QUALITY ASSURANCE AN APPROACH TO IMPROVING THE QUALITY OF CARE IN HEALTH SETTLING IN NIGERIA

1.1 Introduction

The choice of health facility varies from one person to another and from one place to another, and it also depends on certain predisposing factors to the use of health facilities (Oluyemi et al., 2018). Actual utilization of health services will differ in accordance with various factors. Hence, when a country is not interested in merely providing physical access, but also in ensuring that modern health services are used by the population, it becomes important for such country to also understand the factors affecting health care utilization. Although there may be health centers in some rural area, access to care might be impeded by other barriers. One is inadequate transportation, either because travel time is excessive, because no public transportation is available (MACPAC, 2016; NCHS, 2016).

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

Over the past health workers have been contributing immensely to the primary prevention of disease in both community and health facilities with emphasis on the front-line health workers, these are the health care providers that are available to cater for the immediate health need of the patients, according to (Agyeponget al. 2001) the Interventions to improve quality and responsiveness in healthcare have centered on professionals and frontline workers without recourse to a total system reform.

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. 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.

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.

Carrasquillo (2013) stated that utilization is often reported as the number of services used over a period of time divided by the population denominator. Or the percentage of persons who use a certain service divided by individuals eligible to use the service. Oladipo (2014) stated that within the developing countries, differences in health status exist, based on indices such as infant mortality, young and child mortality and maternal mortality. Serious attention is required in improving quality of healthcare services to enhance it utilization, the study therefore seek to investigate the socio-economic factors that affect the utilization of health care services by inhabitants of rural areas of Enugu State PHC.

Health Care Utilization according to Carrasquillo (2013) is “the quantification or description of the use of services by persons for the purpose of preventing and curing health problems, promoting maintenance of health and well- being, or obtaining information about one’s health status and prognosis. It refers to the use of health care services. Utilization can be described as the use or amount usage per unit population of health services. It stated that in health care, utilization is defined as “the consumption of services or supplies such as the number of office visit a person makes per year with a health care provider, the number of prescription made or the number of days a person is hospitalized.

Therefore, in Enugu State PHC where the research was carried out, the activities that was conducted is to know the Quality Assurance an Approach to Improving the Quality of Care in Health Settling in Nigeria.

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1.3 Statement of Problems

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.

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1.4 Aim and Objectives of Study

The aim of the study is to assess the provision and utilization of maternal and child-health care services among women of child bearing age in Enugu State PHC. In achieving this aim, the following specific objectives were laid out as follows:

1. To determine the adequacy of health care services provided to community residents in Enugu State PHC.
2. To assess the influence of location of health care facilities on utilization of health care services among community residents in Enugu State PHC.
3. To assess the influence of educational status on utilization of health care services among community residents in Enugu State PHC.
4. To investigate the influence of attitude of health care personnel on utilization of health care services among community residents in Enugu State PHC.

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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:

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

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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: There is no statistical significant association in the utilization of health services among community residents in Enugu State PHC.
• H1: There is a statistical significant association in the utilization of health services among community residents in Enugu State PHC.

Hypothesis Two

• H0: Socio-economic factors do not have significant influence on the utilization of health care services by rural dwellers of Enugu State PHC
• H1: Socio-economic factors have significant influence on the utilization of health care services by rural dwellers of Enugu State PHC

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1.7 Significance of Study

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

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

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1.8 Scope of Study

The study focuses on the Quality Assurance an Approach to Improving the Quality of Care in Health Settling in Nigeria using Awgu Local Government Area (LGA), Enugu State PHC 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

Health: Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological and social changes with environment.