In Southwest Nigeria: Realities and People's Perceptions and Perspectives
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--T World Health I, 0rganization r @ l-p ,ro,o*,ou,,rro* Africa Ii o The Delivery of Essential Health Senrices in Southwest Nigeria: Realities and People's Perceptions and Perspectives \-,/ 29 AUGUST 2011 Oka Obono, PhD Phone: +234 803 3467863 Sociology Department E-nai/: [email protected] (preferred) University of Ibadan ) E -n ai l: oka,. obono@ur. edu.ng I Ibadan, Nigeria ACKNONTLEDGE,MENTS l ( The Southwest Nigeria Team acknowledges the funding and technical support of the African Programme for Onchocerciasis Control (APOC) and the quality assurance supplied by APOC Management and coordination by the African Regional Office of the World Health Organtzaion. The Team acknowledges the cooperation of the Ministries of Health of Ekiti State and Ogm State and of its personnel and staff who made access to documentation and interyiews possible. In this regard, we record our gratitude to Dr. D.K Aina @ermanent Secretary in the Ekiti State Ministry of Health) and Dr. E.A Ayinde (Head, Department of Planning, Research and Statistics in the Ogun State Ministry of Health). We are grateful for their help in mobilizing health personnel in the districts where we undertook our research in the two states. Similarly, we appreciate the facilitation provided by Dr. O. Fasina (I\zledical Officer in Charge of Ikere Health District); Dr. T.H Kolawole (I\{edical Officer in Charge of Ilejemeje Health District); Dr. O Akeju (Medical Officer of in Charge of Ado Health District); Dr. Adenusi (I\'Iedical Officer of Health in Obafemi Owode); Dr. Lawal (Ivledical Officer of Health in .l Ikenne LGA); Mrs. Adeleke Q.Jurse at Okessa Health Centre in Ado Ekiti). Our profound gratitude is due to His Royal Highness, King S.A Osatuyi, for his enlightening interviews on community efforts at improving health care delivery in his domain. We owe enoffnous thanks to members of the 24 communities in Ekiti and Ogun States where we undertook the studies. Without their cooperation, out investigation into theit perceptions and perspectives of essential healthcare delivery would not have been possible. I a SOUTHIrEST TEAM COMPOSITION Oka M. Obono Dr. Principal S ociology/Anthtopology University of Ibadan Investisator (T)emomaohv) Eme Owoaie Dr. Co-PI Public Health Physician Universiw of Ibadan Ezebunwa E. Dr Principal Sociology (Demography) University of Ibadan Nwokocha Researcher Koblowe Dr. Princlpal Sociology/ Communication Covenant Univetsity, Ota Arikpo Researchet Research Assistants Joachim Mr. RA Sociology/MBA University of Ibadan .1 Nwachukwu Bayo Adewumi Mr. RA MSc. Sociology University of Ibadan Sylvanus Mr. RA MSc. Sociology University of Ibadan Otikwu David Akeju N,ft. RA MSc. Sociology Universiw of Ibadan Charity Ms. RA MSc. Sociology University of Ibadan Umeokoro Opeyemi Ms. RA BSc. Geogtaphy Obaf. Awo. University Balosun Kemi Kalejaiye Ms. RA MSc. African Studies University of Ibadan Abosede Ms. RA MSc. Sociology Univetsity of Ibadan Odunlami C COMMUNITY PERCEPTIONS OF HEAITH AND HEAITH SERVICE DELIVERY 35 Perceptions of Health Jf Awareness and Knowledge of Health Issues 40 Health Problems and Source of Treatment 43 Perceptions of Health Services and Systems 46 COMMUNITY E,XPERIENCE, OF rMPLEr,{ENrl:to*... OF HEAITH SERVICE DELIVERY 50 Experiences with Health Services 51 Why People Did Not Get AII Prescribed Drugs and Altemative Sources of Medicine59 COMMUNITY EXPECTATIONS ABOUT RESPONSNTE HE,ALTH SE,RVICES 61, Perception of Govemment Contributions 64 Ratings of Government Contributions 65 Community Expectations of Services Govemment Should Provide . .. 66 - READINESS OF COMMUNITY TO PARTICIPATE IN HEALTH SERVICE DELIVERY 68 Community Contributions to the Delivery of Essential Health Services 69 Ways Community Can Contdbute to Essential Health Delivery t3 Individual Conttibutions to Community Health Delivery. 75 Willingness to Conttibute to Health in Future 77 Forms of Future Individual Contributions to Health Care 78 Reasons for No Future Contribution 80 Views about Health Services Provided to Communities 81 E,FFECTIVE COMMUNITY ENGAGEMENT IN HEALTH SERVICE DELN'ERY 82 SUMMARY AND . CONCLUSION 86 RECOMMENDATIONS 87 REFERE,NCES 89 o ANNEXES 90 Annex 1: Survey Instrument 90 Annex 2: Focus Group Discussion Guide 1,04 Annex 3: Indepth Interview Guides 1,07 Annex 4: Guidelines for Case Study Research on Disttict-Level Delivery of Essential Health Carc . 71,9 Annex 5: Translated Questionnaire. 1.25 List of Tables Table 1: List of Selected LGAs and Communities in Ekiti State 22 Table 2: List of Selected and Non-Selected LGAs in Ogun State 23 Table 3: DPI3 Covetage by states in the Southwest Zone ... 26 Table 4: Distribution of selected States and LGAs by Locality and DPT3 Covetage... 27 Table 5: Sample Size Calculation ... 27 Table 6: Distribution of Methods and Instruments by Related Research Objectives 30 Table 7: Sociodemographic Characteristics of Respondents in the Health Districts 34 Table 8: Distribution of Respondents by Length of Stay in Communities 35 Table 9: Individuals'Perception of Health... 36 I Table 10: Distribution of Respondents by ftsligious Affiliation 36 Table 11: Distribution of Respondents by Petception of What Constitutes Good Health 38 Table 1.2: DifFrculty with Activities across Distticts ... 39 Table 13: Common Health Problems across Districts 4t Table 14: Tlpe of Health Problems and Place of Treatment 43 Table 15: Sites for the Management of Health Problems 44 Table 16: Regression of Factors Influencing the rating of Health Care Services in the .. 47 Table 17: Rating of Health Care Services and Occupation of Respondents 48 Table 18: Reasons for Ratings of Health Facilities ... 48 Table 19: Assessment of Community need of Health Services 51 Table 20: Reasons Individuals last needed Health Care Across Districts 53 (-' Table 21: Multiple Regression of Social Factors Influencing Access to Health Cate 56 Table 22: Reasons for not Getting Health Care 57 Table 23: Reasons fot Not Getting All Prescribed Drugs and Altemative Sources 59 Table 24: Cost of Drugs, Reimbusement and Health Insurance 60 Table 25: Perceptions of Govemment Contributions to Health Services 64 Table 26: Community Expectations About on Govemment's Contdbution to Health Carc... 66 Table 27: Individual Opinion on Community Contributions to Health 77 Table 28: Ways Communities Can Contribute to Health 73 Table 29: Individual Contribution across Health Distticts 76 Table 30: Individual Willingness to Contdbute to Health Care 79 Table 31: Reasons for not Contributing to Health Care 80 Table 32: Perception of Health Cate Services Provided in the Community 81 List of Figures Figure 1: Conceptual Framework ... 16 Figure 2: Analylj.cal Framework.. 18 Figure 3: Sampling of Six Health Health Districts ... 24 Figure 4: Sampling Three Districts 25 25 Figure 6: General Sampling Approach 26 Figure 7: Difficulty with work 40 Figure 8: Difficulty with moving around 40 Figute 9: Perceptions of Health Services 47 Figure 10: People's Feelings About Govemment Involvement on Community Health 49 Figute 11: Entrance to a PHC FaciJity 53 Figute 1.2: Cardboatd Used as a Registration Card 54 Figure 13: Access to Cate by Locality 55 Figue L4: Histogtam Showing Places \Where People Seek Health Care 57 Figure 15: Drug Prescription and AvailabiJity 58 Figue 16: Availability of Prescribed Drugs 58 Figure 17: Empty Drug Stote in a Health FaciJity ... 63 Figure 18: Ratings of Govemment's Contributions to Health. 65 Figure 19: Ratings of Community Contdbutions to Health ... 70 Figure 20: Community Contributions to Matetnal Healthcare Delivery ^) Figute 21: Items Donated by the Community to facilitate the Delivery of Essential Health 72 Figure 22: Community Contribution of a Health Facility 72 Figure 23:Halr.ed Community-Directed Building of Health Centre 74 Figure 24: Individual Contributions to Health 76 Figure 25: Individuals Willingness to Contribute to Community Health in Future 78 1 10 INTRODUCTION In recent years, the role of communities in the delivery of essential health care services has attracted much recognition from service providers, tesearchers, policy makers and corporate stakeholders. From antiquity, however, that role had always been recognized by communities themselves. It is, therefore, a healthy step in the right ditection for partnets to acknowledge that health service delivery requires multiple inputs that include financing, human resources, inftastructutal support and, without quesdon, effective community involvement. That involvement can be developed in conjunction with other health partners if there is a resolution of complex operational questions. How do people's perceptions of health and the health r) system affect their inclination to use services? What expectations and petspectives do they have of "good" health service delivery? How can they be mobilized or effectively involved in the govemance, management and implementation of essential health care activities? The answers require the disentanglement of a complicated web of providers, services, financing mechanisms, and institutional arrangements that curendy characterize African healthcare delivery systems. New research needed to identiS, appropriate prioritizations and relationships in line with the WHO policy on Primary Health Care (PHC) and the Millennium Development Goals (I\,DG$. In this regard, sttengthening the health service delivery capacity at local level through gteater people's input could faci\tate the scaling up of cost-effective intewentions. At the same time, however, countries and intemational health