PUBLIC PERCEPTION ON THE EFFECTIVENESS OF INDIGENOUS HEALTHCARE DELIVERY SYSTEM IN ENUGU STATE

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

As part of commitment to the United Nations' Sustainable Development Goals, countries around the world aspire to provide universal health care. In 2014, the global coverage of skilled providers during delivery was 71 percent, with 52 percent in Sub-Saharan Africa, where the public sector lacks resources (United Nations 2015). Child and maternal fatalities have decreased dramatically, indicating global success toward the health-related Millennium Development Goals (MDGs). Global under-five mortality fell from 12.7 million to 6.3 million between 1990 and 2013, while the maternal mortality ratio fell from 380 to 210 per 100,000 live births. In Sub-Saharan Africa, however, the proportion of infant and maternal deaths has climbed.

Between 2008 and 2013, the maternal mortality ratio in Nigeria climbed from 545 to 575 deaths per 100,000 live births, indicating a worsening condition. In Nigeria, interventions have been intended to minimize maternal mortality and help the country meet the MDG target of 250 deaths per 100,000 live births. Despite the government's engagement with the private sector to encourage greater access to quality maternal health services, mother and child health continues to deteriorate.

Nigeria's healthcare delivery system consists of primary, secondary, and tertiary healthcare facilities as a Sub-Saharan African country (Uzochukwu et al., 2009). Different local and regional elements that determine the quality and quantity existing in one location have shaped Nigerian health policy (Uzochukwu et al., 2009). The primary healthcare delivery system has been completely degraded and neglected as a result of this. The Enugu State government established the District Health System (DHS) in 1999 to support Nigeria's national health policy on basic healthcare delivery. This is a type of health-sector decentralization that is implemented through a structured management system (District Health Management Team) that integrates primary and secondary healthcare services to meet the needs of the rural population.

However, contemporary realities show that massive global and national investments targeted at delivering effective health care have not given the anticipated results due to low utilization and, as a result, low access. Frost and Reich (2009) argue that the availability of interventions and services does not always imply access. The term "access" refers to the intended clientele's ability to use interventions and services effectively and appropriately. Poor access to health facilities and services has been cited as a barrier to addressing significant health issues in Africa. Perception has emerged as a significant factor of health-care utilization.

People's opinions and judgments are frequently influenced by factors that their traditions and cultures value, such as civility, responsiveness, attentiveness, and perceived competency of health care providers. People's perceptions are shaped by their level of satisfaction with the health-care system, as well as their appraisal of health-care personnel' attitudes, which often decides whether they would return in the future. To enable successful interventions and attain universal health for the people, it is critical that all stakeholders grasp the people's perceptions of health services. This is critical to developing appropriate promotional messages and campaigns, aimed at creating demand for particular health interventions.

1.2 Statement of the problem.

The demand for healthcare services has increased over the years in Enugu urban area due to the growing population of the city. Gaps have also been revealed between need and actual access to some critical health services .In Nigeria, 61% of mothers received antenatal care from a qualified provider. Only 51% of this group visited an antenatal care provider at least four times during their pregnancy. Between the first and fourth usages, there is a 49 percent drop in utilization. Only 19% of children (aged 12–23 months at the time of the survey) had received all of the recommended vaccinations, according to the vaccination cards. The third diphtheria, pertussis, and tetanus (DPT3) vaccine, which was used as a proxy for vaccine use, was only used 22.2 percent of the time, while DPT1 was used 26.7 percent of the time (Eze, C. 2008).

Healthcare facilities that were initially meant for two settlements are now being used by seventeen settlements of Enugu urban area. These has caused over utilization of public healthcare facilities and delays in accessing same. Another problem is congestions on routes in-and-out of these facilities due to traffic and economic activities associated with an urban area. In case of emergency, response to save life is very minimal because of no definite route to those healthcare facilities especially the specialist hospitals. The above mentioned problems lead to self medication, patronage of patent medicine dealers, infant and maternal mortality etc. In order to ameliorate the problems encountered in accessing good healthcare facilities, a GIS based technique was used to measure accessibility of the healthcare facilities in Enugu urban and to define shortest routes and closest facilities during emergencies. The current situation of healthcare delivery in Enugu urban leaves much to be desired. It is against this backdrop that the study which seeks to examine public perception on the effectiveness of indigenous healthcare delivery system in Enugu State was carried out.

1.3 Objective Of the study

The broad objective of this study is to examine public perception on the effectiveness of indigenous healthcare delivery system in Enugu State. Specifically the study seeks to:

1. Ascertain if primary  healthcare is accessible in Enugu State.

2.  Explore how indigine of Enugu state perceive primary healthcare system.

3. Determine if people's perception health care delivery will impact their utilization indigenous healthcare system.

4. investigate if indigenous healthcare system has been effective in healthcare delivery

1.4 Research hypothesis

HO1: Indigenous healthcare system has not  been effective in healthcare delivery in Enugu State.

HO2: People's perception on the accessibility of primary  healthcare service will  not impact their utilization indigenous healthcare system

1.5 Significance of the study

Findings from the study will be helpful to health care providers working at primary healthcare centres those in the medical line, policy maker and academia. The study will reveal the need for government to make provision for more equipped healthcare centre in rural and urban areas. The study will enlighten professional care givers on the need to show empathy to patients while rendering health services. Empirically the study will contribute to body of existing literature and serve a s reference material to both scholars and student who wishes to conduct further studies in related field.

1.6 Scope Of The Study

The scope of this study borders on public perception of the effectiveness of indigenous healthcare delivery system. The study will ascertain  if primary  healthcare is accessible. It will determine if people's perception health care delivery will impact their utilization indigenous healthcare system. The study will also investigate if indigenous healthcare system has been effective in healthcare delivery. The study is however delimited to select6ed local government in Enugu State.

1.7 Limitation Of The Study

Like in every human endeavour, the researchers encountered slight constraints while carrying out the study. The significant constraint was the scanty literature on the subject owing that it is a new discourse thus the researcher incurred more financial expenses and much time was required in sourcing for the relevant materials, literature, or information and in the process of data collection, which is why the researcher resorted to a limited choice of sample size. Additionally, the researcher will simultaneously engage in this study with other academic work. Despite the constraint  encountered during the  research, all factors were downplayed in other to give the best and make the research successful.

1.8 operational definition of term

Healthcare System: The health care system refers to the institutions, people and resources involved in delivering health care to individuals. A health system consists of all organizations, people, and actions whose primary intent is to promote, restore, or maintain health such as hospital systems, patient care, insurance.

---

---