PERCEPTION OF THE QUALITY OF MEDICAL SERVICES IN NIGERIA AMONG STUDENTS

1.1 Introduction

Quality of health care and client satisfaction are key elements in improving the performance of health systems. The health care is relevant to individuals, national productivity and growth cannot be over-emphasized. This is evidenced by the numerous enquiries into the relationship between health and human welfare in the literature. Evidence of the importance of health in growing the economy of a country have shown that good health raises the level of human capital, promotes the productivity capability of individuals in the country and facilitates the rate of economic growth (Cooray, 2013; Nkpoyen, Bassey, & Uyang, 2014). It enhances labour productivity by limiting incapacitation and un-healthiness among workers as well as reduces absenteeism associated with sick leave.

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitations of the Study and Definition of technical terms.

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1.2 Background of Study

Health is an important indicator to measure development. It is indeed a prerequisite for development. No society can develop if the health of its population is poor. Therefore, any nation that seeks to develop should pay attention to health issues. Good health is one of the fundamental human rights everybody is entitled to enjoy. And the burden of proof is on the health care system to provide health services in the three levels of government (federal, state and local government). A health system can then be seen as an organization of people, institutions and resources that provide health care services to meet the health needs of target populations.

The planning of the health system , and should be distributed among market participants , governments, trade unions, charities , religious or other organizations coordinated to provide planned health care services targeted to populations ( Frenk , 2010). Clearly, health has been included in the transformation program of the outgoing government of Nigeria. Then government officials hailed their own efforts and achievements in relation to the agenda of transformation while public opinion differs strongly. Although, a transformation took place in the health sector, but it is not quite clear to the general public especially those in rural areas, because it is negligible. Therefore, the delivery of health care is still considered by many as the poor.

Primary health care service has become a dream come true for the first time in Nigeria in 1975 when Yakubu Gowon, Nigeria leader announced the Basic Health Services Program (BHSS) as part of the Third Plan national Development ( 1975-1980). The program objectives were to increase the proportion of the population receiving health care between 25 and 60 percent, correct imbalances in the location and distribution of health facilities and provide the infrastructure for all preventive health programs such as control of communicable diseases, family health, environmental health, nutrition and other and establish a health care system best suited to local conditions and the level of health technology (Sorungbe, 1989). The goal of primary health care (PHC) was to provide accessible health for all by the year 2000 and beyond. Unfortunately, this has not yet been reached in Nigeria appears to be unrealistic in the next decade. The SSP aims to provide people in the world with the basic health services. Although the PHC centers were established in rural and urban areas in Nigeria with the intent of fairness and easily accessible, unfortunately, the rural population of Nigeria are underserved compared to their urban counterparts.

The poor state of Nigerian healthcare system is generally attributed to several factors such as organization, leadership, infrastructure, financing and delivery of health services (Federal Ministry of Health, 2000). The above problems have been compounded by other socio-economic factors and environmental policies. Similarly, Umeha (2015: 1) succinctly presented the problems of the Nigerian health sector in the following lines - They range from the lack of funding by the government, which are reflected in the inadequate or in some cases, lack of equipment and facilities in hospitals across the country, unhealthy rivalry between the doctors and other professionals leads to a lack of industrial harmony to the brain drain. Some analysts say that the area was literally brought to their knees by international professional quarrels and fighting for supremacy.

Nigeria as a country has a pluralistic health care delivery system (delivery orthodox and traditional health care systems). Orthodox health care services are provided by private and public sectors. However, the provision of health care in the country remains the functions of the three levels of government: federal, state, and local government. The primary health care system is managed by 774 local government areas (LGA), with support from their respective Ministries of Health State and private medical practitioners.

The secondary health care system is managed by the Ministry of Health at the state level. Tertiary primary health care is provided by teaching hospitals and specialized hospitals. The secondary and tertiary levels, are also working with volunteers and non-governmental organizations and private practitioners (Adeyemo, 2005).

In 2005, the Federal Ministry of Health (FMOH) estimated a total of 23.640 health institutions in Nigeria, of which 85.8% are primary health care, secondary and tertiary 14% 0.2%. 38% of these facilities are owned by the private sector, which provides 60% of health care in the country. Despite the availability of this large number of health facilities and the progress of technology in the health sector in Nigeria has witnessed various turbulent assisted with negative effects. As stated Obansa and Orimisan (2013), with the teeming population of the country now more than 150 million, it is still dealing with the provision of basic health services. And according HERFON (2006), health facilities (health centers, staff and medical equipment) are insufficient in the country, especially in rural areas. Of course, that clearly explains the high rate of maternal mortality in children, and even adults over the years.

Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Perception of the Quality of Medical Services in Nigeria among Students.

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1.3 Statement of Problems

Investigation revealed that there is low level of health care spending per capita in Nigeria seems to exclude it short of the Sustainable Development Goals (SDGs) 4 and 5, wherein the effective implementation of the strategy IMNCH require a greater commitment from all levels Nigerian health care system. The abject failure of public health care system in Nigeria has led to comments and criticism from local and national levels. The provision of adequate health care services for citizens, especially those residing in rural areas left much to be desired. Despite the propaganda of the media and the current reforms of the health sector by the government, the public health care system in Nigeria is still inefficient in all ramifications (Obansa and Osrimisan, 2013).

In addition, the implementation of national health policy and the ongoing reforms in the health sector are called upon to solve the perennial problems inflicting the development of public health care in Nigeria. The study further argues that it is only when the government ensures that health is regarded as the right of all citizens of the country, irrespective of status that the public health care system is said to be developed in Nigeria. It is obvious that poor implementation of health care policies and programmes is the major constraint to the achievement of desired goals in public health care provision in Nigeria, particularly at the local government level. For better improvement, the research suggests the need for political commitment as well as elimination of bureaucratic bottlenecks in public health care provision in Nigeria.

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1.4 Aim and Objectives of Study

The aim of the study is to assess the Perception of the Quality of Medical Services in Nigeria among Students. In achieving this aim, the following specific objectives were laid out as follows:

1. To investigate the perception of patients in a teaching hospital in Nigeria to the quality of health care students receive
2. To determine the level of satisfaction on the quality of services received by students.
3. To examine the usefulness of hospital management, health planners and policy makers towards improving students experiences and the quality of health care provided.

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1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• Does Nigeria’s heath care system achieve or about achieving the Sustainable Development Goals (SDGs)?
• What is the perception of patients in a teaching hospital in Nigeria to the quality of health care students receive?
• What is the level of satisfaction on the quality of services received by students?
• What is the usefulness of hospital management, health planners and policy makers towards improving students experiences and the quality of health care provided?

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1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: Nigeria’s heath care system has not achieve but about achieving the Sustainable Development Goals (SDGs)
• H1: Nigeria’s heath care system has achieved the Sustainable Development Goals (SDGs)

Hypothesis Two

• H0: There are no major problems confronting the quality of Medical Services in Nigeria among Students
• H1: There are major problems confronting the quality of Medical Services in Nigeria among Students

Hypothesis Three

• H0: There is no significant level of satisfaction on the quality of services received by students in the area under study
• H1: There is significant level of satisfaction on the quality of services received by students in the area under study

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1.7 Significance of Study

The result of this study will help the government reform health sector programme as well as passage of National Health Bill before the National Assembly to enable Nigeria to successfully revamp its primary health care system and implement the integrated Maternal, Newborn and Child Health (IMNCH) strategy and move closer to achieving SDgs 4 and 5 so to lead to sustainability. The result of this work will also help in illuminating the implication of poor health care system in Nigeria so that most decision makers will understand the good prospect of tackling the issue. It is held that the scheme from this research will help the government as well as the health care providers improve the Nigerian health care system.

This study will be of immense benefit to other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study.

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1.8 Scope of the Study

The scope of this research is focused on the Perception of the Quality of Medical Services in Nigeria among Students using Madonna Elele Campus Students in Rivers State as a case study.

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1.9 Limitations of the Study

During the course of this study, many things militated against its completion, some of which are:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Research material: availability of research material is a major setback to the scope of the study.
3. Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
4. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

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1.10 Operational Definition of Terms

Perception: To notice something in a particular way or hold a view about something.

Attitude: The way one behaves towards somebody or something that shows how you think or feel.

Knowledge: To have information about something because you have experience or because you have learned it or be told.