Health And Fitness Journal International (HFJI) (Vol.1 No.2 2000)
BASIC HEALTH CARE SERVICES PATRONAGE IN SELECTED
RURAL AREAS OF OYO STATE, NIGERIA.
BY
OYERINDE O.O.
UNIVERSITY OF ILORIN ILORTN
ABSTRACT
The main objective of the study was to examine the extent to which the Oyo State
Government and dwellers in selected rural communities patronize Basic Health Care
Services (BHCS).
Five Local Government in Oyo state were selected and 200 subjects were
interviewed. The questionnaire collected were grouped into two, designated 'Type x' for
illiterates and "Type y" for the literate. Data collected were analyzed using
percentages and reproducibility coefficients. The main findings are:
(i)
That government's patronage of BHCS through provision of facilities
equipment, drugs and personnel are evidenced. However, that
the number of hospital and maternity beds per 10,000 population
is inadequate, was revealed.
(ii)
That the people in the rural areas selected for the study
patronize the BHCS in their areas without hindrance. Based on the
findings, it was recommended among others that:
(i)
A revamping of preventive health care provision of environmental and
social facilities by government is necessary.
(ii)
A thorough education of the masses in health related matters will
enhance BHCS patronage.
INTRODUCTION
Achieving health for all by the year 2,000 requires an embarking on mass health
programmes that will involve whole populations and ensure a disease free people, healthy
environment and adequate Basic Health Care Services (BHCS) which is a very important
need of the people in the different local government of the state. The Oyo State publication
on health policy (1980) has health for all as its central theme. This theme is in agreement
with the World Health Organization (WHO) and the International Union for Health theme
of (1981), respectively. This theme epitomizes the only possible means of achieving a
form of balanced National development, that allows each citizen to live most, in a good
adequate house, have proper nutrition, offers him possibilities of a sound education which
enhances the development of his potentials.
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Health And Fitness Journal International (HFJI) (Vol.1 No.2 2000)
It would seem that the Oyo state government is aware as written by Fedall and
Tiwari (1980) that there seems to be a growing consciousness in the government
quarters that the provision of Basic Health Care Services (BHCS) is a basic expectation of
people everywhere and an important responsibility of the state. The amount of attention
given Expanded Programme on Immunization (EPI) and other outreach programmes,
environmental sanitation, provision of comprehensive health centres by government, show
that it is aware that the only antidote to general health is the adoption of a broad and
deep rooted health policy which truly accepts the fact that the primary objective of a state
should be a viable basic health care services.
This study therefore is to ascertain the extent to which the state and selected rural
communities in Oyo State patronize BHCS as either suppliers or consumers of these
services. The central purpose was to examine the present state of BHCS in selected
rural areas of Oyo State and to evaluate the patronage patterns of these services.
Statement of Problem
The study was to find out the state of BHCS in selected rural areas of Oyo State
with a view to ascertaining the health policy of the Oyo State Government and how the
policy is affecting basic health care patronage in the selected rural areas, The following
research questions guided the conduct of the study:
(i)
Does the state patronize BHCS through adequate provision of facilities,
equipment and services to the population of interest?
(ii)
Are the health facilities accessible to the members of the study population?
Significance
This study is significant because it will enhance evaluation of the present health
policy of the Oyo State Government. Suwanwela et al (1981) depicts that an assessment of
the health status of a community is essential if health care programmes are to meet actual
needs.
METHODS AND PROCEDURES
200 rural dwellers or workers sampled from 5 selected local government (LG) of
Oyo State formed the subjects of study. These were the 5 Chief Medical Officers and 5
Supervisory Counselor for health in the local government used, 5 Bales or Chiefs of the rural
population used, 25 sampled local government health personnel, and 160 sampled members
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Health And Fitness Journal International (HFJI) (Vol.1 No.2 2000)
of the rural population used.
The main instruments were oral interview with the Chief Medical Officers of the
Ministry of Health and Supervisory Councilors for health and a previously validated
questionnaire made out in both English and Yoruba. Also, health documents and
department records in the local governments' health units were utilize for gathering
information and data. The questionnaire was administered to two groups of
respondent's type 'X 1 i.e. those who had low educational background and type 'Y' who had
higher educational background. All questionnaire administered were retrieved.
The questionnaire was sectioned A - E. Each section contained questions in
varying numbers designed to find out if there was any influence of the State
Government on BHCS patronage by the rural dwellers in the selected rural areas.
All information collected were interpreted descriptively through the use of
reproducibility coefficient, percentages, tables and graphs. The Guthman Scale, which
helped to determine the reproducibility of the responses on the items, was used. When the
reproducibility was found to be near 0.90 rep, the finding was recorded as being positive.
It was considered negative when the reproducibility was found to be below 0,80.
RESULTS AND DISCUSSION
In producing answer for the first research question of whether there is adequate
provision of Basic Health Care Services (BHCS) to the rural dwellers in the areas used, a
was revealed that there is 84% increase in the total number of medical institutions in the
local government selected between 1987 and 1990. Table 1 illustrates the pattern vividly.
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Health And Fitness Journal International (HFJI) (Vol.1 No.2 2000)
TABLE 1. MEDICAL INSTITUTIONS IN THE SELECTED RURAL AREAS
OF OYO STATE
Variables
Hospital Nursing homes
Leprosy Clinics
Maternity and child
centres
Rulal health centres
Dispensaries
Dental officers
Health offices
Total
A
-
B
2
1978
C D Total
1
I
1
8
5
4
5
7
9
25
13
15
12
16
56
1
4
2
11
8
1
16
1
8
2
24
10
2
22
2
30
7
73
1
14
4
33
200%
1
11
-
1
12
4
30
25%
1
19
2
36
64%
4
56
13
134
84%
%increase
1990
A
1
-
B
2
C
1
5
D
1
Total
3
35
119%
2
8
A = Egbeda and Lagelu
B = Oluyole
C = Ibarapa
D = Akinyele
The table reveals a general increase of about 61 additional medical and health
Institutions called static units in the 10 local government selected for the study. Apart
from this. 3 dispensaries and 5 maternity and welfare centres were still under
construction, 3 were awaiting commissioning while 4 were owned by the communities.
Table 2 is summary table of the subjects' opinion on the provision and
availability of equipment and facilities.
TABLE 2 ANALYSIS OF SUBJECTS REACTIONS TO THE PROVISION OF
EQUIPMENT AND FACILITIES
Group
Positive
Negative
Number of
%of positive % of grand
mean
Type
Responses and response
Respondents Responses
errors
Y
90
75
15
83
X
110
88
22
80
44.94
The table gives indication of a high percentage positive opinion and an equally
substantial reproducibility ® level of 83% and 0.80 r respectively.
Also table 3 below gives evidence of the number of hospital and maternity beds in
each of the local government in 1978 and its status in 1990.
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Health And Fitness Journal International (HFJI) (Vol.1 No.2 2000)
TABLE 3 MEDICAL PROVISION IN THE SELECTED RURAL AREAS OF
OYO SATE
1978
Variables
A
B
c
Hospital beds
Maternity beds
46
46
61
61
2
Hosp. and Maternity
Centres
Hosp. beds per
15,000 population
Hosp. & Maternity
beds/10,000
population
1990
D
Total
A
B
C
D
Total
36 126 92
162 92
36
325
361
46 46
126 158 216 143 643
126 158 262 143 689
-
2
-
2
-
-
3
-
3
4
10
4
26
4
9
15
6
34
%
increase
27%
97%
90%
!
50%
70%
.'
A = Egbeda and Lagelu
B = Oluyole
C = Ibarapa
D = Akinyele
Although the data indicates an increase of 70% in the number of hospital and
maternity beds per 10,000 population, the interesting question is do the figures reflect a
satisfactory bed-population ratios. This is not easy to arrive at because many important
statistical data, which can assist in making this conclusion, are lacking. However,
assuming that a large proportion of the people in the rural areas make good use of the
medical services available and two, that the birth rate is between 40 - 50 per 1,000
population as for African countries, the available hospital and maternity beds per 10,000
population expressed in the Table above which are three and thirty-four respectively are
inadequate. That is, if the United Kingdom figure of 65 and 70.8 per 10,000 population
respectively is any thing to go by. Also, it must be borne in mind that the United
Kingdom birth rate of 12.3 per 1,000 is much lower than that of African (Annual Digest of
Medical and Health Statistics, 1983). In addition, only 38 of the subjects in the type "Y"
group responded positively to the question of provision of beds in the health institutions
in their area while 50% of them responded negatively. It thus appears that the state needs
to make more efforts in this regard. Table 4, items 8 shows this clearly.
The study showed that drug supply is adequate for the people. This situation
might be so because it is easier to provide curative health care than preventive health
care. This fact has been well presented earlier by Anderson et al (1978) when they
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Health And Fitness Journal International (HFJI) (Vol.1 No.2 2000)
stated that the effects of curative measures like drug supply, free medical attention and
provisions of health centres can be easily measured immediately by the public as
opposed to preventive, which effects can not be measured on the short run. It is also
possible that the local governments' efforts in the Expanded Programme on
Immunization (EPI), and Oral Rehydration Therapy (ORT), outreach programmes called
Mobile Units, led the subjects to stating that drug supply to them is adequate.
It was observed that on the whole, the people were positive concerning the
patronage of and provision of equipment and facilities (including drugs). This assertion is
supported by the fact that 83% of the responses got were positive and that 0.80
reproducibility level was detected in this respect.
TABLE 4: RESPONSES ON FACILITIES (8) AND EQUIPMENT (9) DRUG
SUPPLY (14) AND ACCESSIBILITY TO THE MEDICAL HEALTH
INSTITUTIONS (15)
Item Grand %
Number of
% of Positive
Number of
%of
Negative
Positive
Negative
Responses
Men
Responses
Responses
Responses
8
34
41.22
37.77
45
50%
9
51
48,75
56.60
43.33
39
14
72
80.88
80.00
20.00
18
15
75.11
74.44
25.55
67
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It is in doubt that with this finding, the views of smith (1967), Schram (1971) and
Kakufor (1967) who feel that premium placed on curative means like, provision of
hospitals, drugs, free medical attention cannot help in ensuring massive success in
achieving health for all, in the light of government's rigorous pursuit of EPI, ORT and
propaganda measures concerning the International year of the Child (IYC),
International Year for women (IYW), Directorate of Food, Roads and Rural
Infrastructures (DFRRI), and the Better Life for Rural Women programmes as
supportive means of providing health for all. 58 of the type "Y" subjects affirmed that the
government agents and propaganda have reached them while 42 claimed their ignorance
of these special programmes and efforts.
In providing answer to the second research question, Data obtained in table 4
showed positive reactions from respondents to the questions of accessibilities to Basic
Health Care Service like health institutions, personnel and drugs. This finding is
consistent with those of Roghmahn (1971), Roghmahn (1974), Okada and Thomas
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Health And Fitness Journal International (HFJI) (Vol.1 No.2 2000)
(1980) and Okada (1980) who observed in their studies that the increases in clinic visits a
and attendance are attributed to the accessibility of large populations of the public to the
health and medical institutions.
Items 14 and 15 of the questionnaire were analyzed separately so that inference
could be drawn on the number of hours of operation in the health institutions and
accessibility to other BHCS in the area, and also to ascertain the ease of movement to and
from the BHCS in the local governments selected. Positive responses of 80 and 74 were
recorded for both items, respectively. This further supports the inference that the state
health policy has all positive impact on BHCS patronage in the rural communities selected
for the study. The high percentages of the positive responses suggest that the health
institutions were opened to patients' patronage for large parts of the days and that they were
accessible to vehicles. It also shows that both the institutions and other vital basic health
care services are situated close to the people who might wish to make use of them.
CONCLUSION
Based on the outcomes of the results, the following conclusions were made:
(i)
That evidence are available to show government's patronage of BHCS through the
increased provision of facilities, equipment and drug between 1978 and 1990.
However, the number of hospital beds and maternity beds when compared
to the specifications of numbers of beds per 10,000 people in the United
kingdom (U.K.) is inadequate, Records show a 34 hospital and maternity beds per
10,000 population as opposed to the rather higher figure of 65-70 beds per 10,000
population in U.K. Subjects agreed that the number of beds per 10,000
population is inadequate,
(ii)
That data is not conclusive on the provision of other means of BHCS provision
with only 52 positive reaction and 48 negative reaction.
(iii)
That the people in the rural areas selected, patronize the BHCS in their areas
without hindrance.
RECOMMENDATIONS
The following recommendations were made:
That government should give more priority to preventive health care. Adequate supply of
environment and social facilities must be overhauled for the people under study Social
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Health And Fitness Journal International (HFJI) (Vol.1 No.2 2000)
amenities like drinkable water, toilets, incineration's, and recreation facilities when
inadequate may lead to insanitory conditions. A revamping of this area of heath, care
delivery is recommended.
That training programmes of health personnel" should emphasis a "patient
education is the best policy". All health education must be made an integral part of the
general education curriculum. When the rural dwellers are thoroughly educated in
health related matters. 3HCS patronage will definitely improve.
An extended evaluation study of the state health policy on BHCS for the people is
recommended In addition, a comparative study could be attempted.
REFERENCE
Annual Statistical Bulleting: Ministry of Health, Oyo State, and Nigeria, 1978 and 1988.
Annual Reports on Government Health Centres, Maternity Centres and Dispensaries,
Ibadan-Ibadan Zone of Oyo State, 1978, 1982 and 1988.
Anderson, R. R Lion, J. and Anderson, C.W. (1976) . Two Decades of Health Services;
Social Survey, Trends in Use and Expenditure, Ballingers Pub. Co. Cambridge
Fendal, N.T.E. and Tiwari, T.C.: (1980). Trends in Primary Health Care, Tropical
Doctor: A Journal of Modern Medical Practice, 10 (02).
Ministry of Information Handbook of Oyo State, Nigeria, Government Press, (1978).
PP. 9-14.
Okada, L.M. Wan, T.H. and Thomas, T.H. (1980) . Impact of Community Health
Centers and Medical Aid on the Use of Health Services, Public Reports, 96, (6).
Roghmann, K.J., Haggerty, R.J. and Lorenz, R. (1971), Anticipated and Actual Effects
of Medic Aid on the Medical Care Pattern of Children, New England
Journal of Medicine, 285, pp.1053-1057.
Schram, R. (1971). Research into "A History of Nigerian Health Services." Smith, D.J.
(1967). Absenteeism & Presenteeism in Industry, Archives of
Environmental Health, 21, p. 670.
Suwanwela, C. (1980). Assessing Health Status in Remote Villages in Thailand, World
Health Forum - An InternationalJournal of Health Development, 2. (2).
Recommendation of the 1st International All Africa Conference on Health Education,
(1981).
WHO: Health Problems and Policies in the Developing Countries, World Bank Staff
Working Paper, August, (1980) (412). DOC/IBRD Mon/5/412.
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