The Role of Community Health Administration and Rural Development
CHAPTER ONE
Objectives
Overall objectives
To determine the role of Community Health administration on the development of Sagbama L.G.A. using two statistical models.
Specific Objective
- To determine the effect of support supervision on CHA’s contribution to development.
- To determine the effect of training on CHA’s contribution to development.
- To determine the effect of incentives on CHA’s contribution to development.
- To determine accuracy and precision of logit and probit model on assessing CHA contribution to development.
CHAPTER TWO
LITERATURE REVIEW
Profile of community health strategy in Bayelsa
Community based approaches have been carried out where a collaboration of the government, UN-HABITAT and a contingent of NGOs, are making inroads into the
settlements in an attempt to facelift the housing and sanitary conditions that will lead to reduction of diseases. Despite the ‘slum upgrading’ by various NGOs the wellness of the population in Bayelsa has not improved as most people in the households cannot access referral systems due to very uneven topography in the area. Few houses have vehicle access, and many are at the bottoms of steep inclines which heightens the flooding risk (Davis, 2010).
As the Nigeria government came up with the community health strategy, Bayelsa was divided into 13 community units (Map Bayelsa project, 2003).
The community is plagued by high levels of poverty, insecurity, underdevelopment and inadequate access to basic social services. These include basic health care, education, water and sanitation, inaccessibility due to poor roads and inadequate involvement of the government in provision of essential utilities and services.
AMREF and other NGOs have been working in Bayelsa since 1998 and they use an integrated approach to address issues on comprehensive care for people living with HIV, maternal, newborn and child health and Personal Hygiene and Sanitation Education (PHASE). AMREF reaches a population of between 35,000-45,000 in the four locations (out of 13) which include Bayelsa – Laini Saba, Soweto, Mashimoni and Silanga (Davis, 2010).
The Community intergrated programme supports a static health facility that provides outpatient services to children and adults and a 24 hour inpatient maternity service. The clinic also runs an ART program that provides care and treatment for HIV/AIDS and TB patients. So far, the project has enrolled over 6,000 patients for care in the programme with more than 3,000 having started ARVs treatment in the facilities, scaled up door to door awareness by CHAs on HIV percentages, reaching to an average of 70% of households, increased usage of maternity, family planning, ante/postnatal and child health care. A recent intervention was made by Nigeria Water for Health Organization (KWAHO) where it is currently implementing a Solar Water Disinfection project as an effective and inexpensive initiative to enhance the community’s access to safe drinking quality water at the household level (Yap, 2008).
Concept of Community
The term Community has a varied etymology. The Latin root of the word community is communis, which means common‘. It is also associated with the Latin word communitas, denoting a particular quality of relationship. Today the term communities has under gone a lot of semantics changes and have attracted a lot of interpretative exposition due to dynamics of industrialization, urbanization, and suburbanization and globalization, leading to different variety of communities.
People use the term community in a variety of ways. Two of the more common uses of the term refer to those communities known as territory-free‘‘ and those labelled territorybased.‘‘ The term territory-free community‘‘ generally is used to describe types of social groupings or networks. Examples include social groupings or networks such as the business community,‘‘ the farm community,‘‘ the academic community,‘‘ and the Internet community.‘‘ While the other common use of the term refers to geographically localized settlements or territory-based communities‘‘ (Theodori, 2005).
One of the earliest theorists on community, Ferdinand Tonnies considered community as Gemeinschaft and society as Gesellschaft. In Gemeinschaft (community‘) human relationship are intimate, enduring and based on clear understanding of each person standing in society.
Community can therefore be considered as a number of families residing in a relative small area within which they have develop a more or less complete socio cultural definition imbued with collective identification and by means of which they solved problems arising from sharing of an area.
The word community is found in concepts such as community empowerment, wealthy communities and sustainable communities. Others include communities of practice and virtual communities. Community is used also to describe different scales of human organization, including local communities such as tours, villages, regions, neighbours, nations, as well as business communities, academic communities, political communities, and a World community (Connell, 2003)
CHAPTER THREE
RESEARCH METHODOLOGY
Study area
The study was conducted in Sagbama. Sagbama is located in the outskirts of Bayelsa, Nigeria and is approximately 5 kilometers from the city centre, (Map Bayelsa, 1999). This division is the largest slum in Bayelsa, and the second largest urban slum in Africa, (Map Bayelsa, 1999). In 2009 the Nigeria Population and Housing Census reported Bayelsa’s population as 470,070 with an average of one pit latrine for every 50 to 500 people.
Study design
The design was a cross sectional study where the respondents were drawn from the socially deprived urban slum in Bayelsa city.
Study Population
The study population (Sagbama) consists of the districts of Otoni, Sagbama, Ossiama, Adagbariri, Adoni, Agbere, Asamabiri, Angalabiri, Ebedebiri, Osekwenike, Agoro, Toru Ebeni and Trotani.
Sampling frame
Based on convenience sampling method, the following districts were selected for study: Otoni, Sagbama, Ossiama, Adagbariri, Adoni, Agbere, Asamabiri.
CHAPTER FOUR
RESULTS
Socio-demographic characteristics of study sample
It was seen that most of the community health workers were Females with Mashimoni and Soweto West (80%), having the most number of female community health workers (figure 2). The same CUs had the least number of male community health workers. Otoni, Sagbama, Ossiama, Adagbariri, Adoni, Agbere, Asamabiri
CHAPTER FIVE
CONCLUSION AND RECOMMENDATION
Community health administration play a major role in alleviating the shortfall of physicians, midwives and nurses across the community. These effects are highly pronounced in developing countries especially in Africa where pressing health requirements cannot be fulfilled. The shortfall of professional medical practitioners has forced countries like Nigeria to rely on CHAs to deliver life-saving interventions in slum dwellings like Bayelsa. It is therefore crucial for the government to strive and maintain a particular number of motivated CHAs.
CHAs are part of and are influenced by the larger cultural and political environment in which they work. They should be well trained in various health issues so that they are able to play their roles efficiently and effectively.
Incentives play a major role in CHA contribution to development. There are two types of incentives i.e. monetary and non-monetary incentives. Monetary incentives can increase retention since the CHAs are poor people trying to support their families. However, monetary incentives may bring problems; the money may not be enough, it may not be paid regularly or may stop altogether. Non-monetary incentives are critical to contribution to development of CHAs. They need to be given tool kits, supportive supervision, appropriate training and refresher courses. Small tokens such as identification badges may give CHAs a sense of pride in their work and increased status in their communities. Appropriate job aids such as counseling cards and regular replenishment of supplies could ensure that they feel competent in their jobs Probit and logit models give almost the same estimates. Logit model was easier to understand and interpret as estimates are calculated directly.
This study recommends an extension of the implementation of the Community Health Strategy period, a review on the incentives, supervision and training curriculum of the CHA. It also recommends provision of tool kits and reporting tools to CHA. This study did not delve into the quality of the work done by CHAs, an area that could give more information if researched on.
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