ABSTRACT
The study evaluated maternal and child health services (MCHS) in Enugu North Senatorial zone of Enugu State. The research design was an evaluative research design. The population of study comprised 400 mothers of childbearing age and 40 health care personnel in
2 district hospitals in the study area. Through convenience sampling technique, 320 mothers were sampled while the 40 health care personnel were purposively sampled. Six research questions and three null hypotheses guided the study. Self-structured questionnaires (MCHSPQ and MCHSCQ) were instruments for data collection. The data collected were analyzed using means scores and percentages and t-test was used to test the null hypotheses. A criterion means score of 2.5 was used to calculate the means, while 60% was the cut off percentage to determine availability. The findings revealed that majority of the maternal and child health objectives were achieved and that there were inadequate human and material resources for MCHS; mothers expressed their satisfaction with the general conduct of MCHS, except the long waiting time; and there was low utilization of the components of maternal and child health services. Based on the findings, it was recommended that evaluation indicators should be established in district hospitals, enough human and material resources provided and much awareness about MCHS created.
CHAPTER ONE
INTRODUCTION
Background to the Study
Health is freedom from disease or injury and any limitation the disease or injury might impose. It is a degree of wellness or wellbeing that a client experiences which is often expressed in terms of wellness or illness and may occur in the presence or absence of a disease or injury. According to Berman, Snyder, Kozier and Erb (2008), health is an ongoing process through which a person develops and encourages every aspect of the body, mind and feelings to interrelate harmoniously as much as possible. It is a state of the mind, peace and harmony with ourselves and one’s physical and social environment. Federal Ministry of Health (FMOH) (1998) pointed out that health is a fundamental human right and a social goal that is essential for the satisfaction of basic human needs and to improved quality of life. This is why the goal of Health For All Policy of 1988 stipulated that health should be brought within the reach of everyone in a given community (Park, 2003). This Health For All policy emphasized Primary Health Care (PHC) as the key to developing the health care delivery system in all countries of the world. Deep concern also about health care for mothers and children coupled with an effort to curb the high maternal and child mortality led to the global strategy of Primary Health Care.
Berman, et al (2008) opined that Primary Health care is an essential health care based on practical, scientifically sound and socially acceptable methods and technology. It is a system that provides health-related services within the context of people’s daily life. Primary Health Care strives for universal access to and affordability of healthcare, support and empowerment of the client, and targets those at risk for preventable health problems. Primary Health Care has eight components of which Maternal and Child Health Service is one of them. According to Lu and Bragonier (2002), Maternal and Child Health Service is a health service meant for mothers and children as well as a profession within public health committed to
promoting the health status and future challenges of mothers and children. Lucas and Gilles (2003) also stated that Maternal and Child Health care services are designed to meet the special health needs of mothers and children. They believed that special healthcare services for mothers and children are vital because maternal and childhood diseases make a substantial contribution to burden of diseases among mothers and children. So, Maternal and Child Health Service is an important dimension of community health specially meant for mothers and children to guarantee their physical, mental, spiritual and social well being and development. Maternal and Child Health Service has some components which include:
– Antenatal care that refers to pregnant –related healthcare provided by doctors, nurses/ midwives and other health professionals to all pregnant mothers to reduce the incidence of maternal and child mortality among them.
– Family planning through which the number of mothers dying can be lowered both by reducing the risk associated with pregnancy and the number of unwanted pregnancy.
– Immunization that helps in protecting the mothers against tetanus and in fighting against the childhood killer diseases such as measles, tuberculosis, diphtheria, neo-natal tetanus, whooping cough and poliomyelitis among children.
– Nutrition that is essential for the pregnant mothers and children as inadequate nutrition can cause anaemia and malnutrition in pregnancy and stunted growth in children.
– Delivery services which ensure that the best type of care is given to the mother during the crucial period of delivering a baby so that the mother survives and looks after her baby and does not develop any complications.
– Post natal care service which guarantees that mothers do not experience complications following delivery and also provides opportunity to assess the mother and child.
– Health Education that provides an opportunity during which mothers are given necessary information concerning pregnancy and childbirth.
– Counseling service which becomes essential following the assessment of the mother or child and possible detection of any health condition that requires advice (Adesokan, 2011). The current Maternal and Child Health Service objectives lie in the services developed to
improve the welfare of mothers and children. This agrees with Guar (2011) who maintained that the mission of Maternal and Child Health Service is to improve the availability of and access to high quality, preventive and primary health care for all mothers and children. The objectives of Maternal and Child Health Service as outlined by Lucas and Gilles (2003) are:
i. To ensure that pregnant mothers remain healthy throughout pregnancy, have healthy babies and recover fully from the physiological changes that take place during pregnancy and child delivery.
ii. To promote the health of children (0-5 years) to ensure their optimal growth and physical and mental development.
iii. To protect children from major hazards through specific measures e.g. immunization and food supplements.
iv. To treat diseases (e.g. malaria, pneumonia) and disorders with particular emphasis on early diagnosis.
In an effort to achieve these objectives, District Health System as a strategy was established with the intention of providing proper care during pregnancy, at the time of delivery and soon after delivery for the survival and wellbeing of both the mothers and children. In Enugu State, District Health system was established to delivery health services to a defined population (mothers and children) within a geographical area to which the management is accountable. This is to ensure that essential health services are available to mothers and children. Some of these services are antenatal care, delivery service, postnatal
care, immunization, growth monitoring, nutrition and treatment of minor ailment (Enugu State
Ministry of Health (ESMOH), (2008).
The choice of mothers and children is as a result of their large population and vulnerability, and for the fact that the children are the future leaders of the nation (Ayhan, 1993). Women and children constitute over 60% of approximately 7 billion people globally. In Nigeria, mothers and children make up to 49.2% of the population and many of the mothers experience a life that has a web of multiroles and multiranks which require an average woman to conduct different roles at different times in a bid to meet her family needs. These roles have been theoretically characterized as reproductive and community roles. Women also make critical contribution to the life and development of their families, communities and nation (Osinnowo,
2007). This is in line with Bologi (2011) who pointed out that the future of a nation depends largely on the health status of its citizenry, especially mothers and children who make up to two-third (2/3) of the population in most developed countries.
Mothers’ contributions and productivity are most visible in the children they nurture. Their role as producers of children influences, and is influenced by, their role in the economic arena. This is based on the fact that mothers work so hard and contribute much to sustaining their families. It therefore becomes pertinent that these mothers have access to health services and support that will guarantee their good health and survival especially during the childbearing periods. This becomes necessary because despite the honour bestowed on motherhood and appreciation of the birth of a new born baby, pregnancy and childbirth is still considered a perilous journey (World Health Organization (WHO), 2006). As a result, Maternal and Child Health Services becomes necessary as life-saving measures to combat the high maternal and child morbidity and mortality rates (Onuzulike, 2005).
The quality and quantity of Maternal and Child Health Services provided in the hospitals are underscored by the availability of the components of these services as well as the material
and human resources for them. Sometimes, some of the components of maternal and child Health services and material resources for them are not available. Besides, the cadre of health personnel employed to deliver Maternal and Child Health services to mothers and children determine the quality of these services. These health personnel are doctors, nurses/ midwives, pharmacist and laboratory scientist. The quality of Maternal and child Health Services are often compromised when appropriate categories of health personnel are not employed. It has also been identified that poor utilization of maternal and child Health services by mothers and children undermines these services.
In line with Bradley (1990), mothers do not avail themselves of the opportunities to utilize Maternal and Child Health Services due to such factors as ignorance or lack of awareness of the existence and importance of maternal and child health services, the danger signs of pregnancy, the gravity of any identified maternal health problems or where to go to seek help affects these mothers capabilities to make decision about seeking health care. The author further maintained that due to the poor location of these hospitals, some mothers especially those who live more than 5 kilometers away from the hospital usually find it difficult to access Maternal and Child Health Service as a result of the cost of transportation. This has contributed to the majority of the mothers being delivered of their babies at home. Doctor, Bairagi. Findley, Healleringer and Dahiru (2011) also observed that the unavailability of some of the components of Maternal and Child Health services, unavailability of the essential basic materials/ equipment for these services together with the inadequacy of the health personnel hinder the utilization of Maternal and child Health Services. In addition, Mittra, Nair and Gandotra (2000) noted that lack of satisfaction with either the general conduct of maternal and child Health Service or the poor attitudes of the health personnel act as constraints to the mothers from utilizing there services. This is because it is believed that efficient services
rendered in a friendly atmosphere by skilled health personnel are viewed as prelude to clients’
level of satisfaction with Maternal and Child Health services.
On the basis of this, the impact of maternal and Child Health Services are not effectively felt to justify the lofty and laudable objectives of these services and also to meet with the increasing demand for health care of mothers and children. In support of the above, Ladipo (n.d) stated that effective delivery of Maternal and Child Health Service is still fraught with challenges and it is discouraging. Besides, Federal Government of Nigeria (FGN) (2007) pointed out that there are real difficulties with availability of health personnel in most states of the federation as an estimated number of 2, 855 Nigerian doctors and 5, 772 Nigerian nurses migrate to other parts of the world for better employment opportunities or greener pastures. Observation by the researcher equally showed that the rate at which old health personnel are retired seems to be more than the recruitment of new health-personnel. This situation has negatively affected the availability of the health personnel. In the same vein, Bologi (2011) noted that there is high level of maternal mortality ratio (845: 100,000) due to complications from pregnancy and child birth. In Enugu state, it is recorded that the health status of her citizens especially mothers and children is poor (Enugu State Ministry of Health (ESMOH) (2008). In view of this, therefore, it becomes necessary and pertinent to evaluate the maternal and child health services.
Evaluation, according to Administration for children and families (2011), is a systematic method of collecting, analyzing and using information to answer questions about programme’s relevance, effectiveness, significance and efficacy. Administration for children and families (2011) further pointed out that evaluating objectives, efficiency, effectiveness and impact of intervention and actions of a programme are essential in improving performance and in achieving results. Evaluation gives feedback as to whether activities have been implemented as strategically planned.
According to World Health Organization (WHO) (2006), evaluation helps in advocating health programmes like maternal and child health services thereby strengthening it through improved coverage, equity, access, acceptability and continuation of care as well as the quality of care. As a result, WHO has proposed that programmes should be evaluated every two-three years to determine their relevance, significance and effectiveness. In line with WHO proposal and in order to determine whether the MCHS objectives of promoting the welfare and preserving the lives of these vulnerable groups of people (mothers and children) are met, the researcher wishes to evaluate the maternal and child health services.
Statement of the Problem
There has been an increasing demand for healthcare of mothers and children to reduce maternal and childhood mortality through proper maternal and child health services such as immunization services, integrated maternal and new born child health services among others. Despite these services, the situation of maternal and child health in Nigeria is discouraging and is described among the worst in Africa; and has not improved substantially. It is estimated that approximately 59,000 maternal deaths take place annually in Nigeria as a result of pregnancy, delivery and post delivery complications; while the under five mortality ratio is 200 per 1,000 live births. It is estimated that 2,855 Nigerian doctors and 5,772 nurses migrate to other parts of the world in search of greener pasture. It is also noted that thirty-five (35%) percent of births in Nigeria are delivered in a health facility while the majority of these births (63%) occur at home. There is poor utilization of Maternal and Child Health services by mothers and children probably because of ignorance, distance and inadequate number of health personnel.
Observation by the researcher has shown that many mothers prefer to attend private health sector facilities, where services are considered of better quality. It has also been observed by the researcher that the rate at which these health personnel retire seems to
outweigh the rate at which new health personnel are recruited and this negatively affects the availability of health personnel for Maternal and Child Health Services.
In addition, there is high level of maternal mortality ratio due to complications from pregnancy and child delivery. In Enugu State, it has been observed that the health status of her citizens, especially mothers, and the under five children is poor coupled with the paucity of evaluation study on MCHS in this area. These scenarios are worrisome and indicate negative implications for MCHS delivery. In order to determine the worth and efficiency of MCHS in promoting the welfare and preserving the lives of women and the under five children accessing MCHS, there is a need to evaluate MCHS. Therefore, the problem of this study put in question form is: To what extent are the objectives of Maternal and Child Health Services realized in Enugu North Senatorial zone of Nigeria?
Purpose of the Study
The main purpose of this study was to evaluate the maternal and child health services
(MCHS) in Enugu North Senatorial zone of Nigeria. Specifically, the study was designed to:
1. determine the extent of realization of MCHS objectives
2. find out which categories of health personnel are available for Maternal and child Health service.
3. ascertain the availability of the components of Maternal and child Health service.
4. find out which of the essential basic materials/equipment are available for Maternal and child Health Service
5. determine the extent of Maternal and child Health Service utilization.
6. find out the clients’ level of satisfaction with Maternal and child Health Service
Significance of the Study
This study will be significant as it derives from theoretical and practical bases on the uses of MCHS. Theoretically, the study is anchored on Logic Theory which will help to
validate the Logic Theory, identify and describe the elements of a programme e.g. MCHS and show expected connection among them. In addition, the study will provide a framework for monitoring the flow of MCHS and checking whether required activities are being put in place.
Practically, it is hoped that the findings of this study will be of immense benefits to the women of childbearing age, policy makers and planners, evaluators of health programmes, government health agencies, health personnel and researchers. To the women of childbearing age, it will enable them know the basic obstetric cares and what to expect during pregnancy, delivery and after delivery to help them improve their health and that of their children thereby reducing maternal and child mortality rate.
The policy makers and planners will also benefit from the findings hopefully, as it will provide them with accurate health data and make them take the right steps with regard to the provision of efficient and reliable maternal and child health services. The health programme evaluators will hopefully benefits from the findings of the study as it will enable them determine the quality, worth and significance of MCHS and then make necessary decisions.
To the government health agencies, the findings will enhance their proper repositioning of MCHS through the health departments/units. Besides, these agencies will be kept abreast of the availability and utilization rate of MCHS which will be a litmus test for government preparedness in attaining the 2015 Millennium Development Goals.
The health personnel will be made more conscious of the objectives/goals of MCHS to improve themselves and their activities through training and retraining. More so, researchers will benefit from making references to findings in this study which will also form bases for further researches. In essence, the finding will be a source of information for other researchers. Scope of the Study
The study is limited to Enugu North Senatorial zone in Enugu state of Nigeria. It is also limited to the women of childbearing age and the under five year old children who are
described as the vulnerable groups in the society with high mortality rates. The content areas will focus on the evaluation of MCHS which include antenatal care, safe delivery, post-natal care, emergency obstetric care, routine immunization, family planning, growth monitoring, nutritional supplements, and treatment/management of minor ailments.
Research Questions
In an attempt to accurately evaluate the maternal and child health services (MCHS), the following questions are posed to guide the study;
1. To what extent are the objectives of Maternal and child Health Service realized in Enugu North Senatorial zone?
2. Which categories of health personnel are available for Maternal and
Child Health Service?
3. Which of the components of MCHS are available?
4. Which of the essential basic materials/equipment for Maternal and child
Health Service are available?
5. What is the extent of Maternal and child Health Service utilization?
6. What is the level of clients’ satisfaction with Maternal and child Health
Service?
Hypotheses
The following null hypotheses are formulated for the study and will be tested at 0.5 level of significance.
1. There is no significant difference in the mean achievement scores of Maternal and child
Health Service objectives by health personnel in the rural and urban areas.
2. There is no significant difference in the mean utilization scores of maternal and child health service by mothers in the urban and rural areas.
3. There is no significant difference in the mean level of satisfaction scores between mothers in the rural and urban areas who obtain Maternal and child Health Service
This material content is developed to serve as a GUIDE for students to conduct academic research
EVALUATION OF MATERNAL AND CHILD HEALTH SERVICES IN ENUGU NORTH SENATORIAL ZONE OF ENUGU STATE.
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