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JOURNAL OF RESEARCH IN NATIONAL DEVELOPMENT VOLUME 8 NO 1, JUNE, 2010


IMPACT OF COMMUNITY PARTICIPATION ON HEALTH GOALS AMONG THE O-KUN YORUBA OF KOGI STATE, NIGERIA

Steve Metiboba
Sociology Department, Kogi State University, Anyigba, Kogi State, Nigeria.
E-mail: revstevemetiboba@yahoo.com

Abstract
Participation as a process has been defined as the basic right of the people and it is of great significance to the success of development efforts generally. In recent times, a link has been made between participation and programs designed to improve people’s health. In this study, the objective is an investigation of the impacts of community participation efforts on the various health goals in O-kun Yoruba of Kogi State, Nigeria. Data for the study were generated mainly through multi-stage sampling technique, by the use of questionnaire administered to 235 respondents randomly selected from 7 communities in O-kun land of Kogi State, Nigeria. Techniques of data analysis were mainly by the use of non-parametric statistics which included simple frequency distributions, sample means and percentage values from opinion information derived on the Likert 5- point scale. The findings of the study mainly show that community participation in the study area had greatest impact in the area of immunization as one of the areas of health goals identified in the communities studied. This study has also clearly revealed that the predominance of infective and parasitic diseases which especially plague the younger population in the study area must have accounted for the peoples’ maximum participation in immunization. Therefore, this paper recommends that government and all stakeholders in health should take cognizance of the fact that people who live in the rural areas are rational beings who must be treated as such. It must be realized that people tend to choose an option, among several alternatives, which appears to maximize their gain and minimize their pain.

 

Keywords: Health goals, community participation, immunization, parasitic diseases


 

Introduction
Several studies have established high correlation between project performance and levels of community participation in many Third World Countries. Citizen participation has been used for agricultural extension services in Kenya, the rural water supply in irrigation projects in Asia region as well as the control of infectious diseases in Israel Tumwine, 1989 (Moench 1993, Norton and Stephens 1994, Oluwasola, 1999).

In the area of health in particular, the World Health Organization (WHO) has played an important role in the promotion of community participation. Since the 1970s, WHO has actively supported real opportunities which had begun to examine community participation efforts in different fields of health practice so as to define a clear strategy for health development (WHO/UNICEF 1990, World Bank 1996).

Participation as a concept, within the larger frame work of development generally, is often used to connote the involvement of the local people in the development process of a particular program initiated for the general good of the people. Participation has been used in some relevant literature to mean mobilizing people and thus increasing their willingness to respond to development programs, as well as to encourage local initiatives.

 

Statement of problem
It is quite evident from several cross-cultural studies that participation of citizens in health activities is not usually the same or even across the different health goals in any nation. Most researchers in the area of health development are curious to unravel the seeming mystery behind this phenomenon. It is important that one finds out the impact of citizens’ participation on the different health goals within a given human population if only to ensure that government efforts aimed at improving the peoples’ health status are not misdirected or wasted. It is against this background that this study is set to investigate the impact of community participation in the different health goals among the O-kun people of Kogi State, Nigeria.

Objective of the study
This study’s main objective is an attempt to investigate the impact of community participation, among the O-kun people of Kogi State, on each of the health goals as highlighted in the national health policy document.The study would also draw some inference with respect to what government and all stakeholders in health generally can do to enhance the peoples’ participatory initiatives and abilities for health development.

Necessity for participation in community-based projects
Apologists of participatory development have argued that participation of the local people in a project which directly or indirectly affects them is inevitable since it is hardly possible for such a project to succeed by not involving the target group for which it is supposedly designed. In most parts of Africa, south of the Sahara, when the ordinary people are involved in community-based programs, it is usually not beyond the mere provision of money, labour and materials. At the critical stages of project planning, evaluation and implementation, the ordinary man who is the “drawer of water and hewer of wood” is often marginalized or out rightly neglected (Rifkin 1987, Oakley 1989, Nyemetu 1999).
The non-involvement or ‘official’ marginalization of prospective project beneficiaries in a project which concerns them has resulted in colossal amount of financial and material wastage in many developing countries.

Health development
By health development, within the scope of this analysis, is meant the aggregate for all purposeful activities designed to improve personal and public health through a combination of strategies. It is an inter-sectoral phenomenon that involves the socio-cultural, economic and legal aspects of the social structure.

The implication of the preceding paragraph is that health development cannot be divorced from societal general transformation, and it is generally influenced by ecological or environmental factors. It is also implied in that definition that health development is a function of a combination of several strategies including educational, political and regulatory approaches (Oakley, 1989).

Health goals
The fourth National Development Plan (1981-1983) established a government commitment to provide adequate and effective primary health care that is promotive, protective, preventive, restorative and rehabilitative to the entire population by the year 2000. A national health policy was therefore adopted in 1988. Its goal was to provide a formal framework for the direction of health management in Nigeria. This national health policy was also aimed at providing the population was access not only to primary health care but also to secondary and tertiary care, as needed through a functional referral system (FMH, 1988).

The national health goals as highlighted in the National Health Policy document include the following; health education, safe water and sanitation, maternal and child care. Others are; immunization, preventive and control of endemic diseases, treatment of common disease and provision of essential drug supply.

Study area
This study was conducted in seven communities in O-kun land of Kogi State in Nigeria.



Quality control
Validity test and pre-test of the instruments were done by lecturers in the Department of Sociology, University of Ilorin, Nigeria. A reliability co-efficient of 0.85 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 analyzed through the techniques of some non-parametric statistics (simple frequency distributions, simple percentages and sample means).

Materials and methods
Data for the study were generated mainly through multi-stage sampling technique, by the use of questionnaire administered to 235 respondents randomly selected from 7 communities in O-kun land of Kogi State, Nigeria.

Out of a total of 250 questionnaires distributed to subjects on the issue under reference, 235 turned in their completed questionnaires.  This forms 94 per cent of the total; this is considered statistically significant enough to continue with the study. To measure the respondents’ perception of the significant of community participation in health goals, they were asked to rank the health goals generally on a scale of preference between 0 and 10. The individual ranking score of each health goal was summed up and averaged to obtain the mean-index of each health goal in the study area. Simple percentage values were therefore obtained for each of the health goals, from opinions information derived on the Likert 5 – point scale.

 

Data analysis and results
Table 1: Distribution of Respondents by their Perception of major cause of Morbidity in O-kun land


 
MAJOR CAUSE OF MORBIDITY

 

FREQUENCY DISTRIBUTION

 

N

 

%

Infective and parasitic diseases

48

20

Nutritional and metabolic

17

7

Magico-religious

157

67

Others e.g. blood and nervous system diseases

13

6

 

Total

235

100

Source: Author’s Survey, (2009)

 

Table 2: Distribution of Respondents by their Perception of the Significance of Community Participation (CP) in Health Goals in O-kun land

 

 

HEALTH GOALS

 

IMPACT OF CP ON
HEALTH GOALS

 

HE

 

SWS

 

MCC

 

IM

 

P & CE

 

TCD

 

PEDS

No. of Resp.

Very significant

 

0.35

 

0.38

 

0.62

 

0.40

 

0.35

 

0.35

 

0.18

 

35

Significant

 

0.50

 

0.66

 

0.55

 

0.78

 

0.57

 

0.51

 

0.35

 

50

Not quite significant

 

0.75

 

0.75

 

0.58

 

0.94

 

0.88

 

0.87

 

0.68

 

75

Insignificant

 

0.39

 

0.37

 

0.42

 

0.80

 

0.53

 

0.53

 

0.63

 

39

Undecided

 

0.36

 

0.49

 

0.18

 

0.75

 

0.29

 

0.29

 

0.25

 

36

          __
Mean (X)

 

0.47

 

0.51

 

0.47

 

0.73

 

0.53

 

0.51

 

0.41

 

235

Source: Author’s Survey, (2009)


Discussion of findings
The data in table 1 above shows that 157 (67%) respondents cited magico-religious factor as the major cause of morbidity. 48 (20%) respondents said the major cause of morbidity in their community was due to infective and parasitic diseases. Only 17 (7%) traced morbidity to nutritional and metabolic diseases. And even less number of respondents, 13 (6%) cited others (e.g. digestive, organic, accident, genitourinary disease, etc) as causal factors of morbidity.

For data in Table 2 above, a score of 0.5 or 50% is considered significant (P = 0.5), for simplicity, while one below 0.5 or 50% is considered low or insignificant.
Code (1):
8 – 10              = very Significant
5 – 7                = Significant
3 – 4                = Not Quite Significant
1 – 2                = Insignificant
0                      = Undecided
To measure the respondents’ perception of the significance of community participation in health goals, they were asked to rank the health goals generally on a scale of preference between 0 and 10.

Health goals code:
HE                   = Health Education
SWS                 = Safe Water Sanitation
MCC                = Maternal and Child Care
IM                    = Immunization
P & CE            =Preventive and Control of Endemic Diseases           
TCD                 = Treatment of Common Diseases
PEDS               = Provision of essential Drug Supply

The data in Table 2 above shows simple percentage values for each of the health goals from opinion information derived on the Likert 5 – point scale.

An examination of the data in table 2 above reveals that as high as 73% of the respondents indicated that community participation had impact on immunization. The table reveals the impact of community participation is highest on index of immunization. 53% of the respondents claimed that participation had impact in the area of prevention and control of endemic disease. About the same proportion (51%) of the respondents reported that CP had impact on the treatment of common disease. 41% of the respondents claimed that community participation is made most manifest in the supply of essential drugs.

The obviously predominant of respondents who claimed that participation has impact in the area of immunization as far as health goals are concerned is not surprising. This is because apart from magico-religious factor which accounted for the highest percentage of the causes of morbidity in ijumu Local Government Area of Kogi State, in the peoples’ perception, parasitic and infective diseases came next constituting 20.4 percent of the disease causation in the area. It appears necessary therefore to combat the infective and parasitic diseases which especially plague the younger population with all available devices and methods. One of the most available to the community is immunization. This therefore explains to a large extent why the communities’ participation in health goals in the study area is most pronounced immunization than others.

Summary and Conclusions
This study has carefully re-visited the concept of community participation within the context of health development generally. The main thrust of the paper was an investigation of the impact of community participation efforts in the attainment of the various health goals as explained in the Nigerian health policy.  With the application of the relevant statistical tools for analysis, it was discovered that the highest proportion of respondents from this study indicated that community participation had impact on immunization. One inference that can be drawn from this analysis is that just like the theory is rationality posits people do not necessarily respond to policy directives in ways outsiders might predict rather, African people especially, tend to set their own agenda for change in culturally specific ways. Further, this study has unveiled and validated the assumption in some relevant health sociology literature that patients are rational even almost to the point of death in the choice of action(s) they deem relevant to eliminate illness besides it is instructive to note that participation in health activities does not just happen it must have a rational basis.

It is against this background that this paper hereby recommends that policy makers and all stakeholders in the health sector should realize that in a bid to improve the health status of the citizenry generally and that of the rural populace in particular, It must be realized that people tend to choose an option, among several alternatives, which appears to maximize their gain and minimize their pain. And government, at all levels, will do well if they see participation more as an empowering process whereby the common man’s living wage can meet the basic essentials of life.

References
FMH, (1988) Federal Ministry of Health, (Nigerian Health Policy Document). Lagos, Nigeria.

Moench M. (1993) Farmers Participation in Water Management” in             Gujarat World Bank Publication, Washington, DC.

Norton A. and Stephen T. (1994) “Participation in Poverty    Assessments”.Participation’s Source Book, Washington, D.C.: World Bank 

Nyemetu, R. (999) “Mobilizing Popular Participation in Development Planning”. Training Module Prepared for the Development Policy Centre, Ibadan.

Oakley P. (1989) “Community involvement in Health Development: An        Examination    of the Critical Issues”. Geneva: World Health             Organization

Oluwasola, O. (1999) ”Popular Participation in Development Planning”. Training Module Prepared for the Development Policy Centre, Ibadan.

Rifkin, S. (1987) “Lessons from Community Participation in Health Programmes” Health Policy and Planning, Vol.1, No. 3 pp. 240 – 249.

Tumwine J. (1989) “Community Participation as Myth or Reality: a   Personal           Experience from Zimbabwe” Health policy and        Planning 4(2) 157-161.

WHO/UNICEF (1990) “Community Financing of Health Services for the      improvement of Primary Health Care, Pan African Conference on            Community Financing” (Joint WHO/UNICEF Meeting, Kinshasa,       25-28 June).

World Bank (1996) “Nigeria: Poverty in the Midst of Plenty, The Challenge of Growth with Inclusion”, (A World Bank           Assessment Report No. 14733. UN)