COMMUNITY INVOLVEMENT IN DATA MANAGEMENT FOR PRIMARY HEALTH CARE SERVICES IN NIGERIA: A PERI-URBAN WARD MODEL

COMMUNITY INVOLVEMENT IN DATA MANAGEMENT FOR PRIMARY HEALTH CARE SERVICES IN NIGERIA: A PERI-URBAN WARD MODEL

Abstract

This study reports an experience with data management at the community level in a peri-urban setting in Lagos State. The focus was creation of awareness and community involvement in the management of community-based records (procurement and utilization of PHC cards, collection, analysis and utilization of demographic information (population distribution and movement, births and deaths, growth monitoring and immunization coverage).
The methodology for the study included (i) advocacy visits and orientation of Community Development Associations (CDAs), the“Baale”-In-Council and community elders (ii) baseline data collection on knowledge, attitude, practice and expectations with regards to the Ward Health System and data management (iii) orientation of youths on data collection and analysis (iv) procurement, sale and utilization of home-based records and NHMIS forms (v) determination and utilization of the best periods for community mobilization, (vi) establishment of Growth Monitoring, Immunization and Family Planning services at Health Posts, (vii) orientation of TBA, maternity staff and private clinic/hospital staff on data management, (viii) information gathering by Community Health Promoters (CHP), youths and Residents’ Association Chairmen, (ix) data management by youths and CHP, (x) and training of CDA members on prioritization of health problems and drawing up of Action Plans for health interventions.
Baseline findings revealed poor data collection, analysis and utilization at the ward and LGDA levels. The baseline population figures of the target communities were not readily available and that of the newly created LGDA was a “guestimate” from projections of state census figures of the National Demographic Survey of the Year 2003. The private hospitals/maternity and clinics kept records but unlike the PHC clinic, did not send any to the LGDA’s M&E Officer. Information sent by 2 out of the se 7facilities in the ward to the State Private Practitioners Board now the National Health Management and Accreditation Agency (NAHEMAA) was also irregular.
Even though the PHC staff forwarded data on family planning, immunization and HIV/AIDS related activities to COMPASS, a USAID International Agency, no health care provider gave direct feedback to the communities. The facilities did not display information on vital statistics or health problems treated.
Community members who were trained to function as Community Health Promoters (CHP) complemented other Primary Health Care providers (CHO and CHEW) at the Primary Health Care clinic of the ward. CHP attrition rate was initially high (approximately 60%) because they did not receive any honoraria. With the intervention of Magodo CDA and a community-based NGO, 2 and later, 4 were sustained on token honoraria. This few committed CHPs continued to provide services and implemented health intervention programmes at the community level even when the supervisory and outreach services of the PHC clinic staff became irregular.
Contrary to expectations, the Community Development Associations were initially not as keen on managing data as the traditional ruling organs in the communities (the “Baales” and their chiefs). There was, however, a positive and remarkable change in the attitude of the CDA after orientation on data management, education on prioritization of problems and drawing up of “Action Plans” to be used as advocacy tools.
Making the procurement of data collection materials (home-based and community-based records) the responsibility of the CDA has so far ensured sustainability where the LGDA failed. The response to data collection for the purpose of security and revenue generation was faster than for health promotion (e.g. growth monitoring, environmental sanitation), but this entry point created room for generating data relevant for the latter two. Also, communities have started to receive feedback from health care providers and are utilizing relevant information for planning and for intervention activities.
The recommendations from the outcome of this study include:
 Consideration of ethnic variations and utilization of leaders of minority groups when mobilizing in communities for effectiveness.
 Partnering with communities in the management of health data and intervention programmes has great potentials for community development. CDA and Ward Development Committees should be involved in data collection and taught how to develop their own Action Plans based on the findings on health and health related
problems of their communities. Their plans should be harmonized as necessary to form the LGA Action Plan.
 Collaboration of Ward Health Centres (PHC clinics) with other health care providers (private, faith based and traditional providers) in their wards to collect information and to display them in a way that the facility users will understand. Relevant information should also be displayed in CDA offices and other public places as part of feedback to their communities.
 More vigorous promotion of health education programmes on prevention of health and health related problems by the mass media and health care providers at all levels of care, especially the PHC level. Malaria, water borne diseases and road traffic accident control should be priority in the study area (Ward A) while other wards need to identify and address their priority problems.
 Identification and addressing the needs of youths through communal efforts.

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

COMMUNITY INVOLVEMENT IN DATA MANAGEMENT FOR PRIMARY HEALTH CARE SERVICES IN NIGERIA: A PERI-URBAN WARD MODEL

Sharing is caring!