Female clients’ gender preferences for frontline health workers who provide maternal, newborn and child health (MNCH) services at primary health care level in Nigeria

  • BMC Health Services Research, Volume 20, No. 1, Year 2020

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Study Justification:
– The study aims to investigate if female clients have gender preferences for frontline health workers who provide maternal, newborn, and child health (MNCH) services at primary healthcare level in Nigeria.
– Previous studies have not explored gender-based preferences of patients/clients for frontline health workers in primary healthcare settings, specifically for MNCH services.
– Understanding gender-based preferences is important for improving the uptake of MNCH services and achieving universal health coverage.
– The study is based on the theory of change that considers gender issues in healthcare implementation frameworks to improve health outcomes.
Study Highlights:
– The study involved 256 female clients who accessed MNCH services in selected primary health facilities in Bauchi and Cross-River States in Nigeria.
– Out of the participants, 44.1% preferred female frontline health workers, 2.3% preferred male frontline health workers, and 53.5% were indifferent about the gender of the health worker.
– Only 26.6% of female clients were attended to by male frontline health workers.
– Bivariate analysis suggests a relationship between a female client’s health worker gender preference and her pregnancy status, reason for visiting a primary healthcare facility, location in Nigeria, and the gender of the health worker(s) at the facility.
Recommendations for Lay Reader and Policy Maker:
– Sustained advocacy and increased efforts at community engagement are needed to promote the acceptability of healthcare services from male frontline health workers.
– Addressing gender preferences can have a significant impact on the uptake of MNCH services, particularly in northern Nigeria.
– Policy makers should consider gender-based considerations in healthcare implementation frameworks to improve the willingness of patients and clients to access healthcare services.
Key Role Players:
– Public health practitioners
– Policy makers
– Community leaders and influencers
– Healthcare providers
– Non-governmental organizations (NGOs) working in healthcare
Cost Items for Planning Recommendations:
– Advocacy and community engagement campaigns
– Training and capacity building for healthcare providers
– Development and dissemination of educational materials
– Monitoring and evaluation activities
– Research and data collection
– Collaboration with NGOs and community-based organizations

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is cross-sectional and quantitative, which allows for data collection and analysis. The sample size of 256 female clients is reasonable. The study provides descriptive analysis and bivariate analysis to examine relationships between key variables. However, the study could be improved by including a larger and more diverse sample, conducting qualitative research to gain deeper insights into the gender preferences, and considering potential biases in data collection and analysis.

Background: In Nigeria, anecdotes abound that female clients, particularly within northern Nigeria, have gender-based preferences for frontline health workers (FLHWs) who provide healthcare services. This may adversely affect uptake of maternal newborn and child health services, especially at primary healthcare level in Nigeria, where a huge proportion of the Nigerian population and rural community members in particular, access healthcare services. This study explored female clients’ gender preferences for frontline health workers who provide maternal, newborn and child healthcare (MNCH) services at primary healthcare level in Nigeria. Methods: The study adopted a cross-sectional quantitative design with 256 female clients’ exit interviews from selected primary health facilities within two States-Bauchi (northern Nigeria) and Cross-River (southern Nigeria). Data was collected using Personal Digital Assistants and data analysis was done using SPSS software. Descriptive analysis was carried out using percentage frequency distribution tables. Bivariate analysis was also carried out to examine possible relationships between key characteristic variables and the gender preferences of female clients involved in the study. Results: Out of 256 women who accessed maternal, newborn and child health services within the sampled health facilities, 44.1% stated preference for female FLHWs, 2.3% preferred male FLHWs while 53.5% were indifferent about the gender of the health worker. However only 26.6% of female clients were attended to by male FLHWs. Bivariate analysis suggests a relationship between a female client’s health worker gender preference and her pregnancy status, the specific reason for which a female client visits a primary healthcare facility, a female client’s location in Nigeria as well as the gender of the health worker(s) working within the primary healthcare facility which she visits to access maternal, newborn and child health services. Conclusions: The study findings suggest that female clients at primary healthcare level in Nigeria possibly have gender preferences for the frontline health workers who provide services to them. There should be sustained advocacy and increased efforts at community engagement to promote the acceptability of healthcare services from male frontline health workers in order to have a significant impact on the uptake of MNCH services, particularly within northern Nigeria.

As public health practitioners and policy makers strive to achieve universal health coverage and optimize the use of primary healthcare services, this study was designed to investigate if female clients have gender preferences for frontline health workers who provide services to them within primary healthcare settings. Previous studies from Nigeria and other countries have not investigated gender-based preferences of patients/clients for frontline health workers working at primary healthcare level who provide maternal, newborn and child healthcare (MNCH) services nor have previous studies investigated the implications of gender-based preferences for the uptake of MNCH services at the primary healthcare level. This study is based on a theory of change which assumes that to achieve universal health coverage and improve health outcomes within health systems, the implementation frameworks of governments and other key stakeholders should increasingly take gender issues into consideration. Gender-based considerations are important as these may have implications for the willingness to access healthcare services and the uptake of maternal, newborn and child health services by patients and clients. This research study was undertaken in two States (i.e. Bauchi and Cross River States) within Nigeria. Bauchi State is in the north-eastern part of the country with a predominantly Muslim population. Cross River State is in the southern part of Nigeria and has a predominantly Christian population. For Bauchi State, the rural Local Government Areas (LGAs) selected for the research study were Alkaleri and Giade LGAs while for Cross River State, the selected LGAs were Etung and Yala LGAs. The study was based on a cross-sectional quantitative research design. For site selection, multi-stage sampling was applied – the list of LGAs in Bauchi and Cross River States were stratified into urban and rural, which was followed by a random selection of two rural LGAs per State (Bauchi: Alkaleri and Giade LGAs; Cross River State: Yala and Etung LGAs) from the list of rural LGAs in each state. A list of PHC facilities offering maternal, newborn and child health services was stratified as Health posts, Primary Health Clinics and Primary Healthcare Centres; subsequently an equal representation of the different types of facilities was selected. Sixty-six (66) randomly selected primary healthcare facilities in Bauchi and Cross River States were involved. These health facilities represent half of all the available primary healthcare facilities in the randomly selected rural LGAs within the study States, based on a sampling approach used by Adeniyi and colleagues [14]. The researchers applied a purposive sampling strategy for client selection such that a cross-section of female clients who were accessing maternal newborn and child health services from primary healthcare health facilities were involved in this study. This study was part of a larger study undertaken to assess primary healthcare service delivery, using 66 health facilities across two states in Nigeria. For this study focused on assessing female clients’ gender preferences, the selection criteria was such that only health facilities among the 66 health facilities which recorded frontline health workers attending to an average of at least 7 patients/clients per day (determined by analysing data from the larger study) were purposively included within the study sample for this study assessing female clients’ gender preferences. Based on this selection criteria, all female clients who accessed the selected health facilities for maternal, newborn and child health services during the data collection period of the larger study were enrolled in this study. Thus, 256 women who accessed MNCH services from frontline healthcare providers in the selected health facilities for the study, either for themselves, their newborn or under-five children and willing to participate in the study were enrolled to participate in client exit interviews for the study. Pre-tested questionnaires (see Additional file 1) were uploaded on personal digital assistants (PDAs) to facilitate the data collection process. During fieldwork the study supervisors made spot-checks on completed questionnaires, and any irregularities were corrected before the data was sent to the database designed for the study. Data analysis was carried out with SPSS software. Descriptive analysis of the data was carried out using percentage frequency distribution tables. Bivariate analyses of the data were also conducted. Fishers’ Exact test was employed during bivariate analysis (partly due to the small sample size) to explore relationships between female clients’ gender preference and some key characteristic variables such as location, pregnancy status and gender of health worker(s) seen at health facilities.

Based on the provided description, here are some potential innovations that can be used to improve access to maternal health:

1. Gender Sensitization Training: Provide training to frontline health workers on gender sensitivity and cultural competence to ensure they understand and respect the gender preferences of female clients. This can help address any biases or stereotypes that may exist and improve the quality of care provided.

2. Community Engagement: Increase efforts to engage with communities, particularly in northern Nigeria where gender-based preferences may be more prevalent. This can involve community dialogues, awareness campaigns, and education sessions to promote the acceptability of healthcare services from male frontline health workers.

3. Mobile Health (mHealth) Solutions: Utilize mobile health technologies, such as SMS reminders and appointment scheduling, to improve communication and access to maternal health services. This can help overcome barriers related to distance and transportation, particularly in rural areas.

4. Task Shifting/Sharing: Explore the possibility of task shifting or task sharing within the healthcare system. This can involve training and empowering community health workers, including male health workers, to provide certain maternal health services. By expanding the pool of healthcare providers, access to services can be increased.

5. Culturally Sensitive Service Delivery: Ensure that healthcare facilities are culturally sensitive and provide a welcoming environment for female clients. This can include having separate waiting areas or designated female-only spaces within the facility.

6. Peer Support Programs: Establish peer support programs where women who have successfully accessed maternal health services can mentor and support other women in their community. This can help address any fears or concerns related to gender preferences and encourage more women to seek care.

7. Strengthening Referral Systems: Improve the coordination and communication between primary healthcare facilities and higher-level facilities to ensure seamless referral and follow-up care for maternal health services. This can help address any gaps in service provision and ensure that women receive the appropriate care they need.

It is important to note that the implementation of these innovations should be context-specific and tailored to the unique needs and preferences of the communities being served.
AI Innovations Description
The study mentioned in the description explores female clients’ gender preferences for frontline health workers who provide maternal, newborn, and child healthcare (MNCH) services at the primary healthcare level in Nigeria. The study found that 44.1% of female clients preferred female frontline health workers (FLHWs), 2.3% preferred male FLHWs, and 53.5% were indifferent about the gender of the health worker. However, only 26.6% of female clients were attended to by male FLHWs.

Based on these findings, the study recommends sustained advocacy and increased efforts at community engagement to promote the acceptability of healthcare services from male frontline health workers. This is important to have a significant impact on the uptake of MNCH services, particularly within northern Nigeria where gender preferences may be more prevalent.

The study suggests that taking gender issues into consideration is crucial for achieving universal health coverage and improving health outcomes within health systems. By addressing gender-based preferences, policymakers and public health practitioners can optimize the use of primary healthcare services and improve access to maternal health services.

The study was conducted in two states in Nigeria, Bauchi and Cross River, which have different religious and cultural backgrounds. The researchers used a cross-sectional quantitative research design and involved 256 female clients through exit interviews from selected primary health facilities.

The study also conducted bivariate analysis to examine possible relationships between a female client’s health worker gender preference and her pregnancy status, the specific reason for visiting a primary healthcare facility, location in Nigeria, and the gender of the health worker(s) working within the facility.

Overall, the study highlights the importance of understanding and addressing gender preferences in healthcare settings to improve access to maternal health services, particularly in areas where gender-based preferences may exist.
AI Innovations Methodology
Based on the provided description, here are some potential recommendations to improve access to maternal health:

1. Increase the number of female frontline health workers (FLHWs): Since a significant percentage of female clients prefer female FLHWs, increasing the number of female FLHWs can help improve access to maternal health services. This can be achieved through targeted recruitment and training programs.

2. Sensitize and train male frontline health workers: To address the gender preferences of female clients, it is important to sensitize and train male FLHWs on gender-sensitive care. This can help improve their communication and interpersonal skills, making them more acceptable to female clients.

3. Community engagement and advocacy: Sustained advocacy and community engagement efforts are needed to promote the acceptability of healthcare services from male FLHWs. This can involve community dialogues, awareness campaigns, and education on the importance of gender equality in healthcare.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline data collection: Collect data on the current access to maternal health services, including the number of female clients, their preferences for FLHWs, and the gender distribution of FLHWs attending to them.

2. Intervention implementation: Implement the recommended interventions, such as increasing the number of female FLHWs and sensitizing male FLHWs.

3. Post-intervention data collection: Collect data after the interventions have been implemented to assess any changes in access to maternal health services. This can include measuring the percentage of female clients who prefer female FLHWs, the number of female FLHWs, and the gender distribution of FLHWs attending to female clients.

4. Data analysis: Analyze the data collected before and after the interventions to determine the impact of the recommendations. This can involve comparing the baseline data with the post-intervention data to identify any changes in access to maternal health services.

5. Evaluation and interpretation: Evaluate the results of the data analysis to determine the effectiveness of the recommendations in improving access to maternal health. Interpret the findings to understand the implications for policy and practice.

6. Continuous monitoring and adjustment: Monitor the ongoing implementation of the recommendations and make adjustments as needed based on the evaluation findings. This can involve refining the interventions or implementing additional strategies to further improve access to maternal health services.

By following this methodology, policymakers and public health practitioners can assess the impact of the recommendations on improving access to maternal health and make informed decisions for future interventions.


Statistics:
Citations: 1
Identifiers:
DOI: 10.1186/s12913-020-05251-0
Research Areas:
Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants
Study Countries:
Nigeria
Study Design:
Cross Sectional Study, Grounded Theory
Study Approach:
Quantitative
Participants Gender:
Male & Female
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