- Department of Health Administration and Management, University of Nigeria, Enugu, Nigeria
| | - Prince Agwu
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria
- Department of Social Work, University of Nigeria, Nsukka, Nigeria
| | - Pallavi Roy
- Department of Global Health and Development, School of Oriental and African Studies (SOAS), London, UK
| | - Eleanor Hutchinson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Orjiakor
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria
- Department of Psychology, University of Nigeria, Nsukka, Nigeria
| | - Martin McKee
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Aloysius Odii
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria
- Department of Sociology, University of Nigeria, Nsukka, Nigeria
| | - Chukwudi Nwokolo
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria
- Department of Economics, University of Nigeria, Nsukka, Nigeria
| | - Mushtaq Khan
- Department of Global Health and Development, School of Oriental and African Studies (SOAS), London, UK
| | - Susannah Mayhew
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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4
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Uzochukwu B, Agwu P, Okeke C, Uzochukwu A, Onwujekwe O. Ensuring Safety of Patients in Complex Health Systems: A Focus on Primary Healthcare Service Relations in Nigeria. HEALTH & SOCIAL WORK 2023; 48:54-63. [PMID: 36535033 DOI: 10.1093/hsw/hlac041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/04/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
Patient-centered healthcare is a goal for all health systems. However, given the inherent complexities of the health system as one with many nonlinear and dynamic components, the safety of patients could be affected. Therefore, there is the need to study these complexities to manage them toward optimal service delivery. The present study is a qualitative inquiry into the complexities of primary healthcare (PHC) in Nigeria and effects on patients' safety across four PHC facilities in Enugu state in southeast Nigeria. It utilizes a framework that draws on the components of interprofessional collaboration, inclusive of health financing and health workforce satisfaction, to understand the complex PHC system and patient safety. The study findings show that the PHC system in the study area performs suboptimally on the three counts, which implies poor management of the complexities of the system such that patients are highly susceptible to harm. Making a commitment to addressing the shortcomings present in each of the three components will help to decomplexify PHC in line with the World Health Organization agenda of achieving resilient and strong health systems. Importantly, optimizing the psychosocial space in Nigeria's PHC by employing qualified social workers and other psychosocial professionals is crucial for patient safety and a range of psychosocial activities that can enhance job satisfaction of health workers.
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Affiliation(s)
| | | | | | | | - Obinna Onwujekwe
- is professor, Department of Health Administration, University of Nigeria, Enugu, Nigeria
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5
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Agwu P, Orjiakor CT, Odii A, Onwujekwe O. Effects of corruption and unaccountability on responses of frontline health workers to COVID-19 in Nigeria: Lessons and considerations for the social work profession. INTERNATIONAL SOCIAL WORK 2023; 66:206-218. [PMID: 36650896 PMCID: PMC9837023 DOI: 10.1177/00208728211073391] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
COVID-19 stretched health systems, exacerbated by concerns about those that are corrupt and lack equity. Twelve (12) health workers and 12 hospital social workers across Nigeria were purposively sampled and virtually interviewed to explore unaccountability and corruption effects on COVID-19 responses. Findings show that corruption and unaccountability negatively affected responses of frontline health workers to the pandemic. Lack of social care and justice services for patients and health workers across health facilities in Nigeria worsened the negative effects. Effectively mainstreaming social care and justice services into Nigeria's healthcare led by well-trained social workers will improve the health sector via anticorruption.
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Affiliation(s)
- Prince Agwu
- Prince Agwu, Department of Social Work,
University of Nigeria, Nsukka, Enugu, 410001, Nigeria.
| | | | - Aloysius Odii
- University of Nigeria Enugu Campus, Nigeria;
University of Nigeria, Nigeria
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Odii A, Onwujekwe O, Hutchinson E, Agwu P, Orjiakor CT, Ogbozor P, Roy P, McKee M, Balabanova D. Absenteeism in primary health centres in Nigeria: leveraging power, politics and kinship. BMJ Glob Health 2022; 7:bmjgh-2022-010542. [PMID: 36593645 PMCID: PMC9730370 DOI: 10.1136/bmjgh-2022-010542] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Primary health centres (PHCs) in Nigeria suffer critical shortages of health workers, aggravated by chronic absenteeism that has been attributed to insufficient resources to govern the system and adequately meet their welfare needs. However, the political drivers of this phenomenon are rarely considered. We have asked how political power and networks influence absenteeism in the Nigerian health sector, information that can inform the development of holistic solutions. METHODS Data were obtained from in-depth interviews with three health administrators, 30 health workers and 6 health facility committee chairmen in 15 PHCs in Enugu State, Nigeria. Our analysis explored how political configurations and the resulting distribution of power influence absenteeism in Nigeria's health systems. RESULTS We found that health workers leverage social networks with powerful and politically connected individuals to be absent from duty and escape sanctions. This reflects the dominant political settlement. Thus, the formal governance structures that are meant to regulate the operations of the health system are weak, thereby allowing powerful individuals to exert influence using informal means. As a result, health managers do not confront absentees who have a relationship with political actors for fear of repercussions, including retaliation through informal pressure. In addition, we found that while health system structures cannot effectively handle widespread absenteeism, networks of local actors, when interested and involved, could address absenteeism by enabling health managers to call politically connected staff to order. CONCLUSION The formal governance mechanisms to reduce absenteeism are insufficient, and building alliances (often informal) with local elites interested in improving service delivery locally may help to reduce interference by other powerful actors.
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Affiliation(s)
- Aloysius Odii
- Sociology/Anthropology, University of Nigeria, Nsukka, Nigeria
| | - Obinna Onwujekwe
- Health Administration & Management and Pharmacology and Therapeutics, University of Nigeria - Enugu Campus, Enugu, Nigeria
| | - Eleanor Hutchinson
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Prince Agwu
- Social Work, University of Nigeria, Nsukka, Nigeria
| | | | - Pamela Ogbozor
- Psychology, Enugu State University of Science and Technology, Enugu, Nigeria
| | - Pallavi Roy
- Centre for International Studies and Diplomacy, SOAS, London, UK
| | - Martin McKee
- Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Dina Balabanova
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Ogbuabor DC, Ghasi N, Nwangwu N, Okenwa UJ, Ezenwaka U, Onwujekwe O. Stakeholders' perspectives on internal accountability within a sub-national immunization program: A qualitative study in Enugu State, South-East Nigeria. Niger J Clin Pract 2022; 25:2030-2038. [PMID: 36537462 DOI: 10.4103/njcp.njcp_522_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Weak accountability hinders the effectiveness of routine immunization (RI) systems in low- and middle-income countries, yet studies on accountability of immunization programs are scarce. Aim: The study explored stakeholders' perspectives on the functioning of internal accountability within the National Program on Immunization in Enugu State, southeast Nigeria. SUBJECTS AND METHODS We used semi-structured in-depth interviews to collect data from RI officials at state government, local government, and health facility levels (n = 35) in Enugu State between June and July 2021. We adopted maximum variation sampling to purposively select individuals with roles in immunization. The interview guide was developed based on an accountability framework with three dimensions-the axes of power, ability, and justice. Data were analyzed thematically using NVivo software (version 11). The major themes were role clarity, performance standards, supervision, data use, human resources, funding, motivation, sanctions, political influence, and community engagement. RESULTS Performance targets for immunization coverage and reporting timeline were not always met due to multiple accountability failures. Weaknesses in the formal rules that distribute roles among the immunization workforce comprise a lack of deployment letters, unavailability of job descriptions, and inadequate staff orientation. Local officials have a narrow decision space regarding staff posting, transfer, and discipline. Performance accountability was constrained by staff shortages, uneven staff distribution, absenteeism, infrequent supervision, weak data monitoring system, and underfunding. Despite being motivated by job recognition and accomplishments, low motivation from an insecure working environment and lack of financial incentives undermined the constructive agency of service delivery actors. The sanctions framework exists but is weakly enforced due to fear of victimization. Political commitment to the immunization program was low. Yet, political decision-makers interfered with staff recruitment, distribution, and discipline. Community engagement improved resource availability through paid volunteer health workers and maintenance of facilities. However, health facility committees were poorly resourced, non-functional, and lacked the power to sanction erring health workers. CONCLUSIONS Immunization service delivery actors can be held accountable for program performance when there are sufficient formal instruments that provide roles and responsibilities, needed resources, motivated and supervised staff, an effective sanctions framework, genuine political participation, and strong community engagement.
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Affiliation(s)
- D C Ogbuabor
- Department of Health Administration and Management; Health Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Nsukka, Nigeria
| | - N Ghasi
- Department of Management, University of Nigeria Enugu Campus, Nsukka, Nigeria
| | - N Nwangwu
- Department of Sociology, Enugu State University of Science and Technology, Enugu, Nigeria
| | - U J Okenwa
- Enugu State Ministry of Health, Enugu, Nigeria
| | - U Ezenwaka
- Department of Health Administration and Management; Health Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Nsukka, Nigeria
| | - O Onwujekwe
- Department of Health Administration and Management; Health Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Nsukka, Nigeria
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8
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Glynn EH. Corruption in the health sector: A problem in need of a systems-thinking approach. Front Public Health 2022; 10:910073. [PMID: 36091569 PMCID: PMC9449116 DOI: 10.3389/fpubh.2022.910073] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/27/2022] [Indexed: 01/22/2023] Open
Abstract
Health systems are comprised of complex interactions between multiple different actors with differential knowledge and understanding of the subject and system. It is exactly this complexity that makes it particularly vulnerable to corruption, which has a deleterious impact on the functioning of health systems and the health of populations. Consequently, reducing corruption in the health sector is imperative to strengthening health systems and advancing health equity, particularly in low- and middle-income countries (LMICs). Although health sector corruption is a global problem, there are key differences in the forms of and motivations underlying corruption in health systems in LMICs and high-income countries (HICs). Recognizing these differences and understanding the underlying system structures that enable corruption are essential to developing anti-corruption interventions. Consequently, health sector corruption is a problem in need of a systems-thinking approach. Anti-corruption strategies that are devised without this understanding of the system may have unintended consequences that waste limited resources, exacerbate corruption, and/or further weaken health systems. A systems-thinking approach is important to developing and successfully implementing corruption mitigation strategies that result in sustainable improvements in health systems and consequently, the health of populations.
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Affiliation(s)
- Emily H. Glynn
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
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9
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Ogbozor P, Onwujekwe O, Balabanova D, Odii A, Agwu P, McKee M, Obi U, Orjiakor CT, Hutchinson E. The Gendered Drivers of Absenteeism in the Nigerian Health System. Health Policy Plan 2022; 37:1267-1277. [PMID: 35801868 DOI: 10.1093/heapol/czac056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/03/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
The ability to deliver primary care in Nigeria is undermined by chronic absenteeism but an understanding of its drivers is needed if effective responses are to be developed. While there is a small but growing body of relevant research, the gendered dynamics of absenteeism remain largely unexplored. We apply a gendered perspective to understanding absenteeism and propose targeted strategies that appear likely to reduce it. We did so by means of a qualitative study that was part of a larger project examining corruption within the health system in six primary healthcare facilities across rural and urban regions in Enugu State, south-east Nigeria. We conducted thirty in-depth interviews with frontline health workers, healthcare managers, and community members of the health facility committee. Six Focus Group Discussions were held with male and female service users. Data were analysed using thematic analysis. Participants described markedly gendered differences in the factors contributing to health worker absenteeism that were related to gender norms. Absence by female health workers was attributed to domestic and caregiving responsibilities, including housekeeping, childcare, cooking, washing, and non-commercial farming used to support their families. Male health workers were most often absent to fulfil expectations related to their role as breadwinners, with dual practice and work in other sectors to generate additional income generation as their formal salaries were considered irregular and poor. Demands arising from sociocultural and religious events affected the attendance of both male and female health workers. Both men and women were subject to sanctions, but managers and facility chairs were more lenient with women when absence was due to caregiving and other domestic responsibilities. In summary, gender roles influence absenteeism amongst primary healthcare workers in Nigeria and thus should be taken into account in developing nuanced responses that take account of the social, economic, and cultural factors that underpin these roles.
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Affiliation(s)
- Pamela Ogbozor
- Health Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria.,Department of Psychology, Enugu State University of Science and Technology, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria.,Department of Health Administration and Management, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
| | | | - Aloysius Odii
- Health Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria.,Department of Sociology and Anthropology, University of Nigeria, Nsukka, Nigeria
| | - Prince Agwu
- Health Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria.,Department of Social Work, University of Nigeria, Nsukka, Nigeria
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
| | - Uche Obi
- Health Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria.,Department of Community Medicine, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Charles Tochukwu Orjiakor
- Health Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria.,Department of Psychology, University of Nigeria, Nsukka, Nigeria
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Okechukwu CE. A call for improved mental health workforce in low-income countries. Int J Soc Psychiatry 2022; 68:465-467. [PMID: 34387516 DOI: 10.1177/00207640211039255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kirabira J, Ben Forry J, Ssebuufu R, Akimana B, Nakawuki M, Anyayo L, Mpamizo E, Chan Onen B, Ingabire J, Gumisiriza N, Waiswa A, Mawanda A, Ashaba S, Kyamanywa P. Psychological distress and associated factors among hospital workers in Uganda during the COVID-19 lockdown - A multicentre study. Heliyon 2022; 8:e08807. [PMID: 35075435 PMCID: PMC8769903 DOI: 10.1016/j.heliyon.2022.e08807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/28/2021] [Accepted: 01/13/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To assess the prevalence of psychological distress (PD), and its associated demographic, psychosocial, hospital and health-related factors among hospital workers in Uganda during the COVID-19 related lockdown. METHODS An online cross-sectional study was conducted among three hundred ninety six participants recruited from eight hospitals and PD was assessed using the Kessler 6 distress scale from May to June 2020. RESULTS PD was present in 92.7% of the participants with majority (78.3%) having mild to moderate PD whereas 14.4% had severe PD. Severe PD had statistically significant association with having financial liabilities (O.R = 3.69 (1.55-8.77), p = 0.003). However, ability to maintain contact with family members and friends (O.R = 0.43 (0.22-0.84), p value = 0.013), and having enough personal protective equipment and safety tools at work place (O.R = 0.44 (0.23-0.84), p value = 0.012) were protective against severe PD. having excessive worry about getting infected with COVID-19, conflicts within a home, segregation by friends or community, longer working hours or involvement in management of suspected or confirmed case were not associated with severe PD. CONCLUSION The findings indicate the need to take into consideration the mental wellbeing of health workers during this COVID-19 outbreak. Whereas hospital workers continue to provide their services during the COVID-19 pandemic and related lockdown, it is important that they maintain contact with social support networks and be provided with counselling and mental health and psychosocial services in order to optimise their mental health during this pandemic.
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Affiliation(s)
- Joseph Kirabira
- Department of Psychiatry and Mental Health, Kampala International University, Western Campus, Ishaka, Bushenyi, Uganda
- Department of Psychiatry, Busitema University, P.O. Box 236, Tororo, Uganda
| | - Jimmy Ben Forry
- Department of Psychiatry and Mental Health, Kampala International University, Western Campus, Ishaka, Bushenyi, Uganda
- Department of Psychiatry, Mubende Regional Referral Hospital, P.O. Box 4, Mubende, Uganda
| | - Robinson Ssebuufu
- Department of Surgery, Kampala International University, Western Campus, P.O Box 71, Ishaka, Bushenyi, Uganda
| | - Benedict Akimana
- Department of Psychiatry and Mental Health, Kampala International University, Western Campus, Ishaka, Bushenyi, Uganda
| | - Madrine Nakawuki
- Department of Psychiatry and Mental Health, Kampala International University, Western Campus, Ishaka, Bushenyi, Uganda
| | - Lucas Anyayo
- Department of Psychiatry, Lira University, P.O. Box 1035, Lira, Uganda
| | - Emmanuel Mpamizo
- Department of Psychiatry, Gulu University, P.O. Box 166, Gulu, Uganda
| | - Bruno Chan Onen
- Department of Surgery, Makerere College of Health Science, P.O. Box 7072, Kampala, Uganda
| | - Jane Ingabire
- Department of Obstetrics and Gynaecology, Jinja Regional Referral Hospital, P.O. Box 43, Jinja, Uganda
| | - Nolbert Gumisiriza
- Department of Psychiatry and Mental Health, Kampala International University, Western Campus, Ishaka, Bushenyi, Uganda
| | - Ali Waiswa
- Department of Pathology, Makerere College of Health Science, P.O. Box 7072, Kampala, Uganda
| | - Anatoli Mawanda
- Department of Pathology, Makerere College of Health Science, P.O. Box 7072, Kampala, Uganda
| | - Scholastic Ashaba
- Department of Psychiatry and Mental Health, Kampala International University, Western Campus, Ishaka, Bushenyi, Uganda
- Department of Psychiatry, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Patrick Kyamanywa
- Department of Surgery, Kampala International University, Western Campus, P.O Box 71, Ishaka, Bushenyi, Uganda
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12
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Obodoechi DN, Onwujekwe O, McKee M, Angell B, Agwu P, Orjiakor C, Nwokolo C, Odii A, Hutchinson E, Balabanova D. Health Worker Absenteeism in Selected Health Facilities in Enugu State: Do Internal and External Supervision Matter? Front Public Health 2021; 9:752932. [PMID: 34708020 PMCID: PMC8542720 DOI: 10.3389/fpubh.2021.752932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Absenteeism is widespread in Nigerian health facilities and is a major barrier to achievement of effective Universal Health Coverage. We have examined the role of internal (by managerial staff within facilities) and external (by managers at a higher level) supervision arrangements on health worker absenteeism. Specifically, we sought to determine whether these forms of supervision have any role to play in reducing health worker absenteeism in health facilities in Enugu State Nigeria. Methods: We conducted interviews with 412 health workers in urban and rural areas of Enugu State, in South-Eastern Nigeria. We used binary logistic regression to estimate the role of different types of supervision on health worker absenteeism in selected health facilities in Enugu State. Results: Internal supervision arrangements significantly reduce health worker absenteeism (odds ratio = 0.516, p = 0.03). In contrast, existing external supervision arrangements were associated with a small but significant increase in absenteeism (OR = 1.02, 0.043). Those reporting a better financial situation were more likely to report being absent (OR = 1.36, p < 0.01) but there was no association with age and marital status of respondents. Our findings also pointed to the potential for alternative forms of supervision, provided in a supportive rather than punitive way, for example by community groups monitoring the activities of health workers but trying to understand what support these workers may need, within or beyond the work environment. Conclusion: The existing system of external supervision of absenteeism in health facilities in Nigeria is not working but alternatives that take a more holistic approach to the lived experiences of health workers might offer an alternative.
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Affiliation(s)
- Divine Ndubuisi Obodoechi
- Department of Economics, University of Nigeria, Nsukka, Nigeria.,Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Nigeria.,Department of Health Admin and Management, University of Nigeria, Nsukka, Nigeria
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Blake Angell
- The George Institute for Global Health, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Prince Agwu
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Nigeria.,Department of Social Work, University of Nigeria, Nsukka, Nigeria.,School of Education and Social Work, University of Dundee, Dundee, United Kingdom
| | - Charles Orjiakor
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Nigeria.,Department of Psychology, University of Nigeria, Nsukka, Nigeria
| | - Chukwudi Nwokolo
- Department of Economics, University of Nigeria, Nsukka, Nigeria.,Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - Aloysius Odii
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Nigeria.,Department of Sociology and Anthropology, University of Nigeria, Nsukka, Nigeria
| | | | - Dina Balabanova
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Thi Nguyen VA, Könings KD, Scherpbier AJJA, van Merriënboer JJG. Attracting and retaining physicians in less attractive specialties: the role of continuing medical education. HUMAN RESOURCES FOR HEALTH 2021; 19:69. [PMID: 34011364 PMCID: PMC8132429 DOI: 10.1186/s12960-021-00613-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/12/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND Less attractive specialties in medicine are struggling to recruit and retain physicians. When properly organized and delivered, continuing medical education (CME) activities that include short courses, coaching in the workplace, and communities of practice might offer a solution to this problem. This position paper discusses how educationalists can create CME activities based on the self-determination theory that increase physicians' intrinsic motivation to work in these specialties. MAIN CONTENT The authors propose a set of guidelines for the design of CME activities that offer physicians meaningful training experiences within the limits of the available resources and support. First, to increase physicians' sense of professional relatedness, educationalists must conduct a learner needs assessment, evaluate CME's long-term outcomes in work-based settings, create social learning networks, and involve stakeholders in every step of the CME design and implementation process. Moreover, providing accessible, practical training formats and giving informative performance feedback that authentically connects to learners' working life situation increases physicians' competence and autonomy, so that they can confidently and independently manage the situations in their practice contexts. For each guideline, application methods and instruments are proposed, making use of relevant literature and connecting to the self-determination theory. CONCLUSIONS By reducing feelings of professional isolation and reinforcing feelings of competence and autonomy in physicians, CME activities show promise as a strategy to recruit and retain physicians in less attractive specialties.
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Affiliation(s)
- Van Anh Thi Nguyen
- Department of Medical Education and Skills Laboratory, Hanoi Medical University, Room 504, B Building, 1 Ton That Tung Street, Dongda, Hanoi, 10000 Vietnam
| | - Karen D. Könings
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Albert J. J. A. Scherpbier
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Jeroen J. G. van Merriënboer
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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