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THE UTILIZATION OF PRIMARY HEALTH FACILITIES (A CASE STUDY OF ORLU LOCAL GOVERNEMT AREA, IMO STATE)
ABSTRACT
This study assessed service/organisational factors and clients’ perceptions that influenced utilisation of Primary Health Care (PHC) facilities in a rural community in Nigeria. This paper looks at the implementation of primary health care (PHC) through community – based health education programme in Orlu metropolis. The population of the study consists of primary health care workers and the inhabitants of Orlu East, West and South LGAs that make up Orlu metropolis. A total of 240 subjects were selected for the study through a multistage-cluster sampling technique. The instrument used for the study was questionnaire, validated and tested for reliability through a test re-test method. The coefficient for the reliability was 0.82r. Analysis of data revealed, among others, that community based health education programme is a significant factor in the implementation of PHC services. The paper suggested that the people of Orlu metropolis should be adequately informed of the concepts, needs, problems and prospects of PHC programme so that they can perceive the programme positively and participate actively in its implementation. Primary health care aims to provide essential health services and commodities to individuals and communities using available, acceptable, and sustainable resources. However, the demand for and use of primary care has fallen despite government investment. We sought to identify the main barriers affecting use of primary health-care services in Orlu (Imo, Nigeria). The essence of primary health care is the provision of essential health services and commodities to individuals and communities using available, acceptable and sustainable resources. However, there has been a growing lack of confidence by the populace as evidenced by poor utilization of the services. This study sought to identify the predominant barriers affecting the utilization of primary health care services in Orlu Local Government in Imo State, Nigeria. A cluster of 630 households was surveyed in the catchment of the 21 health primary health facilities. A catchment been defined as a household located within 5 km of a primary health center. Using a three digit randomly generated numbers a household was selected. Once selected the start house and twenty-nine contiguous houses were visited. a total of 630 households were surveyed. In all households, questions were asked on the predominant health problems, as well as the major determinants of access and utilization of primary health care services .The results were computed and analyzed using the Statistical Package for Social Sciences software SPSS. Version 17.0. The findings from all the respondents (n=630) showed that majority of the people preferred to seek care from the patent medicine stores (53.63%) as against only 7.6% who utilized the primary health care services. The commonest reasons why respondents do not utilize these services were lack of essential drugs, high cost of services as well as inadequate infrastructure in primary healthcare facilities. The study has highlighted some of the multiple factors affecting the utilization of primary healthcare services. It is expected that these findings will guide policy makers in improving healthcare delivery particularly where the need is greatest – at the grassroots – in line with the national health policy and national health strategic development plan.
CHAPTER ONE
1.0 INTRODUCTION
1.1 BACKGROUND OF THE STUDY
During the1975-1980 period (Nigeria’s Third National Development Plan), there originated some concerted efforts to meet the World Health Organization’s (WHO’s) standard of 1 doctor -10,000 population ratio. The needs in the health sector led to the establishment of Federal and State health institutions and the training of middle-level personnel; also there was the establishment of Basic health Services Scheme (BHSS) and the establishment of Primary health care (PHC) as the centrepiece of health development in Nigeria (Akande, 2002).
Part of the fundamental principle underlying the national health policy in Nigeria to achieve health for all Nigerians is based on the national philosophy of social justice and equity (FMH, 1988). The international conference on Primary Health Care defines primary health care as:
essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and their families in the community through their full participation and at a cost that community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination (WHO, 1989)
The primary health care (PHC) facility is often all that rural communities have in form of a formal health system. How then do we improve the quality of care when attention has consistently been on expanding the reach of PHC services to rural populations and hardly on quality of services? The presence of a PHC facility does not guarantee its use and there is a wrong assumption that a minimal level of input (i.e. infrastructure and staff) is essential before one can discuss quality. Even when quality becomes a real issue, it is often about supervision; but supervision is a poor proxy for quality. The quality of supervision itself is what matters. Handled poorly, this becomes a vicious circle: poor supervision results in low quality of services and low quality of services set a low standard for supervision.
Health services in Nigeria mirror political organisation. The federal government is responsible for tertiary care, state governments for secondary care, and the local governments run primary care. The financing of (but not the responsibility for) public health is tied to the flow of funds from the federation account. Funds are shared between levels of government according to an allocation formula that keeps about half at the federal level, allocates a quarter to the 36 states, and gives the other quarter to the LGs. These resources are not sectorally earmarked and the states and LGs are not constitutionally required to provide budget and expenditure reports to the federal government. Nigeria thus leaves the most important and consequential level of health care – primary health care – to the weakest level of government. This results in poor coordination and integration between levels of care, giving rise to a weak and disorganised health system, in which widely varying patterns of outcomes depend on local situations.
The decentralisation policy that makes local governments run primary health care in Nigeria rests on the imported notion that services are most efficient when governance is close to the people, an assumption that is premised on the existence of a well-functioning participatory democracy where the electorate are neither hungry nor ignorant. Most of the rural people our PHC facilities serve have not been exposed to high quality health services so they accept what they get as the norm or, when they imagine it not to be the norm, without complaints. When they cannot put up with low quality services they ignore the PHCs by staying at home, and they consult quacks, only to present in the PHC or other hospital in emergency, often too late for life-saving interventions.
This is not a new problem, and Nigeria has responded in two important ways to the disjunction between finances and responsibility on the one hand, and between communities and the political administration of health on the other. The National Primary Health Care Developing Agency (NPHCDA) is one such Nigerian innovation, albeit as usual, not completely well thought out. NPHCDA is a federal government agency with policy and oversight roles on PHC implementation at the state and local government levels in Nigeria. The major drawback is that a federal agency has no binding constitutional role to implement programmes or policies at the state and local government levels. The governments must be willing to cooperate or nothing happens, and cooperation often has to come with financial commitment, which for every government are highly contested grounds.
The second innovation, also poorly thought out for the short term, is the creation of Ward or Village Development Committees (WDCs or VDCs). An initiative of NPHCDA, they are designed to strengthen local communities in the hope that they can advocate for themselves. The committees are made up of influential community members who can help to enhance community participation and ownership, and promote demand for quality services. The problem here is that people can only demand what they are really passionate about. People may be empowered by knowledge, but it takes a deeper level of knowledge that can translate into passion and commitment to get people to act and change their behaviour.
It is much easier to ignore community participation when the issue is improving input — infrastructure and staff. But for quality, it is clear that we either find a way to get communities actively engaged in the health system that serves them, or we establish structures and processes that will allow us to temporarily bypass community participation on the road to improving the quality of care at the PHC level in Nigeria.
Health professionals are often in the position to set the standards for themselves, and then police themselves to ensure their practice is up to those standards. Health workers in Nigeria as in many other countries, rather than police themselves, are more likely to protect their colleagues from complaints of negligence, malpractice that may lead to litigation. In a situation where people are not empowered to detect poor quality, speak up and fight, there is need for the health system to fill that role on behalf of the people.
This gap in behaviour means that the solution to the quality issues in primary care has to be innovative. We must think of structures, both government- and civil society-led, to act on behalf of communities in the hope that by so doing, members of the community can learn to make demands in their own voices. This may happen through continuous supportive supervision through the use of standardised checklists. It is also important to openness, while discouraging a culture of blame and fault finding in quality assurance.
Nigeria lacks the technical, financial and political sophistication and robustness required for a complete decentralisation of health services. To streamline the health system, it may be necessary to bring PHC under the federal roof, and add tertiary care to the responsibility of state governments. The role of supportive supervision can then be left to the local governments who will function independently with verification of their activities by civil society. I am afraid this proposal may only look good on paper. Implementation in reality will be difficult, and there are great political hurdles to reorganising a system, especially when such reorganisation involves huge financial commitment by the different tiers of government. PHC, according to the Alma-Ata declaration cited above, was aimed at addressing the main health problems in the community, providing promotive, curative, and rehabilitative services. Eight services were identified as the main focus of PHC as follows:
1. Promotion of nutrition
2. Provision of adequate supply of safe water
3. Provision of basic sanitation
4. Maternal and child care including family planning
5. Immunization against the major infectious diseases
6. Prevention and control of locally endemic diseases
7. Education concerning the prevalent health problems and the methods of their prevention and control.
8. Approximate treatment for common diseases and injuries.
It is evident from the foregoing therefore, that PHC embodies the basic needs approach, and the approach of the 60s was a development away from hospitals towards health centres and sub-centres using auxiliary personnel. PHC however, is a shift towards the front-line of day-to-day activities carried out within the community.
1.2 PROBLEM OF THE STUDY
The problem of the study was to assess the implementation of PHC through a community-based health education programme in Orlu metropolis. The study examined why some of the programme’s components were properly implemented and why some were not. The study also investigated and evaluated the degree of success of the programme and made some recommendations on how to improve on the programme.
Lack of facilities
Lack of Training for the Doctors (they will never be compared to British medical doctors)
Lack of common and basic training especially Nurses!! angry
Lack of empathy
Lack of funding
Lack of hygiene
Lack of GOD GIVEN COMMON SENSE & INTELLIGENCE in the GOVERNMENT among those blood sucking hungry BASTARDS who are Governors!!
Lack of Electricity, how person go operate when light no dey? U go use Lamp how person go do X-ray when NEPA no fit show?
1.3 OBJECTIVE OF THE STUDY
1. To assess the extent of efficiency and effectiveness in utilizing primary health care facilities in Nigeria especially in Orlu local government area of Imo state.
2.To evaluate the differences patterns of health education provided about prevailing health problems towards the implementation of PHC services in Orlu metropolis.
3. To evaluate the effectiveness of community-based health education programme as a significant factor in the implementation of PHC services in Orlu metropolis.
4. To assessed the knowledge and perception of women of child bearing age (15-49 years) about the health services offered at the PHC centers and the factors militating against the efficient and effective use of these facilities.
5. To know the lapses and challenges of primary health care services in Nigeria.
6. To recommend appropriate solution to these problems.
1.4 RESEARCH QUESTION
1. Can it be possible to assess the extent of efficiency and effectiveness in utilizing primary health care facilities in Nigeria especially in Orlu local government area of Imo state?
2. What are the different patterns of health education provided about prevailing health problems towards the implementation of PHC services in Orlu metropolis?
3. How can someone evaluate the effectiveness of community-based health education programme as a significant factor in the implementation of PHC services in Orlu metropolis?
4. What are the lapses and challenges of primary health care services in Nigeria?
5 . Are there appropriate solution to these problems?
1.5 RESEARCH HYPOTHESES
The following hypotheses were tested in this study.
H0: There will be no significant differences in the pattern of health education provided about prevailing health problems towards the implementation of PHC services in the three (3) L.G.A s. of Orlu metropolis.
H0: There will be no significant differences in the way the people of Orlu metropolis perceive PHC delivery system.
H1: Community-based health education programme is not a significant factor in the implementation of PHC services in Orlu metropolis.
H0: It is impossible to assess the extent of efficiency and effectiveness in utilizing primary health care facilities in Nigeria especially in Orlu local government area of Imo state?
H1: It is possible to assess the extent of efficiency and effectiveness in utilizing primary health care facilities in Nigeria especially in Orlu local government area of Imo state?
H0: There are no lapses and challenges of primary health care services in Nigeria.
H1: There are lapses and challenges of primary health care services in Nigeria.
1.6 SIGNIFICANCE OF THE STUDY
The study is on the utilization of primary health facilities using Orlu local governemt area, Imo state as a case study. This topic and field of study is going to be relevant to categories of people in the society such as students, lecturers, researchers and the entire public.
1.7 RATIONALE FOR THE STUDY
The study examined the implementation of primary health care programme as a community-based health programme. It also examined the acceptability of the programme among the people of Orlu metropolis. The result of the study would reveal the areas that need greater improvement and reinforcement. It will also provide information to the people of Orlu metropolis on how to improve their health. Finally the outcome of this study will contribute to public awareness of the nature, needs, priorities and patronage of the primary health care
system.
- SCOPE OF THE STUDY
This study is centered on the utilization of primary health facilities using Orlu local governemt area, Imo state as a case study.
1.9 LIMITATION OF STUDY
Despite the limited scope of this study certain constraints were encountered during the research of this project. Some of the constraints experienced by the researcher were given below:
i. TIME: This was a major constraint on the researcher during the period of the work. Considering the limited time given for this study, there was not much time to give this research the needed attention.
ii. FINANCE: Owing to the financial difficulty prevalent in the country and it’s resultant prices of commodities, transportation fares, research materials etc. The researcher did not find it easy meeting all his financial obligations.
iii. INFORMATION CONSTRAINTS: Nigerian researchers have never had it easy when it comes to obtaining necessary information relevant to their area of study from private business organization and even government agencies. Staff of Orlu local government area Imo state find it difficult to reveal their internal operations. The primary information was collected through face-to-face interview getting the published materials on this topic meant going from one library to other which was not easy.
Although these problems placed limitations on the study, but it did not prevent the researcher from carrying out a detailed and comprehensive research work on the subject matter.
1.10 DEFINITION OF TERMS
Primary Health Care: The term Primary Health Care was used initially to describe the first care given to a person poor in health, irrespective of where the care was given. Things, however, began to change in 1952 when the WHO Expert Committee on Public Health Administration defined Public Health as “’ the Science and art of preventing disease, prolonging life and promoting mental and physical health and efficiency through the organized community efforts for sanitation of the environment, the control communicable infections, the education of the individual in personal hygiene, the organization of medical and nursing services for early diagnosis and preventive treatment of disease and the development of social machinery to ensure to every individual a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity’’
Health care: Health care (or healthcare) is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in allied health, dentistry, midwifery-obstetrics , medicine, nursing, optometry, pharmacy and other care providers. It refers to the work done in providing primary care, secondary care, and tertiary care, as well as in public health.
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