Getting to FP2020: Harnessing the private sector to increase modern contraceptive access and choice in Ethiopia, Nigeria, and DRC. Riley C, Garfinkel D, Thanel K, et al. Getting to FP2020: Harnessing the private sector to increase modern contraceptive access and choice in Ethiopia, Nigeria, and DRC. PLoS One. 2018;13(2):e0192522. Published 2018 Feb 14.
ABSTRACT: An estimated 214 million women have unmet need for family planning in developing regions. Improved utilization of the private sector is key to achieving universal access to a range of safe and effective modern contraceptive methods stipulated by FP2020 and SDG commitments. Until now, a lack of market data has limited understanding of the private sector’s role in increasing contraceptive coverage and choice.
Methods: In 2015, the FPwatch Project conducted representative outlet surveys in Ethiopia, Nigeria, and DRC using a full census approach in selected administrative areas. Every public and private sector outlet with the potential to sell or distribute modern contraceptives was approached. In outlets with modern contraceptives, product audits and provider interviews assessed contraceptive market composition, availability, and price.
Findings: Excluding general retailers, 96% of potential outlets in Ethiopia, 55% in Nigeria, and 41% in DRC had modern contraceptive methods available. In Ethiopia, 41% of modern contraceptive stocking outlets were in the private sector compared with approximately 80% in Nigeria and DRC where drug shops were dominant. Ninety-five percent of private sector outlets in Ethiopia had modern contraceptive methods available; 37% had three or more methods. In Nigeria and DRC, only 54% and 42% of private sector outlets stocked modern contraceptives with 5% and 4% stocking three or more methods, respectively. High prices in Nigeria and DRC create barriers to consumer access and choice.
Discussion: There is a missed opportunity to provide modern contraception through the private sector, particularly drug shops. Subsidies and interventions, like social marketing and social franchising, could leverage the private sector’s role in increasing access to a range of contraceptives. Achieving global FP2020 commitments depends on the expansion of national contraceptive policies that promote greater partnership and cooperation with the private sector and improvement of decisions around funding streams of countries with large populations and high unmet need like Ethiopia, Nigeria, and DRC.
Misuse of Artemisinin Combination Therapies by Clients of Medicine Retailers Suspected to Have Malaria Without Prior Parasitological Confirmation in Nigeria. Nwokolo E, Ujuju C, Anyanti J, et al. Misuse of Artemisinin Combination Therapies by Clients of Medicine Retailers Suspected to Have Malaria Without Prior Parasitological Confirmation in Nigeria. Int J Health Policy Manag. 2018;7(6):542-548. Published 2018 Jun 1
ABSTRACT: Prompt and effective case detection and treatment are vital components of the malaria case management strategy as malaria-endemic countries implement the testing, treating and tracking policy. The implementation of this policy in public and formal private sectors continue to receive great attention while the informal private retail sector (mostly the patent and propriety medicine vendors [PPMVs]) where about 60% of patients with fever in Nigeria seek treatment is yet to be fully integrated. The PPMVs sell artemisinin combination therapies (ACTs) without prior testing and are highly patronized. Without prior testing, malaria is likely to be over-treated. The need to expand access to diagnosis in the huge informal private health sector among PPMVs is currently being explored to ensure that clients that patronize retail drug stores are tested before sales of ACTs.
Emergency transport for obstetric emergencies: integrating community-level demand creation activities for improved access to maternal, newborn, and child health services in northern Nigeria. Oguntunde O, Yusuf FM, Nyenwa J, Dauda DS, Salihu A, Sinai I. Emergency transport for obstetric emergencies: integrating community-level demand creation activities for improved access to maternal, newborn, and child health services in northern Nigeria. Int J Womens Health. 2018;10:773-782. Published 2018 Nov 28.
ABSTRACT: Ensuring adequate access to skilled birth attendants during and after childbirth is a key strategy to reducing maternal and newborn mortalities. Transportation difficulties in emergency situations continue to be a significant barrier to accessing emergency obstetric care, especially in rural and hard-to-reach areas. Emergency transport schemes (ETS) have been introduced in various settings to increase access to emergency care and reduce the second obstetric delay with varying degrees of success. This qualitative study assessed the perceptions of stakeholders and beneficiaries of ETS in two states in northern Nigeria, comparing two models of ETS: one in which the ETS were introduced as a stand-alone intervention, and another in which ETS were part of a package of interventions for increasing demand and improving utilization of maternal and newborn health services.
Methods: We carried out focus group discussions with ETS drivers, mothers who delivered in the past year and utilized ETS, husbands of women who benefited from the schemes in the past year, health care providers, traditional birth attendants, and religious leaders, supplemented by in-depth interviews with program focal persons.
Results: Demand creation activities – especially working with traditional birth attendants and religious leaders – provided a strong linkage between the ETS and families of women in need of emergency transport services. Community members perceived the ETS model that included demand-generating activities as being more reliable and responsive to women’s needs.
Conclusion: ETS remain a key solution to lack of transport as a barrier to utilizing maternal and newborn health services in emergency situations in many rural and hard-to-reach communities. Programs utilizing ETS to improve access to emergency obstetric care should explore the potential of increasing their utility and reach by integrating the schemes with additional demand-side interventions, especially engagement with traditional birth attendants and religious leaders.
Overcoming barriers to access and utilization of maternal, newborn and child health services in northern Nigeria: an evaluation of facility health committees. Oguntunde O, Surajo IM, Dauda DS, Salihu A, Anas-Kolo S, Sinai I. Overcoming barriers to access and utilization of maternal, newborn and child health services in northern Nigeria: an evaluation of facility health committees. BMC Health Serv Res. 2018;18(1):104. Published 2018 Feb 9.
ABSTRACT: Poor quality of health services and socio-cultural dynamics may severely limit utilization of health services. Facility health committees were established in several states in northern Nigeria to reduce these barriers. The committees were charged with mobilizing communities, improving quality of health services, and promoting utilization of maternal and child health services. This study assessed this intervention.
Methods: To obtain a comprehensive picture of facility health committees’ influence on maternal and child health services, we selected 33 facilities in three states in northern Nigeria (Jigawa, Kaduna, Kano) where the intervention was active. For each of these facilities we interviewed committee members (n = 399), conducted focus group discussions with a subset of committee members (18 focus groups), interviewed facility health providers (two providers from each facility), and conducted client exit interviews (n = 501).
Results: Facility health committees appear to have a positive influence on quality of maternal and child health services in the selected facilities. Committee members, health providers, and facility clients all agree that the committees have a tangible positive effect. The most important roles of the committees are to mobilize the community and increase demand for maternal and child health services, in a region where demand is very low. Committee activities further improve health services in many ways, including advocacy, community-facility coordination, fund raising, money donation, and problem mitigation.
Conclusion: Facility health committees can be invaluable in contributing to improved demand for and access to quality maternal and child health services in health facilities in northern Nigeria. They provide strong linkages between community members and the health facilities, directly work to increase demand for services, and address supply-side challenges that often limit utilization of services in health facilities. The intervention can be improved by more broadly communicating committee activities in the community, and by incentivizing facility health committee members.
Assessment of antiretroviral therapy outcomes among key population after 6months of initiation in Nigeria. ER Ugbena, I Stella, I Okekearu, W Fagbemisin. (2018).
ABSTRACT : Key Populations Are Disproportionately Affected By HIV/AIDS In All Settings. Unfortunately, Reaching KPs With HIV Intervention Is A Huge Challenge Because Of Stigma, Discrimination, Violence, And Criminalization Of KPs Lifestyles. Because Of Lack Of KP Specific Interventions, Data On KPs ART Outcomes Is Lacking. This Study Determined ART Outcomes Among KPs 6-Months After Initiation.
Methodology: The Study Was A Longitudinal Study Of All HIV Positive KPs Initiated On ART In 7 One-Stop-Shops From October 2016-March 2017. Both Time-1 And Time-2 Data Were Abstracted From Facility Record After Initiation And 6-Month After For Each Patient. Data Abstracted Include: Age, Sex, Marital Status, Educational Level, Employment Status And ART Outcome 6 Months After Initiation.
Results: Sixty-Seven Percent Of Patients Were Retained On ART, 1.8% Died, 20.6% Were Lost To Follow Up, 4.5% Transferred To Other Facilities And 6.2% Stopped ART By The End Of The 6th Month. PWID Had Highest Retention Rate (74.6%) More Than MSM (70.2%), While FSW Had The Least Retention Rate (65.4%) But Highest Transfer Out Rate (4.9%) More Than MSM (4.7%). Factors Positively Associated With Retention At 6th Months Include: Being A Male P=0.007; Higher Education P=0.000; Employed Patient P=0.000; Living With Sex Partner P=0.000.
Conclusion: This Study Has Laid A Baseline Data For ART Outcomes Among KPs In Nigeria. Further Study Is However Required To Identify Factors That Could Improve Retention On ART Among KPs. This Is Important If We Must Achieve The Second And Third 90s Of UNAIDs 90.90.90 Goals.