BackgroundGetting research into policy and practice (GRIPP) is a process of going from research evidence to decisions and action. To integrate research findings into the policy making process and to communicate research findings to policymakers is a key challenge world-wide. This paper reports the experiences of a research group in a Nigerian university when seeking to ‘do’ GRIPP, and the important features and challenges of this process within the African context.MethodsIn-depth interviews were conducted with nine purposively selected policy makers in various organizations and six researchers from the universities and research institute in a Nigerian who had been involved in 15 selected joint studies/projects with Health Policy Research Group (HPRG). The interviews explored their understanding and experience of the methods and processes used by the HPRG to generate research questions and research results; their involvement in the process and whether the methods were perceived as effective in relation to influencing policy and practice and factors that influenced the uptake of research results.ResultsThe results are represented in a model with the four GRIPP strategies found: i) stakeholders’ request for evidence to support the use of certain strategies or to scale up health interventions; ii) policymakers and stakeholders seeking evidence from researchers; iii) involving stakeholders in designing research objectives and throughout the research process; and iv) facilitating policy maker-researcher engagement in finding best ways of using research findings to influence policy and practice and to actively disseminate research findings to relevant stakeholders and policymakers.The challenges to research utilization in health policy found were to address the capacity of policy makers to demand and to uptake research, the communication gap between researchers, donors and policymakers, the management of the political process of GRIPP, the lack of willingness of some policy makers to use research, the limited research funding and the resistance to change.ConclusionsCountry based Health Policy and Systems Research groups can influence domestic policy makers if appropriate strategies are employed. The model presented gives some direction to potential strategies for getting research into policy and practice in the health care sector in Nigeria and elsewhere.

BackgroundEffective female education on cervical cancer prevention has been shown to increase awareness and uptake of screening. However, sustaining increase in uptake poses a challenge to control efforts. Peer health education has been used as an effective tool for ensuring sustained behavior change. This study was undertaken to assess the effectiveness of peer health education on perception, willingness to screen and uptake of cervical cancer screening by women.MethodsA before and after intervention study was undertaken in 2 urban cities in Enugu state, Nigeria among women of reproductive age attending women’s meeting in Anglican churches. Multistage sampling was used to select 300 women. Peer health education was provided once monthly for 3 consecutive sessions over a period of 3 months. Data was collected at baseline and after the intervention using pre-tested questionnaires. Descriptive statistics and tests of significance of observed differences and associations were done at p-value of <0.05.ResultsStatistical significant difference was observed in participants’ individual risk perception for cervical cancer and perception of benefits of early detection through screening. Practice of screening for cervical cancer increased by 6.8% and the observed difference was statistically significant (p = 0.02). This was significantly associated with marital status, level of education, employment status and parity (p < 0.05).ConclusionPeer health education is an effective strategy for increasing women’s perception of benefits of early detection of cervical cancer through screening. It is also effective for increasing their practice of screening for cervical cancer.Electronic supplementary materialThe online version of this article (doi:10.1186/s12905-017-0399-6) contains supplementary material, which is available to authorized users.

West African countries are ranked especially low in global corruption perception indexes. The health sector is often singled out for particular concern given the role of corruption in hampering access to, and utilization of health services, representing a major barrier to progress to universal health coverage and to achieving the health-related Sustainable Development Goals. The first step in tackling corruption systematically is to understand its scale and nature. We present a systematic review of literature that explores corruption involving front-line healthcare providers, their managers and other stakeholders in health sectors in the five Anglophone West African (AWA) countries: Gambia, Ghana, Liberia, Nigeria and Sierra Leone, identifying motivators and drivers of corrupt practices and interventions that have been adopted or proposed. Boolean operators were adopted to optimize search outputs and identify relevant studies. Both grey and published literature were identified from Research Gate, Yahoo, Google Scholar, Google and PubMed, and reviewed and synthesized around key domains, with 61 publications meeting our inclusion criteria. The top five most prevalent/frequently reported corrupt practices were (1) absenteeism; (2) diversion of patients to private facilities; (3) inappropriate procurement; (4) informal payments; and (5) theft of drugs and supplies. Incentives for corrupt practices and other manifestations of corruption in the AWA health sector were also highlighted, while poor working conditions and low wages fuel malpractice. Primary research on anti-corruption strategies in health sectors in AWA remains scarce, with recommendations to curb corrupt practices often drawn from personal views and experience rather that of rigorous studies. We argue that a nuanced understanding of all types of corruption and their impacts is an important precondition to designing viable contextually appropriate anti-corruption strategies. It is a particular challenge to identify and tackle corruption in settings where formal rules are fluid or insufficiently enforced.

BackgroundAn effective continuum of maternal care ensures that mothers receive essential health packages from pre-pregnancy to delivery, and postnatally, reducing the risk of maternal death. However, across Africa, coverage of skilled birth attendance is lower than coverage for antenatal care, indicating mothers are not retained in the continuum between antenatal care and delivery. This paper explores predictors of retention of antenatal care clients in skilled birth attendance across Africa, including sociodemographic factors and quality of antenatal care received.MethodsWe pooled nationally representative data from Demographic and Health Surveys conducted in 28 African countries between 2006 and 2015. For the 115,374 births in our sample, we estimated logistic multilevel models of retention in skilled birth attendance (SBA) among clients that received skilled antenatal care (ANC).ResultsAmong ANC clients in the study sample, 66% received SBA. Adjusting for all demographic covariates and country indicators, the odds of retention in SBA were higher among ANC clients that had their blood pressure checked, received information about pregnancy complications, had blood tests conducted, received at least one tetanus injection, and had urine tests conducted.ConclusionsHigher quality of ANC predicts retention in SBA in Africa. Improving quality of skilled care received prenatally may increase client retention during delivery, reducing maternal mortality.

Background: Corruption is widespread in Nigeria’s health sector but the reasons why it exists and persists are poorly understood and it is often seen as intractable. We describe a consensus building exercise in which we asked health workers and policy-makers to identify and prioritise feasible responses to corruption in the Nigerian health sector. Methods: We employed three sequential activities. First, a narrative literature review identified which types of corruption are reported in the Nigerian health system. Second, we asked 21 frontline health workers to add to what was found in the review (based on their own experiences) and prioritise them, based on their significance and the feasibility of assessing them, by means of a consensus building exercise using a Nominal Group Technique (NGT). Third, we presented their assessments in a meeting of 25 policy-makers to offer their views on the practicality of implementing appropriate measures. Results: Participants identified 49 corrupt practices from the literature review and their own experience as most important in the Nigerian health system. The NGT prioritised: absenteeism, procurement-related corruption, underthe-counter payments, health financing-related corruption, and employment-related corruption. This largely reflected findings from the literature review, except for the greater emphasis on employment-related corruption from the NGT. Absenteeism, Informal payments and employment-related corruption were seen as most feasible to tackle. Frontline workers and policy-makers agreed that tackling corrupt practices requires a range of approaches. Conclusion: Corruption is recognized in Nigeria as widespread but often seems insurmountable. We show how a structured approach can achieve consensus among multiple stakeholders, a crucial first step in mobilizing action to address corruption.

Background: Parent-child communication is an effective tool for fostering healthy sexual and reproductive behaviours among adolescents. However, the topic is underexplored in Nigeria. This study examines how parents and caregivers communicate sexual and reproductive health-related matters with adolescents aged 13-18 years in Nigeria. Method: The study was undertaken in six communities in Ebonyi state, Nigeria using quantitative and qualitative research methods. Data were collected through, i) cluster randomized survey of 1057 adolescents aged 13-18 years, ii) twelve sex-disaggregated focus group discussions with adolescents aged 13 to 18 years, and iii) eight in-depth interviews with parents and caregivers. Univariate and bivariate analysis were performed for quantitative data, while qualitative data were analysed using thematic framework approach. Results: Less than half (47.9%) of adolescents in the survey reported ever discussing sex-related matters with anyone. Three-quarters of those who had this discussion did so with a friend/peer and this had significant correlation with sex/gender (p = 0.04). Out of 1057 adolescents who participated in the survey only 4.5% had ever discussed sex-related matters with a parent and this correlated significantly with wealth index (p = 0.003). Findings from qualitative interviews show that sex-related discussions between parents and adolescents are sporadic, mostly triggered by unpleasant occurrences, and consist of, i) information on pubertal changes, ii) warnings against intersex relationships and premarital sex, iii) promotion of abstinence, and iv) warnings against teenage pregnancy and unsafe abortion. Some parents were of the opinion that sex-related matters should not be discussed with adolescents because it could be interpreted as tolerance for sexual promiscuity. Overall, parents expressed that their capacity to discuss sex-related matters with adolescents is limited by lack of knowledge, and restrictive religious and cultural norms about adolescent sexuality. Conclusion: Communication between parents and adolescents on sexual health and reproductive-related matters rarely occurs. However, when it does, it mostly consists of strict warnings that may not protect adolescents from making unhealthy sexual and reproductive health choices. Interventions to improve parent-adolescent communication of sexual and reproductive health (SRH) should aim at improving parents' capacity to communicate sexual and reproductive health matters, and deconstructing sociocultural norms around adolescent sexuality.

Background Various attempts to examine health financing mechanisms in Nigeria highlight the fact that there is no single mechanism that fits all contexts and people. This paper sets out findings of an in-depth assessment of different health financing mechanisms in Nigeria. Methods The study was undertaken in the Federal Capital territory of Nigeria and two States (Niger and Kaduna). Data were collected through review of government documents, and in-depth interviews of purposively selected respondents. Data analysis was guided by a conceptual framework which draws from various approaches for assessing health financing mechanisms. Data was examined for current practices, what needs to change and how the change can happen. Results Health financing mechanisms in Nigeria do not operate optimally. Allocation and use of resources are neither evidence-based nor results-driven. Resources are not allocated equitably or in a manner that minimizes wastage and improves efficiency. None of the mechanisms effectively protects individuals/households from catastrophic health expenditure. Issues with social health insurance cut across legal frameworks and use of Health Maintenance Organisations (HMOs) as purchasers. The concomitant effect is that attainment of Universal Health Coverage is greatly compromised. In order to improve efficiency of health financing mechanisms, government needs to allocate more funds for purchasing health services; this spending must be based on evidence (strategic), and appropriately tracked. The legislation that established National Health Insurance Scheme should be amended such that social health insurance becomes mandatory for all citizens. Implementation of the latter should be complemented by revision of benefit package, strict oversight and regulation of HMOs. Conclusion In order to improve health financing in the country, legal and regulatory frameworks need to be revised. Efficient utilization of resources could be improved through strategic purchasing arrangements and strict oversight.

Background: High rate of teenage pregnancy in Nigeria is potentially an indication of poor access to and utilization of contraceptives among this age group. This paper presents findings from in-depth exploration of perceived barriers to utilization of contraceptive services by adolescents. Methods: A qualitative study was conducted in six communities in Ebonyi state, southeast Nigeria. Eighty-one in-depth interviews and six focus group discussions were conducted. Respondents comprised policy makers, community leaders, health service providers and parents of adolescents. Pre-tested interview guides were used to collect information on perceived barriers to utilization of contraceptive services by adolescents. All interviews were audio recorded and transcribed in English. Data was analysed using thematic framework approach, and the socio-ecological model was adapted for data synthesis. Results: Individual level factors that limit access to contraceptives for adolescents include lack of awareness and poor knowledge, fear of side effects, low self-esteem, and inability to afford cost of services. Interpersonal (family-related) barriers to access include poor parent-child communication of sexual and reproductive health matters and negative attitude of parents towards to sexuality education for adolescents. Health systems barriers to accessing contraceptives for adolescents include lack of privacy and confidentiality, stock-out of contraceptive commodities, judgmental attitude of health workers, insufficient staff that are skilled in adolescent sexual and reproductive health. Gendered cultural norms, societal shaming and religious intolerance also preclude adolescents from accessing and using contraceptive services. Wider societal factors such as negative peer and media influence, absence of sexuality education in schools, lack of social networks in communities; and macro level factors such as poor economic conditions were also perceived to limit access to contraceptives for adolescents.