TABLE OF CONTENT

Title page i

Declaration ii

Certification iii

Dedication iv

Acknowledgement iv

Abstract vii

Table of contents viii

CHAPTER ONE

1.1 Background of the study 1

1.2 Statement of the problem 5

1.3 Significance of the study 6

1.4 Research questions 7

1.5 Objectives of the study 8

1.6 Operational Definition of terms 8

2.1 Concept of Primary Health Care 10

2.2 Theoretical Review 37

2.3 Empirical Review 40

2.4 Summary of Literature Review 43

CHAPTER THREE: Research Methodology

3.1 Description of the study area 44

3.2 Research design 47

3.3 Population of the study 48

3.4 Sample Size Determination 48

3.5 Sampling Technique 48

3.6 Research Instrument 49

3.7 Ethical consideration 50

3.8 Validity of the Research Instrument 51

3.9 Reliability of the Research Instrument 51

3.10 Procedure for Data Collection 51

3.11 Method of data analysis 52

CHAPTER FOUR:

4.1 Data Presentation and Analysis 54

CHAPTER FIVE:

5.1 Discussion of finding 71

5.2 Implication of the Study 75

5.3 Summary 75

5.4 Conclusion 76

5.5 Recommendations 76

5.6 Suggestions for further studies 77

References 78

Appendix 80
 CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

A Primary Health Care (PHC) based health system is an overarching approach to the

organization of health systems designed to improve population health and maximize

equity. Such an approach makes the right to health a guiding principle of the health

system, with the health system structures and functions oriented towards achieving equity

in health and social solidarity, based on a core set of principles and elements. Primary

health care can also act as the basis of the healthcare system by establishing fundamental

policies, programs and priorities that respond to the population health needs. In Nigeria, a

notion of primary health care is seen as a defined set of services, which are in accordance

with local needs. It is an entry point into the health care system. (Nigeria health review

2017). The services at that level alone are not sufficient to adequately cater for the more

complex health needs of the populace. (Oladipi 2014) Thus health care systems should

work in an integrated manner through the development of mechanisms that coordinate

care across the entire spectrum of services, including referral systems.

In the Declaration of Alma-Ata of 1978, PHC was defined as essential health care

based on practical, scientifically sound and socially acceptable methods of technology

made universally accessible to individuals and families in the community through their

full participation and at a 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.

(NPHCDA 2015)

It is on the basis of universal accessibility that Primary health centre were

established in Nigeria, among other countries, as a mechanism to provide health care for

all citizens regardless of their location and socio-economic status

The variation in health status among various communities results from

environmental, socio-economic, and cultural factors. Poverty is the most important cause

of preventable death, disease, and disability (Beaglehole R, Bonita R. 2016) Literacy,

access to housing, safe water, sanitation and food supplies is also important determinants

of the health status of an individual (Beaglehole et al 2016)

The World Health Organization defines health as "a state of complete physical,

mental and social wellbeing and not merely the absence of disease or infirmity (United

Nation 2013) Article 25 of the Universal Declaration of Human Rights States that "every

individual has the right to a standard of living adequate for the health and well being of

himself and his family, including food, clothing, housing and medical care Therefore, the

government of every country is responsible for the health of her people at all levels

(WHO Alma-ata 1978)

Nigeria launched the national primary health care policy in 1988 which amongst

other previous health policies made the achievement of "health for all" by year 2000 a

priority (Federal Ministry of Health and National Primary Health (Care Agency 2015). In
consonance with the Alma-Ata declaration of 1978, a national health care system was

adopted in Nigeria with PHC as the main strategy for actualizing the policy. A three-tier

system of health care was developed which featured the support of the Federal, State, and

Local governments. It is a system that is comprehensive and involves multispectral

inputs, community involvement, and collaboration with non-governmental providers of

health (NPHCDA 2015)

The three-tier system includes the primary health care level managed by the local

government, which is the first point of access to health care for individuals and

communities. The state government manages medical care provided at the secondary

health care level, which accepts referrals from PHC centers and provide health services

beyond the capacity at the primary level. The tertiary health care level provides highly

specialized medical care supported by advanced diagnostic capability and modern

technology. The Tertiary care centers are managed by the Federal government or the state

government if the facility is owned by the state (FMOH 2015)

Various problems were observed with the current health care system, amongst

which is the problem of inadequate coverage of the rural population. It was estimated that

the rural population in Nigeria is 53% of the total population, a home to 70% of the poor

in the country (World Bank 2014) and still, not more than 30% of the country's rural

population love access to modern health care services (FMOH 2015). Other challenges

include insufficient number of medical personnel and their uneven distribution in the

country. The deterioration of government facilities, low salaries and poor working
conditions had resulted in a mass exodus of health professionals out of the country.

Despite the desire of the government to ensure equitable distribution of medical facilities,

personnel and manpower, glaring disparities are still evident. A study of 28 health

facilities carried out in Lagos State (22 PHC facilities and 6 secondary facilities) showed

that 23 of the health care facilities were located in urban areas while only 5 were located

in rural areas, Also, 18 primary health centers out of the 22 were located in urban areas

and 4 in rural areas (United Nations Found Population Agency, UNFPA 2016)

Involvement of the community in making rational choices that affect them at

critical points of decision making with regards to health promotion in various

communities is also deficient. Lack of basic health statistics of the Nigerian population,

poor financial resource allocation to health service, especially in high priority areas,

defective basic infrastructure and logistics support are also problems identified

(Beaglehole 2016) Most of these problems can be properly addressed by the prioritization

of primary health care services and encouraging more investment into the preventive

aspect of health care (FMOH, NPHCDA 2015)

Primary health care is provided by the local government through the provision of

health centers and health posts. These are staffed by Community Health Officers and

Health Technicians, Community Health Extension Workers, Nurses, Midwives, and

Physicians (Abdulhraheem I, Olapipo A, Amodu M. 2014) The services provided by

these health facilities include; treatment of communicable and non-communicable

diseases, immunization, maternal and child health services, family planning, public health
education, environmental health, collection of statistical data on health and health- related

events (Abdulhraheem I et al 2014)

The health-related challenges faced by the rural population such as poor socio-

economic and unsatisfactory environmental conditions predispose them to malnutrition

and infectious diseases ( United Nations development programme UNDP Report 2013).

Prevalence of endemic diseases such as malaria and exposure to zoonotic diseases as a

result of close contact with animals is also common. However, despite the availability of

primary health care services in some communities, rural dwellers tend to underuse the

services due to their various cultural and traditional beliefs. Therefore, it is important to

carry out rational assessments and evaluation of ways to satisfy the health needs of rural

communities through obtaining information from members of the community who know

what their health needs are and can objectively identify the various problems associated

with poor health care delivery in their communities (UNDP Report 2013)

1.2 Statement of the problem

It was observed by the researcher that there was a low level of utilization of primary

health care services in Gwer East Local Government Area.

As end-users of the health services, members of the community also have a stake

in ensuring that services are well provided, and they should also be in the position to

monitor the quality of the services provided by the primary health care centres. With the

benefit of local information, they can assess the specific obstacles facing the facilities in
providing services and they can seek to ensure that facilities have the necessary

infrastructure, supplies and staff motivation to provide the services they should provide

(UNDP Report 2013)

The determination of the level of utilization of PHC centers by residents in Gwer

East Local Government Area is a means of evaluating the services that the centers

provide. This would be achieved by the assessing the level of awareness, demand and

utilization of the services they offer.

The choice of this study is based on the need to obtain information from the

perspective of residents of the community on the challenges associated with obtaining

satisfactory health care services from the available PHC centers. This study would also

help to assess the efficiency of the health care referral system in the community

1.3 Significance of the study

This study would be of importance to the government at all level because, it tends to

enlighten the government on the level of utilization of PHC services and also

identified challenges associated with it by the community members, thus enabling

the government to proffer solutions to these identified challenges leading to massive

utilization of PHC services by the community members. Also, the findings of the

study would enable the community members to understand the importance of PHC

services utilization. This will give them room for community participation in solving

the identified problems using the available community resources. Finally, the
 healthcare workers are frontlines in taking responsibility of the community they

serve by using available resources in solving problems identified, leading to more

turnout of community members in utilizing PHC services at the local government

level.

1.4 Research questions

The following questions were formed to guide this study

The following questions were raised and answered in this study:

1) What is the level of awareness of PHC services provided among adult residents in

Gwer East Local Government, Benue State?

2) What level is the utilization of PHC services among adult residents in Gwer East local

Government, Benue State?

3) What are the challenges facing the utilization of PHC services among adult residents in

Gwer East Local Government, Benue State?

The general objective of this study was to investigate the utilization of PHC services in

Gwer East Local Government, Benue State.

The specific objectives of this study were to:

1) assess the level of awareness PHC services among adult residents of Gwer East Local

Government, Benue State;

2) examine the level of utilization of PHC services among adult residents in Gwer East

local government, Benue State; and

3) to identify the challenges of the utilization of PHC services in Gwer East Local

Government, Benue State.

1.6 Operational definition of terms

 Assessment: In education, the term assessment refers to the wide variety of

methods or tools that educators use to evaluate, measure, and document the

academic readiness, learning progress, skill acquisition, or educational needs.

 Level of utilization: this reefer to the degree of action of making practical and

effective use of an available commodity/something.

 Primary health care: Is the essential care based on practical, scientifically sound

and socially acceptable method and technology made universally accessible to

individuals and families in the community through their full participation and at a
 cost they and the country can afford to maintain in the spirit of self reliance and

self determination

 Primary health care centers: The Primary Healthcare Center (PHC) is the basic

structural and functional unit of the public health services in developing countries.

PHCs were established to provide accessible, affordable and available primary

health care to people, in accordance with the Alma Ata Declaration of 1978 by the

member nations of the World Health Organization (WHO).

 Community participation: Community participation can be loosely defined

as the involvement of people in a community in projects to solve their own

problems. People cannot be forced to 'participate' in projects which affect their

lives but should be given the opportunity where possible.

 Essential health care: An Essential Package of Health Services (EPHS) can be

defined as the package of services that the government is providing or is aspiring

to provide to its citizens in an equitable manner.