The growing trends for skilled health worker (SHW) migration in Nigeria has led to increased concerns about achieving universal health coverage in the country. While a lot is known about drivers of SHW migration, including national/sub-national government’s inability to address them, not enough is known about its governance. Underpinning good governance systems is a commitment to human rights norms, that is, principles that enshrine non-discrimination, participation, accountability, and transparency. Hence, this study was aimed at deriving a conceptual framework that captures the scope of SHW migration governance in Nigeria and the extent to which it is human rights based. To describe the scope of SHW migration governance, we conducted an exploratory factor analysis and mapped our findings to themes derived from a qualitative analysis. We also did a multivariate analysis, examining how governance items are related to migration intentions of SHWs. The scope of SHW migration governance in Nigeria can be described across three levels: Constitutional—where policies about the economy and the health workforce are made and often poorly implemented; Collective—which responds to the governance vacuum at the constitutional level by promoting SHW migration or trying to mitigate its impact; Operational—individual SHWs who navigate the tension between the right to health, their right to fair remuneration, living/working conditions, and free movement. Examining these levels revealed opportunities for collaboration through stronger commitment to human right norms. In recognising their role as rights holders and duty bearers at various levels, citizens, health advocates, health workers, community groups and policy makers can work collaboratively towards addressing factors related to SHW migration. Further evidence is needed on how human rights norms can play a visible role in Nigeria’s governance system for SHW migration.

Health workers are pivotal for non-communicable disease (NCD) service delivery, yet often are unavailable in low- and middle-income countries (LMICs). There is limited evidence on what NCD-related tasks non-physician health workers (NPHWs) can perform and their effectiveness. This study aims to understand how task-sharing is used to improve NCD prevention and control in LMICs. We also explored barriers, facilitators, and unexpected consequences of task-sharing. Databases searched in two phases and included MEDLINE, EMBASE, CENTRAL, CINAHL, Cochrane, and clinical trial registries, and references of included studies from inception until 31^st July 2024. We included randomised control trials (RCTs), cluster RCTs, and associated process evaluation and cost effectiveness studies. The risk of bias was assessed using the Cochrane Risk of Bias Tool v2. PROSPERO: CRD42022315701. The study found 5527 citations, 427 full texts were screened and 149 studies (total population sample>432567) from 31 countries were included. Most studies were on tasks shared with nurses (n=83) and community health workers (n=65). Most studies focussed on cardiovascular disease (n=47), mental health (n=48), diabetes (n=27), cancer (n=20), and respiratory diseases (n=10). Seventeen studies included two or more conditions. Eighty-one percent (n=120) of studies reported at least one positive primary outcome, while 19 studies reported neutral results, one reported a negative result, eight (5.4%) reported mixed positive and neutral results, and one reported neutral and negative findings. Economic analyses indicated that task-sharing reduced total healthcare costs. Task-sharing is an effective intervention for NCDs in LMICs. It is essential to enhance the competencies and training of NPHWs, provide resources to augment their capabilities, and formalise their role in the health system and community. Optimising task-sharing for NCDs requires a holistic approach that strengthens health systems while supporting NPHWs in effectively addressing the diverse needs of their communities. Registration: PROSPERO CRD42022315701.

Governments worldwide participate in skilled health worker (SHW) migration agreements to protect access to health services in their countries. Previous studies have described the value offered by t...

To improve the delivery and reach of primary health care, a robust scientific foundation driven by research is needed. However, few family physicians conduct research, especially in sub-Saharan Africa. Early-career and trainee family physicians are a key part of the primary care research pipeline and have an expressed need for research training and mentorship. AfriWon Research Collaborative (ARC) was an online research training and mentorship pilot program whose objective was to increase research activity among participants from AfriWon Renaissance, the family physician young doctors’ movement of sub-Saharan Africa. ARC utilized a 10-module online curriculum, supported by peer and faculty e-mentorship, to guide participants through writing a research protocol. The feasibility, acceptability, and scalability of this program was evaluated via a mixed-methods RE-AIM-guided process evaluation using descriptive statistics and inductive/deductive thematic analysis. The pilot reached participants from Botswana, Democratic Republic of the Congo, Ghana, Nigeria and Sierra Leone and was adopted by mentors from 11 countries across three continents. Four of the 10 pilot participants completed a full research protocol by the end of the six-month core program. Seven out of the 10 participants, and nine out of the 15 mentors, planned to continue their mentorship relationships beyond the core program. The program helped instill a positive research culture in active participants. Some participants’ and mentors’ engagement with the ARC program was limited by confusion over mentorship structure and role, poor network connectivity, and personal life challenges. Online research training and mentorship for trainee and early-career family physicians in sub-Saharan Africa is feasible and acceptable to participants and mentors. Similar programs must pay careful attention to mentorship training and provide a flexible yet clearly organized structure for mentee-mentor engagement. Additional work is needed to determine optimal implementation strategies and ability to scale.