Factors Affecting Utilization of Public Health Facilities by Rural Dwellers in Abia State.
ABSTRACT
BACKGROUND: Utilization of public health services is an important factor in the effectiveness of national health care and achievement of Health for All. Nigeria’s population is predominantly rural and the health needs of rural areas are numerous.
For one to be able to maintain a healthy state, the choice of health care facilities/services and predictors of the choice are important.
An individual’s choice of health facilities for healthcare is largely determined by patient-related factors and provider-related factors and these affect patient’s health outcomes.
These choices of health care provider may also give an insight into how these health facilities can improve on their service delivery, improve client satisfaction and by extension ensure a healthier population.
OBJECTIVES: To determine factors (both patient-related and provider-related ) affecting the utilization of Public health facilities by rural dwellers in Abia state south east Nigeria.
Also to elicit their health related activities and level of satisfaction with Public health facilities.
METHODOLOGY: It was a population based cross-sectional, descriptive study, carried out in selected rural areas of Abia state in south east geopolitical zone of Nigeria.
447 household heads or caregivers adults permanently residing in the selected rural areas were randomly selected and then interviewed using a pretested, semi structured questionnaire.
Frequencies, percentages and mean were calculated, tables were created and comparisons of categorical data were done using descriptive methods.
Chi square test was used to determine factors that were significant at a p- value of 0.05 and logistic regression was used to determine the predictors for choice of health care facility.
RESULTS: The results indicated that 282 out of 447 0f the rural study population utilized public healthcare facilities.
The patient related factors that encourage the utilization of public health facilities included age (31-40yrs), gender (male), marital status (married) and employment status (Government employed).
There were no significant relationship between educational level, family income, household size and duration of stay in community at p- vales of 0.05.
The provider-related variables influencing the choice of public health facility for respondents included factors like internal organization and procedures, availability of health information, working hours, cost of service, waiting time and availability of ancillary services matters.
This study also reported that users of government facilities were just somewhat satisfied with services rendered, location of the facility, overall cleanliness of the center, Staff courtesy and friendliness, skill and competency of the staff the health services they received.
They are very satisfied with the efficiency of nursing care and work schedule of care in the clinic.
CONCLUSION: This study highlighted that the utilization of public health facilities by ural- urban dweller in Abia state is high. Choice of health care providing facility is an important decision that involves the interplay of several factors.
Understanding these factors by health policy makers is important in the provision and the utilisation of health care services . Also satisfaction with services provided is a perception by the clients and must be considered by managers of health institutions when decisions to improve health facility services are to be made.
A healthy population is an asset to any society. Consequently, improving the health- care delivery system in the public setting will in the long run improve the quality of life of the people in the study area.
TABLE OF CONTENTS
Title page- – – – – – – – – – -i
Declaration page- – – – – – – – – -ii
Certification page- – – – – – – – – -iii
Dedication- – – – – – – – – – -iv
Acknowledgement- – – – – – – – – -v
Table of contents – – – – – – – – – -vi
List of figures
List of tables- – – – – – – – – – -ix
Abbreviations and Acronyms- – – – – – – -x
Abstract – – – – – – – – – -xi
CHAPTER 1: INTRODUCTION
1.1 Background- – – – – – – – – -1
1.2 Statement of problem– – – – – – -3
1.3 Justification of study- – – – – – – – -4
1.4 Relevance to public health- – – – – – – -5
1.5 Aim of study- – – – – – – – – -6
CHAPTER 2: LITERATURE REVIEW
2.1 Overview- – – – – – – – – -7
2.2 Factors influencing utilization of public health facilities- – – -10
2.3 Nigerian Health system- – – – – – – -13
2.4 The concept of rural areas – – – – -15
CHAPTER 3: METHODOLOGY
3.1 Background to the study area- – – – – – -17
3.2 Study design- – – – – – – – – -18
3.3 Study population- – – – – – – – -18
3.4 Sample size- – – – – – – – – -18
3.5 Sampling Method- – – – – – – – -19
3.6 Survey instrument- – – – – – – – -19
3.7 Pretesting of questionnaire and orientation of data collectors- – -20
3.8 Data collection- – – – – – – – -20
3.9 Data processing and analysis- – – – – – – -21
3.10 Ethical consideration – – – – – – – -22
CHAPTER 4: RESULTS
4.1 Descriptive analysis of Socio-demographic characteristic/ individual-related factors- – – -23
4.2 Multivariate analysis individual-related factors affecting utilization of public health facilities by rural dwellers in Abia state – – – -29
4.3 Health service provider related factors – – – – -34
4.4 Multivariate analysis health service provider-related factors affecting utilization of public health facilities by rural dwellers in Abia state– -36
4.5 The health-related activities of rural dwellers in Abia state– – -40
4.6 Level of satisfaction with services of healthcare provider- – – -44
CHAPTER 5: DISCUSSION
5.1 Study area and health facility utilization pattern- – – – -55
5.2 Socio-demographic characteristics of respondents (Individual related factors:
predisposing factors) and public health facility utilization- – – -55
5.3 Health provider related factors and health facility utilization- – -58
5.4 The health-related activities of rural dwellers in Abia state- – – -61
5.5 Level of satisfaction with services of healthcare provider- – – -62
5.6 Limitations of the study- – – – – – – -63
CHAPTER 6: CONCLUSION AND RECOMMENDATION
6.1 Conclusion – – – – – – – – -65
6.2 Recommendation – – – – – – – -66
REFERENCES – – – – – – – – -67
APPENDICES- – – – – – – – – -74
INTRODUCTION
The World Health Organization (WHO) is greatly concerned with the provision of quality health care for everyone irrespective of varying levels of living. This implies whether the person is in the advanced or poor countries, rural or urban, poor or rich; good health should be guaranteed by the governments of all countries1.
Health as defined by WHO is a state of complete physical, mental, and social well-being and not merely the absence of diseases or infirmity.2
The determinants of health of an individual at any particular time include: the social and economic environment, the physical environment, and the person’s individual characteristics and behaviours3.
Illness or diseases is a very common thing that can come at anytime to an individual, when this occur the in-born survival instinct in man will want to fight back at all cost to become well again. Methods engaged to maintain and restore healthy status is described by Health seeking behaviors.
Health or care seeking behaviour has been defined as any action undertaken by individuals who perceive themselves to have a health problem or to be ill for the purpose of finding appropriate treatment.7
Health services utilization simply means the willingness of the would-be or potential patients to make use of the most of the services offered at a medical establishment.4
REFERENCES
Ibor UW, Atomode TI. Health Service Characteristics and Utilization in Calabar Metropolis, Cross River State. Nigeria Academic Journal of Interdisciplinary Studies, 2014; 3(1):265-270.
World Health Organization, editor: Declaration of Alma-Ata. In Intern Conference on Primary Healthcare. Alma-Ata, USSR; 1978.
World Health Organization. Health Impact Assessment (HIA), Determinants of Health. Accessed from www.who.int/hia/evidence/doh/en/index/html June 2015
Ibor UW, Ojong EO, Eni DD. Distribution and Utilization of Health Facilities in Calabar Metropolis. Annals of Humanities and Development, 2010; 2 (10): 346-347.
Fatimi Z, Avan I. Demographic, Socio-economic and environmental determinants of utilization of antenatal care in rural setting of Sindh, Pakistan. J Pak Med Assoc 2002;52:138–142.
David P.Rebhan. Health Care Utilization: Understanding and applying theories and models of health care seeking behavior Accessed from www.cwru.edu/med/epidbio/mphp439/healthcareutil.pdf April 2015
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