An Assessment of the Quality of Child Health Services in the Public Primary Health Care Facilities in Nnewi North Lga of Anambra State.

An Assessment of the Quality of Child Health Services in the Public Primary Health Care Facilities in Nnewi North Lga of Anambra State.

CHAPTER ONE

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
To examine the health resources (human, material and financial) available for the provision of child health services in PHC facilities of NNLG Area Anambra
To study the quality of supervision of child health services in the PHC
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

CHAPTER TWO

LITERATURE REVIEW

CHILD HEALTHSERVICES

Children comprise about 40% of the world’s population and are also amongst the vulnerable groups.⁷Child health services respond to three basic needs: the management, surveillance and prevention of acute illnesses; health education; and the care of the child with chronic conditions.The recommended integral components of any medical service for children include: promotion and maintenance of breastfeeding, routine immunization, oral rehydration therapy and control of diarrhoeal diseases, management of acute respiratory tract infection, and growth monitoring. The cornerstone of child health services in the developing world include: health education and promotion, nutritional guidance including growth monitoring, immunization and treatment including surveillance and early diagnosis of disorders.

The basic child health services are growth monitoring, immunization and sick child consultation. Growth monitoring is a key part of essential health care. The growth of the child is a reflection of the well being of the child. Growth monitoring was first introduced in Ilesha, Nigeria by David Morley in the 1960s, and was later adapted by UNICEF as a child survival strategy. It is a component of child health programmes in developing countries. The regular measurement and documentation of a child’s growth and development provide an index of the health and nutrition of the child and the community. Training and supervision of health care workers and participation by mothers are necessary to ensure the effectiveness of the programme.

Immunization is said to be the most cost effective health care strategy ever developed. It is an important foundation of any primary health care structure. The distribution of childhood illnesses in different parts of the world depend on several factors which include: poverty, hygiene and coverage of health services.

The Expanded Programme on Immunization(EPI) which later became known in Nigeria as the National Programme on Immunization(NPI) was launched in 1974. Then in 1974 few children were being immunized in developing countries. The routine immunization in Nigeria is done against tuberculosis, tetanus, whooping cough, pertussis, diphtheria, poliomyelitis, measles, hepatitis B and yellow fever. The schedule for immunization of children in Nigeria is as shown in Appendix I. Immunization was commonly given at school age when the threat from the target diseases had already passed, and was of doubtful potency. Prior to the launch, approximately five million children were dying yearly from the six childhood diseases worldwide. Measles, the highest killer claimed million children yearly, while neonatal tetanus claimed 800,000 infants, polio crippled about half a million.¹⁵ The aim therefore was to increase coverage of immunization against the vaccine preventable diseases.

Starting from the immunization coverage of 15%, the goal was to get 60% of the children immunized by 1987 and 80% by 1990. This was because 70% of childhood deaths in developing countries and 75% of children seeking medical care worldwide was attributed to vaccine preventable diseases. By 1991, a year after the targeted 80% coverage,WHO and UNICEF declared a successful coverage of the world’s children with the vaccines. Evaluation reports in Nigeria have shown that the proportion of fully immunized children under the age of one year has shown a downward trend to 21% in 1995. Due to the low coverage and high morbidity and mortality from the targeted diseases, Nigeria decided to boost her immunization coverage through the National Programme on Immunization (NPI) in 1996. The target of this programme is to achieve high coverage of all vaccines by 2000.

CHAPTER THREE

METHODOLOGY
BACKGROUND OF THE STUDY

Nnewi North Local Government Area is one of the 21 LGAs in Anambra State, South East Nigeria. It is an outcome of the split of the former Nnewi Local Government Area (originally created in 1976) into Nnewi North and Nnewi South Local Government Areas, during the Local Government creation exercise of August 1991.The LGA was further split in 1996 to carve out Ekwusigo LGA, thereby making Nnewi North LGA a one town Local Government. ⁸³

The Local Government Area is about 40 minutes drive from the State capital, Awka and about 30 minutes drive from Onitsha. The Nnewi North LGA lies in the tropical rainforest with typical climatic conditions and two distinct seasons , a rainy season that starts from April or May to September and a dry season which lasts from October to April. The mean temperature is about 30.6 ⁰C, while the vegetation is made up of thick forest, trees and evergreen vegetation.

The land mass has an area dimension of 72km² and an approximate total population of 157,569 people by the population census of 2006.⁸³ From this an average population density of 2.189 people per square kilometre can easily be appreciated. ⁸³ The people are ethnically Ibos and the language spoken is Igbo, although English and its adulterations are spoken. The inhabitants are mainly traders, with a few white collar and blue collar job workers, farmers and artisans, and are predominantly Christians. Nnewi is the second biggest commercial town in the state. It is a town famed for industrialization, with raw materials mainly imported from outside the country, thus attracting dealers on these products from different parts of the country and beyond. Both the Federal and state Institutions have their offices in Nnewi. There are numerous privately and publicly- owned primary and secondary schools in the LGA.The College of Health Sciences of the Nnamdi Azikiwe University is also located in this LGA.

The health programme of the LGA conforms to the National Health Policy. It has a number of health facilities; a federal teaching hospital, the Nnamdi Azikiwe University Teaching Hospital, Nnewi (NAUTH) Nnewi.The NAUTH Nnewi, is a tertiary health institution which provides a wide range of medical, surgical, diagnostic, out-patient, in- patient, rehabilitative and support services to a catchment population of about 25,430,493.There is no public secondary health care facility in the LGA.However, there are two mission hospitals, about 30 private hospitals and clinics, 24 Primary Health Care Centres (12 PHCs and 12 Health Posts) run by the LGA, and maternity homes.There are traditional and religious health care providers as well as community and village health workers, and patent medicine vendors.

The map of Anambra state showing Nnewi North Local Government Area and map of Nnewi North Local Government Area are shown in Appendices III and IV.

THE STUDY DESIGN

The study design was a cross-sectional descriptive study of the quality of child health services in the public PHC facilities in Nnewi North LGA.

CHAPTER FOUR

RESULTS

The results of the study are presented in line with the objectives of the study. The availability of child health services in PHC facilities of NNLG Area Anambra State is presented first. The second part presents the health resources (human, material and financial) available for the provision of child health services.The third, part presents the quality of supervision of preventive and curative child health services (immunization, diarrhoea, ARI) in the PHC facilities, also presented are key findings of the focus group discussions and the key informant interviews while the next part presents the level of clients’ satisfaction with care received at these PHC facilities. Using the checklist the capacity of the health care facilities to provide quality child health care services were assessed and the findings are also shown below.

CHAPTER FIVE

DISCUSSION

Most caregivers visited the health facility that was closest to their home. Reasons given for not visiting the nearest facility include: don’t like the health personnel, inconvenient operating hours, cost, non – availability of drugs and supply.^51, ⁶⁹ The availability of essential child health services which include immunization, growth monitoring and sick child consultation varies with the type of facility. The finding that curative services for children were available for 5 or more days in a week in all the health facilities studied was similar to the findings of the Service Provision Assessment (SPA) survey carried out in Tanzania, Ghana, Egypt. ^66-68. In this study curative services for children are more likely to be available than other services and this is similar to the finding of a study by Adeniyi et al.⁷⁰ However, growth monitoring, routine immunization, health education and health promotion were available for a fewer number of days than was reported in other studies.^66-68.

Overall, outreach activities were found to be carried out by few health centres in Tanzania and Egypt.^66,68 In this study none of the health facilities was carrying out outreach activities. Also a few health centres offered home visits and school health services according to a needs assessment survey carried out by the NPHCDA and reported in 2001,^72,85 but in this study none of the health facilities was offering home visits and school health services. When asked on the child health services provided in the health facilities studied, the respondents mentioned sick child consultation, immunization, and growth monitoring and health education at their respective facilities.

The health personnel were unevenly distributed in the health facilities studied. The manpower in all the four health facilities was less than the minimum staff complement required.^61, ⁷²The finding showed shortage of medical officers and public health nurses, similar to a Kaduna study, and the needs assessment survey of Primary Health Care by the NPHCDA.^63, ^70. The study found out that only one medical officer covered all the health facilities studied.

CHAPTER SIX

CONCLUSIONS

The quality of child health services in the primary health care facilities of Nnewi North LGA is poor. This can be shown by the poor and uneven distribution of health personnel. Also none of the health facilities studied met the minimum requirement for basic equipment nor had all the essential drugs expected for a primary health centre. There was availability of record systems though with paucity of forms which were incompletely and incorrectly filled. The physical structure in most facilities was described as fair but was not sufficient.

The providers of child health services were said to be regularly supervised but no work plan, supervision tools such as schedules and checklist were sighted during the study. Also continuing education especially in–service training was poor.

The managers perceived equipment to be adequate whereas none of the health facilities had the minimum equipment package and all essential drugs available. There were not even essential drugs list. The caregivers had varied perceptions of quality of child health services in different health facilities although majority were at least satisfied with the quality of child health services. Some areas were reported as problems that needed improvement. These areas which may infer perception of quality of child health services include inadequate number of the days services clients were given, amount of explanation received by clients on the health conditions, attitude of staff towards the clients, hours of service, cleanliness of the facilities and availability of drugs and vaccines.

RECOMMENDATIONS.

The following recommendations were made based on the findings of this study.

Stakeholders meeting involving health managers, care providers, caregivers, funders should be convened to deliberate on how the quality of child health services can be improved in the
Functional basic equipments for the delivery of child health services should be provided to the health
The PHC department of NNLG should adopt standard minimum basic equipments and supplies as well as services required at the PHC facility level. These standards should be used for regular inventory and should be It should be regularly updated and used as a guide to supply or refurbish health facilities.
The Drug Revolving Fund Scheme should be revisited and implemented recommenced.
There appeared to be no work plan for 2009 to This is reflected in the lack of goals, target and even job descriptions. The state government should sponsor the PHC, NPI coordinators and heads of facilities in the state on health planning course to improve their managerial abilities.

REFERENCES

World Health Organization, Strategic directions for improving the health and development of children and adolescents, World Health Organization, 2003: 1 –
United Nations Geneva. Millennium Development Goals (MDG) 2000. UNDP approach: undp.org/mdg/goallist.shtml.Assessed 15^th August, 2008.
WHO Goal 4: Reduce child mortality:http://www.who.int/mdg/goals/goal4/en/index.html. Assessed 15^th August, 2008.
World Health Organization. Road Map for Accelerating the Attainment of the MDGs Related to Maternal and Newborn Health in World Health organization,2005.
MDG’s UN statistics division; http://unstats.un.org/unsd/mi/mihtm
Perry H, Weierbach R, El–Arifeen S and Hossan I Comprehensive assessment of the quality of immunization services in one major area of Dhaka City, Bangladesh. Tropical Medicine and International Health, 1998; 3(12): 981 –992.
John M.Children’s rights and power: Charging up for a new century. Jessica Kingsley Publishers Ltd, London,2003:77,198.
Hendrickse R G. Medical services and hospital care for children .In Hendrickse R G (ed). Paediatrics in the Tropics, Oxford Blackwell Scientific Publications, London; 1991: 15 –
PolnayL, Hull Community paediatrics, Churchhill Livingstone, 1985: 15– 65.

George S M, Latham M C, Abel R, Ethirajan N, and Frongillo E A (Jr). Evaluation of effectiveness of good growth monitoring in South Indian villages. The Lancet, 1993; 342: 348 –
Seer M Manual of Tropical Paediatrics, Cambridge University press, Cambridge 2000: 2 –24.
Gerein N M and Ross D. Is growth monitoring worthwhile? And evaluation of its use in three child health programmes in Soc. Sci. Med. 1991; 32 (6): 667 –675.

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