NIGERIAN JOURNAL OF HEALTH EDUCATION VOLUME 13, NUMBER 1,
2005
EDITOR-IN-CHIEF
PROF. IKPONWOSA OWIE
Volume 13, No. 1, 2005
ISSN: 119-7323
An official Journal of Nigerian Association of Health Educators
Editorial Board
Professor Ikponmwosa Owie
Dept. of Physical and Health Education
University of Benin, Benin City
Editor-in-Chief
Professor C.O. Udoh
Dept. of Physical and Health Education
University of Ibadan, Ibadan.
Consulting Editor
Professor O.G. Oshodin
Dept. of Physical and Health Education
University of Benin, Benin City
Consulting Editor
Professor Richard L. Papenduss
Division of Committee and Environment Health
University of Arizona
Tucson Arizona 85719, USA
Consulting Editor
Professor (Mrs.) O.C. Nwana
National Open University
Nekede Centre, Owerri.
Consulting Editor
Professor J. O. Okafor
Dept. of Physical and Health Education
University of Benin, Benin City.
Consulting Editor
Dr. A.F.A. Folawiyo
Faculty of Education,
University of Lagos.
Akoka O- Lagos.
Consulting Editor
1
Professor I.E. Achalu
Dept. of Physical and Health Education
University of Uyo, Uyo.
Consulting Editor
Dr. (Mrs.) C.O. Adegbite
Institute of Education,
Ahmady Bello University, Zaria.
Consulting Editor
Dr. S. N. Omobude-Idiako
Dept. of Physical and Health Education
University of Benin, Benin City.
Consulting Editor
CONTENTS
1.
National President’s Address: Tr Dr. R.U. Okafor
2.
Keynote Address: Dr. P.S. Dakum
3.
Guides to Health Education Policy and Principles in Nigeria.
Prof. Jerome O. Okafor
4.
Health Education Interventions: Dr. C.O. Adegbite (Mrs.)
5.
Health Education Interventions in the Workplace: Golda O. Ekendo
(Mrs.)
6.
The Role of Colour as an Aspect of Visual Arts in Health Education:
Dauda D. Dyek
7.
When Cultural Practices Are Health Risks: The Dilemma of Female
Genital Mutilation: M.O. Olumba (Ph.D)
Situational Analysis of the Present State of the Healthcare Systems in
Nigeria: Mr. Audu Andrew Jatau, Dr. Yakubu Gorah Kajang, Dinatu U.
Davou (Mrs.) Mr. Joseph Philip Dangbin & Simon Yusuf Jatau.
8.
9.
Tackling the Scourge of HIV/AIDS through School and Community
Health Educator Programmes: Dr. T.N. Ogwu (Mrs).
10.
The Health Educator and Promotion of Health Literacy and Advocacy
for the 21 Century: Dr. Suleiman M.A. (Mrs.) Elisha S. Dimka & Dinatu
Dimka (Mrs.)
2
11.
Gender-Role Differentials in Implementation of the Health Policy in
Nigeria: Raheem Adaramaja Shehu & Baba Sheshi.
12.
The Need to Legislate the Teaching of Health Education in Special
School in Nigeria: U.P. Chukwu
13.
Healthcare System in Developing Countries Why Women? Mark J.
Davwar, Dinatu U. Davou (Mrs.) & Hajaratu M. Davwar (Mrs)
14.
Composting: An Effective Strategy Effective Refuse Disposal: A Cure
to Health Hazard: Lucy L. Padung & I.G. Datol
15.
Constitution of he Nigerian Association of Health Educators (NAHE)
An Address Presented by the National President Nigerian
Association of Health Education Teachers (NAHET), Tr. Dr. R.U.
Okafr, at the Opening Ceremony of the 13th Annual National
Conference Held at the Federal College of Education, Pankshin,
Plateu State, on Thursday, June 10, 2004.
The Provost, Federal College of Education, Pankshin
Principal Officers of the College
Honourable Commissioner for Health, Plateau State
Honourable Commissioner for Education, Plateau State
Keynote and Lead Paper Presenters
Dean, School of Science, FCE, Pankshin
Other Deans of School, FCE, Pankshin
Head of Department of PHE, FCE, Pankshin
Other Head, Department and Unit of FCE, Pankshin
Patrons of NAHET
Members of EXCO and other Members of NAHET
Members of the College Community
Respected Guests
Gentlemen and Ladies of the Press
Ladies and Gentlemen.
It is my pleasure to welcome you all, especially our distinguished guests
who have shelved your numerous, but very important engagements to honour
our invitation to the Federal College of Education and to the opening ceremony
of the 13th annual national conference of our honourable Association, NAHET.
3
Significantly, the Association has chosen the theme: “Health Education
Policies and Principles” which guided the planners of this conference in being
fairly specific about the objectives. Specifically, therefore, this conference has
been designed to take a critical, analytical and empirical look at health education
policies and principles from the following perspectives:
1.
Health education models,
2.
Health education plans,
3.
Health education interventions,
4.
Current policies,
5.
Comparative policies,
6.
Health education policies across nations,
7.
foundations of health education policies, and
8.
health education policies in Nigeria.
It is true that a group of professionals can meet in a chosen place at an
agreed time or period to discuss, as we have always done, but if the meeting
ends with only discussion and documentation then it is simply a ritual. In which
case, members of the group meet just for their ritual and disperse with the hope
of meeting at the next agreed place and time. It is hoped that our stay in
Pankshin this year will not only break rituals, but will send the group to offices
and sites for planning, modeling and implementing health education policies in
Nigeria.
4
At thirteen, a child biologically and socially enters the “teen” NAHET is
thirteen this year and, as a teen, queries many things, seeks liberation and
recognition. He or she not recognized as child or an adult strives to asset his or
her independence. It is possible that this stage of development, which NAHET
has attained, may have prompted the present consideration of policies.
Permit me then to lament on our attendance to this conference. We are
not surprised because many of our members do not understand the concept of
“State of Emergency”. Since this pronouncement, I have received and continued
to receive calls and messages from fear-engulfed colleagues expressing their
inability to be here for this conference. Incidentally, we didn’t find it necessary
to succumb to any change in date or place for this conference.
This is not
because we are stubborn or foolhardy, but because we are sure that the “state
of Emergency” does not affect any function such as ours in the State. People in
Plateau State go about their normal Businesses.
The highest thing that can
happen to our participants could be that we may not enter Pankshin from the
Shendam-Lantang axis, but entry from the Huru-manyu axis has remained
unthreatened.
Besides, Pankshin is undisputedly the land of peace and
hospitality. I have the courage to say this because I did my youth corps service
here in the college where I had free food for one full year.
Let me at this juncture, appreciate the Provost of the Federal College of
Education, Pankshin, the Dean, staff and students of the School of Sciences, the
Head, Staff and students of the Department of Physical and Health Education,
5
and the entire College community, because you made this conference possible.
The honourable members of NAHET are particularly grateful to the Provost for
the administrative blessings he showered on the LOC of this conference. I have
your permission sir, to ask the good Lord to bless you, your staff and the College
community again and again and again. To our guests who found time to be
here, we are most grateful. Our sincere prayer is that God shall lead all of us
safely back home.
In conclusion, ladies and gentlemen, I urge us to make this 13 th annual
national conference of NAHET memorable since policies and principles make their
marks in every sphere of life or human endeavour do not rush to present your
papers and disappear. Rather allow your mind, intellect and your heart interact
with those of colleagues to enable us come up with stimulating health education
models, plans intervention and policies. It is in this spirit of collective
responsibility of developing Health Education that I invite us all to take a serious
look a the plight of Health Education in our country and to match on together in
the formulation and implementation of Health Education Policies and Principles.
Once more, I welcome you, thank you for coming and for listening to me.
Remain blessed.
Tr Rueben U. Okafor, Ph.D.,
National President.
6
Gender-Role Differentials in Implementation of the Health Policy in
Nigeria
Raheem Adaramaja Shehu
Department of Physical and Health Education,
University of Ilorin,
Ilorin.
And
Baba Sheshi
Department of Physical and Health Education,
Bayero University,
Kano.
Abstract
The paper identified the hierarchy involved in the formulation and execution of
health policy in Nigeria and gave an insight into the “Health for All” policy, how
Nigeria intended to achieve it through Primary Health Care (PHC) programmes.
The paper further examined the effects of culture, religious and biological factors
on gender-role differentials and how they fear on PHC implementation in Nigeria.
It was observed that though men have management and implementation of
health policies, women remain the major beneficiaries and key providers of
health care services in Nigeria. In most cases they as physicians, nurses,
community health workers, sanitary inspectors and health educators, following
from a synopsis of women’s roles in PHC programme.
The authors
recommended advised that government should encourage more women in the
management and implementation of health policies in Nigeria.
7
Introduction
A policy statement consists of a web of decisions and actions that allocate
values (Christopher, 1993). This definition suggests that policy may involve a
web of decisions rather than a single decision and that the actors who make
decisions are rarely that same people as those responsible for implementation.
The health policy statement of a nation consists of series of outlines, guidelines
or official pronouncements on how a government intends to provide and improve
the health status of its citizens.
In Nigeria, the provision of health services is the joint responsibility of the
federal, state and local governments (Federal Ministry of Health, 1997). The
Federal Ministry of Health is the planning and policy coordinating body at the
national level. The State’s Ministry of Health implement the national health
policies and programmes and run state health institutions, while the Local
Government Authorities deliver health services through a network of health
centres, clinics maternities and dispensaries controlled by the local government
councils.
At the national level, there is the National council on Health, a high-
powered body, composed of the federal ministers and state commissioners of
health, responsible for advising on national policies on health.
In 1987, Nigeria adopted a comprehensive National Health Policy which
accepted Primary Health Care (PHC) as the foundation of the country’s health
policy and the principal method of ensuring the provision of health policy and the
principal method of ensuring the provision of health for all her citizens by the
8
year 2000 and beyond (Bravema & Tarimo, 1994). Historically, the 30th World
Health Assembly of May, 1987, decided that the main social target of
governments and World Health Organization (WHO) in the coming decades
should be the attainment by all people of the world by the year 2000, of a level
of health that permits them to live a socially and economically productive life.
This statement of intention is now popularly referred to as “Health for All in the
year 2000 and beyond. The member countries at the conference deliberated
extensively on this policy and concluded with a declaration that (PHC) is the key
to attaining health for all in the year 2000 and beyond (WHO, 1978). Since then
most countries of the world, developed and developing including Nigeria, have
adopted PHC programmes to ensure even distribution of resources, health and
social services.
The Federal Ministry of Health (1989) upheld the World Health Assembly
absolution-WHA BO. 43 that by the year 2000, all socially and economically
productive life. This implies those that are capable of working productively and of
participating actively in the mean that in the year 2000 doctors and nurses will
provide medical care for everybody in the world for all their existing ailments;
nor does it mean that in the year 2000 and beyond nobody will be sick or
disabled (Ransome-Kuti, 1987).
It does mean that health begins at home, in schools and in factories. It is
there where people live and work, that health is made or broken. It also means
people will use better approaches than they do now preventing diseases and
9
alleviating unavoidable disease and disability, and have better ways of growing
up, growing old and dying gracefully. Besides, it will make room for an even
distribution among the population of whatever resources for health available and
for essential health care to be accessible to all individuals and families, in an
acceptable and affordable way, and with their full involvement. It still means the
people will realize that they themselves have the power to shape their lives and
the lives of their families, free from avoidable burden of diseases, and aware that
ill-health is not inevitable.
Gender Issues in PHC Implementation in Nigeria
Gender-role differentials begin in early childhood when the behaviour and
personality characteristics of boys and girls are modified according to parental
and societal expectations. This is associated with reproductive differences
between the sexes and is transmitted through habit, custom and education to
perpetuate the notion that women specifically adopt feminine” tasks and men
“masculine” ones. Gender-role differentiation produces a sexual division of labour
in the family as well as in the formal labour market.
Culturally, what is
considered to be proper work for women in one society may be typical men’s
work in another. Both men and women are conditioned from early age to have
different functions, capabilities and aspirations for women in most societies.
These functions include not only looking after the home and the family, but also
more general caring, counselling and nurturing functions extended into the
neighborhood and community.
10
A further differentiation between the sexes within families is the
assignment of sub-ordinate roles to women and dominant roles to men. This
pattern is frequently found in our health care delivery system, where the
management and implementation of PHC services are positively skewed to the
men at the expense of the women (Helena, Alfonso, Irene and Leslie, 1989).
Gender differentials in PHC are as a result of perceived male and female child
roles and responsibilities. Recent happenings in PHC delivery system in the
northern part of Nigeria showed that separate queue is emphasized for male and
female children during immunization programmes. In addition, separate family
planning clinics were opened for adult males and females in an attempt to
promote gender desegregation using religion as a factor of difference (Kubeyinje,
1989, Shehu, 2000).
Women in most countries are discriminated against in terms of position,
pay, responsibility and authority. The World Health Organization’s growing
emphasis on universal accessibility to PHC and people’s right and duty to
participate individually and collectively in the management of their own health,
make the role and status of women as health care provided an issue of critical
importance in the context of the goal of “Health for all by the year 2000 and
beyond (Helena et al, 1989). In addition, in many countries (including Nigeria
and particularly in the northern part of the country), women’s special needs for
care in connection with their reproductive functions make it imperative that there
should be more professional women health workers to care for those women
11
who do not wish to be treated by men (Shehu, 2000). Apart from being the
major beneficiaries of PHC delivery services as observed by Kubeyinje (1989),
most of the components of the PHC programmes emphasized involement of
women in the service delivery system. This includes maternal health, child
health, food and water supply, keeping the surrounding clean (Sanitation) and
family planning.
A Synopsis of Women’s Roles in PHC Implementation
Women play a far better role than in the delivery of health care services.
As mothers, grand mothers, wives, daughters and neighbours, they are the
principal providers of informal health care services in the traditional birth
attendant (TBA) for relatives and neighbours, often without financial reward and
still carry out the majority of deliveries in towns and villages. Outside the family,
women lead the ranks of volunteers in hospital maintenance, run self-help clinics
and other community organizations.
Equally important is the role of women in the formal health systems
(primary health care) of many countries where they often constitute the majority
of health care providers as physicians, nurses, community health workers,
hospital attendants sanitary inspectors, health educators and community health
extension workers. Whether within or outside the family, whether in a formal or
non-formal setting, women out number men as providers of health care service
implementation.
12
A critical examination of the role of women in the implementation of PHC
in Nigeria and elsewhere in the world show that women’s role significantly out
numbers the role of men as health care providers. This can be done by
examining the role of women in all the eight (8) essential elements of PHC
identified by World Health Organization (1987).
… Education concerning prevailing health problems and
methods of preventing and controlling them; promoting of
food supply and proper nutrition; an adequate supply of safe
water and basic sanitation; maternal and child health care,
including family planning; immunization against the major
infectious diseases; prevention and control of locally
endemic disease; appropriate treatment of common diseases
and injuries; and provision of essential drugs.
Nutrition is one of the most important factors influencing the quality of
life. In most parts of the world, nutrition-related activities take place within the
family. Women are the primary processor, stores and prepare of foods and are
responsible for proper nutrition. They help to increase and improve food supplies
by processing and food to the best advantage and distribute the available
provisions equitably within the family. They are also in the best position to first
recognize and detect cases of malnutrition in the family. Especially among the
children and propound measures needed to reverse it.
Health education for the promotion of health and prevention of disease is
another essential component of PHC. Women are the best health educators in
the family; they help in fostering the type of learning that will motivate people to
want to be healthy and show them how to attain health and how to seek help on
health matters when necessary. At home, women encourage children and other
13
members of the family to obey basic rules of hygiene and to wear appropriate
clothing, especially during cold and hot weather. Women do that in an attempt
to prevent health-related problems with weather conditions.
Immunization programmes reduce morbidity and mortality rate due to
preventable diseases, some of which are major killers of children (i.e. measles,
diphteria, poliomyelitis, whooping cough tuberculosis and cholera). Women are
the main users and promoters of immunization against the principal
communicable diseases, for themselves and their children (Okeahialam, 1987).
They play an indispensable role in this connection even when the immunization is
performed by men. They keep the immunization cards of their children and
always conscious when their children will be taken out for the next immunization
exercise.
Preventable disease associated with contaminated water supplies and a
lack of basic sanitation constitute a major health problem in Nigeria. In
communities where pipe-borne water supply has not been provided or where
there is erratic supply of safe water, women and their daughters are the haulers,
stores and distributors of water and managers of basic sanitation in the family
and often at the community level. They are to promote the use of latrines, sound
personal hygiene and ensure that clean water is used for drinking and other
domestic services.
In the area of material and child health care, including family planning,
the work is at times shared between men and women, but women still play a
14
dominant role. Women are the main providers of maternal and child health care,
including family planning. They take decision in such matters as first aid services
for children; they recognize the need for curative care; they take decisions about
using family planning services though with their husbands; and they are aware
of the nutritional needs of nursing mothers.
Women play a major role in the prevention and control of locally endemic
diseases. This includes early detection of diseases symptoms taking decision to
seek medical care even in the absence of their husband; compliance with the
prescribed treatment environmental activity at the prevention and protection of
locally-endemic diseases.
Women frequently take part in producing and collecting the basic
ingredients for essential drugs. They also share with men the task of distributing
and administering drugs in health care systems. Keeping drugs away from damp
and heat, and out of reach of children are primarily a woman’s function.
Summary, Conclusion and Recommendations
Although the policy of health for all by the year 2000 and beyond adopted
by Nigeria, using PHC as a vehicle to the goal, has greatly helped in the
prevention of preventable or communicable diseases, through immunization,
proper sanitation, health education, essential drugs scheme, provision of safe
water supply and good nutrition, gender-role differentiation remains a cog in the
wheel of progress of PHC programme in Nigeria. This differentiation has led to
the discrimination and condemnation of roles played by women in the successful
15
implementation of PHC programme since its inception. The efforts of the present
National Coordinator of the Programme, Mrs. Awosika, this time a woman, is
highly commendable.
Women, like their male counterparts, remain the major beneficiaries and
health care providers in both formal and non-formal health care delivery systems
in Nigeria, especially in the rural areas where over 80% of the Nigerian
population resides.
Gender-role differentiation in health care delivery system is more
pronounced in Nigeria, particularly in northern Nigeria where separate queue is
emphasized and provided for both sexes, especially during immunization and
innoculation. In addition, male doctors were not allowed to provide health care
services to women (purdan). As part of discrimination against women, subordinate roles were assigned to women and dominant roles to men. This cultural
practice is literally transferred to our health care delivery system when the
management and implementation of health care services are positively skewed to
the men at the expensed of the women. It is on record that since Nigeria
attained its independence in 1960, the country has not got a woman health
minister, whereas men have always dominated this all-important sector of our
life.
The fact that women play a far greater role than men in the delivery of
health care services in Nigeria is not an exaggeration. In the traditional African
society, for example, with particular reference to Nigeria, women are the
16
principal providers of informal health care services in the families and
communities. Also in the formal health care system (primary health care)
constitutes the majority of health care providers are the nurses, physicians
sanitary inspectors, health educators and community health extension workers.
The roles of women in all the eight (8) components of primary health care
delivery system were examined.
Finally,
it
is
hoped
that
giving
all
available
opportunities
and
encouragement to women in the management and implementation of health
policy in this country, women are going to perform creditably in this all-important
sector of our life. The contributions and effort of Mrs. Awosika, the PHC National
Coordinator and Dr. (Mrs) Dora Akunyili-Director General National Food and Drug
Administration and Control (NAFDAC), remain very significant.
It seems most appropriate to advance some recommendations aimed at
attaching the present gender-role differentials in implementing the Nigerian
health policy.
1.
Due recognition should be given to the roles played by women as primary
providers of health care delivery system in Nigeria. Where possible they
should be trained as formal health care providers in the rural areas. This is
imperative because of inadequate coverage recorded for the programme
over the years.
2.
Active participation of community members in the strategic planning,
organization and implementation is very essential for the success of PHC
17
programme. Both sexes (men and women) should be allowed to
participate
in
the
decision-making
process
of
the
programme
implementation.
3.
For any policy to be effectively implemented in this country, Nigerians
should be adequately informed and educated on the needs for such
polices and programmes through workshops, seminars and symposia.
4.
More women should be appointed and encouraged to manage and
implement policies and programmes in all-important sectors of our life.
18
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Federal Ministry of Health, (1997). Health Policy Implementation Strategy, FMOH
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Helena, P. Alfonso, M. Irene, B. & Leslie, E. (1989). Women as Providers of
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Kubeyinje, K. (October, 1989). Health Care and the Rural Areas. Daily Times, P.
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Okeahilam, T.C. (1987). Expanded Programme on Immunization as Child survival
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19