Health Strategy and Delivery Foundation

BackgroundQuality improvement (QI) collaboratives are increasingly popular. However, there is a need for an in-depth understanding of the influence of context on its implementation. We explored the influence of context on the change concepts considered by public primary (primary health centres), public secondary (public hospitals) and private (private facilities) collaboratives established to improve maternal and newborn health outcomes in Lagos State, Nigeria.MethodsBetween February 2019 and January 2020, we conducted a qualitative study using meeting reports, key informant interviews and participant observation. Data were analysed using the high-quality health system framework for assessing health system and user experience that distinguished three quality domains: quality impacts, processes of care and health system foundations.ResultsNineteen change concepts and 158 change ideas were observed across 28 facility QI teams. Change concepts and ideas prioritised were influenced by government and non-governmental leaders but ultimately shaped by facility QI capacity, time allocated for QI activities and availability of local data. Of the three quality domains, process of care, including patient satisfaction, received the most attention across facility types. There was considerable variation in the change concepts considered across domains. For example, more public hospitals focused on complication management because of a relatively high prevalence of and capacity to manage maternal complications; primary health centres focused more on complication referrals, while private facilities prioritised revenue generation. Problems with availability of resources were particularly highlighted in primary health centres which had relatively less financial commitment from stakeholders.ConclusionOur findings provide insights into QI collaboratives’ mechanism of change in which external stakeholders, including government, drove QI priorities for action but the ultimate decisions depended on local realities of facilities. Our findings underscore the need for strong QI leadership and sufficient resources to enable facility QI teams to prioritise change concepts for greater health impact.

BackgroundLong-haul drivers play a role in the spread of sexually transmitted infections (STI) globally. Truck drivers engage in frequent travel away from home. They are exposed to risky sex with commercial sex workers who are a reservoir of HIV and other STIs. The study aimed to identify factors associated with commercial sexual exposure among long-haul truckers in a southern Nigerian town.MethodsA sample of 300 long-haul truckers from a highway park in Ahor, southern Nigeria was recruited in a cross-sectional study. An interviewer-administered questionnaire was used to collect socio-demographic and sexual risk behavior data. Data were analyzed with SPSS version 20 software. Chi-square test, Odds ratio, and confidence intervals were used to find the association between condom use, STI history, HIV status, duration of a trip, number of sexual partners, and truckers’ exposure to commercial sex workers.ResultsWhile 42.0% of the truckers used condoms, 58.0% were non-users. Reasons for non-condom use were commitment to partner (72.0%), lack of pleasure (21.0%), and beliefs (7.0%). Fifty percent of respondents reported two or less sexual contacts while a third of them reported 12 sexual contacts in 6 months. Overall, 59.0% of respondents had a history of multiple sexual partners. Factors associated with truckers’ exposure to a commercial sex worker were use of psychoactive substance (OR 2.5 (1.5–4.4), p=0.00; condom use (OR 16.3 (8.0–32.5), p=0.00; previous sexually transmitted infection (OR 2.5 (1.2–5.1), p=0.01. The odds of single-sex partner exposure to a commercial sex worker were 10% less than the odds in multiple sex partner truckers, p=0.00.ConclusionThis study shows that psychoactive substances and condoms may be fueling exposure to commercial sex among truck drivers. Intervention programs should emphasize a single partner relationship, target substance users and highlight the potential impact of previous sexually transmitted infections on the risk of acquiring an HIV infection.DisclosureNo significant relationships.