Antenatal care gives opportunity for care of women during pregnancy, prevention and treatment of diseases as well as behavioral change interventions. The perception of users about services influences service utilization. This study was performed to assess user satisfaction with antenatal care services at the centre and to identify constraints at service points. Women attending antenatal care at a cottage hospital In Nigeria were administered questionnaires to evaluate their satisfaction with services and their views about services at various points of care. Data analysis was made using Statistical Package for Social Science version 15.0. Statistical significance was set at P < 0.5. Four hundred correctly completed questionnaires were analysed. The mean age of the respondents was 29 years (SD of 4) and their parity ranged from 0 to 5 (mean 2.5 ± 1.9). The overall satisfaction with care was 94 % and it was highest (95.8 %) with health talks and least with medical consultations (64 %). Attributes valued at service points were educating nature of health talks, prompt attention, and friendly and polite staff. Reasons for dissatisfaction were unfriendly attitudes of staff and delay at service points. Additional care packages women would want were: more staff employed 61 (15.3 %), better organized services 34 (8.5 %) and routine ultrasound scans 25 (6.3 %). Women valued antenatal care and were highly satisfied with services received at the centre. Health education forums should be used to address issues with service delivery. Constraints at service points should be addressed to enhance better service delivery.

Background: The Expanded Program on Immunization was launched in Nigeria in 1980 but the target for immunization coverage has been elusive. As part of its social responsibilities the Shell Petroleum Development Company (SPDC) supported immunization activities in the Niger Delta region of the country. In this study a cross sectional study was carried out to estimate the coverage of BCG, OPV, DPT and measles vaccines and, to determine the predictors of full immunization coverage among children aged 12 to 23 months in selected SPDC supported communities in the Niger Delta. Using modified cluster randomization, 2432 children were included in the study. Results: Of 2432 children studied 1585 (65.2%; 95% CI: 61.9% to 68.5%) were fully immunized with the four vaccines; 2323 (95.5%) had received at least one dose of a vaccine (card and history). About one third (36.6%) of the children aged 12 to 23 months with immunization card were fully immunized by their first birthday. The proportion of children fully immunized with valid doses of vaccines by one year was 19.9% (485 of 2432) based on card only. One hundred and nine (4.5%) had never received immunization. Major reason for failure to be immunized was fear of side reactions. Main predictor for full immunization was availability of a health facility in the community. Discussion: The coverage of immunization was high in the study area; but the proportion of valid doses administered was low. Training of health workers and strategic behavioral communication to dispel fears of side reactions are recommended

Health service delivery in the Niger Delta region of Nigeria has suffered many setbacks. Community participation may help break the barriers limiting access to health services, especially those associated with family planning and reproductive health services. This is a two-year review of family planning and reproductive health services records offered by the Obio Cottage Hospital from the onset of the Community Insurance Scheme (2010-12). Since the inception of the Community Insurance Scheme, there has been an increase in the uptake of family planning methods of more than 50%; 1,274 women in 2011 vs 3,140 in 2012. An increase in number of women seeking reproductive health services was also observed. The Community Health Insurance Scheme (CHIS) at the Obio Cottage Hospital provides evidence for expansion, as seen in the improvement in patronage for family planning and reproductive health services.

Although the poor were found to benefit, this BIA revealed a tendency towards pro-rich distributions. Removing co-payments for the poorest, reducing long wait and visit times and using community volunteers to help increase access to health services may improve benefits for the poor.

Objectives/Scope The vast majority of 170 million Nigerians have no access to affordable and quality assured health care. The government provided medical facilities are mostly over-stretched and most Nigerians pay out of pocket for basic health care. The Shell Petroleum Development Company of Nigeria Limited embraced the concept of Public Private Partnership as a strategic approach to Corporate Social Responsibility in the health sector. In 2010, SPDC in collaboration with the Rivers State government upgraded the Obio health center to a cottage hospital and worked with the local community to catalyse the Obio Community Health Insurance Scheme. The partners in the CHIS agreed an annual premium of N7,200 [about$36] per participant for access to essential primary and secondary health care, with special focus on maternal and child health. Methods, Procedures, Process As the insurance package covers more than 95% of community health care needs, patients seen daily increased from 20 to 147 per day. Patients spent long hours on visits leading to dissatisfaction. In 2012, Lean methodology was deployed to address this problem. The outpatient transit time starts from the time the patient reports to the reception, goes through the medical records, vital signs, consultations, laboratory investigation (if necessary), and pharmacy, till discharge. With the use of Lean tools such as value stream mapping, lack of standardisation of key activities at transit points was found to be causing proportionate delay in patients waiting time. 5S exercise was carried out, Standard Operating Procedures and visual measures were developed and deployed with onsite trainings. Results, Observations, Conclusions These led to 78% reduction in transit time, hospital handling more patient flow per day and improved customer satisfaction. Novel/Additive Information Lessons learnt include using leadership Gemba visits and inculcating Lean thinking among hospital staff to improve operational efficiency and bring about a culture change.