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AHEAD

Capacity Development

Public Health research is not an end in itself; it is intended to generate knowledge that can be used to improve service delivery, policies and practices. AHEAD aids capacity building of health professionals through training and mentoring, bridging the gap that exists between researchers and policy makers which inevitably impacts on quality of research and intervention. The health care systems in Nigeria is continually challenged with inadequately resourced professionals in terms of leadership and management knowledge and skills, this immensely contributes to the perpetual under-performance of health professionals and systems in Nigeria. This is the underlying philosophy of the “Leading and Managing for Result” workshop developed and implemented by Academy for Health Development, and many other relevant workshops.

Workshop Title: Workshop on Programme Management Training for Health Professionals (Lagos State AIDS Control Agency (SACA) & State + SMOH) – 21st to 23rd, October, 2015

Client Organisation/Sponsoring Agency: AIDS Preventive Initiative of Nigeria (APIN)

Training Location: Ikeja, Lagos state, Nigeria

 

Workshop Title: Programme Management and Leadership Training for Health Professional (OYSACA+SMOH) – 28th to 30th October, 2015

Client Organisation/Sponsoring Agency: AIDS Preventive Initiative of Nigeria (APIN)

Training Location: Ibadan, Oyo State, Nigeria

Workshop Title: Workshop on Programme Management Training for Health Professionals (Plateau SACA) – 4th to 6th November, 2015

Client Organisation/Sponsoring Agency: AIDS Preventive Initiative of Nigeria (APIN)

Training Location: Jos, Plateau State, Nigeria

Workshop Title: Training Programme on Grant and Project Management for Civil Society Organisations in Partnership with the Anti-Corruption Academy of Nigeria – 15th to 19th December, 2015

Client Organisation/Sponsoring Agency: Anti-Corruption Academy of Nigeria (ACAN) / UNDP

Training Location: Ibadan, Oyo State, Nigeria

Workshop Title: Training Programme on Grant and Project Management for Civil Society Organisations in Anti-Corruption Sectors – 30th May to 3rd June, 2016

Client Organisation/Sponsoring Agency: Anti-Corruption Academy of Nigeria (ACAN) / UNDP

Training Location: Ikoyi, Lagos State, Nigeria

Workshop Title: Programme Management and Leadership Training for Health Care Professionals (APIN Middle-Level Managers) – 15th to 17th June, 2016

Client Organisation/Sponsoring Agency: AIDS Preventive Initiative of Nigeria (APIN)

Training Location: Ile-Ife, Osun State, Nigeria

Workshop Title: Programme Management Training for Health Care Professionals (APIN Technical Associates) 28th to 30th June, 2016.

Client Organisation/Sponsoring Agency: AIDS Preventive Initiative of Nigeria (APIN)

Training Location: Ile-Ife, Osun State, Nigeria

Workshop Title: Fundamentals of Manuscript Writing Workshop (APIN Research Team) – 11th to 15th July, 2016

Client Organisation/Sponsoring Agency: AIDS Preventive Initiative of Nigeria (APIN)

Training Location: Ile-Ife, Osun State, Nigeria

Workshop Title: Training Programme on Grant and Project Management for Civil Society Organisations in Partnership with the Anti-Corruption Academy of Nigeria – 21st to 23rd July, and 4th to 6th October, 2016

Client Organisation/Sponsoring Agency: Anti-Corruption Academy of Nigeria (ACAN)/UNDP

Training Location: Abuja, Nigeria

Workshop Title: Corruption Risk Assessment Training of Trainers – 26th to 30th September, 2016

Client Organisation/Sponsoring Agency: Anti-Corruption Academy of Nigeria (ACAN)

Training Location: Keffi, Nasarawa State, Nigeria

Workshop Title: Training on Monitoring and Evaluation for ICPC CMED Staff – 6th to 8th June, 2017

Client Organisation/Sponsoring Agency: Anti-Corruption Academy of Nigeria (ACAN)

Training Location: Keffi, Nasarawa State, Nigeria

Workshop Title: Leading and Managing for Results (Management Team, HAI) – 11th to 13th July, 2017

Client Organisation/Sponsoring Agency: Heartland Alliance International (HAI), Nigeria Chapter

Training Location:Ikeja, Lagos State, Nigeria

Workshop Title: Introduction to Grant Writing and Essentials of Project Management – 28th August to 1st September

Client Organisation/Sponsoring Agency: Heartland Alliance International (HAI), Nigeria Chapter

Training Location: Ibadan, Oyo State, Nigeria

Workshop Title: Management & Leadership Workshop on ‘Site Sustainability and Close-Out Strategic Meeting’ (for CIHP Management Team) – 20th to 22nd, September, 2017

Client Organisation/Sponsoring Agency: Centre for Integrated Health Programs (CIHP)

Training Location: Ikeja, Lagos State, Nigeria

Workshop Title: Management & Leadership Workshop on ‘Site Sustainability and Close-Out Strategic Meeting’ (for CIHP State Team) – 26th to 29nd, September, 2017

Client Organisation/Sponsoring Agency: Centre for Integrated Health Programs (CIHP)

Training Location: Akwanga, Nasarawa State, Nigeria

Workshop Title: Workshop on Using Reference Managers & ATLAS.ti 8 Windows for Literature Review – 27th to 28th march, 2018

Client Organisation/Sponsoring Agency: Academy for Health Development

Training Location: Ile-Ife, Osun State, Nigeria

Workshop Title: Thesis/Dissertation Writing Skill-Building Workshop – 28th to 30th November, 2018

Client Organisation/Sponsoring Agency: Academy for Health Development

Training Location: Ile-Ife, Osun State, Nigeria

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Research Implementation

AHEAD serves as a platform for promoting inter-disciplinary research activities capable of improving health. Our research efforts are focused on strengthening the evidence-based facts and findings for effective policy making and programme development. The organisation has a leverage of accomplished researchers and experts with robust track records of attracting grants from a variety of sources, designing and conducting research activities in many states within the country. AHEAD has successfully implemented several health researches that are of significance at national and international level over the last couple of years of her operation. We also assist and provide services for the implementation of health researches to private and public sectors, and disseminate findings so as to make evidence-based facts available to stakeholders. The researches implemented by AHEAD so far include:

The Accelerated Action for the Health of Adolescents (AA-HA) Framework (Sept 2016, and May 2017)

Name of Client: World Health Organisation (WHO), Geneva, Switzerland

Funder: WHO

Overall Project Value: USD 2,500

Project Summary: A framework which was developed by WHO as a global document to provide countries with guidance for developing a coherent national  plan  for  the  health  of  adolescents,  and  to  align  the  contribution  of  relevant stakeholders in planning, implementing, and monitoring a comprehensive response to the health needs of adolescents. The AA-HA Framework was also aimed to support the Global Strategy for Women’s, Children’s and Adolescents’ Health. For the development of the AA-HA Framework, WHO, through an open, global competitive bidding, selected AHEAD and 6 other organisations across the world to conduct the formative research that informed the content of the framework, and to field-test the materials for young people at a second phase.         

OVC MER Outcome Monitoring in Nigeria in 6 states across Nigeria (Aug, 2016 – March, 2017)

Name of Client: Measure Evaluation/Palladium

Funders: USAID

Partners: Centre for Research, Evaluation Resources and Development (CRERD), Nigeria.

Overall Project Value: USD 699, 972. 57   

Project Description: The survey measured the outcomes of OVC project funded by CDC/USAID using a standardized methodology that has been developed for application across multiple countries.

National Tuberculosis Quality of Care Study (April 2017 – March 2018)

Name of Client: Measure Evaluation/JSI USA

Funder: USAID

Overall Project Value: 53, 031, 325.00 Naira

Project Description: The project aimed to measure the quality of care of tuberculosis (TB) program in 12 states of Nigeria (2 states per region) and involved 144 facilities (12 facilities each from 12 states) and to provide actionable results for the Nigeria’s national Tuberculosis, Buruli Ulcer, and Leprosy Control Programme (NTBLCP) to develop program or interventions to improve TB service delivery using an innovative mobile-assisted data and dissemination system.

Tuberculosis Knowledge, Attitude and Practice (TBKAP) Follow-up Survey/Nigeria (Nov, 2017 – March 2018)

Name of Client: Association for Reproductive and Family Health (ARFH), Abuja, Nigeria

Funder: Global Fund

Overall project Value: 56, 209, 736.00 Naira

Project Description: The project aimed to determine the change in            the level of           knowledge, attitude and practices (KAP) of people towards Tuberculosis in Nigeria. The survey was implemented in 12 states (two states per geo-political zone of the country). The study involved mixed-method approach, entailing the quantitative survey of over 10,000 respondents (general population, TB patients,  patients  living  with  HIV,  and  health  workers),  focus  group discussion, in-depth interview, and facility record review.

Understanding the use of misoprostol to induce abortion in countries with restrictive abortion laws – Nigeria (Jan, 2018 – )           

Name of Client: Guttmacher Institute, USA

Funder: Guttmacher Institute, USA

Overall Project Value: USD 214, 899   

Project Description: The project aimed to understand current gaps in knowledge on women’s experiences obtaining abortions using Medical Abortion, and providers’ experiences in distributing it in an illegal setting. The project focuses on the two largest states in Nigeria – Lagos in South-west region, and Kano in North-west region

Microbiome Study (May, 2018)

Name of Client: African Research Group of Oncology (ARGO) & Sloan Kettering Institute, USA

Funder:

Overall Project Value:

Project Description: ARGO in partnership with Sloan Kettering Institute in the United States, and Academy for Health Development being the consultant, carried out a research on Microbiome in Osun State, Nigeria, primarily to identify factors that cause cancer, so as to effect changes that will prevent its viral spread in Nigeria.

Starting Right at School (StaRS), Gendered Socialisation among Very Young Adolescents in Schools and their Sexual Reproductive Health (Aug, 2018 – till date)

Name of Client: International Development Research Centre (IDRC)

Funder: International Development Research Centre (IDRC)

Overall Project Value:

Project Description: The Starting Right at School (StaRS) Project is a study aimed at understanding the gender socialization norm among very young adolescents. It is implemented in three different countries. In Nigeria, it is currently being carried out by the Academy for Health Development (AHEAD) in Osun state, Nigeria. The project which is comprised of 3 stages; baseline, intervention and endline phases has just rounded up the baseline phase.

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AHEAD Meets with the School Principals and Leaders of the State Education Board

As a follow-up to the assessment of school facilities, the organization held a Project Intervention Discussion with the principals and leaders of the state education board to discuss the intervention plans for the school. The most recurrent issues among the schools were Water and
Sanitation Hygiene, Bullying and Violence and issues surrounding Gender.

Based on these findings, the AHEAD team developed a body of interventions that were divided into 3 classes:

  1. Physical Interventions which include provision of sanitary facilities like hand-wash basins and Information Education Communication (IEC) materials.
  2. Policy which covers the setting up of laws and rules to ensure adherence and compliance with the interventions.
  • Training curricula which would be taught to the teachers who would then teach the students to ensure mind-shifts and improve acceptance of the interventions.

The curricula developed were divided into the 3 thematic areas of WASH, Gender, Bullying & Violence as identified to be addressed in the project. These curricula will be delivered to the teachers in a series of trainings and they in turn will deliver it to the students through the agreed delivery methods.

The curriculum will be delivered by the schools during the periods assigned for extracurricular activities, holding fortnightly, after which, clubs would be formed to encourage and advocate for good practices of what would have been taught. Teaching aids such as video, charts and materials would be employed for the demonstration of specific topics like hand washing and menstrual hygiene

PHOTO HIGHLIGHTS FROM THE MEETING

 

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1st Prof. Babatunde Osotimehin Legacy Forum

 

The Academy for Health Development (AHEAD) in conjunction with the Partnership For Advocacy in Child and Family Health @ Scale (PASA) organised the 1st edition of the Professor Babatunde Osotimehin Legacy Forum. It was held on the 19th of July, 2019 at the Conference Centre in the University of Ibadan.

In her remarks, Mrs Funke Osotimehin advocated for the education of Family Planning to be extended to not just young and teenage girls, but also to their mothers.

In his goodwill message, the Permanent Secretary, Federal Ministry of health, through his representative Dr Kayode Afolabi recognized the contributions of Prof. Osotimehin to the health sector through his leadership at the National Action Committee on AIDS (NACA), as the Honourable Minister of Health, and as the UNFPA Executive Director. He said the FMOH is committed to ensuring Nigeria achieves the modern contraceptive prevalence rate of 27% by the year 2020.

Dr Omolola Omosehin, speaking on behalf of the UNFPA said the organization would remember Prof. Osotimehin for his tenacious advocacy for the health of women, for gender equality and youth and women empowerment. He described Prof. Osotimehin as a man of vision who was politically astute and incredibly eloquent.

Other goodwill messages came in from guests present, like the Provost of the College of Medicine at the University of Ibadan and the former Vice-Chancellor of Igbenedion University, Professor Eghosa Osarumen.

KEYNOTE ADDRESS

Prof. Otolorin who delivered the keynote address talked about a lot of family planning variables and their impact on the country. He said our rapid population growth is a barrier to our development as our economy is growing below the population growth rate. He identified an inverse relationship between the rate of contraception use and degree of education and economic status and emphasized the needs to improve the numbers.

PANEL DISCUSSION

Discussions by the panel made up of state and private actors in the Family Planning sector surrounded issues such as adopting a multi-sectorial sector-wide approach to implementing administrative and financial policies, public health financing, the role of the private sector in advocacy and implementation of family planning, the factors that affect the use of contraceptives among young people, innovations in the uptake and use of family planning methods and the need for collaboration rather than competition in the advancement of family planning goals.

VOICES FROM THE FIELD

Private organizations and Civil Society Organizations also presented their works and researches around family planning advocacy and implementation across the country.

JOURNAL LAUNCH

The Forum came to an end with a launch of a special edition of the African Journal of Medicine and Medical Sciences Supplement. The edition holds works of about 30 authors and was compiled in honour of Prof. Osotimehin who was a one-time editor of the journal.

A review of the 1st Professor Babatunde Osotimehin Legacy Forum would not be complete without highlighting the camaraderie and warm collegiality among discussants at the event.

PHOTOS FROM THE 1ST PROFESSOR BABATUNDE OSOTIMEHIN LEGACY FORUM

We look forward to your contribution to and participation in next year’s event, which promises to be more exciting still.

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The A, B, C of Tuberculosis in Nigeria

Introduction

TB is currently the leading cause of morbidity and mortality from an infectious disease and while a lot of progress has been made in the identification and treatment of tuberculosis, the WHO still estimates that about 4 million cases   of TB were missed in 2017. Improving basic standards of TB care can attract more patients by ensuring that they receive the care that they deserve and     that providers offer better services, improve adherence, diagnosis and treatment, and reduce lost to follow-up rate, ultimately contributing to  reducing the burden of TB disease.

Nigeria ranks as one of the high-burden TB countries in the world and contributed 4% of all TB cases in 2017, ranking her in the 6th position globally in terms of percentage contribution.

Catching them early

Standards set by the International Standards for Tuberculosis Care (ISTC) provide a reference point for assessing provider or system performance and quality of care which help to identify the current and expected levels of quality in health care delivery. The failure of providers or systems to adhere to the defined standards of diagnosis, care and treatment of TB compromises the quality of services provided to the patients.

Understanding the quality of care will enable policy makers and program implementers to strengthen TB care and prevention, by positively influencing timely diagnosis, treatment adherence, and treatment completion in Nigeria. This brief presents findings from an examination of the adherence of TB services in Nigeria to the international and national standards guidelines to ensure that TB services are delivered in an accessible, timely, safe, effective, efficient and equitable manner.

Quality of Care; Where? How… And then?

Quality of care can be said to consist of three key elements, namely: structure of the resources available at a health facility; process or the interaction between providers and patients; and outcomes or the consequences of care.

In a recent study carried out by the Academy for Health Development (AHEAD) Nigeria, supported by the National Tuberculosis and Leprosy Control Program and Challenge TB project funded by United States Agency for International Development (USAID) and The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), Quality of Care of Tuberculosis was assessed in a total of 144 facilities across 12 states in a bid to understand how care is accessed and received, uncover loopholes and opportunities in the care delivery system and make recommendations for improving the overall access, delivery and outcomes of care and treatment for tuberculosis.

Structure (Where)

Structure includes all of the factors that affect the context or enabling environment in which care is delivered. This includes the physical facility, equipment and human resources as well as organizational characteristics such as staff training and supervision. We measured structure through  the availability of services, infrastructure, capacity of TB providers, and management of TB services.

TB drug supply

The NTBLCP continues to address challenges to the maintenance of an uninterrupted supply of anti-TB drugs by working to improve stock status at the state and LGA levels, train staff on proper anti-TB drug stock management, and advocate at the Federal and State Ministries of Health to improve and expand storage conditions for anti-TB drugs at all levels. TB drug monitoring mechanisms are in place at different levels to ensure an uninterrupted supply of quality-assured anti-TB drugs, which will help prevent the emergence of drug-resistant TB.

Trained TB Care Providers

Staff training is essential for keeping health workers updated with knowledge, skills, and technical competence to maintain high quality or improve the quality of TB care services. This study assessed whether TB providers received any formal or structured in-service training related to the services they offer in the 24 months preceding the survey.  The findings from the facility audit/checklist (with the health facility unit in-charges as respondents) indicate that a majority of staff (73%) received in-service or training updates on TB care and treatment in the last 24 months.

Process (How)

Process is the sum of the interaction between service providers and patients during which structural inputs from the health care system are transformed into health outcomes. Findings presented measured process through the level of TB awareness among TB patients, patient-provider interaction and communication, barriers to TB care and access to follow-up care.

The most common barrier to accessing TB care mentioned by patients is the distance to the facility providing TB diagnosis and treatment (22%). Lack of adherence   to   a   patient’s   treatment   plan   for   TB   can   lead   to   prolonged infectivity, drug resistance and poor treatment outcomes.

Access to follow-up care through Directly Observed Treatment (DOT) seeks to improve adherence to TB treatment by observing patients while they take their anti-TB medication. This study shows that approximately 40% of patients did not have access to DOT.

Patients on treatment who were observed taking their TB medication by a health care provider (DOT)

Outcome (And then)

Outcome in the context of our conceptual framework refers to the effects of health care on patients, including changes in their health status.

Treatment outcome is defined based on the 2013 WHO definitions that have two broad classifications namely; treatment success and unsuccessful treatment  outcomes. In addition, the two classifications are sub-divided into 6 distinct outcomes, namely; cured, treatment completed, died, treatment failure, loss to follow-up, and not evaluated.   The addition of “cured” and “treatment completed’ is defined as treatment success. Patients with PTB with bacteriologically confirmed TB at the beginning of the treatment who had proven negative microbiological results upon completing treatment are defined as cured. Treatment completed is used  for the patients with no evidence of clinical failure, but without the record to show negative microbiological results after taking anti-TB drugs for the prescribed length of time, either because tests were not performed or because no biological material was available (e.g., patient without sputum production). Patients with treatment outcome such as treatment failure, death, loss-to-follow-up and not evaluated are classified as unsuccessful. A patient that failed to appear in the health facility for more than 2 consecutive months after the scheduled appointment is referred to as  lost to follow-up.  If a patient dies for any reason during the treatment, the outcome  is classified as died.

For patients that move to another health clinic regardless of the cause, the outcome is defined as transferred. Patients transferred out are excluded from the analysis because of the challenges of determining the outcome based on the WHO definition. Outcomes are classified as treatment failure if a patient has positive sputum smears throughout the treatment period or at the end of treatment (even if the patient initially converted from positive to negative). Patients without treatment outcomes are classified as not evaluated either because the tests were not performed or have not completed the treatment.

 

RECOMMENDATIONS

A key policy outlined in this study is the need to improve the factors highlighted that affect the quality of care. Availability of proper equipment and an increase in service providers for tuberculosis will be effective in addressing the needs of the number of identified patients and enable better detection and identification  of  otherwise  missing cases. This recommendation can be achieved through the following ways:

  • Collaboration with private health organizations at the state and local government levels for more primary facilities to be set up in the rural areas with emphasis placed on  reduction  of  patients’  commute  time  and  increment  of  health  service providers at

The study showed that only 14% of facilities had been implementing risk assessment for TB infection, prevention, and control annually. This statistic can be improved by including in the supervision carried out by the LGTBLS, the assessment of the availability of other important documents such as up-to-date  TB policies and guidelines.

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AHEAD Organises a Workshop on Using Reference Managers and ATLAS.ti 8 Windows for Literature Reviews

In an effort to build capacity for research and action – which is part of the organization’s mission,the first edition of a workshop on “Using Reference Managers and ATLAS.ti 8 Windows for Literature Review”came up in March, 2018, at the Academy for Health Development. The aim of this workshop was to impart the participants on how to conduct a good literature review with the aid of reference managers (EndNote and Mendeley) and ATLAS.ti 8 windows software.This was achieved through exposing participants to the fundamentals of doing rigorous literature reviews with the use of reference managers such as EndNote and Mendeley, as well as providing the participants with the basic knowledge and the use of ATLAS.ti 8 windows software in preparing literature review by following an approach emphasizing data integration, organization and constant documentation of the process.The participants were first taken on Fundamentals of Writing Literature Review as well as the Ethics of Effective Writing (approach and styles), before they were introduced to the use of the softwares. The workshop featured many hands-on sessions in which the participants had first-hand experience with the software. The participants included Resident Doctors, University Lecturers, Civil Servants and students.

At the end of the workshop, a raffle draw was done with a prize of ATLAS.ti software, courtesy of ATLAS.ti.

 

Testimonies from Participants:

“The workshop was excellent on my overall analysis”

“A job well done. Please keep it up”

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Site Sustainability and Close-Out Strategic Meeting

The Centre for Integrated Health Programs (CIHP) is working to be able to successfully respond to the changing landscape in the healthcare sector and donor environment in order to achieve greater impact, through the strengthening of the organization. To accomplish this, the Academy for Health Development (AHEAD) was invited to facilitate a Site sustainability and Close-Out Strategic meeting for her staff. The goal of the meeting was to build competencies of her senior-level managers in the Lagos and Nasarrawa branches of the organization.

As there is a difference between leadership and management, the meeting served to expose the managers to the different skills required for each, the convergence of both and how to deploy significant and effective leading and managing strategies in organizational practice in order to be better equipped healthcare professionals.

The objectives of the meeting as set by CIHP were to:

  • improve the knowledge of senior level managers on key leadership and management issues,
  • facilitate the ascension of new managers to management,
  • assist CIHP Managers to be well-rounded executives, and
  • develop the skills of managers in the areas of managing people, organizing teams, supervising and delegating.

The themes explored at the meeting include ‘Leadership-Management soft skills’, ‘Leadership Management hard skills’, and ‘Leadership dynamics for effective growth and change management’. PowerPoint Presentations, case-studies on real life scenarios, role plays and team-building activities were some of the tools employed by the seasoned health leadership and programme management specialists from AHEAD to further explain and dissect these themes.

While participants were able to fill out an evaluation form on the last day, daily evaluations were taken and reported and on the last day, a session was allotted to discussing feedback.

The 34 members of staff from both locations who participated in the training were very satisfied with its outcome based on their assessments, and suggested topics like ‘Team Dynamics’, ‘Performance Appraisal’ and Financial Management amongst others be included in subsequent trainings.

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