Critical assessment of community participation in primary health care
Background of the Study
In 1978, the World Health Organization (WHO) adopted the policy of “Health for all by the year 2000”. The factors that trigger the need for such an ambitious vision were embedded in the global socio- political, geographical, cultural and economic contexts. Other prime stimuli in rising in equalities in the distribution and allocation of health care resources and lack of social justice along with the rising costs that lead to in accessibility in the proper utilizing of health care services were the prime stimuli for WHO to adopt a rather radical idea of “Health for all by the year 2000” (Shi, Starfield, Politzer & Regan, 2002, WHO, 2006).
Primary health care became a component of health for all in 1978, when member state of the WHO were attending a meeting in Alma Ara/Russia who supported the policy which is for the betterment and development of all nations.
Health for all would entail national allocation and utilization of resources with fairness in access to health care services and efficiency meets the objective of Primary Health Care. According to Olise, (2011) National Health Policy aims to provide health care service that is preventive, promotive, curative and rehabilitative (restorative) in a wider perspective through active and immediate community involvement and participation. Community participation entails mechanisms for involving the communities in the planning and implementation of services on matters affecting their health, also community participation and Primary Health Care are inseparable of the proper utilization of health services is to be successful attained and achieved; (Federal Ministry of Health, 2004).
According to United Nations Children Education Fund (UNICEF) (1999) Community participation is the active involvement of people from communities preparing for ovacting to disaster, or is the involvement of the people concerned in analysis, decision making, planning and program implementation as well as in all the activities concerning health matters. One of the factors that stimulated the indoctrination of community participation and primary health care policy is the rising in equalities in the distribution and allocation of health care resources and lack of social justice along with the rising costs of health care leading to in accessibility to various health care services.
Community participation as in integral component of Primary Health Care is seriously neglected which manifests in the lack of active inclusion and involvement of various programs within their localities and domains. Community participation is effectively put into consideration would lead to the attainment of the objective of primary health care. This is to provide health care services to every individual in a wider coverage for the attainment of health care for all using available, accessible and affordable resources within the cultural acceptability of every nation in particular and the global nexus at large Olise, (2011).
Primary Health Care has been introduced into the Nigeria state in 1987. Federal Ministry of Health, (2001); in which it was launched throughout the country with the sole aim of providing a better health care for all, through community participation. It also plays a central role as it offers affordable and accessible health services to various individuals, families and communities at their door steps using available resources, more especially with emphasis to immunization, sanitation, family planning, child health care and welfare as well as food hygiene and nutrition.
Primary Health Care is more relevant at the third tier of government i.e. local governments, due to its grassroots, first level of contact and doorstep health care approach. As part of Alkaleri Local Government’s effort, the council has built various health centers and employed various health personnel and deployed them to managed the health centers. (Bauchi State Primary Health Care Development Agency, 2012).
But the point of concern is to assess the level of progress in the successful implementation of the services through community participation as an integral part of Primary Health Care in the Local Government. Against this back ground, this study seeks to examine the effectiveness, shortcomings and possible ways of improving community participation in primary health care delivery in Alkaleri L.G.A of Bauchi State.
Statement of the Problem
Community participation as an integral part of Primary Health Care services is seriously ignored in the fenets of the policy, the notable in adequacy of participation have continued to make health care delivery system difficult to attain efficiency especially in the developing world (Herrington, 2004). These in adequacies range from the levels of individual, family, community and government in general. The problems at the individual level include, the nature of interactions with other community members, value / moral practices fear of disgrace and exclusive, lack of community feelings at heart by the community members where they tend to be highly individualistic. There is also unfair distribution of work and benefits amongst members of the community. There is also inadequate qualified manpower that will sensitize and mobilize the community for a better action and involvement in changing their attitudes toward health from negative to positive (OLISE, 2011).
Linking these problems to the area under study one may identify a reported cases whereby most of the community members in the study area express their felt needs instead of the real problems facing their localities to the government officials and even the distribution of health resources in the study area is not equitably and fairly done but based on the political party affiliation of the particular community more especially in the previous regimes (1999-2015) (McEvoy and Tierney, 2014).
Interms of recruitment exercise it was not done in the local government for the past five years, also the level of educational attainment of the community members within the study area is mostly characterized with large number of illiterate and school drop outs in line with the above, the study area is left far behind in terms of locating health programs which are the infrastructures that shape the health care sector therefore absent of effective community participation more especially in the aspect of immunization and public sanitation which if care is not taken may lead to an outbreak of diseases that may claim many lives (Centre for Disease Control, 2011).
Finally, influence of political and related interference in assignment of roles, allocation of resources and infrastructure in the study area makes the participation more complicated, which weakens the community members effort to actively participate (BSPHCDA, 2012). Based on the above context, this study is desired to assess the level of community participation in Primary Health Care Services in Alkaleri Local Government Area of Bauchi State.
Purpose of the Study
The broader purpose of the study is to assess the level of community participation in Primary Health Care Services in Alkaleri Local Government Area, Bauchi State.
The specific objectives of this study are to:-
1. Examine the level of community participation in primary health care services in Alkaleri Local Government Area.
2. Identify the motivating factors responsible for participation of community members in primary health care services in Alkaleri Local Government Area, Bauchi State.
3. Identify ways to resolve the challenges facing community participation in Primary Health Care Services in Alkaleri Local Government Area, Bauchi State.
Significance of the Study
This study is very important in many respects. The study will shed light on the progress achieved in terms of community participation in Alkaleri Local Government Area, Bauchi State.
The study will also contribute to the body of knowledge in the area of community participation, thereby advancing literature in the area. The study will serve as a guide for future research to students, non governmental organizations and the government for proper implementation of health programs to the study area and help government in decision making and policy formulations concerning community participation without difficulties, finally the study will help the government to know where the lapse in community participation arises and assist government on how effectively to tackle the problems for effective health care coverage, also the study will assist the community in identifying their real problems concerning their own health and harnessing local resources thereby solving the problems by themselves.
Following research questions were formulated to guide the study;
1. What is the level of community participation in primary health care services in Alkaleri Local Government Area, Bauchi State?
2. What are the motivating factors responsible for participation of community members in primary health care in Alkaleri Local Government Area, Bauchi State?
3. How can the challenges facing community participation in Primary health care in Alkaleri Local Government Area be resolved?
Scope and Delimitation of the Study
This study covers the entire community participation in primary health care services in Alkaleri Local Government Area from 2015 – 2018. The researcher examined the achievements of community participation in primary health care services in Alkaleri Local Government Area. The study covers six wards from the three districts of the local government with abundant health resources that of properly and appropriately utilized will lead to a better health care.
The study is also restricted to the assessment of community participation in the provision of primary health care services within the study area. The more construction and establishment of health clinics and enlightenment campaign by government on any given health program without involvement of community members in the implementation of the primary health care programs will not lead to the attainment of the goals of primary health care.
The target population comprises the household heads, house wives, heads of community based clubs and associations and health care workers within the study area.