The organisation of primary health care service delivery for non-communicable diseases in Nigeria: A case-study analysis

Abstract

As chronic diseases, non-communicable diseases (NCDs) require sustained person-centred and community-based care. Given its direct link to communities and households, Primary Health Care (PHC) is well positioned to achieve such care. In Nigeria, the national government has prioritized PHC system strengthening as a means of achieving national NCD targets. However, strengthening PHC systems for NCDs require re-organization of PHC service delivery, based on contextual understanding of existing facilitators and barriers to PHC service delivery for NCDs. We conducted a mixed method case study to explore NCD service delivery with 13 PHC facilities serving as the cases of interest. The study was conducted in two northern and two southern states in Nigeria–and included qualitative interviews with 25 participants, 13 focus group discussion among 107 participants and direct observation at the 13 PHCs. We found that interprofessional role conflict among healthcare workers, perverse incentives to sustain the functioning of PHC facilities in the face of government under-investment, and the perception of PHC as an inferior health system were major barriers to improved organisation of NCD management. Conversely, the presence of physicians at PHC facilities and involvement of civil society organizations in aiding community linkage were key enablers. These marked differences in performance and capacity between PHC facilities in northern compared to southern states, with those in the south better organised to deliver NCD services. PHC reforms that are tailored to the socio-political and economic variations across Nigeria are needed to improve capacity to address NCDs.

“We just have to help”: Community health workers' informal task-shifting and task-sharing practices for hypertension and diabetes care in Nigeria

“…As seen in this study and others, non-adherence to referral guidelines was common practice among CHWs ( 54 , 55 ). It is therefore important to implement more effective mechanisms to support adherence to referral guidelines including supportive supervision and continuous CHW training ( 56 ). Although these findings are limited to NCDs (in particular hypertension and diabetes management), they are likely to be relevant to other areas of CHW practice.…”

It is not all about salary: a discrete-choice experiment to determine community health workers’ motivation for work in Nigeria

“…The data were thematically analysed using NVivo software. 35 Attributes for the DCE were informed by themes that emerged from the qualitative data. From these, seven candidate attributes were developed and subsequently presented to stakeholders to validate the relevance and importance of the attributes and their levels.…”

“…This was part of a larger study that assessed CHWs’ practices, and barriers and enablers of organizational structure within which they deliver services. The data were thematically analysed using NVivo software 35. Attributes for the DCE were informed by themes that emerged from the qualitative data.…”

Experiences of Communities with Lebanon's Model of Care for Non-Communicable Diseases (NCD): A Cross-Sectional Household Survey from Greater Beirut

“…7,8 Second, for countries which are undergoing substantive socio-political unrest, but also economic challenges, NCD service delivery may be particularly needed but costly to set up. 9 For example, skilling up existing health workers with limited NCD experience, 10 investing in the continued supply and maintenance of medical devices and medications needed for diagnosis and disease management, 11 as well as adapting existing, or creating new, health management and information systems 12 require relatively high up-front costs, despite likely cost-effectiveness of such interventions. 13 Across all these situations, successful implementation of a person-centred comprehensive and continuous care model is particularly difficult.…”