Enablers and barriers to implementing cholera interventions in Nigeria: a community-based system dynamics approach.

IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Kelly Elimian, Karin Diaconu, John Ansah, Carina King, Ozius Dewa, Sebastian Yennan, Benjamin Gandi, Birger Carl Forsberg, Chikwe Ihekweazu, Tobias Alfvén
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引用次数: 0

Abstract

Nigeria accounts for a substantial cholera burden globally, particularly in its northeast region, where insurgency is persistent and widespread. We used participatory group model building workshops to explore enablers and barriers to implementing known cholera interventions, including water, sanitation and hygiene, surveillance and laboratory, case management, community engagement, oral cholera vaccine, and leadership and coordination, as well as exploring leverage points for interventions and collaboration. The study engaged key cholera stakeholders in the northeastern States of Adamawa and Bauchi, as well as national stakeholders in Abuja. Adamawa and Bauchi States' group modes building participants comprised 49 community members and 43 healthcare providers, while the 23 national participants comprised government ministry, department and agency staff, and development partners. Data were analysed thematically and validated via consultation with selected participants. The study identified four overarching themes regarding the enablers and barriers to implementing cholera interventions: (1) political will, (2) health system resources and structures, (3) community trust and culture, and (4) spill-over effect of COVID-19. Specifically, inadequate political will exerts its effect directly (e.g. limited funding for prepositioning essential cholera supplies) or indirectly (e.g. overlapping policies) on implementing cholera interventions. The healthcare system structure (e.g. centralization of cholera management in a State capital) and limited surveillance tools weaken the capacity to implement cholera interventions. Community trust emerges as integral to strengthening the healthcare system's resilience in mitigating the impacts of cholera outbreaks. Lastly, the spill-over effects of COVID-19 helped promote interventions similar to cholera (e.g. water, sanitation and hygiene) and directly enhanced political will. In conclusion, the study offers insights into the complex barriers and enablers to implementing cholera interventions in Nigeria's cholera-endemic settings. Strong political commitment, strengthening the healthcare system, building community trust and an effective public health system can enhance the implementation of cholera interventions in Nigeria.

在尼日利亚实施霍乱干预措施的有利因素和障碍:基于社区的系统动力学方法。
在全球范围内,尼日利亚的霍乱负担沉重,尤其是在其东北部地区,那里的叛乱活动持续且普遍。我们利用参与式小组模型构建(GMB)研讨会探讨了实施已知霍乱干预措施的有利因素和障碍,包括水、环境卫生和个人卫生(WASH)、监测和实验室、病例管理、社区参与、口服霍乱疫苗以及领导力和协调,同时还探讨了干预和合作的杠杆点。这项研究吸引了东北部阿达马瓦州和包奇州的主要霍乱利益相关者以及阿布贾的国家利益相关者参与。阿达马瓦州和包奇州的 GMB 参与者包括 49 名社区成员和 43 名医疗服务提供者,而 23 名全国参与者包括政府部委、部门和机构的工作人员以及发展合作伙伴。研究人员对数据进行了专题分析,并与选定的参与者进行了协商验证。研究确定了有关实施霍乱干预措施的促进因素和障碍的四大主题:(1)政治意愿;(2)卫生系统的资源和结构;(3)社区信任和文化;(4)COVID-19 的溢出效应。具体来说,政治意愿不足会直接(如用于预先放置基本霍乱用品的资金有限)或间接(如政策重叠)影响霍乱干预措施的实施。医疗保健系统结构(如在州府集中管理霍乱)和有限的监测工具削弱了实施霍乱干预措施的能力。社区信任是加强医疗系统在减轻霍乱爆发影响方面的应变能力所不可或缺的。最后,COVID-19 的溢出效应有助于促进与霍乱类似的干预措施(如讲卫生运动),并直接增强了政治意愿。总之,这项研究为我们深入了解在尼日利亚霍乱流行地区实施霍乱干预措施的复杂障碍和有利因素提供了启示。坚定的政治承诺、加强医疗保健系统、建立社区信任以及有效的公共卫生系统可以促进霍乱干预措施在尼日利亚的实施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Health policy and planning
Health policy and planning 医学-卫生保健
CiteScore
6.00
自引率
3.10%
发文量
98
审稿时长
6 months
期刊介绍: Health Policy and Planning publishes health policy and systems research focusing on low- and middle-income countries. Our journal provides an international forum for publishing original and high-quality research that addresses questions pertinent to policy-makers, public health researchers and practitioners. Health Policy and Planning is published 10 times a year.
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