CHAPTER ONE
INTRODUTION
1.1 BACKGROUND OF THE STUDY
The concept of Primary Health Care (PHC) was formulated during a meeting in Alma Ata on September 12, 1978, involving 134 countries. This initiative aimed to achieve "Health for All by the year 2000," which had been proposed by Dr. Halfdan Mahler, a former Director-General of the World Health Organization (WHO), as a means to enhance global health. The conference was organized by the World Health Organization (WHO) and the United Nations Children Fund (UNICEF) and was centered on the idea that PHC should offer comprehensive health services encompassing prevention, promotion, treatment, and rehabilitation, serving as the entry point into the healthcare system.
The Alma Ata Declaration underscored health as a fundamental human right and stressed that healthcare should be accessible, affordable, and socially relevant to meet the people's needs. The PHC strategy was identified as the means to achieve "Health for All by the year 2000," and it included several components, such as health education, nutrition and food supply, water and sanitation, immunization, maternal and child health (including family planning), control of endemic diseases, treatment of common ailments, and the provision of essential drugs. Countries had the flexibility to add additional components based on their experiences, and Nigeria incorporated mental health and oral health. The PHC strategy was founded on five principles: universal coverage, community participation, the use of appropriate technology, intersectoral collaboration for health, and a focus on prevention.
In Nigeria, PHC plays a crucial role in the country's social and economic development and serves as the first point of contact for individuals and communities within the national health system. This approach brings healthcare as close as possible to where people live and work and forms the initial element of an ongoing healthcare process.
According to the 1999 constitution of the Federal Republic of Nigeria, healthcare is included in the concurrent legislative list, meaning that all three tiers of government (federal, state, and local) share the responsibility of promoting health. The constitution outlines a three-tier system of healthcare: Primary health care for local government administration, secondary health care for state government administration, and tertiary health care for federal government management. This arrangement implies that local governments are primarily responsible for providing PHC with support from federal and state ministries of health and international agencies, all aligned with the national health policy.
However, the current state of PHC services provided by local governments, particularly in Eti-Osa L.G.A., leaves much to be desired. Challenges include the mode of service organization, drug availability, staff attitudes towards patients/clients, traditional beliefs and taboos, local terrain and topography, the shortage of healthcare staff and facilities, as well as socio-political obstacles. The division of roles and responsibilities between the three tiers of government, especially between states and local governments, is complex and not always clear, which undermines the accountability relationships between citizens, policy makers, and healthcare providers.
To address these challenges and improve PHC services, there is a need for synergy among stakeholders at the local government level, including health professionals, council administrators, philanthropists, and others. Additionally, clear lines of responsibility should be established among the three tiers of government, along with involvement from donor agencies interested in supporting PHC services. It is crucial to consider that the sophistication of PHC services depends on the socio-economic development of the local population. PHC aims to address common health issues within specific communities, such as Eti-Osa Local Government Area. Healthcare facilities at the PHC level encompass dispensaries, clinics, health centers, comprehensive health centers, and primary health care bases in some Local Government Areas.
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1.2 STATEMENT OF THE PROBLEM
2 The Local Government Authority is the responsible entity for Primary Health Care (P.H.C) and is tasked with providing and maintaining services within its jurisdiction. Legally, the 774 local government councils in Nigeria have taken on the full-scale responsibility of planning and setting objectives for P.H.C services. In Lagos State, the actual implementation of the P.H.C program began in 1987 during the presidency of Ibrahim Babangida, under the ministerial leadership of Prof. Olikoye Ransome-Kuti. During this period, essential strategies were put in place, and all the local government areas in each state actively participated, with the federal government, state government, and voluntary agencies supplying equipment, funds, manpower, and material resources needed for the effective implementation of P.H.C programs.
3 At present, the role of the state government as a provider of P.H.C services is limited. The state government's responsibility is primarily to interpret federal government policies on health. Since the shift of the P.H.C role to the local government councils, the level of funding for health services is often inadequate in some councils within the state. For example, in Eti-Osa Local Government Area, there is still a significant gap between what could be considered optimal P.H.C and the actual services provided to the people. While the local government council operates its P.H.C services in accordance with the principles and framework of the National Health Policy, various problems exist, including a lack of infrastructure, resource scarcity, uneven resource distribution, financial constraints, political instability, insufficient medical personnel, and socio-economic and environmental challenges.
4 Furthermore, community participation and involvement in P.H.C management are low in Eti-Osa L.G.A., as is the case in other local government areas in Nigeria, despite being a cornerstone of the P.H.C program. There are also issues with the liaison between the P.H.C development committees (village development communities) and the local government area P.H.C management, which is not as thorough as planned. Additionally, the irregular accessibility to many communities in Eti-Osa local government area, owing to natural topographical conditions like excessive flooding during rainy seasons, hilly and mountainous terrain, and unfamiliar traditional and cultural beliefs, has hindered the smooth implementation of P.H.C programs in some hard-to-reach communities. Moreover, there is a lack of timely training and retraining of health staff, low motivation, supervision, and evaluation of P.H.C programs, as well as a shortage of health data collection by field service delivery personnel. These factors serve as impediments to the implementation of P.H.C in the study area.
5 In light of the above challenges, the researcher is motivated to undertake a study on the role of the local government in primary health care services in Eti-Osa local government area, Lagos state.
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1.3 AIMS AND OBJECTIVES OF THE STUDY
The aim of this study is to assess the role of local government in primary health care services in Ibono Ibom local government area with a view to proffering strategies that will improve PHC programmes,
Specifically, the objectives are:
- To assess the level of awareness of people on the existence of primary health care services in Ibion Ibom local government area, Lagos state.
- To assess the role of local government in primacy health care services in Ibono Ibom local government area.
- To identify challenges/problems militating against smooth implementation of PHC services in the study area.
- To identity strategies that could be adopted to enhance the activities of Ibono Ibom local government in PHC implementation.
1.4 RESEARCH QUESTIONS
- Are the people aware of the existence of primary health care services in Eti-Osa local government area of Lagos state?
- What are the role of Eti-Osa local government council in primary health care services?
- What challenges militate against smooth implementation of PHC services in the study Area?
- Which strategies could be adopted to enhance the activities of Ibono Ibom local government council in PHC services?
1.5 RESEARCH HYPOTHESES
1. There is no association between the roles of local government in primary health care and the actual PHC services rendered to the people of Eti-Osa local government area.
2. There is no significant relationship between the level of awareness of people on PHC Services and the role of Eti-Osa local government council on PHC implementation.
3. There is no significant relationship between inherent PHC challenges and smooth implementation of PHC services in the study area.
4. There is no significant relationship between identified strategies and the role of Eti-Osa local government council in PHC implementation
1.6 SIGNIFICANCE OF THE STUDY
1. Findings of this study will help governments and Donor Agencies like WHO, UNICEF, Rotary club, USAID etc. in formulating appropriate policies and strategies that will enhance smooth implementation of PHC services.
2. Academically, finding of this work will serve as reference material to future researchers who may wish to venture into is this topic in a different setting
3. Finding of this study may also provide a reliable base line data to local government council administrator, health consultants and practitioner in designing programmers that will ensure that PHC services are brought closer to the rural populace.
4. Finding of this work will motivate governments Donor Agencies and philanthropists in providing financial and material and assistance to local government council health facilities located in hard to reach communities.
5. Findings of this study will equally ginger up the PHC health personnel to improve upon the current level of health education, monitoring and community involvement in PHC programmers.
1.7 OPERATION DEFINITION OF TERMS
1. Community: these are people living together, sharing common culture, tradition, interest, and residing within a specific geographical area or boundary.
2. Hard –To – Reach Communities: Rural areas or villages with natural impediments like hills, streams, flood, rivers, in which one can access them using bicycles, canoes or on foot by trekking.
3. Health Facility: Refers to all health institutions at the PHC level such as Dispensaries, Health post, clinics, Health centres and comprehensive health centre / PHC based in local government councils providing primary health care services and/or including secondary health care services excluding tertiary services.
4. Health Worker/Practitioner: Any health professional serving in primary health care facility like doctors, pharmacists, Nurses, midwives, community health extension workers (CHEW), environmental health officers, (EHOS), medical records officers (MROS) etc. excluding auxiliaries like Drivers, Typists, Electricians etc.
5. Local Government Council / Area: Refers to government at local level established by law to exercise specific powers within defined areas to complement the activities of the state and federal Governments.
6. Ngos: Non-governmental organizations such as WHO, UNICEF etc.
7. Primary Health Care Services: All health care services rendered by the local government owned health facilities like immunization services, Antennal care to pregnant women, contraceptive services, treatment, of locally endemic diseases eg malaria, typhoid fever, diarrhea, plus environmental services eg house inspection, abatement of nuisances etc.
8. Role: means duties, activities or performances of someone in a particular situation.
9. Unicef: United Nations children’s fund.
10. Usaid: United States Agency for International Development.
11. who: World Health Organization.
