Strategic investment in frontline health workers is vital in achieving the Sustainable Development Goal 3 centered around good health and wellbeing. The most populous country in Africa, Nigeria faces an increasing burden of disease due to mental health, cancer, and complications from pregnancy and childbirth. Like many low- and lower middle-income countries, Nigeria’s situation is compounded by poorly funded health systems, shortages and inequitable distribution of medical doctors, nurses and midwives, and inadequate programs for capacity strengthening.
“We must focus on a people-centred approach to strengthening our health system in Nigeria.”
Frontline health workers need to be skilled, resourced, deployed and retained to ensure equitable quality of care—an approach consistent with the people-first model of the Johnson & Johnson Center for Health Worker Innovation. With support from the Johnson & Johnson Foundation, the Center collaborated with Liverpool School of Tropical Medicine, Real Visionaries Initiative and Medicaid Cancer Foundation to convene two multi-stakeholder co-creation workshops held in Abuja and Lagos in early April to understand the gaps and needs that exist in strengthening nursing and midwifery in Nigeria—specifically focused on pre-service and in-service education and continuous professional development in the areas of mental health, oncology, and maternal and newborn health. The end goal is the creation of a strategic roadmap to identify and prioritize potential areas for partnerships and investment.
“The thematic areas focused on in this workshop is quite important to the national development, and the fact that mental health is included make us at Real Visionaries Initiative really interested in this project.”
The burden of mental illness in Nigeria is high, with close to 30% of its population affected by some form of the disease. This is exacerbated by a critical shortage of specialist mental health professionals, with a ratio of one psychiatrist to every one million people. The COVID-19 pandemic has also highlighted work-related stress and mental health issues experienced by health workers and the need for adequate support to ensure resilience and optimal well-being of frontline health workers.
Cancer is the second leading cause of death globally, accounting for an estimated 9.6 million deaths in 2018. Many health systems in low- and lower middle-income countries are not equipped to manage this burden and statistics show that Nigeria has fewer than 90 clinical oncologists providing treatment to over 100,000 cancer patients across the country. Although Nigeria has a National Cancer Control Plan 2018 to 2022, interrupted provision of oncology services brought about by COVID-19 and a lack of investments in infrastructure, equipment and human resources hinders its full implementation.
A recognized barrier to improving maternal and newborn health has been the poor quality of care provided by midwives, nurses, doctors and other health workers in low- and lower middle-income settings. Pre-service midwifery education, training curricula and professional development in these countries has been shown to be deficient. This is evident, for example, in the slow rate of decline in the maternal mortality ratio in Nigeria—in 2017, the country had the highest estimated number of maternal deaths, accounting for approximately 23% of estimated global maternal deaths.
Co-creation workshops bring together expertise and experience from all sectors
“The experience over the last four days has given us the opportunity to engage with stakeholders in oncology care and how we can use those challenges… to co-develop solutions to strengthen the system for both pre- and in-service training for the future.”
The Center worked with the Liverpool School of Tropical Medicine, Real Visionaries Initiative and Medicaid Cancer Foundation to build the participant list and ensure the right expertise and experience was in the room. The workshops were well attended, with strong representation from federal and state Ministry of Health, nursing and midwifery education bodies, professional associations, non-government organizations, administrators, researchers, and health workers including surgeons, nurses, midwives, student nurses and phycologists. Cross-sector participants from local Johnson & Johnson businesses in Nigeria were also in attendance.
Participants identified and highlighted challenges faced in oncology, mental health, and midwifery, providing recommendations on the way forward and calls to action needed to reform and implement improved, accessible and affordable health services for the well-being of Nigerian citizens. The event provided a forum for dialogue and learning amongst participants, with high levels of active engagement. The concept of co-creation was well received, with participants saying that they owned the outputs of discussions and played a key role in addressing the identified interventions.
Speaking at the event, Laura Nel, Director, Johnson & Johnson Global Community Impact, Africa said she was inspired by the passion, expertise, and the willingness to engage, share, and learn. “I think that the solutions to the issues facing nursing in Nigeria can be found in this room,” she said. “We’ve got all the experts here and I have heard people tell me that this forum has been helpful for them to understand issues of other partners better.”
Charles Ameh, Head of the Emergency Obstetric Care and Quality of Care Unit, International Public Health Department at the Liverpool School of Tropical Medicine and lead for the co-creation workshops, echoed these sentiments. “After four days of workshop in Abuja and Lagos, I think we have seen the passion displayed by our stakeholders at national and sub-national level, we know where the problems are, and we were able to share experiences of improving the situation from one state to the other," he said.