A case study of health service provision in Yobe State, Nigeria in the context of the Boko Haram insurgency (original) (raw)
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Conflict and health, 2015
Yobe State has faced severe disruption of its health service as a result of the Boko Haram insurgency. A systems dynamics analysis was conducted to identify key pathways of threat to provision and emerging pathways of response and adaptation. Structured interviews were conducted with 39 stakeholders from three local government areas selected to represent the diversity of conflict experience across the state: Damaturu, Fune and Nguru, and with four officers of the PRRINN-MNCH program providing technical assistance for primary care development in the state. A group model building session was convened with 11 senior stakeholders, which used participatory scripts to review thematic analysis of interviews and develop a preliminary systems model linking identified variables. Population migration and transport restrictions have substantially impacted access to health provision. The human resource for health capability of the state has been severely diminished through the outward migration ...
HEALTH SECTOR DEVELOPMENT AND SUSTAINABILITY IN NIGERIA USING THE RESILIENT HEALTH SYSTEMS FRAMEWORK
Health care delivery in Nigeria is complex and dependent on several determinants of health. While, re-emerging health threats such as the Ebola which occurred in Nigeria and some other parts of West Africa in 2014 have given rise to the need to understand what it means for a health system to be resilient. Although the present health system in Nigeria remains less resilient, the work of Kruk, Myers, Varpilah, and Dahn (2015) on resilient health systems (RHS) framework is beneficial to develop and sustain it. The resilient health systems framework offers insights on the need for health systems to be aware, diverse, self-regulating, integrated and adaptive in their approach to public health and primary care matters. This paper focuses on how Nigeria can develop, strengthen and sustain its health system by becoming more resilient using the RHS framework.
Health Policy and Planning, 2019
Health systems resilience (HSR) is defined as the ability of a health system to continue providing normal services in response to a crisis, making it a critical concept for analysis of health systems in fragile and conflict-affected settings (FCAS). However, no consensus for this definition exists and even less about how to measure HSR. We examine three current HSR definitions (maintaining function, improving function and achieving health system targets) using real-time data from South Sudan to develop a data-driven understanding of resilience. We used 14 maternal, newborn and child health (MNCH) coverage indicators from household surveys in South Sudan collected at independence (2011) and following 2 years of protracted conflict (2015), to construct a resilience index (RI) for 9 of the former 10 states and nationally. We also assessed health system stress using conflict-related indicators and developed a stress index. We cross tabulated the two indices to assess the relationship of...
BMJ Global Health
BackgroundIn the context of universal health coverage in the Sahel, the study focuses on primary health centres and the difficulties of their implementation in the context of insurgency conflicts in central Mali.MethodsThis is qualitative research through a multiple case study. We selected six health centres according to a reasoned choice to bring together contrasting situations. We conducted 96 semistructured interviews and consulted secondary quantitative data on attendance. By focusing on community health centres, the conceptual approach focuses on the process of resilience that unfolds in a dual context of chronic health system dysfunctions and armed conflict.ResultsThe resilience strategies deployed by health professionals were relatively basic and uncoordinated. In the end, it was the individuals who showed absorption. However, their room for manoeuvre was limited. In the most isolated health centres, resilience was based on subordinate, poorly trained staff, often from the lo...
PLOS ONE, 2022
The need for resilient health systems is recognized as important for the attainment of health outcomes, given the current shocks to health services. Resilience has been defined as the capacity to “prepare and effectively respond to crises; maintain core functions; and, informed by lessons learnt, reorganize if conditions require it”. There is however a recognized dichotomy between its conceptualization in literature, and its application in practice. We propose two mutually reinforcing categories of resilience, representing resilience targeted at potentially known shocks, and the inherent health system resilience, needed to respond to unpredictable shock events. We determined capacities for each of these categories, and explored this methodological proposition by computing country-specific scores against each capacity, for the 47 Member States of the WHO African Region. We assessed face validity of the computed index, to ensure derived values were representative of the different elem...
The case study was conducted principally from the perspective of the International Center for AIDS Care and Treatment Programs (ICAP) at Columbia University, an implementing partner funded by Centers for Disease Control and Prevention (CDC) under the U.S. President’s Emergency Plan for Aids Relief (PEPFAR). ICAP provided technical assistance for HIV- related programming to the Ministry of Health during this period. ICAP supported family- focused and multidisciplinary HIV services in health facilities across the country, working to build district capacity for provision of comprehensive HIV services1. These services included: pediatric and adult HIV care and treatment (including provision of ART); integrated tuberculosis/HIV care and treatment; rapid HIV testing for adults and children; diagnostic testing/analysis (including Dried Blood Spot DNA PCR testing for infants); community outreach; HIV support groups; and peer education programs. While the Ministry of Health (MOH) provided salaries to the majority of health facility staff and was also responsible for the procurement of drugs, ICAP provided salary support to some staff at health facility level such as data clerks.
The Implication of Boko Haram Insurgency on Healthcare Service Delivery in Borno State, Nigeria
Ilorin Journal of Administration and Development , 2017
The insurgency of Boko Haram in the northeastern Nigeria has overwhelming implication on the various developmental sectors. The incessant attacks launched by the insurgent group is reported to have damaged infrastructures and leads to deaths, destructions and displacement of lives, properties and people. Against this background therefore, this paper examines the specific implications that insurgency has on healthcare service delivery in Borno State. The paper utilises secondary data, with bias on healthcare service reports of Borno State Government, Human Rights Watch, Integrated Regional Information Network and Medicins Sans Frontiers. The paper reveals that governmental efforts in healthcare service delivery in the state has been greatly affected, as well as that of profit making establishments. However, the humanitarian based International Non-Governmental Organisations (INGOs) remain fully functional. The paper therefore concluded that efforts must be made to retain the INGOs as well as improve the governmental and private sector provisions of the healthcare services in order to avoid the total collapse of the sector. As such, the paper recommends strong partnerships by governments with donor agencies and individuals sponsoring healthcare programmes in the state. More funds should also be allocated to healthcare in Borno state subsequent budgets so as to revive the sector.