A census-based health facility assessment datasets for effective review of the Lagos State Health Scheme

Introduction

The United Nations Millennium Development Goals have sparked several global health initiatives over the past ten years that aim to provide straightforward, targeted solutions to the diseases that are the biggest burden on developing nations. These initiatives have demonstrated that raising significant funding for health programs is possible. However, the outcomes fall short of what was anticipated. Because the health system that is supposed to deliver effective health programs falls short of doing so, many people do not benefit from them. According to the World Health Organization (WHO), a well-functioning health system aims to improve health outcomes, remain responsive to people's legitimate health needs, and provide financial security against ill-health costs (WHO, 2010). Health financing is one of the building blocks of health systems. It performs three primary functions: Collecting revenue/funds and mobilization, pooling funds, and purchasing health care services. These related tasks ensure that there are enough resources and that they are allocated appropriately to offer the population equitable, high-quality, affordable healthcare. This emphasizes the idea of Universal Health Coverage (UHC), which guarantees everyone has access to the medical care they require without experiencing financial hardship. Lagos State established the Lagos State Health Management Agency (LASHMA) through the Lagos State Health Scheme Law (Law No. 4 of 25 May 2015). LASHMA is the agency in charge of the Lagos State Health Scheme (LSHS), a scheme that aims to give all residents of Lagos State access to efficient, high-quality, and equitable healthcare services while protecting them financially from the costs of healthcare. Appropriate information on the health facilities in Lagos State is needed to have a functional LSHS. This prompted the need for a baseline evaluation of health facilities to provide data that will help with the review of the scheme's design elements, such as benefit and premium packages, operational guidelines, implementation strategies, monitoring and evaluation for the LSHS, and the readiness of facilities to offer services under the LSHS. Health Systems Consult Limited (HSCL) conducted a health facility assessment as part of its technical assistance to LASHMA. The data collected during the health facility assessment will provide the necessary information for the effective implementation of the LSHS. The specific objectives for the health facility assessment were to determine the distribution pattern of the different types of health facilities in Lagos State, the current level of service availability and general service readiness in health facilities, the level of service-specific readiness of health care facilities in Lagos State, and to provide high-priority services on the LSHS. The data was collected across the following thematic areas: human resources, basic infrastructure, basic medical equipment and infection prevention, health services in health facilities, medical supplies and commodities, health insurance coverage, financial management system, and clinical governance.

Technical approach and methodology

The COVID-19 pandemic situation that existed in Lagos State at the time of the assessment influenced the technical approach used to evaluate the health facilities in the State. A telephone interview method was adopted for data collection, which decreased the risk of contracting and spreading the coronavirus. The COVID-19 pandemic remarkably affected global health systems, public health, societies, and individuals. Many nations put in place travel bans, national lockdowns, and physical quarantines in response to outbreaks to stop the spread. Many public health researchers opted to switch from traditional face-to-face data collection methods to remote data collection techniques to support ongoing research. This informed the shift from the initially planned approach of in-person facility visits by data collectors, as it is no longer realistic due to the COVID-19 pandemic.

An essential source of all survey data is obtained from surveys for data collection via telephone interviews. Telephone surveys continue to be a significant source of the data gathered for media, marketing, academic, and other types of research, despite the rise in popularity of online surveys over the past few years. Since the 1970s, telephone interviewing has become more common than face-to-face interviewing, which was previously the most popular survey research technique. Although other survey research data collection methods, especially online surveys, have become more popular recently, telephone interviewing is still a commonly used technique (Tyebjee & Lavrakas, 1988). In addition, real-time interviews allow the interviewer to probe, check to understand, and follow the direction of the conversation. The telephone is commonly used for interviewing because it is much less expensive than face-to-face (Block & Erskine, 2012); it is generally acknowledged that telephone interview has all but revolutionized health survey research. Virtual health assessment methods have been widely used in developed countries, but it is still not common in developing countries, especially in Sub-Saharan Africa (Gignoux, 2020). In Nigeria, 71% of the population use mobile phones as a primary platform for communication and accessing the Internet, with 89.79% of the population covered by 2G signal, 62.05% by 3G signal, and 11.04% by 4G signal (Summary, 2020). Among the Nigerian states, Lagos State recorded the highest number of active GSM internet subscriptions, with 13,631,562 representing 13.81% of all active internet subscriptions (Summary, 2020). Researchers have advocated for telephone interviews when assessing a more extensive database of facilities' assessments like the Lagos States facilities' assessments (Gignoux, 2020).

A quantitative research methodology was adopted for the health facility assessment. HSCL developed a list of health facilities, which served as a sample frame for health facilities in Lagos State. The sample frame consisted of 2,398 health facilities, and a census approach was adopted. The data collection method used was Computer Assisted Telephone Interview (CATI). The health facilities' target respondents (Chief Medical Directors and Medical Directors) were interviewed through the telephone using the Questionnaire Processing Software for Market Research (QPSMR).¹ The software allows for custom logic, skip question/filter questions, data entry error control, quality control checks, specific quotas, and overall project management. The entered data in QPSMR CATI can be converted to other spreadsheets and statistical software (Excel, SPSS, Stats) for further data processing. A copy of the questionnaire can be found in the Extended data.

Before actual data collection, survey training and pilot were conducted. The survey training involved a two-day training for survey personnel consisting of enumerators, supervisors, quality controllers, research assistants, data managers, project managers, and technical leads on survey objectives, methodology, call protocol, and COVID-19 protocol. After the two-day training, the third day was used for the pilot exercise. The pilot survey involved calling five randomly selected hospitals. The pilot interviews assessed the survey instruments, call protocols, and COVID-19 protocols. Observations during the training and pilot exercise were incorporated into the final survey instruments before commencing the interviews. These processes were observed before the commencement of the survey to ensure that all enumerators understood the survey instruments. The five hospitals called during the pilot were re-interviewed with the final survey instrument during actual data collection, and their data were included in the survey data set.

Some of the measures adopted for quality assurance:

The telephone interview call protocol specified that each health facility in the sample frame was attempted six times for an interview before being placed into the unsuccessful category. Two thousand two hundred-six (2,206) hospitals were attempted from the sample frame of 2,398 health facilities, 950 had uncompleted calls/interviews, and 199 had duplicate numbers. In total, 1,256 completed interviews were conducted for the survey. The assessment was conducted and completed between November 2020 and December 2021 with an average interview time of 90 mins for completed interviews.

Ethical approval

Ethical approval for the study was obtained from the Health Research and Ethics Committee of Lagos State University Teaching Hospital (LREC), a state owned ethical review committee, with approval number LREC/06/10/1328.

Consent

HSCL complied with all aspects of the principles of human research ethics. Detailed information about the study was communicated clearly to each participant. Verbal informed consent was obtained from the participants. Before commencing the interviews, participants were asked to give verbal consent after being fully briefed on the study objectives. Audio recordings documenting the consent process was stored securely on password protected devices and HSCL’s OneDrive.