How ready is the system to deliver primary healthcare? Results of a primary health facility assessment in Enugu State, Nigeria

Ekenna, Adanma Chidinma; Itanyi, Ijeoma Uchenna; Nwokoro, Ugochukwu Uzoechina; Hirschhorn, Lisa R.; Uzochukwu, Benjamin

doi:10.1093/heapol/czaa108

Cited by 29 publications

(36 citation statements)

References 27 publications

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“…We found that, a number of higher-level facilities had an ambulance or other vehicle available. This is however different from what Ekenna et al [ 49 ] reported in Nigeria. In their study, none of the facilities surveyed had a functional ambulance.…”

Section: Discussioncontrasting

confidence: 97%

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Sub-national variations in general service readiness of primary health care facilities in Ghana: Health policy and equity implications towards the attainment of Universal Health Coverage

et al. 2022

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Background Service availability and readiness are critical for the delivery of quality and essential health care services. In Ghana, there is paucity of literature that describes general service readiness (GSR) of primary health care (PHC) facilities within the national context. This study therefore assessed the GSR of PHC facilities in Ghana to provide evidence to inform heath policy and drive action towards reducing health inequities. Methods We analysed data from 140 Service Delivery Points (SDPs) that were part of the Performance Monitoring and Accountability 2020 survey (PMA2020). GSR was computed using the Service Availability and Readiness Assessment (SARA) manual based on four out of five components. Descriptive statistics were computed for both continuous and categorical variables. A multivariable binary logistic regression model was fitted to assess predictors of scoring above the mean GSR. Analyses were performed using Stata version 16.0. Significance level was set at p<0.05. Results The average GSR index of SDPs in this study was 83.4%. Specifically, the mean GSR of hospitals was 92.8%, whereas health centres/clinics and CHPS compounds scored 78.0% and 64.3% respectively. The least average scores were observed in the essential medicines and standard precautions for infection prevention categories. We found significant sub-national, urban-rural and facility-related disparities in GSR. Compared to the Greater Accra Region, SDPs in the Eastern, Western, Upper East and Upper West Regions had significantly reduced odds of scoring above the overall GSR. Majority of SDPs with GSR below the average were from rural areas. Conclusion Overall, GSR among SDPs is appreciable as compared to other settings. The study highlights the existence of regional, urban-rural and facility-related differences in GSR of SDPs. The reality of health inequities has crucial policy implications which need to be addressed urgently to fast-track progress towards the achievement of the SDGs and UHC targets by 2030.

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Section: Discussioncontrasting

confidence: 97%

“…Although health centres and clinics had an average GSR of 78.0%, this is relatively higher than what was reported in Mongolia [ 45 ] and this indicates good service readiness. Variations in service readiness of different facilities have also been reported in Nigeria [ 46 , 49 ].…”

Section: Discussionmentioning

confidence: 99%

Sub-national variations in general service readiness of primary health care facilities in Ghana: Health policy and equity implications towards the attainment of Universal Health Coverage

et al. 2022

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“…The current study, for instance, found that the availability of equipment for NCD interventions was generally good, and this should be viewed as a positive step forward. In Consistent with our current ndings, previous studies have also shown disparities in the availability of health care resources for the prevention and control of NCDs between levels of care, types of facilities, and their rural-urban locations [1,24,27]. These current ndings are important in that they further highlight that where NCDs health services are needed most by the populations (that is, at primary care, public and rural facilities), they are not always readily available in these settings.…”

Section: Discussionsupporting

confidence: 92%

Readiness Of Health Facilities To Deliver Non-Communicable Diseases Services In Kenya: A National Cross-Sectional Survey

Wami

Ammoun

Otieno

et al. 2022

Preprint

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Background: Non-communicable diseases (NCDs) account for an estimated 71% of all global deaths annually and nearly 80% of these deaths occur in low- and middle-income countries. This study aimed to assess the readiness of existing healthcare systems at different levels of care in delivering NCDs management and prevention services in Kenya.Methods: A cross-sectional survey of 258 facilities was conducted between June 2019 and December 2020 using multistage sampling, examining facility readiness based on the availability of indicators such as equipment, diagnostic capacity, medicines and commodities, trained staff and guidelines for NCDs management. Readiness scores were calculated as the mean availability of tracer items expressed as a percentage and a cut-off threshold of ≥70% was used to classify facilities as “ready” to manage NCDs. Descriptive and bivariate analyses were performed to assess the readiness of facilities by type, level, and location settings. Logistic regressions were used to identify factors associated with the readiness of facilities to provide disease-specific services. Results: Of the surveyed facilities, 94% offered chronic respiratory disease (CRD) diagnosis and/or management services, 82% diabetes, 65% cardiovascular disease (CVD), and only 24% cervical cancer screening services. The mean readiness scores for diabetes (74%; 95% CI: 70-77) and CVD (69%; 95% CI: 66-72) were relatively high. Although CRD services were reportedly the most widely available, its mean readiness score was low (48%; 95% CI: 45-50). The majority of facilities offering cervical cancer services had all the necessary tracer items available to provide these services. Modeling results revealed that private facilities were more likely to be “ready” to offer NCDs services than public facilities. Similarly, hospitals were more “ready” to provide NCDs services compared to primary health facilities. These disparities in service readiness extended to the regional and urban/rural divide.Conclusions: Important gaps in the current readiness of facilities to manage NCDs in Kenya at different levels of care were revealed, showing variations by disease and healthcare facility type. A collective approach is therefore needed to bridge the gap between resource availability and population healthcare needs.

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“…It remains unclear how ready the health systems are to deliver quality CLD care in these settings. Several studies have examined the state of preparedness of health systems in LMICs to deliver general health services, specific disease services or primary health care in the context of universal health coverage [19][20][21][22]. Studies investigating preparedness for CLD services are however rare.…”

Section: Introductionmentioning

confidence: 99%

Management of chronic lung diseases in Sudan and Tanzania: how ready are the country health systems?

Egere

Shayo

Ntinginya³

et al. 2021

BMC Health Serv Res

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Background Chronic lung diseases (CLDs), responsible for 4 million deaths globally every year, are increasingly important in low- and middle-income countries where most of the global mortality due to CLDs currently occurs. As existing health systems in resource-poor contexts, especially sub-Saharan Africa (SSA), are not generally oriented to provide quality care for chronic diseases, a first step in re-imagining them is to critically consider readiness for service delivery across all aspects of the existing system. Methods We conducted a mixed-methods assessment of CLD service readiness in 18 purposively selected health facilities in two differing SSA health system contexts, Tanzania and Sudan. We used the World Health Organization’s (WHO) Service Availability and Readiness Assessment checklist, qualitative interviews of key health system stakeholders, health facility registers review and assessed clinicians’ capacity to manage CLD using patient vignettes. CLD service readiness was scored as a composite of availability of service-specific tracer items from the WHO service availability checklist in three domains: staff training and guidelines, diagnostics and equipment, and basic medicines. Qualitative data were analysed using the same domains. Results One health facility in Tanzania and five in Sudan, attained a CLD readiness score of ≥ 50 % for CLD care. Scores ranged from 14.9 % in a dispensary to 53.3 % in a health center in Tanzania, and from 36.4 to 86.4 % in Sudan. The least available tracer items across both countries were trained human resources and guidelines, and peak flow meters. Only two facilities had COPD guidelines. Patient vignette analysis revealed significant gaps in clinicians’ capacity to manage CLD. Key informants identified low prioritization as key barrier to CLD care. Conclusions Gaps in service availability and readiness for CLD care in Tanzania and Sudan threaten attainment of universal health coverage in these settings. Detailed assessments by health systems researchers in discussion with stakeholders at all levels of the health system can identify critical blockages to reimagining CLD service provision with people-centered, integrated approaches at its heart.

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How ready is the system to deliver primary healthcare? Results of a primary health facility assessment in Enugu State, Nigeria

Cited by 29 publications

References 27 publications

Sub-national variations in general service readiness of primary health care facilities in Ghana: Health policy and equity implications towards the attainment of Universal Health Coverage

Sub-national variations in general service readiness of primary health care facilities in Ghana: Health policy and equity implications towards the attainment of Universal Health Coverage

Readiness Of Health Facilities To Deliver Non-Communicable Diseases Services In Kenya: A National Cross-Sectional Survey

Management of chronic lung diseases in Sudan and Tanzania: how ready are the country health systems?

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