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JOURNAL OF RESEARCH IN NATIONAL DEVELOPMENT VOLUME 7 NO 2, DECEMBER, 2009

PRIMARY HEALTH CARE SERVICES FOR EFFECTIVE HEALTH CARE DEVELOPMENT IN NIGERIA: A STUDY OF SELECTED RURAL COMMUNITIES

Steve Metiboba
Department of Sociology, University of Ilorin, Nigeria

E-mail: revstevemetiboba@yahoo.com

 

Abstract
 This is an empirical study of 7 communities among the O-kun Yoruba of Ijumu, Kogi State, Nigeria. The general objective of the study was to investigate the prioritizing pattern of the various Primary Health Care services (PHC) in the study area. Data for the study were generated mainly through multi-stage sampling technique, by the use of questionnaire administered to 235 respondents randomly selected from the 7 communities under review. The major finding of this study is that there is no uniformity in the ranking of PHC services in most rural communities and that every community will want to opt for a PHC service whose end they are able to see more clearly and utilize more to advantage, among several alternatives. The implication of this finding forms the thrust of this paper for health development.

                    Keywords: Primary health care, participation, ranking, health behaviour, services


Introduction
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)

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.

Evolution of primary health care in Nigeria

Primary Health Care Service became a dream come true for the first time in Nigeria in 1975, when Yakubu Gowon, Nigeria’s leader announced the Basic Health Service Scheme (BHSS) as part of the Third National Development Plan (1975-80). The objectives of the scheme were to increase the proportion of the population receiving health care from 25 to 60 percent, correct the imbalances in the location and distribution of health institutions and provide the infrastructures for all preventive health programmes such as control of communicable diseases, family health, environmental health, nutrition and others and establish a health care system best adapted to the local conditions and to the level of health technology (Sorungbe, 1989).
            Akande (2002) observed that the basic plan for the implementation of the scheme was to

 

build in each local government area a comprehensive health institution that would serve as the headquarters of the services, four primary health centres and 20 health clinics. This was called a basic health unit designed for a population of 150,000. The health clinics were to be the most peripheral health facilities, each serving a population of 2,000. The aim was that a primary health centre would serve as a referral centre for four health clinics and serve a population of 20,000, while the comprehensive health centres, and the four health clinics would serve a population of 50,000, with mobile clinics from the primary health centres.

Nineteen (19) schools of health technology in each state were established to train three categories of community health workers (the supervisors, assistants and aides). The community health officers were to be trained in the teaching hospitals. In 1978, a decision was taken to build a basic health centre in a local government in each state so that a model health service could be set up that would later be copied by other local governments (Oyegbite, 1989).
provision of essential health services with community involvement and participation. BH

Several factors have been adduced by critical observers and stakeholders for the poor
implementation of the scheme in some quarters. For instance, the relatively notable problem of maldistribution of health personnel and facilities between rural and urban centres and the budgetary allocation to health at all levels of government are believed to be crucial factors, among others, still militating against the reality of PHC scheme in Nigeria. Other challenges along the pathway of the scheme in Nigeria include the following:

  1. poor accessibility to the few health facilities in both urban and rural centres
  2. Inadequate balance between curative and preventive health services
  3. Inadequate support infrastructures like pipe-borne water, electricity, etc.



    Beyond the limitations highlighted above, critical observers in recent times have argued that the scheme still suffers from inadequate awareness and mass mobilization for increased involvement of the citizenry in PHC activities. Till now for instance, a greater proportion of the rural population in many communities do not seem to know what PHC is all about, nor are they aware of the various services under the PHC scheme (Metiboba, 2005).

This paper therefore, is an attempt to highlight what PHC services are within the context of Nigeria’s health policy and to know how the people in rural communities prioritize these services when health care providers come their way. It is strongly believed in this analysis that an in-road into the ranking
of PHC services by the rural dwellers is important for arriving at better initiatives for overall health care development in the country.

Materials and methods
Social survey of a descriptive type was used for this study. Data for the study were generated mainly through multi-stage sampling technique,

 

by the use of questionnaire administered to 275 respondents randomly selected from seven communities in Ijumu Local Government Area (LGA), in Kogi state, Nigeria. 235 respondents  (or 85 per cent )turned in their completed

questionnaires, which is  statistically significant enough to proceed with this study.

Preference Based Analysis (PBA) is used in this study for prioritizing the eight PHC services identified, since expectations provide a problem of choice (preference) for people to act or not to act. The eight PHC services under review in this study were ranked by each community. The mean preference score of each service by each community was used as the criteria for ranking. The individual preference score of each service was summed up and averaged at each community level to obtain the mean preference score. The ranking order of each PHC service gives identification for the independent variables (X1-X7) in each community. Each community was asked to give a score between the ranges of 1-10

 

to each of the PHC services (ascending order of priority).

Quality control
Validity test and pre-test of the instrument were done by lecturers in the Department of Sociology, University of Ilorin, Nigeria. A reliability co-efficient of 0.82 was obtained with the use of Pearson product moment correlation co-efficient.
Data analysis
Data obtained through the instrument of a structured interview guide were analysed through the techniques of Pearson product moment correlation co-efficient and preference-based analysis.
Results and discussion

Table 1: Respondent’s perception of the most relevant PHC service to their community

 

PHC services

 

Frequency distribution

 

No

 

Percentage

 

Health Education

 

17

 

7.2

 

Promotion of food supply and nutrition

 

25

 

10.7

 

Supply of safe water and basic sanitation

 

48

 

20.4

 

Maternal and child health + Family planning

 

40

 

17.0

 

Immunization against major infections and Diseases

 

38

 

16.2

 

60

  Prevention and control of locally endemic Diseases

 

24

 

10.2

 

Appropriate treatment of common Diseases and injuries

 

10

 

4.3

 

Provision of essential Drugs

 

33

 

14.0

 

Total

 
235

 

100

Source:Field  survey, 2008

 

Table 2: Mean Preference Scores (MPS) of PHC services by communities

 

PHC services

 

Communities

A

B

C

D

E

F

G

 

Health education

 

4.24

 

5.78

 

4.2

 

2.10

 

2.24

 

2.17

 

5.20

 

Promotion of food supply and nutrition

 

3.16

 

4.21

 

3.75

 

2.20

 

3.31

 

1.68

 

3.17

 

Supply of safe water and basic sanitation

 

5.24

 

5.68

 

2.18

 

2.18

 

4.12

 

3.27

 

4.17

 

Maternal and child health + family planning

 

5.49

 

5.10

 

3.16

 

4.17

 

4.16

 

2.18

 

3.11

 

Immunization against major infections and diseases

 

3.51

 

419

 

2.81

 

2.18

 

3.38

 

3.17

 

3.28

 

Prevention and control of locally endemic Diseases

 

4.25

 

4.15

 

4.17

 

2.21

 

3.16

 

3.13

 

1.61

 

Appropriate treatment of common diseases and injuries

 

4.85

 

3.11

 

3.15

 

2.22

 

1.98

 

2.61

 

2.22

 

Provision of essential drugs

 

4.18

 

1.9

 

3.86

 

3.16

 

1.50

 

2.18

 

1.50

Source: Field survey, 2008

61

  


 

Table 1 above shows respondent’s perception of the most relevant PHC service in the seven communities that were surveyed. The responses of the subjects are shown in the simple frequency distribution as indicated in Table 1 above. A close examination of the table reveals that the three most recognized PHC services according to

the 235 respondents randomly selected from the study areas, in descending order of priority are: supply of safe water and basic sanitation, maternal and child health and family planning and immunization against major infections and diseases with 20.4%, 17% and 16.2% respectively. It is likely that no other thing than

personal, utilitarian factor that most informed the preference choice of the respondents in Table 1 above. For instance, only 4.3 and 7.2 per cent of the respondents saw the relevance of treatment of common diseases and injuries as well as health education as far as the PHC is concerned. Individuals within the various communities studied seemed to have perception of PHC services in accordance with the perceived benefits that could accrued to them.

Table 2 above shows the mean preference score of each PHC service by the community members. In this analysis only the first 3 mean preference scores (MPS) for the PHC services for each of the 7 community are stated in descending order. Each community ranked the difference PHC services on a scale of value between 1 and 10 in ascending order of priority. The analysis revealed that:

Community A identified the following as its priorities in descending order

  1. Maternal and child health including family planning
  2. Adequate supply of safe water and basic sanitation
  3. Appropriate treatment of common diseases and injuries – with the mean

preference scores (MPS=5.49, 5.04 and 4.85 respectively as its priorities in     descending order.)

Community B identified the following as its priorities in descending order

  1. Health education
  2. Adequate supply of safe water and basic sanitation
  3. Maternal and child health including family planning (MPS = 5.78, 5.68

and 5.10 respectively)



Community C identified the following as its priorities in descending order

  1. Health education
  2. Prevention and control of locally endemic diseases
  3. Promotion of food supply and proper nutrition (MPS= 4.2, 4.17 and 3.75

 respectively)

 

Community D identified the following as its priorities in descending order

  1. Maternal and child health including family planning
  2. Provision of essential drugs
  3. Appropriate treatment of common disease and injuries (MPS= 4.17, 3.16 

and 2.22 respectively)

Community E identified the following as its priorities in descending order

  1. Maternal and child health including family planning
  2. Adequate supply of safe water and basic sanitation
  3. Immunization against major infectious diseases (MPS= 4.16, 4.12 and 3.38

respectively)

Community F identified the following as its priorities in descending order

  1. Adequate supply of safe water and basic sanitation
  2. Immunization against major infectious diseases
  3. Prevention and control of locally endemic diseases (MPS= 3.27, 3.17 and

3.13 respectively)

Community G identified the following as its priorities in descending order

  1. Health education
  2. Adequate supply of safe water and basic sanitation
  3. Immunization against major diseases and injuries (MPS= 5.20, 4.17 and

3.28 respectively)

General observation and inference
On the whole, there seems to be no uniformity as regards the pattern of identification of the 3

services of PHC that are of priority to the communities. There is variation in the priority of PHC services by the different communities. This agrees with Rifkin’s (1986) findings that community participation is specific, dynamic and grows out of specific situation. The preference scores of the respondents in Table 2 above to each of the PHC service shows to a large extent

the level of participation that the respondents would be involved if they had choice(s).

However, it can be observed in Table 2 that the supply of safe water and basic sanitation as a PHC service appears to be the most preferred by almost all the communities. This is an area of primary health care in which community participation in likely to be more effective in the communities under review. As in Table 1 where the supply of safe water and basic sanitation claimed 20.4 %, same is observed in Table 2 where the same PHC service became the most preferred by almost all the communities. The utilitarian value of portable water and environmental sanitation to human productivity could have informed such ranking of this PHC service by the different communities.

It was only community C that did not identify supply of safe water and basic sanitation as one of its 3 top most priorities. The findings again revealed that community participation in primary health care services is based on nothing else than rational considerations. The PHC service preferred in one community may not be relevant or desirable in another community.

Implications for national health care development
The major findings of this study have far-reaching implications for health care development in Nigeria. First, government, health policy planners, and all stakeholders in the health industry must know that health behaviour is always a rational action including those of the rural dwellers. Second, it should be noted in any health development programme that there can be no perfect model for community participation anywhere.



Any plan for beneficiary participation in health matters, and in the primary health care scheme in particular that has become Nigeria’s health policy corner stone, should take into cognizance the unique socio-cultural context in which health actions are being taken. Besides, health care development in Nigeria can only attain the Millennium Development Goals (MDGs) of 2015, if the target population for whom most primary health care services are supposedly designed, are not only treated as rational beings but are also sufficiently involved in the critical

stages of project planning, evaluation and decision making.

Summary and conclusions
An attempt has been made in this study through a case study research to investigate the prioritizing pattern of PHC services in 7 rural communities in O-kun Yoruba of Kogi state, Nigeria. Relevant literature had been consulted on the subject matter with a view to providing a theoretical frame work that could guide the study with in its highlighted scope and context.

Findings from this study have revealed that there is no uniformity in the ranking of PHC services in most rural communities. The pattern is likely to be the same in the urban centres because most of our cities have become receiving ends of ceaseless migrants from the rural areas. One major inference that has been drawn from this analysis is that every community will want to opt for a PHC service whose end they are able to see more clearly and utilize more to advantage, among several alternatives.

It is against this background that this paper strongly recommends to government and all stakeholders in the health industry to endeavour to first clearly understand the needs and

aspirations of their target population before delivering any health service to them. This is because this study has abundantly shown that every community has its unique health needs and preference. Both health providers and consumers should work together as partners in progress and treat one another as rational beings.   

References
   Akande, T. (2002): Enhancing Community Ownership and Participation in Primary Health Care in Nigeria, Nigerian

  Medical Practitioner.Vol 42, No 1/2, Pp 3-7.

Federal Ministry of Health (FMH, 1988): The National Health Policy and Strategy to Achieve Health for all Nigerians. Lagos (A Federal Ministry of Health Publication)

Metiboba, S. (2005): Social Factors, Community Participation and Health Development among the Okun Yoruba of Ijumu in

Kogi State, Nigeria. An unpublished Ph.D Thesis, University of Ilorin, Ilorin, Nigeria.

Oyegbite, S. (1989): Strengthening Primary Health Care at LGA Level. Lagos, Academy Press Ltd.

Rfikin, S.B. (1986) “Health Planning and Community Participation”, World Health Forum 7(2) pp. 156-162.

Sorungbe, O.O. (1989): Strengthening Primary Health Care at LGA Level. Lagos, Academy Press Ltd.

World Health Organization (WHO, 1989): Alma-Ata Primary Health Care (Report of the International Conference on Primary Health Care, Alma-Ata, USSR).