HEALTH CARE DELIVERY, ACCESS AND
UTILISATION IN SLUMS OF URBAN SOUTHWEST, NIGERIA.
S. Akinmayọwa Lawal
PhD Candidate
Centre for Global Health
Trinity College Dublin.
Supervisors
Femi Omololu, PhD
University of Ibadan, Nigeria
Joseph Assan, PhD
Trinity College Dublin, Ireland
INTRODUCTION
• In Sub-Saharan Africa gaining access to health care services is
still a challenge as health systems performance is very low (Kruk
and Freedman, 2008).
• There exist profound inequities in health within this region (Haines
and Cassels, 2004, Sanders et al, 2005 and World bank 2004); and
• As a result of either geographical, physical, financial or socio-cultural barriers,
the use of effective health services and interventions is a
challenge (Hanson et al, 2003),
• In Nigeria, Private Out-Of-Pocket Expenditure (OOPE)
accounts for over 70% of the estimated $10 per capita
expenditure on health (FMOH, 2004), therefore limiting equitable
access to quality health care services (Ibekwe, 2010), also in urban
slums.
Health Statistics in Nigeria
Percentage Share of Total Health Expenditure by Financing
Agents, 2002 (%) (Soyibo, 2005).
Source: WHO, 2009
Source of Health Expenditure in Nigeria 2003 (%) (Soyibo,
2005).
Health Statistics in Nigeria (2)
Source: WHO, 2009
Health Care Delivery in Nigeria
Source: WHO, 2009
Background to the Problem
• Across countries of sub-Saharan Africa and parts of Asia and
Latin America slum dwellers, do not have access to basic
amenities such as potable water, electricity, drainage, roads,
sanitation, education, health care, recreation and waste
disposal facilities (DFID, 2004; Ndulu et al., 2005; Ayogu, 2006; World Bank, 2006).
• As a result of this, many urban slum dwellers in these regions
live in deteriorating conditions that affects human health (UNHABITAT, 1992, 2003; DFID, 20032; WHO, 2005; ADB, 2007; UNFPA, 2007).
• Slum dwellers occupy irregular settlements, squatter housing,
unauthorized land developments, and rooms and flats in
dilapidated and uncompleted buildings (Chome, 2002). Nigeria has a
fair share of these irregular settlements (Agboola and Olatubara, 2003).
Urban Slums in Sub-Saharan Africa
•
Sometime in the next year, a woman will give birth
in the Lagos slum of Ajegunle... Davis, Planet of
Slums, 2006
• Slums are underserviced and or
with no service parts of cities
where living conditions are often
appallingly poor (Chowdhury and NurulAmin, 2006).
• Slums are an active, grassroots
attempt by the desperately poor to
take care of themselves (Sclar and
Northridge 2003).
•
The UN-HABITAT 2003 Global report on
human settlement “The Challenge of
Slums” reveals that:
• Within the developing regions, subSaharan Africa had the largest
proportion of the urban population
resident in slums in 2001 (71.9 per
cent).
• Slums are a physical and spatial
manifestation of urban poverty and
intra-city inequality.
•
Slums in Nairobi are homes to urban
residents who earn comparatively low
incomes and have limited assets.
• The majority of slum dwellers in
developing country cities earn their
living from informal sector activities
located either within or outside
slum areas.
Slums in Urban South West Nigeria
• In Nigeria, the growth of slums is
4.23 per cent with urban population
in 2007 of 50 per cent;
• In Ogun state, slum communities
exist in Abeokuta, Sagamu, Ijebuode, Ilaro, Mowe, and Ibafo areas
of south west Nigeria.
• These Slums are precarious,
unplanned and environmentally
degraded, while existing available
health facilities cannot cater for the
growing number of slum dwellers.
• In Lagos state, slums can be
located in the following areas of
Makoko-Ebute-meta, Ajegunle,
Okokomaiko, Abaranje, AkesanIgando, Berger, Iyana-Ipaja/Ayobo,
Mushin, and Agege; while
•
Makoko in Lagos (Up) and Ibafo in Ogun
state (Down).
Objective of the Study
• To examine access to health care services and effective
utilisation of health care in slum communities of urban south
west Nigeria.
• To explore the social processes by which health care services
emerge in urban slums of south west Nigeria.
• To determine the extent in which the health care needs of
residents are being met and evaluate the effectiveness of
health care delivery services in slum communities of urban
south west Nigeria.
Research Question
• How do health care services emerge in slum communities of
urban areas in south-west Nigeria?
• How do households in urban slums of south west Nigeria
access health care services?
• To what extent is health care delivery meeting the needs of
residents in urban slums of south west Nigeria?
• How are the health care needs of residents in urban slums of
south western Nigeria met?
• How effective is health care delivery services in slum
communities of south west Nigeria?
Research Hypothesis
• Presence of health facilities in urban slums increases the
utilization of the health services
• Affordability of health care services in urban slums of south
west Nigeria increases patient utilization
• Good road network, transport system and income increases
access to health care services among households
• The quality of care offered to patients encourages the effective
utilization of health care services
• Availability of drugs, equipments, attitude of health workers and
prompt treatment increases the utilization of health care
services in urban slums of south western Nigeria
Justification and Significance for the Study
The findings of this study will:
• Provide information on the varied nature of health care delivery in
slum communities.
• Help in the conceptualisation of health care delivery and utilisation in
urban slums
• Highlight the social determinants of access to health care services in
slum communities in relation to what the literature says.
• Contribute to strengthening health care systems in slum
communities.
• Provide insight into the social processes by which the health system
in urban slums develop overtime.
Selected Literature Review
• Scalar and Northridge (2003) Indeed, slum settlements represent an active,
grassroots attempt by the desperately poor to take care of themselves.
• Janovsky (2006) argues that improving health services and strengthening
health systems is equally essential in slum communities
• Dahlgren and Whitehead (2007) adequate policies and strategies to promote
social equity in health
• According to WHO 2008 report on Social determinants of health, access and
utilisation of health care in informal settlement is problematic
• Ibekwe (2010) asserts that access to health care services is a challenge
especially in slum communities Africa
• Omachonu and Einspruch (2010) concedes that innovation in healthcare
delivery systems will improve health conditions even in slum communities
Theoretical Framework
Structuration Theory
Social Determinants of Health
• The use of Structuration theory for
this study will show:
• The SDH holds that:
• The social gradient in health within
countries, and the marked health
inequities are caused by the
unequal distribution of power,
income, goods, and services.
• How Giddens' concepts of 'social
system', 'structure' and 'agency'
help to conceptualize health care
delivery in urban slums;
• Access and utilisation of health
services among actors in urban
slums of south west Nigeria;
• The relationship between
“Structures of Health Care” (Health
System) and “Actors of Health
Care” (Providers, Slum Dwellers).
• Unequal distribution of healthdamaging experiences is the result
of a toxic combination of poor
social policies and programmes,
unfair economic arrangements,
and bad politics;
• Health inequality exist especially
among slums dwellers of urban
south west Nigeria.
Conceptual Framework
Methodology
Qualitative/Quantitative
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In-depth interviews
Key Informant Interview
Focused group discussion
Survey
Sampling Technique
-
Multi stage sampling;
Systematic random sampling of
households
Purposive sampling
Snowball sampling
Study Population
-
•
Study Area
Households, Public Health Officials,
Key Informants, Community Leaders,
Health Care Practitioners, Folk
Healers, Community Residents, Drug
Peddlers and Local Pharmacy, NGOs
Study Design
•
The study will adopt an exploratory
and evaluation approach. A
triangulation of research methods to
capture existing social realities of
health care delivery, access and
utilization in urban slums of south
west, Nigeria
Lagos State and Ogun State
Methodology Table 1
Methodology Table 2
Research Hypothesis
• The stated hypothesis will be answered through the items of the
quantitative research instrument and analyzed to state existing
relationship between the independent and dependent variables.
Changes in the study thus far
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Concept of “Emerging Communities” removed from title
Research Hypothesis
WHO Health System Framework
Literature on Health Systems
Key Informant Interview
Inclusion of NGO, Folk Healer in study population
Social Model of Health removed from the theoretical framework
PhD Work Plan
Dissemination of Findings
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Supervisor and Co-Supervisors
Centre for Global Health, Trinity College Dublin
Department of Sociology, University of Ibadan, Nigeria
School of Medicine, Trinity College Dublin
Postgraduate School, University of Ibadan, Nigeria
Federal Ministry of Health, Nigeria
Commissioner of Health, Lagos State, Nigeria
Commissioner of Health, Ogun State, Nigeria
Host Communities
Reputable Journals for Publication
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