Can Strategic Health Purchasing Reduce Inefficiency and Corruption in the Health Sector? The Case of Nigeria

Despite limited government budgets for health in many sub-Saharan African countries, some countries have improved health outcomes at low cost by being strategic in allocating and spending available resources. Strategic health purchasing is receiving increasing attention as a way to improve health system performance within financial constraints. Health purchasing, one of the health financing functions of health systems, is the transfer of pooled funds to health providers to deliver covered services. Strategic health purchasing uses evidence and information about population health needs and health provider performance to make decisions about which health services should have priority for public funding, which providers will provide these services, and how and how much providers will be paid to deliver those services. Strategic purchasing has enabled some countries to make progress on health sector goals while improving efficiency, equity, transparency, and accountability. However, when countries have high levels of corruption and low levels of accountability, as in Nigeria, strategic purchasing may be less effective and more money for health may not yield the expected public health benefits. This commentary uses the Strategic Health Purchasing Progress Tracking Framework developed by the Strategic Purchasing Africa Resource Center (SPARC) and its technical partners to examine health purchasing functions in Nigeria’s main health financing schemes, how corruption affects the effectiveness of health purchasing in Nigeria, and opportunities to use strategic purchasing as a tool to address corruption in health financing by improving the transparency and accountability of health resource allocation and use.</p

Can Strategic Health Purchasing Reduce Inefficiency and Corruption in the Health Sector? The Case of Nigeria

Despite limited government budgets for health in many sub-Saharan African countries, some countries have improved health outcomes at low cost by being strategic in allocating and spending available resources. Strategic health purchasing is receiving increasing attention as a way to improve health system performance within financial constraints. Health purchasing, one of the health financing functions of health systems, is the transfer of pooled funds to health providers to deliver covered services. Strategic health purchasing uses evidence and information about population health needs and health provider performance to make decisions about which health services should have priority for public funding, which providers will provide these services, and how and how much providers will be paid to deliver those services. Strategic purchasing has enabled some countries to make progress on health sector goals while improving efficiency, equity, transparency, and accountability. However, when countries have high levels of corruption and low levels of accountability, as in Nigeria, strategic purchasing may be less effective and more money for health may not yield the expected public health benefits. This commentary uses the Strategic Health Purchasing Progress Tracking Framework developed by the Strategic Purchasing Africa Resource Center (SPARC) and its technical partners to examine health purchasing functions in Nigeria’s main health financing schemes, how corruption affects the effectiveness of health purchasing in Nigeria, and opportunities to use strategic purchasing as a tool to address corruption in health financing by improving the transparency and accountability of health resource allocation and use.</p

Complex roles of families in enabling sex trafficking in Edo, Nigeria

Families are an expected haven for their members but could present threats in some contexts. Part of a large-scale PhD study with 101 participants, empirical findings on the roles played by families in encouraging sex trafficking in Edo, Nigeria are presented here. Using in-depth interviews and group discussions, data were elicited from actors within trafficking in persons. Core findings included the exploitation of roles and responsibilities in families towards enabling sex trafficking, the abuse of shared meanings of family in communities, and the exploitation of vulnerable families. Vulnerable families were identified to lack fathers or those whose parents were older adults and/or uneducated. Thus, women in such families were at greater risk of being trafficked. For conceptual understanding of these family roles in sex trafficking, we employed structure-agency insights. In all, anti-sex trafficking interventions must begin with families as the smallest unit of interventions.<br/

Complex roles of families in enabling sex trafficking in Edo, Nigeria

Families are an expected haven for their members but could present threats in some contexts. Part of a large-scale PhD study with 101 participants, empirical findings on the roles played by families in encouraging sex trafficking in Edo, Nigeria are presented here. Using in-depth interviews and group discussions, data were elicited from actors within trafficking in persons. Core findings included the exploitation of roles and responsibilities in families towards enabling sex trafficking, the abuse of shared meanings of family in communities, and the exploitation of vulnerable families. Vulnerable families were identified to lack fathers or those whose parents were older adults and/or uneducated. Thus, women in such families were at greater risk of being trafficked. For conceptual understanding of these family roles in sex trafficking, we employed structure-agency insights. In all, anti-sex trafficking interventions must begin with families as the smallest unit of interventions.<br/

Improving service delivery at primary healthcare facilities for achieving Universal Health Coverage: Examining the effects of insecurity in such facilities in Enugu State, Nigeria

Background:&nbsp;Availability of health services at the primary healthcare (PHC) level is crucial to the achievement of Universal Health Coverage (UHC). However, insecurity of PHC facilities inspires unavailability of health services. From perspectives of primary health service providers, we examined the effects of insecurity at rural and urban PHC facilities in Enugu, Nigeria. Methodology:&nbsp;The study adopts a qualitative method using in-depth interviews and non-participant observation. The study sites were eight (8) PHC facilities (rural/urban) that were purposively selected. The first author interacted with the health workers and made extensive observations on infrastructure, policing, and other security gaps affecting the facilities. Findings:&nbsp;While health workers wish to provide services as stipulated, the fear of getting hurt or losing their properties to hoodlums scares them, especially during the dusk hours. Owing to infrastructure deficits and lack of security personnel, incidents of losing phones, stolen babies and facility items/consumables, and patients being attacked were said to be recurring. The absence of power supply during the dusk hours tend to heighten their fears, hence health workers close before it gets dark, not minding the consequences on health service users. Conclusion:&nbsp;The issue of insecurity of lives of both the health workers and their clients is paramount to the optimal use of services in the PHC facilities. Insecurity is a priority concern for the health workers, and if not addressed could cause them to completely shun working in certain areas, or shun their jobs completely, with dire consequences for the achievement of UHC

Improving service delivery at primary healthcare facilities for achieving universal health coverage:Examining the effects of insecurity in such facilities in enugu state, nigeria

Background: Availability of health services at the primary healthcare (PHC) level is crucial to the achievement of Universal Health Coverage (UHC). However, insecurity of PHC facilities inspires unavailability of health services. From perspectives of primary health service providers, we examined the effects of insecurity at rural and urban PHC facilities in Enugu, Nigeria. Methodology: The study adopts a qualitative method using in-depth interviews and non-participant observation. The study sites were eight (8) PHC facilities (rural/urban) that were purposively selected. The first author interacted with the health workers and made extensive observations on infrastructure, policing, and other security gaps affecting the facilities. Findings: While health workers wish to provide services as stipulated, the fear of getting hurt or losing their properties to hoodlums scares them, especially during the dusk hours. Owing to infrastructure deficits and lack of security personnel, incidents of losing phones, stolen babies and facility items/consumables, and patients being attacked were said to be recurring. The absence of power supply during the dusk hours tend to heighten their fears, hence health workers close before it gets dark, not minding the consequences on health service users. Conclusion: The issue of insecurity of lives of both the health workers and their clients is paramount to the optimal use of services in the PHC facilities. Insecurity is a priority concern for the health workers, and if not addressed could cause them to completely shun working in certain areas, or shun their jobs completely, with dire consequences for the achievement of UHC

Community engagement in COVID-19 responses:Evidence from qualitative interface with community opinion leaders in Enugu, Nigeria

Successful stories of community engagement existed during the Ebola disease outbreak in Liberia, indicating that a combination of government and community efforts are needed in addressing pandemics or epidemics. However, for communities to rise to the challenge of containing and combatting the spread of any disease, they must be communicated most effectively and supported by the government. Therefore, our study investigates how applicable successful community engagement has been in the charge against the Coronavirus disease 2019 (COVID-19) in Nigeria. Through telephone interviews, we sourced data from 12 community opinion leaders in Enugu State, Nigeria. After conducting a thematic analysis of responses, we discovered that the Nigerian government had several gaps in engaging the grassroots in the charge against COVID-19. These gaps comprise the lack of effective inclusion strategies of rural communities and the uneducated, weak accountability, poor database of citizens, weak accountability of security agents, weak primary healthcare system, and the dearth of grassroots-targeted communication. The effects of these gaps majorly manifested in the compromise and disregard of safety measures, which most likely put Nigeria at risk of increased cases of COVID-19 or poor response to disease outbreaks in the future. We concluded that the government must improve its accountability records while effectively interfacing with the grassroots during disease outbreaks and co-producing strategies.<br/

Community engagement in COVID-19 responses:Evidence from qualitative interface with community opinion leaders in Enugu, Nigeria

Successful stories of community engagement existed during the Ebola disease outbreak in Liberia, indicating that a combination of government and community efforts are needed in addressing pandemics or epidemics. However, for communities to rise to the challenge of containing and combatting the spread of any disease, they must be communicated most effectively and supported by the government. Therefore, our study investigates how applicable successful community engagement has been in the charge against the Coronavirus disease 2019 (COVID-19) in Nigeria. Through telephone interviews, we sourced data from 12 community opinion leaders in Enugu State, Nigeria. After conducting a thematic analysis of responses, we discovered that the Nigerian government had several gaps in engaging the grassroots in the charge against COVID-19. These gaps comprise the lack of effective inclusion strategies of rural communities and the uneducated, weak accountability, poor database of citizens, weak accountability of security agents, weak primary healthcare system, and the dearth of grassroots-targeted communication. The effects of these gaps majorly manifested in the compromise and disregard of safety measures, which most likely put Nigeria at risk of increased cases of COVID-19 or poor response to disease outbreaks in the future. We concluded that the government must improve its accountability records while effectively interfacing with the grassroots during disease outbreaks and co-producing strategies.<br/

Transcriptional analyses of adult and pediatric adamantinomatous craniopharyngioma reveals similar expression signatures regarding potential therapeutic targets

Adamantinomatous craniopharyngioma (ACP) is a biologically benign but clinically aggressive lesion that has a significant impact on quality of life. The incidence of the disease has a bimodal distribution, with peaks occurring in children and older adults. Our group previously published the results of a transcriptome analysis of pediatric ACPs that identified several genes that were consistently overexpressed relative to other pediatric brain tumors and normal tissue. We now present the results of a transcriptome analysis comparing pediatric to adult ACP to identify biological differences between these groups that may provide novel therapeutic insights or support the assertion that potential therapies identified through the study of pediatric ACP may also have a role in adult ACP. Using our compiled transcriptome dataset of 27 pediatric and 9 adult ACPs, obtained through the Advancing Treatment for Pediatric Craniopharyngioma Consortium, we interrogated potential age-related transcriptional differences using several rigorous mathematical analyses. These included: canonical differential expression analysis; divisive, agglomerative, and probabilistic based hierarchical clustering; information theory based characterizations; and the deep learning approach, HD Spot. Our work indicates that there is no therapeutically relevant difference in ACP gene expression based on age. As such, potential therapeutic targets identified in pediatric ACP are also likely to have relvance for adult patients

Health Worker Absenteeism in Selected Health Facilities in Enugu State:Do Internal and External Supervision Matter?

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