Utilisation of Primary Health Care (PHC) Centers by Residents of the Community. A Scientific Study


Bachelor Thesis, 2013
66 Pages

Free online reading

TABLE OF CONTENTS

TITLE

DECLARATION

ATTESTATION

DEDICATION

AKNOWLEDGEMENT

TABLE OF CONTENTS

LIST OF TABLES

LIST OF FIGURES

ABSTRACT

CHAPTER ONE : INTRODUCTION

CHAPTER TWO: LITERATURE REVIEW

CHAPTER THREE: MATERIALS AND METHOD

CHAPTER FOUR: RESULT AND ANALYSIS

CHAPTER FIVE: DISCUSSION

CHAPTER SIX: CONCLUSION AND

RECOMMENDATION

REFERENCES

APPENDIX: QUESTIONNAIRE

LIST OF TABLES

TABLE 1: SOCIODEMOGRAPHICS

TABLE 2: AWARENESS OF PRIMARY HEALTH CARE (PHC) CENTERS

TABLE 3: SOURCE OF INFORMATION ABOUT PHC CENTERS

TABLE 4: AWARENESS OF SERVICES PROVIDED AT PHC CENTERS

TABLE 5: USE OF PHC CENTER

TABLE 6: SERVICES UTILISED IN THE PAST SIX MONTHS

TABLE 7: REASONS FOR NON-UTILISATION OF PHC CENTERS

TABLE 8: HEALTH FACILITY RESPONDENTS GO FIRST WHEN ILL

TABLE 9: REFERRAL TO THE HOSPITAL FROM THE PHC

TABLE 10: PREFERRED MEDICATION

TABLE 11: HEALTH INFORMATION

TABLE 12: HOME VISIT BY A COMMUNITY HEALTH CARE WORKER

TABLE 13: REASON FOR VISIT

TABLE 14: GENDER AND USE OF PHC CENTERS

TABLE 15: USE OF PHC CENTERS AND LEVEL OF EDUCATION

TABLE 16: STATISTICAL TEST FOR THE RELATIONSHIP BETWEEN USE OF PHC CENTERS AND LEVEL OF EDUCATION

TABLE 17: USE OF PHC CENTERS AND DISTANCE FROM HOME OF RESPONDENTS

TABLE 18: STATISTICAL TEST FOR THE RELATIONSHIP BETWEEN THE USE 39 OF PHC CENTERS AND DISTANCE FROM HOME OF RESPONDENTS

TABLE 19: OCCUPATION AND USE OF PHC CENTERS

TABLE 20: STATISTICAL TEST FOR THE RELATIONSHIP BETWEEN OCCUPATION AND USE OF PHC CENTERS

LIST OF FIGURES

FIGURE 1: THE PERCEPTION OF RESPONDENTS ON THE ADEQUACY OF MEDICAL PERSONNEL AT THE PHC CENTERS

FIGURE 2: THE PERCENTAGE OF RESPONDENTS WHO ARE SATISFIED WITH THE SERVICES RECEIVED AT THE PHC CENTERS

FIGURE 3: A TIME MEASURE OF THE DISTANCE OF PHC CENTERS FROM THE HOMES OF THE RESPONDENTS

FIGURE 4: THE PERCENTAGE OF RESPONDENTS WHO ARE SATISFIED WITH THE HEALTH FACILITIES AT THE PHC CENTERS

DEDICATION

I dedicate this project to God Almighty, my source and help in time of need, and to my parents, Mr and Mrs Osifeso whose love and support have been my inspiration always.

ACKNOWLEDEMENT

My profound gratitude goes to the Almighty God; this project would not have been possible without him.

My sincere appreciation goes to my supervisor, Dr C.E. Enabulele, for his assistance, patience and support from the beginning to the end of this project. I also want to thank the head of department Dr (Mrs.) K.O. Wright and other lecturers in the department for their patience in imparting knowledge.

My sincere appreciation goes to my parents and siblings for their prayers encouragement, financial and moral support.

ABSTRACT

BACKGROUND

The need for the world communities to provide and promote essential health care for all led to the development of the concept of Primary health care (PHC) as a key to achieving this goal. This was meant to aid in bridging the gap of existing inequality in health status among different people of various socioeconomic backgrounds in developed and developing countries of the world.

OBJECTIVES

To study the level of utilization of PHC centers by the residents of Agbowa community in Ikosi-Ejinrin Local council development area (LCDA), Lagos State.

METHOD

The study employed a descriptive cross-sectional survey conducted using interviewer administered semi-structured questionnaire among residents of Agbowa community between October and November 2012. Analysis of the result was done using the Epi-info 2012 statistical software.

RESULTS

Out of 180 respondents, 91.1% are aware of the PHC centers within their community, 75.6% use the PHC centers and Immunization services were mostly utilized by the respondents (31.1%). (52.2%) of the respondents are satisfied with the health care facilities available at the centers and (32.8%) of the respondents

are satisfied with the services provided by the centers. Among the common reasons for not using the PHC centers are the preference of respondents for the hospitals (27.7%) and the unavailability of drugs (15.9%), there was also a significant relationship between the distance from homes of the respondents and the use of PHC centers.

CONCLUSION AND RECOMMENDATIONS

This study has shown that there is a high level of utilization of the services available at PHC centers in Agbowa community. The level of utilization of the PHC centers among the residents is not affected by their level of education or occupation. The results also show that more respondents are not satisfied with the services obtained at the centers due to their poorly-maintained facilities, inadequacies in health care equipment and medical personnel. Therefore, adequate drug supply and medical equipment should be made maintained at the PHC centers and Incentives should be available for medical personnel to encourage them to work in rural areas.

It should also become compulsory that any ill individual that require the services of secondary care facilities must obtain a referral from the PHC centers before they are attended to. This would further improve the utilization of the PHC centers.

CHAPTER ONE INTRODUCTION

1.1 BACKGROUND

The need for the world communities to provide and promote essential health care for all led to the development of the concept of Primary health care (PHC) as a key to achieving this goal. This was meant to aid in bridging the gap of existing inequality in health status among different people of various socioeconomic backgrounds in developed and developing countries of the world.1

In the Declaration of Alma-Ata of 1978, Primary health care was defined as "essential health care based on practical, scientifically sound and socially acceptable methods of technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self reliance and self determination".1 It is on the basis of universal accessibility that Primary health centers were established in Nigeria, among other countries, as a mechanism to provide health care for all citizens regardless of their location and socioeconomic status.1

The variation in health status among various communities results from environmental, socioeconomic, and cultural factors. Poverty is the most important cause of preventable death, disease, and disability.2 Literacy, access to housing, safe water, sanitation and food supplies are also important determinants of the health status of an individual.3

More people live in poverty today than 20 years ago. About a fifth of the world's population, 1-3 billion people, live on a daily income of less than US$1.3 Although, most of the world's poor live in South-east Asia, sub-Saharan Africa has the fastest growing proportion of people who live in poverty.3

The World Health Organization defines health as "a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity"4 Article 25 of the Universal declaration of human rights states that "every individual has the right to a standard of living adequate for the health and well being of himself and his family including food, clothing, housing and medical care"5 Therefore, the government of every country is responsible for the health of her people at all levels.1

Nigeria launched the national primary health care policy in 1988 which amongst other previous health policies made the achievement of "health for all" by year 2000 a priority.6 In consonance with the Alma-Ata declaration of 1978, a national health care system was adopted in Nigeria with PHC as the main strategy for actualizing the policy.6 A three-tier system of health care was developed which featured the support of the Federal, State, and Local governments. It is a system that is comprehensive and involves multisectoral inputs, community involvement, and collaboration with non-governmental providers of health.6

The three-tier system includes the primary health care level managed by the local government, which is the first point of access to health care for individuals and communities. The state government manages medical care provided at the secondary health care level, which accepts referrals from PHC centers and provide health services beyond the capacity at the primary level.6 the tertiary health care level provide highly specialized medical care supported by advanced diagnostic capability and modern technology. The Tertiary care centers are managed by the Federal government or the state government if the facility is owned by the state.6

Various problems were observed with the current health care system, amongst which is the problem of inadequate coverage of the rural population. It was estimated that the rural population in Nigeria is 53% of the total population, a home to 70% of the poor in the country7 and still, not more than 30% of the country's rural population has access to modern health care services6. Other challenges include the insufficient number of medical personnel and their uneven distribution in the country. The deterioration of government facilities, low salaries and poor working conditions had resulted in a mass exodus of health professionals out of the country8. Despite the desire of the government to ensure equitable distribution of medical facilities, personnel and manpower, glaring disparities are still evident. A study of 28 health facilities carried out in Lagos state (22 PHC facilities and 6 secondary facilities) showed that 23 of the health care facilities were located in urban areas while only 5 were located in rural areas, 18 primary health centers out of the 22 were located in urban areas and 4 in rural areas.9

Involvement of the community in making rational choices that affect them at critical points of decision making with regards to health promotion in various communities is also deficient. Lack of basic health statistics of the Nigerian population, poor financial resource allocation to health service, especially in high priority areas, defective basic infrastructure and logistics support are also problems identified.2 Most of these problems can be properly addressed by the prioritization of primary health care services and encouraging more investment into the preventive aspect of health care.6

Primary health care is provided by the local government through the provision of health centers and health posts. These are staffed by nurses, midwives, community health officers and health technicians, community health extension workers and physicians.10 The services provided by these health facilities include; treatment of communicable and non-communicable diseases, immunization, maternal and child health services, family planning, public health education, environmental health, collection of statistical data on health and health- related events.10

The health-related challenges faced by the rural population such as poor socioeconomic and unsatisfactory environmental conditions predispose them to malnutrition and infectious diseases.11 Prevalence of endemic diseases such as malaria and exposure to zoonotic diseases as a result of close contact with animals is also common. However, despite the availability of primary health care services in some communities, rural dwellers tend to underuse the services due to their various cultural and traditional beliefs. Therefore, it is important to carry out rational assessments and evaluation of ways to satisfy the health needs of rural communities through obtaining information from members of the community who know what their health needs are and can objectively identify the various problems associated with poor health care delivery in their communities.11

As end-users of the services, members of the community also have a stake in ensuring that services are well provided, and they should also be in the position to monitor the quality of the services provided by primary health care centers.11 With the benefit of local information, they can assess the specific obstacles facing the facilities in providing services and they can seek to ensure that facilities have the necessary infrastructure, supplies and staff motivation to provide the services they should provide11.

1:2 JUSTIFICATION

The determination of the level of utilization of PHC centers by residents in a rural community like Agbowa is a means of evaluating the services that the centers provide. This would be achieved by the assessing the level of awareness, demand and uptake of the services they offer. This assessment will help to point out the various problems associated with the delivery of proper health care and give an insight into the impact of these services on the health of the people.

The choice of this study is based on the need to obtain information from the perspective of residents of the community on the challenges associated with obtaining satisfactory health care services from the available PHC centers. This study would also help to assess the efficiency of the health care referral system in the community.

1:3 AIMS AND OBJECTIVES

AIM

This study is aimed at assessing the level of utilization of PHC centers by residents of Agbowa community in Ikosi Ejinrin Local council development area (LCDA), Lagos state.

OBJECTIVES

- To assess the level of awareness of the services provided by PHC centers.
- To assess the level of utilization of the PHC centers available in the community.
- To determine the various problems and challenges associated with the use of the PHC centers in the community.

CHAPTER TWO

LITERATURE REVIEW

PRIMARY HEALTH CARE IN NIGERIA

Health services delivery in Nigeria had its historical antecedents. It had evolved through a series of developments including a succession of policies and plan, which had been introduced by previous pre-colonial and post colonial administrations in Nigeria.12 The beginning of a meaningful health service policy started with the first Ten year National plan (1946 -1956) wherein health was put on the concurrent legislative list with both Federal and Regional government exercising defined powers within their areas of direct administrative control.12

The first Ten-year National plan (1946 -1956) whose proponents were mainly expatriate officials had a number of deficiencies in health man-power development, provision of comprehensive healthcare, disease control, efficient utilization of health resources, medical research, health planning and management, and in health care delivery.12 The health policy at the Second National Development Plan (1970-1974) focused in part at correcting some of these deficiencies. The Third National Development Plan of 1975 - 1980 was aimed at increasing the proportion of the population receiving health care from 25% to 60%. The Basic Health service scheme policy which was incorporated into the Development Plan had its objectives which were to initiate the provision of adequate and effective health facilities and care for the entire population, to correct the imbalance between preventive and curative care.12 '13 The Fourth National Development Plan too made the Basic Health Services Scheme the core of its orientation in the health sector. However, it suffered total neglect.13 The Federal Government in particular focused much more attention on the establishment of teaching and specialist Hospitals. This was reflected in the budgetary allocations for health capital projects and programmes as they were contained in the Fourth National Development Plan.13

The military administration of General Ibrahim Babangida and the appointment of Prof. Olukoye Ransome-Kuti brought about the creation of the Primary Health Care Directorate in the Federal Ministry of Health.14 Its main goal was to improve the standards of living, promote health and welfare especially through preventing premature deaths and illnesses among high risk mothers and children and to achieve lower population growth rates through reduction of birth rates by voluntary fertility regulation methods that are compatible with the attainment of economic and social goals of the nation"14

THE CONCEPT OF PRIMARY HEALTH CARE

Provision of essential health care made universally accessible is the basic foundation of PHC which is a goal that most countries of the world plan to achieve. Primary health care aims at making health care services accessible and available to people where they work and live.6 The people of the community must also be able to maintain the technology used to provide the services, this is termed "appropriate technology". The community should also be involved in evaluating the services provided to ensure that it effectively serves their need6.

All social and economic sectors have to be involved in the implementation of primary health care and cooperate in the effort of promoting the health of the people. The goal of health promotion is put to play by laying emphasis on preventive and promotive measures integrated with treatment and rehabilitation in a multidisciplinary manner.1

STRATEGIES FOR THE IMPLEMENTATION OF PRIMARY HEALTH CARE

Promotion of Health awareness is an important strategy to sensitize the people of their health needs. Health education programs through campaigns, locally prepared health education materials or the use of the media like radio and television are proven means of promoting awareness.15 Creating awareness would help the community to understand the importance of the health services being made available, it would also give members of the community the insight to question traditional and cultural practices which have a negative impact on the health of the people.6

Political commitment on the part of the government in the provision of adequate resources and funding for the PHC facilities would determine the level of utilization of the facilities by the people of the community.6 Other non­governmental organizations and different social and religious groups can also be

Involved in the promotion of health care delivery for members of the community.. Motivating the people to accept the services provided by health facilities could be a challenge in some communities based on their various traditional and cultural norms and practices.15 Legislative approaches through laws making it compulsory to receive services such as adequate immunization before primary school admission would greatly increase the demand for primary health care services thereby improving the health of the people.15

Provision of health facilities such as PHC centers and health post carry out the provision of health services that are tailored to the needs of the community. The facilities are to be equipped with basic amenities required to provide these services.6

PRIMARY HEALTH CARE SERVICES

The services provided by PHC are based on the following eight essential elements of Primary health care:

a. HEALTH EDUCATION

This involves the teaching, learning and inclusion of habits concerned with the objectives of healthy living, it also informs motivates and helps people to adopt and maintain healthy lifestyles.15 The objective of health education is to make people value health as a worthwhile asset, with a desire to live long and feel well; and with the support of health personnel, to learn what they can do as individuals, families and communities to protect and improve their own health.6

An important strategy through which highly valued involvement of the people and communities in the identification and solution of their health problems is the Information, Education and Communication (IEC) strategy.6 '15 It involves a direct or indirect application of basic health education principles and theories for the purpose of promoting positive health behavior that may influence the promotion of good health and prevention of diseases.6 This is achieved by listening to the people and talking to them about their health problems, identifying the behaviors or action of the people that could cause, cure or prevent these problems and helping people to understand the relationship between their actions and their health problems.6 It also involves asking people about their own ideas for solving health problems, helping them to decide the most useful and simplest to practice, and encouraging them to choose the idea best suited to their circumstances.6

b. PROMOTION OF FOOD SUPPLY AND PROPER NUTRITION

Food is the most basic human requirement. It is the sum of the processes involved in eating, digesting and absorbing and using it for the maintenance of normal physical growth, development and body repairs.16 The state of health of the individual as determined by what a person eats dictates the health status of that individual and a good health status cannot be achieved without adequate food security. Food security refers to the availability of food at the house hold level thought the year and the promotion of food security involves various activities, such as production, storage, processing, distribution as well as food safety.6 '16

Malnutrition is a common problem caused by deficiency of nutrient intake in relation to its requirements. Under nutrition is a prevalent type of malnutrition in tropical developing countries.16 Distributing supplementary foods and nutrients, promoting breast-feeding and complementary feeding, controlling disease by checking food hygiene and safety, monitoring nutrition and child growth, providing maternal health services and nutrition education and facilitating community-based programmes on nutrition are some of the strategies used at primary health care level to tackle problems related to poor nutrition and food supply in communities.16

c. PROVISION OF COMPREHENSIVE MATERNAL AND CHILD HEALTH INCLUDING

FAMILY PLANNING

The goal of maternal, child health and family planning is a reduction in maternal and childhood morbidity and mortality.17 In Nigeria factors such as unsafe abortions and inadequate post-abortion care, early and child marriages, early pregnancies and high fertility rates are significant contributory factors to maternal death. Others include, inadequate family planning services, low rate of contraceptive usage leading to unwanted and unplanned pregnancies, and lack of sex education especially in the rural areas.17

The terminal events that cause maternal death occur against a background of predisposing factors in the community, and within the health service.

Participation of government and everyone in the community is important to reduce maternal deaths.18 Community involvement in the reduction of maternal deaths is desirable because there is a complex interaction of medical and non­medical factors that are involved in perpetuating the high mortality rates occurring in the developing world19. At the community level, community health workers, village health workers and traditional birth attendants, have the primary responsibility of health education on maternal and child health issues therefore, they require basic training with support from both local government and communities for effective performance.6

Infant and child mortality remains high in developing countries, where almost 10 million deaths occur annually in children under-5 years old, most deaths are from common, preventable and easily treatable childhood diseases20. The millennium development goal for child mortality commits nations to reduce child deaths by two thirds by 201521. More than 60% of global child deaths could be prevented by proven interventions available and affordable today22, but coverage remains low particularly in low income countries23. The challenge is to improve coverage of child survival interventions to a level that will have a positive impact on child mortality.

Integrated Management of Childhood Illness (IMCI) is a strategy developed by the World Health Organisation (WHO) and United Nations Children's Fund (UNICEF) to improve child survival in resource poor settings6 '24. It involves improved management of childhood illness, improved nutrition, immunization, breast­feeding support, vitamin A and micronutrient supplementation, use of insecticide impregnated nets; and compliance with treatment. The above combination of interventions is aimed at improving practices both in the health facilities and at home.24

d. IMMUNIZATION

The objective is to reduce morbidity and mortality caused by vaccine preventable diseases such as poliomyelitis, tuberculosis, tetanus, pertusis, yellow fever and hepatitis B virus. Immunization of children is one of the most cost effective public health interventions.25 WHO and UNICEF estimate that childhood immunization saves 3 million lives. But 30 million children do not complete the standard course of immunization.25 Each child should be immunized against the common communicable diseases for which vaccines are available.6

e. PREVENTION OF LOCALLY- ENDEMIC DISEASESs

Identification of locally endemic diseases, their mode of transmission and educating members of the community on ways of preventing them reduces the health risk. Members of the community are advised on controlling disease vectors, hygiene and nutrition, sanitation and life style changes through general health promotion. Prophylaxis is also provided against diseases such as malaria. Other methods include the provision of nutritional supplements to prevent diseases caused by poor nutrition.6

f. PROVISION OF ADEQUATE WATER SUPPLY AND BASIC SANITATION

PHC ensures access to water supply and the promotion of basic sanitation. Adequate water supply and sanitation is vital for the dignity and health of all people. The health and economic benefits of water supply and sanitation to households and individuals cannot be overemphasized.6 '26 Lack of improved domestic water supply lead to diseases.26 Adequate quantities of safe water for consumption and its use to promote hygiene are complementary measures for protecting health. The quantity of water people use depends upon their ease of access to it.26 If water is available through a house or yard connection people will use large quantities for hygiene, but consumption drops significantly when water must be carried for more than a few minutes from a source to the household. Sanitation facilities interrupt the transmission of much faecal-oral disease at its most important source by preventing human faecal contamination of water and soil.26

Epidemiological evidence suggests that sanitation is as effective in preventing disease as improved water supply. Often, however, it involves major behavioral changes and significant household cost.26 Sanitation is likely to be particularly effective in controlling worm infections. Safe disposal of children's faeces is of critical importance, children are the main victims of diarrhea and other faecal- oral disease, and also the most likely source of infection. Child-friendly toilets, and the development of effective school sanitation programmes, are important and popular strategies for promoting the demand for sanitation facilities and enhancing their impact.26

g. APPROPRIATE TREATMENT OF COMMON DISEASES

Primary health care through health centers provide services for the treatment of common diseases and injuries in the community. These health conditions are peculiar to specific communities due to factors such as their various socioeconomic conditions and physical environment.6 In communities with limited number of doctors, community health officers, community health assistants and community health aides help to deliver Primary health care to the people in the community. They act as "physician extenders" treating patients with simple needs using standing orders and referring other cases beyond their capability to doctors.6

h. PROVISION OF ESSENTIAL DRUGS

The provision of essential drugs enhances the services of primary health care by making quality essential drugs, vaccines, family planning commodities, consumables and other materials available and affordable to the community. The system ensures the continuous supply of drugs by an effective management system which eliminates drug wastages.27 Primary health care also function by effectively analyzing the need for medication in relation to the most important health problems and procuring the most effective medications at affordable prices. It assess the quality of drugs so as to detect fake medicines and manages the storage and distribution of drugs, it also ensures access to basic drugs by every member of the community.27

OTHER SERVICES

COMMUNITY MENTAL HEALTH

Mental and behavioural disorders are common, affecting more than 25% of all people at some time during their lives. They are also universal, affecting people of all countries, societies and individuals at all ages, women and men, the rich and the poor, from urban and rural environments.16 They have an economic impact on societies and on the quality of life of individuals and families. Mental and behavioural disorders are present at any point in time in about 10% of the adult population.16 Around 20% of all patients seen by primary health care professionals have one or more mental disorders. One in four families is likely to have at least one member with a behavioural or mental disorder.16 The main objective of promoting mental health is to ensure for each individual optimal development of mental abilities and a satisfactory emotional adjustment to the community and the environment.16

ORAL HEALTH

Oral health is an integral part of general health.6 No individual can be considered healthy while there is active disease in the mouth. Primary health care is involved in identifying groups of people in the community that may need special dental care, educating the community on causes of oral diseases and the providing measures for the prevention and treatment of such diseases.6

REFFERAL SYSTEM

This is a vital system in the provision of primary health care services at the local government level. It is named the "Two-Way Referral System".6 In this system clients that cannot be managed at the primary level can be referred to the secondary level, likewise, clients that have been treated successfully at the secondary level can be referred back to the primary level for continuity of care and follow up.6

PRIMARY HEALTH CARE (PHC) CENTERS

A PHC center is a core institution in the primary health care program. Infact, in many communities in Nigeria it is not only the first point of contact but the only available health practice in the rural areas28. Therefore a quality of health care at these primary care facilities is an issue of interest not only for the success of primary health program but for the justifications of the community resources deployed therein. Indeed, health care services are examples of services in which quality is critical. It is demanded, many times, out of necessity. Hence, it is often asserted and demanded that providers supply output of highest quality, an output that produces perceptible health gains or reduction of sufferings.29

The choice of health facilities for healthcare by an individual is largely determined by his or her taste, satisfaction with service and the perceived quality of care provided30 '31. The choice is however limited by factors such as availability, accessibility, affordability of services of the health facilities, cultural beliefs, the situation per time (i.e. urgency of care needed) and whether the kinds of services provided meet the need of the user32. The choice is also influenced by the users' understanding of the functions of the different levels of health facilities which ultimately result in the appropriate utilization of health services.

Studies have been conducted that have given facts and information regarding the level of utilization of primary health centers in Nigeria. In a study carried out at the University of Ilorin in 2010, probing into the preferred choice of health facilities among residents in Ilorin metropolis, The preferred health facility for medical care was private hospitals (35.2%) followed by pharmaceutical store (27.9%) and 17.0% for general/teaching hospitals and only 12.3% for primary health care (PHC) centers. Quick service and availability of drugs were the major reasons for their preference which were said to be better in private hospitals. Sex, marital status, educational status, occupation and city area where the respondents dwell are all associated with the preferred choice of health facility for care.33

Another study carried out on factors affecting the use of PHC clinics for children, it showed that the socioeconomic status of the families studied affected their disposition toward the immunization services provided at the clinics. Among the skilled workers 79% of their children were fully immunized, the semi skilled workers 77%, and the unskilled workers 57% of their children were fully immunized.34

In a study on the quality of health care service in rural health centers, three PHC centers in three villages three villages of a local government in south western part of Nigeria were assessed. The three centers were rated 37%, 40% and 39% respectively based on the assessment of the quality of health satisfaction in these health centers. These results are below average.35

A study carried out in rural Urhobo region of Delta State on the physical access and utilization of primary health care services in rural Nigeria showed that the distance from the health services are strongly linked and associated with the utilization of family planning services and vaccination of children. The health services are underutilized by the rural people, however, the quality of services were satisfactory.36

A survey carried out on decentralized delivery of PHC services in Nigeria using evidence from Lagos and Kogi state showed that Public health care facilities in Lagos and Kogi function in quite different contexts. In Lagos, a much higher proportion of public facilities are providing a higher level of health care whereas in Kogi, 80% of facilities are health posts. Moreover, there are more private facilities in Lagos than those in Kogi, and health facilities are also much better provided with public amenities such as water and electricity. Data indicate that Kogi facilities succeed in functioning under very difficult circumstances in terms of lack of basic amenities, and maintain public facilities better than those in Lagos, despite their better endowments. A substantial proportion of facilities in both states were in poor repair.37

Also, the PHC centers are supposed to be the first point of contact for patients in need of health care services. Patients are then referred from here to other levels of health care. A study on the referral system in Nigeria carried out at University of Ilorin teaching hospital showed that a total only 7.1% of them were referred to the hospital, 92.9% reported to the hospital directly without referral. The new patients 87.1% were predominantly resident in Ilorin. The proportion of those referred is higher among patients from outside Ilorin than those from within.

Most of the patients referred were from doctors from private clinics. Both the educated and non-educated bypass the primary and secondary levels of health care.38

In a study carried out at Obafemi Awolowo University on the management of primary health care services in Nigeria, primary data generated from social survey, interviews and secondary data generated from health institutions were used. It showed that PHC programs were grossly underfunded and a low level of interaction and coordination among tiers of government resulted in poor performance of PHC at the grass root.39

In another study at Obafemi Awolowo University to determine the utilization of PHC facilities in a rural community of southwest Nigeria, 44% of respondents to the survey who were ill in preceding six months visited a PHC facility. Poor education about when to seek care, poverty, perceived high cost of PHC services, and inadequate medical personnel on ground at PHC facilities were some of the causes of its underutilization.

In a cross sectional study on mothers of children under 5yrs carried out in Ahamdu Bello University to determine the factors that affect the utilization of PHC services available by residents of Barkin Ladi , Plateau state Nigeria, the study showed that 29% of the total respondents claimed that high cost of drugs are among the reasons for the underutilization of PHC services other findings of the study showed that 19% of the respondents had access to traditional healers,39% of them had difficulty in getting transport to the health facility, 3.6% of the respondent complained of the unfriendly attitude of health workers and 7.8% claimed that health personnel waste patient's time at the facility.41

A survey conducted on the distribution, accessibility and utilization of modern health care facilities in rural communities of Bayelsa State Nigeria, 58% of the respondents have ever visit a Primary health care for medical attention, 5% of the respondent visit a tertiary health establishment, while 2% of the proportion of respondents visit secondary health establishments.42

A study that examined the problems of effective primary health care in Owan east and Owan west local government areas of Edo State, showed that 44 percent or the total respondents use the hospital and the primary health care centers more often, 30.7 percent use only the primary health centers while 15.3 percent rely on local and spiritual means for treating their ailments. 10 percent patronize roadside chemist and 25.5 percent uses traditional means and roadside chemists. About 64.2 percent of patients who rely on traditional means and 57 percent of those that use the chemists more often do so because of lack of primary health care centers, lack of personnel and equipment and far distance from the PHC centers.43

In another study on the effect of distance on utilization of health care services in rural Kogi State, Nigeria. Results showed that only 18% of the rural households live close (0-4km) from a public health centre and therefore use the facility.

Others prefer to use self-medication and traditional care which is closer to their area of residence. This indicates that utilization of available public health facilities increases with reduced proximity to the health facilities.44

From the above studies, it can be deduced that several factors affect the level of utilization of PHC centers ranging from accessibility of the health facilities, level of education of members of the community, poor condition of health facilities and the poor health care referral system in Nigeria.

CHAPTER THREE MATERIALS AND METHODS

3.1 STUDY AREA AND POPULATION

The study area is the Ikosi -Ejinrin Local Council Development Area (LCDA) it is a rural settlement in Epe Local Government Area of Lagos State located between latitude 60 39' 0"North and longitude 30 43' 0" East46. It has a total population of 21,030 according to the population Census records obtained at Ikosi Ejinrin LCDA council office. The LCDA is made up of two wards: Agbowa Ward Ai with a population of 10,595 and Ward A2 with a population of 10,435. Agbowa ward Ai consists of major communities which include: Agbowa town, Owu , Ikosi and Ado, while ward A2 consists of communities such as Orugbo, Ajebo, Itokin and Ota.

The LCDA consists of people of different socioeconomic and religious background with the Yorubas as the major ethnic group. It is predominantly a fishing community due to its close proximity to the lagos lagoon. Other common occupation in this area includes trading and farming.

Agbowa community has a total of 5 PHC and 4 health posts. Each of the major communities has at least one health facility to cater for their health needs.

3.2 STUDY DESIGN

This was a cross-sectional descriptive study conducted among residents of Agbowa in Ikosi Ejinrin (LCDA) of Lagos State to assess the level of utilization of the services of PHC centers in the communities.

3.3 STUDY DURATION

Information required for this study was obtained within a period of one month.

3.4 STUDY POPULATION

This comprises of 200 residents of Agbowa in Ikosi Ejinrin (LCDA) of Lagos State

Inclusion criteria

This consists of Residents of Agbowa who are present in the various communities as at the time of conducting the study.

Exclusion criteria

All visitors and workers who are at the location of the study and do not reside in the community.

SAMPLE SIZE DETERMINATION

A sample size was determined using the prevalence of 12.3% from a similar study conducted among residents in Ilorin Metropolis, Kwara State, Nigeria.33 The sample size of this research was worked out using the following formula since the study population was more than 10,000.45

Abbildung in dieser Leseprobe nicht enthalten

Where n = desired sample size when the population is greater than 10,000

z = the standard normal deviate, usually set at 1.96 which corresponds to 95% confidence interval

p = the proportion in the target population estimated to have a particular characteristics (prevalence). For this study 12.3% from a previous study was used33

q =1-p

d = degree of accuracy desired (maximum error of estimate) was set at 0.05.45

Abbildung in dieser Leseprobe nicht enthalten

A total of 200 questionnaires were distributed to accommodate for non respondents and questionnaire losses. A total of 180 questionnaires were retrieved.

SAMPLING METHOD

A multi stage sampling technique was used to select respondents from the study area.

Stage 1: A Simple random sampling technique by balloting was used to determine where the study would be carried out in either of the two wards comprising Agbowa community. Agbowa ward A1 was selected.

Stage 2: In the selected ward there are 10 major streets and 5 major roads.

Simple random sampling technique was used to select 8 streets and 2 roads by balloting; this represents 10 areas in Agbowa ward A1. A sample of 20 residents is required from each selected area.

Stage 3: The list of the number of houses in each of the selected streets and roads to be sampled was prepared. An average of 40 houses was obtained on each of the streets or roads.

A sample interval of 5 was selected using systematic sampling technique by dividing a total of 200 representing the population to be sampled by 40 houses. Therefore, every fifth house on the streets or roads was selected to obtain the required sample.

This process was aided with the use of the map of Agbowa.46

3.5 ETHICAL CONSIDERATION

Ethical approval for this study was obtained from the Department of Community Health and Primary Health care of Lagos State University College of Medicine. Approval to carry out the study within the target population was obtained at the Ikosi Ejinrin LCDA office in Epe Local Government area of Lagos state. Informed consent was obtained from the respondents to assure them that the information they would provide would be treated with utmost confidentiality.

3.6 DATA COLLECTION

Data collection was done with the use of interviewer-administered semi structured questionnaires. The questionnaire which was the tool used to carry out this study to obtain information on the awareness, problems, challenges and utilization of Primary Health care (PHC) centers in Agbowa community was designed to contain closed ended and open ended questions which were subdivided into four sections (Section A on demographics, Section B on Awareness, Section C on Utilisation, Section D on Problems and challenges) and were interviewer administered by research assistants who were properly instructed on the requirements of the study. They were specifically instructed to ask the questions in the questionnaire in clear terms and in a language that the target population would understand this includes the use of Yoruba, the native language of the community. All copies of the questionnaires were numbered and completed ones were retrieved from interviewers after every survey for collation.

3.6 DATA PROCESSING AND ANALYSIS

Data obtained was analyzed using Epi-info 2012 statistical software (version 7.1.0.6). Initial analysis was by generation of frequency tables while further analysis involved cross tabulations to explore statistical relationships between variables. The observed differences were subjected to Chi- square to test for association between variables related to the utilization of the services of PHC centers in Agbowa community. The level of statistical significance was

set at P< 0.01.

3.7 LIMITATIONS OF THE STUDY

1. Financial commitment for the study was very much especially in the aspect of transportation to the places where the questionnaire were administered.

2. The manpower required to obtain the sample size was insufficient. I had to administer most of the questionnaires by myself.

CHAPTER FOUR

RESULT AND ANALYSIS

A total of 200 questionnaires were administered to the respondents and 180 questionnaires were retrieved giving a response rate of 90%.

TABLE 1: SOCIO-DEMOGRAPHICS

Abbildung in dieser Leseprobe nicht enthalten

Majority (18.9%) of the respondents were aged between 25-39 years;

114 (63.3%) were female, 66(36.7%) were male, 57.2% of the respondents had secondary education.

Majority (75.5%) are Yoruba and most(48.3%) of the respondents are self - Employed.

TABLE 2: AWARENESS OF PRIMARY HEALTH CARE (PHC) CENTERS

Abbildung in dieser Leseprobe nicht enthalten

(164, 91.1%) respondents are aware of PHC centers within their communities

TABLE 3: SOURCE OF INFORMATION ABOUT PHC CENTERS N=164

Abbildung in dieser Leseprobe nicht enthalten

"Others" in the above table include information from Religious institutions, Schools and Seminars.

TABLE 4: AWARENESS OF SERVICES PROVIDED AT PHC CENTERS N=180

Abbildung in dieser Leseprobe nicht enthalten

TABLE 5: USE OF PHC CENTER N=180

Abbildung in dieser Leseprobe nicht enthalten

(136, 75.6%) respondents use the PHC center while 44(24.4%) have never used the PHC center at anytime.

TABLE 6: SERVICES UTILISED IN THE PAST SIX MONTHS

N=136

Abbildung in dieser Leseprobe nicht enthalten

Immunisation services were mostly utilized (33.1%). Referral to other health facilities was least utilized (1.11%) while promotion of proper nutrition and provision of essential drugs were not utilized.

Abbildung in dieser Leseprobe nicht enthalten

Out of 44 respondents that do not use the PHC center, 12(27.7%) do not use the centers because they prefer going to hospitals.

Abbildung in dieser Leseprobe nicht enthalten

General hospitals are mostly the first point of call (55%) when respondents are ill Followed by PHC centers(28.9%). Others (8.89%) include Chemists and Traditional centers

TABLE 9: REFERRAL TO THE HOSPITAL FROM THE PHC N=136

Abbildung in dieser Leseprobe nicht enthalten

11.8% of the respondents who use the PHC center have once been referred to the hospital from the center.

TABLE 10: PREFERRED MEDICATION N=180

Abbildung in dieser Leseprobe nicht enthalten

Out of 180 respondents, 114(63.3%) prefer prescribed drugs

TABLE 11: HEALTH INFORMATION

N=180

Out of 180 respondents, 87(48.3%) of the respondents obtain information about their health from PHC centers.

Out of 180 respondents, 99(55%) utilize the General Hospital to obtain health information while 52(28.9%) utilize the PHC center.

N=180

TABLE 12: HOME VISIT BY A COMMUNITY HEALTH CARE WORKER

Abbildung in dieser Leseprobe nicht enthalten

74.4% of the respondents have been visited at home by a community health worker.

TABLE 13: REASON FOR VISIT

N=134

Abbildung in dieser Leseprobe nicht enthalten

Majority 120(66.7%)were visited at home by community health workers for the purpose of Immunisation

Abbildung in dieser Leseprobe nicht enthalten

FIG 1: A PIE CHART SHOWING THE PERCEPTION OF RESPONDENTS ON THE ADEQUACY OF MEDICAL PERSONNEL AT THE PHC CENTERS

Out of 180 respondents, 112(62.22%) said there are enough medical personnel at the PHC centers.

Abbildung in dieser Leseprobe nicht enthalten

FIG 2: A PIE CHART SHOWING THE PERCENTAGE OF RESPONDENTS WHO ARE SATISFIED WITH THE SERVICES RECEIVED AT THE PHC CENTERS

Out of 180 respondents, 59(32.78%) were satisfied with the services received at the PHC centers

FIG 3: A PIE CHART SHOWING A TIME MEASURE OF THE DISTANCE OF PHC CENTERS FROM THE HOMES OF THE RESPONDENTS

Out of 180 respondents 125(69.44%) of the respondents have PHC centers within 30 minutes from their homes.

Abbildung in dieser Leseprobe nicht enthalten

FIG 4: A PIE CHART SHOWING THE PERCENTAGE OF RESPONDENTS WHO ARE SATISFIED WITH THE HEALTH FACILITIES AT THE PHC CENTERS

Out of 136 respondents who use the PHC centers, 71(52.21%) are satisfied with the facilities at the PHC centers.

N=136

Abbildung in dieser Leseprobe nicht enthalten

TABLE 14: GENDER AND USE OF PHC CENTERS

Out of 136 respondents who uses the PHC centers, 38(27.9%) are male and 98(72.1%) are female

TABLE 15: USE OF PHC CENTERS AND LEVEL OF EDUCATION

Abbildung in dieser Leseprobe nicht enthalten

Out of 103 respondents who had secondary education, 76(73.7%) use the PHC centers and out of 17 respondents who had other non-formal forms of education, 11(64.7%) use the PHC centers.

TABLE 16: STATISTICAL TEST FOR THE RELATIONSHIP BETWEEN USE OF PHC CENTERS AND LEVEL OF EDUCATION

Abbildung in dieser Leseprobe nicht enthalten

X2 =1.9736 df=1 p= 0.1600 p>0.01

Since p>0.01, the relationship between the use of PHC centers and the level of education of respondents is not significant. Therefore, the level of education of the respondents does not affect the use of PHC centers.

TABLE 17: USE OF PHC CENTERS AND DISTANCE FROM HOME OF RESPONDENTS

Abbildung in dieser Leseprobe nicht enthalten

Out of 37 respondents who live more than 30 minutes from their PHC center, 21(56.7%) use the PHC centers.

TABLE 18: STATISTICAL TEST FOR THE RELATIONSHIP BETWEEN THE USE OF PHC CENTERS AND DISTANCE FROM HOME OF RESPONDENTS

Abbildung in dieser Leseprobe nicht enthalten

X2 =2.0000 df=1 p= 0.0000014587 p>0.01

Since p<0.01, the relationship between distance from the home of respondents and use of PHC Centers is significant. Therefore, the distance of the PHC centers from the homes of the respondents affects its use.

TABLE 19: OCCUPATION AND USE OF PHC CENTERS

Abbildung in dieser Leseprobe nicht enthalten

A high level of utilization of the health facilities can be observed from the above results including those who are unemployed.

TABLE 20: STATISTICAL TEST FOR THE RELATIONSHIP BETWEEN OCCUPATION AND USE OF PHC CENTERS

Abbildung in dieser Leseprobe nicht enthalten

X2 =12.0000 df=9 p= 0.2133 p>0.01

Since p>0.01, the relationship between occupation and use of PHC centers is not significant. Therefore, the occupation of the respondents does not affect the use of PHC Centers.

CHAPTER FIVE DISCUSSION

The age range of the population studied was between 15 to 60 years with 70% of respondents were between the ages of 15 to 39 years. From this study, majority of the respondents were female (63.3%); this is mainly because the females were more accessible and available at the residences during the day when most males have gone to their various workplaces. This is also similar to results obtained from a study in Kwara State, Nigeria where 52.9%33 of the respondents were female.

(91.1%) of the respondents are aware of the presence of Primary health care centers in their various communities. Most of the respondents were also aware of the services these centers provide. The major source of information was the community. The respondents claim that for every health programme planned within the community, a local information carrier goes round all the communities to announce the programme.

This study showed that 136(75.6%) out of 180 respondents utilize the PHC Centers; this is in contrast to similar studies reported in Kwara State, Nigeria where 12.3%33 of the respondents utilize the PHC centers. Also, a similar study in Osun State, South-western Nigeria, reported that 44%40 of the respondents utilize the PHC centers. This report is however, similar to 73% which was obtained in a similar study carried out in Tshwane region of South Africa47 and 93.34% reported also from a similar study in Pakistan.48

Antenatal care (81.1%) and Immunisation (77.2%) are amongst the services that majority of the respondents were well aware of, hence utilized the most in the past six months. The results for utilization of antenatal care (27.2%) is similar to result (25%) reported for coverage of antenatal care in Nigeria and other countries like Uruguay and Afghanistan compared to 80% reported in countries like Gambia, Columbia and the Philippines49.

Results obtained for the level of utilization of immunization services (33.1%) in the past six month by the respondents is low compared to results obtained from similar studies that reported 93.34% in Pakistan48, this is due to the fact that house to house immunization programmes organized nationwide would have covered most of the children requiring immunization within the community.

Referral to other health facilities from PHC centers was poorly utilized by the respondents (1.11%). Only 11.8% of the respondents have ever been referred to the hospital from the PHC center. Most of the respondents (55%) prefer going to the General hospital as the first point of call when they are ill; this is in contrast to similar studies reported in Pakistan where 34% of the patients preferred private hospitals for children emergencies compared to 25% who preferred public hospitals.50

Results have also been reported in developed countries like United Kingdom where 30% of patients in Birmingham were reported to use private hospital because of perception of higher standard and better quality of care.51 However, these results are quite different from the situation reported in Germany where less than 8% of the population preferred using private health facilities51.

Among the reasons that majority of the respondents gave for their preference of the General hospital as first point of call for health services is that the PHC centers are meant for pregnant women and children. Majority of the respondents would not go to the PHC centers first when they are ill because they believe the centers do not have adequate supply of drugs and others believe they are poorly equipped. This a contrast to the purpose for which the Primary health care centers were created. PHC centers are expected to provide basic health care for at least 60 to 70 percent of the Nigerian population.52 This is what contributes to the continuous increase in the work load of most secondary and tertiary health care facilities in the country. Despite the preference for the use of General hospitals by majority of respondents, most of them still obtain information they require about their health at the PHC centers.

Among the reasons why respondents do not go to the PHC centers as the first point of call when they are ill are because of the lack of medical personnel, especially doctors to attend to their health needs. 62.22% of the respondents agreed that medical personnel are mostly inadequate at the PHC centers; this is different from 20.7% obtained from reports in a similar study in Kwara State, Nigeria33

This result also shows that 92% of respondents who live within 30 minutes from their PHC centers utilize the facility. This is similar to reports obtained from studies carried out in South Africa which showed 70.9% accessibility to those who live within 30 minutes or less from the PHC centers47. Also this result shows that the statistical relationship between the time measured distance from the PHC centers and its level of utilization was significant.

Home visits by medical personnel from the PHC centers which should be a useful resource for community members who live far from the PHC centers seem to be a service poorly rendered by these centers. Majority of the reasons for home visits by the medical personnel is for immunization (66.7%) and not medical treatment (3.33%).

(32.78%) of the respondents are satisfied with the services obtained from the PHC centers this is probably due to the fact that only about 52.21% of the respondents agreed that there are adequate facilities required to cater for the health needs of the community. Most respondents also agreed that the centers are old with poor amenities and old equipments which greatly hinder the activities of the medical personnel available no matter their level of competence; this result is similar to another study reported in Nigeria were 50.3% of the respondents agreed that the PHC centers were poorly equipped.33

CHAPTER SIX CONCLUSION AND RECOMMENDATIONS

6.1 CONCLUSION

This study has shown that there is a high level of awareness and utilization of the services at PHC centers in Agbowa community. The level of utilization was however very much higher among the females in the community than the males.

The level of utilization of the PHC centers among the residents is not affected by their levels of education or occupations. The results also show that many respondents are not satisfied with the services obtained at the centers due to the poorly-maintained facilities, inadequacies in health care equipment and the medical personnel.

6.2 RECOMMENDATIONS

From the findings of this study, the following recommendations were made:

- Policy makers' and all stakeholders' attention ought to be drawn to improving the status and performance of the Primary health care centers of the various communities in Agbowa by properly maintaining these facilities and providing basic utilities such as water supply and electricity.
- The image of PHC centers should be improved by educating members of the community on the purpose for establishing centers within the community as the first point of call in providing health care. This would also discourage the notion that the PHC centers are meant for only pregnant women and children.
- Adequate medical personnel should be made available at the PHC centers to provide medical treatment for members of the community. There should also be medical personnel available for home visits for members of the community who are too ill to come to the PHC centers.
- Incentives should be made available for medical personnel to encourage them to work in rural areas.
- Adequate drug supply and medical equipment should be made available at the PHC centers to make the jobs of the medical personnel easier and more effective.
- It should become compulsory that any ill individual that requires care at secondary health facilities must obtain a referral from the PHC centers before they are attended to. This would further improve the utilization of the PHC centers and their services. It would also reduce the workload on the secondary health facilities and make them concentrate more on the treatment and management of more serious cases that the PHC centers cannot handle. If these cases cannot be handled by these secondary health facilities, they should be referred to the tertiary health facilities.

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13.Sani M. Integrating Federal Health Resources at the local level: A Case Study of the Development of the National Primary Health Care Delivery System. M.P.A Field report. Obafemi Awolowo University. 1990; 1-5

14. Ebingha E, Ushie M. Culture and policy implementation. An Appraisal of population policy in Nigeria. International J. Humanities and social sciences. 2012;(2) 17, 226

15. Alakija W. Essentials of community health and Primary health care and Health Management. Medisuccess Benin city, 2nd Edition. 2000:156-157,172

16. Lucas AD, Gilles HM. A short textbook of preventive medicine for the tropics. Oxford University press 4th Edition. 2003: 239, 261, 353

17.Steve M. Reducing maternal mortality in Nigeria through community participation a new paradigm shift. European J. Social sciences. 2011; 561­565

18. I mosemi D. "Why Maternal Deaths Rise" In: The Nation newspaper, April 7, 2009

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APPENDIX

LAGOS STATE UNIVERSITY COLLEGE OF MEDICINE, DEPARTMENT OF COMMUNITY HEALTH AND PRIMARY HEALTH CARE

QUESTIONNAIRE

I am a final year medical student of Lagos State University College of Medicine, carrying out a study on the utilization of the services of Primary health care (PHC) centers by residents of Agbowa in Ikosi-Ejinrin Local Council Development Area, Lagos State. This is in partial fulfillment of the requirements for the award of Bachelor of Medicine, Bachelor of Surgery (MB; BS) degree of Lagos State University. The results obtained from this study will be used for this purpose only.

Please kindly answer the following questions as best as you can. Your name is not required and strict confidentiality will be kept. The report of the survey shall be used only for research purpose and a condition of complete anonymity is guaranteed.

Thank you.

SECTION A: BIODATA

1. Age(years)

below 20 ( ) 20-24 ( ) 25-29 ( ) 30-34( ) 35-39 ( ) 40-44 ( ) 45-49 ( ) above 50 ( )

2. Gender. Male ( ) Female ( )

3. Nationality.

Nigerian ( ) Non- Nigerian ( )

4. Ethnicity

Hausa ( ) Ibo ( ) Yoruba ( ) Other(s) (please, specify)

5. Religion

Christianity ( ) Islam ( ) Traditional ( ) Other(s) (please, specify)

6. Marital status

Single ( ) Married ( ) Divorced ( ) Widowed ( ) Separated ( )

7. Level of Education

Primary ( ) Secondary ( ) Tertiary ( ) Other(s) (please, specify)

8. Occupation

Employed ( ) Unemployed ( ) Self Employed ( ) Student ( )

SECTION B: AWARENESS

9. Have you ever heard of Primary health care (PHC) center before? Yes ( ) No ( )

10. If yes to question 10, how did you get to know about Primary health care centers? The community ( ) Family/ Friends ( ) Media( television, radio)

( ) Health personnel ( ) Other(s) (please, specify)

11. Tick the services provided at Primary health care centers

Abbildung in dieser Leseprobe nicht enthalten

SECTION C: UTILISATION

13. Do you use the Primary health care center ?

Yes( )no ( )

14. If "yes" to 13 which of the above services have you used in the past six

months?

15. If "no" to question 13 why?

16. Which health facility should you go to first when you are ill?

Primary health care center ( ) General hospital ( ) Teaching hospital ( )

Private hospital ( ) Other(s) (please, specify)

17. Have you ever been referred to the hospital from a Primary health care center?

Yes( )no ( )

18. Which would you prefer when you fall ill?

Medically prescribed drugs ( ) Herbs ( )

19. Where do you obtain information about your health?

General hospital ( ) Primary health care center ( ) Teaching hospital ( ) Media (radio,

television ( ) Private hospital ( ) other(s) (please, specify)

SECTION D: PROBLEMS AND CHALLENGES

20. Have you ever been visited at home by a community health care worker?

Yes ( ) no ( )

21. If "Yes" to question 20, why were you visited?

Immunization ( ) Health inspection ( ) Medical treatment ( ) Other(s) (please, specify)

22. Are there enough medical personnel at your primary health care center?

Yes ( ) no ( ) I don't know ( )

23. Are you satisfied with the service you receive at your Primary health care center?

Yes ( ) no ( ) don't know( )

24. If no to question 23, why?

25. How far is the Primary health center from your home?

Within 30 minutes from my home ( ) More than 30 minutes from my home ( ) I don't know ( )

26. Are you satisfied with the health facilities available at your Primary health center? Yes ( ) no ( )

27. If "no" to question 26, why?

Inadequate medical equipments ( ) The facilities old ( ) Old medical equipments ( ) Other(s) (please, specify)

66 of 66 pages

Details

Title
Utilisation of Primary Health Care (PHC) Centers by Residents of the Community. A Scientific Study
College
Lagos State University  (College of Medicine)
Course
Medicine and Surgery
Author
Year
2013
Pages
66
Catalog Number
V424444
ISBN (Book)
9783668699038
File size
692 KB
Language
English
Tags
Primary health care, Health, Public health, community health, rural, primary health centre, utilisation
Quote paper
Adetola Osifeso (Author), 2013, Utilisation of Primary Health Care (PHC) Centers by Residents of the Community. A Scientific Study, Munich, GRIN Verlag, https://www.grin.com/document/424444

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