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Ezekannagha O, Drimie S, Von Fintel D, Maziya-Dixon B, Mbhenyane X. A Qualitative Exploratory Study of the Political Commitment for Nutrition Programming: A Case Study of Anambra and Kebbi States of Nigeria. Int J Environ Res Public Health 2024; 21:175. [PMID: 38397666 PMCID: PMC10888008 DOI: 10.3390/ijerph21020175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 02/25/2024]
Abstract
In Nigeria, varying levels of malnutrition across states present a critical challenge to public health, demanding tailored policy responses. This paper delves into the specific issues and dynamics influencing nutrition programs in the country. Advocating for nutrition-sensitive actions requires analyzing context-specific political commitment. This article presents a case study on two Nigerian states with varying malnutrition profiles to explore the political economy of nutrition. The study used stakeholder analysis, in-depth interviews, and semi-structured interviews through workshops, incorporating the Political Commitment Rapid Assessment Tool. The objective was to measure political commitment, the window of opportunity for action, and stakeholder analysis. The results showed that despite having a significant child malnutrition problem, Kebbi State received a high political commitment to nutrition, with proportions ranging from 0.67 to 1 in each of the six domains measured. On the other hand, Anambra State, where malnutrition was less severe, had varying commitment levels. Institutional commitment was marginally high (0.67), expressed commitment was high (0.71), and budgetary commitment was lower at 0.33. Kebbi had better support for programs dependent on foreign donors than Anambra. Both states need to use media to increase awareness about nutrition issues. When the nutrition situation is severe, foreign donors' influence grows. In conclusion, there are opportunities for strategic framing and advocacy of the nutrition profile of the states. Local state media can be effective, and institutional coordination committees that include various sectors already facilitate commitment to nutrition actions. However, individual, uncoordinated sectoral action can counterbalance the benefits of these committees. Further possibilities to generate political commitment for nutrition in the states are available. This study not only offers insights into the effectiveness of political strategies in addressing malnutrition but also lays the groundwork for future research and provides actionable recommendations for government policymaking.
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Affiliation(s)
- Oluchi Ezekannagha
- Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences, Tygerberg Campus, Stellenbosch University, Cape Town 8000, South Africa
- International Institute of Tropical Agriculture, Ibadan 200001, Nigeria
- CGIAR System Organization, c/o Alliance of Bioversity and CIAT, 00153 Rome, Italy
| | - Scott Drimie
- Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences, Tygerberg Campus, Stellenbosch University, Cape Town 8000, South Africa
| | - Dieter Von Fintel
- Department of Economics, Faculty of Economic and Management Sciences, Stellenbosch University, Stellenbosch 7602, South Africa
| | | | - Xikombiso Mbhenyane
- Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences, Tygerberg Campus, Stellenbosch University, Cape Town 8000, South Africa
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Durotoye T, Ilegbune I, Schofield D, Ajieroh V, Ezekannagha O. Industry Self-Regulation of Food Fortification Compliance: Piloting the Micronutrient Fortification Index in Nigeria. Food Nutr Bull 2023; 44:S74-S84. [PMID: 36349967 DOI: 10.1177/03795721221132610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Sustaining large-scale and good-quality food fortification requires strategies that incentivize food processors to invest in and consistently meet national food fortification standards where they exist. A standardized Micronutrient Fortification Index (MFI) piloted in Nigeria has provided a ranking of fortified branded products for each participating company, based on a score aggregating the effectiveness and efficiency of the company's systems and levels of product fortification. The MFI has demonstrated the significance of brands as a focal point for investment and industry accountability in food fortification and the power of harnessing the competitive nature of businesses to drive their food fortification performance. The initiative started with a pilot consisting of well-known brands of 4 companies and has since expanded participation to 15 companies, representing 31 brands, having completed the first entire ranking cycle. The publicly listed brands on the Index now cover approximately 80% of the flour milling market, 40% of the edible oils market, and 88% of the sugar market in Nigeria, reaching an estimated 134 million people in the country in 2022 according to analysis by TechnoServe Supporting African Processors of Fortified Foods (SAPFF) program in Nigeria. The data inputs are made through company-owned digital portals, and the results are published on a secure, web-based public portal which also serves as a gateway for stakeholders to access related information on micronutrient fortification and food quality (https://technoserve-mfi.web.app/). The ultimate aim of the MFI is to serve as a leverage for private sector efforts to both digitalize quality assurance and business processes linked to industrial automation and to harness their competitiveness through voluntary participation in the Index to drive improved food fortification performance based on industry best practices and quality benchmarks.
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Affiliation(s)
- Tobi Durotoye
- Strengthening African Processors of Fortified Foods Project-TechnoServe, Arlington, VA, USA
| | | | - Dominic Schofield
- Strengthening African Processors of Fortified Foods Project-TechnoServe, Arlington, VA, USA
| | | | - Oluchi Ezekannagha
- Dalberg Advisors, Abidjan, Côte d'Ivoire. Ezekannagha is now with CGIAR System Organization, Rome, Italy
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Durotoye T, Yusufali R, Ajieroh V, Ezekannagha O. Building the Commitment of the Private Sector and Leveraging Effective Partnerships to Sustain Food Fortification. Food Nutr Bull 2023; 44:S61-S73. [PMID: 36221237 DOI: 10.1177/03795721221123699] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The private sector is a critical partner in achieving the universally adopted Sustainable Development Goals (SDGs)-UNDP 2022. As part of a national strategy to address malnutrition (SDG2), Large-Scale Food Fortification of commonly consumed staple foods and condiments with vitamins and minerals is a proven intervention that requires the concerted engagement of multiple actors in a country's agri-food and public health ecosystems. Lessons from TechnoServe's Strengthening African Processors of Fortified Foods (SAPFF) Program, implemented from 2016 to 2022 in Kenya, Nigeria, and Tanzania with support from the Bill and Melinda Gates Foundation, provide essential learnings about how to effectively engage, motivate, and improve the food fortification performance of the industry in compliance with national standards, through capacity building, responsive technical assistance, and multistakeholder engagement that builds trust and accountability of industry in the fight against malnutrition.
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Affiliation(s)
- Tobi Durotoye
- TechnoServe Inc Ringgold Standard Institution, Arlington, VA, USA
| | | | - Victor Ajieroh
- Bill & Melinda Gates Foundation Ringgold Standard Institution, Abuja, Nigeria
| | - Oluchi Ezekannagha
- CGIAR Ringgold Standard Institution, via di San Domenico, Rome, Lazio, Italy
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Ezekannagha O, Adeyemi O, Ajieroh V, Onabolu A. Advancing a Multisectoral Platform for Nutrition-Sensitive Agriculture in Nigeria: Reflections on Effectiveness and Lessons Learned. Food Nutr Bull 2023; 44:S52-S60. [PMID: 37317523 DOI: 10.1177/03795721231179786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Inadequate coordination mechanisms and capacity to coordinate are limiting factors for maximizing the ability of agriculture to improve nutrition in Sub-Saharan Africa. Effective coordination requires the availability of a platform for stakeholder convening, planning, operationalization of ideas, communication, and accountability. Nigeria's Federal Ministry of Agriculture and Rural Development established one such platform to support the institutionalization of nutrition-sensitive agriculture. Platform members include several departments within the Ministry, other ministries, and development partners. While the platform achieved key milestones and fostered collaboration, some gaps remained. OBJECTIVE This study reports an assessment to understand the perspectives of members of the coordination platform and identify ways of increasing effectiveness. METHODS Desk reviews of relevant documents and 18 key informant interviews were conducted. Documents and interview notes were coded and analysed to identify recurring themes. Themes were appraised using a nutrition coordination framework. RESULTS Sufficiently understanding the nutrition role of representatives' own organization/department and the purpose of the coordination platform and its activities was important for success. The profile and seniority of representing officers also mattered. While the leadership of the Ministry was committed to advancing nutrition through agriculture, the coordination platform could improve its functionality through consistent leadership, increased seniority of member representatives, and appropriate communication. CONCLUSIONS Multisectoral coordination platforms are necessary but do not alone achieve nutrition coordination. Effective leadership and investments in time, strategic orientation, and training are critical to achieving a shared purpose, individual sector fulfilment of nutrition roles, and additional coordination success factors.
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Affiliation(s)
| | - Olutayo Adeyemi
- Department of Human Nutrition and Dietetics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | | | - Adeyinka Onabolu
- Global Alliance for Improved Nutrition, Abuja, Nigeria
- Federal Ministry of Agriculture and Rural Development, Abuja, Nigeria
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Ajieroh V, Onabolu A, Ezekannagha O, Adeyemi O. Fostering an Enabling Environment for Nutrition-Sensitive Agriculture and Food Systems in Nigeria. Food Nutr Bull 2023; 44:S3-S13. [PMID: 37283222 DOI: 10.1177/03795721231173852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Although recommendations exist for making agriculture and food systems nutrition sensitive, guidance about how to successfully operationalize these recommendations within national institutions is limited. Over the 13 years from 2010 to 2023, there were several undertakings to strengthen the enabling environment for sustainable nutrition-sensitive agriculture (NSA) and food systems in Nigeria. Some studies were also conducted over the period to foster better understanding of the national enabling environment and facilitate effective actions. OBJECTIVE This article documents successes and failures from Nigeria's experiences by reflecting on critical developments, events, policies, and programmes on Nigeria's journey toward advancing nutrition through agriculture and food systems; as well as findings from conducted studies. DISCUSSION Successes include the existence of a Nutrition and Food Safety Division in the Ministry of Agriculture and an approval for a Nutrition Department, existence of an agriculture sector nutrition strategy, increased private sector engagement and commitment to nutrition-sensitive food systems, and increased funding for nutrition in the agriculture sector. Challenges especially remain for scaling up strategic, operational, and delivery capacity of both organizations and individuals involved in advancing NSA and food systems. Lessons learned include-institutionalizing NSA and food systems takes time; knowledge brokering is indispensable and requires several collaborating entities and stakeholders; and approaches used should be suited to available government capacity. CONCLUSION More than a decade of efforts targeting different enabling environment factors has resulted in greater political commitment for nutrition within the agriculture sector and an improved enabling environment for NSA and food systems.
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Affiliation(s)
| | - Adeyinka Onabolu
- Federal Ministry of Agriculture and Rural Development, Abuja, Nigeria
- Global Alliance for Improved Nutrition, Abuja, Nigeria
| | | | - Olutayo Adeyemi
- Department of Human Nutrition and Dietetics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
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Adeyemi O, Adesiyun Y, Omenka S, Ezekannagha O, Adanlawo A, Oyeleke R, Umunna L, Aminu F, Onabolu A, Ajieroh V. Government Budget for Nutrition-Sensitive Agriculture in Nigeria Increased Following Development of Related Strategy. Food Nutr Bull 2023; 44:S103-S114. [PMID: 37317553 DOI: 10.1177/03795721231179783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Financial resources that are commensurate with the magnitude of malnutrition problem are requisite for effective interventions to reduce malnutrition. Understanding the amount and nature of sectoral investments in nutrition is important for advocating and mobilizing increased government budgetary allocations and release. OBJECTIVE This study assessed trends in Nigeria's agriculture sector nutrition allocations and whether launch of nutrition-sensitive agriculture strategy and/or the COVID-19 pandemic may have affected these nutrition allocations. METHODS Agricultural budgets from 2009 to 2022 of Nigeria's federal government were analyzed. Nutrition-related budget lines were identified using a keyword search and were then classified as nutrition-specific, nutrition-sensitive, or potentially nutrition-sensitive, based on defined criteria. Potentially nutrition-sensitive items were further screened. Budget lines finally included as nutrition allocations directly targeted improvements in nutrition or intermediate outcomes in pathways between agriculture and nutrition. Budget lines were summed, and these nominal values were adjusted for inflation (using the consumer price index for each year) to obtain real values. RESULTS Nutrition allocations in the agriculture budget increased considerably even after adjusting for inflation and went from 0.13% of agriculture capital budget in 2009 to 2.97% in 2022; while the real value of total government agricultural budget declined. Large budgetary increases coincided with the development/launch of costed strategies with nutrition-sensitive agriculture components. Still, there were some missed opportunities to increase nutrition allocations. CONCLUSIONS Existence of nutrition-sensitive agriculture strategies has facilitated increased nutrition funding and improved the enabling environment. There is need to optimize existing nutrition allocations while advocating for additional funds.
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Affiliation(s)
- Olutayo Adeyemi
- Department of Human Nutrition and Dietetics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Yeside Adesiyun
- Department of Human Nutrition and Dietetics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
- Federal Institute of Industrial Research, Oshodi, Lagos, Nigeria
| | - Samuel Omenka
- Budget Office of the Federation, Federal Ministry of Finance, Budget and National Planning, Abuja, Nigeria
| | | | - Adekunle Adanlawo
- Federal Ministry of Agriculture and Rural Development, Abuja, Nigeria
| | - Rasaq Oyeleke
- Federal Ministry of Agriculture and Rural Development, Abuja, Nigeria
| | | | | | - Adeyinka Onabolu
- Federal Ministry of Agriculture and Rural Development, Abuja, Nigeria
- Global Alliance for Improved Nutrition, Abuja, Nigeria
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Achoki T, Sartorius B, Watkins D, Glenn SD, Kengne AP, Oni T, Wiysonge CS, Walker A, Adetokunboh OO, Babalola TK, Bolarinwa OA, Claassens MM, Cowden RG, Day CT, Ezekannagha O, Ginindza TG, Iwu CCD, Iwu CJ, Karangwa I, Katoto PD, Kugbey N, Kuupiel D, Mahasha PW, Mashamba-Thompson TP, Mensah GA, Ndwandwe DE, Nnaji CA, Ntsekhe M, Nyirenda TE, Odhiambo JN, Oppong Asante K, Parry CDH, Pillay JD, Schutte AE, Seedat S, Sliwa K, Stein DJ, Tanser FC, Useh U, Zar HJ, Zühlke LJ, Mayosi BM, Hay SI, Murray CJL, Naghavi M. Health trends, inequalities and opportunities in South Africa's provinces, 1990-2019: findings from the Global Burden of Disease 2019 Study. J Epidemiol Community Health 2022; 76:jech-2021-217480. [PMID: 35046100 PMCID: PMC8995905 DOI: 10.1136/jech-2021-217480] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Over the last 30 years, South Africa has experienced four 'colliding epidemics' of HIV and tuberculosis, chronic illness and mental health, injury and violence, and maternal, neonatal, and child mortality, which have had substantial effects on health and well-being. Using data from the 2019 Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), we evaluated national and provincial health trends and progress towards important Sustainable Development Goal targets from 1990 to 2019. METHODS We analysed GBD 2019 estimates of mortality, non-fatal health loss, summary health measures and risk factor burden, comparing trends over 1990-2007 and 2007-2019. Additionally, we decomposed changes in life expectancy by cause of death and assessed healthcare system performance. RESULTS Across the nine provinces, inequalities in mortality and life expectancy increased over 1990-2007, largely due to differences in HIV/AIDS, then decreased over 2007-2019. Demographic change and increases in non-communicable diseases nearly doubled the number of years lived with disability between 1990 and 2019. From 1990 to 2019, risk factor burdens generally shifted from communicable and nutritional disease risks to non-communicable disease and injury risks; unsafe sex remained the top risk factor. Despite widespread improvements in healthcare system performance, the greatest gains were generally in economically advantaged provinces. CONCLUSIONS Reductions in HIV/AIDS and related conditions have led to improved health since 2007, though most provinces still lag in key areas. To achieve health targets, provincial governments should enhance health investments and exchange of knowledge, resources and best practices alongside populations that have been left behind, especially following the COVID-19 pandemic.
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Affiliation(s)
- Tom Achoki
- Research, Africa Institute for Health Policy, Nairobi, Kenya
- Center for Pharmaceutical Policy and Regulation, Utrecht University, Utrecht, Netherlands
| | - Benn Sartorius
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - David Watkins
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Scott D Glenn
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Andre Pascal Kengne
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Non-communicable Diseases Research Unit, Medical Research Council South Africa, Cape Town, South Africa
| | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Charles Shey Wiysonge
- School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Alexandra Walker
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Olatunji O Adetokunboh
- Centre of Excellence for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Tesleem Kayode Babalola
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Community Health and Primary Care, University of Lagos, Lagos, Nigeria
| | | | - Mareli M Claassens
- Department of Biochemistry and Microbiology, University of Namibia, Windhoek, Namibia
- Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - Richard G Cowden
- Department of Psychology, University of the Free State, Park WEst, Free State, South Africa
| | - Candy T Day
- Health Systems Research Unit, Health System Trust, Westville, South Africa
| | - Oluchi Ezekannagha
- Independent Consultant, Awka, Nigeria
- International Institute of Tropical Agriculture, Ibadan, Nigeria
| | - Themba G Ginindza
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Chidozie C D Iwu
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Chinwe Juliana Iwu
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Innocent Karangwa
- Department of Statistics and Population Studies, University of the Western Cape, Cape Town, South Africa
| | - Patrick Dmc Katoto
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Centre for Tropical Diseases and Global Health, Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Nuworza Kugbey
- University of Environment and Sustainable Development, Somanya, Ghana
| | - Desmond Kuupiel
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Department of Nursing, Research for Sustainable Development Consult, Sunyani, Ghana
| | - Phetole Walter Mahasha
- Grants, Innovation and Product Development Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - George A Mensah
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Center for Translation Research and Implementation Science, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Chukwudi A Nnaji
- School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Mpiko Ntsekhe
- Division of Cardiology, University of Cape Town, Rondebosch, Western Cape, South Africa
- The Cardiac Clinic, Groote Schuur Hospital, Cape Town, South Africa
| | - Thomas Elliot Nyirenda
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- European and Developing Countries Clinical Trials Partnership (EDCTP), European Commission, Cape Town, South Africa
| | - Julius Nyerere Odhiambo
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Management Science and Technology, Technical University of Kenya, Nairobi, Nairobi, Kenya
| | | | - Charles D H Parry
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Julian David Pillay
- Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa
| | - Aletta Elisabeth Schutte
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Karen Sliwa
- Hatter Institute Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council, Cape Town, South Africa
| | - Frank C Tanser
- University of KwaZulu-Natal, Durban, South Africa
- Africa Health Research Institute, Berea, South Africa
| | - Ushotanefe Useh
- Health Sciences Department, North-West University, Mmbatho, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Unit on Child & Adolescent Health, Medical Research Council South Africa, Cape Town, South Africa
| | - Liesl J Zühlke
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | | | - Simon I Hay
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mohsen Naghavi
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Lozano R, Fullman N, Mumford JE, Knight M, Barthelemy CM, Abbafati C, Abbastabar H, Abd-Allah F, Abdollahi M, Abedi A, Abolhassani H, Abosetugn AE, Abreu LG, Abrigo MRM, Abu Haimed AK, Abushouk AI, Adabi M, Adebayo OM, Adekanmbi V, Adelson J, Adetokunboh OO, Adham D, Advani SM, Afshin A, Agarwal G, Agasthi P, Aghamir SMK, Agrawal A, Ahmad T, Akinyemi RO, Alahdab F, Al-Aly Z, Alam K, Albertson SB, Alemu YM, Alhassan RK, Ali M, Ali S, Alipour V, Aljunid SM, Alla F, Almadi MAH, Almasi A, Almasi-Hashiani A, Almasri NA, Al-Mekhlafi HM, Almulhim AM, Alonso J, Al-Raddadi RM, Altirkawi KA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amini S, Amini-Rarani M, Amiri F, Amit AML, Amugsi DA, Ancuceanu R, Anderlini D, Andrei CL, Androudi S, Ansari F, Ansari-Moghaddam A, Antonio CAT, Antony CM, Antriyandarti E, Anvari D, Anwer R, Arabloo J, Arab-Zozani M, Aravkin AY, Aremu O, Ärnlöv J, Asaad M, Asadi-Aliabadi M, Asadi-Pooya AA, Ashbaugh C, Athari SS, Atout MMW, Ausloos M, Avila-Burgos L, Ayala Quintanilla BP, Ayano G, Ayanore MA, Aynalem YA, Aynalem GL, Ayza MA, Azari S, Azzopardi PS, B DB, Babaee E, Badiye AD, Bahrami MA, Baig AA, Bakhshaei MH, Bakhtiari A, Bakkannavar SM, Balachandran A, Balassyano S, Banach M, Banerjee SK, Banik PC, Bante AB, Bante SA, Barker-Collo SL, Bärnighausen TW, Barrero LH, Bassat Q, Basu S, Baune BT, Bayati M, Baye BA, Bedi N, Beghi E, Behzadifar M, Bekuma TTT, Bell ML, Bensenor IM, Berman AE, Bernabe E, Bernstein RS, Bhagavathula AS, Bhandari D, Bhardwaj P, Bhat AG, Bhattacharyya K, Bhattarai S, Bhutta ZA, Bijani A, Bikbov B, Bilano V, Biondi A, Birihane BM, Bockarie MJ, Bohlouli S, Bojia HA, Bolla SRR, Boloor A, Brady OJ, Braithwaite D, Briant PS, Briggs AM, Briko NI, Burugina Nagaraja S, Busse R, Butt ZA, Caetano dos Santos FL, Cahuana-Hurtado L, Cámera LA, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Castro F, Catalá-López F, Causey K, Cederroth CR, Cercy KM, Cerin E, Chandan JS, Chang AY, Charan J, Chattu VK, Chaturvedi S, Chin KL, Cho DY, Choi JYJ, Christensen H, Chu DT, Chung MT, Ciobanu LG, Cirillo M, Comfort H, Compton K, Cortesi PA, Costa VM, Cousin E, Dahlawi SMA, Damiani G, Dandona L, Dandona R, Darega Gela J, Darwesh AM, Daryani A, Dash AP, Davey G, Dávila-Cervantes CA, Davletov K, De Neve JW, Denova-Gutiérrez E, Deribe K, Dervenis N, Desai R, Dharmaratne SD, Dhungana GP, Dianatinasab M, Dias da Silva D, Diaz D, Dippenaar IN, Do HT, Dorostkar F, Doshmangir L, Duncan BB, Duraes AR, Eagan AW, Edvardsson D, El Sayed I, El Tantawi M, Elgendy IY, Elyazar IRF, Eskandari K, Eskandarieh S, Esmaeilnejad S, Esteghamati A, Ezekannagha O, Farag T, Farahmand M, Faraon EJA, Farinha CSES, Farioli A, Faris PS, Faro A, Fazlzadeh M, Feigin VL, Fernandes E, Ferrara P, Feyissa GT, Filip I, Fischer F, Fisher JL, Flor LS, Foigt NA, Folayan MO, Fomenkov AA, Foroutan M, Francis JM, Fu W, Fukumoto T, Furtado JM, Gad MM, Gaidhane AM, Gakidou E, Galles NC, Gallus S, Gardner WM, Geberemariyam BS, 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Sigurvinsdottir R, Silva DAS, Silva JP, Simonetti B, Simpson KE, Singh JA, Singh P, Sinha DN, Skryabin VY, Smith EUR, Soheili A, Soltani S, Soofi M, Sorensen RJ, Soriano JB, Sorrie MB, Soyiri IN, Spurlock EE, Sreeramareddy CT, Stanaway JD, Steel N, Stein C, Stokes MA, Sufiyan MB, Suleria HAR, Sultan I, Szumowski Ł, Tabarés-Seisdedos R, Tabuchi T, Tadakamadla SK, Taddele BW, Tadesse DB, Taherkhani A, Tamiru AT, Tanser FC, Tareque MI, Tarigan IU, Teagle WL, Tediosi F, Tefera YGG, Tela FG, Tessema ZT, Thakur B, Titova MV, Tonelli M, Topor-Madry R, Topouzis F, Tovani-Palone MRR, Tran BX, Travillian R, Troeger CE, Tudor Car L, Uddin R, Ullah I, Umeokonkwo CD, Unnikrishnan B, Upadhyay E, Uthman OA, Vacante M, Valdez PR, Varughese S, Vasankari TJ, Vasseghian Y, Venketasubramanian N, Violante FS, Vlassov V, Vollset SE, Vongpradith A, Vos T, Waheed Y, Walters MK, Wamai RG, Wang H, Wang YP, Weintraub RG, Weiss J, Werdecker A, Westerman R, Wilner LB, Woldu G, Wolfe CDA, Wu AM, Wulf Hanson S, Xie Y, Xu R, Yahyazadeh Jabbari SH, Yamagishi K, Yano Y, Yaya S, Yazdi-Feyzabadi V, Yearwood JA, Yeshitila YG, Yip P, Yonemoto N, Younis MZ, Yousefi Z, Yousefinezhadi T, Yusefzadeh H, Zadey S, Zahirian Moghadam T, Zaidi SS, Zaki L, Zaman SB, Zamani M, Zamanian M, Zandian H, Zastrozhin MS, Zewdie KA, Zhang Y, Zhao XJG, Zhao Y, Zheng P, Zhu C, Ziapour A, Zlavog BS, Zodpey S, Murray CJL. Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396:1250-1284. [PMID: 32861314 PMCID: PMC7562819 DOI: 10.1016/s0140-6736(20)30750-9] [Citation(s) in RCA: 251] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/05/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. METHODS Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0-100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target-1 billion more people benefiting from UHC by 2023-we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. FINDINGS Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2-47·5) in 1990 to 60·3 (58·7-61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9-3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010-2019 relative to 1990-2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6-421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0-3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5-1040·3]) residing in south Asia. INTERPRETATION The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people-the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close-or how far-all populations are in benefiting from UHC. FUNDING Bill & Melinda Gates Foundation.
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Ezekannagha O, Drimie S, von Fintel D, Maziya-Dixon B, Mbhenyane X. Validation of a roadmap for mainstreaming nutrition-sensitive interventions at state level in Nigeria. Nutr J 2020; 19:96. [PMID: 32907577 PMCID: PMC7488070 DOI: 10.1186/s12937-020-00612-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 08/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND National programs are often developed with little consideration to the sub-national local factors that might affect program success. These factors include political support, capacity for implementation of program and variation in malnutrition indices being tackled. State context factors are evident in the distribution of malnutrition (e.g. high prevalence or gap among Local Government Areas), in the implementation of nutrition-sensitive interventions (e.g. access to early childhood education) and in the political economic context (e.g. presence of external funding agencies). Context is shaped by the economy, population, religion, and poverty, which impact everyday lives. Considering these contexts, a roadmap was developed and validated. The aim of this paper is to report expert review and stakeholder validation to determine feasibility of the developed contextualised roadmap for two Nigerian states. METHODS A validation tool was developed and reviewed using three experts. The content review occurred in two rounds to obtain recommendation and revisions of the developed roadmap and the validation tool. A pilot test of the roadmap and validation tool was done using two stakeholders in South Africa. The roadmap and the validation tool were then sent to the stakeholders and potential end-users in Nigeria using electronic media. Two research assistants were also engaged to deliver and collect hard copies to those who preferred it. RESULTS Of the ten stakeholders invited, nine responded. All participants showed an adequate understanding of the roadmap as evidenced by the scores given. Responses regarding the translation of the roadmap to implementation varied. The majority (86,6%) either strongly agreed or agreed that the actions were translatable (43.0 and 43.6% respectively). CONCLUSIONS The final roadmap comprises of actions that are appropriate for the state's context. It is recommended that stakeholders or end-users of any programme must be involved in the validation of such contextual programmes to improve chances of success.
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Affiliation(s)
- Oluchi Ezekannagha
- Division of Human Nutrition, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
- International Institute of Tropical Agriculture, Ibadan, Nigeria
| | - Scott Drimie
- Division of Human Nutrition, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Dieter von Fintel
- Department of Economics, Stellenbosch University, Stellenbosch, South Africa
| | | | - Xikombiso Mbhenyane
- Division of Human Nutrition, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa.
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Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17. Lancet Glob Health 2020; 8:e1162-e1185. [PMID: 32827479 PMCID: PMC7443708 DOI: 10.1016/s2214-109x(20)30278-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/01/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. METHODS We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. FINDINGS Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4-40·7) to 50·3% (50·0-50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1-46·5) in 2017, compared with 28·7% (28·5-29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2-89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664-711) of the 1830 (1797-1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6-80·7) of countries from 2000 to 2017, and in 53·9% (50·6-59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. INTERPRETATION Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation. FUNDING Bill & Melinda Gates Foundation.
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