The distribution of health facilities across Nigeria is nonuniform. As such, a UHC strategy must be responsive to the variation in health facility distribution across the country. Additional investments are needed in some parts of the country to improve access to tertiary health facilities and leverage private sector capacity.

Background.Health-care systems based on primary health care (PHC) are more equitable and cost effective. Family medicine trains medical doctors in comprehensive PHC with knowledge and skills that are needed to increase quality of care. Family medicine is a relatively new specialty in sub-Saharan Africa.Objective.To explore the extent to which the Primafamed South–South cooperative project contributed to the development of family medicine in sub-Saharan Africa.Methods.The Primafamed (Primary Health Care and Family Medicine Education) project worked together with 10 partner universities in sub-Saharan Africa to develop family medicine training programmes over a period of 2.5 years. A SWOT (strengths, weaknesses, opportunities and threats) analysis was done and the training development from 2008 to 2010 in the different partner universities was analysed.Results.During the 2.5 years of the Primafamed project, all partner universities made progress in the development of their family medicine training programmes. The SWOT analysis showed that at both national and international levels, the time is ripe to train medical doctors in family medicine and to integrate the specialty into health-care systems, although many barriers, including little awareness, lack of funding, low support from other specialists and reserved support from policymakers, are still present.Conclusions.Family medicine can play an important role in health-care systems in sub-Saharan Africa; however, developing a new discipline is challenging. Advocacy, local ownership, action research and support from governments are necessary to develop family medicine and increase its impact. The Primafamed project showed that development of sustainable family medicine training programmes is a feasible but slow process. The South–South cooperation between the ten partners and the South African departments of family medicine strengthened confidence at both national and international levels.

IntroductionObesity is a global epidemic. There are rising rates of obesity and its associated disorders, especially in developing countries, including among Health Service Providers (HSPs). Obesity is associated with early retirement, increased morbidity and mortality. Thus, obesity has the potential of reducing long-term retention of HSPs in inadequately staffed health systems of developing countries. This study aimed to determine the magnitude of and factors associated with obesity among HSPs of a tertiary health care facility in Lagos, Nigeria.MethodsA cross sectional study was carried out with a questionnaire, which included the International Physical Activity Questionnaire short form (IPAQ-SF). Obesity was defined as BMI ≥30kg/m2. Statistical significance was set at p < 0.05.Results300 HSPs were recruited, of which 47.7% were medical doctors and dentists, 43.3% were nurses and other categories of HSPs. The mean age and BMI of the HSPs were 39.3(9.0) years and 27.7(4.6) kg/m2 respectively. Eight two (27.3%) HSPs were obese and 134 (44.7%) were overweight, 149(49.7%) had central obesity. After adjusting for confounding variables using multivariate logistic regression, age > 40 years (OR 3.51, p=0.003), female gender (OR 2.84, p=0.007) and earning a monthly salary of ≤ 200,000 naira relative to 201,000-400,000 naira (OR 2.58, p=0.006) were significantly associated with obesity.ConclusionObesity was prevalent among these Nigerian HSPs. This calls for concern, especially with the implication of loosing health workers to obesity related disorders and early retirement.

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Objective: A high mortality rate is associated with anesthesia in low and middle income countries. The provision of basic and emergency surgical services in developing countries includes safe anesthetic care. We sought to determine the resources available to deliver anesthesia care in low and middle income countries. Methods:A standard World Health Organization tool was used to collect data from 34 Low and Middle-Income Countries (LMICs) regarding infrastructure and capacity of facilities. We then performed a database query to extract information on anesthesia-related capacity.Findings: Twelve countries were excluded for providing data on less than four facilities, leaving 22 countries in our results, with a total of 590 facilities surveyed. Thirty five percent of hospitals had no access to oxygen and 40% had no anaesthesia machines; despite this, 58.5% of hospitals offered general inhalational anesthesia. All facilities reported presence of an anaesthesia provider: a nurse or clinical assistant was present in all 590 facilities. Hospitals with > 200 beds reported a range of 2-10 providers; the average number of anesthesia physicians increased from one to four as the hospital size increased from less than to greater than 300 beds. The majority of facilities were district/rural/community hospitals (34.7%), followed by health centres (23.2%), private/NGO/missions hospitals (16.6%), provincial hospitals (11.7%), and general hospitals (13.1%). Conclusion:The delivery of anesthesia is limited by deficiencies in human resources, equipment availability and system capacity in many low and middle income countries.

BackgroundIn optimising the health of individuals, families and communities, attention should be focused on the clinical processes at medical facilities based in the community. Networks of general and family practices offer this unique opportunity. In establishing the burden of diseases in a community, the traditional classification used is the International Classification of Diseases. This study uses the International Classification of Primary Care. The aim of the study was to document the pattern of illnesses presenting in general/family physician practices in a city in Nigeria.MethodA nine-item interviewer-administered questionnaire containing closed-ended questions was administered to 881 patients presenting at 67 private general/family practice clinics/hospitals in 15 local government areas of urban Lagos by trained general practitioners, using the ICPC-2 pager, which asks for socio-demographic information, reasons for the presentation, and the provisional diagnosis within a 24-hour period.ResultsChildren younger than five years accounted for 20.4% of those presenting, while 25- to 39-year-olds accounted for 44.4%. Geriatric patients (60 years and older) comprised 3.0%. Social classes 1 to 4 accounted for 36.8% of the patients, while social classes 5 to 8 accounted for 43.2%. Of all the patients, 18.7% earned less than 1 US$/day. The seven topmost reasons for visiting the medical practice/clinic/hospital were: General and unspecified 23.1%; pregnancy, child bearing and family planning 13.9%; respiratory problems 10.9%; problems related to the digestive system 9.6%; musculoskeletal 5.6%; Skin 4.4%; and neurological problems 4.2%.ConclusionThe skills of general/family practitioners in West Africa and on the rest of the continent should concentrate on general and unspecified illnesses, routine and emergency maternal and child care, and problems related to the respiratory, digestive, musculoskeletal, skin and neurological systems.

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