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Article History

Received: 20 February 2023

Accepted: 8 April 2026

First Online: 15 April 2026

Declarations

:

: Ethical approval was sought for and obtained from the Health Research and Ethics Committee of the State Ministry of Health Awka, Anambra State, Nigeria (Ref. no. MH/AWK/M/321/408). Following ethical approval, permission to conduct data collection was obtained from the management of all the selected health facilities. This study was conducted in accordance with the Declaration of Helsinki. All participants provided both written and verbal informed consent. Participants were informed of the purpose of the research, rights of participants and measures that will be taken to protect them and their data. Hence, participation was voluntary, and confidentiality was assured. Verbal permission to audio-record interviews was also obtained from respondents.

: Bothe written and verbal consents were obtained from the study participants to use anonymized data or quotes from them for publication.statement.

: One of the authors is affiliated with the Health Insurance Agency under studyHowever, certain measures were taken to reconcile the conflict of interest in the data analysis. these include:-Excluding the researcher from the Agency from being part of the coding of the transcript and analysis of coding outputs. -Engaging independent researchers to participate in the coding of the transcripts and validation of the coding outputs to ensure the accuracy and quality of the results presented (the independent researcher has been acknowledged in the acknowledgement section of the manuscript). The authors stated in their contribution that only one author not affiliated with the agency participated in the data analysis.