Abstract
The Nigerian health system is confronted with challenges, including but not limited to incompleteness of health data, dilapidated medical equipment, and poor healthcare financing. Thus, the Nigerian health system needs to be improved. A quality improvement intervention is a systematic continuous approach that aims to solve problems in the health system and is commonly employed to support health system development. A quality improvement intervention is more likely to work if the approach fits the targeted health system, but, there is no in-depth information on how to make a quality improvement intervention fit for the Nigerian health system. Thus, the authors consulted with health workers, key actors in the Nigerian health system regarding this. Fifty-one diverse health workers (30 health care providers & 21 health service managers) participated in this qualitative survey. The age and work experience of the participants ranged from 24 to 76 years and 1 to 50 years, respectively. Thematic analysis was performed on the data, and the main findings are reported in this abstract. The findings support that there are diverse problems across all health system building blocks. Problems in a health system building block may affect other health system building blocks. Thus, a contextually relevant quality improvement intervention in the country needs to utilize a systems thinking approach. Further, the findings suggest that collaboration, government involvement, and a data-driven approach are beneficial for developing a contextually relevant quality improvement intervention. In addition to being beneficial for developing a contextually relevant quality improvement intervention, collaboration is beneficial for implementing a contextually relevant quality improvement intervention. Finally, the findings suggest that a client-centered approach and monitoring activities are also beneficial for implementing a contextually relevant quality improvement intervention. This study provides important insights into the factors that may help the planning and implementation of a contextually relevant quality improvement intervention. Future work must investigate if the application of findings to the Nigerian context results in improved outcomes of a quality improvement intervention.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
The data associated with this study are available from the corresponding author upon request.
References
Adam, T., & de Savigny, D. (2012). Systems thinking for strengthening health systems in LMICs: need for a paradigm shift. Health Policy and Planning, 27(suppl_4), iv1-iv3. https://doi.org/10.1093/heapol/czs084
Adeloye, D., David, R. A., Olaogun, A. A., Auta, A., Adesokan, A., Gadanya, M., … Iseolorunkanmi, A. (2017). Health workforce and governance: the crisis in Nigeria. Human Resources for Health, 15(1), 1–8. https://doi.org/10.1186/s12960-017-0205-4
Aregbeshola, B. S. (2021). Towards health system strengthening: A review of the Nigerian health system from 1960 to 2019. Available at SSRN, 3766017, 1-42. https://doi.org/10.2139/ssrn.3766017
Baatiema, L., de-Graft Aikins, A., Sarfo, F. S., Abimbola, S., Ganle, J. K., & Somerset, S. (2020). Improving the quality of care for people who had a stroke in a low-/middle-income country: A qualitative analysis of health-care professionals’ perspectives. Health Expectations, 23(2), 450–460. https://doi.org/10.1111/hex.13027
Backhouse, A., & Ogunlayi, F. (2020). Quality improvement into practice. BMJ, 368, 1–6. https://doi.org/10.1136/bmj.m865
Balogun, J. A. (2022). The vulnerabilities of the Nigerian healthcare system. In The Nigerian Healthcare System: Pathway to Universal and High-Quality Health Care (pp. 117-152). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-030-88863-3_5
Batalden, P. B., & Davidoff, F. (2007). What is “quality improvement” and how can it transform healthcare? BMJ Quality & Safety, 16(1), 2–3. https://doi.org/10.1136/qshc.2006.022046
Berger, S., Saut, A. M., & Berssaneti, F. T. (2020). Using patient feedback to drive quality improvement in hospitals: a qualitative study. BMJ Open, 10(10), e037641. https://doi.org/10.1136/bmjopen-2020-037641
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
Braun, V., & Clarke, V. (2012). Thematic analysis. In H. Cooper, P. M. Camic, D. L. Long, A. T. Panter, D. Rindskopf, & K. J. Sher (Eds.), APA handbook of research methods in psychology, Vol. 2. Research designs: Quantitative, qualitative, neuropsychological, and biological (pp. 57–71). American Psychological Association. https://doi.org/10.1037/13620-004
Braun, V., Clarke, V., Boulton, E., Davey, L., & McEvoy, C. (2021). The online survey as a qualitative research tool. International Journal of Social Research Methodology, 24(6), 641–654. https://doi.org/10.1080/13645579.2020.1805550
Butler, C. (2015). Making interview transcripts real: The reader’s response. Work, Employment and Society, 29(1), 166–176. https://doi.org/10.1177/0950017014523482
Cascini, F., Santaroni, F., Lanzetti, R., Failla, G., Gentili, A., & Ricciardi, W. (2021). Developing a data-driven approach in order to improve the safety and quality of patient care. Frontiers in Public Health, 9, 667819. https://doi.org/10.3389/fpubh.2021.667819
Chaplin, B., Meloni, S., Eisen, G., Jolayemi, T., Banigbe, B., Adeola, J., … Kanki, P. (2015). Scale-up of networked HIV treatment in Nigeria: creation of an integrated electronic medical records system. International Journal of Medical Informatics, 84(1), 58–68. https://doi.org/10.1016/j.ijmedinf.2014.09.006
Coles, E., Anderson, J., Maxwell, M., Harris, F. M., Gray, N. M., Milner, G., & MacGillivray, S. (2020). The influence of contextual factors on healthcare quality improvement initiatives: a realist review. Systematic Reviews, 9, 1–22. https://doi.org/10.1186/s13643-020-01344-3
de Loyola González-Salgado, I., Rivera-Navarro, J., Gutiérrez-Sastre, M., Conde, P., & Franco, M. (2022). Conducting member checking within a qualitative case study on health-related behaviours in a large European city: Appraising interpretations and co-constructing findings. Health, 13634593221109682. https://doi.org/10.1177/13634593221109682
de Savigny, D., Adam, T., Alliance For Health Policy And Systems Research, & World Health Organization. (2009). Systems thinking for health systems strengthening. Alliance For Health Policy And Systems Research.
Dixon-Woods, M., & Martin, G. P. (2016). Does quality improvement improve quality? Future Hospital Journal, 3(3), 191–194. https://pubmed.ncbi.nlm.nih.gov/31098223
Dossett, L. A., Kaji, A. H., & Cochran, A. (2021). SRQR and COREQ reporting guidelines for qualitative studies. JAMA Surgery, 156(9), 875–876. https://doi.org/10.1001/jamasurg.2021.0525
Eboreime, E. A., Nxumalo, N., Ramaswamy, R., & Eyles, J. (2018). Strengthening decentralized primary healthcare planning in Nigeria using a quality improvement model: how contexts and actors affect implementation. Health Policy and Planning, 33(6), 715–728. https://doi.org/10.1093/heapol/czy042
Eldh, A. C., Årestedt, L., & Berterö, C. (2020). Quotations in Qualitative Studies: Reflections on Constituents, Custom, and Purpose. International Journal of Qualitative Methods, 19, 1–6. https://doi.org/10.1177/1609406920969268
Elliott, R., & Timulak, L. (2005). Descriptive and interpretive approaches to qualitative research. In J. Miles & P. Gilbert (Eds.), A handbook of research methods for clinical and health psychology (pp. 147–159). Oxford University Press.
Fakih, M. G., George, C., Edson, B. S., Goeschel, C. A., & Saint, S. (2013). Implementing a national program to reduce catheter-associated urinary tract infection: a quality improvement collaboration of state hospital associations, academic medical centers, professional societies, and governmental agencies. Infection Control & Hospital Epidemiology, 34(10), 1048–1054. https://doi.org/10.1086/673149
Hickman, A. B., Backus, K. V., Burns, P., & Brock, J. B. (2020). Evaluation of a postpartum linkage and retention quality improvement initiative for women living with HIV in the Deep South. Journal of Public Health, 30(4), 841–847. https://doi.org/10.1007/s10389-020-01355-3
Kaplan, H. C., Brady, P. W., Dritz, M. C., Hooper, D. K., Linam, W. M., Froehle, C. M., & Margolis, P. (2010). The influence of context on quality improvement success in health care: a systematic review of the literature. The Milbank Quarterly, 88(4), 500–559. https://doi.org/10.1111/j.1468-0009.2010.00611.x
Kitto, S., Goldman, J., Etchells, E., Silver, I., Peller, J., Sargeant, J., … Bell, M. (2015). Quality improvement, patient safety, and continuing education: a qualitative study of the current boundaries and opportunities for collaboration between these domains. Academic Medicine, 90(2), 240–245. https://doi.org/10.1097/ACM.0000000000000596
Kroezen, M., Buchan, J., Dussault, G., Glinos, I., & Wismar, M. (2016). How can structured cooperation between countries address health workforce challenges related to highly specialized health care?. https://run.unl.pt/bitstream/10362/36650/1/How_can_structured_cooperation_between_countries_address_health_workforce_challenges_related_to_highly_specialized_health_care.pdf
Manyazewal, T. (2017). Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities. Archives of Public Health, 75(1), 1–8. https://doi.org/10.1186/s13690-017-0221-9
Morse, J. M. (2015). Critical analysis of strategies for determining rigor in qualitative inquiry. Qualitative Health Research, 25(9), 1212–1222. https://doi.org/10.1177/1049732315588501
Munir, K., & Worm, I. (2016). Health systems strengthening in German development cooperation: making the case for a comprehensive strategy. Globalization and Health, 12(1), 1–8. https://doi.org/10.1186/s12992-016-0215-3
Mutale, W., Bond, V., Mwanamwenge, M. T., Mlewa, S., Balabanova, D., Spicer, N., & Ayles, H. (2013). Systems thinking in practice: the current status of the six WHO building blocks for health system strengthening in three BHOMA intervention districts of Zambia: a baseline qualitative study. BMC Health Services Research, 13, 1–9. https://doi.org/10.1186/1472-6963-13-291
Nasheeda, A., Abdullah, H. B., Krauss, S. E., & Ahmed, N. B. (2019). Transforming transcripts into stories: A multimethod approach to narrative analysis. International Journal of Qualitative Methods, 18, 1609406919856797. https://doi.org/10.1177/1609406919856797
Obansa, S. A. J., & Orimisan, A. (2013). Health care financing in Nigeria: prospects and challenges. Mediterranean Journal of Social Sciences, 4(1), 221–236.
Ogueji, I. A., Ogunsola, O. O., Abdalla, N. M., & Helmy, M. (2023). Mistrust of the Nigerian health system and its practical implications: Qualitative insights from professionals and non-professionals in the Nigerian health system. Journal of Public Health, 1–12. https://doi.org/10.1007/s10389-022-01814-z
Olaniran, A. A., Oludipe, M., Hill, Z., Ogunyemi, A., Umar, N., Ohiri, K., ... & Marchant, T. (2022). From theory to implementation: adaptations to a quality improvement initiative according to implementation context. Qualitative Health Research, 32(4), 646–655. https://doi.org/10.1177/10497323211058699
Oyeledun, B., Phillips, A., Oronsaye, F., Alo, O. D., Shaffer, N., Osibo, B., … Becquet, R. (2017). The effect of a continuous quality improvement intervention on retention-in-care at 6 months postpartum in a PMTCT program in Northern Nigeria: results of a cluster randomized controlled study. JAIDS Journal of Acquired Immune Deficiency Syndromes, 75, S156–S164. https://doi.org/10.1097/QAI.0000000000001363
Parkin, S., & Kimergård, A. (2022). A critical analysis of respondent quotes used as titles of qualitative research papers that are published in peer-reviewed journals. Accountability in Research, 29(2), 109–132. https://doi.org/10.1080/08989621.2021.1901224
Sheikh, K., Ranson, M. K., & Gilson, L. (2014). Explorations on people centredness in health systems. Health Policy and Planning, 29(suppl_2), ii1-ii5. https://doi.org/10.1093/heapol/czu082
Skinner, B. F. (1963). Operant behavior. American Psychologist, 18(8), 503–515. https://doi.org/10.1037/h0045185
Smith, B. M., Eden, J., & Corrigan, J. M. (Eds.). (2003). Leadership by example: Coordinating government roles in improving health care quality. National Academies Press.
Ubochi, N. E., Ehwarieme, T. A., Anarado, A. N., & Oyibocha, E. O. (2019). Building a strong and sustainable health care system in Nigeria: The role of the nurse. International Journal of Nursing and Midwifery, 11(7), 61–67. https://doi.org/10.5897/IJNM2019.0374
Ugo, O., Ezinne, E. A., Modupe, O., Nicole, S., Winifred, E., & Kelechi, O. (2016). Improving quality of care in primary health-care facilities in rural Nigeria: successes and challenges. Health Services Research and Managerial Epidemiology, 3, 2333392816662581. https://doi.org/10.1177/2333392816662581
Uneke, C. J., Ezeoha, A. E., Ndukwe, C. D., Oyibo, P. G., Onwe, F., & Aulakh, B. K. (2014). Research priority setting for health policy and health systems strengthening in Nigeria: The policymakers and stakeholders perspective and involvement. Pan African Medical Journal, 16, 1–10. https://doi.org/10.11604/pamj.2013.16.10.2318
Vasan, A., Mabey, D. C., Chaudhri, S., Brown Epstein, H. A., & Lawn, S. D. (2017). Support and performance improvement for primary health care workers in low-and middle-income countries: a scoping review of intervention design and methods. Health Policy and Planning, 32(3), 437–452. https://doi.org/10.1093/heapol/czw144
Vaughn, V. M., Saint, S., Krein, S. L., Forman, J. H., Meddings, J., Ameling, J., … Chopra, V. (2019). Characteristics of healthcare organisations struggling to improve quality: results from a systematic review of qualitative studies. BMJ Quality & Safety, 28(1), 74–84. https://doi.org/10.1136/bmjqs-2017-007573
Visscher, M., King, A., Nie, A. M., Schaffer, P., Taylor, T., Pruitt, D., … Keswani, S. (2013). A quality-improvement collaborative project to reduce pressure ulcers in PICUs. Pediatrics, 131(6), e1950–e1960. https://doi.org/10.1542/peds.2012-1626
Wagenaar, B. H., Hirschhorn, L. R., Henley, C., Gremu, A., Sindano, N., & Chilengi, R. (2017). Data-driven quality improvement in low-and middle-income country health systems: lessons from seven years of implementation experience across Mozambique, Rwanda, and Zambia. BMC Health Services Research, 17, 65–75. https://doi.org/10.1186/s12913-017-2661-x
Williams, M., & Moser, T. (2019). The art of coding and thematic exploration in qualitative research. International Management Review, 15(1), 45–55.
World Health Organization. (2010). Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. World Health Organization.
World Health Organization. (2016). Global strategy on human resources for health: workforce 2030.
World Health Organization. (2020). Quality health services: a planning guide. https://apps.who.int/iris/bitstream/handle/10665/336661/9789240011632-eng.pdf
Zurn, P., Zapata, T., & Okoroafor, S. C. (2021). The importance of strengthening the health workforce in Nigeria to improve health outcomes. Journal of Public Health, 43(Supplement_1), i1-i3. https://doi.org/10.1093/pubmed/fdab012
Acknowledgements
Thank you to all of the health workers in this study who shared their perspectives. Also, thanks to Dr. Rosie Steege and Laurina Edet Nyang for their helpful feedback on earlier drafts of this paper.
Author information
Authors and Affiliations
Contributions
Ifeanyichukwu Anthony Ogueji – Conception, study design, data collection, data analysis and interpretation, drafting the article, critical revision of the article, and final approval of the version to be submitted.
Oluwatosin Olakunle Motajo - Study design, data collection, interpretation of data, drafting the article, critical revision of the article, and final approval of the version to be submitted.
Obinna Orjingene - Study design, data collection, interpretation of data, drafting the article, critical revision of the article, and final approval of the version to be submitted.
Adebayo O. Adejumo - Study design, interpretation of data, critical revision of the article, and final approval of the version to be submitted.
Abiodun Bolarinwa Oduola - Study design, data collection, interpretation of data, critical revision of the article, and final approval of the version to be submitted.
Abimbola Victoria Ajayi - Study design, interpretation of data, critical revision of the article, and final approval of the version to be submitted.
The content of this paper is solely the responsibility of the authors and does not represent the views of their affiliations.
Corresponding author
Ethics declarations
This study was in accordance with the 1964 Helsinki ethical declaration, its later amendment, or a comparable standard.
Conflict of Interest
The authors have no conflict of interest to declare.
Consent to Participate
Consent was obtained from all participants prior to data collection.
Consent for Publication
All authors consent to the publication of this paper in Current Psychology. All participants consent that findings from their data should be published in this paper.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Ogueji, I.A., Motajo, O.O., Orjingene, O. et al. “Allowing the community, that is, the essential beneficiaries, to take the lead”: Using the perspectives of health workers to inform a contextually relevant quality improvement intervention in the Nigerian health system. Curr Psychol 43, 13679–13691 (2024). https://doi.org/10.1007/s12144-023-05359-6
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12144-023-05359-6