Conceptualizing and implementing a health workforce registry in Nigeria

Background Nigeria’s health sector aims to ensure that the right number of health workers that are qualified, skilled, and distributed equitably, are available for quality health service provision at all levels. Achieving this requires accurate and timely health workforce information. This informed the development of the Nigeria Health Workforce Registry (NHWR) based on the global, regional, and national strategies for strengthening the HRH towards achieving universal health coverage. This case study describes the process of conceptualizing and establishing the NHWR, and discusses the strategies for developing sustainable and scalable health workforce registries. Case presentation In designing the NHWR, a review of existing national HRH policies and guidelines, as well as reports of previous endeavors was done to learn what had been done previously and obtain the views of stakeholders on how to develop a scalable and sustainable registry. The findings indicated the need to review the architecture of the registry to align with other health information systems, develop a standardized data set and guidance documents for the registry including a standard operating procedure to ensure that a holistic process is adopted in data collection, management and use nationally. Learning from the findings, a conceptual framework was developed, a registry managed centrally by the Federal Ministry of Health was developed and decentralized, a standardized tool based on a national minimum data was developed and adopted nationally, a registry prototype was developed using iHRIS Manage and the registry governance functions were integrated into the health information system governance structures. To sustain the functionality of the NHWR, the handbook of the NHWR that comprised of an implementation guide, the standard operating procedure, and the basic user training manual was developed and the capacity of government staff was built on the operations of the registry. Conclusion In establishing a functional and sustainable registry, learning from experiences is essential in shaping acceptable, sustainable, and scalable approaches. Instituting governance structures that include and involve policymakers, health managers and users is of great importance in the design, planning, implementation, and decentralization stages. In addition, developing standardized tools based on the health system's needs and instituting supportable mechanisms for data flow and use for policy, planning, development, and management is essential.

Quality of life and challenges experienced by the surviving adults with transfusion dependent thalassaemia in Malaysia: a cross sectional study

Background Improvement in medical management has enabled transfusion dependent thalassaemia (TDT) patients to survive beyond childhood, building families, and contributing to the labour force and society. Knowledge about their adult life would provide guidance on how to support their needs. This study aims to explore the general well-being of adults with TDT, their employment status and challenges. Methods This study recruited 450 people with TDT, aged 18 and above, of both genders through all regional Thalassaemia societies in Malaysia and from the two participating hospitals, over five months in year 2016. A self-administered questionnaire including ‘Healthy Days Core Module’, WHOQOL-BREF and employment measurements was used. Multiple linear regression models were fitted with associations adjusted for several potential confounders. Results A total of 196 adults with TDT responded to the survey (43.6% response rate). Almost half (45%) had comorbidities and 9% suffered multiple complications: bone-related (13%), hormonal (12%), cardiac (3%) and infections (2%), resulting in 23% seeking treatment more than twice monthly. Within a month, they suffered from at least three days with poor physical and or mental health and their normal daily activities were disrupted up to three days. 36% were jobless and 38% of those with a job were receiving salaries below RM1000. The mean WHOQOL-BREF score (mean (SD)) was: physical health 62.6 (15.5), psychological health 64.7 (15.7), social relationship 64 (15.9), environmental health 60.8 (16.7). Having days with mental issues, financial status, education level, ethnic and marital status were main factors affecting QOL scores. Open questions showed dissatisfaction with health service provision, conflicting judgement in prioritising between health and job, and poor public empathy. Conclusion The adults with TDT perceived their health as good and had less unhealthy days when compared with people with other chronic diseases. However, some perceived themselves to be facing more life disruption in a rather non-supportive community and that health services do not meet their needs. Future qualitative studies are needed to focus on their perceived needs and to look for more tailored supportive approaches.

Non-use of modern contraceptives among women in humanitarian contexts: evidence from a qualitative study in Akwa Ibom State, Nigeria

The continuing conflict situation in Nigeria have created over 2 million displaced persons. In 2019, women and children accounted for about 80% of the internally displaced population in the country. Displacement increases the need for reproductive health services. This study explored the reasons for non-use of modern contraceptives among forcibly displaced Bakassi women in Akwa Ibom State, southern Nigeria. Focus group discussions were used to collect data from a convenience sample of 40 women of reproductive age (15–49 years) in two makeshift resettlement camps in the region in January and February 2020. Data were analysed using a qualitative inductive approach, with thematic organization and analysis of the transcribed responses from the focus group discussions. The findings revealed that many of the women were not using modern contraceptives at the time of the study, and the major reasons they gave for non-use were misconceptions, costs, religious beliefs, desire for more children and the inaccessibility and unavailability of contraceptive services. The use of family planning services can be a life-saving intervention in unstable, crisis environments. Programme implementation to address non-use of contraceptive services among women in crisis contexts should target social norm change, reproductive health education, empowerment programmes and health service provision.

COVID and Counseling

Due to the COVID-19 crisis, the mental health profession has shifted to online service provision, or telehealth. The aim of this chapter is to describe the COVID-19 crisis and subsequent changes that occurred to mental health service provision; the benefits and drawbacks to telehealth from practical, ethical, and cultural perspectives; and the learning opportunities that have come from this crisis. Finally, reflections on the future of the counseling profession and trends in service provision for serving an increasingly diverse population will be analyzed.

Towards Implementation of Context-specific Integrated District Mental Health Care Plans: A Situation Analysis of Mental Health Services in Five Districts in Ghana

Background: Access to quality mental health services in Ghana remains poor, yet little is known about the extent of integrated mental health service provision in districts in Ghana. The purpose of the study was to conduct a situation analysis of integrated mental health service provision in five districts, to inform the development and implementation of tailored district mental healthcare plans in Ghana. Methods: A cross-sectional situation analysis was conducted using a standardised tool to collect secondary routine healthcare data supplemented with interviews with key informants across five purposively selected districts in Ghana. The PRIME (Programme for Improving Mental health care) situation analysis tool was adapted to the Ghanaian context and used for data collection. Results: The districts are predominantly rural; more than eight out of ten people in each selected districts live in rural areas. Mental Neurological and Substance use (MNS) conditions were not routinely reported in the top 10 causes of OPD attendance. Across all districts there are severe challenges with the provision of mental health care, primarily because of the slow enforcement of the mental health Act 2012 (Act 846). There are no mental health care plans, supervision of the few mental health professionals is weak and unstructured, access to regular supply of psychotropic medications is a major challenge, and psychological treatments are extremely limited given the lack of trained clinical psychologists. Data on treatment coverage was unavailable but we estimate this to be <0.5% for depression, schizophrenia, and epilepsy across districts. Nonetheless, opportunities for mental health systems strengthening were noted. These included commitment and willingness of leadership, the existence of a district health information management system, well-established network of community volunteers and some collaboration with traditional and faith-based mental health service providers. Conclusion: The baseline data from this situation analysis confirms the widely reported poor mental health infrastructure across Ghana and other Low and Middle-Income Countries. There are opportunities for strengthening mental health systems through interventions at the organisation/policy level, health facility, and community levels. A standardised situation analysis tool is useful to inform district level mental health care planning in low resource settings in Ghana and potentially other sub-Saharan African countries.

Trialogue Meetings: Engaging Citizens and Fostering Communities of Wellbeing Through Collective Dialogue

Community-based participatory approaches are widely recognized as valuable methods for improving mental health and well-being by enabling a greater sense of liberty among participants, through the development of equitable policies and practices, which accommodate a range of diverse perspectives. One such approach, “Trialogue Meetings,” has been found to encourage disclosure and dialogue surrounding mental health, facilitate the growth and development of communities in relation to people’s experience of mental health difficulties, service provider and community response. Emerging in the 1990s because of perceived and felt inequitable relations between people with lived experience of mental health difficulties, family members of people with mental health difficulties and professionals providing mental health service provision. This approach has been shown to successfully reduce stigma and discrimination and improve relations between stakeholders in community and mental health care settings. Trialogue Meetings incorporate Open Dialogue methods to allow multiple stakeholder groups to participate in conversations around a given topic and enable the creation of a common language and mutual understanding. Trialogue Meetings have added benefits of allowing individuals to express themselves better, gain a sense of relationality and community with others and address predetermined power hierarchies with prescribed responses to people’s experiences. In this perspective, we present an outline for Trialogue Meetings as a medium for enhancing wellbeing, providing a transformative empowering process for deliberate discursive practice and engaging citizens through sustained collective dialogue.

Examining Access to Psychiatric Care in Michigan’s Upper Peninsula

Introduction: There is a shortage of mental health services in rural America, and little research is focused on rural underserved communities. Our aim was to identify and map clinical mental health services located in the Upper Peninsula of Michigan (UP) and explore primary care physician (PCP) mental health service provision and barriers to access experienced by this population. Methods: We mapped clinically active psychiatrists and inpatient psychiatric units in the UP, and identified high-risk regions based on &gt;30 mile distance to ambulatory services or low inpatient bed to population ratio. We surveyed PCPs in identified high-risk areas regarding provision of mental health services, comfort with providing services, and perceived barriers to care. Results: Half of UP counties had no psychiatrists, and only two counties had inpatient psychiatric beds. PCPs are attempting to fill gaps in care, and report comfort with treating depression and anxiety, but less comfort with treating with bipolar disorder and substance use. Nearly all PCPs report barriers to accessing mental health resources; 70% report no psychiatrists to whom they can readily refer. Conclusion: Michigan’s UP has a shortage of mental health resources. Proposed strategies to confront this shortage include additional training of PCPs for substance use and bipolar disorder, bolstering the mental health workforce, and improving access to consultative services.

Looking ahead in the COVID-19 pandemic: emerging lessons learned for sexual and reproductive health services in low- and middle-income countries

The COVID-19 pandemic has caused widespread disruption to essential health service provision globally, including in low- and middle-income countries (LMICs). Recognising the criticality of sexual and reproductive health (SRH) services, we review the actual reported impact of the COVID-19 pandemic on SRH service provision and evidence of adaptations that have been implemented to date. Across LMICs, the available data suggests that there was a reduction in access to SRH services, including family planning (FP) counselling and contraception access, and safe abortion during the early phase of the pandemic, especially when movement restrictions were in place. However, services were quickly restored, or alternatives to service provision (adaptations) were explored in many LMICs. Cases of gender-based violence (GBV) increased, with one in two women reporting that they have or know a woman who has experienced violence since the beginning of the pandemic. As per available evidence, many adaptations that have been implemented to date have been digitised, focused on getting SRH services closer to women. Through the pandemic, several LMIC governments have provided guidelines to support SRH service delivery. In addition, non-governmental organisations working in SRH programming have played significant roles in ensuring SRH services have been sustained by implementing several interventions at different levels of scale and to varying success. Most adaptations have focused on FP, with limited attention placed on GBV. Many adaptations have been implemented based on guidance and best practices and, in many cases, leveraged evidence-based interventions. However, some adaptations appear to have simply been the sensible thing to do. Where evaluations have been carried out, many have highlighted increased outputs and efficiency following the implementation of various adaptations. However, there is limited published evidence on their effectiveness, cost, value for money, acceptability, feasibility, and sustainability. In addition, the pandemic has been viewed as a homogenous event without recognising its troughs and waves or disentangling effects of response measures such as lockdowns from the pandemic itself. As the pandemic continues, neglected SRH services like those targeting GBV need to be urgently scaled up, and those being implemented with any adaptations should be rigorously tested.

Status of Public Primary Schools: Safety, Health Service Provision and Environmental Health Facilities in Sokoto Metropolis, Northwestern Nigeria

Background: Provision of security, health services and environmental health facilities in schools is crucial in achieving the overall goals of the School Health Programme (SHP) because of their implications in all the areas of school health and plays an important role in the safety of school community and in retention and learning outcomes of students. We aimed to determine the status of public primary schools with respect to safety, health service provision and environmental health facilities in Sokoto metropolis, Northwestern Nigeria. Methods: We conducted a cross sectional descriptive study among 40 public primary schools by multistage sampling technique. We collected data with an observation checklist using an electronic Open Data Kit (ODK) and analysed for descriptive statistics using SPSS version 23. Results: The majority of schools had no security fence 21 (52.5%). Security/ safety teams were present in about a third 15 (37.5%) of the schools. None of the schools had a fire alarm. However, fire extinguisher was available in only 3 (7.5%) of the schools. Health room or sick bay 16 (40.0%) and health register 14 (35.0%) were available in less than half of the schools. Health personnel 3 (7.5%) and school ambulance or school bus 3 (7.5%) were available in only a few schools. First aid box was available in most, 38 (95.0%) of the schools. However, less than half, 17 (40.0%) of the schools had Iodine in their first aid boxes. Presence of handwashing facilities with soap was observed in only 3 (7.5%) of schools. All the schools use open dumping as means of refuse disposal; however, dustbin for refuse collection in classes was observed only in about a third, 15 (37.5%) of the schools. Traditional pit latrine was the most predominant toilet type 27 (67.5%) in schools. Conclusion: Resources concerning safety, health service provision and environmental health facilities were found to be grossly inadequate in most of the schools observed. Government agencies involved in school administration should collaborate with other stakeholder’s in ensuring the provision of adequate resources for school health program.