Maternal and newborn health prioritization in Yobe State, Nigeria: analysis of stakeholders' perspective.

IF 3.1 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Emilia Ngozi Iwu, Charity Pring'ar Maina, Rifkatu Sunday Aimu, Rejoice Helma Abimiku, Sussan Israel-Isah, Kazeem Olalekan Ayodeji, George Odonye, Hadiza Sabo, Naoko Kozuki, Mamothena Mothupi
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引用次数: 0

Abstract

Background: Maternal and newborn mortality and morbidity in conflict-affected northeastern areas of Nigeria, such as Yobe State, are disproportionately higher than those in the rest of the country. There is limited evidence on the factors that influence maternal and newborn health (MNH) policymaking and implementation in this region, particularly with respect to the impact of conflict and context-specific issues. This study explores the political, economic and health system factors that drive the prioritization of MNH policies in Yobe State. The aim of this study was to elucidate the conflict-related factors influencing MNH outcomes, which could inform targeted interventions to improve MNH.

Methods: The study is a descriptive case study that relies on multiple data sources and is guided by the Health Policy Analysis Triangle. We reviewed national and subnational research, technical reports and policies related to reproductive health and the MNH in Nigeria since 2010. Following stakeholder mapping, we identified and invited prospective participants in the MNH policymaking space. Nineteen stakeholders from the government, civil society and nongovernmental organizations, donor agencies, and public and private sector health providers in Yobe State participated in the semistructured in-depth interviews. Data were collected from November 2022 through January 2023 and were thematically analysed via Dedoose software.

Findings: MNH services in Yobe State have received considerable attention through initiatives such as the National Midwifery Service Scheme, free MNH services, training of midwives with deployment to rural areas, and health facility renovations. The effective implementation of MNH services and policies faces challenges due to insufficient funding, and sustainability is hampered by changes in governance and political transitions. The Boko Haram insurgency exacerbated the humanitarian crisis in Yobe State and disrupted MNH services due to the displacement of populations and the decline in the number of health workers. Additionally, sociocultural and religious beliefs hinder timely access to and utilization of MNH services. Although policies and guidelines for MNH services exist in the state, they are inadequately disseminated to health providers, which affects their effective implementation across facilities. Collaboration and intersectoral coordination platforms exist, but competition and rivalries among unions, political entities, and implementing agencies sometimes impede progress.

Conclusion: Enhancing MNH services in Yobe state requires increased commitment for funding through the Northeast Development Commission rehabilitation fund; strengthening the health workforce, safety and retention plan; promoting gender inclusivity within the health sector; and addressing sociocultural barriers to women's health-seeking behaviors. Concrete, time-bound plans for policy dissemination are necessary to ensure effective service implementation.

尼日利亚约贝州孕产妇和新生儿保健优先次序:利益相关者观点分析。
背景:受冲突影响的尼日利亚东北部地区(如约贝州)的孕产妇和新生儿死亡率和发病率远远高于该国其他地区。关于影响该地区孕产妇和新生儿健康(MNH)政策制定和实施的因素,尤其是冲突的影响和特定环境问题,目前证据有限。本研究探讨了推动约贝州优先制定孕产妇和新生儿保健政策的政治、经济和卫生系统因素。本研究旨在阐明影响 MNH 结果的冲突相关因素,从而为改善 MNH 的针对性干预措施提供依据:本研究是一项描述性案例研究,依赖于多种数据来源,并以卫生政策分析三角为指导。我们审查了尼日利亚自 2010 年以来与生殖健康和 MNH 相关的国家和国家以下各级研究、技术报告和政策。在对利益相关者进行摸底后,我们确定并邀请了 MNH 决策领域的潜在参与者。来自政府、民间社会和非政府组织、捐助机构以及约贝州公共和私营部门医疗服务提供者的 19 名利益相关者参加了半结构化深度访谈。数据收集时间为 2022 年 11 月至 2023 年 1 月,并通过 Dedoose 软件进行了专题分析:通过国家助产服务计划、免费的产妇保健服务、培训助产士并将其部署到农村地区以及翻新医疗设施等举措,约贝州的产妇保健服务受到了广泛关注。由于资金不足,有效实施产妇保健服务和政策面临挑战,而治理变革和政治过渡也阻碍了可持续性。博科圣地 "组织的叛乱加剧了约贝州的人道主义危机,并因人口流离失所和卫生工作者人数减少而中断了孕产妇和新生儿保健服务。此外,社会文化和宗教信仰也阻碍了产妇保健服务的及时获得和利用。虽然该州制定了母婴保健服务政策和指南,但这些政策和指南并未充分传播给医疗服务提供者,从而影响了这些政策和指南在各医疗机构的有效实施。合作和跨部门协调平台已经存在,但工会、政治实体和执行机构之间的竞争和对抗有时会阻碍进展:要加强约贝州的 MNH 服务,就必须通过东北发展委员会的重建基金增加资金投入;加强卫生工作者队伍、安全和留用计划;促进卫生部门内的性别包容;以及消除妇女寻求健康行为的社会文化障碍。有必要制定具体的、有时限的政策宣传计划,以确保服务的有效实施。
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
Conflict and Health
Conflict and Health Medicine-Public Health, Environmental and Occupational Health
CiteScore
6.10
自引率
5.60%
发文量
57
审稿时长
18 weeks
期刊介绍: Conflict and Health is a highly-accessed, open access journal providing a global platform to disseminate insightful and impactful studies documenting the public health impacts and responses related to armed conflict, humanitarian crises, and forced migration.
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