Critical assessment of community participation in primary health care

CHAPTER ONE

INTRODUCTION

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.

Research Questions 

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. 

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UTILIZATION OF ANTENATAL CARE AND DELIVERY SERVICES AMONG WOMEN OF CHILD BEARING  AGE

CHAPTER ONE

 INTRODUCTION

 Background to the study

Antenatal care service is an important goal concerning in the health status of the pregnant women during their reproductive period and its health beneficial accounting for nearly one quarter of all pregnant worldwide Terry TL (1942)

Through the antenatal care service attempts have been made to identify pregnant women not at risk and those at risk group based on their previous pregnant or currently historical or clinical factors and steps are planned to prevent it in this allegedly high-risk group of women to reduce adverse pregnancy outcomes Lincetto et al (2013).

Unfortunately, adverse pregnancy outcome can occur even in women without identifiable risk factors. Numerically, more pregnant women without risk factors have seen to end up with serious adverse outcome compared to those with risk factors during the attendance of antenatal care service Villar J, bergsj P (2002). In order to prevent pregnancy adverse outcome world wide as well as in developing countries, interventions should therefore be targeted at all pregnant women attending antenatal care service and during childbirth Dowswell T, et al. (2013).

Early attendance intervention at the antenatal care service in those with and without risk group pregnant women seems to beneficially in relation of their health  and this intervention that has been promoted as an effective intervention in preventing adverse pregnant outcome Adewoye KR, Musa IO, Atoyebi OA, Babatunde OA (2013).

The need of implementing knowledge, attitude and practice of ANC intervention in pregnant women it has been showed that as a package comprising the following interlocking system includes interventions, early screening, administration of a preventive prophylactic therapy and curative of the various detected risk conditions effectively on the basis of reduced maternal complications Zegey AM, Bitew BD, Koye DN (2013).

Additionally, antenatal care service is not a single intervention; instead, it represents a series of assessments and interventions over time that is not uniformly applied effectively by different health care providers found in developing countries Hajela S (2014).

Although not only  the “quantity” of antenatal care service  is relatively easy to measure through the required  timing and number of visits adjusted for gestational age at delivery but also the “quality” of antenatal care service  and the effectiveness of individual components on outcome are quite difficult to measure. However, the major goal of antenatal care service is to ensure the birth of a healthy baby with minimal risk for the mother.

Despite high ANC attendance in Nigeria, only 14% of pregnant women start ANC during the first trimester as per the national guidelines. The median number of months that women are pregnant at their first visit is 5.4 months. One third of women do not seek ANC until their sixth month or later Tekelab T, Berhanu B (2014). However, early booking has an advantage for proper pregnancy information sharing and pregnancy monitoring

Statement of the problem

In spite of the fact that exercise programs during pregnancy and after childbirth are designed to minimize impairment and help the woman maintain or regain function while she is preparing for the arrival of the baby and then caring for the infant, it is submitted that women are not meeting the exercise recommendations of the previous studies. A myriad of factors not limited to beliefs and attitudes of women with respect to exercise in pregnancy, level of knowledge, level of education, safety concern of the pregnant woman and her physician , race/ethnicity, and previous involvement in regular exercise have been implicated as important factors predisposing to exercise engagement or phobia among pregnant women.Some identifying factors that affect beliefs and behaviors would objectively encourage a change in attitude. Therefore, an assessment of knowledge and attitude about exercise in pregnancy may help to determine whether or not women will participate in exercise during and after pregnancy. This study was designed to assess knowledge and attitude of Nigerian pregnant women towards antenatal exercisesDownload Full Material-N5000

KNOWLEDGE ATTITUDE AND PRACTICES OF MENSTRUAL HYGIENE AMONG SECONDARY SCHOOL STUDENTS

CHAPTER ONE

1.0 Introduction

This chapter examined the background of the study, problem statement, significance of the study, the main objectives, specific objectives, the research questions, and the conceptual framework of the study.

 

1.2 Background of study

The onset of menstruation is one of the most significant milestones in a woman‟s life (Polat et al., 2009). Menstrual hygiene which is defined as the effective management of menstrual bleeding by females, is a principal aspect of reproductive health, that if not handled properly could facilitate infections of the urinary tract, vaginal thrush and pelvic inflammatory diseases, along with bad odour, unclean garments and extreme shame, causing infringement on the girl’s‟ dignity (Oche et al., 2012).

 

Worldwide, approximately 52% of the females are of reproductive age; hence menstruation is part of their normal life. Menstrual hygiene therefore is a fundamental aspect of basic hygienic practices (House et al., 2012). 56% of the girls are in and out of school and do not receive any information about menstruation (UNICEF, 2014). In India, for the absorption of menstrual blood, 88% used cloth, 4% used cotton wool, 7% sanitary pads while 3% used ash. In Nepal 75% of the adolescent secondary school girls do not have any idea about what material to use to absorb the flow (Water Aid, 2013). 23% of the adolescent girls in rural areas of India, having their period are one of the reasons to quit school. Nonetheless, not much attention is paid to the specific health needs of the girl‟s (Nagar et al., 2011).

 

In Africa about 1 in 10 school age adolescent girls absent themselves from school during periods or drop out at puberty because of lack of private, clean and hygienic sanitation facilities in schools (UNICEF, 2014). In Nigeria 91 % of the adolescent girls were aware of menstruation before starting their periods, their use of sanitary protection material was low at

27.6 % and 64.4 % used pieces of cloth and rags, 25% use nothing, and typically isolate themselves during menstruation and 11% of girls in Nigeria change their menstrual cloths once a day. (Abera Y, 2014). 83% of girls in Burkina Faso and 77% in Niger have no place at school to change their sanitary materials (Iliyasu Z, 2012). All the above indicates poor knowledge, attitude and practice as far as menstrual hygiene is concerned.

 

In Nigeria like most resource limited countries, menstruation, though a natural physiological process has been and still dealt with secrecy (Mahon and Fernandes, 2010). Majorly this is because of cultural and traditional taboos associated with sexuality and reproductive health. Cultural beliefs and norms, the physical infrastructure and socio- economic circumstances influence the practices associated with menstrual hygiene, some of which when coupled with lack of or inadequate knowledge are responsible for notably high rate of school absenteeism, along with withdrawal from social activities, illness, poor reproductive health and infections of adolescent girls in Nigeria (Jarrah and Kamel, 2012).

 

Although menstruation is highly valued and significant for womanhood, still very few studies have found positive experiences towards menstruation in girls.

 

Problem statement

Unpublished reports at  some Secondary School in Ebonyi indicate that the challenge of menstrual hygiene is mostly manifested through school absenteeism of adolescent girls and the awareness of these school girls has not been investigated. This is worsened by lack of efforts by individual teachers and parents to facilitate menstruating girls through provision of information and advice hence making menstrual hygiene a difficult topic to talk about. The school has inadequate water and sanitation facilities hence girls have difficulty in managing menstruation while at school. Poor menstrual hygiene affects the psychosocial wellbeing of girls for example increased stress levels, fear and embarrassment, and social exclusion during menstruation that impact negative on their education and social life (Sanyal et al., 2008).

 

Despite efforts by non – governmental organizations and other individuals who have tried to provide sanitary materials to some school going adolescent girls, expansion of sanitation facilities and the Nigerian education system that promotes menstrual hygiene through health education programs, menstrual hygiene is still one of the biggest challenges especially among under privileged adolescent school girls.

 

Poor hygienic practices can lead to various gynaecological problems in the reproductive life of girls, accompanied by discomfort, smelling and embarrassment among others. This makes menstrual hygiene crucial in an attempt to assist a girl child as far education and the future is concerned therefore this study seeks to investigate the menstrual hygiene related knowledge, attitude and practices among the adolescent girls between SS1- SS3 at Ebonyi secondary school

 

Significance of the Study

This research work is significant for the following reasons

This research breaks the silence on Menstrual Hygiene by creating awareness on the topic and the impact it has on adolescent secondary school girls, exploring and sharing lessons of the management aspects and promoting integration of Menstrual Health Management in health and hygiene sectors of the Ministry of Health and Health related Nongovernmental organization.

 

Provide information that strengthens preventive programs that promote women‟s sanitary health and also this study adds to the existing body of knowledge as far as menstrual hygiene is concerned.

 

This study discusses ways of supporting the sanitary campaign for women and girls, by informing the society of need for females‟ access to appropriate, decent, affordable and quality health care, information and related services.

 

Also this research critically studies an issue that faces every woman in every society in the world over including ours (International Health Sciences University); with the aim of providing viable information for managing menstrual hygiene in girls and women at large.

 

And finally, this work would serve as reference material for future researchers who intend to carry out researches that are related to this one in particular. A lot of information can be sourced from this work and they can be further improved on as well.

 

Objectives

      Major objective

To assess the knowledge, attitude and practices of menstrual hygiene among adolescent girls between SS1- SS3 at Ebonyi secondary school so as to adopt interventions to promote adequate menstrual hygiene.

 

      Specific objectives

1.    To determine the level of knowledge of menstrual hygiene among adolescent girls between SS1- SS3 at Ebonyi secondary school between September and November 2016.
2.    To examine the attitude of menstrual hygiene among adolescent girls between SS1- SS3 at  Ebonyi secondary school between September and November 2016.
3.    To identify the practices of adolescent girls between S1-S4 towards menstrual hygiene at Ebonyi secondary school between September and November 2016.

Research questions

1.    What is the level of knowledge of adolescent girls between S1-S4 towards menstrual hygiene at Ebonyi secondary school.
2.    What is attitude of adolescent girls between S1-S4 towards menstrual hygiene at Ebonyi secondary school.
3.    What are the practices of adolescent girls between S1-S4 towards menstrual hygiene at Ebonyi secondary school.

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