DOI: 10.5061/dryad.b8gtht7mn
title: Perceptions of healthcare finance and system quality among Nigerian healthcare workers

description: Background: Nigeria’s healthcare system faces significant challenges in
 financing and quality, impacting the delivery of services to its growing
 population. This study investigates healthcare workers’ perceptions of
 these challenges and their implications for healthcare policy and
 practice. Methods: A cross-sectional survey was conducted with 600
 healthcare professionals from eight states across Nigeria, representing a
 variety of healthcare occupations. Participants completed a questionnaire
 that assessed their perceptions of healthcare financing, quality of care,
 job satisfaction, and motivation using a 5-point Likert scale, closed- and
 open-ended questions. Descriptive statistics, Chi-squared test, and
 regression analysis were used to analyze the data. Results: The findings
 revealed that healthcare workers were generally not satisfied with the
 current state of healthcare financing and system quality in Nigeria. Poor
 funding, inadequate infrastructure, insufficient staffing, and limited
 access to essential resources were identified as major challenges. These
 challenges contributed to low job satisfaction, demotivation, and a desire
 to leave the profession. Socioeconomic factors, location State of
 practice, professional designation (clinical vs nonclinical), clinical
 designation (profession), and employment type (full-time vs part-time)
 were found to influence healthcare workers' perceptions (p &lt;
 0.05). Conclusion: The findings indicated a need to improve healthcare
 workers' satisfaction and retention, and quality of care in Nigeria,
 by increasing healthcare funding, transparent fund management protocols,
 investing in infrastructure and human resource development, and addressing
 regional healthcare disparities. By implementing these reforms, Nigeria
 can enhance the quality and accessibility of healthcare services and
 improve the health and well-being of its citizens.
description: <strong>Research Design</strong>
 This study employed a quantitative cross-sectional survey design
 to assess healthcare workers’ perceptions of quality, challenges, and best
 financing interventions within the Nigerian healthcare system over the
 preceding period. <strong>Population and
 Scope</strong> The research focuses on healthcare
 workers in Nigeria, a West African nation (Figure 1) with a population
 exceeding 220 million as of 2024 (Worldometer, 2024).
 The nine States selected for the study have a combined population
 of 72,025,500.  Nigeria has an overall estimated healthcare worker density
 of 19.97 per 10,000 individuals (WHO, 2023). Therefore, the target
 population for the study was 143,835 healthcare workers in addition to
 some non-clinical healthcare workers who are working in Nigerian
 government health facilities currently or within the last year  (WHO,
 2023). Healthcare workers were sampled from two
 randomly selected representative States in each of five geopolitical zones
 (except one for the South-east, the smallest geopolitical zone), capturing
 Nigeria’s cultural and economic diversity. The North-east zone was
 excluded due to logistic difficulties.   The States are Kwara and Plateau
 (North-central); Kano and Kaduna (North-west); Lagos and Oyo (South-west);
 Delta and Rivers (South-south); and Enugu (South-east geopolitical zone)
 (Figure 1). <strong>Sample Size
 Determination:</strong> The sample size was
 calculated with the formula Z^2*p*q / m^2, {where Z = 1.96 at 95%
 Confidence Interval, p = 0.5 (incidence rate), q = 0.5 (non–incidence
 rate) and m = 0.05 (Margin of error)} using a total healthcare workers
 population of 143,835 across the nine States. The resultant sample of 384,
 predominantly comprised of clinical healthcare workers, was
 proportionately selected across the nine states (Table 1). For
 inclusiveness, a broader range of perspectives, enhanced statistical
 power, and representativeness in the selected States, non-clinical
 healthcare workers were added to the sample. In
 Nigeria, the proportion of clinical and non-clinical team members is
 approximately 65% to 35%, respectively, based on a pilot study conducted
 in Edo and Imo States. This is unlike the composition of the estimated
 19.97 density reported by the WHO which significantly excludes the
 non-clinical staff from the measurement even though they closely interact
 with the healthcare system and typically make up about half of the
 healthcare staff (Health, 2018).  An additional sample of 216 (36%)
 non-clinical workers was, therefore, selected during the survey to
 increase the initial sample size to a target of 600 participants (Table
 1).                 Table 1: Sample size
 determination. 
 <strong>State (Locations)</strong>
 <strong>Total Population
 (N)**</strong> 
 <strong>+Estimated Healthcare Workers
 [N/10,000)*19.97]</strong> 
 <strong>Targeted Sample</strong>
 
 <strong>Clinical</strong> 
 <strong>Non-Clinical</strong>
 
 <strong>Total</strong> 
 Lagos 
 13,481,800 
 26,923 72
 38 
 110 
 Delta 
 5,636,000 
 11,255 30
 19 
 49 
 Kwara 
 3,551,000 
 7,091 19
 21 
 40 
 Plateau 
 4,717,300 
 9,420 25
 12 
 37 
 Kano 
 15,462,200 
 30,878 82
 34 
 116 
 Enugu 
 4,690,100 
 9,366 25
 13 
 38 
 Kaduna 
 9,032,200 
 18,037 48
 25 
 73 
 Rivers 
 7,478,800 
 14,935 40
 31 
 71 
 Oyo 7,976,100
 15,928 
 43 24
 67 
 
 <strong>Total</strong> 
 <strong>72,025,500</strong>
 
 <strong>143,835</strong> 
 <strong>384</strong> 
 <strong>216</strong> 
 <strong>600</strong> 
 <em>+ Average
 National Healthcare workers density applied **projected
 </em>(CityPopulation, 2024)<em>.</em>
 <strong>Data Collection Tools</strong>
 Data was collected via a structured questionnaire in print and
 online on Google Forms, measuring sociodemographic data, perceptions of
 healthcare quality, challenges, and areas of improvement as developed
 based on Donabedian healthcare quality assessment model (Donabedian,
 1988), the SERVIQUAL framework (Parasuraman et al., 1988), Mosadeghrad
 conceptual framework for quality of care (Mosadeghrad, 2012) as applied by
 other similar studies (Akinyinka et al., 2019), as well as the Patient
 Satisfaction Questionnaire (PSQ-18) which is used for the measurement of
 patient satisfaction with the medical care received (RAND, 2023). It was
 composed of both yes or no questions and a Likert scale that measured the
 perceptions of healthcare quality. A reliability test was conducted with
 two samples of 25 healthcare workers from Imo and Edo States respectively
 with a reliability coefficient (Cronbach alpha) of 0.70.
 <strong>Data Collection Process</strong>
 At least three government health facilities were randomly
 selected in each state and visited to engage the workers for data
 collection: one urban (capital city) and two semi-urban/rural areas. The
 selected settings were approached by providing the National Research
 Ethics Committee approval and research protocol to the hospital management
 teams who granted the Researchers access to their employees. Participants
 were randomly selected and engaged during the data collection with print
 paper and online questionnaires, proof of ethical clearance, and consent
 forms provided to each participant to review and sign before interviews or
 provision of responses. Some respondents were accessed online via social
 media groups and emailing lists. <strong>Data
 Analysis</strong> The survey was conducted
 between 8/6/2023 and 20/8/2023 and the data was collated with Google sheet
 and transferred to Microsoft Excel and SPSS version 29 to be analyzed. The
 Likert scale evaluation of the Nigerian healthcare system, ratings were
 assigned as follows: 5 for Excellent, 4 for Good, 3 for Fair, 2 for Poor,
 and 1 for Very Poor. The cumulative scores of participants were then
 categorized into ranges: 6-10 for Very Poor, 11-15 for Poor, 16- 20 for
 Fair, 21-25 for Good, and 26-30 for Excellent. Simple frequency
 distributions and percentages were applied to the sociodemographic data
 and various variables. Multiple linear regression analysis and Chi-square
 test were used to evaluate relationships between the workers’ healthcare
 quality and system ratings and several factors like professional
 designations, clinical designations, type of employment, the States, and
 other sociodemographic attributes. The variations within each State were
 not examined due to the unified approach in data collection at the State
 level. <strong>Ethical
 Consideration</strong> The study is the
 healthcare workers' aspect of a compounded proposal submitted as
 “Critical review of healthcare financing and end-users’ quality perception
 in Nigeria”, which received approval from the Nigerian Health Research
 Ethics Committee (NHREC) with ID: IRB-23-018. The research is designed to
 separately access healthcare workers and the patient’s perspectives on
 healthcare financing and the quality of care they receive using separate
 questionnaires as approved. This ethical process ensured that voluntary
 participation, anonymity, and secure data storage, were observed
 throughout this research. Also, written consents were obtained from each
 participant prior to their participation in the study.
description: # Perceptions of Healthcare Finance and System Quality Among Nigerian
 Healthcare Workers
 [https://doi.org/10.5061/dryad.b8gtht7mn](https://doi.org/10.5061/dryad.b8gtht7mn) ## Description of the data and file structure * This is the healthcare workers' part of our nationwide research. * You can open the file using Microsoft Excel, Google Spreadsheet, or any other spreadsheet processor. * Data Set 1 is the survey responses: * This Excel spreadsheet contains the data from a survey that spanned nine states from five geopolitical zones in Nigeria from June to August 2023. * It contains participants' responses about their social demographics, perceptions towards the healthcare systems, and their opinions regarding the quality of the healthcare system.  ### Files and variables #### File: Data\_1.xlsx **Description:** This is the healthcare workers' part of our nationwide cross-sectional survey on healthcare quality. ##### Variables: Variables include the following * State * Years of experience * Professional designation * Clinical designation * Satisfaction with healthcare system, etc. ## Access information Other publicly accessible locations of the data: * Analysed and Published on PLOS Global Public Health Data was derived from the following sources: * Cross-sectional Quantitative Survey