Governance challenges in Primary Health Care Delivery in Delta State, Nigeria: An Assessment of Community Participation

Abstract

Background: Until the late 1970s, health care services in Nigeria were mostly curative and delivered through a vertical, hospital-based structure. Because the structure was top-bottom, communities were alienated from its governance and management. This has affected the utilization of facilities. This study seeks to explore the nature of community participation, their effects on utilization and how to improve primary health care delivery in Delta State. Methodology: The study used both qualitative and quantitative approaches of investigation. Structured questionnaires as well as focus group discussions and key informant interviews were deployed. It covered nine local government areas, three each from the senatorial districts. The aspects of community participation investigated were: the committees involved; frequency of meetings; factors inhibiting participation in meetings; and perceived solutions to poor community participation. Quantitative data were cleaned up, processed and analysed, using SPSS 10.0. Results: There was varying degree of participation. Community/village health management committees accounted for 54% of the committees involved in governance; 30.33% of the committees did not meet in the year preceding the study; 55% of the communities attributed poor participation to lack of awareness; adequate finance and enlightenment accounted for 47% and 33%, respectively, of the perceived solutions to poor community participation. Conclusion: Community participation in the governance of primary health care delivery in Delta State is unsatisfactory. Policy should ensure adequate funding as well as robust enlightenment campaign to tackle ignorance in order to address poor community participation in PHC governance and management in Delta State.

Keywords

• Community participation
• Governance
• Primary health care
• Funding and enlightenment