THE ROLE OF COMMUNITY HEALTH ADMINISTRATION AND RURAL DEVELOPMENT IN BAYELSA STATE. (A CASE STUDY OF SAGBAMA LOCAL GOVERNMENT AREA ABSTRACT This project work on the importance of community health administration and rural development was carried out to find out the importance community health administration in rural development and what are the adverse health implications when the community involvement is very minimal. It also try to find out what factors are responsible for its ineffectiveness during its implementation. While it also took a look at the method best suited for the checkmating and control of all factors and conditions that adversely affects the amdinistraiton. However, this project is divided into five(5) chapters, the chapter one gives a general overview of the topic, which includes background overview of the topic, which includes background of study historical background of study area, statement of problem, purpose and objectives of the study, signifcnace of study, delimitation and scope of study, research questions and definition of terminology used. Chapter two focuses on literature rreview. The researcher reviewed the work of experts and renounce authors that are related to the rsearch work. Chater three deals with the research methodology which includes research design, smapling techniques, sample size, determination, and instruments for data collection. In the chapter four, the data were vividly presented and carefully analyzed, using the simple percentage table. While in chapter five the findings were discussed in relation to the literature review and analysis from chpter four. It also talks about the summary, conclusion and recommendations. CHAPTER ONE 1.0 INTRODUCTION The basic human needs of psychological needs, love needs, Esteem needs and self-actualization hinge on the availability of good health care delivery services. Although quality health is seen as one of the active ingredients for the development of any nation. Woyd, (2009). It is pertinent to note that in Nigeria, inequality and poor accessibility to health care has been a persistent problem. This is so, because majority of the population lives in the rural areas. The sustainability and viability of country’s economy and social growth depends largely on a well vibrant health care sector. While health care needs is increasing, government expenditure on health services are declining. This expenditure has been described as being inadequate, insufficient, inequitable and unsustainable. Thus, the burden of paying for health care services, especially by the ever increasing rural populace, has been very difficult due to the fact that majority of the country’s citizens could not afford a good and quality health care service, Olubenga, (2010). Ebuehi et al (2008), states that quality health is one of the active ingredients for the development of any nation. That a nation suffers economically, educationally, physically and socially if a greater percentage of its population, especially the work force is ill or mained. For example, persons suffering from AIDS, Tuberculosis, and terminal stage of cancers, may not be as productive as if is expected of them. Consequently, they may become liabilities to the rest members of the community. Wadinga A, (2007). According to Amadi, (2004) he stated that the vulnerable ones in any society or community, includes the infants, childbearing/ pregnant women and the aged who are very susceptible to infections. He further attributes this to the inability of the three tiers of government to provide basic health care infrastructures and services, and also the scarcity of health care providers in the country especially in the rural areas. Felicia Monye, states that shortage of health workers is a major problem in Nigeria, especially in the rural areas where more than 70% of the entire population lives. Also, she states that of the primary care level, trained community health officers provides services normally reserved for doctors or medical specialists. That in order to improve such services, especially in the rural areas, the community health officers must therefore be supported and motivated in order to provide effective and efficient health care services. Thus, this study is carried out on how community health administration can be improved for efficient and effective health care delivery services in the rural communities. Also to find out what factors either motivates or demotivates the health workers in accepting/rejecting rural posting. Through this study, we will know the role the local government NGO’s, the community and the health care providers in enhancing the community health administration in the rural areas. 1.1 BACKGROUND OF THE STUDY Access to health care in Nigeria today is generally limited. The problem of poor funding has resulted in low quality of health services and facility. It is pertinent to note that health services and facilities of all levels, is either dilapidated, poorly equipped, or dysfunctional. The poor management of the available health personnels translate to inefficient and ineffective health care delivery services in the rural areas, Osuorji, (2009). There is considerable interest by local governments in the country in exploring the potential of social health insurance in order to increase accessibility and affordability of health care delivery service, Ojo, (2008). Also Airede (2006) identified with the above statement and also went further to suggest that if the local governments are ready to support and motivates health care providers, the morbidity and mortality rate of most rural communities will greatly reduced. Thus, the reverse is the case, because most local government administrators do not take the health sector seriously . they handle it as they handle all political issues. It is pertinent to note that every community accepts some forms of treatment as appropriate and others as unacceptable. Though all forms of treatment is seen to have multiple effects and this varies from person to person, and are greatly influenced by age, level of susceptibility, finance, culture and ignorance, which is attributed mostly to the rural dwellers, sturgeon and Meer, (2006). In Sagbam local government area which happens to comprise of rural communities, there ahs been an unprecedented rise in mortality and morbidity rate of infants due to either maladministration in the health sector or inadequate well trained health personnels. According to Dr. Kpokiri (2008), we states that three (s) of one thousand (3/1000) death occurs yearly while two hundred (100) in one thousand (1000) infants falls sick monthly. Still births is recorded as three (3) in three hundred (300) births. Also, the health facilities are very few and it cannot carter for the ever increasing rural populace. Though at times it is due to the low patronage, poverty and ignorance of the rural dwellers. In Sagbanna local government, there has been an increase in the participation by community members in the administration of health care delivery services. It has been highly accepted by most groups in individual communities that made up the local government. This is due to the prevalence of infections agents that abound in the communities which is responsible for ever increasing morbidity rate of infants and women of childbearing age, Wilfred, (2009). According to Kpokiri (2009), he states that for any community health administration to function in any rural setting, two things are basically involved. Firstly, the need of local government administration to adequately fund thee health sector, by providing adequate health facilities, helth care equipment and qualified and well trained health personnels to handle all health care delivery services in the communities. Secondly, the community members needs to be well mobilized, involved, sensitized and allowed to effectively participate in all health related causes, should be ensured. Based on the aforementioned, there is need for everyone in the community to become aware of the importance of community health administration in the development of the rural dwellers. Thus, this project work will attempt to discuss and determine the success, failures and factors that are responsible for the successful implementation of community health administration in our rural communities. HISTORICAL BACKGROUND OF STUDY AREA The surviving historical account of the settlement of the people of gagbama local government area, has it that Sagbama probology settled in its present location on the 16th century, having broken off from their kins from the Benin kingdom. According to Mr. Emmanuel Ogosi, the descendant of OPOROZAOWE, was from the Benin kingdom. He left the kingdom of the time when it was under severe political pressure from within and outside the period of the historical rupture which some how corresponded with the reign of king Ovour, amwem Nogbaisi, who suffered Torment and physical defeat from the British government. Oporozawei settle somewhere in the deep Nigeria Delta with his sons namely Kabowel, kumbowei and gbanwei. At the death of their father, kabowei exhibited his hostile behaviour towards his brothers. Based on this gbaranwei left for another area and found Gbaran kingdom now in the present day yenagoa local government area of Boyelsa state named gbaran Ekpeteiama. Kabowei left too, to find another settlement andd established his kingdom known as kabowei Kingdom with its headquaters in patani, presently in delta state. Meanwhile Kumbowei with his hine sons left and lived in a palce known as udophori, one of his sons, named Sagbamaowei left his dad and brothers and found Sagbama community which later spread to different other settlements that made up the present day Sagbama local government area in the present Bayelsa state PEOPLE AND POPULATION The present day Sagbama local government area comprises various tribes of the country but originally it consist mainly of Ijaw aand Urobo speaking tribes. The local government has an estimated population of about nine hundred and six thousand eight hundred people (906,800), according to the 1991, national population commission. OCCUPATION The major occupation of the people of Sagbama L.G.A are basically that of Agriculture and fishing according to Mr. Emmanuel Ogesi. Though, due to civilization, most people are now civil servants, self employed and politicians. RELIGION The people of Sagbama L.G.A today are more of Christians, this is because, the majority of people have disengaged themselves from idol worshipping. Yet there are few who still practice idolatry. CULTURE The first thing here to mention is the language. The language mostly spoken in Sagbama L.G.A, is the Izon Language while Uhrobo and igoko languages are spoken by very few communities. Also the English language is often spoken in all the communities that make up sagbama l.G.A. Another aspect of the culture of the people of Salga is their festival which often differ from community to community. Also their traditional marriage ceremonies differs from one community to another. STATEMENT OF THE PROBLEM There is no denying the fact that our health care index is very poor and that majority of our people are suffering. Today, Sagbama L.G.A, has been rated as one of the highest maternal morbidity and infant mortality rate in Bayelsa state. This is because public hospitals and health centres are grossly under-equipped while private hospitals provides cash and carry health services and take-away medical services, to the deteriment of the poor. Also, self medications is on the increase just as the market for quackery has blossomed in the community, Aganaba (2008). Ojo, (2004), identified with the above statement and also went further. He said that factors that contributes to the dwindling effect of community health administration in any rural areas, includes, inadequate funding of health care delivery services by the local government chairmen, rising cost of treatment, poor integration of private health sector, low public enlightenment and lack of community involvement and participation. Thus, there is need for urgent intervention of the governments, parastatals to seek for solutions to tackle the problem of low patronage by members of the community. It is against this background that the researcher undertook the study as a means of bringing a lasting solution to the challenges faced in the implementation of the community health administration in the development of the rural areas. PURPOSE OF THE STUDY The purpose of carrying out this study is to establish the relationship between community health administration and the effects it has in the development of our rural areas. Also the suggest strategies that would make the program more effective and accepted by all community members. It is also intended to identify the challenges affecting the implementation of community health administration programme in Sagbama L.G.A and to suggest appropriate recommendations and best solutions. DELIMITATIONS OF STUDY This project work is meant to study the role of community health administration plays in the development of the people of Sagbama local government area, while it is limited to the literate and non-literate adult of the local government area. The researcher is greatly constrained with time factor in terms of meeting up lectures, coupled with other financial problems as opposing factors to each other. Also the searching of materials did not prove easy, since materials on the subject matter are not easily gotten or accessed within the school environment. However, the above constraints did not in any way invalidate this project work in any form. OBJECTIVES OF THE STUDY This project work is designed to meet the following objectives o establish the relationship between community health administration and rural development To identify ways by which the programme will be successful To identify ways by which the community will effectively participate in the programme to identify problems of poor access to healthcare in the rural areas. To suggest ways to integrate the private sector to participate in community health administration to identify challenges in the implementation of community health in the rural areas To identify public health problems associated with non-compliance by community members in the community health programme to identify factors that motivates or demotivates health workers to rural settings to identify problems of community administration to identify ways by which stakeholders, NGO’s and L.G can assist in community health adminsitraiton. RESEARCH QUESTION Are there ways that the private sectors/NGO’s could be integrated into the community health administration? What are the challenges that hinders the successful implementation of the programme what are the strategies needed for the successful implementation of the programme? How can the community be motivated to effectively participate in the programme? Is the leverage of community health administration adequate? What are the motivating factors that attracts health workers to rural areas? SIGNIFICANCE OF THE STUDY This project work will help to inform three tiers of governments on ways by which healthcare services will be made readily available, affordable and easily accessible to the ever increasing rural populace. To suggest ways the government could easily integrate the private sector in order to ensure a wider coverage of the programme. This study will intend to identify the challenges that hinders the successful implementation of the programme. And the management of such challenges being faced by the health workers. The results and recommendations of this study might serve as a guide to the local authorities in promulgating laws relating to community health administration. 1.9 DEFINITION OF TERMS 1. Primary Health Care This is an 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 a cost which the country can afford to maintain at ever stage of their development in the spirit of self-reliance and self determination, WHO (1980) 2. Community Mobilization This is a process of encouraging and arousing the interest of members of ta given community to b actively involved in identifying their problems and planning for solutions to them, to ensure self-reliance and initiative. 3. Community diagnosis This is the process of finding out the needs (problems) of a particular community with the assistance of members of the community. 4. Advocacy Advocacy in primary health care simply means the process of creating awareness on certain whealth programmes 5. Health This is defined as a state of complete physical, social and mental wellbeing of an individual and not mainly the absence of disease or infirmities, WHO (1999) 6. Community Is defined as a specific group of people living in a defined geographical area, who share a common culture, values and norms and arranged in a social structure according to relationships over a period of time WHO, (1988). 7. Management This is the organization and co-ordination of the activities of an enterprise in accordance with certain policies and in with certain policies and in achievement of defined objectives.
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