Covid-19 Recovery and Growth: Promoting Technology Innovation in Healthcare Sector on Hygiene and Safe Medication Practices in Low-Resourced Nigerian Societies

Introduction Globally, the healthcare sector is primarily designated to provide timely, efficient and effective medical services. In African countries like Nigeria, the inequality in the healthcare sector is worsened by the limited coverage of healthcare delivery. This has evolved to an unprecedented effect on the provision of healthcare services in low-resource societies. In the post COVID-19 era, recovery and growth from the pandemic become more demanding with an emphasis on promoting innovative technology in the healthcare sector on hygiene and safe medication practices. Method Data was sourced from mixed research method. Questionnaires, focus group discussions, and in-depth interviews were used to deduce data from 142 healthcare providers, users, and social workers. Participants were randomly selected from three healthcare institutions in Nsukka, Enugu state. Result Findings revealed that although greater positive perception (66.7%) holds on promoting innovative technology in the healthcare sector; concerns on negative perceptions (33.3%) were; the choice of medication, cultural health behavior and non-adherence to health guidelines. Major factors militating against innovative technology in healthcare sector were corruption in healthcare system, patients’ economic level and poor healthcare delivery. Findings depict that age (χ²cal= 84.0, p=0.000<0.05) and income (χ²cal= 53.7, p=0.000<0.05) of patients were found to be significant in the utilization of innovative technology in healthcare. Evidence-based interventions on innovative healthcare systems on hygiene and safe medication practices were; intensive community health education at the grass-root, implementation of health policies, and tutors’ improved healthcare knowledge. Participants showed little knowledge of social workers’ engagement in health institutions. Conclusion Equity in healthcare is a core concern in Sustainable Development Goals. Achieving equal distribution of health services between urban and rural societies in recovery from covid-19 pandemic and growth of the healthcare sector is pegged on promoting innovative technology in hygiene and safe medication practices. The study recommends that social workers’ engagement with health providers and users in low-resourced societies could help propagate awareness and self-care management of health challenges through digital information technology in Nigeria.


Introduction
Globally, the healthcare sector is primarily designated to provide timely, efficient and effective medical services. As such, the sector encompasses all formally recognized institutions that provide healthcare, including primary health clinics, secondary and tertiary district or national hospitals, public and private (including faith-run), and temporary structures designed for emergency (pandemic) contexts (World Health Organization [33] . The availability of healthcare institutions ensures that attaining a low proportion of communicable diseases and infections remains a major goal worldwide. This stems from the fact that achieving universal health coverage (UHC) and accomplishing the sustainable development goal (SDG):3 "to ensure healthy lives and promote wellbeing for all" [32 , 34] ; are paramount in the protection from diseases caused by poor hygiene and unsafe medication practices.
In most African countries, Nigeria inclusive, the last few decades have been preceded by diseases like Ebola, Monkey-pox, Laser-fever, and the novel Coronavirus [33] . The COVID-19 pandemic has affected several continents of the world causing large-scale loss of life, severe human suffering and has also exposed the weaknesses in our healthcare sector [8] . Squeal to this, the pandemic had an unprecedented effect on the provision of healthcare services, with staff, budget and facilities all directed toward managing the crisis (WHO & United Nations Children's Fund [35] [UNICEF], 2020). Consequently, building resilience for the population requires strengthening the healthcare sector. Hence, effort aimed at achieving the UHC and SDG: 3 in the post-covid-19 era, comes with promoting innovative technology in healthcare sector, which is a source of concern to healthcare providers and users. use In Nigeria, healthcare is mainly driven by the public sector, despite the increasing country's population projected to hit 400 million by 2050 (National Bureau of Statistics, 2021), and healthcare expenditure to be 9% by 2040 [25 , 27] . The World Health Organization (WHO) reports that Nigeria is placed 187 th among 200 countries in the global healthcare delivery system ranking [5] . The country runs a national health insurance scheme meant for only federal public workers who constitute 1% of the total population and reside mostly in urban areas . Report has it that 66% of the country's 34,0 0 0 health facilities are owned by the three tiers of government, whilst the private sector also contributes substantially to the provision of health services [2 , 24] . Hence, Ozawa et al., [27] , posit that households' out-of-pocket expenditure for health in Nigeria constituted 72% of public health expenditure and 95% of private health expenditure in 2018.
Nevertheless, the situation in the Nigerian healthcare system stems from reduced state investment in public health systems, low insurance fees, higher demand for services, with a backlog of procedures, increasing costs of equipment, consumables and services. Again, it relates to factors including inequality in the distribution of healthcare facilities between urban and rural areas, increasing corruption levels in the healthcare sectors and high levels of household out-of-pocket payments for health goods and services [5 , 24] . Additionally, concerns ranging from ignorance, uncaring and poor attitude to personal hygiene, lack of basic infrastructure and sanitary facilities (water, soap and toilets), lack of food preservation facilities, inadequate self-medication associated to unhealthy living, have been reported in literature [12 , 15 , 23 , 33] . Obviously, these difficulties deter people from seeking hygienic and safe medication practices at the very moment they need them most.
Against these backdrops, the challenges in the healthcare sector must be overcome to maximize the health difficulties of Nigerian population [24] . Scholars have asserted that overcoming major health barriers could be by increasing the national budget allocation for healthcare to match the global standard, expanding the scope of national healthcare scheme to reduce out-of-pocket spending, prioritizing continuous medical education for healthcare staff to improve their knowledge base, and awareness campaigns regarding healthcare advice for the population [2 , 10 , 12] . Consequently, the healthcare system needs to evolve substantially. This is evident from the fact that the healthcare resource allocation is skewed; with a high proportion going towards secondary and tertiary care facilities [29] . This implies that the primary healthcare facilities available at the grass-root may be neglected, with the implication of increasing cases of diseases in low-resource societies.
In this study, an attempt is made to explore concerns on recovery and growth from COVID-19 aftermath through innovative technology in healthcare. This becomes significant in that the world today is powered by technology in various sectors including health. Pal et al. [28] stated that innovations in healthcare can drive economic growth by improving efficiency and increasing productivity, as well as optimizing patient outcomes. Again, it tends to address deficits in cost, safety and quality while offering new and improved approaches to diagnosis, therapy, and self-care management [9] . Further, innovation can be guided by a framework targeted at achieving health success through hygiene practices, safe medication and digital information technology [21] ; with effective intervention by social workers.
Medical social work practitioners collaborate with health workers in public healthcare sectors [16] . For instance, to foster greater adherence to hygiene and safe medication practices, particularly in low-resourced societies, it becomes pertinent to consider the influence of certain social and demographic factors, all of which fall within the preview of social workers. Specific to this context, social workers are expected to lobby, advocate and intensify education on healthcare utilization [1] . Regarding Nsukka, Enugu state, where the study was conducted, social workers could push for a new narrative of hygiene and safe medication culture, organize counseling and discourse sessions for support networks of patients, draw follow-up programs, enlighten and encourage the adoption of innovative digital healthcare systems [16 , 31] .
It is a well-established fact that good hygiene practice is one of the best ways to prevent infectious diseases; whilst safe medication ensures access to the safe use of medicine [12 , 15] . However, hygiene and safe medication practices aim to promote healthy living. To this end, strategizing measures for healthy living through promoting the Nigerian healthcare sector to recover from the pandemic requires concentration on innovative healthcare system [28] . Apparently, innovations in healthcare sector include utilization of web-internet services which offer online prescribed medication, information to understand and manage disease conditions and various generic alternatives to costly drugs [9] . Smartphone applications can also provide services like heart and body temperature monitors, electrocardiograms and the like. Others are online pharmacopeia aids and the growing applications of computer device health machines and mobile phones specifically utilized in creating awareness and reminders through Short Message Services (SMS), YouTube, Instagram, Google, Twitter, Facebook and WhatsApp. These, ultimately enhance the adherence to hygiene and safe medication [21] .
Despite all the advanced medical innovations, worrisome is the adherence to hygiene and safe medication practices; which remains one way of recovery from the COVID-19 aftermath. In low-and middle-income countries, available evidence shows that there is a deficiency in hygiene and safe medication culture; which is compromising patients' safety [15 , 27] . For instance, the washing of hands is only observed when food is about to be served; whilst symptoms of ill-health go first with self-medication, adopting inadequate and traditional drug treatment from pharmacists. However, a steadily growing knowledge base indicates the need for improvement in patients' safety using common healthcare innovative technologies.
To date, numerous studies abound that have discussed issues on COVID-19 pandemic, hygiene practices and medication safety in healthcare institutions [1 , 8 , 12 , 27] . Those that are African-based, have successfully unraveled the experiences of the pandemic and challenges militating against the efficacy of hygiene and safe medication practices in the continent. Scarcely are their studies that have used mixed research methods in deriving an in-depth understanding of promoting innovative technology in healthcare sector on hygiene and safe medication practices for COVID-19 recovery and growth in low-resource Nigerian societies. This study therefore contributes to the existing literature on COVID-19 recovery, advocates for infection prevention and safe medication practices, ensures the inclusion of medical social workers in the healthcare system and the need for the improvement of the Nigerian healthcare sector. It is against this background that this study is posing the following research questions; (1) What perception holds on promoting innovative technology in healthcare institutions on hygiene and safe medication? (2) What factors militate against promoting innovative technology in healthcare institutions on hygiene and safe medication? (3) What interventions can intensify innovative technology in the healthcare sector on hygiene and safe medication? (4) What is the involvement of social workers in promoting innovative technology in healthcare settings?
The study was guided by the following hypothesis : Substantive hypothesis 1) H1: Younger patients are more likely to accept innovative healthcare technology in treatment than older patients. 2) H1: Patients who have higher income are more likely to accept innovative healthcare technology in treatment than patients who have lower income.
Null hypothesis 1) H0: Younger patients are not more likely to accept innovative healthcare technology in treatment than older patients. 2) H0: Patients who have higher income are not more likely to accept innovative healthcare technology in treatment than patients who have lower income.

Study area
The study area is Nsukka Local Government Area (L.G.A) in Enugu State. This is one of the 36 states in the South-East geo-political zone in Nigeria. The total population figure of Enugu State is about 4.1 million [19] . In Enugu State, there are about 1,037 healthcare facilities [6] comprising of government hospitals, orthopedic, neuropsychiatric, primary healthcare centers, mission (faith-based), and privately-owned health facilities. These health facilities operate at the primary, secondary, and tertiary levels and are mal-distributed politically. However, they generally lack facilities and personnel particularly in the rural areas, with an estimated staff strength of 4,422 as of 2016 [6] . Nsukka L.G.A was purposively selected because it is a semi-urban area made up of 17 rural communities with a major urban area which is Nsukka town. Hence, most rural indigenes owing to proximity, migrate to the town for healthcare services. The locality has small-sized private (for-profit) health facilities but is dominated by government and mission health institutions. Despite these, it is characterized by heavy disease burden and great out-of-pocket financing, as is the case with most communities in Nigeria.

Population and sampling
In this locality, there are ten major healthcare facilities [6] . Purposive sampling procedure was applied in selecting three healthcare institutions. The institutions were selected based on their category. Hence, one each of the tertiary, secondary and primary healthcare institutions was selected for the study. The institutions include the University of Nigeria Medical Center (UNMC, tertiary), General Hospital Nsukka (GHN, secondary) and the Nsukka Primary Healthcare Center (NPHC, primary). From these institutions, a total of 142 study participants comprising three different categories were obtained.
This study involved a mixed research method. First, a cross-sectional design for the quantitative study and second; a phenomenological study design using qualitative approach was adopted to ensure an in-depth description of innovative technology on hygiene and safe medication practices among healthcare providers and users. Primary data was collected between June and August 2022. With the assistance of the health personnel, simple random sampling procedure was used to select 42 participants aged 30-60 years from the healthcare institutions. The rationale is that this age distribution is actively involved in production (labor) and providing healthcare assistance. These participants were randomly selected with the assistance of health staff to ensure that certain type of persons displaying certain attributes were included in the study [14] . This gave a total of 126 institutional health users who participated in the quantitative study.
The second phase was the phenomenological qualitative research approach. According to Crossman [4] , the approach enables the description, explanation and interpretation of a phenomenon among a subset of the population. A phenomenological approach provided an opportunity to give a voice and understanding to what participants said based on their lived experiences [20] . This comprised three focus group discussion (FGD) sessions with 24 participants, made up of eight health personnel (four males and four females) from each health institution. They were mostly physicians, nurses and other clinical professionals.
Thirdly, two in-depth interviews with male and female medical social workers guided the study. They were selected based on their five-years' experience in the University of Nigeria Medical Center, Nsukka. This was to allow us to collect diverse views from the study participants. The criterion used in selecting the participants was willingness to participate and availability on the date set aside for filling the questionnaire, discussions and interview

Data collection
Data was first collected using self-administered questionnaires. This was titled "Questionnaire for Innovative Technology on Hygiene and Safe Medication Practices for Health Facility Users". The instrument has twenty open/close-ended questions (to prevent fatigue), comprising socio-demographic characteristics, and views on innovative technology in healthcare on hygiene and safe medication practices. The questionnaires were distributed to health users only, with the help of two trained post-graduate students from the University of Nigeria Nsukka.
A semi-structured question guide was also, used to collect qualitative data. This was done by first conducting a general introduction of all the participants and researchers present for the discussion. The objective of the discussion was read to the participants after giving assurance of confidentiality, anonymity, and obtaining oral consent from the participants on audiorecording, their willingness to participate and freedom to decline during the discussion. Researchers designed questions with probes termed "Focus Group Discussion Guide for Innovative Technology on Hygiene and Safe Medication Practices for Healthcare Workers"; was used to elicit responses from participants. To uphold confidentiality, the participants were given numbers (as names) to identify responses from them. We held our group discussions in a round sitting position with a large table at the center (used for tape recording and note-taking). The FGD guide was collectively designed by two researchers and pretested with a group of four health personnel in a private hospital. Insights from the pretest were captured in the final polishing of the FGD guide before the main study. Among the four researchers trained to assist in this study, one person moderated, while the others were coders who took notes and monitored the recording gadget. Care was taken to ensure the effective participation of all the participants. The discussions were in English languages, which was convenient for all the participants; hence there were no interpreters. Each discussion lasted not more than 2 hours to prevent fatigue. Time and location were based on the choice of the participants.

Data analysis
Data generated from the questionnaire were first coded and analyzed using the Statistical Package for the Social Sciences (SPSS) version 21. Adopting the four response categories in the Likert scale, respondents' opinions were presented in percentages. Correlation analysis using Chi-square was adopted to test the hypothesis at 0.05 level of significance. All p-value less than 0.05 was considered to be statistically significant.
The qualitative data analysis technique began with note-taking and careful audio-recording of all the discussions and interviews. Data was analyzed after transcribing the discussions and interviews in English language. This was to enable easy understanding. Data immersion commenced by repeatedly hearing the audio and reading the transcribed discussion and field notes for familiarization. The data analysis process followed the qualitative procedure of data reduction, data display Table 1 Percentage distribution of socio-demographic characteristics, action at first sign of illness and perception of technology innovation in healthcare system. and conclusion [20] . We compared the contents of the transcripts with the field notes and recorded information to ensure coherence. Next, we coded the data into parent and child nodes. The coded data were further checked by other researchers, grouped and categorized. An inductive coding approach was adopted; meaning and themes were generated as we studied the transcripts This was done to ensure that codes with similar characteristics were grouped thematically to arrive at key themes. The use of thematic clusters to understand and communicate qualitative data is rooted in phenomenology [3] . The themes generated were developed following the research questions courtesy of field experience. To add more rigor to our data analysis, the transcripts generated were read for content validity by two academic peers who were not part of the research for further examination. Their insights contributed to the final checks on the analysis. These exercises are in line with Crossman [4] overview of qualitative research method. The final themes include; • Perception on promoting innovative technology in health institutions on hygiene and safe medication.
• Factors militating against promoting innovative technology in health institutions on hygiene and safe medication.
• Interventions to intensify innovative technology in health institutions on hygiene, and safe medication.
• Assessment of knowledge and involvement of social workers in promoting innovative technology in health settings.
Finally, special connotations that addressed the research questions were pulled out as illustrative quotes from the thematic cluster to exemplify the key issues. Inscriptions were used to connote the hospital initials and gender (M-male, Ffemale). Ethical clearance for the study was sought from the oral voluntary consent of participants. Also, anonymity was assured to all study participants before the discussions and interviews. The Strategic Contacts Ethics and Publications (STRA-CEP) of the University of Nigeria, Nsukka Campus, Enugu State granted the ethical approval. Table 1 The result of our findings are presented first with a table showing the socio-demographic features of the study participants and their actions at first sign of illness. It is imperative to note that equal representation of gender was considered. Most of the participants (63.5%) earned below ₦30,0 0 0 monthly ($60) which is the country's minimum wage. All the participants were married and are from the Igbo ethnic group.

Result
It is imperative to state that the question on item seven (7) was a close-ended question. Respondents gave various responses including "no, yes, somehow and don't know. These responses were grouped by the researchers into two categories which were positive and negative perception of innovative healthcare technology. Responses like 'yes and somehow' was categorized as positive perception while responses including 'no and don't know' was categorized as 'negative perception'. Other responses specified were merged in this two categories.
In Table 2 , the researchers categorized the participants' responses based on the four research questions that guided the study. The Likert scale method was adopted for the analysis to facilitate easy understanding. Items in the questionnaire  consist of four response categories on the Likert scale. Values were assigned to the response categories as follows: Strongly agree (SA) = 4, Agree (A) = 3, Strongly disagree (SD) = 2 while Disagree (D) = 1. These items were coded in the SPSS data. Items under strongly agree and agree were coded and categorized as positive perception, while items under strongly disagree and disagree were coded and also categorized as negative perception. Results show that more than half of the respondents (66.7%) had positive perceptions of promoting innovative technology in the healthcare sector while (33.3%) had negative perceptions of concerns. Also, from the computation (average) of their responses, findings show that above half of the respondents (65%) were optimistic about factors that influence promoting innovative technology in healthcare sector while (34.9%) were pessimistic. Lastly, greater respondents (75.9%) than few (24.1%), supported interventions on promoting technology innovation in healthcare sector, whilst greater respondents (80%) than few (20%) had little or no knowledge of social workers' involvement in the healthcare settings in Nigeria.
In this study two substantive and null hypotheses were formulated. In other to test the hypothesis, two independent variables (age and income) were cross-tabulated with the dependent variable (perception of innovative technology in healthcare treatment). The purpose was to determine the statistical relationship between the independent variables on the dependent variables. Table 3 explains further: The Table 3 shows the cross-tabulation of two independent variables on age and income level with perception of innovative healthcare technology. In the first variable on respondents' age, result shows that the calculated Chi-square ( χ² cal = 84.0) is greater than the Critical value ( χ² tab = 3.841) at p = 0.0 0 0 < 0.05 level of significance and degree of freedom 1. In the Chi-square test, the decision rule (on accept or reject the null or substantive hypotheses) was by comparing the calculated Chi-square and the Critical tabulated value ( χ² cal and χ² tab ). The null hypothesis (Ho) is rejected while the substantive (H1) hypothesis is accepted if the Chi-square ( χ² cal = 84.0) is greater than the Critical value ( χ² tab = 3.841). In this regard, the substantive hypothesis is accepted while the null hypothesis is therefore rejected. This implies that there is statistically significant relationship between age and acceptability of innovative healthcare technology in treatment. Hence, younger patients are more likely to accept innovative healthcare technology in treatment than older patients.
Concerning the variable on respondents' income, result shows that the calculated Chi-square ( χ² cal = 53.7) is also greater than the Critical value ( χ² tab = 3.841) at p = 0.0 0 0 < 0.05 level of significance and degree of freedom 1. Base on the foregoing, the substantive hypothesis is hereby accepted while the null hypothesis is rejected. This implies that there is a statistically significant relationship between income and acceptability of innovative healthcare technology in treatment. Hence, patients who have higher income are more likely to accept innovative healthcare technology in treatment than patients who have lower income.

Socio-demographic characteristics of participants for qualitative study
The socio-demographic characteristics of the participants for the focus group discussions indicate that they were all health practitioners. Their ages ranged from 30-55 years. They all had qualifications above secondary school certificates with five years of working experience in the practicing healthcare institution. Except for three who were non-indigenes, the others were Igbo indigenes. Only two participants were Islam while the others were Christians. The medical social workers who volunteered to be interviewed were aged 37 and 45 years old, had Master's degree qualifications, are Christians and Igbos.

Perception on promoting innovative technology in health institutions on hygiene and safe medication
Generally, participants from health institutions agreed that innovative technology in healthcare sector on hygiene and safe medication is greatly needed in the recovery from COVID-19 era. First, most participants lamented on the attitude of their colleagues towards patients during and after the pandemic. Below is an illustrative quote: Really the attitude of health workers towards patients during the pandemic signified that we are not dedicated to our profession. But it is good for patients to understand that we need to protect ourselves and others. With medical innovations, healthcare management would be easier for everyone (GHN, F).
Elaborating more on their perception of promoting innovative technology in the health sector, the participants gave various opinions based on their experiences. While some participants expressed positive perception, others had negative perception.

Positive effect of innovative technology in health institutions
Except for a few, most of the participants perceive innovative technology in health institutions as a welcomed development. The majority of the participants were of the view that it will reduce the demand for medical professionals. Others suggested that it will increase knowledge of health-related issues and as well fill the gap existing in rural healthcare management. Some, however, asserted that innovative technology has been useful in other sectors like sports and education; and so, could be applied in healthcare sector. The following are some illustrative quotes: …one can google online to acquire certain health information needed to cope with ill-health or even make a phone call to a physician (Social worker, M).
I learned that there are online computerized doctors one could call for consultation on health needs. If the information they give is accurate, then it is a good development in the healthcare sector with the ratio of the national population and health workers (GHN, F). This era calls for innovative healthcare considering the COVID-19 experience. It is important because it will serve numerous purposes like increasing health awareness, help reduce demanding healthcare services and other vital roles (UNMC, M).
The participants who suggested that healthcare innovation will increase knowledge of health-related issues and health management skills testified that they practice it. This they suggested will assist caregivers of patients with health needs. See quotes below: …every morning I use the heart and blood monitor to examine my health status. It is one of the things I have learned to do during this era. I urge caregivers to adopt this (UNMC, F). …with technology innovation, it has become possible to invent vaccines for evolving diseases like coronavirus. It has also helped to boost immunity for some vulnerable patients. As a radiographer, this is my field and it has been of great assistance to medical advancement (UNMC, M).

Negative perception of technology innovation in health institutions
Few participants gave concerns about negative perception of technology innovation in healthcare. Some of the negative issues narrated by the participants that may reduce the effect of technological innovation in health sector include the choice of medication, cultural health behavior and non-adherence to health guidelines.

Choice of medication
Regarding this concern, participants were of the view that there is a gradual preference for the use of traditional medication over modern drugs. This preference is associated with the advent of coronavirus diseases as most patients utilized local medicine to stay safe from infection. A participant narrated that the choice of local medication could influence the acceptance of health innovation in low-resourced societies. A male participant narrated a sympathetic experience saying: "I have a patient who died after taking medication, with the use of local herbs. It was just a simple mistake that killed the woman". Although some participants were against utilizing local medication, few participants gave support. This was noted when a participant said: "…not all local medications are bad, some are very good and effective and I have used them".

Cultural health behavior of the patients
Other participants, stressed on cultural health behavior of patients. They were of the view that people rarely visit health institutions on early signs of ill-health. Hence, they give room for prolonged illness before health service visitation. For instance, a participant who was very vocal in the group said: "… patients have the culture of poor routine and late hospital visits …". A similar view was shared by another participant: …people have this attitude that slight illnesses should be self-treated. So, all one can do is buy drugs from patent drug dealers and administer them by oneself using the trial and error method. Though some get well, others do not (UNMC, M).
Elaborating on the cultural health behavior of patients, participants explained that health attitude in most low-income societies is discouraging. The participants reported poor water utilization owing to supply, poor hygiene in nutrition, and sanitation among others. Below are some illustrative quotes: In this town water is scarce and so, the utilization is poor. It is only during meals that washing of hands is observed often without soap; then they clean their hands on their bodies after eating. Even the drinking water obtained is not reliable. The worst is during the dry season when we are forced to fetch water (GHN, F).
You see, most low-resource families are found in rural areas. They often adopt the culture of poor sanitation and hygiene like open defecation. Despite the teaching and innovation in health, they often disregard effective health information. Really, some of them are ignorant and often do not believe in the existence of these diseases (NPHC, M).

Adherence to health guidelines
More discussions indicated that adherence to health guidelines proved a negative perception of technology innovation in healthcare. In this regard, majority of the participants lamented that despite the health guideline stipulated (like social distancing and washing with soap and running water) using various social media, patients rarely adhere to these instructions. The same goes for technological innovations in healthcare. In order words, failure to adhere to health guidelines by health instructors will also result in the failure to adhere to innovation in healthcare. They stressed that adherence could be by observing proper hygiene and sanitation in our environment, taking appropriate drug dosage and the like.

Factors militating against innovative technology in health institutions on hygiene and safe medication
Contrasting views were raised by the participants in this regard. While some participants noted patients' economic level, others reported on corruption in the health sector and poor health delivery.

Patients' economic level
Regarding patients' economic level, participants identified factors that limit the capability of innovative technology. The factors include lack of access to technologies such as smartphones and social media access, inability to pay for subscriptions and high cost of technology services. A participant explained that some individuals may not be able to afford minor health gadgets like heart and blood monitors or smartphones, so they resort to the use of local medication. Some of the illustrative quotes are as follows: Most patients do not have access to technology such as smartphones that can perform these functions. Even if they wish to use them, they are not able to buy them (GHN, F). You see, in most rural societies there are no internet services while some have poor networks. So how then can you gain access to online communication? The only option is to go to a nearby town where services are available (UNMC, M).
Rural dwellers often may not be able to pay for the cost of technology services in health centers. They may desire to use them but most of these health technologies are expensive (Social worker, F).

Corruption in the health sector
Regarding corruption in the health sector, participants noted the rapid dilapidation of healthcare equipment that requires urgent replacement. However, funds are not released and when the government eventually raises funds, it is diverted and does not cover much. Participants explained that primary health centers in these communities are not adequately equipped, so, many professional health workers' rejects being assigned to these areas. For another participant, she said: " healthcare should be made free for all. It is so in other countries except in this country ". Another participant buttressing this point orates: Healthcare in this country is discouraging. Health institutions are not adequately funded so health workers go on periodic strikes. Funds meant to revitalize health institutions are diverted by individuals for personal gains. Our politician resort to seeking health needs in foreign countries to the detriment of the general masses (UNMC, M).

Poor health service delivery in low-resource societies
In our discussion, it was revealed that in low-resourced societies, healthcare centers exist in various communities. Some of the participants narrated that owing to the nature of the study community, and considering the inequity in healthcare distribution, poor healthcare delivery exists therein. A participant explained that rural communities have few health workers who are poorly rewarded. This affects their attitude towards patients and service delivery. Hear her: …life in rural communities is hard and health workers are poorly rewarded. So some health workers exhibit attitudes like negligence and unfriendly relationship with patients while others are ignorant and lack competence. With poor quality of healthcare delivery, various diseases and infections could evolve in these communities (GHN, F).
Stressing more on poor health service delivery, some factors were identified to be responsible for militating against technology innovation in healthcare sector on hygiene and safe medication practices . They include age, religious belief and communal living. Participants reported that most low-resource societies practice communal living with older family members. Oftentimes, older family members and friends are oblivious of the need for technological innovation in healthcare sector and would never give in to the idea. They attribute the practice to modernity and tend to be very skeptical of the importance. In the words of two participants, they narrated: …one could rarely mention technology health gadgets to my aged father. For him, life support rest with God (UNMC, F) I know of a friend whose faith is against innovative technology in healthcare. He once told me that it is the increase in technology innovation that has increased new diseases (Social worker, F)

Evidence-based intervention to promote innovative technology in health institutions on hygiene and safe medication
The participants gave various suggestions to promote technology innovation in health institutions on hygiene and safe medication. Interventions highlighted were categorized under three sub-themes including implementation of healthcare policies, community education for low-resource dwellers and tutors' capacity building.

Implementation of health policies
Some participants suggested that they want government legislators to implement health policies and laws that will ensure free healthcare for all. They emphasized that this is greatly needed particularly for the vulnerable at the grass-root. For a participant, she stressed that the implementation of health laws will ensure regular utilization of health institutions. This will encourage and increase their knowledge of technology innovations in healthcare sector. Additionally, some participants explained that periodic sanitation exercises should be conducted particularly in rural communities to encourage environmental sanitation and hygiene. See an illustrative quote below: Government should institute health laws on compulsory sanitation. This should be enforced with collaboration from local chiefs, leaders, health workers and security officials. With their effort, community development practice, environmental sanitation and hygiene could be sustained and disease-causing infection and illness can be reduced (GHN, F).

Community education and enlightenment
Another suggestion raised by the participants was community education and enlightenment. This is necessary based on the fact that some individuals had doubts concerning the effectiveness of certain drugs. Others reported that aside effective drugs, people doubt the existence of some of these diseases and pandemics. This could be associated with low adherence to health guidelines. Below are illustrative quotes: …see some people have refused to accept drugs like the COVID-19 vaccination and even other vaccinations. They say that the disease is 'Whiteman's illnesses and do not exist in our place. They see it that their forefathers received none of these drugs and vaccines but they lived long. So, taking these vaccines and drugs will only reduce their body immunity (NPHC, M). …ignorance of some individuals has led to some diseases still in existence. Government should use police and arrest anybody who refuses to adhere to recommended health regulations, particularly on environmental sanitation and hygiene. This will serve as a detriment to others (Social worker, M).

Tutors' education, capacity building and training
Lastly, some participants gave suggestions on tutors' education, capacity building and training on digital healthcare. Regarding this view, majority of the participant were quick to point this out. An elderly participant responded: "it is what you know that you teach another, and again, you practice what you teach". Other illustrative quotes include: Health workers must indulge in regular training. They could go for online courses, vacation study programs and the like. This will help increase their knowledge on treading health technologies and evolving diseases (Social worker, M) Seminars could be organized periodically for health workers. This would keep them informed on current and vital health issues" (GHN, F) The world is ruled by digital technology and innovation becomes vital in healthcare sector. This calls for increased digital training for health workers both in urban and rural sectors" (UNMC, M).

Assessment of the involvement of social workers in promoting technology innovation in healthcare settings
In this regard, the resounding view was that there is little or no knowledge about social work practitioners' involvement in healthcare settings. To use evidence in informing the involvement of social workers in this context, we gleaned responses of the participants to understand connecting narratives. Some of the participants do not know who social workers are and what they could do. As narrated by this participant "I don't know them and who they are ". For another participant, she reported, " I have heard of one in this hospital, but I do not know their roles here".
Stressing on this view, the two interviewed social workers explained that formal social work practice in Nigeria is relatively new and emerging. This implies that it is still unpopular, especially in low-resource communities where the study was conducted. The following contains some illustrative quotes from them: Social work in healthcare is unpopular and faces an uncertain future. Really, the professionals are being pushed to rethink their mission and identify the practice components and gaps needing their expertise (Social worker, M).
…their roles in the health setting are numerous. They educate patients and families, provide care assistance, indulge in-home visits and follow-up in special cases. Their services cannot be overemphasized (Social worker, F).

Conceptual framework
Adopting a conceptual framework for this study, we considered the diffusion of innovation theory developed by Rogers E.M, in 1962. The diffusion of innovation theory has been used in the child survival sustainability assessment (CSSA) specifically designed to examine health program implementation in low-resourced societies as reported by Fox et al. [7] . The choice of this theory is that it seeks to explain how, why and at what rate new ideas and technology spread; with the result that people, as part of the social system, adopt new ideas, behaviors, or techniques [30] . This means that people adopt attitudes that are different from what they exhibited previously that is, observing improved hygiene and safe medication practices through the use of new technology in healthcare. The key to adoption is that persons must perceive the idea, behavior, or strategy as innovative [18] . It is through this that diffusion is possible.
However, the adoption of innovation does not happen simultaneously but is a process whereby some people are more apt to adopt the innovation than others [13] . For instance, persons in low-resource societies in this study may experience difficulties in adopting technology innovation in healthcare owing to poor adherence to healthcare innovation, financial incapacitation, corrupt government, gap in healthcare delivery and cultural health behavior among others. Against these backdrops, we suggest strategies through which health innovation diffusion can be accomplished including grass-root community education, health policies and improved tutors' knowledge. These measures with social workers' involvement will ensure achieving universal health coverage. Overall, Fig. 1 presents a graphical illustration of our framework.

Discussion
Despite the advancements in medical science and health technology, diseases and infections continue to pose a threat to the world. With an increasing global population and to achieve universal health coverage [34] ; promoting technology innovation in the healthcare sector becomes paramount. A novel finding in this study is the low utilization of healthcare institutions. It was found that the highest percentage of participants (43.7%) choose to visit a pharmacist to purchase medication at the first sign of ill-health. Although a smaller (24.6%) proportion visit health institutions; others (22.2%) and (9.5%) adopt self-medication and traditional medicine respectively to this effect. This finding correlates with the qualitative data on the view that worsening health condition comes with increasing health needs. This finding is a clear indication that prompt utilization of health facilities and safe medication practice must be advocated as evidenced by several studies [12 , 26] . This will ensure early identification of diseases, quarantine and adequate treatment. This is amidst the need to advance across social and economic challenges posited by the pandemic for a swift recovery.
Another novel finding is that above half of the participants (66.7%) had positive perception of promoting innovative technology in the health system on hygiene and safe medication. This was based on their experiences during the COVID-19 era, where challenging health decisions which may be against their professional ethics must be made for the protection of lives. The participants asserted that based on their experiences during the COVID-19 pandemic including series of lockdowns and social distancing; technological innovation in healthcare would definitely fill the gap in healthcare delivery between medical professionals and patients. The high involvement of technology innovation in health sector has been evidenced in literature by Nolte [21] following Pal et al. [28] . It is important to note that the finding on the high involvement of health workers could be associated with the high demand in health sector during the pandemic. To fill the gap in health demand; there is a need, to advocate for a technologically innovative environment, particularly on improving hygiene and safe medication practices in low-resource societies. This can be done through the use of smartphones, health monitors and the like to examine health status. More so, internet services could be used in sourcing vital health information, on-line medical consultation and safe medication for cases of future pandemics.
A novel finding from this study is that none of the younger respondent (30-45 years) had negative perception of innovative healthcare technology (see Table 3 ). This finding support the fact that times are changing and so is our environment. This observation is obvious among the younger population who easily adapt to technology innovation. Findings from this present study show that fewer participants (33.3%) who had negative perceptions of promoting technological innovation in healthcare sector on hygiene and safe medication practices were all older respondents (46-60 years). Their perception was accompanied by various concerns regarding cultural health behavior, choice of medication and non-adherence to health guidelines. First, cultural health behavior was stressed by the participants. This is the attitude of prolonged ill-health and self-medication before utilization of health facilities which comes only when critical health situation arises. Second, it was found in our discussion that health attitudes in most low-income societies are discouraging. Reports from the participants indicated that rural dwellers oftentimes exhibit attitudes associated with poor water utilization owing to supply, poor hygiene in nutrition, and sanitation, among others. Third, adherence to health instructions was expressed as a concern in technological innovation. The failure of adhering to health guidelines will also result in failure to adhere to innovations in healthcare. These reports have been found in the literature [12 , 15 , 23] .
The test of hypothesis in Table 3 , shows that patients who had high level of income where more likely to accept innovative healthcare technology in treatment than patients who had low level of income. This is sequentially and logically true given that innovative technology for medical treatments is expensive. Hence, people with higher income are more likely to afford them. For example, the use of telemedicine is significantly not affordable to the poor or those with lower level of income, because the required efficient gadgets such as computers, smartphones, medical diagnostics equipment and internet access. These gadgets are relatively not affordable to the patients in the study region. Telemedicine is a subset of e-health that utilize communication technologies and networks to deliver medical education and healthcare services from one place to another [28] . It also involves the use of video conferencing and telecommunication to access health services. Health issues like blood pressure, cardiac status, oxygen level and respiratory rates can be monitored remotely, but it takes significant amount of money to have access to these technologies. Evidence from arrays of literature collaborated with the foregoing results, which provided evidence of under-utilization of innovative health technologies and e-health during COVID-19 pandemic in Nigeria. This was due to low income, poverty, low access of technological facilities, and the internet [11 , 17] .
Another novel finding from this study on the promotion of innovative technology in health institutions on hygiene and safe medication practices is the concern on the patients' resort to the use of local medication. They respondents know that innovative healthcare technology is better and they desire to use them. However, some of the respondents adopt local medication because it is cheaper, easily accessible and will help them not to incur debts. In the course of this study, it was revealed that greater respondents (65%) who were optimistic about factors that could hinder the promotion of innovative technology in health institutions on hygiene and safe medication practices stressed on the patients' economic level. In Nigeria, the healthcare sector is not adequately funded which reflects the gap that exists among the three categories of healthcare institutions [2] . Consequently, this challenge results in out-of-pocket health expenditure for patients and nonutilization of healthcare institutions as observed by Urama et al, . We then argue that the exploration of health innovation could be helpful in domesticating traditional medication as a safe medication practice in the Nigerian healthcare sector.
Indeed, the medical profession can be demanding, difficult and challenging. It is against this backdrop that we argue that strategizing healthy living measures, in promoting the growth of the Nigerian healthcare system in recovering from the COVID-19 pandemic, requires concentration on innovative technology in healthcare system. Regarding other studies that advocated for improving the healthcare sector in Nigeria ( [22 , 24] ), we observed that greater respondents (75.9%) than few (24.1%), supported government interventions on promoting technological innovation in healthcare sector. First, they suggested the implementation of health laws like health insurance policies for all citizens as obtained in developed countries. Second, they reported on the need for community education. Third, the participants stressed the importance of tutors' training and capacity building. These strategies they highlighted will not only ensure the utilization of health institutions but will create awareness of the existence of certain diseases, efficacy of the drugs, ensure increased knowledge for healthcare workers and adherence to health instructions by low-resource community dwellers. These strategies raised point to the pivotal obligation of government and health workers.
Another unique finding in this study that is not common in other studies is the involvement of social workers in the healthcare institutions. Quite disturbing is the finding that a greater percentage (80%) of the respondents than few (20%), had little or no knowledge of social workers' involvement in the healthcare settings. This could be associated with the fact that formal social work practice is relatively new and emerging in Nigeria [1] . These professionals with their skills in community mobilization can advocate and intensify health education on early and regular health facility visits. They could equally organize health programs including home out-patient care, mobile healthcare and follow-up home health visits, among other healthcare services [16] . Social workers collaborate with medical professionals and caregivers in the management of health challenges that require diffusion of innovative technology in healthcare. This is achieved by playing mediating, counseling, referral, and resource mobilization roles, particularly at community levels [1] . Additionally, discourse sections for support networks of family members, encouraging them on the utilization of medical technology is needful, and social workers are key to galvanizing such services. This will fill the gap in the shortage of various unavailable but needed health services and ensure adequate recovery from the pandemic and growth of the health sector.

Strength and Limitations
First, the researchers encountered difficulties in recruiting respondents and participants who would volunteer for the study. Second, the patients and healthcare workers who participated in this study were drawn from a particular locality. These limitations notwithstanding, we believe that the findings of this study remain valid.

Conclusion
In the post COVID-19 era, emphasis on the growth and recovery from the pandemic becomes daunting with concerns on achieving the UHC and SDG:3. This study then revealed that: • First, to ensure healthy living and promote wellbeing for all, equity in healthcare remains paramount in the protection from diseases caused by poor hygiene and unsafe medication practices. This is pegged on ensuring equal healthcare services distribution between urban and rural societies. • Second, urgent attention is needed in the Nigerian healthcare sector. Sadly, the existing norm in most-low and middleincome countries is the absence of national health insurance for the growing population. Implementing rural healthcare policies and mainstreaming the primary health sector (where the bulk of the rural poor obtain health services) into the national health insurance scheme will help in achieving universal health coverage. • Third, health education programs for all and sundry should be intensified. This will ensure public awareness of digital knowledge for health workers and users on innovative medical technology. In the case of rural dwellers, dissemination of health information could be done with medical social workers taking the lead. • Lastly, healthcare assistance could also emanate from the inclusion of medical social workers in health institutions. The collaboration of social workers with health professionals and caregivers on various digital health programs becomes essential with the aim of achieving hygiene and safe medication practices in the recovery from COVID-19 pandemic and the growth of the healthcare sector in Nigeria.