CHAPTER ONE

1.0 INTRODUCTION

1.1 Background to the study

Globally the job of community health services (CHWS) cover a broad range of activities such as
linking individuals to health care services, increasing awareness about health through outreach
advocacy, undertaking home visit, acting as intermediaries between the community and the
health professionals and helping to manage patients and the childbearing woman as to the
hazards and precautionary measure needed to observe in their communities (Shadish, Cook and
Leviton, 2014). Nigeria presently has the second highest absolute number of maternal deaths
and prenatal death (still birth and neonatal deaths) in the world (Oladele, 2015). One of the very
efficient means of stemming the tide of maternal mortality globally is Primary Health Care.
Primary health care as conceptualized by the Alma Ata declaration of 1978 is a grass-root
approach towards universal and equitable health care for all (World Health Organization-United
Nations Children Fund, [WHOUNICEF], 1978).

Nigeria is still at the first stages of the epidemiological transition; where preventable
complications of pregnancy and delivery result to several mortality and morbidity among
women and children in the country. The situation poses a threat in the nation’s effort at
achieving the SDGs. According to Egharevba et al (2016), there cannot be meaningful
development without good health and quality life. It is at the grassroots health care system that
we can be able to reverse the unacceptable but ever increasing maternal and child mortality in
Nigeria. While about one million children die each year before their fifth birthday, an estimated
52,900 Nigerian women die annually from pregnancy related complications out of a global total
of 529,000 maternal deaths. In fact, Nigeria needs immediate intervention to reduce her
unacceptably high levels of maternal deaths which is even grave in rural areas in Nigeria where
the health care system is poor and overstretched coupled with high level of poverty (Azuh et al
2017).

All through the country, patronage of health care services are worsened by knowledge of those
staggering maternal mortality statistics. In different rural communities and semi-urban

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settlement, most of the women in the community have their belief in traditional health care
delivery and find it unnecessary to attend any outreach and effective primary health care service
due to the bottle neck protocols coupled with their cultures and beliefs (Oladele, 2015).

Factors that discourage outreach and Primary Health Care attendance particularly among the
woman of childbearing age includes time and money constraints, the perceived necessity of
“giving birth on a hot bed, “the need for “mother roasting” after given birth, the belief that
preparing for was a bad omen for the birth, the belief that colostrum is unhealth for the new born
child and the preference for courting the umbilical cord with a pieces of sharpened bamboo
(Dairo and Owoyokun, 2010). According to Azuh et, al (2017) Positive attitudes about the
antenatal and outreach care services were found in some villages. The reason for some of those
attending these services is mainly to ensure safe health of both mothers and infants. Financial
difficulty was the major issue for women who did not attend any of the outreach programs or
primary healthcare services as recommended. Physical distance to health facilities and
aggravatedly poor road conditions (especially during rainy season) hindered women of child
bearing age in the community from receiving the so-called outreach services. In general, the
services of antenatal care were provided as recommended, the women of childbearing age in the
community believe that traditional birth attendants play strategic roles either during or post-
delivery, so their services were considered essential and were largely utilized in these
communities (Azuh et, al, 2017).

Some women in villages do not attend any outreach or PHC services even though the services
were made available at the village level. It is said that either financial difficulties limit the ability
of the women in the community to attend the outreach services (West, 2014). This finding is
confirmed by previous studies from developing countries, which demonstrated that communities
with low household wealth were more likely not to use healthcare services (Walker and Avant,
2010). Limited access to information, especially among those who had less frequent contact with
health providers or other village authorities, might be linked to a lack of understanding. The
services of traditional birth attendants for maternal and childcare have also been recognized for a
long time prior to the advent of the village outreach program and PHC services.

Even today, in some communities, traditional birth attendants’ services are highly utilized due to
just and everyday cultural practices in the community. This is also due to better access

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particularly in remote areas where traditional birth attendants outnumber the outreach centers and
PHC services centers. There is strong attachment to those attendants and their services, the
women also preferred the attendants in the event of an emergency during antenatal and postnatal
period. The direct cost of care in the primary healthcare centers was expressed by some of the
women as barrier, saying each time they go to the outreach for checkup, antenatal visits and
checkup, they have to pay for these services. All these put together are some of the factors that
put them off attending the outreach centers and PHC services. This study intend to find out
perceived factors associated with low patronage of health care services (outreach programs)
among women of child bearing age in the Ikorodu area

1.2 Statement of problems

Based on the observation of the researcher while attending to clients as a Community Health
Worker in the Ikorodu community, low patronage of women of child bearing age was observed
at the outreach centres linked to Primary Health Care centres in Ikorodu community. There
abound in the area other forms of health care which are unorthodox such as traditional birth
homes scattered all over the place.

Researcher interviewed some women and from their responses, researcher gathered that they
have little information regarding how to seek health appropriate health care services, as they do
could not distinguish between the types of available health care services made available by the
government. One of such health care services is the outreach programs. Researcher opined that
women of childbearing are not even maximizing the available primary health care services as an
option in maintaining their health not to talk of utilizing the outreach services made available to
them. Literature reports in the area concerning women patronage of health care services are
limited. Hence, directing an investigation into this could reveal perceived factors associated with
low patronage of health care services among women of child bearing age in the Ikorodu area of
Ikorodu local government of Lagos state.

1.3 General objective

The general objective of this study is to find out perceived factors regarding low patronage of
health care services (outreach programs) among women of child bearing age in the Ikorodu area
of Ikorodu Local Government Lagos state.

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1.4 Specific objectives

- To identify factors promoting proliferation of Traditional Birth Attendant Homes in Ikorodu

Community despite the presence of fundable outreach programs and effective primary health
care services.
- To examine the knowledge of women towards the role of the outreach program in primary
health care service in Ikorodu local government
- To document the perceived impact of health education conducted by the health workers on
women of child bearing age

- To assess ongoing effort of PHC centres aimed at improving patronage of outreach services
among

1.5 Research Questions

1. To identify factors promoting proliferation of Traditional Birth Attendant Homes in Ikorodu

Community despite the presence of fundable outreach programs and effective primary health
care services.
2. To examine the knowledge of women of childbearing age on the role of the outreach program
in primary health care service in Ikorodu local government

3. To document the perceived impact of health education conducted by the health workers on
women of child bearing age

4. To assess ongoing effort of PHC centres aimed at improving patronage of outreach services
among

1.6 Significance of the study

Finding from this study can be of tremendous value to women of child bearing age In Ikorodu
local government of Lagos state if made public by publishing as this can inform them of proven
ways by which health problems can be prevented through patronage of outreach health services.
Globally, Findings from this study can be of help in revealing current status of low patronage of
health care services on this side of the world especially in Ikorodu Local Government. Nationally,
findings from this study if published can be useful in drawing the attention of both governmental
and non-governmental organizations to the initiation of additional programs that will focus on

4
educating the populace on available health care services that can be utilized particularly among
women of child bearing age in Ikorodu local government and Lagos state as a whole. Findings
from this study may also serve as reference material for other researchers interested in the area of
health care service utilization in the nearest future.

1.7 Delimitation/Scope of the Study

The study was delimited to

1. Independent variable of (Perceived Factors) Dependent variable of (outreach services)

2. Women aged 20-45years

3. 150 respondents as sample from the population,

4. Self-developed questionnaire as instrument for data collection.

5. Selected communities in Ikorodu Local Government of Lagos state,

6. Frequency count, Percentages %, Tables and descriptive tools of bar charts as tools data

analysis

1.8 Limitation of the study

The research work was limited by the first lock down and movement restriction imposed on the
whole of Lagos state because of COVID-19 pandemic but researcher made use of essential
worker identity card to carry on with the study at times when movements was allowed.

Unwillingness to fill questionnaires was also a major limitation to the study as some of the
respondents were afraid to collect questionnaires forms but researcher motivated them by sharing
face masks and hand sanitizers to encourage participants of the study.

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1.9 Definition of terms

Childbearing: The process of giving birth to children

Outreach health program services: Any health services that mobilize health workers to provide
services to the population or to the other health workers, from the location where they usually
work or live.

Primary health care services: This is a broad range of basic health services provided by the
medical and other skilled professional health workers in the community.

Women of Childbearing age: Women of childbearing age in this study are women withing the
ages of 20 years to 45 years.

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 CHAPTER TWO

2.0 LITERATURE REVIEW

The chapter in view presents the literature review which encompasses the following important
captions.

2.1 Conceptual Review

What is an outreach health services

Types of outreach health services
Functions and features of outreach health services
What is an outreach programme
Benefits of outreach programme

Importance of outreach in the community

Outreach strategy plan template

How to implementing effective outreach services
The Concept of Primary Health Care (PHC)
Roles and function of Primary Health Care
Principles of PHC
Benefits of integrated health care services
Features of PHC

2.2. Empirical review

2.3 Appraisal of Review

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2.1 Conceptual Review

What is an outreach health services

This report presents an overview of outreach services provided by health workers to remote and
rural populations in different countries and contexts. It aims to highlight the potential for these
alternative health service delivery models, such as mobile clinics and telemedicine, to enhance
the attraction and retention of health workers in underserved areas and encourages further
evaluations to be conducted in this area. The term" outreach services” is used to describe any
type of health service that mobilizes health workers to provide services to the population or to
other health workers, away from the location where they usually work and live.

Outreach services are one of the possibilities to enhance access to health workers and to improve
overall retention at country level. Better mobilization of urban health workers to serve remote or
underserved areas is a strategy to improve access to health to the population in remote and rural
areas. This collection of case-studies (seven case-studies in the Annexes) illustrates different
physical or technology-based strategies that mobilize health workers from hospitals for outreach
services. A wide variety of players can provide outreach services: hospitals or health institutions,
professional boards, private companies, non-governmental organizations or government agencies.
This report also aims to engage policy- makers to adopt innovative approaches to attract and
retain health professionals in underserved areas.

Types of outreach health services

Community outreach programs vary greatly. They are commonly seen in organizations that have
a religious, social activist, health oriented purpose. Examples of groups that might conduct
community outreach programs are universities conducting a trial on a new contraceptive product.
The community outreach program would have a coordinator who would actively advertise,
recruit people to test the new contraceptive and record and analyze the data. Further, this
information could be used to plan programs to fulfill a need: contraceptives that young people
would use to prevent the transmission of HIV and AIDS.

There are types of community outreach programs. For example, if a church wanted to help
homeless women and their children find safe shelter, the church would hire a person to actively
organize a team to locate and identify homeless women and their children in their community.

8
By talking with these women, the organizer could identify what their most pressing needs were:
safe shelter, food, protection from violent ex-husbands and ex-boyfriends. The goals for this
particular community outreach program would be to raise funds to support a temporary shelter
for these women and their children. Other types include community outreach programs that are
based on health issues: teenage smoking or teenage drug use or teenage pregnancy. In each case,
the goal would be to identify the group of people, identify their needs, and design a program to
help them move out of harm's way by intervention, education and or even physically providing
safety.

Functions and features of outreach health services

The overriding function of most community outreach programs is to fulfill a goal. One group
might be charged with identifying the eating habits of teen girls with eating disorders. Another
group might be to locate runaway teens to bring them to safety or reunite them with responsible
family members. The function is to identify a specific demographic, study their needs
surrounding particular issues, and create a program to help them recover, learn or become self-
sufficient. Nearly every community outreach program has a lead outreach coordinator charged
with organizing volunteers and other staff to carry out the group's goals. These programs are
often funded by grants and may require that all the activities and outcomes be recorded in a
formal report to show the program's supporters that their money was used as intended. Many
programs rely on this kind of funding and may have to re-apply for their funding each year or
every few years. Reporting their activities ensures their programs continue and that people in the
program continue to have the help they need.

What is an outreach programme

Outreach programme is an activity of providing services to any populations who might otherwise
have access to those services. A key component of outreach is that the groups providing it are not
stationary, but mobile; in other words they are meeting those in need of outreach services at the
locations where those in needs are. In addition to delivering services, outreach has an educational
role, raising the awareness of existing services.Outreach is often meant to fill in the gap in the
services provided by mainstream (often, governmental) services, and is often carried out by non-
profit, non-governmental organizations. __This is major element differentiating outreach from

9
public relations. Compared with staff providing traditional services, Dewson et al. (2006) notes
that outreach staff may be less qualified, but are more highly motivated.

Rhodes (1996) distinguishes between three types of outreach: domiciliary (undertaken at

individual homes), detached (undertaken in public environments and targeting individuals), and
peripatetic (undertaken at public or private environments and targeting organizations rather than
individuals). Dewson et al. (2006) lists another type in addition to those three: the satellite type,
where services are provided at a dedicated site. Dewson et al. (2006) list the following tools of
outreach: leaflets, newsletters, advertising; stalls and displays, and dedicated events, with the
common location being local community institutions such as libraries, community centers, and
markets and so on. Compared with traditional service providers, outreach services are provided
closer to individuals residence, are voluntary, and have fewer, if any, enforceable obligations.
Outreach can target various populations, from sex workers and drug users, to museum goers. The
Jewish counter-missionary organization outreach Judaism describes itself as "an international
organization that responds directly to the issues raised by missionaries and cults, by exploring
Judaism in contradistinction to fundamentalist Christianity".

Benefits of outreach programme

The different experiences covered by this review show positive and encouraging health outputs.
Quantitative indicators, e.g. numbers of patients treated, are often collected, but the absence of
systematic reporting makes it impossible to measure the impact nationally. In these case-studies
in the annexes, there is no measurement of results expressed in terms of impact on countries'
burden of disease. At the local level, however, each of these activities has a positive health
impact on the communities which, in the absence of such interventions, would not have had any
access to care. Without larger-scale studies, it is not possible to estimate the potential impact of
outreach activities on health outcomes.

Furthermore, outreach strategies have an impact on care demand, which is limited by financial
and geographical factors; if those factors were partially removed, the demand for care would
increase. Outreach services can provide closer surveillance of the population, which would
improve the continuum of care and make collecting, retrieving and disseminating health
information more efficient and comprehensive. This contributes to disease surveillance and to
better health care management. The workload related to disease management can be better

10
shared between front- line workers and backup teams. Reaching out to the population can also
save a lot of time for health workers, while involving more people in participating in priority
health programmes.

Most developing countries lack specialists. This is particularly the case in remote or rural areas,
where front-line health centers are very often staffed only with nurses. Outreach strategies can
provide specialist visits to underserved populations. In some cases, specialists go to remote
facilities for short periods of time but on a regular basis. With virtual strategies, specialists are
consulted in a more rapid and interactive way and their advice increase the capacity of front-line
health workers. Furthermore, the continuous availability of qualified health workers, such as
provided by the telemedicine model, can enhance the referral system. Quick and direct
connection to a qualified health worker will allow the patient's referral needs to be better
identified. Conversely, if patients know that consultations with a qualified health worker are
available in the area, they may be encouraged to consult there before (or instead of) going to a
hospital.

This can increase the relevance of referrals and also reduce expenses to the population or delays
compromising health outcomes. Tele-assistance to front- line workers may increase the
immediate workload of health workers but it should also improve health outcomes.
Unfortunately, to date, documentation on tele-assistance has not fully assessed the impact on the
workload of both front-line and back-up health workers, and the impact on health outcomes.
Such an evaluation is a priority before scaling up this approach.

Without outreach activities, specialist competencies would not serve populations in remote areas.
These activities increase the effectiveness of front-line health workers and respond directly to
patients' concerns. Poor monitoring of human resource activities in facilities does not allow
either the measurement of the time allocated to these activities or the definition of evolutionary
trends in recent years. Outreach services can be used by policy- makers to reduce inequity in
access to care by inciting health workers based in well-served areas to dedicate part of their time
to underserved populations. To do this, it is necessary to improve human resource management
monitoring and evaluation tools.

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Importance of outreach in the community

Community outreach programs is an important vehicle for reducing the discovery-delivery

disconnect by bringing health education and Health screening services directly to community
members. Such programs are consistent with the priority areas of Trinity Care Foundation
initiatives for reducing health disparities. Outreach programs are important tools for bringing
health education and screening services directly to community members and serve to contribute
to reducing health disparities. They assist communities and hospitals to reach mutually beneficial
goals that would otherwise not be achievable for promoting accessible and equitable care.

Many developers of outreach programs are not aware of their audiences' literacy level as well as
the major cultural norms and boundaries that support or impede community members' behaviors
relating to screening, early detection and prevention. Thus, meeting the challenge of a strong
health disparities agenda in community outreach requires integration of culture and literacy in all
phases of intervention, communication and programmatic development.

Outreach strategy plan template

It's a good idea to establish an outreach work plan to help you structure and evaluate your
outreach efforts. Your staff members can use the work plan as a tool to ensure they stay focused
and on target with their activities. Remember, there are different ways you can develop an
outreach work plan, and people often use different terminologies to describe their plan.

Sample template:

Outreach Work Plan: List program or organizations' name-this is for the master work plan.

Outreach Staff Member Name: List the staff member's name this is the individual work plan

Goal: List what you planning to achieve during the work plan period.

Strategy: List overall strategy to achieve the goal above

Activities Timeline Expected Staff Measure of Status/

outcomes responsibilities effectiveness comments

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List tasks you Specify the List what you List who will List the Note if the
will perform timeline for hope to implement each indicators that activity is
include completing achieve with outreach will help you complete,
outreach each activity. your reach activity. measure and incomplete or
methods and activities. evaluate your in progress.
tools you will process and Its also
use. Add outcomes for helpful to
where and example, the specify if this
how you will number is a one time
conduct each events held activity or
activity (process) and ongoing.
the number of
calls received
(outcome).

2.7 How to implement effective outreach services

The following guidelines and strategies for outreach are adapted from Outreach Works. While
that program focused on health insurance coverage, many of the elements can be applied to other
health promotion and community development efforts.

Guidelines for effective outreach

 Meet people where they are

 Be respectful
 Listen to your community
 Build trust and relationships
 Get the word out in a non-stigmatizing manner
 Offer service and information in a variety of locations (including home visits) and at non-
traditional times, especially after work hours
 Make written information friendly and easy to understand

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  Provide information in the primary language of those who will use the service
 Follow-up, follow-up, follow-up!

Planning and implementing effective outreach

Depending on the nature of your initiative and the type of outreach you think is needed, consider
the following steps as you begin or expand your outreach. Determine the purpose and methods
of outreach for initiative

Determine staffing needs. If you use trained outreach workers, it helps if they come from the
community they work in and are familiar with its characteristics. Outreach workers can play a
vital role in developing community trust and a good reputation "on the street". Workers who live
in the community they serve will understand the needs, concerns, and questions of the people
they serve, and understand the barriers they face. They are better equipped to develop strategies
designed to address the specific needs of your population, especially in minority communities.

Whether your staff is paid or volunteer, they must be well-trained and knowledgeable. Provide
training through modeling by other workers experienced in outreach, time on the job, a formal
training program, supervised case review for education purposes, identifying resources for
keeping current and distance learning, internet access, or other innovative methods for workers
in rural or isolated areas.

Choose physical space carefully (if you need it). The location and feel of an outreach office sets
a tone. Look for a space that:

 Is on a major transportation line

 Is accessible to the disabled
 Has a private area for meeting with clients
 Provides a cheerful environment
 Accommodates children

Plan your services or activities. Develop strategies and action plans using principles for
effective program design.

14
If a local, national or international organization can provide resources or programming (such as
for breast cancer awareness week), take advantage of their materials and marketing. For an
outreach plan, organizational preparation should include:

 Developing systems and making information available in manuals or other formats

 Establishing protocols
 Integrating services with other organization or agencies to increase
 Effectiveness.

Consider potential partners. Partnering, of course, can influence your services or activities, so
this step might come earlier in the sequence for your effort. Again, depending on your purpose,
find people and organizations to work with as your allies. Identify their motivations (how they
will "profit") and work to develop win-win partnerships. Depending on your initiative and target
population, you can look for partners in:

 Community leaders
 Churches, synagogues, mosques, temples and other places of worship
 Hospitals (including emergency rooms)
 Health centers (including office staff such as medical secretaries'
 Doctors' office (including office staff and billing managers)
 Pharmacies
 Billing agencies that serve medical providers health-related clinics (such as immunization,
blood pressure, smoking cessation
 Visiting Nurse Associations
 Schools (nurses, counselors, health coordinators). This might require the initial support of
the superintendent, principal, or PTA
 Childcare centers and home daycare (including "unofficial care
 providers")
 Housing authorities
 Courts, police and public safety departments
 Local agencies or local offices of state or national associations that provide services to
your population

15
  Programs for those in need (shelters, job training, literacy programs'
 Local media (print, radio, TV, billboard)
 "Satisfied customers" of your services. Word of mouth is the best source
 of referrals

Expand your outreach gradually. There are many possible avenues for outreach, so new
outreach programs are wise to develop a prioritized strategy for raising awareness. The authors
of Outreach Works suggest a gradual Expansion of outreach by moving through” zones".

The Concept of Primary Health Care

At the outset it is an international philosophy that sees practical, scientifically sound, socially
acceptable and affordable healthcare as a basic human right.

As a clinical definition, PHC is regarded as the first point of contact that a person has with the
healthcare system (hence the services of a local clinic or day hospital would be regarded as PHC).
In a corporate sense, PHC is regarded as health care that people can afford or which is free. At its
most basic level though, for the person in the street, PHC is about having access to a doctor or
nurse and being assisted in the case of illness or disease.

The Alma Ata declaration, which is a seminal document providing not only a comprehensive
definition of PHC but also clear guidelines on government's responsibilities with respect to this,
defines primary health care as among others: Essential health care based on practical,
scientifically sound and socially acceptable methods and technology made universally accessible
to individuals and families in the community through their full participation and at a cost that the
community and country can afford to maintain at every of their development in the spirit of self-
reliance and self-determination. It forms an integral part both of the country's health system, of
which it is the central function and main focus, and of the overall social and economic
development of the community. It is the first level of contact of individuals, the family and
community with the national health system bringing health care as close as possible to where
people live and work, and constitutes the first element of a continuing health care process.

 World Health Organization. Declaration of Alma-Ata. Adopted at the International

Conference on
 Primary Health Care, Alma-Ata, USSR, 6-12 September 1978.
16
  Starfield, Barbara. "Politics, primary healthcare and health. "J Epidemiol Community
Health 2011; 65:
653-655 doi: 10.1136/iech.2009.102780

Roles and Functions of PHC

In the mid '80s the World Health Organization initiated the "Health Promotion" program
considered as an essential strategy in achieving the general objective "Health for all” -health
promotion for the population. Promotional and preventive measures require support from the
community, health politics and multisectoral approach.

Health sector has an essential role in health promotion and disease prevention. It requires
reorientation of work, education and financing towards these levels of prevention.

Primary health care (PHC) is an essential part of health care and its main principles are equity,
health promotion and disease prevention, community participation, appropriate health
technology and multisectoral approach.

Organizational and management key elements of PHC are strategic management,

decentralization, coordination and development of strategic systems.

The primary health care physician has a number of functions (World Health

Organizational 1971):

 To provide continuous and comprehensive care

 To refer to specialists and/or hospital services
 To co-ordinate health services for the patient
 To guide the patient within the network of social welfare and public health services
 To provide the best possible health and social services in the light of economic
considerations.
 Specific responsibility for the health of the community.

Primary health care staff is to be alert to the possibility of family problems.

Teamwork, usually involving health visitors, social work staff and community nurses, as well as
the doctor, is particularly essential in tackling simple family problems. Good communication

17
between members of the team is also essential, and visits to the family home and/or simple
family therapy with couples or family groups may be part of the team's strategy.

For more major problems, it is usually desirable to seek help from

specialist family therapists.

Full spectrum of medical services provided by PHC clinics

PHC clinics provide the full spectrum of health care services for patients of all ages.
Comprehensive services include: Behavioral Health. Chronic Disease Management.
Immunizations. Family Planning. Family Support Services. Nurse Care Management. OB/Gym
Services. Pediatric Care. Sick Care. Physicals. Well Checks

Goals and Principles of PHC

The ultimate goal of primary healthcare is the attainment of better health services for all. It is for
this reason that World Health Organization (WHO), has identified five key elements to achieving
this goal. Reducing exclusion and social disparities in health (universal coverage reforms);
Organizing health services around people's needs and expectations (service delivery reforms);
Integrating health into all sectors (public policy reforms); Pursuing collaborative models of
policy dialogue (leadership reforms); and Increasing stakeholder participation. Behind these
elements lies a series of basic principles identified in the Alma Ata Declaration that should be
formulated in national policies in order to launch and sustain PHC as part of a comprehensive
health system and in coordination with other sectors. Equitable distribution of health care -
according to this principle, primary care and other services to meet the main health problems in a
community must be provided equally to all individuals irrespective of their gender, age, caste,
colour, urban/rural location and social class Community participation - in order to make the
fullest use of local, national and other available resources. Community participation was
considered sustainable due to its grass roots nature and emphasis on self-sufficiency, as opposed
to targeted (or vertical) approaches dependent on international development assistance.

Health workforce development - comprehensive healthcare relies on adequate number and

distribution of trained physicians, nurses, allied health professions, community health workers
and others working as a health team and supported at the local and referral levels. Use of

18
appropriate technology - medical technology should be provided that is accessible, affordable,
feasible and culturally acceptable to the community. Examples of appropriate technology include
refrigerators for vaccine cold storage. Less appropriate could include, in many settings, body
scanners or heart-lung machines, which benefit only a small minority concentrated in urban areas.
They are generally not accessible to the poor, but draw a large share of resources. Multi-sectional
approach - recognition that health cannot be improved by intervention within just the formal
health sector; other sectors are equally important in promoting the health and self-reliance of
communities. These sectors include, at least: agriculture (e.g. food security); education;
communication (e.g. concerning prevailing health problems and the methods of preventing and
controlling them); housing; public works (e.g. ensuring an adequate supply of safe water and
basic sanitation); rural development; industry; community organizations (including Panchayats
or local governments, voluntary organizations, etc.).

In sum, PHC recognizes that healthcare is not a short-lived intervention, but an ongoing process
of improving people's lives and alleviating the underlying socioeconomic conditions that
contribute to poor health. The principles link health and development, advocating political
interventions, rather than passive acceptance of economic conditions.

- To support and raise awareness about the re-engineering of public health care;
- To strengthen demand and uptake of primary health care services;
- To facilitate greater community participation and monitoring of primary health care
services'
- To increase public awareness and demand for Thuthuzela Care Centers;
- To increase uptake and consistent use of dual method family planning; is also included in
CARMMA
- To support the Campaign for Accelerated Reduction of MATERNAL Mortality in Africa
(CARMMA)
- To increase knowledge of pending obstetric, neonatal and infant emergencies among he
general population in order to facilitate earlier presentation of such emergencies and
facilitate a reduction in maternal mortality in South Africa
- To increase knowledge of all aspects of PMTCT and particularly to

19
- Improve early attendance at ANC and follow-up of babies from the PMTCT programme at 6
weeks.
Community Participation

A classic definition was provided by Arnstein (1969) who described participation as a

"ladder" with the lowest rung as manipulation and the highest as citizen control. The concept
of participation in the area of health care has generally come to mean the involvement of
intended beneficiaries in improving health care. However, there is no standard acceptance of
what exactly participation means. It has been defined as activities undertaken by health
professionals to sensitize people about the need to be involved in health activities and
undertake local initiatives. It has been defined as having local people involved in decisions
about programs. It has been defined as organized efforts to have intended beneficiaries
manage and control health programs and activities. Given the wide diversity of definitions
that range from professionals telling people how to act to having people take full
responsibility for their decisions, it may be best to view participation as information sharing;
at the other there is empowerment. How participation is defined depends on the objectives of
planners who want to have participation in health programs. Community participation in
health a complex entity that has been extensively examined by a number of authors and
continues to be of great interest even today. The genesis of the idea and its conceptual
development are attributed to large multinational organizations particularly the World Health
Organization (WHO). Achieving community participation in health service delivery in
resource- limited but a high disease burden setting is not a simple task. Here the perception
of the general population is often that of a grossly inefficient formal health sector that has
simply failed to deliver. Additionally, that is not often sustainable in poorly resourced
developing countries. Alternatively, health service personnel may not be willing to involve
laypersons in the execution of health programmes, an act that they may view as a dilution of
their own expertise.

Intersectional Collaboration

In the health literature, the term inter-sectoral collaboration frequently refers to the collective
actions involving more than one specialized agency, performing different roles for a common
purpose. But the point must be made that multispectral actions are necessary but not sufficient to

20
constitute ISC. Thus, vertical but related multi-sectoral actions do not constitute ISC. The
coordination of efforts of sectors as an essential requirement for ISC is highlighted in the 1978
Declaration of Alma ATA, Article VII (4): (PHC) involves, in addition to the health sector, all
related sectors and aspects of national and community development, in particular agriculture,
animal husbandry, food industry, education, housing, public works, communications and other
sectors; and demands the coordinated efforts of all those sectors;

Article VII: All governments should formulate national policies, strategies and plans of action to
launch, and sustain primary health care as part of a comprehensive national health system and in
coordination with other sectors. To this end, it will be necessary to exercise political will, to
mobilize the country's resources and to use available external resources rationally. More recently,
the WHO promoted the concept of intersectional action for health (IAH) as "a recognized
relationship between part or parts of the health sector with parts of another sector which has been
formed to take action on an issue to achieve health outcomes (or intermediate health outcomes)
in a way that is more effective, efficient or sustainable than could be achieved by the health
sector acting alone". Being a recognized relationship suggests that IAH is a managed process.

The involvement of parts of sectors may be understood as pointing to the structural and
functional nature of the relationship, not just a conceptual one. Improved effectiveness,
efficiency and sustainability refer to the benefits expected from the relationship based on
specified roles and responsibilities played. For the purpose of this article, IAH may conveniently
be taken as synonymous with ISC for health. It must be borne in mind that the collaboration can
be between different departments and bodies within the government, between actors within and
outside government, such as civil society organizations, for-profit private organizations and
communities; all the actors may be outside the government.

Benefits of Integrated Health Care Services

Integration is a system of healthcare delivery. It is the coordination of general and behavioral

healthcare. It corporate mental health, primary care, and substance abuse services. This system is
complex, with many levels of care, screening, communication, and education. It produces the
best outcomes and proves to be the most effective approach in caring for people with multiple
healthcare needs. Integration at Spectrum Healthcare seeks to provide these services with high
quality, and ease of access.

21
  Integration creates a better healthcare experience for you
 Integration decreases the cost of healthcare delivery
 Integration promotes better health outcome

Equity

The first key principle in primary health care strategy is equity or equitable distribution of health
services. Health services must be shared equally by all people irrespective of their ability to pay
and all (rich or poor, urban or rural) must have access to health services. Currently health
services are mainly in towns and inaccessibility to majority of population in the developing
world.

Self-Reliance

Primary health care has many goals, but the most important is introducing the importance of self-
reliance to individuals. Individuals should know where health care starts, such as the home and
individuals become more self-reliant, they may use various alternatives to prevent disease and
promote a healthy lifestyle. Health services should be accessible, affordable, and acceptable to
all individuals who require. Typically, care providers are located in centralized urban areas that
most people can easily reach. Health services should also promote the use of traditional medicine,
such as essential vitamins and drugs.

Health care providers should provide the essential health services that are needed by the majority
of people in a particular area. This can include training based on the needs and priorities of the
local or regional community. Health care providers should also be monitored with periodic
evaluations in a community to rate their performance. According to WHO, traditional medicine
is used by approximately 80% of the people in Africa, and it is also widely used in Asia and
Latin America. Traditional healers take a more holistic approach to treating illness, and are
widely available in rural areas. This session will explore models to enrich these practices in
health settings.

The People's Charter for Health is a statement of shared vision, goals, principles and action and
is the most widely endorsed consensus document on health since the Alma Ata Declaration. The
People's Charter calls for the provision of universal and comprehensive primary health care and
"on people of the world to support, recognize and promote traditional and holistic healing

22
systems and practitioners and their integration into Primary Health Care". It is estimated that
there approximately 400 million Traditional Health Practitioners (THPs) around the world, often
providing access to health care in remote and rural areas. Apart from frequently being available
in areas with poor access to public health facilities (e.g. rural areas), traditional healers also treat
illnesses in a more holistic and comprehensive way, recognizing the relationship between the
environment, social circumstances, mental health and illness and disease.

Unlike institutionalized medicine such as western biomedicine, traditional health practice is

primarily healer or physician centered. Through non institutionalized training and oral
transmission, healers develop skills and utilize ways of knowing and validation which have
evolved from traditions.

Governments need to recognize traditional health systems in their entirety and create space for
oral transmission, to ensure that this knowledge is enhanced rather than lost. The practices of
THPs need to be fully legalized at an appropriate level of the health system.

Features of primary health care (PHC)

A strong primary health care system provides access to high quality care delivered by a team of
health professionals that meets the needs of patient and their families of all ages in any health
care setting.

Characteristics of PHC include:

 Patient/family centeredness, self-reliance and participation

 Community engagement and participation
 Health workers collaborating in inter-disciplinary teams
 Proactive Prevention Focus
 Integration and coordination of services
 Accessibility
 Better management of chronic conditions
 Localized set of choices
 Sustainability
 Multi-sector alignment and involvement

23
Primary health care is an essential health care based on practical, scientifically sound and
socially acceptable methods and technology made universally accessible to individuals and
families in the community through their full participation and at the cost that the community and
the and the country can afford to maintain at every stages of their development in the spirit of
self-determination.

Characteristics of the concept of primary health care (PHC)

1. Easily available and most essential health services: The service delivered within the
primary health care should be easily available and should meet the primary needs of the
mass. It does not include sophisticated and specialized service. In fact, the health services
which can be easily delivered to every individual come under primary health care.
2. Acceptable for the family and community: the services provided in PHC should be easily
acceptable to every individual and community. The traditional and illiterate community
like ours cannot easily accept any kinds of means and services. We can also change the
traditional thinking and attitude of the people and make PHC services acceptable to them
but it requires qualified manpower.
3. Wholesome Community Participation: In this system, communities are encouraged to
take the initiation in identifying their own health and social problem. Therefore, the
integration of curative, preventive and promotional health services are given in a unified
way by the participation of local mass.

Community and nation can bear the expenses: PHC service is based on local technology and can
be easily managed by the local people and community. It does not require more infrastructures
and complex technology which can be easily handled by the national economy. If the planning is
done to construct hospitals with modern technology in every village. It is very difficult to bear
the expenses by the state. It is almost impossible for national economy. But primary health care
system is cheaper and affordable to the people of community. The state also gets more benefits at
low cost

2.2 Empirical review

Previous literature has reported that utilization of health services strongly associated with
access to health services despite efforts to bringing health services closer to the community,

24
physical distance remains a major problems and has therefore enable the women lost complete
interest in attending any so called outreach programs or attend a primary health care services.
The remoteness from health facilities increase community members out of pocket expenditure
for transport cost. The opportunity cost lost due to travelling and waiting time were constrains to
the uptakes of services even though the outreach health services could be an option.

Empirical referents are the final step to defining a concept’s attribute. They are classes or
categories of actual phenomena that consider the following questions: “If we were to measures
this concept or determine the existence in the real world, how would we do it, (Walker and
Avant, 2010: p.168). The present study identified the empirical indicators for each attributes of
the community health outreach. First, intervention strategies for achieving the project goals were
identified as empirical indicators of purposeful intervention. For instance, the aim of the project
was to probe into the “perception of the women of childbearing age in Ikorodu Local
Government towards outreach programs in effective primary health care services” through
personal and community – level activities. Secondly, specific operational periods serve as
empirical indicators to the attributes of temporality. Such an outreach programs aimed at
improving maternal health has been operating for years in Nigeria.

Thirdly, moving towards the targeted population serves as an empirical indicator towards
mobility. For instance, the outreach staff that render help for the project to be actualized went to
certain places, such as streets, markets, religious places and so on to meet the targeted audience
of women of childbearing age and the nursing and pregnant mothers to educate them on the
importance of outreach programs and to seek their opinion on their believes towards the program.

Fourth, collaboration with community was identified as community participation, expressing

collaboration with some women groups called “Egbe orogun”, “Egbe odobirin” “the Alasalatu”
etc. within the community to get more study participant and provide intervention more
effectively.

2.3 Appraisal of literature review

To be effective, outreach must entail something more collaborative or participatory than one
organization venturing into the community. Evaluation, like the outreach itself, must also engage
other stakeholders in deciding what is important to accomplish, what community resources to

25
combine with health information, and how to measure whether outreach is effective. This study
considered whether outreach is effective and how findings about outreach effectiveness are used.
The following were found out concerning outreach; what is an outreach health services. Types of
outreach health services. Functions and features of outreach health services. What is an outreach
programme. Benefits of outreach programme. Importance of outreach in the community.
Outreach strategy plan template. How to implementing effective outreach services. The Concept
of Primary Health Care (PHC). Roles and function of Primary Health Care. Principles of PHC.
Benefits of integrated health care services. Features of PHC

26
 CHAPTER THREE

3.0 METHODOLOGY

This Chapter considered methodology used for this study under the following sub headings:

3.1 Research Design

3.2 Research Setting

3.3 Study Population

3.4 Sample and sampling technique

3.5 Research Instrument

3.6 Data Collection

3.7 Validity and Reliability

3.8 Data Analysis

3.1 Research Design

Descriptive survey research design was used for this study; this design was selected because it

involves a clear definition of the problem, collection of relevant and adequate data, interpretation

of the data and skillful reporting of the findings.

3.2 Research setting

The study setting is in Ikorodu community in Ikorodu division of Lagos state. Ikorodu is
situated at a distance of approximately 36km North of Lagos. The term is bombed in the south by
the Lagos. In the North, Ikorodu share common boundary with Ogun State. While in the East, it
has common boundary with Agbowa Ikosi a town in Epe division of Lagos State. In identifying
some of which are today called “itun”, Each itun has an exist boundary. There are about sixteen
or seventeen “itun” in Ikorodu. Examples are: Itunmaja and it is inhabited by people mainly from
Idowa, an important Ijebu town, Itunwaiye, was occupied by people from Iraiye (Iwaye) in Ogun
state, Remo and people of Itun Ojoru, are from Igbrin of Egba etc. There are three principals in
Ikorodu namely:

27
 (i) Ishei
(ii) Ijomu
(iii) Aga.

The Ituns: (minor areas), The Itas (squares). Ikorodu in the last 40 years or so, did not extend
beyond the inner circular route, Ojubade, Etunrenren, Epadi, (Ayangburen Road), Ojuogbe,
Ireshe, Eluku Street, Ojubode Street, Ojubode Orere garage (m Oriwu Hotel), Lagos road.
Ikorodu Township has now metamorphosed into a metropolis over a million people. Therefore,
Ikorodu has now extended to Agatitun, Agbele, Erunwen, Solomade, Eyita, Agbala, Lowa,
Gbasemo, Okeotaona etc. It has again extended to greater Ikorodu by the creation of Ikorodu
West Development Area with Owutu as the Administrative Headquarters which comprises of
Ipakodo, Otowolo, Oriokuta, Ajaguro, Ogolonto,Araromi,- Solebo, and Ikorodu North Local
Government Area, with the Administrative Headquarters at Isiu, and includes Odogunyan,
Odonla, Odokekere, Okegbegun, Rofo, Lasunwon, Agbede, Losioba, Erikorodo, Araromi,
Mojoda, Oke ogbodo, Laiyeode/Akaun, Liadi, Maya, Parafa, Adamo, Aleke etc. Surroundings
major towns that makes 16 up Ikorodu division are Imota, Ijede, Igbogbo-Bayeku and all these
major towns constitutes their Local Government Development Areas, with their respective
traditional rulers (Oba).

3.3 Population of the study

The population for this study comprised of women of Child bearing age in Ikorodu local

government of Lagos State.

3.4 Sample and Sampling Technique

110 women of child bearing age was selected as sample for this study, a multi –stage sampling

method was employed for this study, at stage one, simple random sampling technique was used

to select 5 populated communities in Ikorodu Local Government Area. At stage 2, 22 women of

child bearing age were selected randomly again in each of the areas to make a total of 110

women of child bearing age study respondents for the study.

28
 Selected PHC Centre’s No of respondents
Igbo Olomu 22

Oriokuta Ikorodu 22

Majidun Ikorodu 22

Ipakodo Ikorodu 22

Itaelewa Ikorodu 22
total = 110

3.5 Research Instrument

The instrument for data collection used for this study was a researcher’s designed questionnaire
which was divided into four sections: Section A sought information of demographic
characteristics of the respondents: Section B was based on Knowledge of women towards the
role of the outreach program in primary health care service in Ikorodu local government.
Perceived factors associated with utilization of outreach services: Perceived impact of health
education conducted by the health workers on women of child bearing age And effort of PHC
centres aimed at improving patronage of outreach services among

3.6 Validity of the instrument

Validity is the process of ensuring that an instrument measures what it is designed to measure. In
other to ensure the validity of the instrument items, in terms of clarity, appropriateness of the
language expression and accuracy of word, a draft of the instrument was given to the study
supervisor in the Primary Health Care Tutors Course Department, UCH Ibadan. Her comments
and corrections were used to improve face and content validity of the instrument.
3.7 Reliability of the instrument

Reliability is the consistency of a measure to yield the same result over a period of time. The
reliability of this instrument will be carried out using test-retest technique through pilot study.
Twenty copies of the questionnaire was given to twenty respondents attending Primary Health
Care Centres in Osodi Local Government who are not part of the study but share the same
characteristics with the intended respondents for this study and their twenty copies were re-
administered to the same respondents at interval of two weeks. The result of the first and second

29
administration was compared using Pearson Product Moment Correlation Co-efficient statistical
analysis. A reliability result of the correlation co-efficient that fell between r = 0.60 - 0.90 was
adjudged to make the instrument reliable.

3.8 Data Collection

On the days slated for data collection by the researcher, researcher approached the PHC
coordinator of the Local Government with a letter from the school in other to obtain permission
to retrieve data from mothers attending PHC centres in the Local government, after obtaining
approval from the PHC coordinator the researcher with 4 trained research assistants proceed to
the that were selected randomly for the study to meet with potential respondents of the study and
to administer the questionnaires drafted for the study, researcher and assistants ensured that
questionnaires are retrieved on the spot to ensure high retrieval rate.
3.9 Data Analysis

Descriptive statistics of frequency count and percentages was used to analyze the demographic
characteristics of the respondents and research questions drafted for the study, tables and
descriptive tool of pie chart was used to present the results of analysis using the Statistical
Package for the Social Sciences version 20.

3.10 Ethical Issues

A Formal letter was collected from the Primary Health Care Tutors Course, UCH Ibadan,
specifying the researchers name and topic; the letter was taken to the Baale of the communities
in Ikorodu Local Government. Each questionnaire specify non-inclusion of name and personal
information of respondent as that helped in maintaining confidentiality of respondents’
information.

30
 CHAPTER FOUR

4.0 DATA ANALYSIS AND PRESENTATION

Introduction
This chapter is a presentation of data obtained from the fieldwork. It comprises three sections;
which are the Socio-Demographic attributes of respondents, negative and positive perception of
child bearing age women about the role of PHC and discussion of findings. One hundred and ten
questionnaires were distributed and all were retrieved. Analysis and interpretation is based on
these three sections including the Socio-Demographic attributes of the respondents.

4.1 Analysis of the field data from the respondents’ responses

Section A: Analysis of Socio-Demographic Attribute Data of Respondents

This section examines the Socio-Demographic attributes of respondents such as their age, marital
status, and marital type, religion, ethnic group, and educational level, types of occupation and
status of income.

Table 1: Age range of Respondents

Age Range (years) Frequency Percentage %

19-25 10 9
26-35 25 23
36-40 50 45
41-49 25 23
Total 110 100
Table 1 above shows the age distributor of the respondents used for this study. Out of the total
number of 110 respondents, 10 respondents which represent 9 percent of the population are
between 19-25years. 25 respondents which represent 23 percent of the population are between
26-35years. 50 respondents which represent 45 percent of the population are between 36-40years.
25 respondents which represent 23 percent of the population are between 41-49years.

Table 2: Marital Status of Respondents

Marital Status Frequency Percentage %

Single 26 24
Married 52 47

31
Cohabitation 22 20
Separated 10 9
Total 110 100

Table 2 above shows the marital status of the respondents used in this study. 26 which represent
24 percent of the population are single. 52 which represent 47 percent of the population are
married. 22 which represent 20 percent of the population are cohabiting. 10 which represent 9
percent of the population are separated.

Table 3: Religion of the Respondents

Religion Status Frequency Percentage %

Christian 60 55
Moslem 40 36
Tradition 10 9
Total 110 100

Table 3 shows that the respondents have higher % of Christian 60 which is 55% of the
respondents’ population, Moslem are 40 which is 36% of the respondents’ population, while
Traditional religion accounts for 10 respondents representing 9%. the higher % of the Christian
might be due to the study centre.

Table 4: Types of Family of the Respondents

Types of Family Frequency Percentage %

Nuclear 53 48
Extended 40 36
Joint 17 15
Total 110 100
In the table 4 above, it shows the family background of the respondents. From the total

population, 53 respondents representing 48% were from nuclear family, 40 respondents

32
representing 36% lives with their extended family while the rest of the respondents were from

joint family (17 respondents representing 15%).

Table 5: Educational Status of the Respondents

Educational Status Frequency Percentage %

No formal education 18 16
Primary 32 29
Secondary 40 36
Graduate 20 18
Total 110 100

Table 5 above shows the educational background of the respondents used for this study. Out of

the total number of 110 respondents, 18 respondents which represent 16 percent of the

population have no formal education. 32 which represent 29 percent of the population only had

primary education. 40 respondents which represent 36 percent of the population were secondary

school graduate. 20 which represent 18 percent of the population graduated from higher school

of learning.

Table 6: Ethnicity of the Respondents

Ethnicity Frequency Percentage %

Yoruba 70 64
Hausa 5 5
Igbo 20 18
Others 15 14
Total 110 100
Table 6 shows that the respondents have higher % of Yoruba tribe are 70 which is 64% of the
respondents’ population, Hausa tribe are 5 which is 5% of the respondents population, Igbo tribe
are 20 which is 18% of the total population while others tribes are part from the three major
tribes accounted for 15 respondents representing 14%.

33
Table 7: Occupation of the Respondents

Occupation Frequency Percentage %

Unemployed 19 17
Employed 55 50
Self-employed 15 14
Full House wife 21 19
Total 110 100

Table 7 above and fig. 7 below revealed the employment status of the respondents. Out of the

total number of 110 respondents sampled, 19 respondents which represent 17 percent of the

population were unemployed, 55 respondents which represent 50 percent of the population work

with an organization, 21 of the respondents representing 19 percent are completely housewife

while the rest 15 respondents representing 14 percent were self-employed.

Table 8: Family Income of the Respondents

Family Income Frequency Percentage %

<10000 5 5
10,000-20,000 32 29
21,000-40,000 53 48
>40,0000 20 18
Total 110 100

Table 8 above and fig. 8 below shows the gross income of the respondent used for this study.

From the data analyzed, out of the total number of 110 respondents, 5 respondents which

represent 5% of the population earn less than 10,000, 32 respondents which represent 29% of the

population received 10,000-20,000 as income, 53 respondents which represent 48% earn 21,000-

40,000. It can then be concluded that the majority of the population (90 respondents) earn or gets

low income

34
Section B: Negative Perception about the Role of PHC
Table 9: Physical accessibility factors
S/No Items SA A SD D
9 Poor road networks 30 (27%) 50 (45%) 10 (9%) 20 (18%)
10 Difficulty in getting transportation 50 (45%) 30 (27%) 5 (5%) 25 (23%)
11 Due to a far distance to a health facility 49 (45%) 32 (29%) 11 (10%) 18 (16%)
12 Uncertainty about the facility being open
61 (55%) 28 (25%) 3 (3%) 18 (16%)
for patients at all time was a problem

The data analysis from table 9, revealed the perception of child bearing age women towards

primary health centers as majority of the respondents with 72%, 72%, 74% and 80% respectively

agreed with the facts that poor road networks, difficulty in getting mobility to the health center,

and due to a far distance to a health facility from their place of residence, and uncertainty about

the facility being open for patients at all-time resulted to a situation where the child bearing age

women lost interest in attending PHC and decides to use traditional birth alternative that were

closer to them. It can then be concluded that most of the sampled respondents within the study

area have a wrong perspective towards using PHC for their medical needs.

Table 10: Quality of care

S/No Items SA A SD D
65 16 10 19
Provider competence
13 (59%) (15%) (9%) (17%)
50 30 25
The unfriendly attitude of providers 5 (5%)
14 (45%) (27%) (23%)
71 18 13
Fear of providers and preference for home/TBAs 8 (7%)
15 (65%) (16%) (12%)
Inadequate providers and necessary drugs in the 47 32 13 18
16 facility (43%) (29%) (12%) 16%)
Long procedures in registration even during an 58 31 17
4 (4%)
17 emergency (53%) (28%) (15%)

35
 Inappropriate referral to private facilities owned 61 28 18
3 (3%)
18 by the matrons who work in the PHC facilities (55%) (25%) (16%)
Drugs are sold at rates higher than the 49 32 11 18
19 conventional price (45%) (29%) (10%) (16%)
32 11 49 18
PHC environment/facilities
20 (29%) (10%) (45%) (16%)

Table 10 shows that 81 respondents representing 74% out of the sampled respondents revealed

that some of the health workers there are not competence enough to take delivery, it was also

noted that 80 (72%) respondents avoid using PHC because of the unfriendly attitude of the

providers. 89 respondents representing 81% said they prefer TBA than PHC because of the fear

of the providers at primary health center, coupled with the fact of the wasting of time as a result

of long procedures during registration even at the period of emergency and sudden referral to

private facilities owned by the matrons who work in the PHC facilities for their own gain.

However, 67 (61%) agreed that the environment and facilities are standard but their drugs are too

expensive, this was supported by 81 respondents representing 74%. Despite the quality of service

available at PHC within the study area, the age child bearing women had negative opinion

towards PHC.

Table 10: Cost of care and others

S/No Items SA A SD D
64 25 11 10
21 High cost of care compare to traditional birth care
(58%) (23%) (10%) (9%)
Informal payment or demand for materials that is 69 15 15 11
22
unofficial (63%) (14%) (14%) (10%)
55 21 11 23
23 Lack of female health workers
(50%) (19%) (10%) (21%)
54 35 12
24 Minimal or no support from the husband 9 (8%)
(49%) (32%) (11%)
Source: Personal Field Survey, 2020

36
From table 10, it is obvious that majority of the respondents 81% and 77% are not making use of
PHC because of the cost, unnecessary payment or unofficial demands on materials things
respectively compared to traditional birth care. Most of the respondents 76 representing 69% are
not comfortable seeing a male health worker attending to them as a result of no female health
workers on ground. Also 79 respondents representing 81% prefer patronizing traditional birth
care due to the fact that there were minimal or no support from their husband to attend PHC. It
then means that cost of cares and other arising issues the respondents are getting from the PHC
had made the child bearing age women to have biased mind against the role of PHC.

Section B2: Table 11: Perception about the Role of PHC

S/No Items SA A SD D
64 25 11 10
25 It reduces the rate of mortality compare to TBA
(58%) (23%) (10%) (9%)
The PHC provided facility is far better than of 50 30 25
26 5 (5%)
TBC (45%) (27%) (23%)
70 11 19 10
27 Standard treatment after child birth
(64%) (10%) (17%) (9%)
Stand by equipment and mobility in case of 47 34 20
28 9 (8%)
emergency (43%) (31%) (18%)
Availability of various seminar on child bearing, 60 20 13 17
29
antenatal, child nutrition etc. (55%) (18%) (12%) (15%)

Table 11 analysis shows that majority of the respondents 81 (74%), 81 (74%) and 80 (73%)

agreed that those PHC within the study center has standard treatment after child birth, available

stand by equipment and mobility in case of emergency coupled with various seminar on child

bearing, antenatal, child nutrition respectively. The study also revealed that the PHC provided

facility is far better than that of TBC and this in turn reduced the rate of mortality compare to

TBA as it was attested by 80 (73%) and 89 (81%) respondents respectively. Despite this positive

opinion of the respondents toward the role of PHC, the age child bearing still prefer to attends

TBC because of the proximity, cost and friendly atmosphere given to them.

37
 CHAPTER FIVE
5.0 DISCUSSION OF FINDINGS SUMMARY, CONCLUSION AND
RECOMMENDATIONS

5.1 DISCUSSION OF FINDINGS

The results of this study identified diverse reasons with detailed explanations in respect to the

perception of age child bearing towards the role of PHC as to why women do not use PHC

facilities for pregnancy care in the study center. The reasons proffered can be broadly

categorized into 1) accessibility factors – poor roads, difficulty with transportation, long

distances to PHC facilities and that the PHC centres are not always open; 2) perceptions relating

to poor quality of care in PHC centres, including inadequate drugs and consumables, abusive

care by health providers, providers not in sufficient numbers and not always available in the

facilities, long waiting times, and inappropriate referrals; 3) unfriendly attitude of the health

workers; and 4) high costs of services, which include the inability to pay for services even when

costs are not excessive, and the introduction of informal payments by staff.

5.2 CONCLUSION

The results of this study have implications for health systems reforms for the prevention of

maternal mortality in the country. Low skilled birth attendance, especially in rural communities,

is currently the most important challenge facing Nigeria in efforts to reduce the currently high

rate of maternal deaths and neonatal mortality. The use of PHC offers the best opportunity to

increase the access of rural women to skilled pregnancy care. However, the evidence from this

study suggests that rural women will not use PHC for pregnancy care if they cannot physically

access the health facilities, if the PHC centres offer low quality and non-respectful care if the

38
cost is not affordable and partner support is lacking or minimal. Clearly, policies and

programmes based on the revitalization of PHC through adequate budgetary allocations and good

development planning that target these barriers are critical if the country desires to improve

women’s access to skilled pregnancy care and reduce the number of maternal deaths. The utmost

goal of every one seeking health care service is to get the best that will put them in a state of

optimal health. Health is defined as a state of complete physical, mental and social wellbeing of

an individual and not merely absence of disease or infirmities (WHO, 2014). The childbearing

woman is not left out in this desire hence, the choice of health institution they perceive as

favorable to them is important not minding the proximity of the undesired health care facility.

Contributing to body of knowledge is the fact that every nurse should maintain positive

therapeutic interpersonal relationship with their clients. The clients need quality service and

attitudes of the staff toward them are seen by most as an important factor in influencing their

choice. A smile will go a long way to impact positively as non-verbal communication is an

important aspect the nurse/midwife should never neglect. More so, government can intervene by

making training of personnel a standardized one to make sure that all staff are competent to carry

out effectively the task that may be required of them and there is need for more greater

deployment of health workers with midwifery skills in poor and rural areas not just the big cities.

Provision of adequate functioning medical equipment to the primary health care centres will be a

motivating factor for childbearing women's use.

5.3 RECOMMENDATIONS

The study recommends that managers of this health institution put in place programs and

schemes that will facilitate more effective service delivery especially in relation to the workers in

this health sector. In addition, orientation programs lauding the benefits of the PHC facilities to

39
correct wrong opinions about PHC among local communities and creation of good access routes

that link primary health centers to the communities should be on the priority list of the managers

of PHC to enhance utilization of services. Health care workers especially midwives and nurses

should accord each client unique care as required; the government should ensure adequate

funding of the primary health centers for provision of necessary facilities and make health

accessible to everyone at the grass root level; the government should create a forum for women

of child- bearing age who are in dearth need of the services of the tertiary health institutions

following complications at subsidized rate especially when they cannot afford it.

40
 REFERENCES

Azuh, D. E., Azuh, A. E., Iweala, E. J., Adeloye, D., Akanbi, M., & Mordi, R. C. (2017)..
Factors influencing maternal mortality among rural communities in southwestern Nigeria.
International Journal of Women’s Health, 9, 179–188

Dairo M, Owoyokun K. (2010). Factors affecting the utilization of antenatal care services in
Ibadan, Nigeria. Benin Journal of Postgraduate Medicine. 2010; 12(1):3–13.

Egharevba, M. E. and Eguavoen, A. and Azuh, Dominic E., Iruonagbe, C. T. and Chiazor, A.I.
(2016). Microfinance and Poverty Reduction Strategy for Promoting National
Development: The Challenge of Social/Financial Inclusion. The Social Sciences, Vol.11
(22), 5373-5386.

Federal Government of Nigeria (2013). Integrating primary health care governance in Nigeria
(PHC under one roof). Abuja: implementation manual: National Health Care Development
Agency; 2013.

Hounton S, Chapman G, Menten J, et al. Accessibility and utilisation of delivery care within a
skilled care initiative in rural Burkina Faso. Tropical Medical International Health. 2008;
13(s1):44–52.

Kakaire O, Kaye D.K, Osinde M.O., (2011) Male involvement in birth preparedness and
complication readiness for emergency obstetric referrals in rural Uganda. Reproductive
Health. 2011; 8(1):12.

Katung P. (2000). Socio-economic factors responsible for poor utilization of the primary health
care services in a rural community in Nigeria. Nigerian Journal of Medicine. 2000;
10(1):28–9.

Ntoimo L, Okonofua F, Gana M, (2018). Prevalence and risk factors for maternal mortality in
Nigerian referral hospitals. International Journal of Women’s Health. 2018; 10:69–76.

Oladele Tomike (2015). Health care utilization among rural women of child-bearing age: a
Nigerian experience. Pan African Medical Journal. 2015; 20:151.
https://doi.org/10.11604/pamj/ 2015.20.151.5845

Shadish, M., Cook, R., and Leviton, S., (2014). Overcoming barriers to health service access:
influencing the demand side. Health Policy Plan.19 (2):69–79.
https://doi.org/10.1093/heapol/czh009

Milbank Q, (2013). Societal and individual determinants of medical care utilization in the United
States. Health care Aborigine 2013; 83(4):1–28.

41
Tayler-Smith K, Zachariah R, Manzi M, et al.(2013). An ambulance referral network improves
access to emergency obstetric and neonatal care in a district of rural Burundi with high
maternal mortality. Tropical Medical International Health. 2013; 18(8):993–1001

Walker, F and Avant, W,(2010). Utilization of health care services by pregnant mothers during
delivery: a community based study in Nigeria. Journal of Medical Science. 2010;2(5):
p.168

West J, (2014). Overcoming barriers to health service access: influencing the demand side.
Health Policy Plan. 2004; 19(2):69–79. https://doi.org/10.1093/heapol/czh009.

World Health Organization and UNICEF (1978). Declaration of Alma-Ata: Adopted at the
International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978.

Yargawa J, Leonardi-Bee J. (2015). Male involvement and maternal health outcomes: systematic
review and meta-analysis. Journal of Epidemiology Community Health. 2015.
https://doi.org/10.1136/jech-2014-204784.

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 APPENDIX i

PRIMARY HEALTH CARE TUTORS COURSE

FEDERAL TRAINING CENTRE FOR TEACHERS OF HEALTH SCIENCES
UNIVERSITY COLLEGE HOSPITAL, IBADAN OYO STATE

Dear respondents,

I am a student of the above-named institution carrying out a research work on the topic
“Perception of women of childbearing age in Ikorodu Community towards the role of outreach
program in an effective Primary Health Care service”.

This questionnaire is designed to seek opinion on these questions. I hereby need your
cooperation to give honest answers as all information provided will be treated with utmost
confidentiality and will be used for the purpose of the study only. You are therefore requested to
provide accurate information.

Your identity is not required.

Folarin Kehinde Afolake Iretimi

(Demographic Characteristics)

INSTRUCTION: Please Tick (√) the appropriate response.

1. What is the highest level of school you completed

Primary [ ]
Secondary [ ]
Diploma [ ]
Degree [ ]
None [ ]
2. How old are you now
18 – 24 [ ]
25 – 34 [ ]
35 – 44 [ ]
45 – 49 [ ]
43
 3 What is your sex
Male [ ]
Female [ ]
4 What is your religion
Christianity [ ]
Islam [ ]
Traditionalist [ ]
Other (Specify) [ ]
5 What is your marital status?
Single [ ]
Married [ ]
Divorced [ ]
Widow [ ]
Separated [ ]
Don’t want to talk [ ]
6 What is your occupation?

Trading [ ]

Civil servants [ ]

Self Employed [ ]

Unemployed [ ]

Other Specify [ ]

7 What is your Ethnic group

Yoruba [ ]

Igbo [ ]

Hausa [ ]

Other specify [ ]

44
8 How long have you been in this community?

1–5 [ ]
6 – 10 [ ]
11 – 15 [ ]
16 – 20 [ ]
21 - 25 [ ]
26 - 30 [ ]

2 Have you ever given birth before?

Yes [ ]

No [ ]

3 If answer (2) above is yes, how many children have you

1–5 [ ]

6 – 10 [ ]

4 At what age did you start bearing children

18 – 22 [ ]

23 – 27 [ ]

28 – 32 [ ]

33 – 37 [ ]

38 – 42 [ ]

5 Do you know any outreach center or PHC close to your area

Yes [ ]

No [ ]

6 How often do you attend the outreach program or PHC?

Often [ ]

45
 Rarely [ ]

Not sure [ ]

7. If answer in (6) above is rarely, can you give reasons why you rarely
attend ……………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
……………………………………………………………………………………. ………
………………………………………………………………………………………………
…………………………………………………
8. If answer in (6) above is often, how do you perceived the services provided by the health
workers at the outreach centers.

Satisfactorily [ ]
Unsatisfactorily [ ]
Don’t want to talk [ ]
9. What are your belief\ perception towards the role of the outreach programs in your
community
Very Strong [ ]
Strong [ ]
Have no believe [ ]
Undecided [ ]
10 What are the constrains that make you have a negative perception in the organized outreach
Bad roads leading to the centers [ ]
Financial constrain [ ]
Unfriendly attitude of the health workers [ ]
Quality of care not good enough [ ]

All [ ]

Can’t decide [ ]

46
11 Do you attend TBA HOMES?

Yes [ ]

No [ ]

12 What are your perceptions toward their roles?

Very good [ ]

Good [ ]

Satisfactory [ ]

Unsatisfactory [ ]

13 How do you compare the services of the TBA homes with that received in the outreach and
the PHC?

Satisfactorily [ ]

Unsatisfactorily [ ]

Don’t Know [ ]

14 Did your customs and traditional belief influence your belief towards the role of outreach
program.

Yes [ ]

No [ ]

15. If Yes, to what level, give reasons?

………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
…………………………………………………………………………………………….………
………………………………………………………………………………………………………
…………………………………….

16 How do you rate the services provided by the health worker in the outreach and PHC
47
 Very good [ ]

Good [ ]

Satisfactory [ ]

Unsatisfactorily [ ]

Undecided [ ]

17 Do you perceive the role of the outreach services and that of the PHC as effective?

Strongly agreed [ ]

Agreed [ ]

Strongly disagreed [ ]

Disagreed [ ]

Undecided [ ]

48