Assessing health institutional readiness for Ebola epidemic containment in Nigeria

Abstract

Background: This study investigated the health institutional readiness to implement innovations for combating Ebola epidemic outbreak in the post-epidemic era between the periods of June 2016 and May 2017 in Nigeria at healthcare facility levels. Rationale: There is paucity of literature on the subject of organisational readiness to implement innovations in the health space. Previous studies often depict readiness as a minor element of the implementation space .In this study, readiness is considered as an instrumental element with strong essence in the implementation framework. Objectives: the study was guided by four objectives;(1) to assess readiness to implement innovations in response to Ebola epidemic outbreak containment;(2)to identify the drivers/detrminants of motivation , general and innovation-specific capacities to implement innovations in response to Ebola epidemic outbreak containment and (4)to investigate predictors of readiness to implement innovations in response to Ebola epidemic outbreak containment. Methods: The sequential exploratory cross-sectional mixed method design was employed. The study population was 785 health care workers (HCWs) and non-health workers working UPTH and four affiliated sites .The purposive sampling was used for qualitative study while Stratified random sampling technique was utilised for the quantitative study. Qualitative data were collected from fifteen respondents while a total of 511 questionnaires were administered at the study site. The qualitative data was analysed using inductive thematic analysis. The quantitative data was analysed using univariable analysis , multivariable analysis, exploratory factor analysis and confirmatory factor analysis /structural equation modelling (SEM) Results: From the qualitative study, quality improvement was perceived as most useful in influencing all the tree sub-components of readiness and readiness. Training is perceived as most useful in building readiness while it is perceived to be moderately useful in influencing the sub-component of readiness. The OLS estimates indicates that QI/QA exert a positive and significant effect on motivation (β=0.004, p<0.05) and general capacity score (β= 0.28 p<0.05) while it inversely but significantly exerts influence on innovation specific capacity (β=-0.21x 10-3, p<0.05).The SEM /pathway analysis showing the direct and indirect routes of interactions among variables that predict institutional readiness reveals that after adjusting for confounders, all the explanatory variables have significant effect on readiness except gender which was dropped from the final model.

Conclusion: Health institutional readiness is a vital element in the implementation space. The strength of evidence of how Evidence-Based System for Innovation Support (EBSIS) can influence readiness was established. Though readiness is a rate-determining step in ensuring robust and effective implementation outcomes, exploring innovation outcomes and their amplification through explicitly target readiness dynamics and subcomponents as part of an innovation implementation process is a desideratum that requires stakeholders in the health sphere and implementation space to fill the void.

Keywords: innovation, readiness, innovation specific capacity, general capacity, motivation resilience Ebola Virus disease.