426 Indian Journal of Public Health Research & Development, April-June 2021, Vol. 12, No. 2 Factors Influencing the Quality of Primary Healthcare Services in Southern Senatorial District of Cross River State, Nigeria Uzomba Amalachukwu E.1, Ndep Antor O.2, Uzomba Chigozie I.3, Ekpenyong Bernadine N.4, Edom Awara E.5 1Research Scholar, Department of Public Health, 2Senior Lecturer/Researcher, Department of Public Health, Faculty of Allied Medical Sciences, College of Medicine, 3Lecturer/Researcher, Department of Paediatrics, Faculty of Medicine, College of Medicine, 4Senior Lecturer/Researcher, Department of Public Health, Faculty of Allied Medical Sciences, College of Medicine, 5Research Scholar, Department of Paediatrics, Faculty of Medicine, College of Medicine, University of Calabar, Calabar, Nigeria Abstract Background: The aim of this study is to determine the factors influencing the quality of primary healthcare services in southern senatorial district of Cross River State, Nigeria. Materials and Method: A cross sectional descriptive study design with both qualitative and quantitative method of data collection was used. Donabedian’s structure, process and outcome model guided the research protocol. Ethical clearance for the study was obtained from Cross River State Ministry of Health Ethics Committee. Two semi-structured questionnaires and a Focus Group Discussion Guide were used for data collection. Four hundred and eighty clients and 144 healthcare providers from 12 primary healthcare centres in the study area were selected by simple random sampling method. Statistical package for social sciences version 20.0 was used to analyze the quantitative data while thematic coding was used to analyse the qualitative data. Results: The major structure factors mitigating the quality of care as observed by the healthcare providers include insufficient manpower 58(40.28%), lack of basic amenities (light, water supply and good road) 58(40.28%), insufficient equipment 26(18.06%), insecurity and communal crises 22(15.28%). The perceptions of the clients were similar to that of the healthcare providers. In terms of process factors; poor attitude of some healthcare providers and clients was the main response of healthcare professionals. The qualitative results were similar to that of quantitative. All the basic primary health care services (including health education, health promotion, environmental sanitation, immunization, reproductive health, nutrition, HIV/AIDS and oral care) were provided in the selected health centres except mental health. Conclusions: The quality of healthcare services in the southern senatorial district,Cross River State, Nigeria, is affected by structure and process factors of the Donabedian’s model. Keywords: Caregivers, Clients, Quality, Primary Healthcare. Introduction World Health Organization (WHO), defines Quality Corresponding Author: of Care as the extent to which healthcare services Dr. Uzomba CI provided to individuals and patient populations improve Department of Paediatrics, Faculty of Medicine, desired health outcomes,hence, healthcare must be College of Medical Sciences, University of Calabar, safe, effective, timely, efficient, equitable, and people PMB 1115, Calabar, Nigeria centered.1 Health care and quality are inextricable, Contact No.: +2348037344688 therefore to provide health care services without e-mail: [email protected] concern for quality is unprofessional and potentially Indian Journal of Public Health Research & Development, April-June 2021, Vol. 12, No. 2 427 deadly.2 Quality improvement is a key function of health population projected at 1,590,200 in 2016 from the 2006 managers who lead the process at every level of the national population census and land mass of 9,731 square health system. kilometres, and is bounded by Akwa Ibom State to the South, Yakuur Local Government Area to the North, Improving quality through improving structures Abi Local Government Areas, Cross River state to the and processes leads to a reduction of waste of resources West and the Republic of Cameroon to the East where (human, material and finance), delays (long waiting the Atlantic Ocean lies.13-15 It has the largest forest area time by clients before being attended to at the health in the state with a very fertile land and the people are facilities), lower costs and enhances positive image of mostly subsistent farmers.13 the organization.3,4 This is a cross sectional descriptive study, both 5 In an Iranian study by Mosadeghrad, factors qualitative and quantitative method of data collection influencing the quality of care were identified as patients’ were used. Four Local Government Areas (Akpabuyo, socio-demographic variables, patients’ co-operation with Calabar Municipality, Calabar South and Odukpani) care, provider socio-demographic variables, provider were selected using simple random sampling method motivation and satisfaction, provider-competence, through balloting with replacement out of the seven 6 resources and facilities. Bradly et al, suggested that Local Government Areas in the study area. Three any effort to strengthen health systems in Africa must primary healthcare (PHC) facilities were randomly incorporate strategy to improve access and quality of selected from each of the selected LGAs, making a total health care services particularly in rural areas. of twelve. Ethical clearance for the study was obtained WHO,7 stated that although Nigeria constituted less from the Health Research Ethics Committee, Ministry than 1% of the total world’s population, she accounts of Health, Cross River State, Nigeria. Donabedian’s for about 19% of the global maternal deaths, with a structure, process and outcome model guided the maternal mortality ratio of 814 per 100,000 live births. In research protocol. Two semi-structured questionnaires Nigeria, approximately 2,300 under-five-year-olds and and a Focus Group Discussion (FGD) Guide were the 145 women of childbearing age die daily, these deaths instruments for data collection. 8 are mostly preventable. These increased mortality The study population comprises health care rates are linked to delays and poor quality of care in the professionals and clients aged 18 years and above, 9 health system of the country as observed by Oyekale. who work in and/or utilize PHC facilities in Southern 10 Babatunde et al, in their study in north central Nigeria, senatorial district of Cross River state, Nigeria. Sample suggested the need to train Primary Health Care size for the clients was 480 obtained using Cochran’s providers on improvement of quality of care. Utilization formula16 while that of health care professionals were of maternity care in 2013 was low and only about 36% 144 using simple percentage of the population of the of births occurred in health facilities with 38% being desired category of healthcare professionals in the 11 assisted by skilled personnel. This shows that Nigeria PHCs in the selected Local Government Areas,17as is still far from achieving the universal health coverage recommended by Ejifugha.18 and quality health care for all. Hence, the need to assess the factors influencing the quality of primary healthcare Four hundred and eighty clients and one hundred services which is the foundation of the health system in and forty four healthcare providers from the 12 Primary order to improve the quality of care and also, improve healthcare centres were selected by simple random the health status of the people which is an indicator of sampling method. Five field assistants were trained to development of any nation. assist the researcher in data collection. The questionnaires were administered to the health professionals and each Materials and Method client on exit, having received care, after obtaining his The study was carried out in the Southern Senatorial or her verbal informed consent. The respondents filled District of Cross River State, Nigeria from September, the questionnaire but where the client had limited ability 2018 to August, 2019. Southern Senatorial District is in reading and writing English language, the researcher made up of seven Local Government Areas (LGAs) and the trained field assistants explained the hard to read namely: Akamkpa, Akpabuyo, Bakassi, Biase, Calabar terms in consistent Pidgin English and he/she is assisted Municipality, Calabar South, and Odukpani.12 It has a to tick the appropriate response. 428 Indian Journal of Public Health Research & Development, April-June 2021, Vol. 12, No. 2 Focus Group Discussion (FGD) was conducted to Results explore the clients’ perception of the quality of care. Out of the four hundred and eighty clients,18(3.8%) One session of the FGD was done in one of the selected were males, 462 (96.3%) were females giving a M:F PHCs in each of the four selected Local Government ratio of 1:26, aged 18 to 57 years. Majority were married Areas. The four sessions of the FGD conducted 395(82.3%), while others were single 78(16.3%), widow/ comprised 8 participants per session with the researcher widower 5(1%) and separated 2(0.4%). Most completed as the facilitator, two trained field assistants as the note secondary education 273(56%) but 13(2.7%) had no taker and the observer. Participants were recruited using formal education, 125(26%) had tertiary education purposive sampling method. The focus group discussion and 69 had primary education. However,one hundred was guided by a set of protocol with questions that sought and forty-four healthcare providers were recruited for to explore the