COMPLETE PROJECT-PERCEIVED CONSTRAINTS TO EFFECTIVE UTILIZATION OF PRIMARY HEALTH CARE SERVICES

ABSTRACT

This study was carried out on the Perceived constraints to effective utilization of primary healthcare services 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 Guma Local Government Area of Benue 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 services available in Moro LGA, kwara state is low, more so, the factors affecting the utilization of health care services in Moro LGA, kwara state 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 Moro LGA, kwara state. 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.

CHAPTER ONE

INTRODUCTION

• 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 factor’s affecting utilization of primary health care facilities. Other objectives of this study are:

1. To determine the extent of utilization of primary health care facilities in Nigeria
2. To examine the factors affecting the utilization of healthcare services in Moro LGA, kwara state.
3. Identify the underlying causes for health facility inefficiencies in Moro LGA, kwara state.
4. To proffer strategies for enhancing the use of PHC services in Moro LGA, kwara state.

1.4 RESEARCH QUESTION

The following research question guides this study

1. To what extent is the utilization of primary health care facilities in Nigeria?
2. What are the factors affecting the utilization of health care services in Moro LGA, kwara state?
3. What are the causes for health facility inadequacy in Moro LGA, kwara state?
4. What are the strategies for enhancing the utilization of Primary Health Care services in Moro LGA, kwara state?

1.5 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.

1.6 SCOPE OF STUDY

This study focuses on assessing the factors affecting the utilization of primary health care facilities. 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.

1.7 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.

1.8 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.