ASSESSMENT OF CHILD HEALTH SERVICES AT HEALTH FACILITY LEVEL IN OSUN STATE, NIGERIA

ASSESSMENT OF CHILD HEALTH SERVICES AT HEALTH FACILITY LEVEL IN OSUN STATE, NIGERIA

Abstract

Introduction
In Nigeria, progress towards the child health-related Millennium Development Goal has been slow. Traditional evaluation of related services using large-scale surveys conducted every 2 – 5 years is too long for health system managers to wait to take decisive action to improve services. In addition, data is not disaggregated to allow managers to know where to focus managerial attention. Furthermore, the management function of the health system is weak at first level facilities especially PHCs. This has resulted in poor performance of health workers during service delivery. Lot Quality Assurance Sampling (LQAS) is a useful tool in this regards as it allows local managers to identify small areas of poor performance to track. This study was structured to assess child health services using a systems approach. Inputs (staff, infrastructure, equipment, supplies) are managed through a process (training, supervision, record keeping, and data management) to deliver the outputs (quality health worker performance in delivery of care for children).
General objective
The aim of the study was to assess the delivery of child health services at health facility level in Osun state, Nigeria.
Methodology
This study, a rapid assessment was a cross-sectional survey of child health services in Osun state, Nigeria using Lot Quality Assurance Sampling. Each of the three senatorial districts (senatorial districts) – Osun East, Osun West and Osun Central was chosen as the sampling universe for this study. Using a four-module rapid health facility assessment tool, i) 63 clinicians were observed while attending to 378 randomly selected ill children (who presented with any of fever/malaria, cough/difficulty in breathing and diarrhoea – with or without blood), ii) exit-interviews were conducted for 378 mothers of children whose consultations were observed, iii) an infrastructure and equipment checklist for 63 facilities and iv) a health worker interview for 63 facilities. Analysis using MS Excel and PASW (version 18) followed LQAS principles and identified performance of senatorial districts, state proportions and individual items.
Results
All senatorial districts performed adequately in the availability of essential infrastructure except in the design of the consulting rooms (West and Central senatorial
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districts performed poorly) and availability of overnight beds (West and East senatorial districts). In the 63 facilities surveyed, basic equipment as well as items for infection control were adequate in all senatorial districts but not supplies. All senatorial districts performed poorly in availability of curative services for children with a state aggregate of 50.6% (95% CI: 41.7 – 59.5) while preventive services were largely adequate in availability. In the 12 months preceding this study, only the west senatorial district had adequate numbers of health workers trained in at least one child health topic including malaria management. Supervisory visits were poor across all senatorial districts but the west and east senatorial districts performed adequately in the use of facility-generated data sent in the mandatory monthly service report in the preceding 3 months. Health workers in all three senatorial districts were adjudged to perform below standard on adequacy of clinical consultation, assessment and explanation of medications.
Conclusion
I found in this study that infrastructure and basic equipment for child health services in Osun state were largely adequate but the management processes and health worker performance deficient. There were variations across the different senatorial districts and the findings from this study will enable health system managers make targeted interventions. Recommendations are made for improvement in child health services and for periodic rapid assessment for continuous monitoring.

Title Page———i

Certification——–ii

Dedication———iii

Acknowledgement——-iv

Abstract ———vi

Table of Content——–vii

Chapter One

1.0 Introduction ——-1

1.1 Statement of Problem——4

1.2 Purpose of the Study——5

1.3 Significance of Study——8

1.4 Limitation——–9

1.5 Scope of Study——-11

Chapter Two

2.0 Review of Related Literature —-12

2.6 Summary of Literature Review—- 19

Chapter Three

3.0 Research Methodology and Procedure—22

3.1 Population ——–22

3.2 Sample and Sampling Technique—-22

3.3 Validation of the Instrument —-23

3.4 Reliability of the Instrument —–23

3.5 Data Analysis——-23

Chapter Four

4.0 Presentation and Discussion of Result—24

4.1 Analysis and interpretaion of Data—25

4.2 Discussion of Results——38

Chapter Five

5.0. Summary, Conclusion, and Recommendation  –40

5.1 Summary——–40

5.2 Conclusion——–41

5.3 Recommendation——42

References ———45

Appendix 1——–47

Appendix ———50

ASSESSMENT OF CHILD HEALTH SERVICES AT HEALTH FACILITY LEVEL IN OSUN STATE, NIGERIA