11 results on '"Abimbola, Seye"'
Search Results
2. Where there is no policy: governing the posting and transfer of primary health care workers in Nigeria
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Abimbola, Seye, Olanipekun, Titilope, Schaaf, Marta, Negin, Joel, Jan, Stephen, and Martiniuk, Alexandra L. C.
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human resources for health ,education ,Nigeria ,behavioral disciplines and activities ,Quality Improvement ,Organizational Policy ,Personnel Management ,primary health care ,community health committees ,governance ,Workforce ,Humans ,Research Articles ,Research Article - Abstract
Summary The posting and transfer of health workers and managers receives little policy and research attention in global health. In Nigeria, there is no national policy on posting and transfer in the health sector. We sought to examine how the posting and transfer of frontline primary health care (PHC) workers is conducted in four states (Lagos, Benue, Nasarawa and Kaduna) across Nigeria, where public sector PHC facilities are usually the only form of formal health care service providers available in many communities. We conducted in‐depth interviews with PHC workers and managers, and group discussions with community health committee members. The results revealed three mechanisms by which PHC managers conduct posting and transfer: (1) periodically moving PHC workers around as a routine exercise aimed at enhancing their professional experience and preventing them from being corrupted; (2) as a tool for improving health service delivery by assigning high‐performing PHC workers to PHC facilities perceived to be in need, or posting PHC workers nearer their place of residence; and (3) as a response to requests for punishment or favour from PHC workers, political office holders, global health agencies and community health committees. Given that posting and transfer is conducted by discretion, with multiple influences and sometimes competing interests, we identified practices that may lead to unfair treatment and inequities in the distribution of PHC workers. The posting and transfer of PHC workers therefore requires policy measures to codify what is right about existing informal practices and to avert their negative potential. © 2016 The Authors The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd
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- 2016
3. Confronting power in low places: historical analysis of medical dominance and role-boundary negotiation between health professions in Nigeria
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Badejo, Okikiolu, Sagay, Helen, Abimbola, Seye, and Van Belle, Sara
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Interprofessional Relations ,media_common.quotation_subject ,Nigeria ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,0302 clinical medicine ,Humans ,lcsh:RC109-216 ,030212 general & internal medicine ,Sociology ,Cooperative Behavior ,Human resources ,Rivalry ,Original Research ,media_common ,lcsh:R5-920 ,Delegation ,Negotiating ,business.industry ,030503 health policy & services ,Health Policy ,Public Health, Environmental and Occupational Health ,Health services research ,Public relations ,health services research ,Negotiation ,health policies and all other topics ,Health Occupations ,Dominance (economics) ,Workforce ,Thematic analysis ,lcsh:Medicine (General) ,0305 other medical science ,business ,health systems - Abstract
IntroductionInterprofessional interaction is intrinsic to health service delivery and forms the basis of task-shifting and task-sharing policies to address human resources for health challenges. But while interprofessional interaction can be collaborative, professional hierarchies and discipline-specific patterns of socialisation can result in unhealthy rivalry and conflicts which disrupt health system functioning. A better understanding of interprofessional dynamics is necessary to avoid such negative consequences. We, therefore, conducted a historical analysis of interprofessional interactions and role-boundary negotiations between health professions in Nigeria.MethodsWe conducted a review of both published and grey literature to provide historical accounts and enable policy tracing of reforms related to interprofessional interactions. We used Nancarrow and Borthwick’s typology for thematic analysis and used medical dominance and negotiated order theories to offer explanations of the conditions that facilitated or constrained interprofessional collaboration.ResultsDespite an overall context of medical dominance, we found evidence of professional power changes (dynamics) and role-boundary shifts between health professions. These shifts occurred in different directions, but shifts between professions that are at different power gradients were more likely to be non-negotiable or conflictual. Conditions that facilitated consensual role-boundary shifts included the feasibility of simultaneous upward expansion of roles for all professions and the extent to which the delegating profession was in charge of role delegation. While the introduction of new medical diagnostic technology opened up occupational vacancies which facilitated consensual role-boundary change in some cases, it constrained professional collaboration in others.ConclusionsHealth workforce governance can contribute to better functioning of health systems and voiding dysfunctional interprofessional relations if the human resource for health interventions are informed by contextual understanding (informed by comparative institutional and health systems research) of conditions that facilitate or constrain effective interprofessional collaboration.
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- 2020
4. Evaluation of a pilot intervention to redesign the decentralised vaccine supply chain system in Nigeria.
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Molemodile, Shola, Wotogbe, Maruchi, and Abimbola, Seye
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DECENTRALIZATION in management ,FEDERAL government ,FOCUS groups ,IMMUNIZATION ,INTERVIEWING ,RESEARCH methodology ,MEDICAL protocols ,RESEARCH evaluation ,RESEARCH funding ,STATE governments ,VACCINES ,PILOT projects ,THEMATIC analysis ,DATA analysis software ,DESCRIPTIVE statistics ,FIELD notes (Science) - Abstract
Responsibility for immunisation in Nigeria is decentralised to sub-national governments. So far, they have failed to achieve optimal coverage for their populations. We evaluated a pilot intervention implemented between 2013 and 2014 to redesign a vaccine supply chain management system in Kano, Nigeria. The intervention included financing immunisation services from a designated pool of government and donor funds, a visibility tool to track vaccine stock, and a private vendor engaged to deliver vaccines directly to health facilities. The number of local government areas within the state with adequate vaccine stock increased from 21% to 98% after 10 months. To understand how the intervention achieved this outcome, we analysed immunisation coverage for the period and interviewed 18 respondents across different levels of government. We found that the intervention worked by improving ownership and accountability for immunisation by sub-national governments and their capacity for generating resources and management (of data and the supply chain). While the intervention focused on improving immunisation coverage, we identified gaps in the demand for services. Efforts to improve immunisation coverage and vaccine supply systems should streamline decentralised structures, empower sub-national governments with financial and technical capacity, and promote strategies to improve the demand and use of services. [ABSTRACT FROM AUTHOR]
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- 2017
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5. Evaluating the sub-national fidelity of national Initiatives in decentralized health systems: Integrated Primary Health Care Governance in Nigeria.
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Amaize Eboreime, Ejemai, Abimbola, Seye, Abrahams Obi, Felix, Ebirim, Obinna, Olubajo, Olalekan, Eyles, John, Nxumalo, Nonhlanhla Lynette, Nankasa Mambulu, Faith, Eboreime, Ejemai Amaize, Obi, Felix Abrahams, and Mambulu, Faith Nankasa
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PRIMARY health care , *MEDICAL care , *HEALTH policy , *DECENTRALIZATION of public health administration , *MEDICAL care costs , *EXECUTIVES , *FEDERAL government , *POLICY sciences , *PRACTICAL politics , *PUBLIC administration , *PUBLIC welfare , *STATE governments , *GOVERNMENT programs , *CLINICAL governance - Abstract
Background: Policy making, translation and implementation in politically and administratively decentralized systems can be challenging. Beyond the mere sub-national acceptance of national initiatives, adherence to policy implementation processes is often poor, particularly in low and middle-income countries. In this study, we explore the implementation fidelity of integrated PHC governance policy in Nigeria's decentralized governance system and its implications on closing implementation gaps with respect to other top-down health policies and initiatives.Methods: Having engaged policy makers, we identified 9 core components of the policy (Governance, Legislation, Minimum Service Package, Repositioning, Systems Development, Operational Guidelines, Human Resources, Funding Structure, and Office Establishment). We evaluated the level and pattern of implementation at state level as compared to the national guidelines using a scorecard approach.Results: Contrary to national government's assessment of level of compliance, we found that sub-national governments exercised significant discretion with respect to the implementation of core components of the policy. Whereas 35 and 32% of states fully met national criteria for the structural domains of "Office Establishment" and Legislation" respectively, no state was fully compliant to "Human Resource Management" and "Funding" requirements, which are more indicative of functionality. The pattern of implementation suggests that, rather than implementing to improve outcomes, state governments may be more interested in executing low hanging fruits in order to access national incentives.Conclusions: Our study highlights the importance of evaluating implementation fidelity in providing evidence of implementation gaps towards improving policy execution, particularly in decentralized health systems. This approach will help national policy makers identify more effective ways of supporting lower tiers of governance towards improvement of health systems and outcomes. [ABSTRACT FROM AUTHOR]- Published
- 2017
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6. 'The government cannot do it all alone': realist analysis of the minutes of community health committee meetings in Nigeria.
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Abimbola, Seye, Molemodile, Shola K., Okonkwo, Ononuju A., Negin, Joel, Jan, Stephen, and Martiniuk, Alexandra L.
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COMMUNITY health services ,HEALTH policy ,PRIMARY health care ,MEDICAL care ,COLLECTIVE action ,COMPARATIVE studies ,COOPERATIVENESS ,INFORMATION services ,RESEARCH methodology ,MEDICAL cooperation ,RESEARCH ,GOVERNMENT programs ,EVALUATION research - Abstract
Since the mid-1980s, the national health policy in Nigeria has sought to inspire community engagement in primary health care by bringing communities into partnership with service providers through community health committees. Using a realist approach to understand how and under what circumstances the committees function, we explored 581 meeting minutes from 129 committees across four states in Nigeria (Lagos, Benue, Nasarawa and Kaduna). We found that community health committees provide opportunities for improving the demand and supply of health care in their community. Committees demonstrate five modes of functioning: through meetings (as 'village square'), reaching out within their community (as 'community connectors'), lobbying governments for support (as 'government botherers'), inducing and augmenting government support (as 'back-up government') and taking control of health care in their community (as 'general overseers'). In performing these functions, community health committees operate within and through the existing social, cultural and religious structures of their community, thereby providing an opportunity for the health facility with which they are linked to be responsive to the needs and values of the community. But due to power asymmetries, committees have limited capacity to influence health facilities for improved performance, and governments for improved health service provision. This is perhaps because national guidelines are not clear on their accountability functions; they are not aware of the minimum standards of services to expect; and they have a limited sense of legitimacy in their relations with sub-national governments because they are established as the consequence of a national policy. Committees therefore tend to promote collective action for self-support more than collective action for demanding accountability. To function optimally, community health committees require national government or non-government organization mentoring and support; they need to be enshrined in law to bolster their sense of legitimacy; and they also require financial support to subsidise their operation costs especially in geographically large communities. [ABSTRACT FROM AUTHOR]
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- 2016
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7. Transaction costs of access to health care: Implications of the care-seeking pathways of tuberculosis patients for health system governance in Nigeria.
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Abimbola, Seye, Ukwaja, Kingsley N., Onyedum, Cajetan C., Negin, Joel, Jan, Stephen, and Martiniuk, Alexandra L.C.
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EVALUATION of medical care , *TUBERCULOSIS diagnosis , *TUBERCULOSIS treatment , *MEDICAL care , *ACADEMIC medical centers , *CONFIDENCE intervals , *STATISTICAL correlation , *DECENTRALIZATION in management , *HEALTH services accessibility , *INTERVIEWING , *MEDICAL care costs , *MEDICAL referrals , *PRIMARY health care , *PROBABILITY theory , *QUESTIONNAIRES , *RESEARCH funding , *SURVEYS , *LOGISTIC regression analysis , *MULTIPLE regression analysis , *CROSS-sectional method , *DATA analysis software , *DESCRIPTIVE statistics , *SECONDARY care (Medicine) , *ODDS ratio - Abstract
Health care costs incurred prior to the appropriate patient–provider transaction (i.e., transaction costs of access to health care) are potential barriers to accessing health care in low- and middle-income countries. This paper explores these transaction costs and their implications for health system governance through a cross-sectional survey of adult patients who received their first diagnosis of pulmonary tuberculosis (TB) at the three designated secondary health centres for TB care in Ebonyi State, Nigeria. The patients provided information on their care-seeking pathways and the associated costs prior to reaching the appropriate provider. Of the 452 patients, 84% first consulted an inappropriate provider. Only 33% of inappropriate consultations were with qualified providers (QP); the rest were with informal providers such as pharmacy providers (PPs; 57%) and traditional providers (TP; 10%). Notably, 62% of total transaction costs were incurred during the first visit to an inappropriate provider and the mean transaction costs incurred was highest with QPs (US$30.20) compared with PPs (US$14.40) and TPs (US$15.70). These suggest that interventions for reducing transaction costs should include effective decentralisation to integrate TB care with services at the primary health care level, community engagement to address information asymmetry, enforcing regulations to keep informal providers within legal limits and facilitating referral linkages among formal and informal providers to increase early contact with appropriate providers. [ABSTRACT FROM PUBLISHER]
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- 2015
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8. Health Systems in an Interconnected World: A View from Nigeria.
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Abimbola, Seye
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COMMUNICATION ,INFORMATION storage & retrieval systems ,MATHEMATICAL models ,MEDICAL care ,POVERTY ,WORLD health ,THEORY ,ACCESS to information - Abstract
The benefits of an interconnected world for health care remain untapped. As a result of the politics of inequality between rich and poor countries, one or a few health systems are set up as models. Every country, irrespective of political or economic status, should be open to learning from others to build relevant and cost-effective systems. To combat the current global challenge of chronic noncommunicable diseases, poor countries have the advantage of flexible health systems that are veritable laboratories of health systems research. Not only can research conducted in these health systems help harness the potential of mobile communication technologies and informal health providers, it can also help rich country health systems adapt to meet the chronic disease challenge. [ABSTRACT FROM AUTHOR]
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- 2011
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9. Factors associated with the healthcare-seeking behaviour of older people in Nigeria.
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Atchessi, Nicole, Ridde, Valéry, Abimbola, Seye, and Zunzunegui, Maria-Victoria
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CONFIDENCE intervals , *HEALTH services accessibility , *HELP-seeking behavior , *INCOME , *MEDICAL referrals , *POISSON distribution , *POPULATION geography , *SELF-evaluation , *STATISTICS , *SURVEYS , *UNEMPLOYMENT , *EDUCATIONAL attainment , *ATTITUDES toward illness - Abstract
Highlights • Among older adults in Nigeria, women, the very old and those unable to work consult more often. • People living in the South South and in the South East report illness more often but consult less when feeling ill. • For Nigerian older adults, poverty and lack of education impede healthcare-seeking behaviour. • Improving access to healthcare for older adults in Nigeria will very likely require lifting the financial and additional social barriers. Abstract This study aimed to examine the factors associated with healthcare-seeking behaviour of Nigeria's older adult population. Data were retrieved from the Nigeria General Household Survey (GHS - year 2013) database, representative at the national level. Bivariate analysis and Poisson regression were performed. Among 3587 adults aged 50 years and over, 850 reported having been sick in the previous four weeks, and 53% of those had consulted a health practitioner in that period. Those consulting were more likely to be women (PR = 1.30, 95% CI [1.1–1.15]), older than 65 (PR = 1.25, 95% CI [1.1–1.5]), and unemployed (PR = 1.24, 95% CI [1.0–1.4]), whereas lack of education (PR = 0.73, 95% CI [0.6 0–0.8]), low household income (PR = 0.72, 95% CI [0.5–0.9]) and living in the South East (PR = 0.59 95% CI [0.4–0.7]) and in the South South zones (PR = 0.60 95% CI [0.4–0.7]) were associated with lower consultation rates. Our results suggest that improving older adults' healthcare-seeking behaviour in Nigeria will require the lifting of financial barriers and improvements to education. More studies are needed to better understand geographic differences and the low consultation rate by men. [ABSTRACT FROM AUTHOR]
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- 2018
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10. How decentralisation influences the retention of primary health care workers in rural Nigeria.
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Abimbola, Seye, Olanipekun, Titilope, Igbokwe, Uchenna, Negin, Joel, Jan, Stephen, Martiniuk, Alexandra, Ihebuzor, Nnenna, and Aina, Muyi
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DECENTRALIZATION in management , *ENDOWMENTS , *FEDERAL government , *EMPLOYMENT of people with disabilities , *INTERVIEWING , *LOCAL government , *RESEARCH methodology , *MEDICAL personnel , *METROPOLITAN areas , *PRIMARY health care , *RURAL population , *STATE governments , *WAGES , *EMPLOYEE retention , *QUALITATIVE research , *SOCIAL support , *MIDDLE-income countries , *LOW-income countries , *SECONDARY care (Medicine) , *TERTIARY care - Abstract
In Nigeria, the shortage of health workers is worst at the primary health care (PHC) level, especially in rural communities. And the responsibility for PHC – usually the only form of formal health service available in rural communities – is shared among the three tiers of government (federal, state, and local governments). In addition, the responsibility for community engagement in PHC is delegated to community health committees. This study examines how the decentralisation of health system governance influences retention of health workers in rural communities in Nigeria from the perspective of health managers, health workers, and people living in rural communities. The study adopted a qualitative approach, and data were collected using semi-structured in-depth interviews and focus group discussions. The multi-stakeholder data were analysed for themes related to health system decentralisation. The results showed that decentralisation influences the retention of rural health workers in two ways: 1) The salary of PHC workers is often delayed and irregular as a result of delays in transfer of funds from the national to sub-national governments and because one tier of government can blame failure on another tier of government. Further, the primary responsibility for PHC is often left to the weakest tier of government (local governments). And the result is that rural PHC workers are attracted to working at levels of care where salaries are higher and more regular – in secondary care (run by state governments) and tertiary care (run by the federal government), which are also usually in urban areas. 2) Through community health committees, rural communities influence the retention of health workers by working to increase the uptake of PHC services. Community efforts to retain health workers also include providing social, financial, and accommodation support to health workers. To encourage health workers to stay, communities also take the initiative to co-finance and co-manage PHC services in order to ensure that PHC facilities are functional. In Nigeria and other low- and middle-income countries with decentralised health systems, intervention to increase the retention of health workers in rural communities should seek to reform and strengthen governance mechanisms, using both top-down and bottom-up strategies to improve the remuneration and support for health workers in rural communities. [ABSTRACT FROM AUTHOR]
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- 2015
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11. Towards people-centred health systems: a multi-level framework for analysing primary health care governance in low- and middle-income countries.
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Abimbola, Seye, Negin, Joel, Jan, Stephen, and Martiniuk, Alexandra
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Although there is evidence that non-government health system actors can individually or collectively develop practical strategies to address primary health care (PHC) challenges in the community, existing frameworks for analysing health system governance largely focus on the role of governments, and do not sufficiently account for the broad range of contribution to PHC governance. This is important because of the tendency for weak governments in low- and middle-income countries (LMICs). We present a multi-level governance framework for use as a thinking guide in analysing PHC governance in LMICs. This framework has previously been used to analyse the governance of common-pool resources such as community fisheries and irrigation systems. We apply the framework to PHC because, like common-pool resources, PHC facilities in LMICs tend to be commonly owned by the community such that individual and collective action is often required to avoid the 'tragedy of the commons'-destruction and degradation of the resource resulting from lack of concern for its continuous supply. In the multi-level framework, PHC governance is conceptualized at three levels, depending on who influences the supply and demand of PHC services in a community and how: operational governance (individuals and providers within the local health market), collective governance (community coalitions) and constitutional governance (governments at different levels and other distant but influential actors). Using the example of PHC governance in Nigeria, we illustrate how the multi-level governance framework offers a people-centred lens on the governance of PHC in LMICs, with a focus on relations among health system actors within and between levels of governance. We demonstrate the potential impact of health system actors functioning at different levels of governance on PHC delivery, and how governance failure at one level can be assuaged by governance at another level. [ABSTRACT FROM AUTHOR]
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- 2014
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