PROSPECT AND CHALLENGES OF PHC PROGRAMS IN RURAL COMMUNITY

1.1 Introduction

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).

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.

At the assemblage of world leaders in 2000 to define global development goals for the millennium, child mortality was identified as one key indicator of development. It was thus identified to be monitored as an indicator of social, economic and health development for different countries and zones in the world. Targets were set for attaining the millennium development goals (MDGs). For instance, it was expected that by 2015, global child mortality rate would be reduced to 45/1000.

To achieve this target, global efforts were galvanized to produce technologies that would ensure child health the world over. The production and distribution of effective vaccines and technology that protect children against the known childhood killer diseases were promoted. The primary healthcare (PHC) system in every country of the world was identified as the main driver for successful struggle against childhood deaths. The PHC centres were expected to provide the platform for the delivery of ante-natal and post-natal care for women, during which the babies would also be immunized against childhood killer diseases. Consequently, one primary function of the health centers was to promote access to health interventions and thus reduce childhood mortality.

In 2004, the United Nations established the Inter-Agency Group for Child Mortality Estimation (IGME) to advance the work of monitoring the progress towards MDG4 which targets the reduction of under-five mortality rate by two-thirds between 1990- 2015 as global momentum and investment for accelerating child survival and growth (UNICEF, 2010). This has prompted a renewed focus on the issue of access to health interventions. Thus while addressing the World Health Assembly in 2005, Bill Gate (2005) called on world players in global health to devote more thinking and funding to promoting access to interventions that exist for good health. The study proposed here is intended to examine the issue of access to PHC services in Nigerian rural communities, employing data from Offa Local Government Area (LGA) ofKwara State.

Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Prospect and Challenges of PHC programs in Rural Community.

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1.3 Statement of Problems

Investigation reveals that according to Frost and Reich (2008) the prevailing child mortality rate in developing countries is because many people do not have access to healthcare programs especially the rural dwellers. The low child health status and poor uptake of interventions designed to promote child health in Nigeria are largely attributable to poor antenatal care (ANC) practices, lack of access to and weak health systems. The situation is further aggravated by poverty and ignorance, which account for women’s inability to access critical ANC services and counseling on important safety measures, drugs and other interventions like ITN use (Onokerhoraye, 2000). In many cases, medical facilities are few and thinly spread. In the hard to reach rural areas, with difficult terrain and poor road network, modern health facilities are luxuries the dwellers can hardly afford, even when they wish (Okonofua, 2010). Attendance at ante natal clinics (ANC) is very poor for a number of personal and logistic issues confronting mothers especially with respect to distance, means of transport and sometimes attitude of health staff.

Nigeria is signatory to several agreements reached at international conferences in 1993 to solve the problem of poverty, hunger, malnutrition and child survival in the world. But it is a sad commentary to note that 18 years after this historic movement began, several millions of children have been left behind (Ogundipe, 2008). Ojanuga (2009) opined that child mortality rate is still on the increase and is buoyed by sociocultural factors which negatively impinge upon physical well being and accessibility to appropriate healthcare programs.

There is also the problem of low education especially health education among the rural dwellers. This has limited the abilities of community members to make rational choices (Federal Ministry of Health and Social Services, 1998). According to Ugwueje (2008), education acts as a very important variable because it alters other features of household living conditions such as knowledge of proper health facilities, perception of illness and disease etiology and personal illness control measures.

Furthermore, World Bank (2002) observed that economic hardship is one of the major causes of the increased child mortality rates in Africa. Resources to buy adequate and high quality foods have declined in most families and this has affected the feeding practice of the children (Rokx& Brown, 2002). In her study, Onyeneho (2005) argued that failure to access child health programmes in developing countries depends upon bridging gaps in delivery and community utilization of services.

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1.4 Aim and Objectives of Study

The aim of the study is to scrutinize the Prospect and Challenges of PHC programs in Rural Community in Offa Local Government of Kwara State. In achieving this aim, the following specific objectives were laid out as follows:

1. To ascertain the health situation of children and level of uptake of technologies for child survival in the Local Government Area.
2. To ascertain the cultural factors affecting access to Primary Healthcare programs in Offa LGA.
3. To find out how the cost of healthcare programs impedes access to healthcare programs in the LGA.
4. To identify the implications of mothers level of education on accessing healthcare programs in the LGA.
5. To find out the effects of distance in accessing Primary Healthcare programs in Offa LGA.
6. To ascertain the consequences of poor access to Primary Healthcare programs on child survival.

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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:

• Is the cost of healthcare programs an impediment to access to healthcare programs in the Local Government Area?
• Are there spatial differences in access to Primary Healthcare programs by communities in Offa Local Government Area?
• What is the situation of infant and child health and level of uptake of technologies for child survival in Offa Local Government Area?
• What are the cultural factors affecting access to Primary Healthcare programs in Offa Local Government Area?
• What are the implications of the mother’s level of education on accessing healthcare services in the Local Government Area?
• What are the consequences of poor access to Primary Healthcare programs on the child health in the Local Government Area?

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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.

• H₀1: There are no significant implications of mothers’ level of education on accessing healthcare programs in Offa Local Government Area
• H₀2: There are no significant consequences of poor access to Primary Healthcare programs on child survival.

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1.7 Significance of Study

The population situation in Nigeria shows that the level of mortality, especially infant and child mortality is still high. To this effect, this study has both theoretical and practical relevance.

Theoretically, this study stands to provide additional knowledge to the body of existing literature on child health in Nigeria and other developing countries with particular reference to rural areas. The result of this study will serve as good base or guide for future reference and it will also encourage further research on the health of the children in the rural areas since currently, it demands for proper attention. Furthermore, this study will provide relevant information on the factors that affects childhood mortality and poor utilization of primary Healthcare programs especially in developing countries. The study will provide empirical data to test the relevance of some of the existing theories on child health in rural Nigeria.

Practically, the findings of this study will reveal the factors that militate against proper utilization of primary healthcare programs and its effects on child mortality. The result from this research will also help planners design relevant, persuasive health messages that will help change the people’s attitude on the utilization of primary healthcare programs and create more awareness on the situation of child mortality in the country. More important, the process of interviewing and supply of responses to the questions will afford the people in the study communities the opportunity to review their child health practices for the better.

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1.8 Scope of Study

The study focuses on the Prospect and Challenges of PHC programs in Rural Community using Offa Local Government of Kwara 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 Definition of Terms

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.

Mortality: The number of death in a particular situation or period of time.

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

Access to Healthcare Programs: Access to healthcare programs is defined as one’sability to obtain and appropriately use good quality health technologies and commodities when needed for good health (Frost & Reich, 2008).

Childhood Mortality: “Mortality refers to decrement process by which living members of a population gradually die out” (Preston, Heuveline, & Guillot, 2001:92). Childhood mortality refers to death of persons under-5 years (WHO, 2020). It is measure by the number of deaths occurring between the first year of birth and the fifth birthday in a given population.

Infant Mortality: This is the death occurring during the first year of life (UNICEF, 2010). In this study it will refer to the death of person aged 12 months or less.

Mortality Rate: This is a measure of the number of deaths(in general, or due to a specific cause) in some population, scaled to the size of that population, per unit time.

Neo-natal Mortality: The neonatal period commences at birth and ends 28 completed days after birth. Neonatal mortality thus refers to deaths during the first 28 completed days of life (WHO, 2020).

Primary Healthcare: According to WHO (1978), Primary healthcare is defined as essential healthcare based on practical, scientifically sound, and socially acceptable methods and technology made accessible to individual and families in the community through their full participation and at a cost that the community and country can afford to maintain in the spirit of self-reliance and self-determination.