NIGERIAN SCHOOL HEALTH JOURNAL
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1
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Department of Human Kinetics and Health Education
University of Ibadan
2
NIGERIAN SCHOOL HEALTH JOURNAL
Editorial Board
Prof. C.O. Udoh – Editor-in-Chief – University of Ibadan
Prof. James A. Ajala – Member – University of Ibadan
Prof. J.D. Adeniyi – Member – University of Ibadan
Prof. Fajewonyomi – Obafemi Awolowo University, Ile-Ife
Dr. S.D. Nwajei – Member – Delta State, Asaba
D.A.K. Fabiyi – Member – Obafemi Awolowo University, Ile-Ife
Dr. (Mrs.) B.A. Oladimeji – Member – Obafemi Awolowo University, Ile-Ife
Dr Danladi Musa – Member – Bayero University, Kano
Dr. O.A. Moronkola – Member/Journal Secretary – University of Ibadan
3
- MAIN FOCUS OF THIS EDITION ISSUES IN HEALTH EDUCATION
Nigerian School Health Association (NSHA)
Contents
Page
Editorial ……………………………………..……………………………………………..
ARTICLES
1. Umaru
Musa
&
M.A.
Suleiman,
Physical
and
Health
EducationDepartment Ahmadu Bello University, Zaria – Healthful School
Environment: The Need of Nigerian Schools.
2. Amunega Stephen Bankole, University of Ilorin – Complexity and
Simplicity in Teaching of Health Education
3. Akinbile, P.O. and Oladumoye, A.O. Adeyemi College of Education,
Ondo-Systematic approach to health instruction
4. Moronkola, O.A. & Olukanni, M.Y. University of Ibadan – Parental
Educational, Social-Economic Status and Nature of Family Set-Up As
Determinants of Prevalence of Child Labour in Bodija Market, Ibadan.
5. Grace Inyang Masha, Federal College of Education Kano-Sexual
Education in Nigeria: Issues on Parent Child Communication.
6. Sanusi, A.A. & Igbanugo V.C. University of Ibadan – Adequacy of
School Health Services Communities in Maiduguri.
4
7. Bolarinwa, R.O. Osun State College of Education Ilesa-Diagnosis of
Health Problems in Osogbo Steel Rolling Company: Application ‘PRECEDE’
MODEL.
8. Odewumi, G.I., University of Ibadan – Health Benefits of Participation in
Aquatic Activities.
9. Onifade, O.A. & Oyerinde, O.O. University of Ilorin – University
Students Perception of Engagement Types on Marriage Success in
Nigerian Societies.
10. Adegbenro, C.A. Obafemi Awolowo University Ile-Ife – Health
Education and Primary Health Care
11. Ogundele, B.O. & Bolajoko, O.A., University of Ibadan – Health
Workers’ opinion about the impact of safe motherhood initiative training
programme on the prevalence of material mortality.
12. Tejumola, T.O. Ogun State University, Ago-Iwoye Effects of Traditional
Birth Attendants Services on the Safe Delivery of Pregnant Women in
Akute Ifo Local Government Area of Ogun State
13. Okanlawon, F.A.
University of Ibadan Community Based Care of
HIV/AIDS Clients; Implication for Community Health Nursing
14. Gaya, M.W.U. & Bwala, D.W., University of Maiduguri – Impact of
Regular Exercise Programme on Risk Factors of Cardiovascular Diseases:
An Overview
5
15. Edegbai, Ben Federal College of Education, Abeokuta – Influence of
Health Information and Education (HIE) on Lactation Among Mothers
Attending Post-Natal Clinic of Family Health Care Centre, Abeokuta.
16. Umar Hassan, Shehu Shagari College of Education, Sokoto –
Strengthening The Utilization of Primary Health Care Services Through
Increased Health Education Activities.
17. Lawal, M.B. & Haastrup, E.A., Adeniran Ogunsanya College of
Education, Otto-Ijanikin – Pre-Service Teachers Profile on The Knowledge
Of And Attitude Towards Adolescent Reproductive Health Issues.
18. V.C. University of Ibadan’s Welcome Address During NSHA 2000
Conference
19. Oyo State Commissioner of Health Address During NSHA 2000 Conference
20. NSHA General Secretary Welcome Address During NSHA 2000 Conference
21. Ogwu, T.N., Ahmadu Bellow University, Zaria – Perception of Students
and Teachers on Teaching of Sexuality Education in Zaria Educational
Zone.
22. Achalu, E.O. & Bassey, F.S. University of Uyo – Wrk and Socio
Economic Status as Aetiological Factors Incidence of Hypertension
23. Adeleke, A.O., Ojo, A.A., Osayande, O.O., Irinoye Lola & MukoroObafemi Awolowo Univeristy, Ile-Ife – Knowledge and attitude towards
Pre-Marriage Genetic Screening Among Undergraduates in a Nigeria
University.
6
24. Uwakwe, C.B.U, Moronkola, O.A. & Ogundiran, Adeniyi – University
of Ibadan – Awareness, Prevalence of Sexually Transmitted Diseases and
Health Care Seeking Behaviour of Adolescents Attending STDs Clinics in
Urban Nigeria.
25. Okanlawon, F.A., University of Ibadan – AIDS Epidemics in Nigeria: A
great challenge
26. Oyerinde, O.O. – University of Ilorin – The Impacts of Family Structure
Parental Practices and Family Size on Children’s Academic Performances.
27. Kalesanwo, O.O. Ogun State University Ago-Iwoye – The Impact of
Health Education Package on Safe Delivery of Pregnancy Mothers in IjebuOde.
28. Omonu J.B., Kogi State College of Education Ankpa – Preparing Bachelor
Degree Health Teachers to Meet National Development
29. Ajibike, Y.B., Oyo State Ministry of Education, Ibadan – Effects of 12
Weeks Exercise Therapy on Hypertensive Men
30. Yayo, A.A., Umar Dikko & M. Kabir – Bio Ecological Studies of Kadawa
Project,
Kano:
Implications
for
Appropriate
Environmental
Health
Education Programme.
31. Shehu Raheem Adaramaja, University of Ilorin – Implementation of
Primary Health Care (PHC) Through Community Based Health Education
Programme in Ilorin Metropolis
7
32. Adeyemo, F.O., University of Ibadan – Review of Adolescents Attitude
Towards Sexual Practice
33. Odesanmi, M.A., Osun State College of Education – Promoting Healthful
Living Lifestyles Among Competing Athletes in the New Millennium
34. Oke, Kayode, Ogun State University Ago Iwoye – The Challenges and
Prospects of Basic Health Services in Nigeria
35. Ademola Onifade, Dean, Faculty of Education, Lagos State University –
Contributions of Physical Education to Attainment of Healthful Living
36. Nwajei, S.D. Delta State University – Health Education in the New
Millennium: Pedagogical Considerations
EDITORIAL TO
VOLUME 13 NUMBER 1 & 2, 2001
The editorial board wishes to thank all NSHA members and authors for
their emotional attachment towards the sustainability of our prestigious journal.
As usual, Journal production is expensive in Nigeria and we still look forward to
financial support from government and founders to enable us to publish good
health and education - related articles.
Issues in Health Education.
The Main focus of this volume is on
We commend it to all policy makers,
researchers, teachers, libraries, students, etc.
The Editors.
8
IMPLEMENTATION OF PRIMARY HEALTH CARE (PHC) THROUGH
COMMUNITY - BASED HEALTH EDUCATION PROGRAMME IN ILORIN
METROPOLIS
BY
SHEHU RAHEEM ADARAMAJA
Department of Physical and Health Education,
University of Ilorin, Ilorin, Nigeria.
Abstract
This paper looks at the implementation of primary health care (PHC) through
community - based health education programme in Ilorin metropolis. The
population of the study consists of primary health care workers and the
inhabitants of Ilorin East, West and South LGAs that make up Ilorin metropolis.
A total of 240 subjects were selected for the study through a multistage-cluster
sampling technique. The instrument used for the study was questionnaire,
validated and tested for reliability through a test re-test method. The coefficient
for the reliability was 0.82r. Analysis of data revealed, among others, that
community based health education programme is a significant factor in the
implementation of PHC services. The paper suggested that the people of Ilorin
metropolis should be adequately informed of the concepts, needs, problems and
prospects of PHC programme so that they can perceive the programme positively
and participate actively in its implementation.
9
Introduction
In 1987, Nigeria adopted a comprehensive national health policy which
accepted Primary Health Care (PHC) as the foundation of this policy and the
principal method of ensuring the provision of health for all her citizens by the
year 2000 and beyond (Bravema and Tarimo,1994). The National Health Policy
(1988) adopted the Alma‘s definition and declaration of primary health care as:
Essential health care based on practical, scientifically
sound and socially acceptable methods and
technology made universally accessible to individuals
and families in the community and 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 selfdetermination (National Health Policy, 1988:2:3).
The idea of primary health care scheme is to ensure that both rural and
urban dwellers not only have access to meaningful health care but also that
they participate actively in the implementation of every facet of the prorgamme.
The idea of equal access and affordable health care for all the people could only
be brought about by the education of the public about how they could effectively
carry out their own health care. For primary health care programme to succeed
in this country, Nigerians must be educated about primary health care concepts.
This involved a number of educational issues which are essentially dependent on
systematic health education.
Udoh, Fawole, Ajala, Okafor and Nwana (1987)
defined health education as a process with intellectual, psychological and social
dimensions relating to activities which increase the abilities of people to make
informed decisions affecting their personal, family and community well being.
10
According to them, health education is an integral part of the school curriculum
at all levels, and an integral component of community based health programme.
Mass health education and mobilization of individuals and the community to
create health awareness is an important tool in the realization of health for all by
the year 2000 and beyond.
Adegoroye (1984) stated that health education
should run through, and be built into all sectors of the community. There should
be family health education, school health education and community health
education.
Community - based health education programme is an essential tool in the
implementation of primary health care programme towards the attainment of
health for all by the year 2000 and beyond. Health education should be carried
out both at the group and individual levels in the homes, clinics, market squares,
places of worship and other social gatherings. In the past, health workers were
found of underrating the level of intelligence and problem - solving skills of
health services consumers (community members). They were often labelled as
ignorant, unhygienic or illiterate. Hence, health services providers saw little or no
need to involve the consumers in the process of providing services (Folawiyo,
1990). For example, in the past, if a dispensary was to be built in a village, the
government would only acquire land and start to build the dispensary, without
consulting the villagers. This wrong approach has led to non-utilization or underutilization of many government health centres or hospitals. But today, with the
introduction of community health education programme in the primary health
11
care delivery system, the orientation has changed tremendously. Henry (1993)
asserted that in reciprocity, the community now sees the primary health care
programme as our programme instead of government’s programme.
Ransome-Kuti (1987) in his broadcast to the nation on the launching of
Primary Health Care as Health Minister and as contained in Shodeinde (1982),
described Primary Health Care (PHC) as community-based health programme.
This means that it is organized from the grassroot upward, with the active
participation of the people who will identify their health needs and participate in
planning, implementing and evaluating the services. In planning the services,
they will ensure that it is designed to tackle those health problems that take the
greatest toll of their lives. They will also ensure that the cost of delivering the
services can be afforded, bearing in mind all the resources available in the
community to run and maintain the services. WHO (1978) reported that health
can not be imposed on the community nor is it something that can be provided
for the people. What can be provided is healthcare. It is the people who decide
whether to utilize the services or not. The challenge of health has to be attained
and not imposed.
With the experience of child survival/family planning programme in Ilorin
metropolis and Nigeria in general, the essence of PHC has shown that individuals
and communities need to be informed, educated, motivated and involved
formally or informally in health programmes so that they can be convinced that
the programme is convenient, efficacious, affordable and as good as, if not
12
better, than that which they already had. The community can bring energy, time
and even financial resources to develop health-related programmes/activities
when they see that their own interests are being served (WHO, 1984).
The implementation of PHC in Ilorin metropolis (Ilorin East, Ilorin South
and Ilorin West LGAs) has shown that only the components of the programme
that involved community participation were effectively implemented in the area
i.e, immunization, health education, essential drugs, and maternal and child
health care, including family planning programme.
All other components like
mental health, AIDS control programme, water supply scheme and basic
sanitation services were not properly implemented in the area.
Statement of the Problem
The problem of the study was to assess the implementation of PHC
through a community-based health education programme in Ilorin metropolis.
The study examined why some of the programme’s components were properly
implemented and why some were not. The study also investigated and evaluated
the degree of success of the programme and made some recommendations on
how to improve on the programme.
Hypotheses
The following hypotheses were tested in this study.
1.
There will be no significant differences in the pattern of health
education provided about prevailing health problems towards the
13
implementation of PHC services in the three (3) L.G.A s. of Ilorin
metropolis.
2.
There will be no significant differences in the way the people of Ilorin
metropolis perceive PHC delivery system.
3.
Community-based health education programme is not a significant
factor in the implementation of PHC services in Ilorin metropolis.
Rationale for the Study
The study examined the implementation of primary health care
programme as a community-based health programme. It also examined the
acceptability of the programme among the people of Ilorin metropolis. The result
of the study would reveal the areas that need greater improvement and
reinforcement. It will also provide information to the people of Ilorin metropolis
on how to improve their health. Finally the outcome of this study will contribute
to public awareness of the nature, needs, priorities and patronage of the primary
health care system.
Methodology
The research design adopted for this study was a descriptive survey
method. The population for the study consisted of the participants (Beneficiaries)
in PHC programmes in the three (3) Local Government Areas (Ilorin East, South
and West LGAs) that make up the Ilorin metropolis. In addition, medical officers
and PHC co-ordinators in the LGAs were also included in the study.
14
The investigator used a multistage-cluster sampling technique in the
selection of samples for the study. The procedure involved the repetition of two
basic steps: Listing and sampling. The list of primary sampling units (PHC
centres) was compiled and stratified for sampling. Then a sample of those units
was made. In all, a total of two hundred and forty (240) samples were selected.
Questionnaire method was used for the study.
The respondents were
requested to indicate their opinion on a 4-point Likert scale ranging from
Strongly Agree, Agree, Strongly Disagree and Disagree.
The instrument was face validated and the reliability of the instrument
was established through a test-re-test method. The scores from the first
administration were correlated with the second administration using Pearson
Product Moment Correlation co-efficient which yielded 0.82.
The questionnaire forms were administered to the respondents by the
researcher and his assistants. The hypotheses formulated were tested using ttest to determine the significant differences between the mean scores of
respondents from the three (3) LGAs on the implementation of PHC services
through a community-based health education programme.
Results
The results of the data analysis were presented as follows.
hypotheses were tested at 0.05 alpha level of significance.
15
All the
Hypothesis 1:
There will be no significant differences in the pattern of
health education provided about prevailing health problems towards the
implementation of PHC services in the three (3) LGAs of Ilorin metropolis.
Table 1:
Means, Standard Deviation and t-value of Respondents
on the pattern of Health Education Provided about
Prevailing Health problems towards the
Implementation of PHC Services in Ilorin Metropolis
L.G.A No of Means Standard
cases
Deviation
Ilorin
80
6.54
Degree Calculated Table
of
T-value
Value
Freedom
0.43
Remark
Significant
East
at 0.05
Ilorin
80
6.03
0.4
237
*1.36
1.96
Alpha
Level
South
Ilorin
80
6.4
0.42
West
Table 1 shows the responses of the respondents on the patterns of health
education provided to the people about prevailing health problems towards the
implementation of PHC services in Ilorin metropolis. The calculated t-value of
1.36 as against the table value of 1.96 with a degree of freedom of 237 was
obtained.
Since the calculated value was less than the table value, the null
hypothesis (Ho) was accepted at 0.05 alpha level. This implies that there was no
difference in the pattern of health education provided to the people of Ilorin
East, South and West LGAs in the implementation of PHC services in the area.
16
Hypothesis II: There will be no significant differences in the way the people of
the three (3) LGAs of Ilorin metropolis perceive PHC delivery system.
L.G.A No of Means Standard
cases
Deviation
Ilorin
80
15.38
1.08
Degree Calculated Table Remark
of
T-value
Value
Freedom
237
1.96
Significant
East
at 0.05
Ilorin
80
12.51
??
0.07
Alpha
Level
South
Ilorin
80
16.02
1.26
West
*P <0.05
Table 2 shows the perception of PHC delivery system by the people of
Ilorin metropolis. The calculated t-value of 4.73 as against the table value of
1.96 with a degree of freedom of 237 was obtained. Since the calculated value is
greater than the table value, the null hypothesis (Ho) was rejected at 0.05 alpha
level. This means that there was a significant difference in the way the people of
the three (3) LGAs perceived PHC delivery system. Residents of Ilorin East and
West LGAs were well informed of the activities of PHC, hence they perceived the
programme positively.
Their counterparts in Ilorin South LGA saw the
programme on the negative side. This may be attributed to the fact that Ilorin
South is a new LGA in the metropolis, the health information unit of the LGA is
not yet equipped and staffed to carry out the necessary enlightenment campaign
in the area.
17
Hypothesis III: Community Based Health Education Programme is not a
significant factor in the implementation of PHC services in Ilorin Metropolis.
Table 3:
Means, Standard Deviation and t-value of Respondents
on Whether Community Based Health Education
Programme is no a Significant Factor in the
Implementation of PHC services in Ilorin Metropolis
L.G.A No of Means Standard
cases
Deviation
Ilorin
80
22.02
0.9
East
Ilorin
80
23.43
Degree Calculated Table
of
T-value
Value
Freedom
0.9
Significant
237
2.32
1.96
at 0.05
Alpha
Level
South
Ilorin
Remark
80
22.65
0.9
West
Table 3 shows the responses of the respondents on whether communitybased health education programme is or is not
a significant factor in the
implementation of PHC services in Ilorin metropolis. The calculated t-value of
2.32 as against the table value of 1.96 with a degree of freedom of 237 was
obtained. Since the calculated value is greater than the table value, the null
hypothesis (Ho) was rejected at 0.05 alpha level. This implies that communitybased health education programme is a significant factor in the implementation
of PHC services in Ilorin metropolis.
18
Discussion of Findings
The finding that no significant difference existed in the pattern of health
education provided to the people on the prevailing health problems towards the
implementation of PHC delivery system is consistent with the fact that Ilorin is
the capital city of Kwara State: people of the area are bound to benefit from the
health education programme of the Federal State and Local Government Areas;
and non-governmental organizations like WHO, UNICEF and UNESCO are various
attempts to reduce health problems in the area to the bearest minimum.
Ebomoyi, (1986) was of the view that effective implementation of health
information programme of PHC services is dependent on adequate staffing,
facilities and enabling conditions for the health workers. The finding shows that
health education, is given to the inhabitants on individual and group basis in the
homes, clinics, markets, places of worship and other gatherings.
Health
education on the prevailing health problems in the (3) local government areas, is
given to the recipients by health personnel, parents, teachers, community
leaders and members or non-governmental organizations.
The finding that a significant difference existed in the respondents
perception of PHC delivery system by the people of Ilorin metropolis is
predictable because the implementation, management and socio-economic status
of respondents in the area were slightly different. The people of Ilorin East and
West LGAs were well informed of the activities of PHC. This is because the two
LGAs were fairly in the heart of the city, while their counterparts in Ilorin South
19
LGA were not well informed. The reason for this is that Ilorin South is located in
Fufu village, a suburb of Ilorin metropolis where the majority of the inhabitants
are illiterate and know nothing about PHC delivery system. Ilorin South, being a
new LGA, the health information unit of the State Ministry of Health (SMOH) has
been trying to assist the LGA in the organisation of workshops, seminars and
lectures to educate the inhabitants of Ilorin South LGA on the efficacy and
effectiveness of PHC services.
Ransome-Kuti (1987) described primary health care in his broadcast to the
nation as Health Minister and as contained in Shodeinde in (1982) in page 13 as
a community - based health programme which lays credence to the findings of
this study that community-based health education programme which
is a
significant factor towards the effective implementation of PHC services in Ilorin
metropolis in particular and Nigeria in general. Caliendo (1989) reported that
community participation is the essential prerequisite of PHC programme. Such
involvement can only be inspired through a properly conducted educational effort
(Health Education Programme). In line with the National Health Policy (1989)
which stated that,
The government of the federation shall drive
appropriate mechanisms for involving the community
in the planning and implementation of health services.
The policy further stated that the traditional system
and community organization shall be fully utilized in
reaching the people.
20
The three (3) LGAs in the metropolis have decided to bring health services to the
grass root by involving community leaders and members at all the four
operational levels of PHC in the LGAs viz: the village level, the health facility
level, the district level and the LGA level. They were allowed to serve as
members of health development committees.
Recommendations
Based on the findings of this study, the following recommendations were
made:
1.
The people of Ilorin metropolis (Ilorin East, South and West LGAs)
should be adequately informed of the concepts, needs, problems and
prospects of PHC programme so that they can perceive the
programme positively and participate actively in its implementation.
2.
Government should provide more funds, procure health facilities,
recruit qualified health personnel, create enabling conditions and
provide the personnel with good incentives in order to achieve
effective implementation of PHC programmes in the rural areas.
3.
Members of the community should be made to participate in the
implementation of all sectors of PHC service as members, programme
co-ordinators, initiators and supervisors. They should be well oriented
through seminars, lectures, workshops and symposia.
21
References
Adegoroye, A. (1984). Community health care, London, Macmillan Publishers.
Bravema, P.A. & Tarimo., E. (1994). Screening in Primary Health Care: Setting
Priorities with Limited Resources. Publications of the World Health
Organisation.
Caliendo, P.V. (1989). Expanded programme on Immunization. The continuing
role of the European Region. World Health Organization Chronide. 39 (3)
pg. 92.
Ebomoyi, E. (1986). Towards an Ideal curriculum for primary health care
Education. Nigerian Journal of Curriculum Studies. 4 (1) pg. 140.
Federal Ministry of Health (1988): National Health Policy, Federal Republic of
Nigeria 2:3.
Federal Ministry of Health (1989): National Health Policy, Federal Republic of
Nigeria 1:1.
Folawiyo, A.F.A (1990). Promoting effective health for all the year 2000: Myths
and Realities.
Journal of Nigerian Association for Physical, Health
Education and Recreation. Special edition, 7 (2) September 71-78.
Henry, A.A. (1993). A to Z of Community Health and social medicine in medical
and Nursing practice with reference to Nigeria.
Published 3Am
Communications, Dugbe, Ibadan.
Shodeinde, A.O. (1992). Primary Health Care in Nigeria: Our children can not
Live. 1st Published 1992 by Emancipation Consultants and Publishers Ltd.
Lagos. Printed by ICIC (Directory) Publishers Ltd.
22