INTRODUCTION

Background of the Study

Nigeria health services originated from British Medical Corps or services

who were brought to care for only British Army that was protecting

Nigeria when the Army was integrated into the colonial government

they focused on the health problems of their citizen only. Later on the

health services were extended to Nigeria Civil Services and their

securities (Salaudeen 1995).

The first attempt at planning ahead for the development of health

services in Nigeria took place between 1946 and 1956 which was based

on the needs of the British only to take care of British citizens and their

army.

Since Nigeria became independent in 1960 health policies have been

enunciated in various forms in national development plans.

Government trained nurses and midwives and health facilities were built

with the good intention of taking care of the citizen. However the

planning was done without giving the community full care thereby

leading to under utilization of the facilities. Some of the reasons leading

to inaccessibility of the facilities to the majority are as enumerated

below:

1) Government emphasis was laid on curative services

2) Health facilities were built mostly in urban areas

3) There were poor coverage of the population

4) Poor data gathering and utilization

5) High prevalent rate of mortality and morbidity.

The Second National Health Development Plan (1970-1974) was

established to correct the above deficiencies.

In the Third National Development Plan (1975-1985) emphasis was

shifted from curative aspect to preventive aspect of health care services.

Basic Health Services Scheme was introduced and it was mandated that

there should be a health clinic for the coverage of a population of 2000

people. There should always be primary health care clinics for the

coverage of a population of 5000 and there should be comprehensive

health centres for the coverage of a population of 40000 to 50000 then

primary health care clinic should be referred facility clinic (Saheed

1995). Things however began to change in 1952 when the World

Health Organization Expert Committee on Public Health Administration

defined public health as “the science and art of preventing diseases

prolonging life and promoting mental and physical health and efficiency

through the organized community efforts for sanitation of the

environment the control of communicable infections or diseases the

education of the individual in personal hygiene. The organization of

medical and nursing services for early diagnosis and preventive

treatment of diseases the development of social machinery to ensure

that every individual has a standard of living adequate for the

maintenance of health so organizing these benefits as to enable every

citizen to realize his birth right of health and longevity (Abubakar 2007).

In 1953 the National Health Committee met again and took a closer

look at the available strategies for extending public health services to the

rural areas and came up with the idea of “Basic Health Service”. The

package includes:

● Maternal and child health

● Communicable disease control

● Environmental sanitation

● Health education of the public

● Maintenance of records for statistical purposes

● Public health nursing and medical care (Ogundeji 2002)

In September 12th 1986 Professor Olukoye Ransome-Kuti the then

Minister of Health started implementing primary health care and 52

local government areas were picked out of 450 as models for primary

health care activities.

Out of the 52 12 were assigned to the teaching hospitals 20 were

assigned to the schools of health technology (Ogundeji 2002).

To achieve this noble objective the federal government designed health

care delivery system with three tiers of health care system;

1. Primary health care

2. Secondary health care

3. Tertiary health care

Each of the health care level in terms of responsibility was placed as

follows:

● Local government for primary health care

● State government for secondary health care

● Federal government for tertiary health care

Alma Ata Declaration defined primary health care as “essential health

care based on practical scientifically sound and socially acceptable

methods and technology made universally accessible to individuals and

families in the community through their full participation and at the cost

that the community and country can afford to maintain at every stage of

their development in the spirit of self-reliance and self determination”.

In September 17th 1978 a conference was held at Alma Ata Union of

Soviet Socialist Republic where primary health care was declared as the

key for attainment of health for all by the year 2000 and beyond. It was

an outcome of the 30th World Health Assembly of May 1974 decision

(Saheed 1995).

The Alma Ata Declaration stressed health as a fundamental human right

and stated that health care must be accessible affordable and socially

relevant to meet the needs of the people (Saheed 1995).

The concept of primary health care is based on four major pillars:

● Political commitment

● Intersectional cooperation

● Community participation

● Use of appropriate technology

Components of Primary Health Care

1. Health education

2. Maternal and child health including family planning

3. Environmental health

4. Appropriate treatment of common diseases and injuries to prevent

stability and health

5. Provision of essential drugs supplies and drugs revolving fund

6. Immunization against major infectious diseases

7. Promotion of food supply and proper nutrition

8. Prevention and control of locally endemic diseases

9. Mental health

10. Dental health

11. Primary eye care

12. Care of the aged

(Akinsola 2006).

It is important to mention some fundamental principles underlying the

utilization of health facilities nationwide.

First access to good health services is a constitutional right of every

Nigerian and health services must benefit the entire nation.

Secondly good health services can make a tremendous difference in the

health status of a population.

Thirdly the health of the communities is the sacred duty of community

health workers Nigeria Journal of Medicine (2007).

Health facilities are static or mobile structure where different types of

health services are expected to be provided by various categories of

health workers.

From the management level of government health facilities the

responsibility of managing the primary health care facilities are under

the control of local government and the communities.

Also it is necessary to realise that both health workers and the

community have a common goal and that the best possible health

services should be rendered to all members of the community

irrespective of their geographical location and political learning.

Health workers can help the communities to achieve this goal by acting

as community health advocates as well as providing qualitative health

services to the people.

Statement of the Problem

Despite various initiatives the integrated maternal and child health

Minimum Health Package Safe Motherhood and Millennium

Development Goal (MDG) at various governmental levels the health

indicators are still very poor hence the need to investigate the

happening within the health system and the communities they are to be

serving as it is in Nigeria Journal of Medicine.

In pursuance of this health policy the government established Ipaye

Health Centre in 1990 by the Military governor of Kwara state.

Objective of the Study

1. To find out the level of utilization of health facility in Ipaye

community.

2. To find out the reason why the health facility is not being

patronized by the community.

3. To find out the level of commitment of health facility workers.

Significance of the Study

The research will help the local government to effectively manage the

clinic and its resources. Members of the community will also be

enlightened about their health needs so as to achieve maximum health

enhance their socio-cultural economic and environmental status.

Health facility workers will find this research resourceful in the

performance of their day to day duties in order to improve on the

standard of care.

Researchers and students in tertiary institutions will also find this

information resourceful for updating their knowledge on health care

services.

It will help the state government to provide the necessary equipments

and information that will help the community to be conversant with their

health needs and the utilization of the health facilities.

Research Questions

1. What is the level of utilization of the health facility in Ipaye

community?

2. What are the factors responsible for non-utilization of health

facility by the community?

3. What is the attitude of health facility workers towards

non-utilization of the health facility?

Scope of the Study and Limitation

The research is generally aimed at studying the factors responsible for

non-utilization of health facility in Ipaye town of Moro local government

of Kwara state.

The study is however limited to the study of the factors responsible for

the non-utilization of health facility in Ipaye community.