Provider and facility readiness for age-friendly health services for older adults in primary health care centres in southwest, Nigeria

Abstract

There is a growing focus on interventions at the health system level to promote healthy aging and provide age-friendly health services (AFHS) in low- and middle-income countries where populations are aging. This study aimed to determine the provider and facility readiness for AFHS. We developed and implemented surveys to collect PHC facility capacity and readiness to deliver AFHS and a KAP survey for facility healthcare workers based on guidelines from the WHO age-friendly tool kit and questionnaires from other studies. Direct observation and structured interviews of facility heads were conducted in a stratified random sample of 15 out of the 57 comprehensive PHC facilities in Lagos, Nigeria. One hundred and twenty providers were conveniently sampled for the KAP survey. Statistical analysis was conducted using STATA version 15 (StataCorp, College Station, Texas, USA). For facility readiness, only 13.3% of PHCs sometimes offered hearing assessment and none of the PHCs offered colorectal cancer assessment. Few (20.0%) facilities offered home services and only 1 (0.7%) had dedicated funding for care of older people. Ramps were at the entrance in 60.0% of facilities and almost half (43.3%) of the PHCs had wheelchair accessible entrances to the public toilets. The majority of HCWs (81.7%) had heard about healthy aging but only 5.0% about AFHS, only 10.8% reported formal training. Around a third knew about specific conditions which affect people as they age, including; depression (37.5%), urinary incontinence (35.0%), and falls/immobility (33.3%). Over half of the providers (54.2%) screened for malnutrition in older patients, 25.8% screened for suspected elder abuse and much less (19.2%) for delirium. This study found some areas of strength but also gaps in facility readiness as well as knowledge and training needed to support AFHS care. We recommend identifying interventions to improve the availability and delivery of care for older adults.

Barriers and facilitators to the delivery of age-friendly health services in Primary Health Care centres in southwest, Nigeria: A qualitative study

“…In our preliminary study that assessed the facility readiness of selected PHCs for AFHS, we found that two-fifths of the PHCs did not have ramps at their entrances, and a third did not have a reception area near the entrance. In addition, 86.7% of the public toilets in the PHCs did not have grab bars, and 33.3% were not served by public transportation [ 21 ]. According to several of the participants, there was a current effort by the present state government to ensure donors complied with the building template provided.…”

“…Minimizing barriers to accessing primary health care and improving care provided for older adults would both enhance health outcomes, and reduce public health spending substantially [ 13 ]. Our previous study in comprehensive PHCs across Lagos, southwest Nigeria, found health care workers to be inadequately trained for the care of older persons, sub-optimal screening for conditions common among this population, and infrastructural gaps in the physical environment that should allow older people to move around independently, actively, safely and securely while receiving health care [ 21 ]. A study in Benin City, Nigeria, demonstrated a positive and supportive approach by health providers, maintaining helpful, friendly communication with older patients, explaining treatment processes and medication side effects as facilitators to provision of age-friendly services [ 22 ].…”

“…In Lagos, Nigeria, the promotion of age-friendly services was facilitated by healthcare providers acknowledging the importance of delivering suitable care for the elderly. The majority emphasized the need for compassionate staff in the care of older persons and expressed their readiness to undergo specialized training aimed at enhancing their skills and knowledge for effective [ 21 ]. To gain further insight into our findings, we aimed to explore further the barriers and facilitators to the delivery of age-friendly health services from the perspectives of PHC managers.…”

Primary health facility readiness to care for infants under six months at risk of poor growth and development: A HHFA-based survey

“…First, we purposively selected three districts among the 77 in Senegal-where collaborators had existing partnerships: two rural (Dahra, Kaffrine) and one urban (Pikine) district. The sample size was determined by resources available for the study, as has been described in earlier service readiness studies with sample sizes of between 12 and 30 health facilities [31], [32]. We selected fifteen PHC facilities, five from each district using random number allocation from the sample frame list from the chief medical officer (18 facilities in Dahra, 24 in Kaffrine and 12 in Pikine).…”

Unlocking the WHO’s Age-Friendly Healthcare Principles: Portugal’s Quest and Recommendations

“…However, a systematic review [12] aiming at understanding the global implementation of the WHO Principles in healthcare revealed that their adoption is not as widespread as desired, indicating limited use of the WHO toolkit. Notably, international studies evaluating the application of the WHO Principles predominantly focus on primary care [13,14] or hospital care [15], without conducting a comprehensive assessment of the National Health Service (NHS). Moreover, within the European context, studies on this subject are scarce, often deviating from the precise utilization of the WHO Principles and failing to assess their implementation in healthcare [16][17][18][19].…”