Patterns of rural community participation: Implications for health development in Nigeria

This study aimed to identify the existence and interaction of some of the factors which facilitate community participation or community involvement in a rural setting. Data were generated from questionnaire and field observations. Relevant community groups and leadership were interviewed. The questionnaire was designed to elicit information about knowledge, attitude and practice. It was administered to one resident per household in Inua-Akpa village, Cross River State of Nigeria. Seventy-nine respondents out of 114 households [69.29%] were interviewed. Socio-cultural information, showed that the village was highly organized, hierarchical, and most people belonged to at least one secondary group/organization in the village. There was awareness about elements of health promotion, and preference for orthodox health care [despite inaccessibility]. There was evidence of self-help and community participation, derived from community development activities. Infectious diseases were most prevalent and there was no evidence of organized health projects. Only occasional visits from the Comprehensive Health Centre [8 km away] provided basic health services. Relative Mean Response [RMR] to major findings was introduced to link the enabling factors of community involvement. Social Action Model was built into a 'sequence' of awareness-understanding-motivation-mobilization-participation-involvement. Entry-points for external input to facilitate health/community development exist. It is concluded that this study has serious implications for rural health development in Nigeria

Primary health care system development in Nigeria Reorientation as a framework for planning and implementation

This paper focuses on the urgent need to reorient health planners, professionals and the community towards primary health care [PHC] as a system. The structural and functional transition and relationships of health care delivery systems in Nigeria, from the old monosectoral health services to a new multisectoral PHC-based one, is illustrated. PHC-based system is consistent with Nigeria's new national policy on health which promiscs the realization of the global goal of health for all. Effective implementation of expert PHC-model plans in Nigeria is beset by constraints posed by entrenched negative professional and community attitudes. Reorientation or "retooling" of health care operators, providers, communities and the whole system is advocated. Reorientation demands attitudinal change from the existing basic services approach to a health systems development. Such an intervention requires that structure be articulated with process to produce desirable PHC outcome. A reorientation matrix is a possible tool can be applied to detect and evaluate indicators of actions and impact of reorientation. Overall, the roles of health education and research are shown to be pervasive. These roles are explained as the cohesive force that would help to bridge the gap between planning and implementation in PHC. Appropriate field examples in Nigeria are cited