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

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.

COMMUNITY PARTICIPATION IN PRIMARY HEALTH CARE: A CASE STUDY OF EKLESSIYAR YAN UWA A NIGERIA RURAL HEALTH PROGRAMME, GARKIDA