COMMUNITY INVOLVEMENT IN HEALTH CARE PROGRAMMES IN UMUNZE ORUMBA SOUTH LOCAL GOVERNMENT AREA ANAMBRA STATE

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ABSTRACT
This work investigated Community Involvement in Health Care (CIH) programmes in Umunze, Orumba South Local Government Area of Anambra State. The study specifically verified the extent of involvement of the community in preventive, promotive and curative components of health programme; reasons behind the extent of community involvement in health programmes, community agencies behind community involvement in health programmes; gender and age differences in community involvement in health programmes; community agencies behind community involvement in health programmes; and relative involvement of the various villages in Umunze in health programmes. The population for study comprised twenty-two health workers and 37409 adult members of the population in Umunze.


A cross-sectional survey design was employed in the study. A sample of 300 adults (comprising 150 males and 150 females) was used in the study. Data were collected using structured questionnaire and key informants interview. The mean (x), standard deviation, t-test and analysis of variance (ANOVA) were used for data analysis. Results showed that the community involvement in the various components of health programmes varied: The community was involved in preventive health to a great extend; promotive health to a little extent; and curative health programme to a very great extent. The results also revealed, among others, that several reasons were behind community involvement in health programmes such as availability of qualified health personnel, awareness of health needs, presence of female caregiver. The hypotheses tested at.05 level of significance showed that there was significant difference in the extent of community involvement in health programmes according to gender, age and villages. Females were more involved than males in preventive and curative health programmes. The age brackets 18 – 25 and 46 – 55 were more involved than others in curative health. Among the villages, Ugwuano and Amuda villages led in the various health programmes. The need for the use of local and modern media to promote greater community involvement in promotive health; and greater empowerment of women and certain age groups for greater participation in matters concerning health programmes, were recommended.

TABLE OF CONTENTS

Title Page
Table of Contents
List of Tables
Abstract

CHAPTER ONE:  Introduction
Background to the study
Statement of the Problem
Purpose of the Study
Research Questions
Research Hypotheses
Significance of the Study
Scope of the Study

CHAPTER TWO: Review of Related Literature
Conceptual Framework
Primary health care (PHC)
Community participation
Community involvement in health (CIH) development
Mechanisms of promoting community involvement in health care services
Socio-cultural factors affecting community involvement in health
Demographic factors associated with CIH programmes provision and utilization
Theoretical Framework
The top down model
Alternative development model
Urban development model
Integrated rural development mode
Empirical Studies on Community Involvement in Health care Programme
Summary of Literature Review

CHAPTER THREE:  Methods
Research Design
Area of Study
Population for the Study
Sample and Sampling Techniques
Instrument for Data Collection
Validity of the instrument
Reliability of the instrument
Method of Data Collection
Method of Data Analysis

CHAPTER FOUR: Results and Discussions
Results
Summary of Major Findings
Discussion
Extent of community involvement in preventive, promotive and curative health programmes in Umunze
Reasons behind the extent of community involvement in health
Agencies behind community involvement in health programmes in Umunze
Age/Gender differentials in community involvement in health programmes in Umunze community
Relative involvement of the various Umunze Village in health programmes

CHAPTER FIVE: Summary, Conclusions and Recommendations
Summary
Conclusions
Recommendations
Suggestions for Further Studies
Limitations of the Study
References
Appendix

CHAPTER ONE

Introduction

Background to the Study

Good health is basic to human welfare and a fundamental objective of social and economic development (Ukwu, 1993). It is not by accident therefore that three of the eight Millennium Development Goals (MDGs) adopted by world leaders in September 2000 are on health. These are to reduce child mortality (MDG-4); improve maternal health (MDG-5) and combat HIV/AIDS, malaria and other diseases (MDG-6). Nigeria is signatory to this pledge targeted for achievement before 2015. While government and donor agencies are stepping up efforts to strengthen health systems in order to meet the target, community involvement appears to be the only way to reach the grassroots. (Abiodun & Kolade, 2006).

In most parts of Africa, the concept of community development and local involvement is a cultural phenomenon. Self-help efforts through which several social amenities were provided by local communities are not new in this part of the world. Since no local, state or even federal government can meet all the health demands of its people, especially in the light of contemporary complex health issues, local involvement in health care programmes has become indispensable and is intensified in recent years in Nigeria.

Annett (2006) defined community involvement in health as a deliberate strategy which systematically promotes community participation and supports and strengthens it in order to provide better health care for the majority of people. It involves both a commitment to promote better health with people and not merely for them, and a strategy radically different from the more conventional approaches to health development. Community involvement in health is conceptually one of partnership between government and local communities in the three key areas of planning, implementation and utilization of health programmes.
Health projects like the building of clinics, maternities, dispensaries, cottage hospitals, National Programme on Immunization (NPI) and so on, have tended to become focal points across the nooks and crannies of the Nigerian society since the 1980s (Ewhrudijapor & Ojie, 2005) . Indigenous participation as an approach in most developing economies has been able to penetrate the health sector as it is seen as a method of accelerating the reduction of ill health in the society. This is against the backdrop of contemporary public health issues like reproductive health, HIV/AIDS, tuberculosis, female genital mutilation and other harmful traditional practices.

Aregbeyen (2006) observed that there was a deliberate attempt to draw a comprehensive national health policy dealing with such health issues as manpower development and the provision of comprehensive health care service based on the health services scheme, disease control, and efficient utilization of health resources, medical research, health planning and management. However, the mentioned factors below seem to account for the seemingly futile efforts of governments in Nigeria over the years to improve health care delivery under several health projects (NHPS, 1988):

The coverage were inadequate, no more than 35% of the Nigerian population had access to health care services; rural communities and urban poor were not well served the orientations of the services were inappropriate with a disproportionately high investment on curative services to the detriment of preventive ones. The involvement of the communities were often negligible at critical points in the decision making process; and the management of the funds often showed major weaknesses resulting in defective basic infrastructures and logistic supports.

It is therefore apparent that government alone neither can shoulder the responsibilities of communities health problems nor can the effort of government mean much in the absence of community involvement. Population is a question of people, healthy people, not of numbers. It is the indigenous participatory efforts in health issues that determine the extent of success of government health programmes. Udoye (1989) stated that community involvement in development programmes and strategies have become a handy framework for the provision of the basic needs of rural Nigeria communities.

In Anambra State cooperative effort is a way of life, a philosophy embraced by the government and the people alike. What is perhaps new is that for the first time a direct and conscious effort is being made to harness this abundant resource (Adeyeye, 1987). There are two principles emerging from the idea of community participation. These are the principle of individual and corporate survival and the principle of societal felt need. According to Udoye (1992) these two have been the propelling force behind organizing and mobilizing the people in the pursuit of self-development.

Apart from initiating certain programmes of self-help like building of health centres, the community must be involved in the context of embracing the health programmes of government especially in the light of the prevailing health problems. Erinosho and Oke (1994) stated that chronic diseases and disability cannot be understood or treated solely as medical phenomena; but should be in the context of the total environment. According to them, there is general agreement among health providers that macro environmental variables of the people are as necessary and sufficient as physical conditions. The communities need to know the implications of some health hazards and certain behaviours on their well being. There is therefore symbiotic relationship between the government and the communities in the achievement of the health programmes. Hence, the idea of primary health care (PHC) emerged in the 1960s, in recognitions of the shortcomings of the health systems inherited by developing countries, like Nigeria after independence (1d 21, insights 2008). The Alma Ata conference of 1978 placed emphasis on preventive, rural peripheral and appropriate services, integration and local communities. According to Okoye (1989) the success of this programme requires the promotion of maximum community and individual self-reliance and participation in the planning, organization and control of primary health care, making fullest use of local, national and other available resources. Health programme is a deliberately planned activity by government aimed at eradicating or controlling specific identified diseases (Mbah, 2000). Health progrmmes are aimed at achieving public or community health and by so doing promote socio – economic activities and well-being of the society. There are three components of any health programme – preventive, promotive and curative health programmes.

The preventive health programme seeks to prevent the occurrence of diseases. The programme tries to identify the habits of man that encourage the occurrence of diseases with a view to educating the masses on ways to avoid the habit or eliminating it. The promotive component of health programme is closely related to preventive health programmes since the main purpose of promotive health programme is to encourage people to lead healthy life style. However, promotive health programme could also be used to provide basic health education to communities, as well as provide information to communities on certain health concerns. Curative component of heath programme on the other hand aims at curing some specific diseases in order to curtail its prevalence for a health society.
Against this background, Moronkola and Okanlawon (2003) concluded that the community is the common target of all the health programmes or activities....

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