PRIMARY HEALTH CARE SERVICES IN NIGERIA: CRITICAL ISSUES AND STRATEGIES FOR ENHANCING THE USE BY THE RURAL COMMUNITIES
ABSTRACT
Quality health is a fundamental right of all Nigerian citizens. While primary health care (PHC) centers are relatively uniformly distributed throughout local government areas (LGAs) in Nigeria, the rural people tend to underuse the basic health services. This project aims at the primary health care in Nigeria critical issues and strategies for enhancing the use by rural communities.
in other to increase Capacity building and empowerment of communities through orientation, mobilization and community organization as regards training, information sharing and continuous dialogue, could further enhance the utilization of PHC services by rural populations.
 CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
The goal of primary health care (PHC) was to provide accessible health for all by the year 2000 and beyond. Unfortunately, this is yet to be achieved in Nigeria and seems to be unrealistic in the next decade. The PHC aims at providing people of the world with the basic health services. Though PHC centers were established in both rural and urban areas in Nigeria with the intention of equity and easy access, regrettably, the rural populations in Nigeria are seriously underserved when compared with their urban counterparts. About two-thirds of Nigerians reside in rural areas therefore they deserve to be served with all the components of PHC.
Quality health is a fundamental right of all Nigerian citizens. While primary health care (PHC) centers are relatively uniformly distributed throughout local government areas (LGAs) in Nigeria, the rural people tend to underuse the basic health services. This article examines some cross cutting issues in PHC and outlines strategies to enhance the utilization of health services by rural people. The responsibility for perpetuating the existing low use of PHC services should be held by PHC policy makers and LGA. Responsible health personnel can build a new social order, based on greater equity and human dignity, in which health for all by the year 2015, including that of rural populations, will no more be a dream but a reality. Capacity building and empowerment of communities through orientation, mobilization and community organization as regards training, information sharing and continuous dialogue, could further enhance the utilization of PHC services by rural populations.
 While most PHC facilities are in various state of disrepair, with equipment and infrastructure being either absent or obsolete, the referral system is almost non-existent. The goal of the National Health Policy (1987) is to bring about a comprehensive health care system, based on primary health care that is promotive, protective, preventive, restorative and rehabilitative to all citizens within the available resources so that individuals and communities are assured of productivity, social well-being and enjoyment of living. The health services, based on PHC, include among other things: education concerning prevailing health problems and the methods of preventing and controlling them, promotion of food supply and proper nutrition, material and child care, including family planning immunization against the major infectious diseases, prevention and control of locally endemic and epidemic diseases and provision of essential drugs and supplies. The provision of health care at PHC level is largely the responsibility of local governments with the support of state ministries of health hand within the overall national health policy (Nigeria Constitution, 1999). Private medical practitioners also provide health care at this level. Although PHC was said to have made much progress in the 1980s, its goal of 90% coverage was probably excessively ambitious, especially in view of the economic strains of structural adjustment that permeated the Nigerian economy throughout the late 1980s. But many international donor agencies such as UNICEF, World Health Organization (WHO) and the United States Aids for International Development, (USAID) embraced the programme and participated actively in the design and implementation of programmes at that level (USAID, 1994). At a stage, most of the programmes were donor driven. It was not surprising that at the height of the political crisis in 1993, most of them withdrew their funding and the programme started experiencing hiccups. With the return to democracy in 1999, however, primary health care system deteriorated to an unacceptable level. The availability of basic health services provided by the PHC especially to rural areas in a country might be used as a yardstick to measure the extent of its health level of development. The aim of this article is to describe some strategies which, if implemented, might enhance the proper and timely use of PHC by Nigerian rural populations.
1.2    Statement of the problem
Nigeria, with a population of 170 million, is one of the most populous nations but weak in health-care standards. Among the people of Nigeria a vast majority live in rural areas and at most times have access to little or none of the essential basic amenities. According to the National Primary Health Care Development Agency, Abuja, Nigeria Despite extensive investments, the country still has insufficient healthcare delivery infrastructures, poor quality health-care services, and unevenly distributed human resource capacity. These are reflected in its health-care quality ranking of 187 of 200 countries and listing among countries with some of the worst health indicators in the world. The country has an estimated 23 640 health facilities, and 85.5% of these are primary health-care facilities. Although these facilities serve the majority of the population, they are unable to provide basic and cost-effective services, especially in rural areas. Adeniyi et al 2014 said this poor performance is attributed to various factors including poorly equipped health facilities, insufficient staff, lack of clearly defined roles and responsibilities, inadequate political commitment, and poor accountability. Quality improvement at primary health-care facilities is critical, however, efforts to address the quality of care as a contributory factor to the country’s poor health outcomes receive less attention. It is in light of this that this study seeks to examine the primary health care services in Nigeria based on critical issues and strategies for enhancing the use by the rural communities.
1.3    Objectives of the study
The main aim of this study is assess the primary health care services in Nigeria based on critical issues and strategies for enhancing the use in rural Nigeria. The specific objectives are to;
1.    Find out the critical issues in primary health care services in Nigeria.
2.    Find the current status and gaps in PHC services in rural communities.
3.    Determine the strategies for enhancing the use of PHC services by rural communities.
1.5    RESEARCH QUESTIONS
The following Questions were asked for the purpose of the study;
1.    What are the critical issues in primary health care services in Nigeria?
2.    What are the current status and gaps in PHC services in rural communities?
3.    What are the strategies for enhancing the use of PHC services by rural communities?
1.5    SIGNIFICANCE OF THE STUDY
It is expected that this study would consolidate existing literature on the issues around primary health care services in Nigeria and iits use in rural communities. Furthermore, the outcome of this study would aid policy makers and regulatory bodies in the formulation of policies to enhance the primary health care package. Finally, it is also expected that the results of this study would provide motivation for further studies.
1.7    SCOPE AND LIMITATIONS OF THE STUDY
This study the PHC services usage in rural communities is restricted to the Nigerian environment. However, in the course of this research, the following constraints were encountered thus:
1.    Non-availability of enough resources (finance): A work of this nature is very tasking financially, money had to be spent at various stages of the research such resources which may aid proper carrying out of the study were not adequately available.
2.    Time factor: The time used in carrying out the research work is relatively not enough to bring the best information out of it. However, I hope that the little that is contained in this study will go a long way in solving many greater problems.
1.9    DEFINITION OF TERMS
PRIMARY HEALTH CARE (PHC): This is health care provided in the community for people making an initial approach to a medical practitioner or clinic for advice or treatment.
RURAL AREAS: This is an area of land outside the densely populated Urban Areas in a town or city.
1.8 ORGANIZATION OF THE STUDY
This research work is organized in five chapters, for easy understanding, as follows;
Chapter one is concern with the introduction, which consist of the (overview, of the study), historical background, statement of problem, objectives of the study, research hypotheses, significance of the study, scope and limitation of the study, definition of terms and historical background of the study. Chapter two highlights the theoretical framework on which the study is based, thus the review of related literature. Chapter three deals on the research design and methodology adopted in the study. Chapter four concentrate on the data collection and analysis and presentation of finding.  Chapter five gives summary, conclusion, and recommendations made of the study.