Overcoming Health Barriers and Bridging Gaps Through Appropriate Health Policies and Health Promotion Programmes During Inter- Communal Clashes in Warri Environs.
CHAPTER ONE
Objectives of the study
The following are the objectives guiding the study;
- To establish the influence of Capacity building on the implementation of health policies and health promotion programme
- To find out the influence of support supervision on the implementation of health policies and health promotion programme
- To find out the influence of community health infrastructure on the implementation of health policies and health promotion programme
CHAPTER TWO
LITERATURE REVIEW
Introduction
This chapter examines the literature of the studies and policies that relate to Health policies and health promotion programme (SHP). The chapter discusses general theoretical review of overcoming health barriers and bridging gaps through appropriate implementation of SHP. A conceptual framework is drawn and discussed to emphasize on overcoming health barriers and bridging gaps through appropriate implementation of SHP.
Community health Policy
The community environment is one of the key settings for promoting children’s environmental health and safety as explained in the National Health sector strategic plan as well as the Nigeria education sector support programme. A national community health policy (2009) and national community health guidelines (2009) have been developed and disseminated.
This national community health strategic implementation plan aims to identify and mainstream key health interventions for improved community health and education. The strategy comprises eight thematic areas; these are: Gender issues, Values and life skills, Child rights, child protection and responsibilities, disability and rehabilitation, Special needs, sanitation and hygiene, Water, Nutrition, Disease prevention and control and Community health infrastructure and environmental safety. The strategy outlines critical issues on health and education linkages that are important towards the improvement of child health while in community.
Capacity Building
SHP contemplates a situation where a community has adequate and able human resource to deliver key objectives of the program among these is addressing life skills education and gender issues. World Education Forum in Senegal-Dakar in April 2000 resulted in a Dakar framework for action 2000 which refers to life skills in goal 3. Life Skills Education are abilities which allows an individual develop adaptive and positive behavior so as to effectively deal with demands of everyday and life challenges. The main goals of the Life Skills approach is to enhance young people’s ability to take responsibility for making choices, resisting negative pressure and avoiding risky behavior. Where life skills education is well developed and practiced, it enhances the wellbeing of a society and healthy behavior promote and positive outlook. Life skills are classified into three broad categories namely; skills of effective decision making, skills of knowing and living with oneself, skills of knowing and living with others,
CHAPTER THREE
RESEARCH METHODOLOGY
Introduction
This chapter describes the methodology that the researcher used to carry out this study. The researcher explains different components of research methodology adopted in this study. These include; research design, target population, sampling method, sample size, data collection instruments, validity of the instruments, reliability of the instruments and data analysis method.
Research design
Research design is the outline plan or structure that is used to generate answers to the research problem. It is the glue that holds the research elements and enables the researcher to gather accurate and reliable data (Kombo and Tromp, 2011). The researcher used descriptive survey research design for this study. This is a scientific method of investigation in which data is collected and analyzed in order to describe the current conditions, terms or relationship concerning a certain field problem (Mugenda and Mugenda, 2003). Descriptive survey research design seeks to establish factors associated with certain occurrences, outcomes, conditions or type of behavior. This design was appropriate for the study since the study involved assessment of human behavior which is highly diverse. In addition, the researcher aimed at getting the perceptions of the respondents regarding the issues under study hence this methodology was effective in meeting the objectives of the study.
CHAPTER FOUR
DATA ANALYSIS, PRESENTATION AND INTERPRETATION
Introduction
This chapter focuses on data analysis, presentation, interpretation and discussions. The researcher collected data through a questionnaire that was hand delivered to 60 respondents and collected by the researcher once completed and also through face to face interviews. Descriptive and inferential statistics were used to analyze data collected and the findings were presented descriptively; and through the use of tables.
Response rate
In this study, out of 60 respondents sampled, 50 returned fully filled questionnaires. This represents a response rate of 83%. According to Mugenda and Mugenda (2003) a response rate of more than 80% is more likely to give the researcher accurate findings.
CHAPTER FIVE
SUMMARY OF THE FINDINGS, DISCUSSIONS, CONCLUSIONS AND RECOMMENDATIONS
Introduction
This chapter presents summary of the findings and interpretations as presented in chapter four, discussions of the results, conclusions and recommendations based on the findings. The researcher basis the conclusions and recommendations made on the findings of this study. The researcher also suggests related areas that requires further research.
Summary of the findings
The study established factors of implementation of Health policies and health promotion programmes during inter- communal clashes: a case of Warri Local Government Area, Delta state, Nigeria by studying the following factors; Capacity building, support supervision and community health infrastructure.
The findings show that capacity building is very important in implementation of Health policies and health promotion programme. Ranking the perceptions of the respondents on the extent to which capacity building influences implementation of SHP based on the basis of the mean; shows that training SHP is the most influential with a mean of 4.68 points and standard deviation of 0.68, followed by training on gender issue with a mean of 4.2 points with a standard deviation of 1.03 and life skills training had a mean score of 4.04 points with a standard deviation of 0.75. However, the fact that all the three capacity building strategies had a rating of 4 and more points at minimal standard deviation, indicate that the respondents considered capacity building to play a crucial role in the implementation of Health policies and health promotion programme. The findings also reveal that majority of the respondents had not been trained on SHP and this could explain the poor state of implementation of the SHP in Warri Local Government Area.
The findings indicate that respondents consider support supervision to be crucial in the implementation of Health policies and health promotion programme. Majority of the respondents agreed that support supervision to communities on disease control and prevention, nutrition, special needs and rehabilitation, child rights and protection influenced implementation of SHP. In order of priority, disease prevention and control had the highest rating with a mean rate 4.08 points with standard deviation of 1.07, nutrition 4.04 points with a standard deviation of 0.64, special needs 3.94 points with a standard deviation of 1.0 and child rights 3.82 points with a standard deviation 1.08. Therefore majority of the respondents agreed that the four support supervision areas are key in the implementation of Health policies and health promotion programme.
Majority of the respondents agreed that community health infrastructure influenced implementation of Health policies and health promotion programme. In order of priority water and sanitation was ranked as the most influential with a mean score of 4.76 points and standard deviation of 0.43. This is despite the majority of the respondents 70% stating that the communities they represented did not have access to clean water always and only got clean water sometimes. Environmental safety had a mean rate of 3.82 points with a standard deviation of 0.66 while conducive classrooms had a mean rate of 3.22 points with a standard deviation of 0.93. This indicates that the respondents considered water and sanitation to be the most important infrastructure in the implementation of Health policies and health promotion programme.
Over all, the respondents rated capacity building as the most important factor influencing implementation of health policies and health promotion programme with a mean rate of 4.66 with a standard deviation of 0.48. Support supervision had a mean score of 4.24 with a standard deviation of 0.96 while community health infrastructure had a mean score of 4.22 with a standard deviation of 0.91. Other factors identified by the respondents were coordination and parental involvement. This indicated that the respondents considered all the three factors to be critical in the implementation of Health policies and health promotion programme. On inferential statistics, all the independent variables namely capacity building, support supervision and community health infrastructure were found to have a significant relationship with the dependent variable which is implementation Health policies and health promotion programme. All the independent variables had a t statistic p value of less than 0.05 which indicated that there was a relationship with the independent variable at 5% level of significance
Discussions of the findings
The researcher discusses the findings of this study and compares them with the findings of similar studies or literature conducted by other researchers. In doing this, the researcher is guided by the three independent variables of the study which are capacity building, support supervision and community health infrastructure.
Capacity Building
The study sought to find out whether capacity building influences implementation of health policies and health promotion programme in secondary community. The findings reveal that capacity building through training in SHP, gender issues and life skills has high influence on implementation of Health policies and health promotion programme. This finding is in line with the finding of McLean at al. (2004) who studied health capacity building in communities and found that community systems are open and adaptive to small scale innovations such as introducing programs on individual health or social issues but resistant to large scale reforms that shift basic priorities away from their academic, vocational and accreditation functions towards their socialization or custodial functions through their loosely-coupled and bureaucratic structures. He recommended that key stakeholders be properly trained on new programs before rolling them out in communities to avoid resistance or perceived interruption from the learning path.
On gender issues, the findings reveal that gender norms training is crucial in the implementation of Health policies and health promotion programme. This findings are in line with the literature of Fiona Lean (2006) who argues that gender violence in and around community has been recognized in recent years as a serious global phenomenon. We have ignored for too long what goes on in the community environment. The sad fact is that communities are not always the child-friendly places we expect them to be. Violence can be perpetrated by pupils or teachers in or around the community, or by out of community youth and/or older men who demand sex in exchange for money or gifts. Acts of gender violence are disproportionately directed at girls, but boys and teachers can also be targets hence the need to reach all stakeholders on gender norms training. In addition, United Nations (2006) study on violence against children recommended implementation life skills education to enable students to build personal skills. Governments should ensure that rights-based life skills programs for non-violence should be promoted in the curriculum through subjects such as peace education, citizenship education, anti-bullying, human rights education, and conflict resolution and mediation; with emphasis placed on child rights and positive values such as diversity and tolerance, and on skills such as problem-solving, social and effective communication, in order to enable girls and boys to overcome entrenched gender biases and to prevent and deal with violence and harassment, including sexual harassment. This is in line with the findings of the study.
Support supervision
The study sought to find out ways in which support supervision influences implementation of Health policies and health promotion programme by studying support supervision on disease prevention and control, nutrition, special needs and child rights and protection. Majority of the respondents agreed that support supervision on these areas is key in the implementation of the program. This is in line with the findings of R. Govinda and Shahjahan Tapan (1999) study on support supervision in Bangladesh communities that found support of community programs by external personnel enhanced the performance of students and improved the conditions of the community.
Community health infrastructure
The study also sought to find out the influence of community health infrastructure on the implementation of Health policies and health promotion programme. The finding revealed that infrastructure is tied to the health of the pupils hence is key in implementing the program. This is in line with the finding of Sheets, M.E (2009) who studied the impact of community facilities on students and teachers and found that Poor facilities affected the health and productivity teachers and make retention of teachers difficult. On the academic side, a shift from the best facilities to the worst decreases student test performance by 3%. The study also found that the condition of community facilities has a measurable effect over and above socioeconomic conditions on student achievement and teacher experience/turnover. In addition, according to Schneider, M (2003) Communities play a critical role in promoting the health and safety of young people and helping them establish lifelong healthy behaviors. Community health facilities can reduce the prevalence of health risk behaviors among young people. This argument is in line with the findings of this study.
Conclusion
The study established that implementation of Health policies and health promotion programme is influenced by capacity building, support supervision and community health infrastructure. Capacity building as a factor influences implementation of the program by equipping the stakeholders with knowledge and skills on SHP, gender norms and life skills training. The study established that majority of the respondents were not trained on these yet they identified these areas as key in the implementation of Program.
Support supervision was also found to be key in disease prevention and control, special needs, child rights and rehabilitation and Nutrition. This mainly requires additional expertise that may not be readily available within the community or on issues that keep changing over time and require technical assessment and control. Support supervision not only enhances the health of the students but also promotes academic performance and general community welfare.
Infrastructure also was found to influence implementation of the program since health of the students could be affected by the state of the infrastructure. The researcher established that the infrastructure play a crucial role in prevention of infections and diseases and cannot be ignored while implementing Health policies and health promotion programme.
Recommendations
Based on the findings of this study, the researcher makes the following recommendations;
- All teachers and BOM should be trained on Health policies and health promotion programme, gender norms and life skills to equip them with the skills and knowledge required to implement the program.
- Communities should work closely with other health related institutions such as hospitals, ministry of health among others for support in technical health issues that the communities may not have the capacity to handle.
- All communities should be equipped with reliable source of clean water and child friendly facilities that cater for the need of children living with disabilities.
Suggestions for further Research
From the findings of this study, the researcher suggests further study should be conducted on engagement of parents in health policies and health promotion programmes to find out whether such engagement has an influence on health outcomes of students. Such research would help to redefine the role of parents in communities and extend healthy practices beyond the community.
REFERENCES
- Ahmed et al (1994) Environmental and positioning antecedents of management commitment to service quality: A conceptual framework in services marketing and management vol 3 Greenwich CT:JAL
- Allensworth, and Kolbe, L.J. (1987). The Health policies and health promotion programme: Exploring an Expanded Concept. Journal of Community health 57(10):409–411.
- American Academy of Pediatrics Committee on Community health, (1993). Community health: Policy and Practice, Nader, P.R. (ed), American Academy of Pediatrics, Elk Grove Village, IL.
- Global Communities (2015) Dreams initiative in Warri Local Government Area, Delta state. Journal on introduction of dreams. USAID Nigeria.
- Health Management Information Systems, (2009). Health facilities statistics: Report on performance of health facilities in Nigeria. Government of the republic of Nigeria.
- Kombo. K.D. and Tromp A.L.D, (2011). Proposal and thesis writing. Nairobi: Pauline’s publication Africa.
- Means, R.K., (1975). Historical Perspectives on Community health. Thorofare, N.J.: Charles B. Slack, Inc.
- Mugenda. M.O and Mugenda. G.A, (2003). Research methods, qualitative and quantitative approaches. ACTS press.
- National Council for Children Services, Nigeria, (2013). National plan of action for children 2008- 2012).Government of the republic of Nigeria.
- Republic of Nigeria, (2008). Child survival and development strategy Nigeria Government of the republic of Nigeria.
- Republic of Nigeria, (2001) Children’s Act. National Council for Law Reporting with the Authority of the Attorney General.
- Republic of Nigeria, (2006). Sexual Offence Act. National Council for Law Reporting with the Authority of the Attorney General.
- Republic of Nigeria, (2009). Health facility service statistics-HMIS report. Government of the republic of Nigeria.
- Republic of Nigeria, (2007) Nigeria Integrated Household Budget Survey 2005/06 Government of the republic of Nigeria.
