ABSTRACT
This study assessed rural households’ utilization of primary health care facilities in Ohafia agricultural zone of Abia State, Nigeria. The specific objectives were to describe selected socio-economic characteristics of respondents; assess rural households perception about primary health care facilities; determine extent of rural households participation in primary health care facilities, among others. A multistage sampling procedure was employed in the selection of 180 respondents as sample size. Primary data were collected with the use of structured interview schedule and analyzed with both descriptive and inferential statistical tools. The result of the study revealed that majority of the respondents (93.89%) were males, middle aged with mean age of 30.74 years. Majority (89.44%) were married and on the average had household size of 4 persons. It was also observed that the respondents had 5.25 years as mean years of schooling with mean distance of 3.31 kilometres to the nearest PHC facility. The result also showed that respondents had positive perception about primary health care facilities (Grand mean = 2.93), their participation was low (Grand mean = 1.94), recorded high utilization (Grand mean = 2.09) of primary health care services. The results show weak financial position of rural households ( = 3.16), lack of awareness and enlightenment ( 3.09),inflexibility of PHC programmes to adapt to community circumstance ( =3.08), among others were perceived constraints militating against rural households participation in PHC facilities implementation activities in the study area. It was also observed that poor households income ( =3.11), high cost of services ( =3.09), absence of qualified doctors and nurses ( 3.09), among others were perceived constraints militating against their utilization of PHC services. The H01 was rejected (F-value = 663.831*** at P<0.05) with R2 = 0.958 which implies that 95.8% of the total variation in the dependent variables was accounted for by the explanatory variables. Meaning that socio-economic characteristics of respondents have significant relationship with utilization of PHC services in the study area. The test of no significant relationship between participation and utilization (Ho2) was rejected as the F-value was 404.257*** at P<0.05 which shows the overall significance of the regression line and coefficient of determination (R2) value of 0.921 which implies that 92.1% of the total variation in the dependent variable was accounted for by the explanatory variables. It was concluded that participation of respondent at the stages of establishment of PHC facilities enhances utilization of PHC services. It is recommended that intended benefiting rural communities should be included in the initiation stage of primary health facility as to promote participation and utilization of PHC facility.
TABLE OF CONTENTS
Title
Page i
Declaration
ii
Certification
iii
Dedication
iv
Acknowledgement
v
Table
of Contents vi
List
of Tables ix
List
of Figures x
Abstract
xi
CHAPTER 1: INTRODUCTION
1.1 Background of the Study 1
1.2 Problem Statement 3
1.3 Research Questions 4
1.4 Objectives of the Study 4
1.5 Hypotheses of the Study 5
1.6 Significance of the Study 5
1.7 Scope of the Study 6
1.8 Definition of Terms 6
1.9 Limitations of the Study 7
CHAPTER 2: LITERATURE
REVIEW
2.1 Conceptual Review 8
2.1.1 Community Participation 8
2.1.1.1 Passive participation 8
2.1.1.2 Information giving participation 9
2.1.1.3Participation
by consultation 9
2.1.1.4Participation
for incentive 9
2.1.1.5 Functional participation 9
2.1.1.6 Interactive participation 9
2.1.1.7
Spontaneous mobilization 9
2.1.2 Utilization of primary health care services 10
2.1.3
Factors influencing participation and utilization of primary health care
services 11
2.1.4 Constraints
to participation and utilization of primary health care services 12
2.2 Theoretical Framework 13
2.2.1 Buchanan and Tullock’s theory of participation 13
2.2.2 The theory of margin 14
2.2.3 Structural functionalism theory 15
2.3 Review of Empirical Studies 16
2.4 Conceptual Framework 17
CHAPTER 3: RESEARCH METHODOLOGY
3.1 Study Area 19
3.2 Population of Study 20
3.3 Sample and Sampling Procedure 20
3.4 Data Collection 20
3.5 Validity of Instrument 21
3.6 Reliability of Instrument 21
3.7 Data Analysis 21
3.8 Measurement of variables 21
3.8.1
Socio-economic characteristics of
respondents 21
3.8.2 Rural households perceptions about primary
health care facilities 22
3.8.3 Extent of rural households participation in
PHC facilitates 22
3.8.4 Extent of utilization of primary health care
services by rural households 22
3.8.5 Constraints associated with participation in
primary health care facilities. 23
3.8.6 Constraint associated with rural household
utilization of primary health Care Services;
23
3.9 Test of Hypotheses 23
3.10 Model
Specification 24
CHAPTER 4: RESULTS AND DISCUSSION
4.1 Socio-Economic Characteristics of Rural
Households 27
4.1.1 Age 27
4.1.2 Sex 27
4.1.3 Marital status 27
4.1.4 Household size 28
4.1.5 Years of schooling 28
4.1.6 Distance to PHC facility 28
4.1.7 Estimated annual income 29
4.2 Rural Households Perception about Primary
Health Care Facilities 32
4.3 Extent of Rural Households Participation
in PHC Facilities 34
4.4 Extent of Utilization of Primary Health Care Services by Rural
Household 36
4.5 Constraints Associated with Rural
Households Participation in PHC
Facilities 38
4.6 Constraints Associated with Rural
Households Utilization of PHC Services 40
4.7 Test of hypotheses 42
4.7.1 Regression estimate of the relationship
between socio-economic
characteristics of respondents and the utilization
of PHC services 42
4.7.2 Regression estimate of the relationship
between rural household’s
participation and utilization of PHC facilities 45
CHAPTER 5: SUMMARY,
CONCLUSION AND RECOMMENDATIONS
5.1 Summary 48
5.2 Conclusion 49
5.3 Recommendations 49
References
Appendices
LIST OF TABLES
4.1:
Selected socio-economic characteristics of rural households 30
4.2:
Mean rating of rural households perceptions about primary care facilities 33
4.3:
Mean rating of rural households participation in PHC facilities 35
4.4:
Mean rating of rural households utilization of primary health care
services 37
4.5:
Mean rating of rural households perceived constraints associated
with participation in PHC
facilities 39
4.6:
Mean rating of rural households perceived constraints associated with
utilization of PHC services 41
4.7: Ordinary least square regression
(OLS) the relationship
between selected socio-economic
characteristics of PHC services 44
4.8: Ordinary least square regression
table of the test of relationship
between participation and utilization
of PHCs by respondents. 47
LIST OF FIGURE
1:
Conceptual framework 18
CHAPTER 1
INTRODUCTION
1.1 BACKGROUND
OF THE STUDY
The
importance of health to national development and poverty reduction has been
appreciating over the centuries, in that improving health status and increasing
life expectancy contribute to long term economic development. The legitimacy of
any national health system depends on how best it serves the interest of the
poorest and most vulnerable people, for which improvements in the health status
contributes significantly to the attainment of the desired rural development
goals through poverty reduction (Abiodun, 2010; Abdulraheem, et al., 2012; Omuta, et al., 2014).
Consequently,
the key purpose of any health care system is to provide universal access to
appropriate, efficient, effective and quality health services, in order to
improve on; and promote people’s health. Many developing countries, especially
those in Sub-Saharan Africa, in the 1970s experienced remarkable and
unacceptable inequalities in the provision and distribution of health services.
This explained the exploration of different approaches to improve health care
delivery by international health organizations in the 1970s (Omuta, et al., 2014).
Rural
community-based primary health care facilities are primary health care
facilities that are situated in the rural communities they serve with main
concern for the health care needs of the rural people who live nearby (Oladipo,
2014). This proximity is important; it makes it easier for people to come for
personal health care or to attend group discussions or community meetings. For
older or disabled people and mothers with their babies and toddlers, it is
especially important that the services should be within easy walking distance
or within easy reach by public transport.
Primary
Health Care (PHC) is driven by a political philosophy that emphasizes a radical
change in both the design and content of conventional health care services. It
also advocates an approach to health care principles that allow people to
receive health care that enables them to live socially and economically
productive lives. The Alma-Ata Declaration of 1978 defined the concept of PHC as
essential care based on practical, scientifically sound and socially acceptable
health care methods and technologies, made universally 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 at every stage of their
development in the spirit of self-reliance and self-determination (World Health
Organization, 2008; World Bank, 2010, Sanda, 2014).
Rural
household is the main actor in the rural space, owner of the main (natural,
human, economic, cultural) resource, which it uses at his own discretion and
whose behavior is very important for the society where it belongs (Lorena and
Dona, 2017). Their participation in
rural community-based primary health care facilities includes people’s
involvement in the decision making process, attending meetings, contributing to
primary health facility projects in their communities as well as their
implementation (Wellington, 2010; Ofuoku, 2011; Adefila, 2012; Ogunleye and
Oladeinde, 2013).
Primary
health care utilization refers to the use of health care services. People use
health care for many reasons including preventive and curing health problems,
promoting maintenance of health and well-being, or obtaining information about
health status and prognosis (Omotoso, 2010; Ayodeji and Michael, 2015).
1.2 PROBLEM
STATEMENT
Health
care participation and utilization are major interest to rural development
because they are vital elements of wellbeing and components of human capital
(Aghion, et al., 2010). In rural
areas, where physical jobs tend to be more abundant, health care access and
utilization stand to be more important than education in determining labour
productivity (Titus, et al., 2015).
Policy makers and regional analysts are concerned about the decline in
participation in rural development activities (primary health care facilities
inclusive) by the rural people who are being protected by the practice of
participatory development (Ibama and Chikaobum, 2017). Rural households
participation in most rural development projects initiated by government appear
to be afterthought. Most often community members are consulted after decisions
are made by government agencies with regards to the kind of rural development
projects that need to be implemented (Ibama and Chikagbum, 2017). As a
consequence, rural development projects which are intended to improve the
quality of life of the majority of rural communities in Nigeria do not meet
this objective due to lack of participation by intended beneficiaries.
The
essence of primary health care is the provision of essential health services to
the host communities. However, there has been a growing lack of confidence by
the populace as evidence by poor utilization of the services of primary health
care facilities (Esimai, et al.,
2002; Sule, et al., 2008; Mojekwu and
Ibekwe, 2012; Muhammed, et al.,
2013).
Given
the fact that rural households participation and utilization of
rural-community-based health facilities in Abia State, Nigeria has hitherto not
seen assessed hence, the need for this study. Based on the foregoing this study
therefore, addressed the following research questions.
1.3 RESEARCH
QUESTIONS
This
study was guided by the following research questions:
i.
What are the
socio-economic characteristics of respondents?
ii.
What are the rural households’
perception primary health care facilities?
iii.
What is the extent of
rural households’ participation in primary health care facilities?
iv.
What is the extent of
utilization of primary health care services by rural households?
v.
What are the constraints
associated with rural households’ participation in primary health care
facilities?
vi.
What are the constraint
associated with rural households utilization of primary health care services in
the study area.
1.4 OBJECTIVES
OF THE STUDY
The
broad objective of this study was to determine rural households’ participation
and utilization of rural community-based primary health care facilities in Ohafia
Agricultural Zone, Abia State, Nigeria. The specific objectives of the study
were to:
i.
describe selected
socio-economic characteristics of respondents;
ii.
assess rural households’
perception primary health care facilities;
iii.
determine the extent of
rural households’ participation in primary health care facilities;
iv.
determine the extent of
utilization of primary health care services by rural households;
v.
examine the constraints
associated with rural households participation in primary health care
facilities;
vi.
examine the constraints
associated with rural households’ utilization of primary health care services in the study area.
1.5 HYPOTHESES
The
following hypotheses were tested:
H01:
There is no significant relationship between socio-economic characteristics
of respondents and their utilizationofprimary
health care services.
H02: There is no significant relationship between
rural household’s participation and utilization of primary health care
facilities in the study area.
1.6 SIGNIFICANCE
OF THE STUDY
The
study was necessary because it added both practical and theoretical
significance to knowledge. Apart from contributing to the existing literatures on
rural households participation and utilization of rural community-based primary
health care facilities, the study will enable relevant stakeholders and actors
in primary health care to realize the importance of rural households
participation, understand the constraints or barriers to rural households participation,
strategies to enhance participation as to ensure sustainability of rural
community-based primary health care facilities, among others.
It
will also contribute to better understanding of accountability and the realization
of an alternative vision which urges
that through participation, rural households are enable and can determine and
control the allocation of development resources and not merely influence its
direction.
Furthermore,
the results will be utilized to encourage and improve the participation of
rural households in rural development projects, thereby contributing towards
improving the quality of human lives. The study serves as an entry point for
further research undertaking in areas of rural households participation in
rural community-based primary health care facilities and other rural
development projects in the study area, and the country as a whole.
1.7 SCOPE
OF THE STUDY
The
study covered Ohafia Agricultural Zone, Abia State in the South-East zone of
Nigeria and delimited to rural households participation and utilization of
rural community-based primary health care facilities with six objectives which
included description of the selected socio-economic characteristics of the
respondents, rural households perceptions about rural community-based primary
health care facilities, determination of rural households extent of utilization
of rural community-based primary health care facilities.
1.8 DEFINITION
OF TERMS
The
under listed words as used in this study are defined below:
Participation:
People’s involvement in the decision making process, attending meetings,
contributing to community projects and implementing programmes.
Rural Development:
Implies a process of increasing productivity and standards of living in rural
areas (Ekong, 2010).
Rural Household:
Is a rural production workshop, based on the work of a family, group,
consumption needs (Ekong, 2010).
Decision Making:
Having a say about actions that affect their lives.
Rural Community:
Is a geographical area that is located outside towns and cities (Ekong, 2010).
Utilization:
Use of health care services (Omotoso, 2010).
Access:
The timely use of personal health service to achieve the best possible health
outcomes (Ronald, et al., 2014).
Primary Health Care:
Is a grassroot approach meant to address the health problems in communities (Abdulraheem
et al., 2012; Olise, 2012).
1.9 LIMITATIONS
OF THE STUDY
There
were limitations in the process of carrying this study and they included the
following:The household heads initially thought they were going to be paid for
the study but after the researcher explained the purpose of the study and the
importance of the validity of study the respondents were able to supplied the
necessary responses or information needed.
Also,
inadequate funds to support the study slowed down movement as at when planned.
However, efforts were put in place to overcome these problems in order to
reduce the time frame for data collection.
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