CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Infrastructural facilities are referred to as the basic physical and organizational structure required for the smooth operation of a society or enterprise, or the services and facilities necessary for an economy to function effectively and efficiently (Oluwakayode, O, 2002). Adeyinka and Olugbamila (2015) defined infrastructure as those facilities and services that provide the backbone for the development of other sectors of the economy. It could be said that from the above explanation that infrastructure plays a crucial role in development of natural and human resources of a particular country both developed and developing countries. This is because it is seen as one of the basic physical and organizational structure needed for the operation of a society or enterprise, or the services and facilities necessary for an economy to function. Infrastructure is of various type which include health infrastructure that have been conceived by Adebayo and Oladeji (2006) to include health system, financial management, institution and legal frame work, operation and monitoring. It is an important term for judging a country or region's development because it contributes positively to economic development by creating healthy work force, which leads to increasing productivity. These testify to reasons why it is globally adjudges to be one of the indexes for measuring health of the people worldwide.
Erinosho (2006) asserted that health infrastructure is in both qualitative and quantitative terms to mean the quality of care and accessibility to healthcare delivery within a country. It is judged by the quality of physical, technological and human resources available at a given period of time. Physical structure involves the buildings and other fixed structures like as pipe borne water, good road networks, electricity and so on within the healthcare environment, whilst the technology is about the equipment meant specifically for hospital use including surgeries. Health infrastructure is a part of a larger concept of the health system which contains the health policy, budgetary allocation, implementation and monitoring Adebayo and Oladeji (2006). When are put together, it then forms the foundation upon which the healthcare delivery is based in any society and the determinants of its infrastructure.
The importance of effective and accessible healthcare system in any country cannot be over- emphasized Sanni (2010). Researches around the world have linked inadequate access to healthcare facilities with increasing avoidable and preventable deaths (Law and Morris, 1998; WHO, 1998 and WHO, 2005). However, accessibility to healthcare services cannot be undermined to fully harness the potentials and opportunities derivable. These include both equitable spatial distribution and availability within affordable means to the people. Spatial distribution of healthcare facilities emphasizes the ease with which these facilities can be reached and utilized satisfactorily. The World Summit for Social Development also asserted that ensuring universal and equitable access to basic social services such as education and health services is pivotal to human development (United Nation, 1995).
Accessibility to social services had been argued to be multidimensional beyond the spatial pattern and location to the patrons Shanon and Deven (1974) because it also comprises financial affordability, time availability, service delivery system, and quality of service among others. How health care facilities are patronised is dependent on how affordable it is to the general public. The ability to afford the cost to enjoy medical services is not unconnected with households’ disposable income and accessibility of healthcare facilities to the patrons Sanni (2010).
The understanding of the importance of healthcare facility to sustainable development has made various levels of government in Nigeria to always budget huge amount of money for the health sector. Every time, in planning for healthcare services at various levels of government in Nigeria, sectorial approaches are adopted, without giving much thought to the spatial dimension of the facilities provided. Since the goal of development effort by the government is to improve the well-being of the citizens it governs, making adequate planning for healthcare delivery is a good welcome development.
In the light of the afore-mentioned, healthcare is of importance to both human and economic development, this is because it had been established that healthy people leads to healthy labour force which in turn lead to economic growth and eventually economic development. It is on this note that this work intends to examine the patronage of rural dwellers towards primary health care delivery system in Itu LGA Akwa Ibom State with a view to providing information that would aid effective planning policies in the location and distribution of healthcare facilities.
1.2 Statement of the Problem
The goal of health care to the people in the communities is to ensure that the management of Public Health Centre services more efficient and effective and closer to the grassroots. However, in view of the level of health awareness, one tends to inquire the extent to which health care has been brought to the doorstep of the rural dwellers. One of the challenges to the development of health especially in Nigeria has to do with inadequate number of medical personnel as well as their unequal distribution. Distribution of medical facilities and manpower/personnel was the focus of The Third Development Plan (1975 to 1980). There are still clear evidences in the disparities of uneven distribution of resources. The deterioration in government facilities, low salaries and poor working conditions had resulted in a mass exodus of health professionals (Iyun, 1988). Medical personnel are now way too concentrated in the urban areas and thereby neglecting the rural areas. Transportation is considered as another challenge in the management of Public Health Centres. It has been reported in the rural areas that Public Health Centres that there are not enough vehicles for workers to transport themselves to perform their task especially to the rural areas. Immunization outreach services are inadequately conducted. The maintenance of the available vehicles is very poor while vehicles meant for Public Health Centres were being used for other purposes not related to health activities. To put succinctly, many of the PHC vehicles donated by UNICEF in the 1980s are totally non-functional (Wunsch and 1996).
Access to many parts of the communities is a function of natural topographical and weather conditions. Inadequate finance; over dependence of the rural areas on federal, state and international agencies for support - the internally generated revenue of the LGA in these areas is meager (Adeyemo, 2005); low level of community involvement (Omoleke, 2005), general misuse and abuse of the scarce resources by some political and administrative leadership and high leadership turnover at LGAs (Adeyemo, 2005). These are some of the challenges facing rural dwellers in patronizing primary health care delivery system not only in Itu LGA of Akwa Ibom State but throughout the nation. It is on basis that this study seeks to examine the patronage of rural dwellers towards primary health care delivery system in Itu LGA Akwa Ibom State, Nigeria.
1.3 Objectives of the Study
The objective of this study is to examine the patronage of rural dwellers towards primary health care delivery system in Itu LGA Akwa Ibom State, Nigeria. However, the specific objectives are:
i) To understand the factors responsible for non-patronage of rural dwellers towards primary health care delivery system
ii) To determine the strategies for enhancing the use of health care delivery system by rural communities
iii) To study the health needs and problems of rural dwellers
1.4 Research Questions
The following questions were generated during the course of this study:
i) What are the factors responsible for non-patronage of rural dwellers towards primary health care delivery system?
ii) What are the strategies for enhancing the use of health care delivery system by rural communities?
iii) What are the health needs and problems of rural dwellers?
1.5 Significance of the Study
The population situation in Nigeria shows that the level of mortality, especially infant and child mortality is still high. To this effect, this study has both theoretical and practical relevance. Theoretically, this study stands to provide additional knowledge to the body of existing literature on child health in Nigeria and other developing countries with particular reference to rural areas. The result of this study will serve as good base or guide for future reference and it will also encourage further research on the health of the children in the rural areas since currently, it demands for proper attention. Furthermore, this study will provide relevant information on the factors that affects childhood mortality and poor utilization of primary Health care services especially in developing countries. The study will provide empirical data to test the relevance of some of the existing theories on child health in rural Nigeria.
Practically, the findings of this study will reveal the factors that militate against proper utilization of primary health care services and its effects on rural dwellers. The result from this research will also help planners design relevant, persuasive health messages that will help change the people’s attitude on the utilization of primary health care services and create more awareness on the situation of primary health care services in the country. More important, the process of interviewing and supply of responses to the questions will afford the people in the study communities the opportunity to review their child health practices for the better.
1.6 Scope of the Study
This study focuses mainly on patronage of rural dwellers towards primary health care delivery system. An extensive writing will be made on the topic patronage and the reasons for this action by rural dwellers. It will however be carried out in some selected rural communities in Itu LGA Akwa Ibom State.
1.7 Definition of Concepts
Access to Health Care Services: Access to health care services is defined as one’s ability to obtain and appropriately use good quality health technologies and commodities when needed for good health (Frost & Reich, 2008).
Patronage of Primary Health Care Services: Nteta, Mokgatte and Oguntibeju (2010) conceptualized this as the practice of visiting and receiving primary health care services from primary health care centres in the communities. In this study it will refer to the manner in which the study subjects use primary health care services in their communities for the prevention of health problems in their children under five years old.
Primary Health Care: According to WHO (1978), Primary health care is defined as essential health care based on practical, scientifically sound, and socially acceptable methods and technology made accessible to individual and families in the community through their full participation and at a cost that the community and country can afford to maintain in the spirit of self-reliance and self-determination.
Primary Health Care Services: This refers to the provision of primary health care, including preventive health services and education (Texas Department of Health Services, 2007). In this study, it will include provision of the first course of health management, especially education and preventive services. It entails basic curative, preventive and promotional health services. In this study focus will be on the provision of basic curative, preventive and promotional health services in government established health care centres.
Rural Communities: According to Mendelson and Bollman (1998), rural communities are populations living outside the commuting zones of larger urban centres. Plessis, Beshiri, Ballman and Clemenson (2002) defined it as population living in towns and villages outside the commuting zone of larger urban centres with population of 10,000 or more. They however suggested that the appropriate definition should be determined by the question being addressed. Thus in this study, rural communities will refer to areas that are outside the urban areas or cities. They have health facilities that provide primary health care while people with serious health problems are usually referred to secondary and tertiary health facilities in large urban centres.
