Ajisegiri Whenayon Simeon, Abimbola Seye, Tesema Azeb Gebresilassie, Odusanya Olumuyiwa O, Peiris David, Joshi Rohina
The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia.
School of Public Health, University of Sydney, Sydney, Australia.
PLOS Glob Public Health. 2022 Jul 1;2(7):e0000566. doi: 10.1371/journal.pgph.0000566. eCollection 2022.
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.
作为慢性病，非传染性疾病（NCDs）需要持续的以患者为中心和基于社区的护理。鉴于初级卫生保健（PHC）与社区和家庭有直接联系，它非常适合实现这种护理。在尼日利亚，国家政府已将加强初级卫生保健系统作为实现国家非传染性疾病目标的一种手段。然而，加强初级卫生保健系统以应对非传染性疾病需要根据对现有促进因素和初级卫生保健服务提供非传染性疾病的障碍的背景理解，对初级卫生保健服务提供进行重新组织。我们进行了一项混合方法案例研究，以13个初级卫生保健机构作为感兴趣的案例来探索非传染性疾病服务的提供。该研究在尼日利亚的两个北部州和两个南部州进行，包括对25名参与者的定性访谈、107名参与者之间的13次焦点小组讨论以及对13个初级卫生保健机构的直接观察。我们发现，医护人员之间的跨专业角色冲突、在政府投资不足的情况下维持初级卫生保健机构运转的不当激励措施以及将初级卫生保健视为较差卫生系统的观念是改善非传染性疾病管理组织的主要障碍。相反，初级卫生保健机构中有医生以及民间社会组织参与协助社区联系是关键的推动因素。与南部州相比，北部州的初级卫生保健机构在绩效和能力方面存在明显差异，南部的机构在提供非传染性疾病服务方面组织得更好。需要根据尼日利亚各地的社会政治和经济差异量身定制初级卫生保健改革，以提高应对非传染性疾病的能力。
