Final Reflection Paper and Practicum Evaluations MPH 599
Concordia University
Practicum position
Name and address of employer: Ibeju-lekki General Hospital, Akodo
Name of supervisor: Mrs Bose O. Osisami
Dr. Adeniyi Mofoluwake A.
12/18/2014
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Abstract
This paper is a reflection and evaluation of a 75 hour health promotion practicum
conducted over three weeks (five hour on every working day of the week). This health promotion
practicum was conducted at various clinics at Ibeju-lekki General Hospital, Akodo (a secondary
health care facility located in a rural area in Lagos State Nigeria) using health education, health
communication, and social marketing strategies. These strategies enabled this author cum
practicum coordinator achieve her goals of improving public health in Ibeju-lekki local
government area. I counseled and educated patients attending antenatal, heart-to-heart
(HIV/AIDS), family planning, medical outpatient, immunization, and booking clinics at Ibejulekki General Hospital, Akodo on health issues of public health concern by translating into
public health practice several concepts, theories, and principles I had learnt in school during my
Masters in Public Health program.
This provided me with an opportunity to interact with, educate face-to-face, and promote
the health of members of Ibeju-lekki local government area at the grass root level.
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Introduction
This health promotion practicum addressed several public health issues using health
education, health communication, and social marketing strategies. This practicum was conducted
over fifteen working days (three weeks) at five hours daily. It addressed public health issues such
as diabetes mellitus, hypertension, obesity, prevention of mother to child transmission of HIV,
the need for people living with HIV to have protected intercourse even if their partners are living
with HIV, modes of HIV transmission, treatment of HIV, caring for oneself if one is living with
HIV, breastfeeding, immunization, post natal check, family planning, eating right when
pregnant, pregnancy, and antenatal care with an aim of promoting public health in the
community in which these health education cum communication practicum was delivered.
Ibeju-lekki General Hospital, Akodo is the only government owned secondary health care
facility located at Ibeju-lekki local government area. It was established in 2006 and its catchment
population cuts across 78 communities within Ibeju-lekki local government area. Ibeju-lekki
local government area is a rural area located on the coastal road in Lagos State, Nigeria. Being a
local government area situated in a rural area it is one of the local governments that contribute
immensely to the poor health indices of Nigeria.
The mission of Ibeju-lekki General Hospital, Akodo is “to provide qualitative and
affordable patient-centered health care services by motivated staff in a clean and hygienic
environment.” Its vision is “to be a leading provider of health care delivery services among its
contemporaries in the state, in pursuit of excellence, integrity and value for the contributions
made by all stakeholders.” Its goal is “to be the hospital of choice in Ibeju-lekki and its environs,
providing efficient secondary health care services comparable to what is obtainable in general
hospitals in urban centers in Lagos state, Nigeria.”
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Ibeju-lekki General Hospital, Akodo renders the following services; general outpatient
clinic, 24 hours accident and emergency services, ante-natal and post-natal care, obstetrics and
gynecology services, surgical care, laboratory services, radiological services, sonologic services,
pharmaceutical services, blood banking services, medical in and out patient care, HIV counseling
and testing services. Adult and pediatric ARV care, prevention of mother to child transmission of
HIV; and community and environmental health services such as child welfare, food
demonstration, immunization, family planning. This healthcare facility funds itself from stipends
patients pay to access healthcare services.
This health education cum communication practicum fits into both the mission and
purpose of Ibeju-lekki General Hospital, Akodo because it increased awareness and knowledge
of health issues that affect patient prognosis, diseases mortality and morbidity rates, and other
health indices. Generally, there is a dearth of education on health issues of public health concern
in this environment and the nation at large. Since the establishment of Ibeju-lekki General
Hospital, Akodo this was the first time it will have a public health physician educate patients and
their care givers on health issues that affect them. For example during health education sessions
on chronic communicable diseases such as diabetes mellitus and hypertension, I educated the
target audience on diabetic and hypertensive diets. Furthermore as a physician at this facility in
which majority of the target audience have earned my trust and respect over the years; I applied
all the appropriate theories, concepts, and knowledge I have learnt while in school in the last two
years to improve on my communication and listening skills; and I framed my health
communication sessions to appeal the “core values” of my target audience and position change in
their mind. Majority of my target audience showed willingness to adopt the desired health
behavior. This health education practicum enabled Ibeju-lekki General Hospital, Akodo provide
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quality patient-centered health care and preventive health care services to its patients. I bet these
health education sessions made Ibeju-lekki General Hospital, Akodo stand out amongst its
contemporaries in Lagos state, Nigeria and become the hospital of choice in Ibeju-lekki local
government area.
According to my colleagues and some of the nurses, the success of these health education
sessions was evident in the clinical outcome of majority of my target audience. Doctors have
been able to achieve better blood pressure and blood sugar control in hypertensive and diabetes
respectively and are recording better hospital attendance and lower emergency room presentation
of hypertensive and diabetic emergencies and urgencies respectively. Child welfare clinics are
recording more patient attendance during immunization days. So also are the family planning,
antenatal, booking, heart-to-heart, and post natal clinics. In the month of December 2014, the
president of the HIV/AIDS support group at the heart-to-heart clinic of Ibeju-lekki General
Hospital, Akodo wrote to the hospital’s management on behalf of the members of the support
group appealing to the hospital’s management to include in the treatment plan of people living
with HIV attending its clinic a minimum of a five hour health communication session monthly.
As a result of this request, my Medical Director asked me if he could attend my commencement
ceremony in Seward next year. I guess he is proud of me and how my health education practicum
has benefited our healthcare facility. He also advised me to submit my Masters in Public Health
– Health Policy and Administration certificate to our human resources department (the Lagos
State Health Service Commission) in order to be considered for a public health position in the
future. I politely turned down his advice because I want to pursue my dream of obtaining a PHD
in public health.
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Discussion
During these health education practicum sessions, I was the public health physician
delivering health communication to the target audiences. Activities I was involved in include;

Studying of the environmental needs of Ibeju-lekki general hospital, Akodo and
Ibeju-lekki local government area. This activity helped me decipher and decide
health issues of public health concern I needed to inform and educate my target
audience on and motivate them to adopt the desired health behavior.

Information dissemination (informing members of staff and patients/ target
audience of my activities; dates, topics, venues, and time.

Developing theories for the development, implementation, and evaluation of my
public health practicum session weekly.

Developing a communication strategy for each health education session I
conducted in order to ensure I met the goals of my health promotion practicum.

Conducting a process and an outcome evaluation measure for each health
education session I conducted in a bid to ensure that my health promotion
practicum resulted in a stronger intervention.

Thinking ahead and planning for how to manage any unintended consequence that
arose from each health education session.

Developing an action benefit statement for each health communication session I
conducted.

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Developing of a message appeal for my health education sessions weekly.

Framing the health education cum communication messages to appeal to my
target audience‘s “core values” of freedom, independence, autonomy, and control
and position change in their mind.

Distribution of fliers, handouts, and brochures to the target audience; and
answering of questions from the target audience.

Ensuring I got a role model (an individual who is already adopting the desired
health behavior but is very similar to the target audience) to mentor the target
audience at each health education session.

Informing and reminding my practicum supervisor of the need to be present at my
health education sessions in order to be able assess me adequately.

Reporting my daily activities to my supervisor.
Below is a table showing the days and dates the health education sessions were
conducted, the target audience that these health education sessions were administered to, the
number of hours in which these health communication sessions took place, and the public health
issues addressed.
Table 1:
Summary of public health promotion practicum conducted at the various clinics at Ibejulekki general hospital, Akodo.
Days
Dates
Hours
Target audience and venue in
Public health issue addressed/
which health communication
health education session
cum education session was
conducted
conducted at Ibeju-lekki
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general hospital, Akodo
1
27th Oct 5
Parents at the immunization
Health education session on the
2014
clinic at Ibeju-lekki general
essence of immunizing a child
hospital, Akodo
2
3
28th Oct 5
Patients at the HIV/AIDS
Health education session on
2014
(heart-to-heart) clinic at Ibeju-
modes of transmitting
lekki general hospital, Akodo
HIV/AIDS
29th Oct 5
Patients at the antenatal clinic
Health communication session
2014
at Ibeju-lekki general hospital,
on benefits of ante natal care
Akodo
for both the mother and the
baby.
4
5
6
30th
Patients at the HIV/AIDS
Health communication session
Oct
(heart-to-heart) clinic at Ibeju-
on the treatment of HIV
2014
lekki general hospital, Akodo
31st
5
Patients at the booking clinic at
Health education session on
Oct
Ibeju-lekki general hospital,
pregnancy
2014
Akodo
3rd Nov
5
5
2014
7
4th Nov
2014
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5
Parents at Ibeju-lekki General
Health education session on
Hospital Akodo’s
benefits of breast feeding a
immunization clinic.
child
Patients at Ibeju-lekki General
Health communication session
Hospital Akodo’s antenatal
on the need to have protected
clinic
intercourse (with the use of
barrier methods such as
condoms) even if one’s partner
is living with HIV.
8
5th Nov
5
Patients at the antenatal clinic
2014
Health education session on
benefits of having a post natal
check.
9
10
6th
Patients at Ibeju-lekki General
Health education session on the
Nov
Hospital Akodo’s family
benefit of planning one’s
2014
planning clinic.
family
Patients at Ibeju-lekki General
Health communication session
Hospital Akodo’s booking
on the right choice of food
clinic
while pregnant.
Patients at the medical
Health education session on
Nov
outpatient clinic at Ibeju-lekki
obesity
2014
general hospital, Akodo
7th Nov
5
5
2014
11
12
13
14
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17th
18th
5
Patients at the HIV/AIDS
Health communication session
Nov
(heart-to-heart) clinic at Ibeju-
on caring for oneself when one
2014
lekki general hospital, Akodo
is living with HIV
Patients at the medical
Health education session on
Nov
outpatient clinic at Ibeju-lekki
diabetes mellitus
2014
general hospital, Akodo
19th
20th
5
5
5
Patients at the HIV/AIDS
Health communication session
Nov
(heart-to-heart) clinic at Ibeju-
on prevention of mother to
2014
lekki general hospital, Akodo
child transmission of HIV
Patients medical outpatient
Health education session on
Nov
clinic at Ibeju-lekki general
hypertension
2014
hospital, Akodo
21st
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5
The goals and objectives of my health education practicum were to inform, educate, and
motivate my target audience to adopt the desired health behavior by positioning change in their
minds by applying theories, concepts, and knowledge I acquired in all my previous classes as a
Masters in Public Health – Health Policy and Administration student at Concordia University,
Nebraska. To develop a communication and social marketing strategy for these health education
sessions in order to ensure I meet the goals described above. To improve on my communication,
listening, and framing skills as a public health physician.
Certainly the goals and objectives of this practicum were appropriate in addressing the
public health issue of a dearth of health education and communication on health issues of public
health concern at both Ibeju-lekki General Hospital Akodo and Ibeju-lekki local government
area.
The only barrier I encountered during this practicum was basically language barrier
because of the level of literacy of some members of my target audiences. My familiarity with the
terrain in which I conducted my practicum was an advantage to me. I already anticipated this
barrier and I prepared well in advance to overcome it. I am aware that majority of the dwellers at
Ibeju-lekki local government area are from three ethnic groups and commonly speak three local
languages which are; Yoruba, Ibo, and Hausa. Other ethnic groups speak adulterated English
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called “pidgin English.” I am Yoruba and I speak and write the language fluently. I served as a
National Youth Service Corps member in Kano State, Nigeria several years ago where I picked
up sufficient Hausa language to enable me take a history from a patient and counsel the patient
effectively. I have not lost the little knowledge of the Hausa language I acquired then. However,
I was able to communicate to illiterate members of my target audience that could not speak
English language and were either Yoruba or Hausa or from other ethnic groups because I speak
and understand “pidgin English” as well. In order to ensure I did not leave the Ibos out, I
befriended an Ibo nurse who was on her annual leave and paid her a stipend to help me translate
English into Ibo and Ibo into English peradventure they had questions for me for the three weeks
in which I conducted my health promotion practicum. This worked very well for me and in the
process I picked up some Ibo words such as “bia” meaning come, “biko” meaning please, “kedu”
meaning how are you, and “odinma” meaning I am fine. Once in awhile I spoke these words to
my Ibo audiences when I interacted with them.
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Personal Assessment
This practicum has contributed in no small measure to my understanding of public
health practice. It enabled me master several concepts, theories, and principles that can be
applied to make health education and health communication programs effective. I have
realized the essence and significance of strategies such as health education, health
communication, and social marketing in promoting public health through behavioral change.
This practicum has stirred up in me a new desire to consolidate on my newly improved
communication, listening, and framing skills. All things being equal, I have decided to sit for
the exam that will qualify me to obtain a Certified Health Education Specialist certificate by
April 2015. This new interest was developed during this health promotion practicum.
During this health promotion practicum, I applied knowledge from several of the
courses I studied as a MPH student at Concordia University, Nebraska such as MPH 588
Marketing in Public Health, MPH 500 Fundamentals of Public Health, MPH 543 Leadership
and Organizational Management, MPH 525 Health Policy and Management, and MPH 515
Principles of Health Behavior. Also, the public health competencies applied during this
health promotion practicum include;

Public health sciences (Public Health Agency of Canada (PHAC), n.d).
I exhibited knowledge and skills related to behavioral and social sciences, environmental public
health, epidemiology, and the prevention of chronic and infectious diseases. I was able to
demonstrate knowledge of the health status of the population in the environment in which I
conducted my health promotion practicum, their determinants of health and illness, factors that
influence delivery and their use of health services, and strategies for health promotion and
disease prevention.
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
Public health assessment (PHAC, n.d).
I demonstrated my ability to recognize the existence of a public health issue(s) and determined
limitations to addressing these public health issues. I was able to recommend health education
cum communication program as an action to address the public health issue(s) recognized.

Public health policy program planning, implementation, and evaluation (PHAC, n.d).
I was able to plan, implement, and evaluate a health promotion program to address specific
public health issues. I also demonstrated an ability to set and follow priorities, and to maximize
outcomes based on available resources.

Communication (PHAC, n.d).
I was able to mobilize my target audience and communicate effectively to them benefits of
adopting desired health behaviors

Leadership (PHAC, n.d).
I was able to describe the mission, vision, and goals of my job and apply them to my health
promotion practicum. Also, I improved on performance standard at my job and enhance the
quality of the working environment.
This health promotion practicum enabled me improve the three Nigeria public health
system’s domains; health improvement, health services, and health protection. I conducted this
health promotion practicum in an interactive manner. This enabled me assess the knowledge
deficits of the public health issues I communicated to my target audience from the questions my
target audience asked, their contributions, and their willingness to adopt the desired health
behaviors. Also, I specifically addressed their knowledge benefits and I believe this not only
further endeared them to me; it will contribute in no small measure into improving both their
health status and clinical outcomes in the short and long run. Furthermore, I perceived that my
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interaction with my target audiences at the grass root level and the health promotion practicum I
conducted enhanced my in-depth understanding of my specialization area which is Health Policy
and Administration. With the knowledge and skills I improved on during this practicum, I
improved on my ability to develop and implement health and public health policies. I feel I have
become a better public health physician after all.
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Conclusions and Recommendations
In conclusion, there is a poor knowledge of diseases, the means of preventing it, and
attitudes towards preventing it amongst the community dwellers of Ibeju-lekki local government
area. This is attributable to the dearth of public health professionals in Nigeria and the lack of
political will to prevent diseases and promote public health. Hence, the Nigerian public health
system needs to empower itself, improve its personnel, and re-distribute both its resources and
personnel to focus on health promotion by effectively preventing both infectious and chronic
communicable diseases at Ibeju-lekki local government area and in the Nigerian society at large.
There is a need for the Nigerian public health system to develop and implement health
education and health communication programs tailored at environmental needs of each community
and aimed at promoting health and preventing disease in each community. The objective of the
nation-wide health promotion and disease prevention programs should be to focus on improving the
level of knowledge of both communicable and non-communicable diseases and means of preventing
diseases and promoting health amongst the population. The Nigerian public health system should
maximize its time and effort by ensuring funding towards these nation-wide health promotion and
disease prevention programs that focus on the deficits in knowledge amongst the population
specifically including the causes, treatment, and prevention of diseases. Development and
implementation of appropriate and effective health education, health communication, and social
marketing strategies to public health issues in this community and Nigeria as a nation will improve the
attitude of the public towards adoption of desired health behavior, disease prevention and health
promotion.
Also, the Nigeria public health system should strengthen its health promotion and disease
prevention efforts by using appropriate health education, health communication, and social marketing
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strategies. This can be achieved by developing and implementing nation-wide health care and public
health professional provider education courses on disease prevention and health promotion programs.
The objective of the health care provider education courses should be to teach health care providers
and public health professionals what to discuss with their patients or clients that are at risk of
developing chronic non communicable diseases, communicable diseases, how to counsel these at risk
population, and educate patients and or clients during clinic visits.
There should be a policy in place to ensure public health professionals are employed as health
educators at all government owned primary, secondary, and tertiary health care facilities to attend to
the health education and health communication needs of the population served by the health facility.
These recommendations will enable the Nigerian public health system bridge the gap on the
knowledge of diseases and willingness of the population to take measures to prevent diseases and
promote health.
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Reference
Public Health Agency of Canada. (PHAC). (n.d). Core competence for public health in Canada.
Retrieved from http://www.phac-aspc.gc.ca/php-psp/ccph-cesp/pdfs/zcard-eng.pdf
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Appendices
Appendix 1: October 27 handout on the essence of immunization.
Appendix 2: October 28 and 30 and November 4, 18, and 20 fliers on HIV/AIDS; treatment
of HIV, tips on how to care for oneself if one is living with HIV, modes of HIV transmission,
the need to have protected intercourse with a barrier method even if ones’ partner is living
with HIV, prevention of mother to child transmission of HIV, and the story of Bola (a mentor
mother).
Appendix 3: October 29, 31, and November 7 handout on pregnancy, benefits of ante natal
care for both the mother and the baby, and the right choice of food while pregnant.
Appendix 4: November 17 handout on obesity.
Appendix 5: November 19 handout on type 2 diabetes.
Appendix 6: November 21 handout on hypertension.
Appendix 7: November 3, 5, and 6 handout on breastfeeding, benefits of post natal check,
and benefits of family planning.
Appendix 8: My supervisor’s evaluation.
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