“Nobody should be treated as an animal”: The dark realities of patients in Nigerian psychiatric hospitals

In a small room with faded paint and worn-out chairs, a diverse group of people with mental health conditions gathered, their stories etched upon their faces. They seemed visibly relieved to have a respite from the chaotic and overcrowded environment of the psychiatric wards. This gathering marked the beginning of narratives coming from a place of pain and the thoughts of improving the quality of care for people with mental health conditions in psychiatric hospitals.
In four focus group discussions, 30 patients in two psychiatric hospitals in Nigeria discussed their perceptions and experiences of coercive practices within the hospitals. Strikingly, the expressions of abuse and hopelessness were the same across the hospitals. It seemed to be a parallel universe where people seeking healthcare got harmed by the very hospitals they had turned to for help.
Talking about mental health issues is no longer taboo these days because almost everyone has either experienced or knows someone who has experienced a common mental health problem like anxiety or depression. Society is, however, still uncomfortable talking about serious problems like schizophrenia or other psychotic disorders. Apart from the widespread stigma and discrimination against people with these conditions, they are subject to a wide range of human rights violations.  They could be subject to coercive practices like the use of chains, holding them hostage in cages, sheds, prayer camps, and severe beatings in traditional healing centers and other community settings.
When people read about the cruel treatment faced by individuals with mental health conditions in the media or reports from human rights organizations, they are often filled with shock and horror. It is easy to assume that the mistreatment and human rights violations happen mainly in traditional healing centers and prayer homes. We think to ourselves, if only these patients could afford proper psychiatric care in hospitals, they would be treated with the respect and dignity they deserve. Our study findings have shed light on the harsh reality that even when these people pay exorbitant fees for psychiatric care, they are still not spared from the horrors of human rights violations.
 
Experiences and ordeals narrated by those that are affected
The participants of the focus group discussions perceived coercion in mental health care to be a necessary evil in severe cases but recognized that it was anti-therapeutic to their recovery. They knew that coercive measures were an extension of the stigma they experienced due to their mental health condition and interestingly, also highlighted that it was a vicious cycle of abuse. Using coercive measures made them frustrated and agitated (as would any other person), and this reaction is met with even stiffer coercive measures evoking more frustration and agitation, thereby perpetuating a cycle of aggression and coercion.
The study participants narrated their experience of involuntary admission which revolved mainly around deception, maltreatment, and disdain. They were either deceived to go to the psychiatric hospital or tied in chains which often caused injuries for them. They were flogged for refusing to accept medications, some of which caused intolerable side effects. Mechanical restraint with chains was a common experience for reasons including refusing medications, preventing absconding, and in other cases, punitively. The use of chains was viewed by participants as dehumanizing and excruciatingly painful. They could not understand why mental health workers who were supposedly knowledgeable about mental health would cause them additional trauma by using inhumane devices such as chains.
Although the common assumption is that ‘their head is not correct’, meaning that they lack the ability to think reasonably, and these coercive measures were done for their good. The study participants unanimously reported that they had clear memories of these negative experiences and that it was traumatic for them and aggravated their conditions. In the words of one of the study participants, “Nobody is supposed to be treated as an animal. For you to be forced to have a chemical, to be injected, or to be chained is not normal.”
 
What must Nigeria do going forward to protect patients in psychiatric hospitals?
At the time the study was conducted, the existing mental health law was the obsolete colonial Lunacy Act of 1958 which was not only derogatory but did not recognize the rights of people with mental health conditions. This meant that being diagnosed with a mental health condition automatically stripped one of many fundamental human rights. Thankfully, Nigeria’s National Mental Health Act 2021 has been passed this year but this is just a first step among several steps the government and society need to take in protecting the rights of this vulnerable population.
Although frequently criticized, mechanical restraints are a typical feature in many psychiatric facilities around the world, yet they are usually soft flexible belts rather than chains. The hospitals had a limited supply of belts and occasionally made do with chains. With less than 300 psychiatrists for its enormous population of over 200 million, Nigeria has very low levels of human resources and infrastructure for mental health care which severely worsens this issue. The World Health Organization (WHO) recommends that setting up community mental health services can be an effective way to encourage people to seek help early and safeguard their human rights. This is daunting for a resource-limited country like Nigeria, however, integrating mental health care into primary care is an effective and feasible alternative. While this is being done, the existing primary care must be revitalized to be accessible and affordable to all.
Another crucial aspect that cannot be overlooked is the stigma surrounding mental health conditions which is a major barrier to early help-seeking for mental health conditions. Addressing this stigma is not solely the responsibility of governments; each one of us has a vital role to play in ending discrimination toward people with mental health conditions.
 
Author: Deborah Oyine Aluh
Deborah is a PhD student researching the contextual factors influencing the use of coercion in mental health services at the Lisbon Institute of Global Mental Health. She is also a staff of the Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka. Nigeria
Affiliations: Lisbon Institute of Global Mental Health, Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka. Nigeria
Twitter: @debbilici0uss
Reference Article The original article was published in International Journal of Mental Health Systems, and you can read it here.

Using scientific evidence to improve healthcare in Nigerian slums: an evolving story of hope and possibilities

Nigerian “ghettos” deserve quality health services
Popularly referred to as “ghettos”, slums have remained in Nigeria, inhabited by those who may not afford to live in well-off urban locations. About 50% of Nigeria’s population live in slums, and there are predictions that more people will relocate to slums if life continues to be difficult.
There have been many positive and negative stories about Nigerian slums. On the positive side, we have heard of several entertainment stars that emerged from slums, including football stars, and very talented technocrats. In fact, the image that is painted for most of Nigerians is that success stories may be incomplete without mentioning living in the slum at a time.
And on the negative stories of slums, we hear about several cases of violence, poor access to sanitation and hygiene, quick spread of diseases, and overall poor living conditions. As regards health, it is of deep concern to the Health Policy Research Group, University of Nigeria (HPRG), that amidst the sufferings in slums, basic quality and safe healthcare is difficult to come by.
HPRG believes that since the government has been slow in improving the overall living conditions in slums or improving lives generally, such that slums will no longer be needed, there should at least be some attention paid to the healthcare of those living in slums.
 
What is HPRG doing to change the face of healthcare in slums?
Slums are not actually in lack of healthcare services, but the problem is that many of those health services are informal, coming from untrained people. In these slums, people rely on those they call ‘chemists’ (technically referred to as Patent Medicine Vendors [PMVs]), traditional birth attendants who are women that help other women to deliver children in their homes, bone setters, and other traditional healers. These informal health providers are well respected in slums, even though they are not trained and they make medical errors that could take lives.
But then, is it possible that the Nigerian government which spends just about 5% of its annual budget on the health sector can build enough health facilities and employ enough health workers that can serve all the slums in the country that house above 100 million persons?
You will agree that the above question is rhetorical, especially when experts are saying that even the appropriated 5% is yet to yield an actual health value of 5%. Therefore, health systems actors like HPRG, Ministries of Health, Primary Healthcare Agencies, healthcare unions, etc., must begin to think differently about improving healthcare in slums using available resources.
 
The strategy of linking informal health providers to a formal health system
Recall the untrained people providing healthcare services in slums – the PMVs, traditional birth attendants, etc.? Do you think they are useful?
Interestingly, HPRG on the CHORUS urban health project has been conducting a study on health service delivery in urban slums. The team has mapped out many informal and formal providers in slums in Enugu and Onitsha and can affirm that a lot of informal health service deliveries go on in slums. Informal providers in slums help their neighbours to deliver children, treat them for malaria/fever and several illnesses, help them to correct dislocated and fractured bones, etc. So, indeed, we can give them flowers because they are doing what they can to meet the health needs of their neighbours who are poor, not so educated, and may not be able to access good health facilities because they are not available. Nevertheless, not so many of these cases turn out successful. Thus, what should we do?
In the urban health study conducted by HPRG, the research thinktank has seen that it is possible to pull these informal providers into a formal system that can monitor their activities, provide them with responsive health facilities where they can make quick referrals, train them to know the scope of health issues they can handle and how to offer basic attention to them, and importantly, identify and sanction those informal providers that continue to be a threat to safe healthcare for those living in slums.
 
Stakeholders continue to converge to shape and implement the findings from HPRG
In what is technically referred to as “co-creation of interventions”, HPRG has pulled together stakeholders from diverse sectors to chart ways forward for safe and quality healthcare in slums. The sectors include, The State Ministry of Health in Enugu, State Primary Healthcare Development Agency, Community Leadership, Unions of informal and formal providers, informal and formal frontline healthcare providers, and the academia. The first co-creation meeting was held between February 6 and 9, 2023, and the second, held on 25th May 2023.
 
Resolutions from the co-creation meetings so far
The stakeholders have agreed that to guarantee quality and safe healthcare in slums, three areas of focus should include governance, service delivery, and information management. Across the three areas, the proposal which will be implemented includes among others:
  • Establishing a desk office at the Ministry of Health to coordinate the linkage of the informal health providers into an efficient formal health system.
  • Through the desk office, identifying, registering, and training informal health providers to understand the scope of health services they can offer.
  • Ensure that the desk office works with focal persons in the slums to monitor activities of informal providers to be consistent with safety.
  • Providing a standard guide for referrals from the informal to the formal, including a simple referral form.
  • Training informal providers on some good practices in health service delivery that can enable them to perform quality basic care and to know when to refer cases exceeding their scope to functional formal health facilities around them.
  • Provide data collection tools for all activities within the informal health space in the slums and the connections with the formal health system.
In all, the policymakers, providers, community leaders, and representatives of the unions of the providers are appreciative of the findings coming from the urban health study being conducted by HPRG. They have looked through the interventions and have agreed that the interventions are feasible to implement. Steps have been designed on how to go about implementing the interventions, and in the coming months, it is believed that reasonable progress will be made to make the healthcare space in slums to be safe.
 
Acknowledgment of contributors
Prince Agwu (PhD)
Chinyere Mbachu (MBBS, FWACP)
Obinna Onwujekwe (MBBS, PhD)
 
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Unfavorable working conditions in primary health centers are hindering access to sexual and reproductive health services for young people in Nigeria

Some facts about the sexual and reproductive health of young people
Adolescents in low- and middle-income countries (LMICs) contribute an estimated 21 million pregnancies yearly. Half of these pregnancies are unplanned, and half of them end in unsafe abortions.
One in every five girls in Nigeria between ages 15 and 19 has commenced childbearing. Early childbearing has negative consequences on the physical and mental health of girls. Up to 50% of dropout among adolescent girls is caused by teenage pregnancy.
The risk of acquiring a sexually transmitted infection (STI) is highest among young people aged 15–24. The most recent National HIV & AIDS and Reproductive Health Survey (NARHS) reported that about 9.8% of young people in Nigeria experienced symptoms of STI in the year preceding the survey.
 
Primary health centres are not meeting the SRH needs of young people
One way to ensure that young people have access to lifesaving SRH information and services is through viable social services like counselling and youth-friendly centres. Unfortunately, such centres are scarce in Nigeria, creating the need for replacements through primary health centres (PHCs). PHCs are well-positioned to address the SRH needs of young people due to the availability of trained health workers, and the possibility of finding social service professionals like social workers and psychologists to work in primary healthcare facilities.
“Think about the 17-year-old pregnant Sophia who resides in a remote village in Nigeria where the only skilled health worker is in the PHC, or the 21-year-old Jimoh who has an STI and his only access to proper treatment is the PHC.”
The reality here is that the PHC should be the rallying point for young people who need SRH services such as counselling, contraceptives, treatment of STIs, maternity care and post-abortion care. However, PHCs in their current state do not appeal to young people. They (young people) prefer to go elsewhere when they need SRH services, and their reasons are linked to the attitudes of health workers.
The big question here, is – “How do health workers repel young people from PHCs, and why?”
 
Findings from a stakeholder consultation workshop
Researchers from the Health Policy Research Group, University, University of Nigeria, held a two-day stakeholder consultation workshop at Abakaliki, Ebonyi State on the 3rd and 4th of May, 2023 with stakeholders in adolescent sexual and reproductive health. In attendance, were: relevant officials from the State Ministries of Health, Women Affairs, Youth, Sports, and Social Development, as well as officials from the Ebonyi State Primary Healthcare Development Agency, implementing partners, facility health managers and representatives of adolescents.
 
Stakeholders lamented that inefficiencies in the Primary Health Care system make it difficult for primary healthcare workers to provide sexual and reproductive health services to young people
 
 
In the table below, we highlight how these inefficiencies are making PHCs less appealing to young people, that is the ‘whys’ and the ‘hows’ respectively.
The ‘hows’ The ‘whys’
PHCs are not open in the late afternoons or evenings (that is after school or work hours) when young people are able to access services PHCs do not have the number of health workers that are required to provide 24-hour services
The skilled health workers are not available in the PHCs in the evenings. There is no provision for accommodation for skilled health workers. Or the available accommodation is poorly maintained and not livable. Absence of security in the facilities to provide cover at night for health workers and epileptic power supply with little or no provision of an alternative means of power supply  
PHC workers do not have the skills or training to provide the services that young people need Many PHCs are manned by unskilled health workers such as community health extension workers. The State government has not employed skilled health workers to replace the retired workforce and there are no qualified social service professionals like social workers and psychologists. 
The design of the PHC may not be appealing to young people and may discourage them from seeking care Many PHCs do not have separate entrances and exits for young people. There is no provision for secluded spaces for young people to receive care
Poorly motivated PHC health workers may affect their attitude toward providing friendly care Many of the health workers at the PHCs are either unpaid volunteers or underpaid workers
Non-provision of certain SRH services to young people who come to seek care Religious beliefs and personal values of health workers conflict with their provision of contraceptive services to young people. Health workers are constrained by the restrictive abortion laws in the country
 
What is the way forward?
  • The stakeholders agreed that there is a need for continuous advocacy to the State government to employ more health workers and social service professionals in the facilities.
  • There is a need to integrate the volunteer health workers formally into the health workforce so that they receive payment for their services. This will improve the motivation of these health workers who are a major contributor to the staff strength of the PHCs.
  • The State government should channel funding to improve the working conditions and environment in the PHCs. The Basic Health Provision Fund (BHCF) can be leveraged in funding things that are allowed by the tenet of the funding.
  • PHC-model which is young people-friendly and welcoming to young people was proposed to enable the PHCs to be the first port of call for young people.
  • The research team will go further to implement co-designed intervention strategies at the PHC level to make SRH services more appealing to young people.
 
Acknowledgement of contributors
Chinazom Ekwueme (MBBS, MWACP) Prince Agwu (PhD)
Ifunanya Agu (MSc) Chinyere Mbachu (MBBS, FWACP)
Irene Eze (MBBS, FWACP) Obinna Onwujekwe (MBBS, PhD)
 
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Evidence from Cross Programmatic Efficiency Analysis of Health Programmes (CPEA) reveals that inefficiencies marr investments in Nigeria’s health sector

By Health Policy Research Group (HPRG), University of Nigeria
 
What to know about Cross Programmatic Efficiency Analysis of health programmes
Nigeria’s health sector enjoys investments from bilateral and multilateral agencies like the WHO, USAID, Global Fund, etc., that come as partners to strengthen the country’s health system and improve health service delivery. Investments from partners are add-ons to budgetary allocations to the health sector by federal and state governments, as well as locally sourced resources for health. Yet Nigeria’s health space is said to suffer suboptimal funding, which is a vital concern documented by the Lancet on Nigeria’s investment in health and population health outcome performance.
However, conversations are currently about how to get value for the current ‘suboptimal’ health investments. Indeed, more money may not guarantee more health, if steps are not taken to ensure efficient allocation and utilization of scarce resources in ways that offer maximal value for every penny invested in the health sector.
To address these concerns about efficiency in resource allocation and use of resources in health sectors, the WHO developed a diagnostic approach, the  Cross Programmatic Efficiency Analysis (CPEA). CPEA focuses on mapping programmes within the health systems of countries, for the purpose of identifying inefficiencies. These inefficiencies manifest in the form of duplications, overlaps and misalignment of roles and functions across or within governance, procurement system, service delivery, financing, and information management systems. And they have implications on success or failure of priority health programmes, such as HIV, Tuberculosis, Malaria, Immunization, and Reproductive Maternal, Newborn, Child and Adolescent Health (RMNCAH).
CPEA study was conducted in three states in Nigeria (Anambra, Imo and Sokoto). Although there is an implementation focus in Anambra, with plans for spreading into other states in future. The study also considers the need to reflect with federal agencies like the Federal Ministry of Health (FMoH) over the work being done at state level, since most of the partners will always come into the country through the ‘Federal gate’.
 
Stakeholders meet to look at previous CPEA findings
The CPEA study was conducted between 2018 and 2019, using key-informant interviews and review of documents. As the study nears implementation of its key recommendations, concerned stakeholders such as directors at the FMoH, State Ministry of Health (SMoH) including commissioners of health, Executive Secretaries/Chief Executive Officers of health agencies, representatives of development/implementing partners, and health systems and health economics expert, were invited to a 2-day implementation meeting (18th and 19th April 2023) at Valencia Hotel, Abuja.
The stakeholders yet again looked through the key findings from the CPEA study, identifying areas of improvement within their health systems since 2019 when the CPEA study was concluded. Indeed, there were some remarkable improvements, especially around centrally governing diverse partners through the SMoH.
A representative of one of the states said, “Unlike at the time the CPEA study was conducted, we now have ownership of health programmes in our state, particularly in terms of approval and oversight. It is no longer the usual case of partners coming in with programmes and we have no idea of what is happening. That has changed since after 2019”.
Nevertheless, there was consensus that a number of inefficiencies still exist in the coordination of the programmes, particularly in areas of financing, information management, service delivery, and some components of governance that have to do with planning, human resource management, and sustainability of programmes at the exit of donors.

 

Cross-section of participants with the Director of Planning, Research, and Statistics, Federal Ministry of Health and Commissioner of Health, Sokoto State
 
In retrospect, what were the findings from CPEA?
During the 2-day meeting, health systems and policy experts from the Health Policy Research Group, (HPRG) University of Nigeria, led by Professor Obinna Onwujekwe, together with Dr Francis Ukwuije of the Health Financing Technical Office of the World Health Organisation, Nigeria, recapped key findings from the CPEA study done in Anambra, Imo, and Sokoto States. Interestingly, identified inefficiencies were common across the three states. Inefficiencies were found in the following areas:
  • Partners pursuing financing of health programmes that do not align with the health priorities of the states.
  • Decisions of health programmes to execute by partners at the federal level with almost no input from the states.
  • Due to the lack of contributions by stakeholders at the state and local government levels to health programmes, partners could bring health programmes that are not actually needed in certain communities, which leads to wastage of resources.
  • Partners fund health programmes and assign budget lines that have already been captured in the national or state health budgets, leading to more wastage of scarce resources.
  • While there is a need for diverse health programmes, supervisory and accountability lines should be mainstreamed for efficiency. As against having too many supervisory/accountability lines, like “too many cooks, spoil the broth”.
  • “Too many cooks spoiling the broth” was again manifest in information management. When different programmes have unique data reporting tools and dissemination platforms, it could cause confusion and even data inaccuracy, which could affect decision-making.
  • Health programmes may not be informed by evidence, as gaps between generated data and decision-making persist.
  • Health programmes could be counterproductive to the management of human resources for health, in the sense that health workers in a bid to attend to the demands of programmes may neglect the core responsibilities of attending to patients in facilities. And some of the health workers could want to lobby themselves into health programmes with more funding.
 
As inefficiencies across the health programmes persist, what way forward?
Interestingly, stakeholders acknowledge that these inefficiencies must be tackled if the health system will make progress. Uche Ezenwaka on behalf of the HPRG, led the activity on priority and agenda setting in addressing the identified inefficiencies.
First, the stakeholders were made to understand the concepts of feasibility and fidelity in designing priorities and agenda. Followed by being talked through the core focus of CPEA in areas of governance, financing, service delivery, information management, and procurement.
Although still a work in progress, a summary of agenda setting achieved by the states with support from the federal level, are:
  • Establish a special desk office under the Commissioner of Health that will compulsorily be the entry and exit of health partners supporting programmes. This will help states to assume ownership of the programmes and stay well informed of the programmes’ contents and management.
  • Activate the health partners coordination committee (HPCC) in the FMoH, and source funding for the committee through budgetary allocation to the Ministry. This will help achieve harmonization of programmes, as well as supervise coordinated input from states on health programmes.
  • Aggregate insights from facilities and local government health authorities before drawing up budgets for the health sector in states.
  • Advocate for early passage of annual budgets to guide annual operational plans for the health sector.
  • Organise state-owned partners’ forum for harmonization of health programmes in the state and achievement of health spending based on unique health priorities in states.
  • Establish desk offices in Ministries of Health for scouting and distilling research evidence for use by policymakers in engaging partners and members of the state executive council.
  • Engage and sensitize the Civil Society Groups to participate in monitoring the activities of partners and demanding accountability.
  • Guided by the Primary Healthcare Under One Roof (PHCUOR) to improve the relationship between the State Primary Healthcare Development Agencies and Local Government Health Authorities to strengthen supervision of programmes at the primary healthcare level.
  • Activate state level data operation center (DOC) that collates, harmonize and coordinate data for decision-making commissioned by UN and WHO to help streamline reporting line and data.
  • Establish a Logistic Management and Coordination Unit (LMCU) to address fragmented procurement system across supply chain
  • Establish a Health Workforce registry to serve as a database to enable acute and timely evidence-based health workforce information and management.
 
Conclusion
The involvement of top players in the health sector of the selected States is an important step towards the achievement of the desired efficiency across the health programmes and health sector at large. Also, the acknowledgement of inefficiencies by these top players, and the commitment of their time to begin drawing up feasible and workable remedial strategies, offers a strong sense of conviction. The implementation of CPEA is large on prioritization, implying that the implementers understand how ambitious it can be trying to address all inefficiencies. So, the focus will be on specific state priority areas for efficiency. Lessons learnt will be used to pursue CPEA in other states of the country.
 
Acknowledgement
(1) World Health Organisation
(2) Federal Ministry of Health, Nigeria
(3) Resource for Development (R4D)
(4) Strategic Purchasing Africa Resource Centre (SPARC)
(5) State Ministries of Health, Anambra, Imo, and Sokoto.
 
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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
  1. Which COVID-19 vaccines should Nigeria purchase and how much would it cost?
  2. How should these vaccines be distributed?
  3. 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 1st Annual Multidisciplinary International Conference of the University of Nigeria, Nsukka (UNN) which took place from 5th – 7th 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/

National Centre of African Health Observatory Platform completes kickoff meeting for documentation of Nigeria’s Health System and Services Profile

By HPRG News
Nigeria’s health system is on a path of growth and keeps evolving. Information about the country’s health system is fragmented, which has occasioned the need for rapid harmonization led by the African Health Observatory Platform (AHOP). The Country Health System and Services Profile (CHSSP) will provide an in-depth description and analysis of Nigeria’s health system and services. It is likewise being conducted in Rwanda, Senegal, Kenya, and Ethiopia, which will provide the basis for comparing the health system and services’ performance across these five countries. The CHSSP is designed to be a key reference document for a wide audience including country-level policy-makers, technical staff, researchers, and development partners. They are intended to provide relevant country-specific and comparative information to support policymaking, analysis, and implementation of approaches related to the re-engineering of health systems and services in the African region.
To commence documenting Nigeria’s CHSSP, the Health Policy Research Group (HPRG), University of Nigeria, which hosts the Nigerian National Centre of AHOP conducted its kickoff meeting to prepare authors for the task ahead. The meeting took place at Hotel Sylvia, Enugu, from 13th – 15th June 2022. Partners with the HPRG on the CHSSP project were in attendance, and they include Veritas University, Association of Public Health Physicians of Nigeria (APHPN), Nigeria Institute of Medical Research (NIMR), Federal Ministry of Health, Nigeria (FMoH), and a representative of the World Health Organisation.

Nigeria’s CHSSP Authors
 
During the meeting, Dr. Enyi Etiaba who is the Project Manager of AHOP in Nigeria emphasized the overall goals of AHOP in the directions of knowledge synthesis and evidence translation, as she stated that the CHSSP is one of the outputs of the stated goals. She used this opportunity to ensure that all CHSSP authors are aligned with the ideals of AHOP, even as they work on the CHSSP project.
Dr Enyi Etiaba introducing AHOP and CHSSP

Documenting the CHSSP will need a uniform reference manager. The gathering was an opportunity for all authors to run through the endnote reference manager, as the approved reference manager for CHSSP documentation. Facilitated by Dr Chinyere Mbachu, authors successfully downloaded the endnote reference manager, went through step-by-step process of uploading reference materials and sources into it, and could make citations as they write. Authors are expected to make use of the Harvard Referencing Style throughout their writing.
Dr Chinyere Mbachu facilitating a session on Endnote reference manager

In addition to the above, CHSSP authors were introduced to the AHOP writing style by Dr Enyi Etiaba. Important points to note include the use of British style (e.g., use organisation instead of organization), dates should be written without punctuation signs, large figures should be written using spaces as against commas, health care should be written as “health care” and not “healthcare”, hyphenate “evidence-based” when used as an adjective but write without the hyphen when used as a noun, etc. Click here to download AHOP writing style guide.
At about noon time, authors had a virtual meeting with the CHSSP Editors from the London School of Economics (LSE) and WHO-African Region (WHO-AFRO). Concerns drawn from the 11 Chapters of the CHSSP were listed and clarified. The 11 chapters comprise the overall context of Nigeria; organization and governance of the health system; health financing; health workforce; medical products and health technologies; health infrastructure and equipment; service delivery; health information and information systems; performance of the health system (outputs); health services coverage and system outcomes; conclusion and key considerations. The meeting with LSE and WHO-AFRO helped resolved grey areas. It was agreed that authors should keep in touch with the Editors as they write, and lead authors will participate in a monthly meeting with LSE and WHO-AFRO for the duration of the writing stage of the CHSSP project. Also, the overall lead author from the National Centre must go through submissions before they get to the Editors.

Cross-section of CHSSP Authors meeting virtually with LSE and WHO-AFRO
 
Authors agreed with the Editors on the need to concentrate on national-level data given the timeframe of production and AHOP’s concentration on secondary sources of data. To help the authors, there are some materials in the SharePoint for this project. All authors now have access to the SharePoint. It was also agreed that more time will be allotted to the completion of Chapters 9 and 10 since they are dependent on the completion of the fore chapters. Authors were reminded to concentrate more on the Excel spreadsheet for needed information than the writing template, as some information in the latter may be wrong. Click to download the slides of LSE/WHO-AFRO
According to Professor Obinna Onwujekwe who heads the HPRG and leads the AHOP Nigerian National Centre, the CHSSP when concluded will be both means and end, in the sense that its recommendations will be used for health system strengthening towards the achievement of the health-related SDG targets, especially Universal Health Coverage (UHC) in Nigeria. As a means, it will also serve as evidence-base for the development of the 3rd National Health Sector Development Plan (NSHDP III), a resource for the planned Nigeria Health Sector Reform Programme and the national UHC plan. It will also provide the required information for the development or revision of policies and strategies in the health sector in Nigeria.
Prince Agwu commented on the dissemination of the CHSSP, which will target academia, policymakers, frontline practitioners, communities, media, and civil societies. Strategies for dissemination will keep evolving and will be cross-sectoral.
More on capacity building, CHSSP authors were taken through data sourcing strategies by Prince Agwu and Uche Ezenwaka. The use of Boolean Operators, introduction to new search engines and databases and the use of keywords were discussed extensively. Uche introduced CHSSP authors to janebiosemantics. On specific data from the Federal Ministry of Health, Martins Otuamah took CHSSP authors through specific databases that will be of help in the documentation process. And finally, on capacity building, Prof BSC Uzochukwu, an HPRG and AHOP National Centre lead took authors through academic writing and production of policy briefs. Authors were exposed to non-linear methods of academic writing and the rationale behind building quality academic arguments. This was one of the high points of the CHSSP meeting.
Download presentation on data sourcing strategies
Download presentation on data sourcing from the Federal Ministry of Health
Download presentation on academic writing and policy brief
On the side, we took this opportunity to go through the projects being worked on by our partners (Veritas University and Nigeria Institute of Medical Research [NIMR]). Dr Chinyere Okeke moderated the presentations from both bodies, and comments were taken after the presentations. Veritas University represented by Ifeanyi Chikezie presented “Assessing the status of state-supported social health insurance schemes in Gombe state, Nigeria”, while NIMR represented by Adewale Ojogbede presented “Utilization of Lagos State Health Insurance Scheme”.
In all, the National Centre is looking forward to 7th July 2022 for first submissions, and 14th and 15th July 2022 for a second workshop that will focus on writing. “We are hopeful authors will stick to the timeframe, and will produce top-quality chapters, which is the signature of the HPRG. Otherwise, we may be forced to substitute authors if and when needed”, as said by the Nigerian AHOP lead, Prof Obinna Onwujekwe.
 
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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!