ArticleGlobal health action2018
Implementation of free maternal and child healthcare policies: assessment of influence of context and institutional capacity of health facilities in South-east Nigeria.
Article in Global health action, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 2 of them syntheses that pooled it.
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Who cites it
24 citing papers in PubMed, 2 syntheses or guidelines pooled it, 50 citations in OpenAlex.
- Effects of decentralization on the functionality of health facility governing committees in lower and middle-income countries: a systematic literature review.Global health action · 2022Pooled it
- Implementation of medicines pricing policies in sub-Saharan Africa: systematic review.Systematic reviews · 2022Pooled it
- Caregivers´ qualitative insights on trust, resilience and vaccination attitudes shaping child health in conflict-affected Northeast Nigeria.Conflict and health · 2026Article
- Assessing the costs of antenatal care in Eastern Ethiopia: implications for improving the free maternity services policy.Health policy and planning · 2026Article
- Who benefits from the donor-supported malaria programme in Enugu State, Nigeria? A benefit incidence analysis.PLOS global public health · 2025Article
- Development and pilot implementation of a novel protocol to assess capacity and readiness of health systems to adopt HPV detection-based cervical cancer screening in Europe.Health research policy and systems · 2024Article
- Using knowledge translation to support the use of evaluation findings: A case study of the linda mama free maternity program in Kenya.PLOS global public health · 2024Article
- Article
- The nature, drivers and equity consequences of informal payments for maternal and child health care in primary health centres in Enugu, Nigeria.Health policy and planning · 2023Article
- Impact of free maternity services on outcomes related to hypertensive disorders of pregnancy at Moi Teaching and Referral Hospital in Kenya: a retrospective analysis.BMC pregnancy and childbirth · 2023Article
- Aspirations and realities of intergovernmental collaboration in national- level interventions: insights from maternal, neonatal and child health policy processes in Nigeria, 2009-2019.BMJ global health · 2023Article
- Understanding context in the implementation of emergency obstetric and neonatal care in health facilities in Osun State, Nigeria- a mixed-methods study.BMC pregnancy and childbirth · 2022Article
- Absenteeism in primary health centres in Nigeria: leveraging power, politics and kinship.BMJ global health · 2022Article
- The effect of health financing reforms on incidence and management of childhood infections in Ghana: a matching difference in differences impact evaluation.BMC public health · 2022Article
- Addressing child health inequity through case management of under-five malaria in Nigeria: an extended cost-effectiveness analysis.Malaria journal · 2022Article
- Article
- The functionality variation among health facility governing committees under direct health facility financing in Tanzania.PLOS global public health · 2022Article
- Examining the implementation of the Linda Mama free maternity program in Kenya.The International journal of health planning and management · 2021Article
- "We have either obsolete knowledge, obsolete equipment or obsolete skills": policy-makers and clinical managers' views on maternal health delivery in rural Nigeria.Family medicine and community health · 2021Article
- Perception of Person-Centred Maternity Care and Its Associated Factors Among Post-Partum Women: Evidence From a Cross-Sectional Study in Enugu State, Nigeria.International journal of public health · 2021Article
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Authors and funding
2 authors at 1 institution in 1 country.
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Abstract
backgroundStudies examining how the capacity of health facilities affect implementation of free healthcare policies in low and middle-income countries are limited.
objectiveThis study describes how the context and institutional capacity of health facilities influenced implementation of the free maternal and child health programme (FMCHP) in Enugu state, South-east Nigeria.
methodsWe conducted a qualitative case study at the state level and in two health districts (Isi-Uzo and Enugu Metropolis) in Enugu State. Data were collected through document review and semi-structured, in-depth interviews with policymakers (n = 16), healthcare providers (n = 16) and health facility committee leaders (n = 12) guided by an existing capacity framework and analysed using a thematic framework approach.
resultsThe findings reveal that active health facility committees, changes in provider payment process, supportive supervision, drug revolving fund, availability of medical equipment, electronic data transmission and staff sanction system enhanced the capacity of health facilities to offer free healthcare. However, ineffective decentralisation, irregular supervision and weak citizen participation limited this capacity. Uncertain provider payment, evidence of tax payment policy and a co-existing fee-exempt scheme constrained health facilities in following the FMCHP guidelines. Poor recording and reporting skills and lack of support from district officials constrained providers' adherence to claims' submission timeline. Poor funding, weak drug supply system, inadequate infrastructure and lack of participatory decision-making constrained delivery of free healthcare. Insufficient trained workforce, mission-inconsistent postings and transfers, and weak staff disciplinary system limited the human resource capacity.
conclusionsEffectiveness of FMCHP at the health facility level depends on the extent of decentralisation, citizen participation, concurrent and conflictive policies, timely payment of providers, organisation of service delivery and human resources practices. Attention to these contextual and institutional factors will enhance responsiveness of health facilities, sustainability of free healthcare policies and progress towards universal health coverage.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.