ABSTRACT
Community participation is of paramount importance for the success of any community project. This study aimed at determining the level of community participation in Health infrastructure in Ini LGA, in Akwa Ibom State. The planning and implementation of rural health care services, is dominated by the individual interests of their leaders or influenced by other local leaders, political leaders and facility in charges rather than the community itself. The objectives of this study were to; To determine at what level the community participates in rural health services, to determine the socio-demographic and community related factors that affect community participation in rural health services and to determine the challenges hindering community participation in rural health infrastructure in Ini LGA, in Akwa Ibom State. An interviewer administered questionnaire which was both closed ended and open ended was used to collect data from 384 participants. A cross-sectional analytical study design was used to conduct this study. The quantitative data obtained was analysed using SPSS software version 24, and Chi square was used to determine significant results. The sociodemographic factors were analysed using descriptive statistics. To analyse the factors, cross tabulation and independent chi square (χ ) tests were used with P values of 0.05 to determine the significant factors. The significant factors were then entered in for Binary Logistic Regression, and finally to multivariate regression. The researcher found out that, 59 (15.4%), of the respondents were involved in needs assessment, 36 (9.4%) at implementation stage, 1.6% at monitoring and evaluation, and 1.3% were involved in all levels of rural health care. However, most 278 (72.4 %) of the respondents reported no involvement at any level of rural health care. The following factors were significantly affecting community participation towards rural health care services; length of stay in the area and community mobilization. Some of the challenges hindering community participation in rural health care facility services included; lack of laws specifically governing implementation of community projects; majority of community members lacked knowledge on community participation 349 (90.9%) on when and where to participate in, lack of community empowerment, poor leadership in the community, lack proper representation and poor infrastructure, poor management systems and poor communication systems. In conclusion, Ini community members community participation in Ini LGA was low at 106 (27.6%). The study recommends that the community should be enlightened on community participation and their role in rural health care facility services, there is need for increased community mobilization and empowerment to the community members on community participation to ensure increased participation and more so in males and the need for Community leaders to be sensitized on governance, community empowerment and establishing good communication systems. All this together will make the community members to gain control of the program and decisions that shape their health care.
CHAPTER ONE
INTRODUCTION
• Background of the Study
Community participation refers to the action of local people being collectively involved in assessing and identifying their needs, implementing and evaluating health programs and sharing the benefits (Rifkin, 2014). Community participation in health plays a vital role in the provision of primary health care (PHC) services to the community. Community participation has been a continuous theme in development discussions for the past 50 years (Rifkin, 2014).
Primary health was initiated as a government policy priority for health systems strengthening due to PHC’s ability to provide accessible and continuous care. In accepting primary health care as a government policy, all members of World Health Organization (WHO) recognized the importance of involving the community in rural health infrastructural development, since the community is the intended beneficiaries of these services (Rifkin, 2014). It was also agreed that community was to be involved all the way from need assessment, planning, implementation and evaluation. This is what constitutes levels of rural health care (Lock, 2017). An effective partnership between community residents and the health professionals and stakeholders of health is essential for community-based solutions. This helps by advancing health equity and making community involvement a shared vision and value, by increasing the community’s capacity to shape outcomes, and fostering multi-sectoral collaboration (Baciu et.al, 2017).
Community participation lays emphasis in PHC collaborations, the residents and health providers need to work in together because each has an area and some level of expertise to participate. Partners are able to employ different unique skills and access resources to serve as a variety of roles in rural health care. A partner could serve as a convener of coalitions in data collection and analysis, as a funder, and also as philanthropy. Through all these skills, the Partners get involved in actions and interventions that address the underlying or predisposing causes of rural health inequity through engaging the community to participate (Mitchell & Black, 2016). In recent years, community participation in healthcare design and co-production is increasingly highlighted in health policy reform in the United States, Canada, Australia, Asia, and Europe as good for rural communities. Implicit in this policy is a view that rural communities require solutions tailored to their challenges and that rural communities provide appropriate places of community health participation.
There is an assumption that, when community members are involved in community health care delivery that local citizens will build the resilient, self-determined communities needed to deal with complicated rural issues of financial and structural access to health care and poor health. Collaborative approach is used, to bring together health care professionals, people using the services in the community setting and citizens to harmoniously develop and deliver rural health services. The key interest in encouraging community participation is that by giving decision making powers to the community members, the members will be responsible of their own health, costs will be contained and health care outcomes will improve (Kenny et al., 2015).
Even after the importance of community involvement in health services has widely been expounded, the actual involvement is less apparent in the community level. Community involvement is viewed as a gate way to success in the delivery of health care, however, there seems to be very little or no actual community involvement in the community context (Musau et al., 2010). The community members can either be directly involved or indirectly involved in provision of primary health care. Indirect involvement means the elected officials and professional administrators should act on behalf of the community members in representing their democracy. Direct involvement includes direct participation of community members in delivery of these services such that they own the government and should be involved in the decisions of the State (Kenny et al., 2014).
• Statement of the Problem
In 1978,the Alma Ata Declaration set principles to guide the planning, implementation, and evaluation of community-oriented health programs. One of the principles as per Alma Ata Declaration outlined the right and duty of people to participate individually and collectively in planning and implementation of rural health care. Despite the Alma Ata Declaration principles, community participation has not yet cultivated enough success in the past (WHO, 1978). Despite a uniform consensus that communities should be actively involved in improving their own health, evidence for the effect of community participation on rural health care outcomes is low (Marston et al., 2013).
There is a growing body of work that documents different levels and models of community participation, significant gaps and outlined practical challenges of community participation in rural health care. Many African countries face challenges in involving communities in rural health care services (WHO, 2014). In the recent past, the process of planning development regarding health care activities in many countries was coordinated and controlled by the central governments. When this strategy failed to achieve the expected development from centralized planning system, policy makers and planners, opted for a decentralized planning and implementation approach from central government down to the community (WHO & UNICEF, 2014).
Communities still face problems in trying to participate in rural health care since decision making and the allocation of resources for primary health care remains in the hands of medically trained people. Until those who make decisions and resource allocations understand that primary health care extends beyond provision of rural health services to help cultivate the culture of community participation, it is likely that community participation will remain a mere theoretical outline (Porche, 2004).
Despite the efforts of the government availing policies, guidelines, and community representative organs, actual implementation of community participation has been poorly achieved. The national policy is well defined with greater focus as improved health care delivery services (Oyore et.al, 2010). The underpinning proposition is that by giving decision-making powers to community members, health care will be locally responsive, costs will be contained, and health outcomes will improve. What happens in the practice of enacting community participation in health-care decision making is less clear. Despite the growing body of work that documents different levels and models of community participation, significant gaps that outline the practical challenges inherent in rural community participation remain (Rifkin, 2014)
Again, there is much recognition of public and community participation by the Nigerian constitution in Articles 10 and 232 and Chapter 6, in which a people- centered approach and social accountability in planning and implementation has been encouraged. Despite all this recognition, there has not been much success in improving the situation of community participation. The planning and implementation of services in rural health facilities, has been seen to be dominated by community leaders’ individual interests or the community participation is influenced by other local leaders, political leaders and facility in charges rather than the community itself (WHO, 2015). The level of community involvement in Akwa Ibom State is not well documented. Therefore, this study seeks to establish the level of community participation in Ini LGA in rural health care, in Akwa Ibom State.
• Research Questions
• At what stage does the community participate in rural health infrastructure in Ini LGA, in Akwa Ibom State?
• What is the socio-demographic and other related factors affecting community participation towards rural health infrastructure in Ini LGA, in Akwa Ibom State?
• What are the challenges hindering community participation in rural health infrastructure in Ini LGA, in Akwa Ibom State?
• Objectives of the Study
• Broad Objective
To determine the level of community participation in rural health care and the associated factors in Ini LGA, in Akwa Ibom State.
• Specific Objectives
• To determine at what level the community participates in rural health infrastructure in Ini LGA, in Akwa Ibom State.
• To determine the socio-demographic and community related factors that affect community participation in rural health infrastructure in Ini LGA, in Akwa Ibom State
• To determine the challenges hindering community participation in rural health infrastructure in Ini LGA, in Akwa Ibom State.
• Research hypothesis
Null Hypothesis (H0): there is no association between socio-demographic/ community related factors and community participation.
Alternative Hypothesis: there is an association between socio-demographic/ community related factors and community participation.
• Significance of the Study
Different community have different health needs, to understand individual community’s’ challenges, it is necessary to encourage community participation or public participation. (Runnels & Andrew, 2013). The Nigerian constitution considers public participation as fundamental pillar in providing services to its citizens. It promotes democracy by providing the public with the opportunity to take part in decision-making process in government.
Community involvement is the key to success in the delivery of rural health care, yet there seems to be very little or no actual community involvement in the community context (Kenny, 2014). Although in the Alma Ata conference (1978), community involvement in health was identified as one of the principles in PHC practice (Alma Ata, 1978), forty years post this conference there is still a missing link between the community and health care system. Community members are being mere recipients of the health care and not involved in the decision making and planning of rural health care (Grady, 2010).
Therefore, the results of this study will be useful in constructing local participatory strategy and programs aimed at enhancing local community participation in Ini LGA rural health facilities, in Akwa Ibom State. Consequently, the results of this study will also be used in policy formulation for community participation purposes in Nigeria. The findings will also be used in various regions of this country with the same geographic and socio-economic characteristics with the aim of improving rural health care. Again, the results of this study will also be important in building the body of knowledge to all people working with the communities in Ini LGA.
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