Factors Militating Against Successful Utilization Of Primary Health Care Facilities In Nigeria
Factors Militating Against Successful Utilization Of Primary Health Care Facilities In Nigeria
Abstract
This study was carried out to examine the factors militating against successful utilization of primary health care facilities in Nigeria using Moro LGA, kwara state as case study. To achieve this 4 research questions were formulated. The survey design was adopted and the simple random sampling techniques were employed in this study. The population size comprise of selected residents in Moro LGA, kwara state. In determining the sample size, the researcher conveniently selected 123 residents while 100 were returned and validated. Self-constructed and validated questionnaire was used for data collection. The collected and validated questionnaires were analyzed using frequency tables and percentage. The result of the findings reveals that the extent to which health care facilities available in Nigeria is low, more so, the factors affecting the utilization of health care facilities in Nigeria include; poverty, ability and propensity to use services, geographic area of residence, race and ethnicity, disability status, poor availability of health care facilities, and long waiting in the health care centres. And inefficient organization of services or work processes; insufficient equipment, supplies, or infrastructure; inadequate staffing; and low health worker motivation/know-do gap are among many others the causes for health facility inefficiencies in Nigeria. In regard to the findings, the study recommends that there is a need to ensure that patients have easy access to health care by ensuring that health personnel are available when needed. Long waiting times should be discouraged by identifying areas in the health care delivery system that is prone to causing long waiting times with a view to developing alternate health systems that will eliminate long hours of stay in public facilities. This can be achieved by involving consumers of health care in government facilities in decision making process to make the facility more customers oriented. Also, periodic evaluation of the quality of care provided by the health facilities should be conducted where clients of the facility are asked to rate the quality of care. And efforts to further upgrade medical equipment and associated workforce skills are needed to sustainably increase access to and utilization. In the same manner, the cost of health care services should be reduced in other for the residents to have access to it as at when needed.
Table of Content
Chapter One:
Introduction
- 1.1 Background of the Study
- 1.2 Statement of the Problem
- 1.3 Objective of the Study
- 1.4 Research Questions
- 1.5 Research Hypothesis
- 1.6 Significance of the Study
- 1.7 Scope of the Study
- 1.8 Limitation of the Study
- 1.9 Definition of Terms
- 1.10 Organization of the Study
Chapter Two:
Review of Literature
- 2.1 Conceptual Framework
- 2.2 Theoretical Framework
- 2.3 Empirical Review
Chapter Three:
Research Methodology
- 3.1 Research Design
- 3.2 Population of the Study
- 3.3 Sample Size Determination
- 3.4 Sample Size Selection Technique and Procedure
- 3.5 Research Instrument and Administration
- 3.6 Method of Data Collection
- 3.7 Method of Data Analysis
- 3.8 Validity of the Study
- 3.9 Reliability of the Study
- 3.10 Ethical Consideration
Chapter Four:
Data Presentation and Analysis
- 4.1 Data Presentation
- 4.2 Analysis of Data
- 4.3 Answering Research Questions
- 4.4 Test of Hypotheses
Chapter Five:
Summary, Conclusion and Recommendation
- 5.1 Summary
- 5.2 Conclusion
- 5.3 Recommendation
- References
- APPENDIX
- QUESTIONNAIRE
Chapter One
Introduction
1.1 Background of the Study
The goal of primary health care (PHC) was to provide accessible health for all by the year 2000 and beyond. Unfortunately, this is yet to be achieved in Nigeria and seems to be unrealistic in the next decade. The PHC aims at providing people of the world with the basic health services. Though PHC centers were established in both rural and urban areas in Nigeria with the intention of equity and easy access, regrettably, the rural populations in Nigeria are seriously underserved when compared with their urban counterparts. About two-thirds of Nigerians reside in rural areas therefore they deserve to be served with all the components of PHC.
Quality health is a fundamental right of all Nigerian citizens. While primary health care (PHC) centers are relatively uniformly distributed throughout local government areas (LGAs) in Nigeria, the rural people tend to underuse the basic health services. This article examines some cross cutting issues in PHC and outlines strategies to enhance the utilization of health services by rural people. The responsibility for perpetuating the existing low use of PHC services should be held by PHC policy makers and LGA. Responsible health personnel can build a new social order, based on greater equity and human dignity, in which health for all by the year 2015, including that of rural populations, will no more be a dream but a reality. Capacity building and empowerment of communities through orientation, mobilization and community organization as regards training, information sharing and continuous dialogue, could further enhance the utilization of PHC services by rural populations.
While most PHC facilities are in various state of disrepair, with equipment and infrastructure being either absent or obsolete, the referral system is almost non-existent. The goal of the National Health Policy (1987) is to bring about a comprehensive health care system, based on primary health care that is promotive, protective, preventive, restorative and rehabilitative to all citizens within the available resources so that individuals and communities are assured of productivity, social well-being and enjoyment of living. The health services, based on PHC, include among other things: education concerning prevailing health problems and the methods of preventing and controlling them, promotion of food supply and proper nutrition, material and child care, including family planning immunization against the major infectious diseases, prevention and control of locally endemic and epidemic diseases and provision of essential drugs and supplies. The provision of health care at PHC level is largely the responsibility of local governments with the support of state ministries of health hand within the overall national health policy (Nigeria Constitution, 1999). Private medical practitioners also provide health care at this level.
Although PHC was said to have made much progress in the 1980s, its goal of 90% coverage was probably excessively ambitious, especially in view of the economic strains of structural adjustment that permeated the Nigerian economy throughout the late 1980s. But many international donor agencies such as UNICEF, World Health Organization (WHO) and the United States Aids for International Development, (USAID) embraced the programme and participated actively in the design and implementation of programmes at that level (USAID, 1994). At a stage, most of the programmes were donor driven. It was not surprising that at the height of the political crisis in 1993, most of them withdrew their funding and the programme started experiencing hiccups. With the return to democracy in 1999, however, primary health care system deteriorated to an unacceptable level. The availability of basic health services provided by the PHC especially to rural areas in a country might be used as a yardstick to measure the extent of its health level of development. The aim of this article is to describe some strategies which, if implemented, might enhance the proper and timely use of PHC by Nigerian rural populations.
1.2 Statement of the Problem
Nigeria, with a population of 170 million, is one of the most populous nations but weak in health-care standards. Among the people of Nigeria a vast majority live in rural areas and at most times have access to little or none of the essential basic amenities. According to the National Primary Health Care Development Agency, Abuja, Nigeria Despite extensive investments, the country still has insufficient healthcare delivery infrastructures, poor quality health-care services, and unevenly distributed human resource capacity (Adeniyi 2014). These are reflected in its health-care quality ranking of 187 of 200 countries and listing among countries with some of the worst health indicators in the world. The country has an estimated 23 640 health facilities, and 85.5% of these are primary health-care facilities. Although these facilities serve the majority of the population, they are unable to provide basic and cost-effective services, especially in rural areas. Adeniyi (2014) said this poor performance is attributed to various factors including poorly equipped health facilities, insufficient staff, lack of clearly defined roles and responsibilities, inadequate political commitment, and poor accountability. Quality improvement at primary health-care facilities is critical, however, efforts to address the quality of care as a contributory factor to the country’s poor health outcomes receive less attention. It is in light of this that this study seeks to examine the factor’s affecting utilization of primary health care facilities.
1.3 Objectives of the Study
The main aim of this study is to assess the factors militating against successful utilization of primary health care facilities in Nigeria using Moro LGA, kwara state as case study. Other objectives of this study are:
- To determine the extent of utilization of primary health care facilities in Nigeria
- To examine the factors affecting the utilization of healthcare services in Moro LGA, kwara state.
- Identify the underlying causes for health facility inefficiencies in Moro LGA, kwara state.
- To proffer strategies for enhancing the use of PHC facilities in Moro LGA, kwara state.
1.4 Research Question
The following research question guides this study
- To what extent is the utilization of primary health care facilities in Nigeria?
- What are the factors affecting the utilization of health care facilities in Nigeria?
- What are the causes for health facility inadequacy in Nigeria?
- What are the strategies for enhancing the utilization of Primary Health Care services in Nigeria?
1.5 Research Hypothesis
Ho: There are no significant factors affecting the utilization of health care facilities in Nigeria.
Ha: There are significant factors affecting the utilization of health care facilities in Nigeria.
1.6 Significance of Study
The findings of this study will aid the bodies in charge of primary health care service delivery at these facilities as it will highlight the factors affecting the utilization of health care services in Nigeria. It will also assist service providers at the facility level in developing strategies and action plans to encourage increased use of the services available. These efforts will help to start the process of enhancing access to health care services, which will eventually improve the overall health of everyone in Moro LGA.
This study will contribute to the current literature in this field and will also serve as a resource for academics, researchers, and students who may want to do future research on this topic.
1.7 Scope of Study
This study focuses on assessing the the factors militating against successful utilization of primary health care facilities in Nigeria using Moro LGA, kwara state as case study. This study will also be focused on determining the extent of utilization of primary health care facilities, examining the factors affecting the utilization of healthcare services, identifying the underlying causes for health facility inefficiencies and proffering strategies for enhancing the use of PHC services.
This study will be using staff of primary health care facilities in Moro LGA, kwara state as enrolled participants for the survey.
1.8 Limitations of the Study
Finance, inadequate materials and time constraint were the challenges the researchers encountered during the course of the study. This study was also limited to Moro LGA, kwara state thus further research is needed if this study is to be used any where else.
1.9 Definition of Terms
Primary Health Care (Phc):
This is health care provided in the community for people making an initial approach to a medical practitioner or clinic for advice or treatment.
1.10 Organization of the Study
The study is categorized into five chapters. The first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. The chapter two covers the review of literature with emphasis on conceptual framework, theoretical framework, and empirical review. Likewise, the chapter three which is the research methodology, specifically covers the research design, population of the study, sample size determination, sample size, and selection technique and procedure, research instrument and administration, method of data collection, method of data analysis, validity and reliability of the study, and ethical consideration. The second to last chapter being the chapter four presents the data presentation and analysis, while the last chapter(chapter five) contains the summary, conclusion and recommendation.
Chapter Five
Summary, Conclusions and Recommendations:
5.1 Introduction
This chapter summarizes the findings into the factors militating against successful utilization of primary health care facilities in Nigeria using Moro LGA, kwara state as case study. The chapter consists of summary of the study, conclusions, and recommendations.
5.2 Summary of the Study
In this study, our focus was to examine the factors militating against successful utilization of primary health care facilities in Nigeria using Moro LGA, kwara state as case study. The study specifically was aimed at investigating the extent to which health care services are available in Nigeria, examining the factors affecting the utilization of healthcare services in Nigeria, identifying the underlying causes for health facility inefficiencies in Nigeria, and proffer strategies for enhancing the use of PHC services in Nigeria.
The study adopted the survey research design and randomly enrolled participants in the study. A total of 100 responses were validated from the enrolled participants where all respondents are residents of Moro LGA, kwara state.
5.3 Conclusions
Based on the findings of this study, the researcher made the following conclusion.
- The extent to which health care services available in Nigeria is low.
- The factors affecting the utilization of health care services in Nigeria include; poverty, ability and propensity to use services, geographic area of residence race and ethnicity, disability status, poor availability of health care facilities, and long waiting in the health care centres.
- Inefficient organization of services or work processes; insufficient equipment, supplies, or infrastructure; inadequate staffing; and low health worker motivation/know-do gap are among many others the causes for health facility inefficiencies in Nigeria.
5.4 Recommendations
In regard to the findings of the study, the researcher recommends that;
- There is a need to ensure that patients have easy access to health care by ensuring that health personnel are available when needed. Long waiting times should be discouraged by identifying areas in the health care delivery system that is prone to causing long waiting times with a view to developing alternate health systems that will eliminate long hours of stay in public facilities. This can be achieved by involving consumers of health care in government facilities in decision making process to make the facility more customers oriented.
- Periodic evaluation of the quality of care provided by the health facilities should be conducted where clients of the facility are asked to rate the quality of care.
- Efforts to further upgrade medical equipment and associated workforce skills are needed to sustainably increase access to and utilization.
- The cost of health care services should be reduced in other for the residents to have access to it as at when needed.
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Frequently Asked Questions
What factors influence primary health care utilization?
Several social and demographic variables that might influence primary health care utilization were divided into five categories: need of medical care; self-care; availability of the doctor; sociodemographic factors; social network factors. Multiple classification analysis was used for the statistical analysis.
Why is there a lack of PHC in Nigeria?
Presently, most of the PHC facilities in Nigeria lack the capacity to provide essential health-care services, in addition to having issues such as poor staffing, inadequate equipment, poor distribution of health workers, poor quality of health-care services, poor condition of infrastructure, and lack of essential drug supply (5).
When was the first National Health Policy launched in Nigeria?
Nigeria’s first comprehensive national health policy based on PHC was launched in 1988 (3). From 1986 to 1990, Professor Olikoye Ransome-Kuti expanded PHC to all local governments, achieved universal child immunization of over 80%, and devolved responsibility for PHC to local government areas (3).
