Background Cross River State is making investments geared towards ensuring equitable distribution and improved retention of its frontline health workforce in remote and rural areas. This informed the conduct of a discrete choice experiment to determine the motivating factors supporting the retention of healthcare workers. Methods Study participants were 198 final year students of nursing, midwifery and community health and frontline health workers. Eight focus group discussions and 38 key informant interviews were conducted to obtain information about the dimensions of the work conditions that are important to frontline health workers when choosing to take up posting or stay in their rural work locations. Results Health workers are 2.7 times more likely to take up a rural posting or continue to stay in their present rural duty posts if they receive a salary increment. They are also four times more likely to take a rural job posting if a basic housing or a housing allowance is provided. Conclusion Improving working conditions of frontline health workers in terms of adequate staff strength, good skills mix and equipment, etc., as well as improving opportunities for career advancement will support retention in rural health posts.

BackgroundAn effective capacity building process for healthcare workers is required for the delivery of quality health care services. Work-based training can be applied for the capacity building of health care workers while causing minimum disruption to service delivery within health facilities. In 2012, clinical mentoring was introduced into the Jigawa State Health System through collaboration between the Jigawa State Ministry of Health and the Partnership for Transforming Health Systems Phase 2 (PATHS2). This study evaluates the perceptions of different stakeholders about clinical mentoring as a strategy for improving maternal, newborn and child health service delivery in Jigawa State, northern Nigeria.MethodsInterviews were conducted in February 2013 with different stakeholders within Jigawa State in Northern Nigeria. There were semi-structured interviews with 33 mentored health care workers as well as the health facility departmental heads for Obstetrics and Pediatrics in the selected clinical mentoring health facilities. In-depth interviews were also conducted with the clinical mentors and two senior government health officials working within the Jigawa State Ministry of Health. The qualitative data were audio-recorded; transcribed and thematically analysed.ResultsThe study findings suggest that clinical mentoring improved service delivery within the clinical mentoring health facilities. Significant improvements in the professional capacity of mentored health workers were observed by clinical mentors, heads of departments and the mentored health workers. Best practices were introduced with the support of the clinical mentors such as appropriate baseline investigations for pediatric patients, the use of magnesium sulphate and misoprostol for the management of eclampsia and post-partum hemorrhage respectively. Government health officials indicate that clinical mentoring has led to more emphasis on the need for the provision of better quality health services.ConclusionStakeholders report that the introduction of clinical mentoring into the Jigawa State health system gave rise to an improved capacity of the mentored health care workers to deliver better quality maternal, newborn and child health services. It is anticipated that with a scale up of clinical mentoring, health outcomes will also significantly improve across northern Nigeria.

Background Health workers are indispensable to service delivery especially in rural and remote communities where the burden of disease is high. Nigeria faces numerous human resources for health challenges, health workers are reluctant to take up rural postings, and the government is struggling to implement planned interventions due to staff shortages. This study explored the perspectives of policymakers and primary health care (PHC) managers on factors that hinder health workers from staying in rural and remote areas and strategies for improving retention. Methods We interviewed purposively selected 10 policymakers and 20 PHC managers in Bauchi and Cross River States, Nigeria. Results Respondents identified a lack of basic social amenities, the poor state of infrastructure, poor working conditions, remuneration and the barrier to career advancement as factors that impede health workers from taking up rural postings. Strategies for improving retention include enforcing bonding; paying salaries promptly, increase in rural allowances and prioritizing health workers in rural and remote areas for capacity building. Conclusion The results of the study indicate the importance of applying context-specific strategies aimed at ensuring the availability of social amenities such as roads, water, electricity, telecommunication, security, the status of infrastructure, working conditions and remunerations.

BackgroundRural communities in Nigeria account for high maternal and newborn mortality rates in the country. Thus, there is a need for innovative models of service delivery, possibly with greater community engagement. Introducing and strengthening community midwifery practice within the Nigerian primary healthcare system is a clear policy option. The potential of community midwifery to increase the availability of skilled care during pregnancy, at birth and within postpartum periods in the health systems of developing countries has not been fully explored. This study was designed to assess stakeholders’ perceptions about the performance of community health workers and the feasibility of introducing and using community midwifery to address the high maternal and newborn mortality within the Nigerian healthcare system.MethodsThis study was undertaken in two human resources for health (HRH) project focal states (Bauchi and Cross River States) in Nigeria, utilizing a qualitative research design. Interviews were conducted with 44 purposively selected key informants. Key informants were selected based on their knowledge and experience working with different cadres of frontline health workers at primary healthcare level. The qualitative data were audio-recorded, transcribed and then thematically analysed.ResultsSome study participants felt that introducing community midwifery will increase access to maternal and newborn healthcare services, especially in rural communities. Others felt that applying community midwifery at the primary healthcare level may lead to duplication of duties among the health worker cadres, possibly creating disharmony. Some key informants suggested that there should be concerted efforts to train and retrain the existing cadres of community health workers via the effective implementation of the task shifting policy in Nigeria, in addition to possibly revising the existing training curricula, instead of introducing community midwifery.ConclusionApplying community midwifery within the Nigerian healthcare system has the potential to increase the availability of skilled care during pregnancy, at birth and within postpartum periods, especially in rural communities. However, there needs to be broader stakeholder engagement, more awareness creation and the careful consideration of modalities for introducing and strengthening community midwifery training and practice within the Nigerian health system as well as within the health systems of other developing countries.

Background In Nigeria, adoption of the primary healthcare approach led to the establishment of numerous primary healthcare facilities, and training of new cadres of community health officers (CHOs), community health extension workers (CHEWs) and junior community health extension workers (JCHEWs). These new groups complemented the work of nurses and midwives. Methods We conducted a workload indicators of staffing needs study in the 20 local governments of Bauchi State, from March 2016 to September 2018, in all 317 ward-level primary healthcare facilities. Results Findings show a total of 128 existing nurses/midwives, a calculated requirement of 402 and a shortage of 274 nurses/midwives. Existing CHOs/CHEWs were 735, a calculated requirement was 948 and a shortage of 213 CHOs/CHEWs. The JCHEWs were 477, a calculated requirement of 481, with a shortage of four JCHEWs. Conclusion Results from this study highlight the unequal distribution of health workers; the abundance of some frontline workers in some communities and dire need of others. We emphasize the need to strengthen health workforce planning to deliver essential primary healthcare services, particularly in rural and remote communities with high levels of vulnerability to diseases.

Background Addressing the challenges of the health crisis requires collaboration by multiple sectors and stakeholders with a complementary role in a single platform that coordinates policy and programs relating to the health workforce for sustainability. Methods Information from purposefully selected stakeholders involved in human resources for health programs in two selected states of Nigeria was collected during a workshop attended by 60 participants drawn from government, multilateral agencies, the private sector, bilateral agencies, academia, professional associations, and regulatory bodies. Results Lessons learnt from Bauchi and Cross River states HRH platforms included successful joint planning and implementation human resources for health strategies that significantly mobilized resources and improved performance. Human resources for health coordination platforms with strong governance structures are sustainable. Conclusion The coordination platforms require governance structures for inter-sectoral coordination and collaboration. This enhances joint planning, implementation and monitoring of HRH activities.

Background The situation of frontline health workers in the rural areas of Bauchi and Cross River States has been classified as critical regarding the shortages due to attrition. This affects health service delivery and outcomes. Methods We targeted 402 participants, and 389 frontline health workers (nurses, midwives, nurse/midwives, community health officers and community health extension workers) responded. They were drawn from 42 public primary healthcare centers: 23 from Cross River and 19 from Bauchi States. Five focused-group discussions were conducted with 42 facilities in-charges to identify what they perceived as the main causes of attrition in the rural areas. Results Our findings indicate that the reasons that had potential to cause attrition of the frontline health workers were either voluntary or involuntary. Out of the 81 nurses in the study, 66 (81 percent) would voluntarily exit the workforce while 15 (19 percent) would leave involuntarily. From a total number of 81 nurses, midwives and nurse/midwives from the two states, 75% would exit due to resignations in search of better prospects in the urban areas. Ninety-nine percent of the community health worker’s attrition had very low intentions of exit, and it would mainly be due to retirements and deaths. Conclusion Implementation of tailor-made strategies that reflect their needs is imperative in the two states to reduce attrition among frontline health workers and improve health service outcomes.

Agricultural sector is still the leading sector in Nigeria's ailing economy as it provides direct employment to about 75% of the population. This paper examines gender involvement in agricultural production as a means towards increased food sufficiency and consequently curbing food crisis. It critically identified the specific gender involvement in agriculture and gender inequality is noticed in the sector and this constitutes a bottleneck to development, calling for a review of government policies on agriculture to all the elements that place women farmers at a disadvantage. The study made use of secondary data which was analyzed by simple descriptive statistics. The result revealed that involvement of both sexes in various field activities may be sex specific, but they are complimentary and reciprocal. The study further revealed that the involvement of women was on the increase (from 32 to 36%), while that of men declined relatively (from 68 to 64%). It was suggested that to curb food crisis and increase the participation of gender in agriculture, there is the need for advocacy for equitable integration of both men and women in agriculture.