ABSTRACT
Background.
Children as a vulnerable group bear an undue share of the
global burden of disease. Attention to the provision of quality child health
services can prevent many diseases that cause severe illness and death in
children in developing countries. Child health services form part of the
maternal and child health services, one of the components of primary health
care. Quality child health services if made available at the primary health
care level will produce an effective and efficient outcome; reduce child
morbidity and mortality and ultimately the attainment of the MDG – 4. The study
was conducted from 15th September to 30th November, 2009
to assess the quality of child health services in the Public PHC facilities in
Nnewi North LGA of Anambra state.
Methodology.
The study was a cross – sectional descriptive study that
assessed the quality of child health services and its determinants in the LGA
using both qualitative and quantitative methods. Focus group discussion of
caregivers and providers of child health services as well as key informant
interviews of the facility heads and the LG PHC coordinators were conducted. A
checklist adapted from the minimum requirements for a primary health centre
developed by the National Primary Health Care Development Agency was used in
assessing the health resources available for child health services in NNLG. A
total of 305 caregivers utilizing child services in the public PHC facilities
in NNLG selected by stratified sampling with proportionate allocation were
interviewed. In addition, some selected health care workers, facility heads and
the health facilities providing child health services were included in the
study.
Result.
The result from the study showed the quality of child health
services as poor. This is as evidenced by inadequacy of basic amenities,
inadequate staff distribution. The providers were not motivated due to delayed
promotion, insufficient training opportunities. The caregivers corroborated the
managers’ views that equipments were sufficient, were not shared by the caregivers
and providers of child health services.
Conclusion.
It was concluded that the quality of child health services
in NNLG was poor. There is a need for the LGA authorities to provide minimum
equipment package, drugs and supplies as well as make funds available for the
delivery of quality child health services. There is also a need for the
adoption of quality of care action plan at the LGA to improve the quality of
child health service delivery which is a step towards the attainment of the
MDG4.
CHAPTER ONE
1.0 INTRODUCTION
Children and women form three-quarters of the population in
low and middle income countries such as Nigeria. They are also the most
vulnerable and most sensitive to their environment. As such, children bear an undue
share of the global burden of diseases.1
Although major gains were made in the reduction of childhood
health indicators in the previous decade, observations are that stagnations or
even reversals were seen in many countries since the 1990s.1 One of the reasons
given for this is low level of utilization of quality health services. Another
reason is that the concept of quality has not received much attention in these
developing countries, coupled with economic decline, political instability, and
emigration of health professionals amongst other factors.1
This has drawn the interest of many international agencies
like the United Nations Children’s Fund (UNICEF), World Health Organization
(WHO), Rockfellers Foundation, among others to plan programmes for interventions
on these alarmingly poor health indices.These intervention programmes have been
developed through integrated approaches (Primary Health Care, Integrated
Management of Childhood Illnesses), selective parallel programmes (Child
Survival Strategies) and development programmes. The latest of such commitments
by these international agencies, were made at the Millennium Summit in
September 2000, from which the Millennium Declaration, and subsequently, the
Millennium Development Goals (MDGs) emerged. Also at the UN General Assembly’s
Special Session on Children in May 2002, this issue resulted in the outcome
document ‘A World Fit for Children’. These two compacts complement each other,
and taken together, form a strategy – a Millennium agenda – for protecting
childhood in the opening years of the 21st century.
In the year 2000, representatives of 189 nations, including
147 heads of state and government, gathered at the United Nations for a
historic Millennium Summit. They adopted a set of goals, the Millennium
Development Goals (MDGs). Achieving these goals by the target date of 2015 will
transform the lives of the world’s people. The MDGs are made up of 8 goals, 18
targets and 48 indicators out of which 3 goals, 8 targets and 18 indicators,
are directly related to health. 2.
The Millennium Development Goal number four, is about the
reduction of child mortality.2,3. The main target of MDG 4 is to: reduce under
– five mortality rates (U5MR) by two-thirds between 1990 and 2015. The
indicators numbers 13,14 and 15 are: under – five mortality rates (U5MR),
infant mortality rates (IMR) and the proportion of 1 year old children
immunized against measles.2,3. U5MR and IMR measure such indices as: the level
of immunization against common childhood diseases; the nutritional state and
health knowledge of mothers; availability of maternal and child health services
within five kilometers or 30 minutes walk. 2, 3.
These children form the base of the
nation’s human resource development and it is only ideal that the society
provides the supportive and enabling environment for the optimal attainment of
their innate qualities. Assessment of the quality of these child health
services that are offered through Primary Health Care facilties in the LGA is a
way of assessing the progress towards the attainment of MDG 4, and is
undertaken in this study.
1.1 PROBLEM STATEMENT
High rates of under–five and infant mortalities still
persist.These unnecessary mortalities reflect a significant breakdown of basic
services, and in particular of primary health care in the country. 4 Coverage
and utilization of these interventions are correspondingly low. The Nigerian
health situation makes it a major sector in the global achievement of MDGs 4. 4
Achieving the MDG 4 means tackling such problems as low
immunization coverage, inadequate provision of clean and potable water, lack of
infrastructures like good roads and transportation in the rural areas. Other
problems to tackle include: unavailability of basic obstetric and neonatal care
in most health facilities, low education level of mothers, unwholesome sale of
expired drugs in the rural areas and urban slums. It is also necessary to
increase political will on the part of government, as health budget still
remains about 5% of national budget.5
Quality of care reflects how the available resources have
been utilized to produce an effective and efficient outcome. However, very few
studies have been done on the assessment of the quality of primary health care
in most developing countries. This number further dwindles when the quality of
child health services is particularly referred to.
In the Nigerian health system, formal mechanisms to assess
quality of care are yet to be developed.2 Evaluation of PHC programmes has
focused mainly on coverage. A little attention is paid to assessing the quality
of service provided.6 An assessment of the quality of the health service will
indicate the degree of its worth and is no doubt a step towards determining its
effectiveness and ultimately the attainment of the MDG-4.
1.2 JUSTIFICATION OF THE STUDY
Globally, the quality of health care services for children
can be better than what it is, especially as these children constitute one of
the vulnerable groups in the society. In Nigeria high childhood morbidity and
mortality from preventable causes remain major public health problems. How then
can we achieve the MDG-4, when the deficiencies in the health system account
for these alarmingly poor health statistics?
Assessment of the quality of child
health services serves as an appraisal of the degree of worth of these services
to meet the identified needs as contained in the Millennium Declaration. It is
necessary to ensure that the limited resources allocated to health care, inspite
of growing demands is effectively utilized to meet the health needs of the
people.
Quality assessment is also a managerial process to ensure
that standards are maintained with the aim of improving the effectiveness of
services. Assessment of health service effectiveness is a wider concern for
assurance of quality of care
It is also important in this era of health sector reforms so
as to serve as a basis for recommendation of appropriate intervention towards
the improvement of the quality of child health services with a consequent
reduction of morbidity and mortality in children.This will facilitate the
attainment of MGD-4 which is to reduce child mortality.The study would also
contribute to research in the quality of child health services in Nigeria.
1.3 AIM AND OBJECTIVES
Aim
To assess the quality of child health services and its
determinants in the PHC facilities of Nnewi North Local Government (NNLG) Area
Anambra state.
Specific objectives
To determine the availability of child health services in PHC
facilities of NNLG Area Anambra state.
To examine the health resources (human, material and
financial) available for the provision of child health services in PHC
facilities of NNLG Area Anambra state.
To study the quality of supervision of child health services
in the PHC facilities.
To assess the level of clients’ satisfaction with care
received at these PHC facilities.
To identify factors influencing the quality of child health
services in NNLG.
================================================================
Item Type: Project Material | Size: 67 pages | Chapters: 1-5
Format: MS Word | Delivery: Within 30Mins.
================================================================
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.