Factors Affecting Utilization Of Health Care Services

Project and Seminar Material for Public Health

Abstract

Good utilization of health services improves the health status of the population. However , the presence of health facilities alone is not enough to guarantee use as other socio – economic factors could influence access and utilization. This study assessed the community perceptions and factors affecting the utilization of health services in a rural community in Southern Nigeria.

A descriptive cross-sectional study was carried out in Anegbette, a rural community in Etsako Central Local Government Area (LGA) of Edo State, Nigeria in 2011. Data was obtained through a structured, interviewer -administered questionnaire administered to adult respondents in two selected settlements in Anegbette using cluster sampling method. Over three-quarters of respondents, 219 (76.8%) utilized the health facilities.

There was no statistical significant association in the utilization of health services with regard to gender (p= 0.889, OR= 1.04; 0.55-2.00), educational level (p= 0.707, OR= 1.16; 0.50-2.79) and age (p= 0.839, OR= 0.94; 0.51-1.72). Community perceptions of poor quality and inadequacy of available services, however , determined largely the level of use of the primary health care facility.

The utilization of the primary health facility was good, community perceptions of poor quality and inadequacy of available services were identified barriers to satisfactory use of primary health services. Identified barriers to access and effective use of qualitative health care services in rural communities should be tackled by the relevant Local Government and State health authority.

Table Of Content

Preliminary Page(s)

Title page
Certification page
Dedication
Acknowledgement
Abstract
Table of content

Chapter One

1.0 Introduction

1.1 Background To The Study
1.2 Statement Of Problem
1.3 Research Questions
1.4 Purpose Of The Study
1.5 Significance Of The Study

Chapter Two

2.0 Literature Review

2.1 Concept Of Health Care Services In Nigeria
2.2 Determinant Of Utilization Of Health Care Services
2.3 Education As A Determinant Of Health Care Services Utilisation
2.4 Socio-Cultural Factors And Health Care Services Utilisation

Chapter Three

3.0 Research Methodology

3.1 Research Design
3.2 Sample And Sampling Technique
3.3 Data Analysis

Chapter Four

4.0 Results And Discussion

4.1 Results
4.2 Discussion

Chapter Five

5.0 Conclusion And Recommendation

5.1 Conclusion
5.2 Recommendations
References

Chapter One

1.0 Introduction

1.1 Background To The Study

Differences in health status, based on indices such as infant mortality, young and child mortality and maternal mortality, between developed countries and developing countries have witnessed historical documentation. Within the developing countries, the phenomenon has shown aggravation as we move from urban to rural areas. Unfortunately, the causes of this disturbing reality are illnesses that can be treated and deaths that can be prevented by simple interventions but for which inappropriate structures have constituted a stumbling block. In order to justify the amount of money spent on health and the number of workers employed, serious attention is required in improving quality of healthcare services while containing costs and also in planning of health care activities and carrying out effective management functions relating to health care delivery systems (HCDS).

This cannot be done outside the imperatives of utilization. This is because utilization is the most activity-related problem, being consumer-oriented with diverse dimensions in needs, perceptions and knowledge. To the extent that utilization entails the cooperation and invitation of people outside the health system crystallizes the magnitude of the problem. Indeed, utilization as a major factor in planning any health care delivery system is validated by past and contemporary situations around the world. At the inception of HFA/2000, WHO had warned that its goals, support activities, management and implementation may be irrelevant if they are not tuned towards maximum utilization. In the United States of America, hospitals and related health facilities require formal utilization review procedures as condition for participation under health plans and some kind of utilization review process in each institution seeking accreditation.

In the United Kingdom, the comprehensive National Health Scheme (NHS) is structured to ensure equity and encourage all constituents to seek the use of services. Even in the apartheid era in South Africa, the health sector enjoyed desegregation by reconstructing health services along the principles of accessibility, affordability, acceptability, equity and efficacy. In developing countries, attempts have been directed towards promoting utilization particularly among the rural populations but success has been limited. Free medical services as a means of improving utilization through the elimination of financial barriers has formed a major issue of political activism. Success in this direction has been limited due to inappropriate structures that result from not tuning planning and management activities towards utilization, a situation compounded by other existing problems including

Rapid population growth
Increasing demand for health services against dwindling resources
Faulty allocation of limited resources
Internal inefficiency of government health care programs and health services
Poor quality of private health care services
Inadequate support infrastructural facilities like water, electricity and good roads.

These problems have resulted in inappropriate structures, faulty allocation of resources and incongruent staff scheduling which would not have arisen if potential utilization had formed the bases upon which the establishment of the facilities were initially hinged. This situation is a call to restructuring which can only be facilitated by x-raying the relationship between distribution of resources, health problems and patterns of utilization whereby identified determinants would reveal the services to be provided for the growing population as well as their magnitude.

1.2 Statement Of Problem

Utilization of service is the actual coverage and it is categorized into ambulatory medical care services (outpatient and home); inpatient services (hospital); and preventive services. To achieve optimal levels of utilization, all the three categories must enlist the cooperation and initiative of the population as well as those of the health service providers. Hitherto, the assumption has been that the Health Ministry and other providers of health services knew the demand on their resources, upon which planning was based, by the number of people that demand services.

There is at present increasing evidence, especially in the developing world, that many more who attempt to obtain such services are not getting them for a number of reasons. In Nigeria, the discrepancy between what the levels of health care utilization are and what they ought to be is easily discernible. This underlines current efforts in relating utilization to resources as well as to past and present planning efforts. It has been said that there is need to review planning efforts and their appropriateness, especially when viewed from the context of utilization of health care services.

1.3 Research Questions

Are health care services adequately provided to community residents in Delta State?
Does the location of health care facility influence the utilization of health care services among community residents in Delta State?
Does educational status influence utilization of health care services among community residents in Delta State?
Does attitude of health care personnel at health care service centres significantly influence utilization of the services among community residents in Delta State?

1.4 Purpose Of The Study

The primary purpose of this study was to assess the provision and utilization of maternal and child-health care services among women of child bearing age in Benue State.

The specific purposes were:

To determine the adequacy of health care services provided to community residents in Delta State.
To assess the influence of location of health care facilities on utilization of health care services among community residents in Delta State.
To assess the influence of educational status on utilization of health care services among community residents in Delta State.
To investigate the influence of attitude of health care personnel on utilization of health care services among community residents in Delta State.

1.5 Significance Of The Study

The outcome of this study would be significant to community residents in Delta State and Nigeria in general in the following ways:

The findings of this study would provide information on the adequacy or otherwise of health services provided to community residents in Delta State with a view to improving the services.
The findings of this study would help policy makers to understand problems militating against effective utilization of health services among community residents in Delta State and the way forward.
It would provide a basis for further research to other interested researchers.
The findings of this study would contribute to existing knowledge on the provision and utilization of health care services.

Chapter Five

5.0 Conclusion And Recommendation

5.1 Conclusion

The utilization of the health facility was good, community perception of poor quality and inadequacy of available services determined largely the level of use of the primary health care services. Inhabitants in the rural community while aware of these services, and having little or no options but to use them, were dissatisfied with identified barriers to effective health delivery in the facility. This study did not show any significant association in the utilization of health services with regards to age group, gender or educational status.

5.2 Recommendations

We recommend service improvement at the facility level by the Local Government and State Health Authority . Further research could probe into these service barriers and prioritize effective interventions to improve client satisfaction with available services.