Evaluation of Primary Health care delivery services in selected Local Government Areas of Bayelsa State

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Evaluation of Primary Health care delivery services in selected Local Government Areas of Bayelsa State

1Akpe, A. & 2*Ephraim-Emmnauel, B.C.

1Department of Community Health Sciences, Bayelsa State College of Health Technology.

2Department of Dental Health Sciences, Bayelsa State College of Health Technology.

*Corresponding Author details: E-mail: benchike2002@yahoo.com, Tel: +234-806-003-8135

Abstract

Background and Aim: Nigeria through the National Primary Health Care Development Agency has adopted a minimum standard which is expected to be used in the primary health care sector. This study thus aimed to evaluate the primary health care delivery services provided in primary health care facilities in selected Local Government Areas in Bayelsa state.

Materials and methods: A descriptive study design was utilized in this study. A multi-stage sampling technique was employed to select the facilities used in the study. The data collected was analyzed using the SPSS statistical software version 21.0. Percentage differences and analysis of variance (ANOVA) were also performed to determine the difference between the required quantities (standard) with the available quantities in selected facilities in the LGAs and significance level was set at p < 0.05.

Results: Compared to the required standard, Sagbama had 0.67 (65%) of medical officers while Kolokuma/Opokuma had 0.50 (50%). Brass and Ogbia had none. Also, with respect to the female ward, the mean required quantity is 1.97. Sagbama and Ogbia got 1.49 (75%) of the standard, Brass local government got 1.80 (91.4%) of the standard required quantity while Kolokuma/Opokuma had 1.67 (84.7%).

Conclusion: The delivery of primary health care in Bayelsa State in terms of facilities, equipments and personnel is not up to standard using the WMHCP and the minimum standard of primary health care in Nigeria as measuring standards. The provision of the lacking primary health care facilities etc.; was recommended.

Keywords: Evaluation, Primary Health Care, Services, Bayelsa, Nigeria.

Introduction

Primary Health care (PHC) plays a fundamental and central role in the health care delivery system worldwide as it offers families cost effective services that are within their reach (Adeyemo, 2005) Nigeria through the National Primary Health Care Development Agency (NPHCDA)(2007-2012) has adopted a minimum standard which is expected to be used in the primary health care sector. It entails the health posts, health centres and the comprehensive health centres. The standard document contains the requirements needed in each facility by type such as personnel, equipment, services that should be rendered in a category of facility (NPHCDA, 2007-2012). The essence of primary health care is for individuals and families to utilize the services as their first port of call when faced with health issues. These should also be gotten at a cost that is affordable by all categories of people. (Thomas, Wakerman & Humphreys, 2015).

Health care delivery in Nigeria has been rated low, in 2000, the WHO (2013) placed Nigeria 187th position among the 191 member countries for service performance, since then not much difference has been made despite tremendous efforts in the provision of health care since independence (Country studies , 2014). One of such efforts is the adoption of the WMHCP in 2007. (NPHCDA, 2007). Most nations have their standards in health care provision for their population in terms of personnel, equipment, services rendered in the facilities, drugs required and the facility by type needed in a given population size. Adeyemo (2005) asserted that most facilities are dilapidated with equipment and infrastructures being absent or out of use. Omoleke (2005) carried out a study to examine the management of primary health care services in Nigeria and found that performance was poor at the grass root. Another study was also carried out in four states (Kaduna, Lagos, Cross Rivers and Yobe) and it was discovered that there was low performance in terms of the services provided. Though primary health care centres were established based on the principles of equity and accessibility, the urban centres in Nigeria were reported to benefit more when compared with their rural counterparts (Abdulraheem, Olapipo & Amodu, 2012).

According to Olakunde (2012) achieving successful health care financing system continues to be a challenge in Nigeria, but there is the need to investigate the standard of delivery of Primary Health care using a standard known as the Ward Minimum Health Care Package (WMHCP) provided by the World Health Organization which was adopted by the National Primary Health Care Development Agency (NPHCDA, 2007-2012). This study thus set out to evaluate the Primary Health Care delivery services provided in primary health care facilities in the selected Local Government Areas in Bayelsa state. This study brought to light the need to ensure that standards were met for better service delivery and in turn increased patronage. This study also served as a means of information to government of the levels at which the primary health care system operates in order to cause policy makers to improve on budgetary allocation and supervision of primary health care services and make provision for communities lacking primary health care facilities.

Materials and Methods

The research design was a descriptive study design within which a comparative study was carried out using the ward minimum health care package (WHO standard document) to compare the available items in the facilities. The population of the study consisted of all government owned primary health care facilities in 4 selected Local Government Areas (LGAs) in Bayelsa state. A multi-stage sampling technique was employed to select the facilities used in the study. First a purposive technique was adopted to select four Local Government Areas (LGAs) to be part of the study and 20% of the wards in the selected LGAs was selected randomly and one facility was also randomly selected to be included the study.

Sagbama LGA has 14 wards, the ballot method was used in selecting the wards and health facilities that were included in the study. In wards with just one facility, the available facility was automatically selected to be part of the study. This procedure was done in the other selected LGAs. Ogbia LGA has 13 wards, 20% is 2.6 approximately 3 wards. Kolokuma/Opokuma (KOLGA) has 11 wards, 20% is 2.2 approximately 2 wards, while Brass LGA has 10 wards, 20% is 2 wards and one facility each was selected randomly from the selected wards in the selected LGAs. The sample size was one health facility of 20% in each of the selected wards in each of the selected LGAs of Bayelsa state. Data was collected from the primary health care facilities and the staff from the health facility helped to provide the available items requested on the check-list. The instrument for data collection was a check-list derived from the Ward Minimum Health Care Package (NPHCDA standard document). The Ward Minimum Health Care Package is a standard document of the World Health Organization, adopted by the National Primary Health Care Development Agency (PHCDA) in Nigeria. Hence the reliability of the instrument is ascertained. The data collected was statistically analyzed using the SPSS statistical software version 21.0. Percentage differences and analysis of variance (ANOVA) were also performed to determine the difference between the required quantities (standard) with the available quantities in selected facilities in the LGAs. Significance was set at p < 0.05. In order to conduct this study under required ethical standards for biomedical research, ethics clearance to conduct this research was sought and gotten from the research ethics committee of the University of Port-Harcourt. Permission to conduct this study was gotten from required Primary Health Care authorities in Bayelsa State.

Results

Table 1: Mean required quantity and available quantities of equipment at selected primary health care Centres.

Equipments Required quantity Sagbama Brass Ogbia Kolokuma/

Opokuma

p-value
Female ward

Labour ward

Laboratory

Dressing and injection room

Family Planning

Infant/Child welfare

First stage room

Antenatal/interview

Nutrition

Sterilization

Cleaning &Utilization

Linen store

Consulting cubicle

Staff room

Records

Male ward

1.97

1.57

4.93

2.0

4.44

1.91

1.74

4.68

3.88

1.60

6.8

11.21

1.74

2.25

1.57

2.33

1.49

1.47

3.48

1.26

3.30

1.67

1.45

4.59

2.21

1.37

1.96

3.36

1.19

1.29

1.14

1.38

1.80

1.54

3.36

1.39

2.67

1.28

1.29

4.0

NA

1.45

3.50

3.71

1.34

1.0

1.36

1.72

1.49

1.51

3.48

1.27

2.44

1.48

1.43

4.14

2.0

1.40

2.09

3.83

1.33

1.25

0.95

1.44

1.67

1.52

3.57

1.21

3.12

NA

1.30

4.12

NA

1.00

2.17

4.21

1.24

1.31

1.21

1.33

.005

Table 1 shows that with respect to the female ward, the mean required quantity is 1.97. Sagbama and Ogbia got 1.49 (75%) of the standard, Brass local government got 1.80 (91.4%) of the standard required quantity while Kolokuma/Opokuma had 1.67 (84.7%) of the required standard equipments in the female ward. Considering labour ward, the minimum required mean is 1.57. However, Sagbama had 1.47 (93.6%), Brass got 1.54 (98.1%), Ogbia had 1.51 (96.2%) and Kolokuma/Opokuma had 1.52 (96.8%). This result revealed that the sampled primary health centres were within tolerable limits. The table also shows the distribution of available equipments for laboratory among various selected primary health centres. From the result, Kolokuma/Opokuma has equipments closer to the standard 3.57 (72.4%), followed by Sagbama 3.48 (70.6%) and Ogbia 3.48 (70.6%) each; while Brass had 3.36 (68.2%). For dressing and injection room, Sagbama centre had 1.26 (63%) when compared with the required quantity, Brass centre had 1.39 (69.5%), Ogbia had 1.27 (63.5%) while Kolokuma/Opokuma had 1.21 (60.5%) only. Under family planning unit with mean required quantity of 4.44, Sagbama had 3.30 (74.3%), Brass centre had 2.67 (60.1%), Ogbia had 2.44 (54.9%) and Kolokuma/Opokuma had 3.12 (70.3%). The child and infant welfare unit was also considered and the table showed that Sagbama had 1.67 (87.4%), Brass 1.28 (67%), Ogbia had 1.48 (77.5%) while for Kolokuma/Opokuma, there was no available record. For first stage room unit, Sagbama centre had 1.45 (83.3%), this was followed by Ogbia centre which had 1.43 (82.1%), then Kolokuma/Opokuma having 1.30 (74.7%) of the required equipments and finally Brass had 1.29 (74.1%). Regarding the nutrition unit, the available equipments compared with the required standard was 2.21 (57%) from Sagbama and 2.0 (51.5%) from Ogbia. There were no available records from Brass and Kolokuma/Opokuma. From Sterilization Unit, Sagbama had 1.37 (85.6%), Brass had 1.45 (90.6%) while Ogbia and Kolokuma/Opokuma had 1.40 (87.5%) and 1 (62.5%) respectively. The minimum standard in terms of equipments for Cleaning & Utilization unit also showed that Sagbama had 1.96 (28.8%), Brass had 3.50 (51.5%), for Ogbia it was 2.09 (30.7%) and Kolokuma/Opokuma had 2.17 (31.9%). This is an indication that Cleaning & Utilization unit had been far below the minimum standard of primary care services. The result from Linen store unit showed that Sagbama had 3.36 (29.9%), Brass had 3.71 (33.1%), Ogbia had 3.83 (34.2%) and Kolokuma/Opokuma showed 4.21 (37.6%). This result showed that Linen store unit is below the minimum standard in terms of equipments. The consulting cubicle unit was also considered and the result showed that Sagbama had 1.19 (68.4%), Brass had 1.34 (77%) while Ogbia had 1.33 (76.4%) and Kolokuma/Opokuma got 1.24 (71.3%). The result from staff room revealed that Sagbama had 1.29 (57.3%), Brass had 1.0 (44.4%), Ogbia also had 1.25 (55.6%) while Kolokuma/Opokuma had 1.31 (58.2%). For records unit and male ward when compared with the required standard, Sagbama got 1.14 (72.6%) and 1.38 (59.2%), Brass got 1.36 (86.6%) and 1.72 (73.8%), Ogbia had 0.95 (60.5%) and 1.44 (61.8%) while Kolokuma/Opokuma had 1.21 (77.1%) and 1.33 (57.1%) respectively. Statistically significant difference of the available services from the required standard for the primary health care facilities in Bayelsa State was also found. (p < 0.05).

Table 2: Mean required personnel and available number of personnel at selected primary health care centres.

Personnel Number required Sagbama Brass Ogbia KOLGA p-value
Medical officer if available

CHO (must work with standing order)

Nurses/ Midwives

CHEW (must work with standing order)

Pharmacy technician

JCHEW (must work with standing order)

Environmental Officer

Medical records officer

Laboratory technician

Health Attendant/Assistant

Security personnel

General maintenance staff

1

1

4

3

1

6

1

1

1

2

2

1

0.67

1.00

2.00

1.67

0.67

1.00

0.67

0.67

0.67

2.33

1.00

2.00

0.00

1.00

0.67

1.67

0.67

1.00

0.00

0.67

0.67

1.33

1.00

1.67

0.00

1.00

0.33

1.67

0.67

1.00

0.00

0.67

0.67

0.67

1.00

1.33

0.50

1.00

2.50

1.50

1.00

1.50

0.00

0.50

1.00

2.50

2.00

2.50

.079

Table 2 shows the mean required personnel and available number of personnel at selected Primary Health Care Centres. Compared to the required standard, Sagbama had 0.67 (65%) of medical officers while Kolokuma/Opokuma had 0.50 (50%). Brass and Ogbia had none. For Community Health Officers (CHO), all the selected centres had the minimum required number of CHO’s. An average of 4 nurses/midwives were expected in each centre, however Sagbama centre had 2.00 (50%), Kolokuma/Opokuma had 2.50 (62.5%) of midwives/nurses, Brass had 0.67 (16.8%) and Ogbia had 0.33 (8.25%). For CHEW, a minimum of 3 CHEWs was required but Sagbama, Brass and Ogbia had 1.67 (55.7%) each while Kolokuma/Opokuma got 1.5 (50%). It is required that at least 1 pharmacy technician must be in each primary health centre, showed that Sagbama, Brass and Ogbia had 0.67 (67.0%) while Kolokuma/Opokuma met the required number. Out of the 6 required JCHEW required from each centre, only 1.00 (16.7%) was found across the sampled centres. For environmental officer, Brass, Ogbia and Kolokuma/Opokuma had none however, Sagbama had 0.67 (67.0%). Also an average of 0.67 (67.0%) medical record officers was found across Sagbama, Brass and Ogbia. Only Kolokuma/Opokuma met the minimum number for laboratory technicians. Surprisingly both Sagbama and Kolokuma/Opokuma had more than the minimum number required for health attendant/assistant. The table also revealed that only Kolokuma/Opokuma centre had the minimum number of security personnel. For general maintenance staff, all had more than the minimum required number. Statistically significant difference of the available personnel in the primary health care facilities in Bayelsa State was found when compared with the minimum standard.

Table 3: Distribution of communities having health facilities

Selected Local Government Area Number of Communities Communities with health facilities Communities without health facilities
Frequency Percentage (%) Frequency Percentage (%)
Kolokuma 66 9 13.6 57 86.4
Brass 244 10 4.1 234 95.9
Ogbia 50 29 58.0 21 42.0
Sagbama 47 30 63.8 17 36.2
p-value: .002

From Table 3 above, it was found that out of 66 communities; only 9 (13.6%) communities in Kolokuma/Opokuma had health facilities. Out of 244 communities, only 10 (4.1%) communities had health facilities in Brass. In Ogbia LGA, it was found that out of 50 communities, 29 (58.0%) had health facilities. Finally, in Sagbama LGA, out of 47 communities, only 30 (63.8%) had health facilities. Analysis of the variance showed a statistically significant difference between the number of primary health care facilities in Bayelsa State and the minimum standard for number of health facilities (p < 0.05).

Discussion of Findings

In this study there is uniformity of the available services across the various health facilities that were selected however certain services were not provided in all the selected primary health care facilities. This is in disagreement with Metibola (2009) in a study that revealed a uniformity of common services provided in primary health facilities among urban cities. It also disagrees with Abdulraheem (2012) who found no similarity in the Primary health care services among the rural facilities. These findings are similar to those of Obembe, Osungbade, Olumide, Ibrahim & Fawole, (2014) who reported that the available community health extension workers in the facilities meet the required standard but the JCHEWs were far below the required standard. This finding of reduced junior community health health extension workers was also reported in this study. This could have been due to the long embargo on employment in the state. Also, those that were JCHEWs had progressively studied further to become CHEWs or CHOs, thus creating a gap in this cadre of personnel. The percentage difference of available equipment in the selected facilities in the LGAs does not meet the minimum required standard. This is in agreement with Shriprasad (nd) who reported that the personnel in the facilities were dissatisfied with the available equipment. The facilities in the communities we also grossly inadequate compared to the required number per settlements. However, a good number of wards in the selected LGAs met the standard of the Ward Minimum Health Care Package (2007) that requires at least one health facility in every political ward. In course of the study, it was discovered that a good number of health workers had not reached their facilities for a period longer than 3 months with a number of the facilities being under lock and key while some facilities were overgrown with grasses. It was also discovered that payment systems to Health Personnel in Government primary health care centres was not regular and there was improper supervision of primary health care activities and projects in the studied areas.

Conclusion

The delivery of primary health care in Bayelsa State in terms of facilities, equipments and personnel is not up to standard using the WMHCP and the minimum standard of primary health care in Nigeria as measuring standards and this could be the cause of the skipping and dwindling patronage of primary health care facilities in Bayelsa state.

Recommendations

In light of the findings of this study, the following recommendations were made:

  • Adequate provision of equipment to carry out the routine services in the health facilities.
  • Communities who are first beneficiaries of the available services should make frantic efforts in the provision of the services that are not available in the health facilities by collaborating with the primary health care personnel and NGOs in the community.
  • Government and political office holders, especially ward representatives (Councilors) should ensure that there is at least one primary health care facility in the wards they represent.
  • There should be thorough supervision of PHC activities in the community especially the services that are delivered in the facilities.
  • Employment of personnel in lacking cadres to fill the gap deficit and deployment
  • Primary health care coordinators should be conversant with the minimum standard for primary health care for them to use it as a monitoring tool and the standard for the establishment of a primary health care facility.

Suggestions for further studies include the evaluation of primary health care delivery in Nigeria, a comparative assessment of the tiers of health care delivery in Bayelsa state as well as an assessment of primary health care personnel training institutions in the Niger Delta region of Nigeria.

References

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Obembe, T.A., Osungbade, K.O., Olumide, E.A., Ibrahim, C.M. & Fawole, O.I. (2014). Staffing situation in PHC facilities in FCT, Nigeria. Implications for attraction and prevention Policies. American Journal of Social and Management Sciences, 5(2).

Omoleke, I.I. (2005primary health care services in Nigeria: constraints to optimal performance g 2005 Apr-Jun;14(2):206-12. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16083247

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Shriprasad, H. (nd) Performance Analysis of Primary Health Care Centres: A Case Study. Minor Research Project. Retrieved from http://www.sdmcujire.in/userfiles/MRP/Shriprasad_H_MRP.pdf

Thomas, S.L, Wakerman, J and Humphreys, J.S (2015) Ensuring equity of access to primary health care in rural and remote Australia – what core services should be locally available? International Journal for Equity in Health. Retrieved from http://equityhealthj.biomedcentral.com/articles/10.1186/s12939-015-0228-1

 

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