FACTORS INFLUENCING THE DISTRIBUTION OF NURSES AND COMMUNITY HEALTH WORKERS IN SELECTED LOCAL GOVERNMENT AREAS IN OYO AND BENDEL STATES

Abstract

A study of the factors associated with the mal-distribution of health service personnel between rural and urban areas was undertaken with a focus on Nurses and Community Health Workers (CHWs). The opinion of health managers was also sought. The study covered four local government areas of Oyo and Bendel States of Nigeria. The nurses and CHWs as units of inquiry were selected by simple random sampling procedure. The management staff as study units were selected by virtue of their position as top level managers of the health services. The samples were made up of 497 nurses, 205 CHWs and 132 managers. The response rate was satisfactory at 78.0% nurses, 81.0% CHWs and 76.0% management staff for analysis. The hospitals and health centres which required selection were chosen by stratified random sampling. The tools for data collection were questionnaires and relevant organisational records of information. Two questionnaires were constructed, one for nurses and CHWs and the other for management staff. The data were collected by the investigator personally. The data collection period lasted for four months in 1989. The responses were put in sets of positive, negative and neutral responses to questions asked. The variables were coded and weights assigned to response categories. The data were analysed by computer. Frequency distribution, chi-square tests and t-test of the Statistical Package for Social Sciences sub-programmes were employed to analyse the data. Included in the findings were that more males than females preferred rural areas for health service. Although married persons preferred rural service than single persons, the single persons were more in the rural areas for health service. Nearness of spouse to staff work place had strong association with personnel location for service, and staff without spouses were more in the rural areas for service. The staff who were predominantly reared in the rural areas preferred rural health service more than those with urban background. Age was neither associated with rural service nor with preference of service location. CHWs were not better distributed between rural and urban areas for service than nurses. Both nurses and CHWs in the rural areas, unlike their urban counterparts were dissatisfied with the availability of basic social facilities in their work environment. Staff influence on management to be left to work in their preferred service location, management staff inability to apply the rules for compliance with posting, and management staff feeling that rural service required special incentives were administrative factors associated with relative scarcity of personnel for health service in the rural areas. Funds for staff employment, manpower status in the labour market, working materials and equipment, and shortage of staff on employment were not associated with relative scarcity of health service personnel in rural areas. More infrastructure in the rural areas did not necessarily concentrate the expected categories of staff in them.

Whereas the rural areas were grossly short of nurses and CHWs, the urban areas had comparatively high ratios of staff to population. There was however surplus manpower in the labour market. Most of the managers were not trained in management skills. More males were managers in the predominantly female occupations, although there was some degree of decentralisation in the administration of the health services, the personnel departments were still centralised. The recommendations include decentralisation of personnel departments and rural development to improve personnel distribution between rural and urban areas.