CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
The primary health care (PHC) system is considered to be the first level point contact between the individual and the health system and the bedrock of national health system. Nigeria embraced PHC as the foundation of her national healthcare system and a top priority for national growth in 1986 and years after, the PHC does not have the capability to accomplish its goals. Primary health care (PHC) accelerates timely intervention during and after pregnancy and child birth, a degree for qualitative health care which is conveniently available and cost effective to the rural masses. Maternal and child health condition have become essential signs for socio-economic development along with health of the people of a nation (Azuh et al 2017). National Health systems in several sub-Saharan African (SSA) nations including Nigeria are weak facing various challenges. Good antenatal care can prevent major cause of neonatal and maternal death particularly amongst rural communities that are hard to reach via the PHC system. PHC is important health care based on practical, scientifically sound and socially acceptable techniques and technology made globally accessible to people and families in the community with their participation and at a cost that the community and nation can afford to maintain at every phase of their development in the spirit of self-reliance and self-determination.
The provision of health care at the PHC level is mostly the obligation of local government with the assistance of states' ministries of health and within the overall provision of the national health plan. The main health care centres are primarily located within communities at the local government level. In each of the 774 local government areas in Nigeria, there is a primary health care centre that offers services at the grassroots. This inarguably can have a huge effect on the health of the community and Nigerians at large.
Primary health care as traceable to the Alma-Ata declaration in 1978 is a lower-level health care campaign directed at global and equitable health care for all. It is a strategy indicated for addressing the major health problems in the community by providing promotive, precautionary, restorative and rehabilitative services, the goal which is to bring health care as close as possible to people as a basis for making sure that their continuing health care process. Simply put, it is targeted at providing families, individuals and communities with all the required health services, besides those which can only be provided in the hospital (Federal Ministry of Health Nigeria, 2004). The primary health care as included in the Alma-Ata declaration has five concepts that have been developed to work together and be executed at the same time to bring about a much better result for the entire population. Pemberton and Cameron (2010) described these concepts to include; accessibility; community participation; health promotion; ideal technology; and inter-sectoral collaboration.
Although PHC is globally accepted as a requirement for transformation in community health, the state of primary health care facilities and utilisation in some developing nations, particularly in Nigeria contradicts international standards and best practices on PHC. Therefore, the delivery of top-quality primary health care services (PHC) can have a big effect on the health of Nigerians, those in (the study area) inclusive. Many of the most affordable health interventions to prevent and treat the major causes of mortality and morbidity can be offered at this level of care, as the poor are most likely to seek care in PHC facilities than the rich. Therefore, this study will assess the utilization of primary health care services in Ilesha, Osun state, Nigeria.
1.2 Statement of the Problem
Quality health is a basic right of citizens around the world, and Nigeria is not an exemption. The objective of primary health care was to provide accessible health for all by the year 2000, and beyond. Undoubtedly, this is yet to be accomplished in Nigeria till today. However, primary health care centres were developed in both urban and rural areas in Nigeria with the objective of guaranteeing equal rights and easy accessibility. Many people living in developing nations of the world, particularly in Africa, have a poor understanding of their national health systems and programmes and for that reason the tendency for putting the health facilities into non-proper usage, since the creation of PHC in 1992, in Nigeria, a number of studies have reported the rate of its usage as low thus adding to poor health condition of the people (Jaro and Ibrahim, 2012; Galadanchi, 2007; Cueto, 2004). Given that one of the significant goals of PHC in developing nations is to enhance the health condition of individuals and the community with health promotion and increased usage of precautionary, curative and rehabilitative health services, an understanding of factors precipitating utilization of health care facilities, particularly at the primary level therefore became necessary.
1.3 Objectives of the Study
The broad objective of this study is to assess the utilization of primary health care services in Ilesha, Osun state, Nigeria. However, the specific objectives are:
- To determine the level of awareness of people in (the study area) on the existence of PHC services.
- To enquire the perception of the people residing in (the study area) about the services they are receiving from the PHCs.
- To understand the level of infrastructure of the PHCs in (the study area).
1.4 Research Questions
The study will attempt to answer the following research questions:
a) What is the level of awareness of people in (the study area) on the existence of PHC services?
b) What is the perception of the people residing in (the study area) about the services they are receiving from the PHCs?
c) What is the level of infrastructure of the PHCs in (the study area)?
1.5 Significance of the Study
The study will identify the availability and access of primary health facilities in (the study area). The findings from this study will reveal the factors inhibiting the use of primary health facilities and services by the populace which is related to causative factors ranging from physical accessibility problems, low-income levels, low technological issues, high illiteracy amongst others. This study will provide valuable information to the local health care authorities on the state of the delivery of primary health care. This will aid in the formation of health policies peculiar to the area.
1.6 Scope and Limitation of the Study
This study explores the various factors influencing the utilization of primary health care and the kind of health facilities available to the community. Also, as part of the study, the identification of health seeking behaviours of the populace in the community will be examined. The study is limited to the factors affecting the provision of primary health care in rural communities specifically in Ilesha, Osun stat, Nigeria.
1.7 Definition of Terms
Primary healthcare: Primary health care is a whole-of-society approach to health and well- being centred on the needs and preferences of individuals, families and communities. It addresses the broader determinants of health and focuses on the comprehensive and interrelated aspects of physical, mental and social health and wellbeing (WHO, 2013). Additionally, primary health care involves the services and products which aim to address acute and episodic health conditions which also includes health promotion efforts. Primary healthcare is the first level of care.
Utilization: Health Care Utilization is the quantification or description of the use of services by persons for the purpose of preventing and curing health problems, promoting maintenance of health and well-being, or obtaining information about one’s health status and prognosis.
