Ease and equity of access to free DR-TB services in Nigeria- a qualitative analysis of policies, structures and processes

dc.contributor.authorOga-Omenka, Charity
dc.contributor.authorBada, Florence
dc.contributor.authorAgbaje, Aderonke
dc.contributor.authorDakum, Patrick
dc.contributor.authorMenzies, Dick
dc.contributor.authorZarowsky, Christina
dc.date.accessioned2021-09-21T12:21:07Z
dc.date.available2021-09-21T12:21:07Z
dc.date.issued2020
dc.description.abstractIntroduction: Persistent low rates of case notification and treatment coverage reflect that accessing diagnosis and treatment for drug-resistant tuberculosis (DR-TB) in Nigeria remains a challenge, even though it is provided free of charge to patients. Equity in health access requires availability of comparable, appropriate services to all, based on needs, and irrespective of socio-demographic characteristics. Our study aimed to identify the reasons for Nigeria’s low rates of case-finding and treatment for DR-TB. To achieve this, we analyzed elements that facilitate or hinder equitable access for different groups of patients within the current health system to support DR-TB management in Nigeria. Methods: We conducted documentary review of guidelines and workers manuals, as well as 57 qualitative interviews, including 10 focus group discussions, with a total of 127 participants, in Nigeria. Between August and November 2017, we interviewed patients who were on treatment, their treatment supporter, and providers in Ogun and Plateau States, as well as program managers in Benue and Abuja. We adapted and used Levesque’s patient-centered access to care framework to analyze DR-TB policy documents and interview data. Results: Thematic analysis revealed inequitable access to DR-TB care for some patient socio-demographic groups. While patients were mostly treated equally at the facility level, some patients experienced more difficulty accessing care based on their gender, age, occupation, educational level and religion. Health system factors including positive provider attitudes and financial support provided to the patients facilitated equity and ease of access. However, limited coverage and the absence of patients’ access rights protection and considerations in the treatment guidelines and workers manuals likely hampered access. Conclusion: In the context of Nigeria’s low case-finding and treatment coverage, applying an equity of access framework was necessary to highlight gaps in care. Differing social contexts of patients adversely affected their access to DR-TB care. We identified several strengths in DR-TB care delivery, including the current financial support that should be sustained. Our findings highlight the need for government’s commitment and continued interventions.en_US
dc.identifier.citationOga-Omenka, Charity, et al. “Ease and Equity of Access to Free DR-TB Services in Nigeria- a Qualitative Analysis of Policies, Structures and Processes.” International Journal for Equity in Health, vol. 19, no. 1, BioMed Central Ltd, 2020, pp. 221–221, doi:10.1186/s12939-020-01342-w.en_US
dc.identifier.issn14759276
dc.identifier.uri10.1186/s12939-020-01342-w
dc.identifier.urihttp://hdl.handle.net/10566/6725
dc.language.isoenen_US
dc.publisherBioMed Central Ltden_US
dc.subjectAdulten_US
dc.subjectFemaleen_US
dc.subjectFocus groupsen_US
dc.subjectHealth policyen_US
dc.subjectHealth servicesen_US
dc.subjectAccessibilityen_US
dc.subjectTuberculosisen_US
dc.subjectQualitative researchen_US
dc.subjectMulti-drug resistant tuberculosisen_US
dc.subjectMDR-TBen_US
dc.subjectNigeriaen_US
dc.titleEase and equity of access to free DR-TB services in Nigeria- a qualitative analysis of policies, structures and processesen_US
dc.typeArticleen_US

Files

Original bundle
Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
Oga-Omenka_Ease_and_equity_2020.pdf
Size:
803.16 KB
Format:
Adobe Portable Document Format
Description:
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
license.txt
Size:
1.71 KB
Format:
Item-specific license agreed upon to submission
Description: