This project work on the importance of community health administration and rural development was carried out to find out the importance community health administration in rural development and what are the adverse health implications when the community involvement is very minimal. It also try to find out what factors are responsible for its ineffectiveness during its implementation. While it also took a look at the method best suited for the checkmating and control of all factors and conditions that adversely affects the administration. However, this project is divided into five(5) chapters, the chapter one gives a general overview of the topic, which includes background overview of the topic, which includes background of study historical background of study area, statement of problem, purpose and objectives of the study, significance of study, delimitation and scope of study, research questions and definition of terminology used. Chapter two focuses on literature rereview. The researcher reviewed the work of experts and renounce authors that are related to the research work. Chapter three deals with the research methodology which includes research design, sampling techniques, sample size, determination, and instruments for data collection. In the chapter four, the data were vividly presented and carefully analyzed, using the simple percentage table. While in chapter five the findings were discussed in relation to the literature review and analysis from chapter four. It also talks about the summary, conclusion and recommendations.
The basic human needs of psychological needs, love needs, Esteem needs and self-actualization hinge on the availability of good health care delivery services. Although quality health is seen as one of the active ingredients for the development of any nation. Woyd, (2009)
Ebuehi et al (2008), states that quality health is one of the active ingredients for the development of any nation. That a nation suffers economically, educationally, physically and socially if a greater percentage of its population, especially the work force is ill or mained. For example, persons suffering from AIDS, Tuberculosis, and terminal stage of cancers, may not be as productive as if is expected of them. Consequently, they may become liabilities to the rest members of the community. Wadinga A, (2007).
According to Amadi, (2004) he stated that the vulnerable ones in any society or community, includes the infants, childbearing/ pregnant women and the aged who are very susceptible to infections. He further attributes this to the inability of the three tiers of government to provide basic health care infrastructures and services, and also the scarcity of health care providers in the country especially in the rural areas.
Felicia Monye, states that shortage of health workers is a major problem in Nigeria, especially in the rural areas where more than 70% of the entire population lives. Also, she states that of the primary care level, trained community health officers provides services normally reserved for doctors or medical specialists. That in order to improve such services, especially in the rural areas, the community health officers must therefore be supported and motivated in order to provide effective and efficient health care services.
Thus, this study is carried out on how community health administration can be improved for efficient and effective health care delivery services in the rural communities. Also to find out what factors either motivates or demotivates the health workers in accepting/rejecting rural posting. Through this study, we will know the role the local government NGO’s, the community and the health care providers in enhancing the community health administration in the rural areas.
1.1 BACKGROUND OF THE STUDY
Access to health care in Nigeria today is generally limited. The problem of poor funding has resulted in low quality of health services and facility. It is pertinent to note that health services and facilities of all levels, is either dilapidated, poorly equipped, or dysfunctional. The poor management of the available health personnels translate to inefficient and ineffective health care delivery services in the rural areas, Osuorji, (2009).
There is considerable interest by local governments in the country in exploring the potential of social health insurance in order to increase accessibility and affordability of health care delivery service, Ojo, (2008). Also Airede (2006) identified with the above statement and also went further to suggest that if the local governments are ready to support and motivates health care providers, the morbidity and mortality rate of most rural communities will greatly reduced. Thus, the reverse is the case, because most local government administrators do not take the health sector seriously. they handle it as they handle all political issues.
It is pertinent to note that every community accepts some forms of treatment as appropriate and others as unacceptable. Though all forms of treatment is seen to have multiple effects and this varies from person to person, and are greatly influenced by age, level of susceptibility, finance, culture and ignorance, which is attributed mostly to the rural dwellers, sturgeon and Meer, (2006).
In Sagbam local government area which happens to comprise of rural communities, there has been an unprecedented rise in mortality and morbidity rate of infants due to either maladministration in the health sector or inadequate well trained health personnels. According to Dr. Kpokiri (2008), we states that three (s) of one thousand (3/1000) death occurs yearly while two hundred (100) in one thousand (1000) infants falls sick monthly. Still births is recorded as three (3) in three hundred (300) births.
Also, the health facilities are very few and it cannot carter for the ever increasing rural populace. Though at times it is due to the low patronage, poverty and ignorance of the rural dwellers.
In Sagbanna local government, there has been an increase in the participation by community members in the administration of health care delivery services. It has been highly accepted by most groups in individual communities that made up the local government. This is due to the prevalence of infections agents that abound in the communities which is responsible for ever increasing morbidity rate of infants and women of childbearing age, Wilfred, (2009).
According to Kpokiri (2009), he states that for any community health administration to function in any rural setting, two things are basically involved. Firstly, the need of local government administration to adequately fund thee health sector, by providing adequate health facilities, helth care equipment and qualified and well trained health personnels to handle all health care delivery services in the communities. Secondly, the community members needs to be well mobilized, involved, sensitized and allowed to effectively participate in all health related causes, should be ensured.
Based on the aforementioned, there is need for everyone in the community to become aware of the importance of community health administration in the development of the rural dwellers. Thus, this project work will attempt to discuss and determine the success, failures and factors that are responsible for the successful implementation of community health administration in our rural communities.
- HISTORICAL BACKGROUND OF STUDY AREA
The surviving historical account of the settlement of the people of Sagbama local government area, has it that Sagbama probology settled in its present location on the 16th century, having broken off from their kins from the Benin kingdom.
According to Mr. Emmanuel Ogosi, the descendant of OPOROZAOWE, was from the Benin kingdom. He left the kingdom of the time when it was under severe political pressure from within and outside the period of the historical rupture which some how corresponded with the reign of king Ovour, amwem Nogbaisi, who suffered Torment and physical defeat from the British government. Oporozawei settle somewhere in the deep Nigeria Delta with his sons namely Kabowel, kumbowei and gbanwei. At the death of their father, kabowei exhibited his hostile behaviour towards his brothers.
Based on this gbaranwei left for another area and found Gbaran kingdom now in the present day yenagoa local government area of Bayelsa state named gbaran Ekpeteiama. Kabowei left too, to find another settlement andd established his kingdom known as kabowei Kingdom with its headquaters in patani, presently in delta state.
Meanwhile Kumbowei with his hine sons left and lived in a palce known as udophori, one of his sons, named Sagbamaowei left his dad and brothers and found Sagbama community which later spread to different other settlements that made up the present day Sagbama local government area in the present Bayelsa state
It is pertinent to note that in Nigeria, inequality and poor accessibility to health care has been a persistent problem. This is so, because majority of the population lives in the rural areas. The sustainability and viability of country’s economy and social growth depends largely on a well vibrant health care sector. While health care needs is increasing, government expenditure on health services are declining. This expenditure has been described as being inadequate, insufficient, inequitable and unsustainable. Thus, the burden of paying for health care services, especially by the ever increasing rural populace, has been very difficult due to the fact that majority of the country’s citizens could not afford a good and quality health care service, Olubenga, (2010)
1.2 The Community Health Strategy
The community health strategy is a plan that acknowledges that communities form the foundation in the provision of affordable, equitable and effective healthcare, (MOH, 2007b). Initiating the Community Strategy is envisioned as a logical, step-by-step process. The community based approach, is the mechanism through which households and
communities take an active role in health and health-related development issues. It aims to develop linkages into existing household/ community-based care systems in order to learn as well as influence them to ensure the adequacy and effectiveness of health actions. This can best be done through partnership, which requires recognition of community systems and a careful process of engagement to build a relationship with the community-based service providers.
Initiatives outlined in the approach target the major priority health and related problems affecting all cohorts of life at the community and household levels. Level 1 of the Nigeria Essential Package for Health (KEPH) defined service delivery, (MOH, 2007b).
The goal of the community strategy is to enhance community access to healthcare in order to improve productivity and reduce poverty, hunger, child and maternal deaths, as well as improve socio-economic performance across all the stages of the life cycle.
One of the key innovations of KEPH is the recognition and introduction of level 1 service which is aimed at empowering Nigerian households and communities to take charge of improving their own health.
The strategic plan recognizes that the health facilities at levels 2 and 3 will improve the effectiveness of their service delivery if they work closely with their catchment communities through various committees in the community strategy framework that link to service delivery at the household level, (MOH, 2007a). This will provide opportunity to generate informed dialogue between the health system and the community, to create demand for quality services on the part of the community, and to enhance their responsibility for action for health at level 1. For this to happen, the committee structures must be inclusive in terms of administrative areas as well as interest groups, (MOH, 2007b).
This study focused on the community health strategy and looked at how the strategy can be best implemented and sustained through motivation, training and support supervision of community health workers. Two statistical models, binomial logit and probit were used in the analysis.
1.3 Statement of the problem
Health is attainable, accessible and sustainable by people for themselves and their communities if they are given the opportunities. Unless people are empowered to take charge of their own lives and health no sustainable achievement in improving health is possible. Effective community program of awareness, education and development of human and economic resource with the emphasis on valuing local cultural practices as sources of preventive and curative health is crucial. However, a large proportion of Nigerians continue to die from preventable diseases and other health conditions. This is despite Nigeria’s well focused national health policies and a reform agenda whose overriding strategies aim to improve healthcare delivery services through efficient and effective health management systems.
The policies and reforms have not yet yielded a breakthrough in improving the situation of households entrapped in the vicious cycle of poverty and ill health. Poverty compounds powerlessness and increases ill health as ill-health increases poverty. Both have become progressively worse since the 1990s, with appalling disparity within and between provinces. The situation is further exacerbated by the widespread prevalence of HIV/AIDS, and the resurgence of communicable diseases such as TB and malaria (MOH, 2006a).
Community systems are faced with the challenge of coping with the growing demand for care, in the face of deepening poverty, and dwindling resources. Nigeria’s troubling health indicators include: Rising infant mortality rate from 72 per 1,000 live births in 1998, to 77 in 2003, 78 in 2005 and 81 per 1,000 live births in 2008 (KDHS, 2008); Rising under-five mortality rate from 90.9 per 1,000 live births in 1989 to 115 per 1,000 live births in 2003
(KDHS, 2008); High maternal mortality rate of 414 in 2002 per 100,000 live births (MOH, 2005), although this marked a significant improvement from the 590 per 100,000 recorded in 1998).
In addition, the 2008-2009 Nigeria Demographic and Health Survey revealed that: 35% of the children below the age of 5 years were stunted; only 13.2% of children were still exclusively breastfeeding at 6 months while 56.8% were still breastfeeding by end of three months. 61.5% of under-fives had child health cards; only 59.2% of children in the second year of life were fully immunized; only 4.3% of under-fives and 4.5% of pregnant mothers slept under ITNs; only 40.8% of deliveries were assisted by a health professional and only 39.4% occurred in health facilities. Both the Health Sector Reform (HSR) and the Primary Health Care (PHC) divisions have been advocating for better health for the people through people’s own active initiative and involvement. HSR expanded community-based healthcare (CBHC) principles through decentralization of planning and service delivery (Simba et al, 2007). The intention was to formalize people’s power to determine their own health priorities and link them to the formal health system in order to reflect their decisions and actions in health plans (Muga et al, 2006).
1.4.1. Overall objectives
1) To determine the role of Community Health administration on the development of Sagbama L.G.A. using two statistical models.
1.4.2 Specific Objective
- To determine the effect of support supervision on CHA’s contribution to development.
- To determine the effect of training on CHA’s contribution to development.
- To determine the effect of incentives on CHA’s contribution to development.
1.4.5 To determine accuracy and precision of logit and probit model on assessing CHA contribution to development.
1.5 Research questions
1) What is the role of Community Health administration on the development of Sagbama L.G.A.?
- What is the effect of support supervision on CHA’s contribution to development?
- What is the effect of training on CHA’s contribution to development?
- What is the effect of incentives on CHA’s contribution to development?
1.6 significance of study
The challenge and potential difficulties that exist in developing community participation in health programs are important and are major indicators that are pointing to Nigeria missing out on the health related millennium development goals. Among the concerns is that the current approaches to health service provision need major rethinking. This is shown when about half of children under five years, do not go to hospitals for major illnesses like malaria, diarrhea and pneumonia and they end up dying.
A large proportion of this could be prevented through early recognition for care, seeking appropriate and low cost treatment of sick children at home or in the community with antibiotic, anti-malaria or oral rehydration. Medics contend that such children are getting services at home, which means, it is crucial to start empowering the community to render certain basic health services. Presently the health sector faces a multifaceted crisis including a unsatisfied workforce. In such a context, the community strategy, now widely referred to as “task-shifting,” where some tasks are delegated to the lower levels can make a big difference in the access to basic health services. The people have learnt through experience that they should not rely only on the conventional service providers.
There is therefore an overwhelming need to negotiate with people and households as partners in healthcare, giving them a chance to influence the way care is delivered and thus restore their confidence in the health system. Meeting this need means focusing attention on enhancing the capacity of households to play their role in action for health effectively. Through continued respectful dialogue, the strategy should be able to enlarge their choices, thereby reversing the trends in health indicators. Turning the competing systems into collaborating partners will add value to all and benefit the households more. Therefore, the need to evaluate the community healthcare program is widely acknowledged and crucial to know whether the program is promising for desired effects or not.
1.7 Scope of study
The research work focuses on community health workers and community health facilities in Bayelsa state, the role they play in the development of Sagbama local government area.
1.8 Organization of study
Chapter one introduces the research work, the background of the study, research questions and objectives and the scope the study covers. Chapter two highlights the literatures reviewed, and also the theoretical framework and empirical review. Chapter three explains the methodology used in analyzing the research work, the sample size and technique. Chapter four shows the data presentation, and analysis of data and results. Chapter five makes recommendations and conclusions.
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