COMMUNITY PARTICIPATION IN PRIMARY HEALTH CARE: A CASE STUDY OF EKLESSIYAR YAN UWA A NIGERIA RURAL HEALTH PROGRAMME, GARKIDA
COMMUNITY PARTICIPATION IN PRIMARY HEALTH CARE: A CASE STUDY OF EKLESSIYAR YAN UWA A NIGERIA RURAL HEALTH PROGRAMME, GARKIDA
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Date
1991-08
Authors
HELLANDENDU, JOSEPH MUTA'A
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Abstract
Community participation in health care has been identified by the World
Health Organisation as the main strategy for attaining Health for All by the
Year 2000. Full community participation in medical services, however,
implies acquisition of a comprehensive knowledge of the principles of western
medicine and the transformation of the knowledge into action. This is
difficult to achieve in developing countries because of structural barriers
and the priority given to the curative over preventive medicine. Another
important factor is the problem of eliciting voluntary unpaid or poorly paid
community services in an entrepreneural society. Even if the economy is
basically agrarian, the communities conform more to Tonnies'(1955) conception
of gesselchaft, which is a form of impersonal inter-dependence, than a
gemmeinschaft, a close - knit community, in a number of important respects
like the sharing of resources and exchange of labour. Because of this, some
rural people who live in the same small communities hold divergent views on
common problems and fail to cooperate in pursuit of a common goal.
It is within the context of these controversies surrounding community
participation in modern health care that this study investigated the
organisation and responses to the community-based Eklessiyar Yan Uwa a Nigeria
Rural Health Programme in Garkida. A random sample of ten villages included
in the programme, five of which had functional health posts and five whose
health posts were defunct, were selected for investigation. A total of 731
households were studied in the ten villages.
It was found that most communities approached by the programme agreed to
participate. The demands to form health committees, select health workers,
collect money for, and, building the health posts were generally promptly
completed after the agreements. Most communities, however, failed to maintain
the enthusiasm shown at the beginning when they were required to help the
health workers, or raise more money for the upkeep of the health posts.
The health committees were generally very weak in discharging their
responsibilities. They did not for instance, solicit for the cooperation
of organised village groups like the Boys Brigade, Girls Guide, Church
Choirs and Women's Fellowships, found in all the villages. Each of these
groups could be mobilised to assist in performing various tasks for the
health post. Women in particular, the category of people who implement a
large number of health lessons like nutrition, maternal-child care, domestic
and personal hygiene were conscious of their marginalisation by the health
committees, mostly made up of males, in the organisation of the health posts.
An indepth interview with women organisations in two villages and uterances
by women in other villages show that women believe that they are more
committed and willing to maintain the health posts than men. These lapses
have resulted in the closure of 62 percent of health posts ever established
in the area studied. Some health workers however, continued to render
services as long as there were funds to procure drugs even in the absence of
community support.
With regards to the services rendered, the community members prefer the
curative more than the preventive and promotive health services. Thus,
599(82.0%) of the respondents pointed out that they wanted their health posts
upgraded to dispensaries to enable them have more elaborate diagnostic and
curative services. The delivery of health education through drama and
stories were rarely done due to lack of volunteers to learn and stage the
dramas and poor turn up of audience respectively. The results are that
only 197(27.0%) of households reported that they had comprehensively
implemented the core tangible aspects of health education, namely; the
provision of latrines, environmental sanitation, personal hygiene, provision
of nutritious food and immunisation. The maternal-child welfare services
were, however, better utilised as 413(75%) of the 552 respondents who
reported births in their houses since the inception of the programme said
that the mothers and babies attended the services at the health posts.
The implications of the findings are that communities may not be
willing to participate in the organisation of health services when this
involves sacrificing time, labour and money routinely. The primary nature
of the rural communities also militates against cooperation by all members
as there is evidence of social differentiation and that conflicts on other
issues are revived or displaced in the process of running the health
services. It is concluded that the problems identified as militating
against the effective organisation of community health services at the
village level where communities are quite homogeneous may manifest themselves
in more complex forms in urban settings and other areas where the communities
are more complex when Nigeria implements her PHC system.
Description
A Dissertstion submitted to the Postgraduate School, Ahmadu Bello University,
Zaria, in partial fulfillment of the award of the Degree of
Ph.D. (Sociology)
Department of Sociology,
Ahmadu Bello University, Zaria.
Keywords
COMMUNITY,, PARTICIPATION,, PRIMARY HEALTH CARE,, CASE STUDY,, EKLESSIYAR YAN UWA,, NIGERIA, RURAL HEALTH PROGRAMME,, GARKIDA