Progress in the face of cuts: a qualitative Nigerian case study of maintaining progress towards universal health coverage after losing donor assistance

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

In the coming years, about a dozen middle-income countries are excepted to transition out of development assistance for health (DAH) based on their economic growth. This anticipated loss of external funds at a time when there is a need for accelerated progress towards universal health coverage (UHC) is a source of concern. Evaluating country readiness for transition towards country ownership of health programmes is a crucial step in making progress towards UHC. We used in-depth interviews to explore: (1) the preparedness of the Nigerian health system to transition out of DAH, (2) transition policies and strategies that are in place in Nigeria, (3) the road map for the implementation of these policies and (4) challenges and recommendations for making progress on such policies.

We applied Vogus and Graff’s expanded transition readiness framework within the Nigerian context to synthesize preparedness plans, gaps, challenges and stakeholders’ recommendations for sustaining the gains of donor-funded programmes and reaching UHC. Some steps have been taken to integrate and institutionalize service delivery processes toward sustainable immunization and responsive primary healthcare in line with UHC. There are ongoing discussions on integrating human immunodeficiency virus (HIV) services with other services and the possibility of covering HIV services under the National Health Insurance Scheme (NHIS). We identified more transition preparedness plans within immunization programme compared with HIV programme. However, we identified gaps in all the nine components of the framework that must be filled to be able to sustain gains and make significant progress towards country ownership and UHC. Nigeria needs to focus on building the overall health system by identifying systematic gaps instead of continuing to invest in parallel programmes. Programmes need to be consolidated within the overall health system, health financing priorities and policies. A comprehensive and functional structure will provide continuity even in the event of decreasing external funds or donor exits.

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Policy Dialogue between African Health Observatory and stakeholders in Nigeria’s Health Financing

Central to the achievement of Universal Health Coverage (UHC) is to improve service coverage, financial access, and financial protection for health service users. Concerned about Nigeria’s slow pace toward UHC, the Nigerian National Centre (NC) of the African Health Observatory Platform (AHOP) organized a policy dialogue (PD) that brought together key members of the National Healthcare Financing (HCF) and equity Technical Working Group (TWG) (HCF-TWG) and FMOH to discuss the current policy issues on health financing (interest on health financing governance and domestic resource mobilization (DRM)), with a focus on UHC. The dialogue was to brainstorm about the future directions in terms of strategic activities or actions that will be taken to make a change in the context of strengthening the Nigerian health system and achieving UHC. The dialogue explored how to specifically enhance efforts towards achieving UHC in Nigeria through domestic funding lenses and improved health financing governance.

The participant for the dialogue comprised 17 people drawn from the NC (HPRG) and the National HCF-TWG: FMoH (5), International/Development partners (4), National Health Insurance Scheme (NHIS) (2), NC (5), and Academia (1).

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Photo representation of participants


Health Policy Research Group, University of Nigeria stretches research into urban health

With an estimated urban population growth rate of 4.3%, Nigeria’s urban population is expected to double by 2050.[1] The notable consequence of the rapid urbanisation that is taking place in the country is the expansion and increase in numbers of informal settlements within and around large cities. These informal settlements, referred to as urban slums, are characterised by poor housing, lack of basic amenities and poor access to urban resources, including health, nutrition and education.

Rapid urbanisation and the growth of unplanned urban slums have necessitated global attention towards ensuring social inclusion and equitable access to urban resources, particularly for vulnerable groups. A critical area of intense concern in Nigeria, and other low resource settings, is access to comprehensive and quality health services in urban slums. Urban slums have a relatively higher burden of communicable disease, and this can be attributed to overcrowding, poor ventilation, low economic status, and low literacy level. Moreover, financial access to quality healthcare for urban slum dwellers is further limited due to lack of social health insurance and heavy reliance on out-of-pocket payments. Hence, ensuring access to quality and affordable healthcare for this group of people should be prioritised.

Informal healthcare providers (IHPs) are a crucial source of healthcare in urban slums, essentially filling the gap caused by the absence of formal healthcare providers (FHPs). Informal healthcare providers include patent medicine vendors (PMVs), village health workers, traditional birth attendants (TBA), traditional healers and itinerant (travelling) drugs vendors, among others. These categories of IHPs are ubiquitous, they provide affordable healthcare to the urban poor, and they enjoy the patronage and confidence of slum dwellers. However, the health services they can provide to clients are limited to their skills and capacities, and there are legitimate concerns about the quality of health care that is provided by IHPs [250 words left]

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COVID-19 containment and coordination strategies in Nigeria and lessons from four other African countries

COVID-19 pandemic will forever remain a major disruption of global activities and lifestyles. However, conversations have rapidly shifted from the dreadedness of the pandemic to the actions and inactions of systems in combating its spread and ameliorating its devastating effects. The pandemic appears to have affected different locations differently, of which there are clinical, public health, economic and social explanations to such dynamics. While it looks as though Africa has one of the least occurrences of fatalities arising from COVID-19, it is never in doubt that the continent has had its fair share of the effects of the pandemic, and some have indeed been extreme. Therefore, to encourage better health emergency responses, it is needful to reflect. The continent needs to look inward to understand its strengths, weaknesses, limitations, and prospects, for the purpose of improving its public health space and better positioned to challenge health emergencies, going forward.

Inspired by the African Health Observatory – Platform on Health Systems and Policies (AHOP), COVID-19 containment and coordination strategies across five African countries, including Nigeria, were evaluated. As quoted from an AHOP document: “[…] Threats of new variants loom and low vaccination coverage raises questions on the future of the response to COVID-19. Prevention remains the key strategy in most sub-Saharan countries. Below, five National Centres (NCs) from the African Health Observatory Platform on Health Systems and Policies (AHOP), based in Ethiopia, Kenya, Nigeria, Rwanda and Senegal, reflect on lessons to be learnt from their coordination and containment responses in the initial phases. They construct timelines to highlight the policies and challenges associated with introducing a range of public health containment measures and discuss the extent to which these measures continue to be valuable given the ever-changing nature of the pandemic.”

To read the report on COVID-19 coordination strategies across the five African countries, kindly click here to download

And to read the report on COVID-19 containment strategies across the five African countries as well, kindly click here to download

You can consider publishing a blog with HPRG. See image below for details.

Understanding the complementary relationships and roles of Integrated African Health Observatory (iAHO) and African Health Observatory Platform (AHOP)

The Ministerial Conference on Research for Health in the African Region, held in Algiers from 23 to 26 June 2008, adopted the Algiers Declaration renewing the commitment of Member States to strengthen national health research, information systems and knowledge management systems to improve health in the African Region. The Algiers Declaration offers a framework to narrow the knowledge gap and thereby improve knowledge generation and the use of knowledge to inform policies, strategies, and actions.

The World Health Organization (WHO) started work on health observatories in the African region in 2010 when it established the African Health Observatory (AHO).1 This followed the 2009 recommendation of the Regional Committee for Africa (AFR/RC59/5).2 In November 2012, during the sixty-second session of the Regional Committee for Africa (RC62) held in Luanda, health ministers of the African Region agreed to establish national health observatories in their respective countries and adopted the resolution entitled “The African Health Observatory: an opportunity to strengthen health information systems through national health observatories.” With the support of the AHO, several countries are developing their national health observatories (NHOs) to strengthen their national health information systems and promote the use of data for better action.

AHO is the regional observatory based and managed by WHO/AFRO. It brings together all the key information (Data – Analytics – Knowledge) on the WHO African region and on the 47 member states. It is a one-stop shop for standardized and validated information at both national and international levels with clear information on data sources. The NHOs are national declinations of the AHO and strengthen the national health information system. They thus contribute to reducing fragmentation and making key information available in a one-stop shop at national and sub-national levels. The institutional anchorage varies from country to country, but in the region, there are three groups: (i) integrated as a structure in the Information System/Planning Directorate of the Ministry of Health, (ii) integrated as a unit attached to the General Secretariat or the Minister’s Office, or (iii) integrated as a fully-fledged structure attached to the Prime Ministry.

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AHOP Writing Style

Researchers working across National Centres of AHOP are to write in a particular style that is consistent with the African Health Observatory Platform (AHOP) and World Health Organisation (WHO). The AHOP’s abridged version of the full WHO editorial style manual, which draws on the abridged style guides used by WHO Africa Regional Office (AFRO) and the European Observatory on Health Systems & Policies can be downloaded below. The style guide aims to ensure correctness, consistency, impartiality, and credibility across AHOP outputs, both electronic and print, and offers guidance on avoiding the most common stylistic errors. Please, note that this guide is a living document and will be adapted as further decisions are made on AHOP style across the various outputs. It is intended to be used alongside the full WHO Style Guide. Both Guides are expected to guide persons who write across the AHOP project.

Click here to download abridged AHOP Writing Style Guide

Click here to download the broader WHO Writing Style Guide



Scientists from the Health Policy Research Group, University of Nigeria rank highly on the globe – AD Scientific Index 2021

In a recent ranking of scientists on the globe, scholars from the Health Policy Research Group took top spots. Professors Obinna Onwujekwe and Benjamin Uzochukwu who are both academics at the University of Nigeria and founders of the renowned Health Policy Research Group clinched 1st and 3rd positions respectively, as top scientists in the University of Nigeria with over 3000 academic staff. The ranking is done by AD Scientific Index.
Prof Obinna Onwujekwe
At country-level, Obinna Onwujekwe ranks 3rd, 171 in the African region, and 39940 on the globe. Whereas, Benjamin Uzochukwu popularly known as BSC ranks 8th in Nigeria, 271 in the African region, and 54284 on the globe. Obinna and Benjamin are each with over 300 research items on ResearchGate, and combined citations of almost 34,000 as calculated by Google Scholar.
Prof Benjamin Uzochukwu
Interestingly, AD Scientific Index has moved beyond citations’ counts to focusing on the actual impact of scientific outputs which can be sourced by designing algorithms around i10 index, h-index and citation scores. You can read more on AD Scientific Index here. It is, therefore, right to say that the duo are impactful scientists, putting the University of Nigeria and the African Scientific Community on the map of global excellence.
Overall, 10 scientists from the University of Nigeria are within the top-100 in the country, and 6 made it to Africa’s top-1000. Their names include Chinua Achebe, Peter Akah, Nnabuk Okon, Joe Mbagwu, James Ogbonna, Martin Eze, Fabian Ezema, and Anthony Attama. You can find more here.
Interacting with Professors Obinna and Benjamin, it is evident that they do not intend to retire from their craft anytime soon. They have extended their wealth of knowledge to younger academics and researchers across the globe, and are indeed worthy models and mentors in the academic community. The Health Policy Research Group which is their brainchild is a no-brainer when it comes to research excellence. It is today, powered by the proteges of the Professors, some of whom are now Professors. Indeed, hearty congratulations to Professors Obinna and Benjamin on this deserving feat.

COVID-19 and crowding out of essential healthcare services: HPRG presents @ 37th Scientific Conference of the Association of Public Health Physicians of Nigeria

The Association of Public Health Physicians of Nigeria (APHPN) held its annual scientific conference at Abuja, Nigeria. The conference featured over 55 selected abstracts from a large pool of submissions. HPRG, under the African Health Observatory Platform (AHOP) presented a synthesis of findings from secondary sources on “crowding out of essential healthcare services amidst COVID-19”. The presentation was made by some members from the AHOP Nigeria Centre. They include Chinyere Okeke, Uche Ezenwaka, Chinelo Obi, Benjamin Uzochukwu, and Obinna Onwujekwe.
The well-researched presentation highlighted the huge burden of COVID-19 on the Nigerian health system, which overwhelmed health resources, with severe impacts on essential healthcare services (EHS). There were mentions of preventable health complications and mortalities that resulted from a somewhat overstretch of health resources. The scholars argued the need for a study of this kind to document the “why” of crowding out of healthcare services during disease outbreaks, and the responses that are expected. The implication of this study to the strengthening of health systems building blocks such as service delivery and governance cannot be overstated.


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Acknowledgement: African Health Observatory Platform (AHOP)

“Everyone!! wants to read a blog but your scholar-colleagues want to read your journal paper”: Research communication for wider reach

Prince Agwu & Obinna Onwujekwe

It is common to find editors of journals ask scholars to make their research papers appeal to a wider readership. By this, they imply that scholars should move away from a narrow lens, which could be their disciplines, communities or countries as target readers and users of their research findings. When these papers are finally published with a wider readership in mind, they might end up just with co-academics who are doing related studies or students researching around the subject. Hence, they circulate just within the academic walls, and at best, might fetch scholars some Google or Scopus citations and/or reads from ResearchGate. So, is that the reason we should publish our research?

If undergoing strenuous activities from research conceptualization to data collection, analysis and presentation, and at last, publishing in a peer-reviewed journal after tons of revision, would end up just with colleagues or researching students, then scholars might just agree to take off the “problem solving” description attached to the meaning of research. We know most persons within the league of the above-mentioned groups might not have the wherewithal to readily move our studies into practice. Thus, there is an urgent need to spread the “reach” of our studies and expand their ends to attract practicable impacts that should be the highest fulfilment for scholars. And if we must start this conversation, we should begin by asking ourselves this question – who reads our research?

Blogs or Publications??

We should be frank enough to accept that many of our students will happily read a news editorial than our publications just because they would not want to be fixed in an academic hotbed which our publications reflect. A handful will prefer to read novels than our 15-paged publications, for the obvious reason that they seem to have a dislike for the stress academics puts them through which we know is typical of publications. Besides, we might have noticed that the many in-text citations that dot our publications are scary to these groups of non-academics but sits just fine with academics.

Have you ever tried to pass a publication to a politician, a public office holder, or an important community actor? Have you tried to gauge their reactions, especially in climes like Africa where reading is “death” to many? Yet these public office holders and community actors would happily read a simple writeup published in a daily or a Facebook post or one of these shared writeups on WhatsApp. And we know that most of these public office holders and community actors are important stakeholders in the practical utilization of the knowledge from our studies. When they are well involved, they can help push knowledge from our studies into physical realities. Therefore, appealing to these groups of persons should be a vital part of our research, and in this article, we share the sentiments that blogs can do the job.

Quick stats!!

In 2018 and 2020, we published two articles in The Conversation a famous blog outlet, while the larger study was published in Health Policy and Planning a popular health policy and systems research journal. We discovered that as of April 2021, each of our articles in the blog outlet got over 6200 reads and counting, while the journal article got below 4500 page views and not up to 1000 downloads, even that it was published before the second blog article. See images below:

Statistics of readership from The Conversation
Statistics of views from Health Policy and Planning

Are scholars bothered?

In a study, scholars agreed to declare an academic emergency in the world of scholarship. They said, scholars must come together to discuss among themselves the need for seamless research communication, condensing research outputs into easy-to-read formats. These professionals shared the sentiment that their studies are often for a clique of co-academic, even when they know that non-academic groups and policymakers would immensely benefit from the wealth of knowledge and evidence their researches offer. They cited that the journalist would easily reach the hearts of communities and policymakers than the academic because of the seamless and easy-to-read way they adopt in the communication of knowledge. Interestingly, they had a consensus to evolve their research communication by introducing formats with which the public can easily relate, and they include blogs, infographics, cartooning, animation, filming, etc. Unfortunately, most academics are not inclined to these outlets.

Doing blogs is never less professional!!

Scholars are known for jargons, and you can find many of them in their published studies. We know how jargons stall the passage of information. So, a health scientist might be interested in econometrics, then he or she stumbles on a paper in that regard but gets discouraged to read further because the concepts are too high and difficult to relate with. This is where the power of a blog is made manifest. It is a rule of thumb that blog writers should have a college fresher in mind. The jargons and the high-handed knowledge must be condensed to what the college fresher can read and grasp.

Would scholars not be pleased if the big concepts are made so understandable to all? Please, we do not attempt to neglect the importance of keeping the writing professional and appealing to peers on that level but we feel that there is more to just the academic community. You can try to issue an editorial from a daily and a journal publication to your teenage son or daughter, and judge which will appeal more to them. Stretching the readership of our publications beyond our academic colleagues to the non-academic groups is an evolving responsibility for scholars. And blogs aim to marry these ends, which in turn will benefit the expansion and practicability of our research.

We cannot deny that there is a rapid change in the academic industry with a focus on research communication. We have seen big agencies sponsoring blog outlets and academic institutions building blogs into their various academic communities. Amidst these changes, many are yet to embrace this evolution. A core reason is that these blogs might not count as a part of their promotion criteria or that blogs do not reveal them in their professional regalia, because of how common and down-to-earth the blog writer is forced to sound.

Getting promoted is a good sight and revelling in your professional regalia through the appropriate use of jargons and concepts could account for a quality scholar. But should it be all about ourselves? Should we not think of our research impacts transcending beyond the academic walls? Are we comfortable being known, respected and hailed just among co-scholars? Are we concerned about those who need “quick-reads” and not our “too serious” academic papers? Also, are we fair and just knowing that our academic publications could be closed-access and so much money needed to gain access?

We conclude!!

Have you ever wondered what it would look like if your students come to class to celebrate your piece published in a blog that they found on Twitter? Or a village-head expressing gratitude for your article he or she read on a daily? Or a policymaker talking about how your blog was a quick go-to while in a meeting where important decisions were reached? And importantly, that our condensed research outputs in blog formats increase accessibility for those without the money to pay “subscription fees” to quality studies? We believe it will make more sense to you to share a blog link to the WhatsApp group of your community chiefs than to share an academic publication there, and you can tell the reason if truthful to yourself. It is important that academics come to know that the academic community is not just the target end for research, and there is more to the “reach”. And in that “more” lies the ultimate!

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.

Prince Agwu is an academic at the Department of Social Work, University of Nigeria and a research associate at the Health Policy Research Group, University of Nigeria. He holds a Commonwealth PhD Position at the University of Dundee, Scotland, and he is the Communication Lead for the African Health Observatory Platform (AHOP) for Health Systems, Nigeria Center.

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Strengthening Health Systems and Policy Research in Nigeria: African Health Observatory Platform [AHOP] Nigeria Centre meets with Partners

The Nigeria National Centre of AHOP (Health Policy Research Group, University of Nigeria) held a two-day inaugural with their three National AHOP Partners- The Nigerian Institute of Medical Research (NIMR), Veritas University Abuja and the Association of Public Health Physicians of Nigeria (APHPN), from 02-03 December 2020. The AHOP concept, goals and objectives were shared with the partners. The partners also shared their previous and on-going experiences of generating Health Policy and Systems Research (HPSR) evidence and getting research into Policy and Practice (GRIPP). This was followed by a brainstorming session, to propose tasks in the next steps to generate evidence with a focus on Universal Health Coverage. Partners committed to, in the first instance, developing a clear institutional framework for engaging with AHOP over the project period and beyond, identifying current strengths, weaknesses, and ideas for further capacity building. The Nigeria NC is happy to have been able to eventually hold this meeting, which was originally scheduled for April, 2020 but cancelled due to the COVID-19 pandemic restrictions.

Present at the meeting were:

Obinna Onwujekwe – Health Policy Research Group, University of Nigeria

Benjamin Uzochukwu – Health Policy Research Group, University of Nigeria

Enyi Etiaba – Health Policy Research Group, University of Nigeria

Chinyere Mbachu – Health Policy Research Group, University of Nigeria

Chinyere Okeke – Health Policy Research Group, University of Nigeria

Chikezie Ifeanyi – Veritas University, Abuja, Nigeria

Olushola Oluwatosin – Veritas University, Abuja, Nigeria

Adewale Ojogbede – NIMR

Babatunde Adewale – NIMR

Ajuba Miriam – APHPN

Ugwusina Nwachukwu Chinedu – APHPN

Ossai Edmund – APHPN

It is expected that the partners will work together with the HPRG-UNN to scale up the collection and synthesis of data and information on health policy and system for evidence-based strengthening of Nigeria’s health system. Overall, the aim is to move data and information from the point of rhetoric to policies, strategies, and practices.