Obstacles and Challenges affecting the move towards Universal Healthcare Coverage in Nigeria

There is increasing pressure for low and middle-income countries to move towards achieving universal healthcare coverage (UHC). According to WHO (2013), UHC guarantees the right to affordable health care for every individual, without financial hardship. The Director-General to the World Health Organization, Margaret Chan (WHO, 2010 p. 1), says UHC “is the single most powerful concept that public health has to offer”.In recent years, UHC has come onto the policy agenda, but Nigeria has been criticised for its slow progress. This study investigates why and how the UHC policy is developed by focusing on the roles and interactions of policy actors, their policy setting, and ‘how’ their actions influence the policy process and outcome of UHC so far in Nigeria. It will provide evidence of Nigeria’s policy process that will enhance the understanding of the politics of such health care policy implementation processes, which is fundamental to the success of policy networks of UHC in low- and middle-income settings.This is an empirical study using a mixed method approach involving quantitative and qualitative research components. The study combines the social network analysis (the quantitative component) with a more general policy process framework (the qualitative component). Data collected between March 2016 and February 2017 involved face-to-face structured interviews, face-to-face semi-structured interviews and documentary analysis to identify members of relevant policy networks and describe the pattern of relationships and influence within the UHC discourse.The SNA analysis displayed a full structural network taxonomy of the UHC policy process and identified key members of the UHC discourse into four key institutions and organisations- such as the power actors, peripheral actors, gatekeepers or brokers, isolated actors, and policy actors connected to the power actors.The theoretical policy process framework highlights five key gaps that exist as challenges and obstacles which impedes the implementation process of UHC Nigeria. These challenges and obstacles include, changing political climate, concerns about system capacity and finance, poor coordination between federal and state levels, corruption and problems with the private sector – HMOs. These challenges and obstacles limit the government’s ability to provide social and financial risk protection and access to quality health services to vulnerable Nigerian communities.Drawing on the theoretical framework and intervention, this thesis concludes that the political, policy, financial and organizational constraints of the health system limit UHC Nigeria implementation progress. Addressing the reasons why these issues ensue would be helpful in taking strategic steps towards achieving financial protection and access to basic health services through UHC for many Nigerians

Using community theater to improve demand for vaccination services in the Niger Delta Region of Nigeria

Abstract Introduction Despite abundant evidence showing immunization as a lifesaving public health measure, a large proportion of Nigerian children are still not or fully vaccinated. Lack of awareness and distrust of the immunization process by caregivers are some of the reasons for poor immunization coverage which need to be addressed. This study aimed at improving vaccination demand, acceptance and uptake in Bayelsa and Rivers State, both in the Niger Delta Region (NDR) of Nigeria through a human-centered process of trust building, education and social support. Methods A quasi-experimental intervention christened Community Theater for Immunization (CT4I) was deployed in 18 selected communities between November 2019 and May 2021 in the two states. In the intervention localities, relevant stakeholders including the leadership of the health system, community leaders, health workers and community members were engaged and actively involved in the design and performance of the theaters. The content for the theater showcased real stories, using a human-centered design (HCD) of ideation, co-creation, rapid prototyping, feedback collection and iteration. Pre- and post-intervention data on the demand and utilization of vaccination services were collected using a mixed method. Results In the two states, 56 immunization managers and 59 traditional and religious leaders were engaged. Four broad themes implicating user and provider factors emerged from the 18 focus group discussions as responsible for low immunization uptake in the communities. Of the 217 caregivers trained on routine immunization and theater performances, 72% demonstrated a knowledge increase at the post-test. A total of 29 performances attended by 2,258 women were staged with 84.2% of the attendees feeling satisfied. At the performances, 270 children received vaccine shots (23% were zero-dose). There was a 38% increase in the proportion of fully immunized children in the communities and 9% decline in the proportion of zero-dose children from baseline. Conclusion Both demand- and supply-side factors were identified as responsible for poor vaccination in the intervention communities. Our intervention demonstrates that caregivers will demand immunization services if they are engaged through community theater using a human-centered design (HCD). We recommend a scaling up of HCD to address the challenge of vaccine hesitancy