Background Maternal and Child Health (MCH) is global priority. Access and utilization of facility... more Background Maternal and Child Health (MCH) is global priority. Access and utilization of facility MCH services remain challenges in low and middle-income countries (LMICs). Evidence on barriers to providing and accessing services omits information on role of security within facilities. This paper explores the role of security in provision and use of MCH services in primary healthcare (PHC) facilities in Nigeria. Methods Study was carried out in Anambra state, Nigeria. Qualitative data was collected from 35 in-depth interviews (IDIs) and 16 focus group discussions (FGDs) with purposively identi ed key informants. Information gathered was used to build a program theory that was tested with another round of IDIs and FGDs and the literature. Data analysis and reporting were based on the Context-Mechanism-Outcome
Background: Endemic tropical diseases (ETDs) constitute a significant health burden in resource-p... more Background: Endemic tropical diseases (ETDs) constitute a significant health burden in resource-poor countries. Weak integration of research evidence into policy and practice poses a major challenge to the control of ETDs. This study was undertaken to explore barriers to the use of research evidence in decision-making for controlling ETDs. It also highlights potential strategies for addressing these barriers, including the gaps in research generation and utilisation in the context of endemic disease control. Methods: Information on barriers and solutions to integrating research evidence into decision-making for controlling ETDs in Anambra State, Nigeria, was collected from 68 participants (producers and users of evidence) during structured discussions in a workshop. Participants were purposively selected and allocated to groups based on their current involvement in endemic disease control and expertise. Discussions were facilitated with a topic guide and detailed notes were taken by an appointed recorder. Outputs from the discussions were synthesised and analysed manually. Results: Cross-cutting barriers include a weak research linkage between producers and users of evidence and weak capacity to undertake health policy and systems research (HPSR). Producers of evidence were purported to conceptualise and frame their research questions based on their academic interests and funders' focus without recourse to the decision-makers. Conversely, poor demand for research evidence was reported among users of evidence. Another user barrier identified was moribund research units of the Department of Planning Research and Statistics within the State Ministry of Health. Potential solutions for addressing these barriers include creation of knowledge networks and partnerships between producers and users of evidence, institutionalisation of sustainable capacity-building of both parties in HPSR and revival of State research units.
Background: Well-trained, adequately skilled and motivated primary healthcare (PHC) workers are e... more Background: Well-trained, adequately skilled and motivated primary healthcare (PHC) workers are essential for attaining universal health coverage and the Sustainable Development Goal 3 of ensuring healthy lives and promoting well-being for all. While there is abundant literature on drivers of workforce motivation, published knowledge on the mechanisms of how motivation works within different contexts is limited, particularly from low-and middle-income countries. This paper contributes to health workforce literature by reporting on how motivation works among PHC workers in a maternal and child health (MCH) programme in Nigeria. Methods: We adopted a realist evaluation design including scoping review of literature, document review of policies and MCH programme handbook, and in-depth interviews of PHC workers (n=25), facility managers (n=16), policymakers (n=12) and programme managers (n=10) to assess the impact of the MCH programme in Anambra State, Nigeria. A realist process of theory development, testing, verification and consolidation was used to understand how and under what circumstances the MCH programme impacted on workers' motivation and which mechanisms helped explain how motivation works. The developed programme theory drew upon Herzberg's two-factor and Adam's equity theories to unpack the influences of contextual conditions on worker motivation. Results: A complex and dynamic interaction between the MCH programme and organizational, societal and policy contexts triggered five mechanisms which explain PHC worker motivation: i) feeling supported, ii) feeling valued and committed to work, iii) morale and confidence to perform tasks, iv) companionship and v) feeling comfortable with work environment. Some mechanisms were mutually reinforcing while others operated in parallel. Further analysis showed that the conditions that enabled worker motivation to occur were organisational values of fairness, recognition of health workers' contributions and a culture of task-sharing and teamwork. Conclusions: Policy designs and management strategies for improving performance of health workers, particularly in resource-constrained settings should create working environments that foster feelings of being valued and supported while enabling workers to apply their knowledge and skills to improve healthcare delivery. Future research can test the explanatory framework generated by this study and explore differences in motivational mechanisms among different cadres of PHC
Background The low usage (demand) of maternity and child health (MCH) services is a key contribut... more Background The low usage (demand) of maternity and child health (MCH) services is a key contributor to the high maternal death rate in most regions of Nigeria. A special health programme called the SURE-P/MCH programme had both supply and demand interventions and was implemented over 5 years in selected states in Nigeria. The paper adds new knowledge on demand and supply-side determinants of MCH services at the primary healthcare level. It provides information on the factors that affect provision and utilisation and then discusses how they may improve access to MCH services. Methods This qualitative study was undertaken in Anambra state, southeast Nigeria. Anambra state was purposively chosen because the SURE-P/MCH programme was implemented in the state. The Three-Delay model was used to analyze supply and demand aspects that affect MCH services and improve access to care for pregnant women/mothers and newborns/infants. Result The findings show that there were problems with both the...
This study examined patterns of service use and payment methods for HIV/AIDS treatment using evid... more This study examined patterns of service use and payment methods for HIV/AIDS treatment using evidence from two data sources. The paper also compares the convergence of evidence from a household and exit survey among persons living with HIV/AIDS. The study was undertaken in Akwa Ibom, Anambra and Adamawa states in south-south, southeast and northeast geopolitical zones of Nigeria respectively. Using a household survey and an exit interview, questionnaires were administered to persons living with HIV who were 18 years and above. The health seeking patterns and payment methods were analysed. The findings showed some differences and similarities. In the exit survey, elicited checkup appointments were predominantly three monthly (35.5%) while about half (49.2%) of respondents from the household survey were on two monthly visits. During actual hospital visits, almost all respondents from exit (96.9%) and household survey (95.1%) received routine drugs for HIV/AIDS as appropriate. Out-of-pocket spending was the main method of payment in the two surveys. Variations exist across states in the patterns of treatment seeking and payment methods for HIV/AIDS but the overall findings from household and exit survey yield similar patterns. Hence, either of the methods may be used in a similar setting to obtain valid responses. However, innovative interventions are needed to reduce the incidence of opportunistic infections to limit the additional burden of hospitalization to patients.
Background Maternal and Child Health (MCH) is global priority. Access and utilization of facility... more Background Maternal and Child Health (MCH) is global priority. Access and utilization of facility MCH services remain challenges in low and middle-income countries (LMICs). Evidence on barriers to providing and accessing services omits information on role of security within facilities. This paper explores the role of security in provision and use of MCH services in primary healthcare (PHC) facilities in Nigeria. Methods Study was carried out in Anambra state, Nigeria. Qualitative data was collected from 35 in-depth interviews (IDIs) and 16 focus group discussions (FGDs) with purposively identi ed key informants. Information gathered was used to build a program theory that was tested with another round of IDIs and FGDs and the literature. Data analysis and reporting were based on the Context-Mechanism-Outcome
In Nigeria’s federal government system, national policies assign concurrent healthcare responsibi... more In Nigeria’s federal government system, national policies assign concurrent healthcare responsibilities across constitutionally arranged government levels. Hence, national policies, formulated for adoption by states for implementation, require collaboration. This study examines collaboration across government levels, tracing implementation of three maternal, neonatal and child health (MNCH) programmes, developed from a parent integrated MNCH strategy, with intergovernmental collaborative designs, to identify transferable principles to other multilevel governance contexts, especially low-income countries.National-level setting was Abuja, where policymaking is domiciled, while two subnational implementation settings (Anambra and Ebonyi states) were selected based on their MNCH contexts. A qualitative case study triangulated information from 69 documents and 44 in-depth interviews with national and subnational policymakers, technocrats, academics and implementers. Emerson’s integrated ...
International Quarterly of Community Health Education, 2021
Relatively little is known about readiness of urban health systems to address health needs of the... more Relatively little is known about readiness of urban health systems to address health needs of the poor. This study explored stakeholders’ perception of health needs and strategies for improving health of the urban poor using qualitative analysis. Focus group discussions (n = 5) were held with 26 stakeholders drawn from two Nigerian states during a workshop. Urban areas are characterised by double burden of diseases. Poor housing, lack of basic amenities, poverty, and poor access to information are determinants of health of the urban poor. Shortage of health workers, stock-out of medicines, high cost of care, lack of clinical practice guidelines, and dual practice constrain access to primary health services. An overarching strategy, that prioritises community-driven urban planning, health-in-all policies, structured linkages between informal and formal providers, financial protection schemes, and strengthening of primary health care system, is required to address health needs of the ...
Journal of Health Services Research & Policy, 2022
Background Community health workers play an important role in linking communities with formal hea... more Background Community health workers play an important role in linking communities with formal health service providers, thereby improving access to and utilization of health care. A novel cadre of community health workers known as village health workers (VHWs) were recruited to create demand for maternal health services in the Nigerian Subsidy Reinvestment Programme (SURE-P/MCH). In this study, we investigated the role of contextual factors and underlying mechanisms motivating VHWs. Methods We used realist evaluation to understand the impact of a multi-intervention maternal and child health programme on VHW motivation using Anambra State as a case study. Initial working theories and logic maps were developed through literature review and stakeholder engagement; programme theories were developed and tested using focus group discussions and in-depth interviews with various stakeholder groups. Interview transcripts were analysed through an integrated approach of Context, Mechanism and ...
Towards making efficient use of household resources for appropriate nets, indoor spray, aerosol s... more Towards making efficient use of household resources for appropriate nets, indoor spray, aerosol spray and cleaning the environment. No significant inequity was found in ownership and Onwujekwe et al. BMC Public Health 2014, 14:315
Georaznolikost je širok pojam koji obuhvaća tri podtipa raznolikosti u prirodi: geološku, geomorf... more Georaznolikost je širok pojam koji obuhvaća tri podtipa raznolikosti u prirodi: geološku, geomorfološku i pedološku. Usprkos činjenici da je georaznolikost neodvojivi dio prirodne raznolikosti, odnosno pojedinačnih ekosustava i ekosfere kao cjeline , bioraznolikost (još uvijek) ima dominantnu ulogu u zaštiti prirode Žeger Pleše i Zwicker Kompar, 2019). Koncept georaznolikosti pojavio se početkom 90-ih godina 20. stoljeća kao odgovor na činjenicu da se veća pozornost pridaje biotičkoj komponenti . Gray ( ) definira georaznolikost kao prirodnu raznolikost geoloških (stijene, minerali i fosili), geomorfoloških (reljefni oblici i procesi) te pedoloških i hidroloških odlika. Kratko vrijeme postojanja ovoga koncepta dovelo je do pojave različitih teorijskih i metodoloških rasprava o geobaštini . Geobaština, najvrjedniji dio georaznolikosti, odnosi se na in situ elemente visoke znanstvene vrijednosti -geolokalitete i ex situ elemente, koji iako premješteni iz svoga prirodnog krajobraza, zadržavaju visoku znanstvenu vrijednost (npr. minerali i fosili u muzejskim kolekcijama). Buzjak (2011) geobaštinu definira kao najvrjednije dijelove nežive prirode (geološki, geomorfološki i pedološki važni lokaliteti i područja) iznimnoga znanstvenog, edukativnog, kulturnog, civilizacijskog i estetskog značenja koje je potrebno sačuvati za buduće generacije. Ipak, jasno je da postoje elementi georaznolikosti za koje nema relevantnih znanstvenih podataka, ali su važan resurs za obrazovanje, turizam ili kulturni identitet lokalnih zajednica. Hose (2005) definira geokonzervaciju kao očuvanje i održavanje geoloških i geomorfoloških lokaliteta, zajedno s pripadajućim zbirkama i arhivskim materijalima. Važno je ipak naglasiti da geokonzervacija ne podrazumijeva samo puko očuvanje georaznolikosti već promiče geološke i geomorfološke odlike lokaliteta te njihovo održivo korištenje (Santos i dr., 2020).
BACKGROUND: Most policies in Nigeria are deliberate choices based on political mechanism, oversig... more BACKGROUND: Most policies in Nigeria are deliberate choices based on political mechanism, oversight, and lack of appropriate information. However in recent times there has been a global shift towards evidence based policy making. Thus Actors' views on evidence and their role in policy development appear critical to the use of evidence.OBJECTIVE: This study aimed to examine how actors' perception, roles and levels of power influenced Human Resources for Health policy development in Nigeria.METHOD: The research was conducted using a case study approach. Systematic reviews of relevant policy documents and reports, in-depth interviews of twelve respondents comprising government policymakers, academia, civil society organizations, health-workers and development partners were done. Interviews were analysed using NVivo 10 software for qualitative analysis.FINDINGS: Most respondents perceived evidence to be factual and concrete to support a given decision. The government policymakers wielded a high level of power and spearheaded the policy process. Development partners were major decision makers because they had financial and technical power. Civil society groups had the power of advocacy and generated evidence. The academia had medium power level of power and also generated evidence.CONCLUSION: The actors' with the highest level of power greatly influenced policy use and type of evidence used in formulating the Human Resources for Health policy. Stakeholders with coercive, financial or group power influenced the type of evidence finally used in formulating the Human Resources for Health policy.KEY WORDS: Human Resource for Health; Health policy making; Role of actors in policy making
Background Maternal and Child Health (MCH) is global priority. Access and utilization of facility... more Background Maternal and Child Health (MCH) is global priority. Access and utilization of facility MCH services remain challenges in low and middle-income countries (LMICs). Evidence on barriers to providing and accessing services omits information on role of security within facilities. This paper explores the role of security in provision and use of MCH services in primary healthcare (PHC) facilities in Nigeria. Methods Study was carried out in Anambra state, Nigeria. Qualitative data was collected from 35 in-depth interviews (IDIs) and 16 focus group discussions (FGDs) with purposively identi ed key informants. Information gathered was used to build a program theory that was tested with another round of IDIs and FGDs and the literature. Data analysis and reporting were based on the Context-Mechanism-Outcome
Background: Endemic tropical diseases (ETDs) constitute a significant health burden in resource-p... more Background: Endemic tropical diseases (ETDs) constitute a significant health burden in resource-poor countries. Weak integration of research evidence into policy and practice poses a major challenge to the control of ETDs. This study was undertaken to explore barriers to the use of research evidence in decision-making for controlling ETDs. It also highlights potential strategies for addressing these barriers, including the gaps in research generation and utilisation in the context of endemic disease control. Methods: Information on barriers and solutions to integrating research evidence into decision-making for controlling ETDs in Anambra State, Nigeria, was collected from 68 participants (producers and users of evidence) during structured discussions in a workshop. Participants were purposively selected and allocated to groups based on their current involvement in endemic disease control and expertise. Discussions were facilitated with a topic guide and detailed notes were taken by an appointed recorder. Outputs from the discussions were synthesised and analysed manually. Results: Cross-cutting barriers include a weak research linkage between producers and users of evidence and weak capacity to undertake health policy and systems research (HPSR). Producers of evidence were purported to conceptualise and frame their research questions based on their academic interests and funders' focus without recourse to the decision-makers. Conversely, poor demand for research evidence was reported among users of evidence. Another user barrier identified was moribund research units of the Department of Planning Research and Statistics within the State Ministry of Health. Potential solutions for addressing these barriers include creation of knowledge networks and partnerships between producers and users of evidence, institutionalisation of sustainable capacity-building of both parties in HPSR and revival of State research units.
Background: Well-trained, adequately skilled and motivated primary healthcare (PHC) workers are e... more Background: Well-trained, adequately skilled and motivated primary healthcare (PHC) workers are essential for attaining universal health coverage and the Sustainable Development Goal 3 of ensuring healthy lives and promoting well-being for all. While there is abundant literature on drivers of workforce motivation, published knowledge on the mechanisms of how motivation works within different contexts is limited, particularly from low-and middle-income countries. This paper contributes to health workforce literature by reporting on how motivation works among PHC workers in a maternal and child health (MCH) programme in Nigeria. Methods: We adopted a realist evaluation design including scoping review of literature, document review of policies and MCH programme handbook, and in-depth interviews of PHC workers (n=25), facility managers (n=16), policymakers (n=12) and programme managers (n=10) to assess the impact of the MCH programme in Anambra State, Nigeria. A realist process of theory development, testing, verification and consolidation was used to understand how and under what circumstances the MCH programme impacted on workers' motivation and which mechanisms helped explain how motivation works. The developed programme theory drew upon Herzberg's two-factor and Adam's equity theories to unpack the influences of contextual conditions on worker motivation. Results: A complex and dynamic interaction between the MCH programme and organizational, societal and policy contexts triggered five mechanisms which explain PHC worker motivation: i) feeling supported, ii) feeling valued and committed to work, iii) morale and confidence to perform tasks, iv) companionship and v) feeling comfortable with work environment. Some mechanisms were mutually reinforcing while others operated in parallel. Further analysis showed that the conditions that enabled worker motivation to occur were organisational values of fairness, recognition of health workers' contributions and a culture of task-sharing and teamwork. Conclusions: Policy designs and management strategies for improving performance of health workers, particularly in resource-constrained settings should create working environments that foster feelings of being valued and supported while enabling workers to apply their knowledge and skills to improve healthcare delivery. Future research can test the explanatory framework generated by this study and explore differences in motivational mechanisms among different cadres of PHC
Background The low usage (demand) of maternity and child health (MCH) services is a key contribut... more Background The low usage (demand) of maternity and child health (MCH) services is a key contributor to the high maternal death rate in most regions of Nigeria. A special health programme called the SURE-P/MCH programme had both supply and demand interventions and was implemented over 5 years in selected states in Nigeria. The paper adds new knowledge on demand and supply-side determinants of MCH services at the primary healthcare level. It provides information on the factors that affect provision and utilisation and then discusses how they may improve access to MCH services. Methods This qualitative study was undertaken in Anambra state, southeast Nigeria. Anambra state was purposively chosen because the SURE-P/MCH programme was implemented in the state. The Three-Delay model was used to analyze supply and demand aspects that affect MCH services and improve access to care for pregnant women/mothers and newborns/infants. Result The findings show that there were problems with both the...
This study examined patterns of service use and payment methods for HIV/AIDS treatment using evid... more This study examined patterns of service use and payment methods for HIV/AIDS treatment using evidence from two data sources. The paper also compares the convergence of evidence from a household and exit survey among persons living with HIV/AIDS. The study was undertaken in Akwa Ibom, Anambra and Adamawa states in south-south, southeast and northeast geopolitical zones of Nigeria respectively. Using a household survey and an exit interview, questionnaires were administered to persons living with HIV who were 18 years and above. The health seeking patterns and payment methods were analysed. The findings showed some differences and similarities. In the exit survey, elicited checkup appointments were predominantly three monthly (35.5%) while about half (49.2%) of respondents from the household survey were on two monthly visits. During actual hospital visits, almost all respondents from exit (96.9%) and household survey (95.1%) received routine drugs for HIV/AIDS as appropriate. Out-of-pocket spending was the main method of payment in the two surveys. Variations exist across states in the patterns of treatment seeking and payment methods for HIV/AIDS but the overall findings from household and exit survey yield similar patterns. Hence, either of the methods may be used in a similar setting to obtain valid responses. However, innovative interventions are needed to reduce the incidence of opportunistic infections to limit the additional burden of hospitalization to patients.
Background Maternal and Child Health (MCH) is global priority. Access and utilization of facility... more Background Maternal and Child Health (MCH) is global priority. Access and utilization of facility MCH services remain challenges in low and middle-income countries (LMICs). Evidence on barriers to providing and accessing services omits information on role of security within facilities. This paper explores the role of security in provision and use of MCH services in primary healthcare (PHC) facilities in Nigeria. Methods Study was carried out in Anambra state, Nigeria. Qualitative data was collected from 35 in-depth interviews (IDIs) and 16 focus group discussions (FGDs) with purposively identi ed key informants. Information gathered was used to build a program theory that was tested with another round of IDIs and FGDs and the literature. Data analysis and reporting were based on the Context-Mechanism-Outcome
In Nigeria’s federal government system, national policies assign concurrent healthcare responsibi... more In Nigeria’s federal government system, national policies assign concurrent healthcare responsibilities across constitutionally arranged government levels. Hence, national policies, formulated for adoption by states for implementation, require collaboration. This study examines collaboration across government levels, tracing implementation of three maternal, neonatal and child health (MNCH) programmes, developed from a parent integrated MNCH strategy, with intergovernmental collaborative designs, to identify transferable principles to other multilevel governance contexts, especially low-income countries.National-level setting was Abuja, where policymaking is domiciled, while two subnational implementation settings (Anambra and Ebonyi states) were selected based on their MNCH contexts. A qualitative case study triangulated information from 69 documents and 44 in-depth interviews with national and subnational policymakers, technocrats, academics and implementers. Emerson’s integrated ...
International Quarterly of Community Health Education, 2021
Relatively little is known about readiness of urban health systems to address health needs of the... more Relatively little is known about readiness of urban health systems to address health needs of the poor. This study explored stakeholders’ perception of health needs and strategies for improving health of the urban poor using qualitative analysis. Focus group discussions (n = 5) were held with 26 stakeholders drawn from two Nigerian states during a workshop. Urban areas are characterised by double burden of diseases. Poor housing, lack of basic amenities, poverty, and poor access to information are determinants of health of the urban poor. Shortage of health workers, stock-out of medicines, high cost of care, lack of clinical practice guidelines, and dual practice constrain access to primary health services. An overarching strategy, that prioritises community-driven urban planning, health-in-all policies, structured linkages between informal and formal providers, financial protection schemes, and strengthening of primary health care system, is required to address health needs of the ...
Journal of Health Services Research & Policy, 2022
Background Community health workers play an important role in linking communities with formal hea... more Background Community health workers play an important role in linking communities with formal health service providers, thereby improving access to and utilization of health care. A novel cadre of community health workers known as village health workers (VHWs) were recruited to create demand for maternal health services in the Nigerian Subsidy Reinvestment Programme (SURE-P/MCH). In this study, we investigated the role of contextual factors and underlying mechanisms motivating VHWs. Methods We used realist evaluation to understand the impact of a multi-intervention maternal and child health programme on VHW motivation using Anambra State as a case study. Initial working theories and logic maps were developed through literature review and stakeholder engagement; programme theories were developed and tested using focus group discussions and in-depth interviews with various stakeholder groups. Interview transcripts were analysed through an integrated approach of Context, Mechanism and ...
Towards making efficient use of household resources for appropriate nets, indoor spray, aerosol s... more Towards making efficient use of household resources for appropriate nets, indoor spray, aerosol spray and cleaning the environment. No significant inequity was found in ownership and Onwujekwe et al. BMC Public Health 2014, 14:315
Georaznolikost je širok pojam koji obuhvaća tri podtipa raznolikosti u prirodi: geološku, geomorf... more Georaznolikost je širok pojam koji obuhvaća tri podtipa raznolikosti u prirodi: geološku, geomorfološku i pedološku. Usprkos činjenici da je georaznolikost neodvojivi dio prirodne raznolikosti, odnosno pojedinačnih ekosustava i ekosfere kao cjeline , bioraznolikost (još uvijek) ima dominantnu ulogu u zaštiti prirode Žeger Pleše i Zwicker Kompar, 2019). Koncept georaznolikosti pojavio se početkom 90-ih godina 20. stoljeća kao odgovor na činjenicu da se veća pozornost pridaje biotičkoj komponenti . Gray ( ) definira georaznolikost kao prirodnu raznolikost geoloških (stijene, minerali i fosili), geomorfoloških (reljefni oblici i procesi) te pedoloških i hidroloških odlika. Kratko vrijeme postojanja ovoga koncepta dovelo je do pojave različitih teorijskih i metodoloških rasprava o geobaštini . Geobaština, najvrjedniji dio georaznolikosti, odnosi se na in situ elemente visoke znanstvene vrijednosti -geolokalitete i ex situ elemente, koji iako premješteni iz svoga prirodnog krajobraza, zadržavaju visoku znanstvenu vrijednost (npr. minerali i fosili u muzejskim kolekcijama). Buzjak (2011) geobaštinu definira kao najvrjednije dijelove nežive prirode (geološki, geomorfološki i pedološki važni lokaliteti i područja) iznimnoga znanstvenog, edukativnog, kulturnog, civilizacijskog i estetskog značenja koje je potrebno sačuvati za buduće generacije. Ipak, jasno je da postoje elementi georaznolikosti za koje nema relevantnih znanstvenih podataka, ali su važan resurs za obrazovanje, turizam ili kulturni identitet lokalnih zajednica. Hose (2005) definira geokonzervaciju kao očuvanje i održavanje geoloških i geomorfoloških lokaliteta, zajedno s pripadajućim zbirkama i arhivskim materijalima. Važno je ipak naglasiti da geokonzervacija ne podrazumijeva samo puko očuvanje georaznolikosti već promiče geološke i geomorfološke odlike lokaliteta te njihovo održivo korištenje (Santos i dr., 2020).
BACKGROUND: Most policies in Nigeria are deliberate choices based on political mechanism, oversig... more BACKGROUND: Most policies in Nigeria are deliberate choices based on political mechanism, oversight, and lack of appropriate information. However in recent times there has been a global shift towards evidence based policy making. Thus Actors' views on evidence and their role in policy development appear critical to the use of evidence.OBJECTIVE: This study aimed to examine how actors' perception, roles and levels of power influenced Human Resources for Health policy development in Nigeria.METHOD: The research was conducted using a case study approach. Systematic reviews of relevant policy documents and reports, in-depth interviews of twelve respondents comprising government policymakers, academia, civil society organizations, health-workers and development partners were done. Interviews were analysed using NVivo 10 software for qualitative analysis.FINDINGS: Most respondents perceived evidence to be factual and concrete to support a given decision. The government policymakers wielded a high level of power and spearheaded the policy process. Development partners were major decision makers because they had financial and technical power. Civil society groups had the power of advocacy and generated evidence. The academia had medium power level of power and also generated evidence.CONCLUSION: The actors' with the highest level of power greatly influenced policy use and type of evidence used in formulating the Human Resources for Health policy. Stakeholders with coercive, financial or group power influenced the type of evidence finally used in formulating the Human Resources for Health policy.KEY WORDS: Human Resource for Health; Health policy making; Role of actors in policy making
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