The Implications of Health Financing for Health Access and Equity in Nigeria

The Nigeria health system has performed woefully against all vital health indices, trailing behind many African countries despite its enormous potentials. The reason for this is mainly due to the financial risk Nigerians face in accessing health care. This study addresses the implications of the current health care financing in Nigeria on access and equity. It shows the imperativeness of an alternative health care financing in line with best practices, from comparable Low- and Middle-Income Countries (LMICs), apart from the current National Health Insurance Scheme (NHIS). The findings from this study recommend that the NHIS should be strengthened through the policy reform to embrace fund pooling/risk-sharing, subsidisation for the poor and the vulnerable, mandatory enrolment, and fragmentation of NHIS. Other considerations include increasing domestic fiscal space for health and utilising a tax-based financing mechanism that has been progressive in all LMICs, thereby preventing the need for unsustainable reliance on external funding. A comprehensive package of health at the point of care is also necessary. However, all these recommendations require the government to show a commitment to improve the country’s healthcare system through its health spending.

Where Have They Gone? Recruiting and Retaining Older Rural Research Participants

Issue: Rural-dwelling elderly have been shown to suffer from health disparities when compared to the general population. Research involving these individuals is important, and to have meaningful results, sample sizes must be adequate. Recruiting and retaining these individuals pose significant challenges. Context: Nurse researchers in the rural northwestern United States conducted a 4-part educational intervention aimed at increasing general and complementary and alternative health care literacy of older rural dwellers. Significant challenges were faced in both recruiting and retaining participants over the 6-month study period. Despite careful planning and community selection, the team had to double the number of communities in which they carried out the project to meet recruitment goals. Retention was also a challenge. Of 127 participants initially enrolled in the study, only 52 remained to the end. Lessons Learned: Challenges of recruiting and retaining are complex and compounded when the target population is rural, older and the study is longitudinal. Recruitment challenges included reaching older adults, offering a compelling program, and offering it in an acceptable format at a convenient time and place. A variety of outreach activities were conducted including in-person presentations, advertising or public interest stories in local newspapers or radio stations, and flyers on bulletin boards in restaurants, clinics, churches, community centers, and libraries. A project champion, an individual well known and connected within the community and committed to the success of the proposed study, is a major asset. Retention strategies included developing relationships with the participants and maintaining contact with them over the course of the study through such mechanisms as appointment cards, e-mail or regular mail, telephone reminders, and thank you cards. Oversampling was important as factors beyond the control of the researcher occurred; for example, illness, death, family crises, unexpected relocations, and weather events that prevented travel to scheduled research events. Keywords: complementary health, health literacy, participant retention, sampling Funding: National Institutes of Health, National Center for Complementary and Integrative Health 1R15AT009097-01DOI: https://doi.org/10.14574/ojrnhc.v21i1.642

SCIENTIFIC RATIONALITY, ADOPTION AND PERCEIVED EFFECTIVENESS OF ETHNOMEDICAL PRACTICES ON BITE REMEDIES IN IDUKKI, KERALA

The study was carried out among tribal farmers of Idukki district, Kerala. Forty gramapanchayats were selected for the study. A total of 90 tribal healers cum age-old farmers and 452 tribal farmers were the respondents of this study. The study recorded sixty eight EMPs on bite remedies. The prevalent categories of EMPs expertise were on poisonous bites (48.55%), snake bites (22.05%), scorpion bites (16.17%), spider bites (10.29%), and dog bites (2.94%). Of the sixty eight EMPs, seventeen were assessed for their scientific rationality and adoptions of which sixteen were studied for their perceived effectiveness among tribal farmers. Of the seventeen practices, fourteen were found to be rational, while the rest three were irrational. In this study, the scientific rationale behind fourteen rational EMPs was also explained. Sixteen practices were adopted by 51.32 to 83.18 percent of the respondents. Of the sixteen EMPs studied for effectiveness, all were perceived as effective by the tribal farmers, and this revealed that many EMPs on bite remedies were both rational and effective. This requires more clinical and pharmacological interference to validate and standardize EMPs, which will consecutively pave way for the development of low cost and effective alternative health care system.

Acupuncture Medical Therapy and its Underlying Mechanisms: A Systematic Review

As a traditional Chinese alternative health care approach, acupuncture is gaining increasing attention and reputation in China and overseas. While becoming increasingly popular globally, some consumers and professionals still know little about the therapy and underlying mechanisms of acupuncture. Due to local superiority, there are large numbers of both clinical applications and mechanistic studies performed in China compared to countries overseas. Herein, this review attempts to give a comprehensive profile of the development, application, and mechanisms of acupuncture in treating major diseases. The number of clinical publications concerning acupuncture-treated neurological diseases, endocrine and metabolic diseases, circulatory diseases, respiratory diseases, etc. is first counted, and then, the application and therapeutic mechanisms of acupuncture on the predominant diseases in each category, including obesity, facial paralysis, sciatica, depression, hypertension, asthma, etc., are specifically discussed in this paper. The evolution of acupuncture tools and the rationality of acupoints are also discussed. This review not only summarizes the mechanisms of acupuncture but also provides useful information, such as specific acupoints and acupuncture procedures, for treating common diseases. Therefore, the current study provides useful information for both investigators and acupuncturists.

Preference of Traditional Bone setting and associated factors among trauma patients with fracture at Black Lion Hospital in Addis Ababa, Ethiopia: Institution Based cross sectional study

Objective Despite the access and availability of modern health care, traditional bone setting (TBS) has a big place as alternative health care. Hence, this study was aimed to assess the preference of traditional bone setting and associated factors among patients with a fracture. Results A total of 224 patients known to have fractured at Black Lion Hospital, Addis Ababa was included in the study. This study revealed that 29.9% of the study participants had a preference for the traditional bone setting. Hospital admission (AOR=8.158, 95% CI: 1.179, 56.439), TBS center as first port of call after injury (AOR=0.004, 95% CI: 0.001, 0.090), knowledge (AOR=9.448, 95% CI: 1.481, 60.251) and perception (AOR=0.026, 95% CI: 0.003, 0.215) were statistically significant. The preference for the traditional bone setting is high. Hospital admission, traditional bone setting center as a first port of call after injury, knowledge, and perception were significantly associated with the preference of traditional bone setting. In addition to deployment of trained in trauma professionals, working more on awareness creation and training are recommended.

Preference of Traditional Bone setting and associated factors among trauma patients with fracture at Black Lion Hospital in Addis Ababa, Ethiopia: Institution Based cross sectional study

Objective Despite the access and availability of modern health care, traditional bone setting (TBS) has a big place as alternative health care. Hence, this study was aimed to assess the preference of traditional bone setting and associated factors among patients with a fracture. Results A total of 224 patients known to have fractured at Black Lion Hospital, Addis Ababa was included in the study. This study revealed that 29.9% of the study participants had a preference for the traditional bone setting. Hospital admission (AOR=8.158, 95% CI: 1.179, 56.439), TBS center as first port of call after injury (AOR=0.004, 95% CI: 0.001, 0.090), knowledge (AOR=9.448, 95% CI: 1.481, 60.251) and perception (AOR=0.026, 95% CI: 0.003, 0.215) were statistically significant. The preference for the traditional bone setting is high. Hospital admission, traditional bone setting center as a first port of call after injury, knowledge, and perception were significantly associated with the preference of traditional bone setting. In addition to deployment of trained in trauma professionals, working more on awareness creation and training are recommended.