Author: HPRG

Media gurus and health systems researchers meet to amplify health research evidence for governance and improving communities

By The Health Policy Research Group, University of Nigeria

Researchers serially complain of the lack of spread of the wonderful and interesting scientific evidence they generate. Why this is so, is because researchers use a lot of technical languages in their works. In contrast, the media remains public friendly, writes using simple words and utilize creative means to reach the public. The media is known for inspiring political debates, causing political actors to pay close attention to them, far more than the attention given to scientific publications. A blog, titled, “Everyone!! wants to read a blog but your scholar-colleagues want to read your journal article” discusses why it is essential for academics to go beyond just writing academic papers.

With the understanding that the media takes care of the limitations of researchers in research communication, the Health Policy Research Group (HPRG), University of Nigeria, through the Community-led Responsive and Effective Urban Health Systems (CHORUS) organised a research-media bootcamp between April 12-14, 2023 in Enugu, for researchers and media/public relations (PR) gurus to have a handshake and build collaborations. The bootcamp provided an opportunity for knowledge and skills exchange between the media experts and researchers, with the focus of improving seamless and widespread communication of health research evidence to the public and policymakers.

What researchers are saying

To pull together and make sense of quality research evidence is no small feat. The processes and funding are tasking. Yet researchers at HPRG have remained committed to the cause of regularly producing research evidence in health systems and policy. In more advanced countries, investments in research are indeed huge, and governments commission researchers to go in search of evidence used to make policies and programmes to improve governance and the lives of citizens. According to the World Bank, Nigeria’s expenditure on research is less than 0.5% of its Gross Domestic Product (GDP), compared to countries like South Africa and more advanced countries like the United Kingdom and Canada that spend close to (and) over 2% of GDP on research. These countries ensure that their policies and programmes, including those of the health sector are informed by research evidence – a practice that is yet to gain strong footing in Nigeria.

Quality time during the bootcamp was dedicated to coaching the media/PR experts on how research is conducted, identification of quality research evidence and their types, and how media/PR experts can find the central message in published studies. This section was facilitated by Dr Aloysius Odii, who emphasized that with the media, research evidence will be at the doorsteps of the public and those that make policies and programmes in Nigeria.

It is important to note that HPRG, since its establishment in 2002, understands the importance of not abandoning research evidence to academic publications alone. The Health Policy and Systems Research (HPSR) Hub has developed a framework on Getting Research into Policy and Practice (GRIPP), published in the Journal of Globalization and Health. Dr Enyi Etiaba, one of the developers of the framework acknowledged the vital roles of the media in GRIPP which were not well captured as of the time the framework was designed. However, in the last couple of years, HPRG has taken seriously, the advantages of the media in research communication by leveraging the radio, social media, blogs, setting up an institutional website, and developing a yet to be published strategic research communication plan with the media as a vital component.

What media/PR experts are saying

The Nigeria Health Watch (NHW) continues to play significant roles in health communication. Chibuike Alagboso representing the NHW addressed the trends in health communication and the usefulness of the approach of solution journalism (SoJo). Supporting NHW were two Mass Communication experts from the University of Nigeria, Drs. Celestine Gever and Ijeoma Ajaero, who spoke about the politics of the media and importance of conducting media assessment during research communication.

Ifesinachi Cyril, Sandra Nwankwo, and Okechukwu Agubama of Radio Nigeria, Dream FM, and NTA Enugu, respectively, buttressed the importance of media assessment to be included in research planning, while adding that researchers must be intentional with building collaborations and partnerships with the media. Steps in building these collaborations, such as courtesy visits and frequent communications of research evidence with the media were enlisted by the PR experts from the University of Nigeria, Inya Agha and Obianuju Akamigbo.

Media-focused writing was extensively discussed during the bootcamp, led by Alex Enebeli of the News of Agency of Nigeria, Patience Ihejirika of Leadership News, and Vanessa Offiong. Researchers writing for the media must ensure that research findings are presented in formats that are clear, brief, and relatable, with results at the top and clear calls to actions. The use of infographics was mentioned to be important in writing for the media, and interestingly, James Ozoagu, an infographic expert was present to drill all attendees at the bootcamp infographics skills.

Finally, as the issue of corruption continues to feature in most of the studies conducted by HPRG, it was important to use this bootcamp as an opportunity to learn and discuss about how the media reports corruption. Victoria Bamas of International Centre for Investigative Reporting (ICIR) touched on vital dos and don’ts in gathering information about corruption issues and reporting them. This cuts across strategic tracking of sharp practices, leveraging the Freedom of Information (FOI) Law, and reporting what is lost to corruption as against just the corruption itself.

Call to action

An established network of researchers and media/PR experts is formed, and a strategic plan for research communication through the media for the next five years is currently being designed. As agreed, the plan will be reviewed intermittently. Objectives of the strategic plan are focused on relationships and communications, responsibilities, funding, and content and style of research products for the media. The network looks forward to expansion in the coming years, strongly believing that all gaps between researchers and media will be bridged, and health research evidence will be regularly disseminated and communicated for policy impact and improvement of the health of Nigerians.

List of presentations

We have compiled all presentations during the bootcamp. Kindly click on the links below to download.

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Improving Access to Quality Healthcare in Urban Slums: Researchers Collaborate with Government, Healthcare Providers and Communities to Design Feasible Interventions

By Prince Agwu, Chinyere Mbachu, & Obinna Onwujekwe

The realities of living in informal settlements in Nigeria are telling of the healthcare conditions in such areas and are described as urban health risk. Over 54% of urban residents in Nigeria reside in informal settlements, and in the absence of actions towards urban renewal, the situation will only get worse. It is as well expected that the continuous increase in multi-dimensionally poor Nigerians may push more citizens into relocating to urban slums or creating more informal settlements as a survival strategy. Thus, while we envision the upgrading of urban slums and proper integration into city plans, we must begin to work towards improving the health conditions of the slum dwellers.

The Health Policy Research Group (HPRG), University of Nigeria, is involved in a multi-country research project, CHORUS Consortium, which is aimed at improving access to quality and essential health services for the urban poor. Having completed a baseline assessment of access to health services in selected urban slums in Enugu and Onitsha, the HPRG has begun to engage key stakeholders in Enugu State to identify, select and design feasible interventions that would guarantee access to safe and decent healthcare for slum dwellers.

The HPRG-CHORUS Strategy for better health for slums

The most radical approach to improve health conditions in slums is to improve the economic livelihood of the residents, demolish shanty structures and replace with better livable buildings, build good hospitals staffed with well-qualified medical practitioners, and provide critical amenities for the people. But we must ask, ‘how realistic can these be achieved in present Nigeria?’

Also, it is important to point out that based on emerging evidence, there are slum residents who choose to patronize traditional practitioners and patent medicine vendors (PMVs), even when a functional health facility is easily accessible. So, a comprehensive approach to ensure safe and quality health for people living in slums is to make sure that the informal healthcare providers are formally engaged in health promotion activities, and conscientiously supervised by the public (government) health system to the benefit of the urban poor. This is what we in HPRG-CHORUS refer to as “linkage of informal providers to the formal public health system”. By informal providers, we refer to the traditional medicine practitioners, traditional birth attendants, and PMVs.

Cross-section of stakeholders co-designing health interventions for slums

HPRG-CHORUS Team reviews research findings and conducts a field validation visit

The team at the University of Nigeria hosted one of the leads of the CHORUS Consortium from the University of York, Professor Helen Elsey between February 6-9, 2023. The four-day visit comprised interactive sessions with HPRG researchers, advocacy visits to key policymakers, and site visits to two urban slums within Enugu city.

Together with Helen, HPRG researchers reviewed findings from the baseline assessment which consisted of (a) reconnaissance of informal and formal health provisions in the urban slums, (b) in-depth interviews and focus group discussions with informal and formal providers, community leaders and residents, and policy makers, and (c) quantitative survey of formal and informal healthcare providers and households in the urban slums. A key output from this conversation is that there are ongoing relationships between the formal and informal providers that need strengthening through education of providers and service users, institutionalization through policies and government-approved/supervised practices and addressing frictions between the informal providers and the formal providers.

HPRG-CHORUS Core Team discussing research findings

The site visits to the urban slums confirmed that the conditions of the slums in terms of access to health services and other basic amenities had worsened or remained the same, at best. Remarkably, the primary health centres in the slums were yet to have the optimal and right mix of staff, lacked pro-poor financing, and lagging behind in overall management. In fact, one of the health facilities had become a den for criminal elements, completely shut, despite being supported by the Basic Heath Care Provision Fund (BHCPF). However, informal providers continue to provide health services in the slums although their connections to the formal health system were still very weak. Due to this lack of formal oversight on informal providers, some had taken to inappropriate practices, including administering harmful substances to persons that reside in and off the slums.

HPRG-CHORUS Team meets with policymakers to chart actions

Armed with evidence from the baseline assessment and the recent site visit, advocacy visits were made to the Executive Secretary of the State Primary Health Care Development Agency and the Commissioner for Health in Enugu State. They expressed convictions over the State government’s commitment to strengthen primary healthcare and outlined some strategies being implemented including the establishment of model PHCs across the State. However, both policymakers acknowledged that a lot still needs to be done to optimize the formal healthcare system, particularly in the urban slums, and that formalizing linkages with informal providers could contribute to improving access to quality and essential healthcare for the urban poor.

Nevertheless, they cautioned that pursuing linkages with informal providers must be done with carefulness, guided by a thorough understanding of the processes and treatment procedures adopted by the informal providers. Interestingly, the WHO has committed to ensuring that informal providers function within defined scope for safety reasons. A Joint Health Sector Inspectorate was recommended by the Commissioner as an important regulatory body to ensure quality service delivery across the formal and informal health blocs. Also, dysfunctional health facilities in the slums have been noted and urgent actions will be taken to ensure that they are considerably efficient to serve the health needs of the slum residents.

HPRG-CHORUS Team with the Enugu Commissioner of Health – Prof Ikechukwu Obi (centre)

HPRG-CHORUS Team with Enugu Executive Secretary of Primary Health Care Agency – Dr George Ugwu (centre)

An organized forum where interventions for proposed linkages are designed

From February 15-17, 2023, the HPRG-CHORUS Team facilitated a workshop in which researchers collaborated with policymakers, programme managers, informal and formal health providers, and community (slum) leaders to identify, select and begin to operationalize feasible interventions for formalizing linkages between the informal providers and the formal (public) health system. A total of 22 interventions were listed, of which in a merging and ranking exercise, they were further condensed to ten.

Group work during the co-design engagement

Currently, stakeholders are working in technical groups to design operational plans and tools for the following interventions, (1) Community engagement for awareness about available formal health services and educate residents on the need for linking informal to the formal (2) Training and reorientation of informal providers to accept linkage to the formal health sector (3) Regulate and improve referral systems between both providers (4) Incentives for informal providers to optimally accept and pursue proposed linkage to the formal (5) Create policies and structures to ensure sustainability of linkages.

Looking forward to the future

In the coming months, the researchers and stakeholders will finalize the operational plans and tools for piloting the interventions in four slums in Enugu State. Also, a co-creation workshop will be implemented with key stakeholders in Anambra State (focusing on Onitsha city).

The HPRG-CHORUS Team appreciates the support and cooperation it has received from policymakers who will be the chief implementers of the interventions and ensure their sustainability. We also appreciate the participation of other stakeholders who are keen on achieving improved access to quality healthcare in urban slums. Indeed, there is hope that healthcare for slums can be made safe and decent, and the outputs from the current study can provide a blueprint to manage the healthcare space across other slums in Nigeria.

We are happy that the HPRG-CHORUS Team will be expanding its research focus on urban health. For the next two years, Prince Agwu, Tochukwu Orjiakor, and Uche Ezenwaka will be leading studies on health seeking of school children in urban slums in Port Harcourt, addressing crime issues and health impacts in slums in Aba and Onitsha, and water/sanitation/hygiene in Onitsha slums, respectively. These novel studies will certainly strengthen urban health understanding and actions in Nigeria, with great lessons to emerge for similar countries.

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HPRG’s Thought Leadership on Advocacy for Policy Change

By HPRG News

Kurt Lewin said, “no research without action, and no action without research”. The reality of this quote lies in the essence of conducting research, which is to change society. Such change could be to inform, influence, or introduce great policies and programmes; or to improve conditions for the poor and vulnerable; or to even inform effective governance. Any which way, a goal for academia is to ensure that research brings real-time and tangible positive changes to the lives of people, and that generated evidence makes sense to policymakers and used for the good of the public.

These precedents motivate the Health Policy Research Group (HPRG), University of Nigeria to engage in building capacities in advocacies and influencing policies and programmes using research evidence. A well-researched study on bridging gaps between policymakers and researchers was published by the HPRG, and they have gone forward to mainstream these insights and approaches into mentorship programmes for organisations. Very recently, HPRG was engaged to build the capacity of the staff of the German Leprosy and Tuberculosis Relief Association/RedAid Nigeria (GLA/RAN) in Enugu on advocacy for policy change using research evidence.

GLA/RAN, Enugu, is currently implementing an innovation grant from the STOP TB Partnership, titled – ‘Catalysing improvements in drug-resistance tuberculosis (DR-TB) care in Nigeria: A sustainable patient-centred approach’. The core aims of the project include reducing pre-treatment loss to follow-up and commencing treatment for newly diagnosed DR-TB cases as fast as possible, by addressing factors that affect the patient-care pathway from efficacy of investigations through initiation of treatment for DR-TB. In addition, a core part of their research aims will be to get generated evidence into policies and practice. To achieve this, the following important resources from HPRG will be needful:

Concept and importance of advocacy for policy change – By Dr Chinyere Okeke (Click here to download presentation)
Understanding the use and role of media and communication for effective advocacy – By Prince Agwu and Chinelo Obi (Click here to download presentation)
Foundational principles and key components of developing advocacy strategies – By Chioma Onyedinma (Click here to download presentation)
Methodologies and tools for effective advocacy – By Prof Chinyere Mbachu (Click here to download presentation)
How to write a policy brief – By Prof BSC Uzochukwu (Click here to download presentation)
Planning, implementing and evaluating advocacy and communication for policy change – By Dr Chinyere Okeke (Click here to download presentation)
Getting research into policy and practice – By Prof BSC Uzochukwu (Click here to download presentation)

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“Corruption in the health sector is stealing from the sick”: Policy Forum for insights and action on accountability and corruption in health

By Prince Agwu, Obinna Onwujekwe, Dina Balabanova and the Accountability in Action Research Team

Background

Despite anticorruption thrusts that have always been a part of the manifestos of successive governments in Nigeria, corruption has remained considerably high in the country. With corruption being common in many sectors of Nigeria, the country in the 2021 Corruption Perception Index (CPI), scored 24 of 100, making it the 154^th most corrupt country out of 180 countries in the world, and among the 15 most corrupt countries in Africa. Disappointingly, the health sector continues to feature as among the top-5 corrupt sectors in the country.

Image 1: Nigeria’s CPI since 2012 (Source: Trading Economics)

Is corruption in health a lack of morals or a failure of systems?

Thomas Hobbes described life as nasty and brutish, constantly in a state of war, which explains how the nature of man is disapproving of principles and good behaviour. Hobbes further used this philosophy to buttress the importance of social control (rules and institutions that keep to the demands of the rule of law) against the deviant nature of people and make them more compliant with rules. Just as Hobbes, Sigmund Freud argued that societies get better when the superego (comprising ideals, principles, laws, etc.) is enforced to quell the irrational and socially unacceptable personalities of people (ego). In these, and in other traditional scholarship, the innate tendency to be corrupt appears to be part of human nature, but people can be less or not corrupt in systems that are built to be intolerant of corruption. This is why the Anti-corruption Evidence Consortium argues for the need to strengthen vertical (government offices) and horizontal forces (grassroots people), such that systems can become self-enforcing against corruption.

Therefore, corruption may not entirely be the moral failure of individuals, but even more, a failure of institutions that creates incentives for corrupt practices. At times, institutions may fail to the extent that corruption becomes the only way for people to survive and support their families. Thus, instead of just identifying and punishing individuals who break the rules, an anticorruption agenda must seek to make corruption unattractive and difficult to perpetuate, and at the same time, build a system that can be self-enforcing against corruption.

A reminder about Nigeria’s health sector corruption

A recent review on health sector corruption and a nominal group technique with frontline health workers and policymakers in Nigeria revealed the most common forms of health sector corruption, which were absenteeism, informal payments, health financing corruption, employment irregularities, diversion of patients from public to private facilities, theft of consumables, and illicit procurement practices. More focused research approaches using ethnography, interviews, and group discussions have also shown that the Nigerian health sector is truly challenged by corruption, devastatingly affecting Nigeria’s progress toward achieving global health goals and leading to inefficient use of the current low budgetary appropriations and donor funding to the health sector. The poorest and most disadvantaged groups are most at risk as they have few alternatives to obtain adequate quality care. Indeed, corrupt practices change the ethos of the health system and distort priorities and procedures.

Image 2: Corruption ranking in Nigeria (Source: Channels TV)

While the situation often seems helpless, there is hope in the fact that anticorruption can be successful when governance structures are set up and incentivized in ways to gradually curb it, and when grassroots actors finally say, “enough is enough”. Therefore, the question is – how do we stimulate and galvanize the interests and actions of macro governance structures and community actors toward anticorruption in the health sector? Also, how do we ensure that anticorruption approaches do not only work for a period of time but become an integral part of the system and sustainable?

Stakeholders in health sector anticorruption gathered to find solutions

The Health Policy Research Group (HPRG), University of Nigeria and the Bayero University, Kano (BUK), with partnership from the London School of Hygiene and Tropical Medicine (LSHTM) are vigorously pursuing an anticorruption agenda in the health sector of Nigeria through research and the use of evidence from research to inform policies and strategies that will eliminate corruption in the health system. To achieve this goal, the team convened a Policy Forum on Anticorruption in Nigeria tagged “Stop Health Sector Corruption”, attracting various key stakeholders in the Nigerian health system and anticorruption vanguards from several bodies in Nigeria.

Those that were represented included the Independent Corrupt Practices Commission (ICPC), Nigeria Academy of Science (NAS), Health Reform Foundation of Nigeria (HERFON), International Centre for Investigative Reporting (ICIR), Results for Development (R4D), National Health Insurance Scheme (NHIS), Budgit, UNODC, Nigeria Health Watch, Project Pink Blue, Anticorruption Academy of Nigeria, National Primary Health Care Development Agency (NPHCDA), SERVICOM, Nigeria Governors Forum, etc. The stakeholders narrated several personal experiences of health sector corruption and reinforced the urgent importance of addressing this failure.

With several presentations of documented evidence from the research team from UNN and BUK on the realities and dynamics of corruption in Nigeria’s health sector, particularly primary healthcare, the stakeholders confirmed that thoroughness of the research already done by the team, even though they pointed more areas to cover. Strong emphases were made on the managerial components of the health sector, as corruption, unaccountability, and sheer incompetence at that level have allowed for the thriving of corruption and accountability issues at the level of service delivery. The weakness of the Human Resource (HR) component of the public sector, as well as the lack of properly communicated context-specific rules and regulations for the health sector, were considered enablers of corruption.

Image 3: Cross-section of policy forum attendees

Where do we go from here?

The stakeholders who attended the Policy Forum were clear on where to begin to address health sector corruption. Unanimously, they emphasized the need to drive solutions using evidence from research. Implying that more conversations between researchers in corruption studies and policymakers should be encouraged. Also, based on the reported evidence, stakeholders opined that anticorruption will be unsustainable if strategies do not emanate and include actors at the frontline and those that are affected. It is more like tying the ends of macro politics (the big ‘P’) that comprise the managers at the authority level and their political networks in local government and beyond, with those of micro politics (the small ‘p’) comprising community actors and frontline health workers.

It was for instance suggested that a ‘Rule book’ on anti-corruption in health should be developed and deployed across the country, and civil society groups and community leaders should be encouraged and incentivized to play supportive supervision roles across health facilities. An important incentivization as mentioned by the policymakers is to ensure that the top-level managers act on reports tendered to them by community actors and civil groups. Such is needed for confidence building and developing trust across the “big” (P) and “small” (p) pees. Also mentioned included rapid digitalization of systems, educating service users on patients’ rights as enshrined in law using townhall meetings and media, establishing and optimizing human resource management across health facilities, and putting together reward mechanisms for committed health workers, to mention but a few.

Image 4: Cross-section of policy forum attendees

There is hope!

With the coming together of these powerful actors sourced from organisations and circles that are influential within Nigeria’s health system and policy space, a critical mass of people and systems that can drive a sustainable anticorruption agenda in the health sector is feasible. The policy forum attendees have made their commitments to this cause and are optimistic about improved situations within the health sector going forward. Therefore, more strategic and meaningful engagements will continuously hold until anticorruption in the health sector becomes an indispensable part of Nigeria’s health system, and the rule of law rises to becoming self-enforcing by the system.

Conclusion

With the amount of information asymmetry in the health system, where service users are barely aware of expectations, ensuring prominence of the rule of law remains a viable anticorruption strategy. We understand that this may be difficult to achieve in developing climes like Nigeria, where individuals and organisations can be even more powerful than the system. It is for this reason scaling-up and optimizing the awareness and voices of citizens at the grassroots is much needed and an achievable anticorruption agenda. And civil groups and researchers will continue to pursue avenues to hold government actors to account and draw their attention to the pathetic consequences of undermining the rule of law as applied to healthcare. More voices are needed in health sector anticorruption, and the Accountability in Action Research Team is excited at the rapidly growing institutionalization of health sector anticorruption, evidenced by:

The Thematic Working Group on Action on Accountability and Anti-corruption for SDGs (TWG AAA) at Health Systems Global, where Prof Obinna Onwujekwe and Prof Dina Balabanova (are Co-Chairs)
The proposed African Resource Center for Accountability and Anti-corruption in Health, to be based in Nigeria
Forthcoming Global Network for Anti-Corruption, Transparency & Accountability in Health Systems (GNACTA) to be launched by WHO, UNDP and other major development agencies in December 2022.
The Nigerian Policy Forum on Accountability and Anti-corruption in the health system

Acknowledgement

Associate Prof Eleanor Hutchinson

Dr Tochukwu Orjiakor

Dr Aloysius Odii

Dr Muktar Gadanya

Dr Maikano Madaki

Pamela Ogbozor

Divine Obodoechi

Accountability and Anti-corruption in Health Project Anti-corruption Evidence Consortium (ACE)

Understanding the Cost-Effectiveness of COVID-19 Vaccination in Nigeria

Benjamin Uzochukwu, Chinyere Okeke, Sergio Torres-Rueda, Carl Pearson, Eleanor Bergren, Anthony McDonnell, Anna Vassall, Mark Jit, Francis Ruiz

Researchers from the Health Policy Research Group (Prof Benjamin Uzochukwu and Dr Chinyere Okeke) were part of a project that sought to understand the cost-effectiveness of COVID-19 vaccination in terms of procurement and administration. This was documented by the Centre for Global Development (CDG), presenting useful information in scaling up campaigns against COVID-19 and improving responses to future pandemics in Nigeria.

Indeed, COVID-19 has disrupted health systems across the globe. Nigeria reported its first COVID-19 case in February 2020, and, since then, the government has rolled out four vaccines to help control the pandemic—Moderna, Oxford-Astra Zeneca (AZ), Johnson & Johnson (J&J) and Pfizer-BioNTech.

Nigeria set an ambitious goal of vaccinating 40 percent of its over 200 million people before the end of 2021, and 70 percent by the end of 2022. The vaccine rollout was organised into four phases, as shown in table 1. Access to vaccines in Nigeria has been limited, however, and vaccine hesitancy has further slowed down deployment. There is also limited evidence on the comparative clinical and cost-effectiveness of COVID-19 interventions—including vaccination—in the Nigerian context specifically.

Health Technology Assessment (HTA) is a framework for assessing whether healthcare interventions—including vaccines—offer good value for money and take into account a wide range of considerations. The University of Nigeria Nsukka, the London School of Hygiene and Tropical Medicine, the Center for Global Development, and the Africa Centres for Disease Control collaborated to support key national and regional stakeholders in evaluating the cost-effectiveness of Nigeria’s COVID-19 vaccine strategies using an HTA framework.

KEY POLICY QUESTIONS

Which COVID-19 vaccines should Nigeria purchase and how much would it cost?
How should these vaccines be distributed?
What age groups should be targeted?

To read more click here

Using Modeled Evidence in Nigeria’s Health System: understanding the gaps and promoting the value of evidence-based decision making

By Chinyere Mbachu, Prince Agwu, God’stime Eigbiromolen, Ifunanya Agu, Benjamin Uzochukwu and Obinna Onwujekwe

Statistics makes it possible to simulate real life behaviors using models, and this is termed ‘modeled evidence. Mathematical models that simulate different potential health scenarios around disease transmission, and/or the impact of policy interventions on health outcomes, can be valuable to decision makers. They can be used to prioritize and choose between complex trade-offs and ensure the best possible results in efficiency, effectiveness and impact of health policies and interventions.

Literature has shown that, although policymakers are aware of the need to make decisions that are based on scientific evidence, they do not regularly put this concept into practice. This is particularly the case with modeled evidence. Recent disease outbreaks and disasters have highlighted the need for a more proactive health system that anticipates and prepares ahead of health emergencies. At the onset of the COVID-19 pandemic, the Nigeria Center for Disease Control (NCDC) relied extensively on evidence from mathematical models to understand the trajectory of the epidemic and to develop an appropriate response strategy.

As the usefulness of modeled evidence gains more traction in the Nigerian health system, it is necessary to learn how policymakers can be supported to use modeled evidence in decision making. This could be achieved by examining the extent to which modeled-evidence is understood, valued and used by decision makers, as well as the factors/mechanisms that enable or constrain the translation of modeled-evidence to decision-making.

Figure 1: Translation of Modeled Evidence to Policy: Nigeria’s Ecosystem Canvas

The target audience for this policy brief comprises all the stakeholders in the modeling to decision making ecosystem, including modelers, decision makers, and knowledge brokers who facilitate exchange between them.

Click here to download and read the full policy brief.

Acknowledgement: This project was done in partnership with Results4Development and funded by the Bill & Melinda Gates Foundation.

Suggested citation: Chinyere Mbachu, Prince Agwu, God’stime Eigbiromolen, Ifunanya Agu, Benjamin Uzochukwu and Obinna Onwujekwe (2022). Values, gaps and getting evidence generated from modeling into decision making in the Nigerian health system. A Policy Brief from the Translation of Modeled Evidence for Decision Making project in Nigeria.

“The pandemic is not over, as its impact persists in Nigeria’s health system”: Professor Onwujekwe at the Congress of Postgrads’ Medical Fellows

By HPRG News

The effects of COVID-19 pandemic continue to bite health systems, particularly those of low-resource regions. Quoting the Organisation for Economic Co-operation and Development, “The COVID-19 pandemic has shown how vulnerabilities in health systems can have profound implications for health, economic progress, trust in governments, and social cohesion”. The question of strengthening health systems has been recurring since the pandemic and has gotten more answers than actions. However, the conversations must not cease, as it is needful to keep discovering and reminding ourselves of those areas in our health system that have been affected by the pandemic, while underscoring practicable solutions. It is in this regard that Professor Obinna Onwujekwe of the Departments of Health Administration & Management/Pharmacology & Therapeutics and the Health Policy Research Group, University of Nigeria delivered a lecture, titled “Impact of COVID-19 pandemic on healthcare delivery in Nigeria” at the 16th Annual Scientific Conference and All Fellows’ Congress of the Postgraduate Medical College Fellows’ Association that held at Eko Hotels & Suites, Victoria Island, Lagos in August 2022.

Figure 1: Cross-section of participants

Prof Obinna questioned the resilience of Nigeria’s health system for its failure to achieve the health-related MDGs and its slow pace toward the 2030 health-related SDGs targets. He showcased the indicators that reveal low-level access to quality healthcare services in Nigeria and minimal financial risk protection for health service users. He discussed further how the pandemic disrupted the delivery of essential health services like antenatal, post-partum, intrapartum care, family planning, vaccination services as well as treatment of non-communicable diseases, as health facilities were forced to shut down, some even shutting down unofficially. The impacts of this lack of resilience on morbidity and mortality cannot be overstated. For instance, UNICEF projected that an additional 950 Nigerian children might die every day from preventable causes over the next six months as the COVID-19 pandemic disrupted routine services. The figure below shows the steep downward dive in antenatal visits as the pandemic persisted:

Figure 2: Antenatal attendance fell drastically in 2020 compared to 2019 (MSDAT, 2020)

Click here to gain access to the full content of the lecture.

How to cite: Onwujekwe, O. (2022). Impact of COVID-19 pandemic on healthcare delivery in Nigeria. https://hprgunn.com/the-pandemic-is-not-over-as-its-impacts-persist-in-nigerias-healthcare-professor-onwujekwe-at-the-congress-of-postgrads-medical-fellows/

Surviving and Thriving in the Post-Pandemic Era: Exploring Research, Science and Innovation at the University of Nigeria

By Chidi Nzeadibe, Geraldine Ugwuonah, Obinna Onwujekwe, Bennett Nwanguma, Theresa Ogbuanya, Paul Oranu, Emmanuel Ezeani, Chinonso Igwesi-Chidobe, Chizoba Obianuju Oranu, Paul Adeosun and Felix Egara

Why yet another conference on Covid-19 Pandemic?

COVID-19 pandemic is arguably the most serious global challenge since World War II. The 1^st Annual Multidisciplinary International Conference of the University of Nigeria, Nsukka (UNN) which took place from 5^th – 7^th July 2021 was convened to explore the role of research, science and innovation arising from the institution and elsewhere in surviving and thriving in the post-COVID era. The theme of the maiden conference was A Whole New World: Research, Development and Innovation in the Pandemic Era. In his remark, the Vice-Chancellor of the institution, Professor Charles Arizechukwu Igwe, FAS, noted that the choice of this theme reflected the university’s recognition of the huge impact that COVID-19 continues to have on public health systems, society, food systems, education, and economies which have led to massive transformations in the way we live and work.

Mainstreaming Science and Innovation in Management of Pandemics- The UNN Example

The pandemic has given rise to significant research, development and innovation possibilities across different fields of human endeavour, typically with the varying aims of understanding, overcoming or adapting to the challenges posed by COVID-19. At the University of Nigeria, many researchers have sought to leverage the opportunities inherent in the adversity of the pandemic to come up with research outputs with huge potential to improve lives and livelihoods and for overcoming or adapting to the challenges posed by COVID-19. The UNN International conference brought together researchers, policymakers, development partners, NGOs and research funders both in Nigeria and beyond to explore research, development and innovations in various disciplines within the context of COVID-19. In line with the realities of the pandemic and to utilize innovations in ICT and remote learning and working, presentations at the conference were done virtually through the Zoom app. Other applicable COVID-19 protocols were also observed.

Science for Social Relevance: Views of the Public Health Expert

The conference keynote paper entitled A Whole New World: Research, Development and Innovation in the Post-Pandemic Era was presented by the globally acknowledged expert on Virology and Infectious Diseases, and Chairman of Nigeria’s Ministerial Expert Advisory Committee on COVID-19 (MEACoC), and former President of the Nigerian Academy of Science, Professor Oyewale Tomori, FAS. He described COVID-19 as ‘the evasive, invasive, elusive, invisible one’ that came to expose the underbelly of our decadent healthcare system and the depravity in our society. Harping on the role of Nigerian scientists in the fight against the pandemic, Prof Tomori averred that:

“the scientists in Nigeria should identify with and be seen by the society as part of the society, must be asking the right questions relating to the problems of our society, must focus research activities on the directions of questions asked, and in collaboration with the government must seek relevance in serving and meeting the identified needs of the society”.

Effective Science Communication: dispelling myth, providing context

In a goodwill message, conference partners – The Conversation Africa (TC-Africa) noted that researchers from the UNN have been writing for the website since 2016 in their mission to mainstream the voices of universities and scientists in the media and to support science engagement and science communication activities in Africa. So far, 41 authors from the UNN have published 37 articles (out of which 16 focused on COVID-19 and other health-related topics) which have been read over 200,000 times. With a monthly readership of 2.5 million, participation of TC-Africa is particularly significant to global dissemination of results of research from this conference. TC-Africa recently recognized the University of Nigeria among the Top Universities in Africa, and her researchers for the most published articles and most read article during the 2nd Annual West Africa Science Communication Awards.

Going forward: Translating research outputs to policy and action

Nearly 200 papers from multidisciplinary perspectives were presented in 33 panels and 6 technical sessions. Topical issues discussed and lessons included innovations in health systems and management, agricultural innovations and food security, lifestyle changes and adaptive behaviours, urban planning innovations and informal settlements, sustainable education, remote learning and digital innovation, and water, sanitation and hygiene (WASH).

A major impact of the conference was the massive public awareness it created, dispelling myths that Nigerians are immune to SARS-CoV-2 and that COVID-19 is a hoax, and also providing context on the pandemic through timely publications in print and electronic media. Research funders both in Nigeria and outside the country were urged to key into the research, development and innovations possibilities at this conference and collaborate with the university to support uptake of the outputs of this conference and other related research projects. It is expected that the quantum of ideas, methodologies and actionable policy recommendations from this conference will contribute immeasurably to global effort at dealing with the pandemic and that products of this conference will help to chart a new development course in the post-pandemic era.

Authors’ bios

Chidi Nzeadibe is Professor of Geography and Chair of the Conference Committee Twitter: @NzeadibeChidi
Obinna Onwujekwe is Professor of health economics, policy and pharmacoeconomics, and, Director of Research, UNN
Geraldine Ugwuonah is Professor of Marketing
Bennett Nwanguma is Professor of Biochemistry and Chair, Senate Ceremonials Committee, UNN
Theresa Ogbuanya is Professor of Industrial Technical Education
Paul Oranu is the Director of ICT, UNN
Emmanuel Ezeani is Professor of Political Science and Director UNN Consult
Chinonso Igwesi-Chidobe is a Senior Lecturer in Medical Rehabilitation
Chizoba Oranu is a Lecturer in Agricultural Economics
Paul Adeosun is a Lecturer in Agricultural Economics
Felix Egara is a Lecturer in Science Education and Conference Committee Secretary.

Acknowledgement

We acknowledge Dr Charles Orjiakor for the review of this blog.

How to Cite

Nzeadibe, C., Ugwuonah, G., Onwujekwe, O., Nwanguma, B., Ogbuanya, T., Oranu, P., …, Egara, F. (2022). Surviving and thriving in the post-pandemic era: exploring research, science and innovation at the University of Nigeria. https://hprgunn.com/surviving-and-thriving-in-the-post-pandemic-era-exploring-research-science-and-innovation-at-the-university-of-nigeria/

University of Nigeria dazzles in latest global science ranking

By HPRG News

Research.com, a prominent academic platform for scientists, has just published the 2022 Edition of its Global Ranking of Top 1000 Scientists in the area of Social Sciences and Humanities. Three academics from the University of Nigeria, including the University, made the list. Professors Obinna Onwujekwe, Benjamin Uzochukwu, and Jude Ohaeri ranked 1st, 2nd, and 3rd respectively in Nigeria, and 892, 3052, and 4039 on the globe, respectively. Also, the University of Nigeria is the lone university in Nigeria that made it to the top 400 on the globe in terms of research outputs from the social sciences and humanities. The University of Nigeria is ranked 305 in the world and 1st in Nigeria.

The green entrance of the University of Nigeria

Professors Obinna Onwujekwe, Benjamin Uzochukwu, and Jude Ohaeri have long been listed as tops in several global ratings of scientists. A Google Scholar search on Professor Obinna Onwujekwe as of 9th June 2022, shows that he has 22,287 citations, 54 h-index, and 210 i10-index. While Professor Benjamin Uzochukwu has 25,025 citations, 46 h-index, and 133 i10-index. Unfortunately, we could not retrieve that of Professor Jude Ohaeri at the time of writing. Speaking to Professors Obinna and Benjamin, we can confirm that the duo are not resting or retiring any time soon from active research, especially, implementation research. They are of the view that governance and development rise on the availability and utilization of scientific evidence, and fall on the dearth and weak recognition of it.

Professor Obinna Onwujekwe

Professors Obinna Onwujekwe and Benjamin Uzochukwu run the Health Policy Research Group, University of Nigeria, which is famous for the production of cutting-edge scientific evidence. It is equally a hub for the nurturing of young scientists. Both Professors remain committed to mentorship, as they look forward to young scientists from Africa carving a niche for themselves in global science.

Professor Benjamin Uzochukwu

The ranking by Research.com is constructed using the H-index data gathered by Microsoft Academic and includes only prominent scientists with an H-index of at least 30 for scientific papers published in the field of Social Sciences and Humanities.

Professor Jude Ohaeri

You can see the full world ranking here: https://research.com/scientists-rankings/social-sciences-and-humanities

You can find the entire ranking for Nigeria here: https://research.com/scientists-rankings/social-sciences-and-humanities/ng

As quoted from the words of Imed Bouchrika for Research.com, “… this is indeed an important accomplishment for you and your university”. The Health Policy Research Group, University of Nigeria joins in congratulating its noble Professors and the University of Nigeria, as it continues in its restoration of man’s dignity!

How countries can make progress towards UHC after transitioning out of DAH: Lessons from Nigeria

By Shalom Obi, Osondu Ogbuoji, Wenhui Mao, Minahil Shahid, Gavin Yamey, and Obinna Onwujekwe

In the coming years, about a dozen middle-income countries are expected to transition out of development assistance for health (DAH). This is so because the eligibility criteria set by most multilateral donors are based on income per capita or rise in GDP. However, an increase in income per capita does not necessarily mean a reduction in disease burden. For example, despite an increase in GDP, Nigeria still stands out as very unprepared for the upcoming transition, based on poor health indices, very low domestic financing for health, and poor government commitment to health.

Nigeria is vulnerable to setbacks, in event of health-focused donors exiting its health funding space because the country struggles with a low per capita income, debt burden, weak capacity to efficiently use public resources, limited and less effective health systems, and weak governance and public institutions. More so, considering the low government funding for health (see Figure 1 below), the impending financial gap will most likely shift to out-of-pocket spending which constitutes 75.2% of total health expenditure. This will be catastrophic and may drive more of the vulnerable population below the poverty line. The decline in donor funding has already been reflected in suboptimal service delivery and health service users are now having to pay for previously free-of-charge services.

Figure 1: Trend of Domestic General Government Health Expenditure (GGHE-D) Global Health Expenditure Database

The more currently appropriated funds for health are not subject to high-level accountability, the effects on the vulnerable may likely to be grave, further drawing the country away from achieving UHC. With changes in DAH and impending transitions, there is an urgent need for sustainable solutions, as stakeholders must begin to think about how to fund healthcare when external funds decrease or end.

For evidence-driven transitioning, away from DAH, stakeholders may wish to refer to a qualitative research that used Vogus and Graff’s expanded framework for evaluating the readiness of Nigeria’s transition. Unfortunately, the illustrated gaps (see Figure 2) identified in the study show that Nigeria is not currently prepared to sustain donor-funded programs and make progress if/when donors leave.

Figure 2: Gaps – using Vogus and Graff’s expanded framework for evaluating country readiness for transition of donor-funded health programs to domestic ownership (Vogus and Graff, 2015)

The above framework shows clearly that Nigerian health system is mostly unprepared to transition out of DAH and make progress towards UHC. This is predominantly due to policy implementation gaps, unaccountability and corruption, and a lack of initial transition plans at the onset of health programs.

Policy implication

To overcome the challenges and bottlenecks that hinder policy implementation and close these gaps,

Policymakers should consider the feasibility, sustainability, and accountability of policy implementation during the policy process. They should ensure that there are feasible road maps for apt implementation of pro-UHC policies.
Secondly, crucial steps must be taken to ensure that transition plans are factored into program planning from the onset, and not as an addendum. A well-grounded health plan that puts transition in perspective is needed to foster sustainability and progress towards UHC at the time of transition.
Nigeria must also endeavor to make political commitment to health – at least improve from current 5% of annual budget allocated to the health sector, while racing toward the 15% commitment as promised in the Abuja declaration of 2001. This will enable the country to integrate healthcare programs and build the overall health system to transition smoothly out of various donor programs, whilst making progress towards UHC. Meeting this commitment has become even more critical given the effects of COVID-19 pandemic.

Lessons for upcoming transitioning countries

Upcoming cohort of transitioning countries should have a robust transitioning plan in place to sustain gains of donor funds and make progress toward UHC. Transition plans should not be an afterthought, but a well-incorporated aspect of health programs’ plans. Therefore, donors and recipient countries should ensure that transition plans are built into health programs at the planning stage. Furthermore, it is not enough for upcoming transitioning countries to have pro-UHC policies, they should also have roadmaps for implementation, with broad stakeholder involvement. It is also crucial for such countries to give careful consideration to increasing their fiscal space for domestic funding for health, integration of health programs, and building the overall health system. This will engender sustainability and ensure progress towards UHC at the time of transition. Donors and recipient countries should endeavor to have inbuilt transition plans to give direction to program implementation and enable institutionalization of service delivery processes for continuity.

Conclusively, to manage transitions from DAH and make progress towards UHC, the Nigerian government needs to identify and address implementation gaps, as well as systematic gaps in using domestic resources for financing critical health services. Policymakers should identify clear road maps for the implementation of the existing pro-UHC policies. Furthermore, funds should be redirected to building the overall system—consolidating and coordinating programs and linking them into the overall health system, health financing priorities, and policies. Instead of continuing to invest in parallel programs, a comprehensive and functional structure for continuity, one that will be robust enough to withstand decreasing external funds or donor exits, should be developed at the national and sub-national levels as a matter of urgency.

Shalom Obi is a Research Fellow at the Health Policy Research Group, University of Nigeria, with focus on health policy research and community health systems.

Obinna Onwujekwe is a Professor of Health Economics, Systems and Policies at the University of Nigeria Enugu Campus. He is the Chief Editor of the African Journal of Health Economics, and the Coordinator of the Health Policy Research Group, University of Nigeria. He also coordinates the African Health Observatory Platform (AHOP) for Health Systems, Nigeria Center.

Acknowledgement: We thank Dr Godstime Eigbiremolen for the review of the blog