Factors Affecting the Utilization of Health Care System in Lagos State University Teaching Hospital
Chapter One
Objectives of the study
General objective
The main aim of the study was to assess the factors affecting utilization of health care services in Lagos State University Teaching Hospital, Lagos state Nigeria.
Specific objectives
The specific objectives of the study were to:
- To assess the different forms of health care services that households use when ill
- To assess the proportion of households that use formal health care services when ill
- To determine how socio-demographic/economic factors influence utilization
- To explore how socio-cultural practices/factors influence healthcare
- To assess how geographical/health facility factors influence healthcare
CHAPTER TWO
LITERATURE REVIEW
Utilization of healthcare
The choice of healthcare service provider and the subsequent utilization of healthcare services is a complex multifaceted process, especially in the context of a developing nation like Nigeria. The National Population and Housing Census data highlights a perplexing scenario in Nigeria that is characterized by low utilization rates of public healthcare services in most rural communities, most especially the three regions of the northern sector of the country. Therefore, given the relevance of public services in a welfare state like Nigeria, the key question that lies at the heart of healthcare services scenario is related to the factors affecting the utilization of healthcare services. Data available shows that Wa Municipal has made some progress on mortality but still has a long way to go in attaining the Millennium Development goals (GSS, 2014). Out of the 10 districts across the the Wa Municipal Assembly recorded the fourth highest in deaths related to accidents, violence, homicides, suicides and all other causes of 7.4% and 92.6% respectively out of total deaths of 538 recorded in Lagos state from the total regional death records of 6,346 (GSS, 2014).
In the same year, deaths in households were 538 (crude birth rate of 5.02 per 1000) of the total deaths of 6,346 and a population of 107,214 and 702,110 for the municipality and region respectively.
Empirically, numerous research have been carried out in developing countries to identify the elements influencing the use of healthcare services (Peters et al., 2008). The evidence shows that the main common cause of underutilization of health care services has to do with cost (Castro- Leal, Dayton, Demery, & Mehra, 2000). However, the works of Garshong (2011), Mills et al. (2012), have outlined other barriers to health care accessibility.
Key access barriers found in Garshong and Akazili (2015), report included economic factors such as direct and indirect costs to seeking health care. Many health facilities are located long distances away from the population they serve. Travel time and cost, including waiting time deter many poor rural populations from seeking health care. Others include organizational factors with regards to availability of staff and equipment and frequent referrals, which many poor people find difficult to adhere to. Unpredictability of opening hours in small rural facilities is a challenge. Poor staff attitudes and lack of confidence in some health facilities in dealing with health needs of segments of the population deter use. Lack of awareness of entitlements and information on the Health Insurance subscription hinders use of health care (Agyepong et al., 2017).
Theoretical models to explain utilization of healthcare services
Researchers from different disciplines of economics, anthropology, epidemiology, public policy and management have explored the reasons behind utilization of healthcare services by an individual. There are diverse paradigms to explain healthcare services utilization. For instance, a psychological model based on social structure and individual medical orientation (Suchman, 1965), the health belief model based on the various perceptions and motivations of the individual (Rosenstock, 1974), and utility driven healthcare seeking decision steps model (Young, 1980), have been suggested.
With regard to the healthcare seeking behavior of an individual, the focus is on contextual elements related to the socio-economic conditions of the individual and the prevailing health system characteristics (Dusanee & Pranee, 2014).
Consequently, the focus of healthcare services utilization research from a behavioral perspective is on identifying the most appropriate factors (both individual and environmental) that may influence the choice of the healthcare services provider (Omu & Reynolds, 2012).
There are two major frameworks that have been proposed to explain the healthcare services utilization of an individual from the behavioral aspect. These are: Andersen and Newman model and the Kroeger’s model (Andersen & Newman, 1973; Kroeger, 1983).
CHAPTER THREE
RESEARCH METHODOLOGY
Study Design
The design used for this study was a cross-sectional descriptive survey where data collection occurred at a single point in time for each household head (Fraenkel & Wallen, 2009).
Key informant interviews were also used to elicit responses from the respondents.
Study population
The study population consisted of heads of households selected from the Lagos State University Teaching Hospital It is a community with 1,299 people and households of 152 with 184 houses (GSS, 2014).
Inclusion criteria
The inclusion criteria involved household heads who were18 years or older and consented to participate and were residents in one of the households in the selected study area. These people should have stayed in Lagos State University Teaching Hospital continuously for at least two (2) months in the preceding six (6) months to the study.
CHAPTER FOUR
DATA ANALYSIS AND RESULT PRESENTATION
Socio-demographic characteristics of respondents
One hundred and sixty-nine (169) household heads were interviewed in the Lagos State University Teaching Hospital Of the 169 household heads, 93(55.03%) of them were females. The mean age of household heads was 41.39 years (SD 19.4) and a mean household size of 6.60. Most 50(29.6%) of the household heads were above 45years old. On average, there were 4 members per household (SD 3.1). The smallest household size was 1 and the largest household had 25 members. There were 169 households that were included in the study. Out of this number, 38(22.5%) of household members were between 18 and 25years, 49(28.9%) were between 26 and 35 years old, 32(18.9%) were between 36 and 45 years old and majority, 50(29.6%) were 45years old and above.
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATIONS
Summary of the study
This study sought to assess factors affecting utilization of healthcare services in a peri-urban community in Nigeria, Lagos State University Teaching Hospital in Lagos state. Its specific objectives such as socio-demographic/economic factors, geographical/health facility factors, socio-cultural practices/factors were used to measure its main objective though most findings were found to be insignificant. The study showed that utilization level was 77%. Many do not have effective means of transport to access healthcare as they resort to walking.
However, it found that most respondents still travelled far distance to access healthcare as a result of dilapidated clinic structure, no consumables, inadequate staff coupled with staff absenteeism, no night shift cover, etc. These were enumerated as challenges faced during the interviews.
The Andersen and Newman’s theoretical models were used to explain the findings of the study.
Conclusion
Level of utilization of 77.8% was higher than as observed in literature (50%). Some similarities and variations in associated factors were established. There is the need to invest in improving the NHIS. A lot of respondents, (13.33%) prefer at home treatment and 17.8% still preferred OTC medications, which could affect health outcomes. Irregular openings, absenteeism and lack of medications at clinic were affecting utilization.
Recommendations
The following recommendations are made based on the findings.
- With the high utilization of formal healthcare services without a properly functioning clinic, the Municipal Director and team should commend the community for the importance they attached to their health.
- Scaling-up and strengthening of Community-Based Health Planning and Services (CHPS) and active community participation in CHPS activities should be intensified in approved
- A lot of people still preferred home treatment such as OTC and herbal or traditional Education should be intensified to reduce adverse drug events.
- Behaviour Change Communication (BCC) or Information, Education and Communication (IEC) should be used to target husbands and household heads on women autonomy to utilize
- A well-furnished health facility should be built for the people of
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