Child healthcare isn’t for infants and under-5 alone: communique from a policy dialogue on the health and health rights of urban school-aged children in Nigeria

More than half of Nigeria’s over 200 million population are under the age of 18, and just about 29 percent of the over 100 million Nigerian children are under 5 years. Children between the ages of 5 and 17 comprise the larger share of Nigeria’s children population but are least catered to by the Nigeria’s health system that is more interested in the under-5s. As such, health rights of children between 5 and 17 years have remained threatened, calling for urgent attention.

Supporting our assertion above is the evidence of demarcation between under-5 and school-aged children (5 – 17 years) in Nigeria’s National Health Policy but the listing of child-health-related Key Performance Indicators (KPIs) for under-5s alone. Similarly, the guideline for the implementation of the Basic Health Care Provision Fund (BHCPF) recognises just under-5s as among the five vulnerable groups, again, leaving out children between 5 and 17 years.

Understandably, policies like the 2003 Child’s Rights Act (CRA), 2006 National School Health Policy (NSHP), 2019 National Policy on the Health and Development of Adolescents and Young People (NPHDAYP), and 2022 National Child Health Policy (NCHP), have made attempts to recognise the uniqueness of children aged 5 – 17 years and the need to dedicate special care to their health and health rights. However, academic assessments and other significant evaluations of these policies have shown that they have not been strategic enough or well-implemented to provide sufficient protection for school-aged children’s health and health rights. Unsurprisingly, the Nigeria’s National Development Plan (2021 – 2025) decried poor enforcement of children’s rights laws and the absence of children’s viewpoints in health policymaking/enforcement.

Indeed, Nigeria may not have come to terms with the significant harm this lack of intentionality towards the health and health rights of school-aged children has caused. This was revealed in a recent research conducted by the Health Policy Research Group – University of Nigeria and the School of Humanities & Social Sciences/Law, University of Dundee, under the CHORUS Urban Health Consortium, with support from the Rivers State Ministry of Health. As national and subnational level stakeholders in health, education, social welfare, and human rights fields, drawn from 24 ministries, agencies, and organisations in Nigeria, we have gone through the study, validated the data, and have come up with our position. But first, we present a summary of the research evidence.

Evidence from the research

Four levels of research inquiries involving document reviews, in-class observations of children, and interviews and policy dialogue with a broad collection of national/subnational stakeholders inclusive of children, caregivers, teachers, school owners, attorneys, and policymakers were applied to gather evidence on (1) the policy environment for the protection and promotion of the health and health rights of school-aged children (2) patterns of seeking healthcare for school-aged children, and (3) threats to the rights of school-aged children to quality, safe, and timely healthcare. The research was focused on urban settlements in Rivers State, inclusive of urban slums. Across the three areas of inquiries, the study found that:

  1. Policies and laws expected to protect and promote the health and health rights of school-aged children failed several set expectations when judged against evidence from academic investigations and other significant inquiries. Notably, the 2006 National School Health Policy designed to play a pivotal role in supporting other related policies, has largely failed in its implementation. Conflicts in the leadership of the School Health Policy undermined its implementation progress and significantly contributed to the isolation of schools away from the health system, especially primary healthcare.
  2. Health seeking for school-aged children largely defied the provisions of safety and quality in the Child’s Rights Act [CRA]. The dominant health-seeking routes were home management of illnesses using self-prescribed medications; drugs bought from drug vendors or self-mixed herbal remedies; herbal practitioners’ recommendations, and solicitation of spiritual interventions from religious clerics even at critical times. The significance of primary healthcare was hardly recognised, as many rather jumped to private clinics or secondary/tertiary facilities when prior self-help and informal arrangements failed them.
  3. The school-aged children decried the absence of health personnel and health facilities in their schools. More so, they complained about the absence of a responsive care and reporting system to either discuss their physical and mental health needs or to report risky health options and behaviours stimulated and encouraged by their caregivers. The children equally recognised inefficiencies and unsupportiveness of health facilities, particularly the unruly attitudes of health workers toward children and their caregivers, high fees for health services, poor emergency response to children in health crises, and constrained physical access to health facilities.

 

Cross-section of stakeholders

 

Policymakers and other stakeholders validate evidence and prioritize actions

On August 5 and 6, 2024, stakeholders met in Port-Harcourt, Rivers State, Nigeria, and without reservations we commended the now nationally accepted and domesticated CRA across the country’s federating units. We also appreciated the working groups for adolescents’ health based on the emergence of health programmes for adolescents and the progressive scaling of adolescent-friendly health centres. And importantly, we hailed the ongoing health systems strengthening blueprint that recognises the centrality of school health services to the health needs of school-aged children.

Notwithstanding these commendable efforts, we pointed out fifty-one concerns which we later condensed to five specific areas using a Modified Delphi Technique to deliberate and consensually rank priorities. Our agreed five areas and suggested actions for governments at all levels are:

  1. Leads of the health, education, and social welfare (women affairs in some cases) ministries must leverage current evidence for the review of school health-related policies with the aims of: (a) harmonization of contents (b) setting very feasible targets with realistic benchmarks to gauge progress, and (c) reaching a definitive consensus on the leadership of school health with clear definition of roles and responsibilities.
  2. Leads of the health, education, and social welfare ministries should work with the legislative committee on health, the criminal justice system, children’s parliament, and the child’s rights implementation committees to design and enforce clear and widely communicated standard operating procedures for reporting and responding to actions that violate the rights of school-aged children to safe, quality, and timely healthcare.
  3. The above actors should work with the national orientation agency, academia, civil society organisations, community-based organisations, children’s parliament, and media to design a simplified and effective communication framework for the harmonized policy contents and standard operating procedures which must include: (a) mainstream into school curriculums (b) pasted prints in health facilities and schools (c) repeated announcements in religious gatherings, and (d) unrestricted digitized accessibility.
  4. The lead of the state health ministry should work with the primary healthcare development agency, health insurance agency, and the education ministry to: (a) design schools’ clusters around designated functional primary health facilities with school health desks headed by appointed school health desk officers (b) encourage appointments of school health focal persons to link schools with the designated health facilities (c) design terms of reference and workflow modalities (d) explore inclusion of school-aged children in the basic healthcare provision fund, and (e) nudge schools toward employing at least one qualified health personnel and setting up equipped sickbays in the long-run.
  5. The consensually agreed leadership of school health will explore external funding while compulsorily including school health services in the annual operation plans and budgets to cover funding the desk offices, enforcement of the standard operating procedures, and all other health systems and wider responses to the health and health rights of school-aged children.

Our conclusive position

As stakeholders, we acknowledge the fragility of the under-5 population, hence the enormous attention accorded to their health needs, and we encourage even more. However, it is worrisome that the bulk of the country’s population between the ages of 5 and 17 years who are also children have not received as much attention as they deserve health-wise. The consequences are regrettable, evidenced by gross violation of their health rights, poor institutional responses to their health needs and rights, and avoidable cases of morbidities and mortalities.

As stakeholders from different fields, we underscore the need for a more coordinated, strategic, and inclusive approach to health policymaking that prioritizes the unique needs of school-aged children. This should begin with reviewing and implementing an effective school-health or holistic child-health policy that prioritises the health rights of school-aged children, school-health services, and easily accessible primary healthcare services for school-aged children. It should be supported by widely communicated and accessible deterrence mechanisms to put an end to the violation of the health rights of school-aged children in Nigeria. By adopting a more holistic and intentional focus on the health rights of school-aged children, Nigeria can make progress towards ensuring that all children, regardless of age, have access to safe, quality, and timely healthcare.

Acknowledgement

  1. Rivers State Ministry of Health
  2. Rivers State Ministry of Education
  3. Rivers State Ministry of Social Welfare and Rehabilitation
  4. Federal Ministry of Health (Family Health Department/Child Health Division)
  5. Federal Ministry of Education
  6. Federal Ministry of Women Affairs
  7. National Primary Health Care Development Agency
  8. Rivers State Primary Healthcare Management Board
  9. National Health Insurance Authority, Rivers State
  10. Rivers State Adolescent Technical Working Group
  11. National Child Rights Implementation Committee
  12. Rivers State Family Court
  13. Aret and Bret LLP Law Firm
  14. Results for Development, Nigeria
  15. Marine Base Community
  16. Assemblies of God Church, Amadi-Ama, Rivers State
  17. Police Station Mini-Okoro Mosque
  18. The Boy Child Support Network
  19. Rhema Care
  20. Channels TV
  21. Wish FM
  22. Model Senior Secondary School, Rivers State
  23. Pneuma Citadel Academy, Rivers State
  24. Dr Tarry Asoka (Independent Health Consultant)
  25. UNICEF, Rivers State Field Office
  26. CHORUS Urban Health Research Consortium
  27. University of Dundee, United Kingdom
  28. Health Policy Research Group, University of Nigeria

Research Team (L-R): Ifunanya Agu (Project Manager), Dr Aloysius Odii (Research Associate), Prof Uzoma Okoye (Research Co-Lead), Dr Adaeze Oreh (Hon. Commissioner for Health, Rivers State, Nigeria), Dr Prince Agwu (Research Lead), Chinelo Obi (Research Associate)

Correspondence: prince.agwu@unn.edu.ng

Click to download the communique in pdf

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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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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.
      1. Using Public Relations for Research Impact
      2. Understanding research methods
      3. Mass Communication for Health
      4. Research in journalism for policymaking
      5. Reporting for corruption in the health sector
      6. The act and practice of journalistic writing
      7. Getting research into policy and practice
      8. Introducing infographics
      9. Infographic with CANVA

     
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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.
     
    Okpoko Slum, Onitsha, Anambra State
    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 at Abakpa Slum, Enugu
     
    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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    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]

    You can read further here

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