A STUDY OF COMMUNITY HEALTH OFFICERS PERFORMANCE IN PRIMARY HEALTH CARE IN NIGERIA

Abstract

The concept of using non-physicians to provide primary health care (PHC) emerged in Nigeria in order to achieve the objective of increasing health care accessibility to larger population, especially in the rural areas. Limited resources such as shortage of doctors, mal-distribution of health personnel and awareness to use appropriate strategies responsive to meet needs of the community in solving health problems are among the factors responsible for such move by the Federal government. Community Health Officers (CHOs) and their training programme was developed in 1979 to serve such purpose. This involved critical appraisal of task allocations. Training was given to acquire necessary skills, knowledge and attitudes adequate to perform PHC functions in the community. The development of this training and the utilization of CHOs at clinical settings after training made it important to study their activities in order to link training with the functions they perform to establish that trainees are performing what they have been trained to do. In developing countries including Nigeria, assessment of health care workers have seldom been accomplished by scientific studies. This new form of health care delivery requires empirical evidence to confirm its effectiveness. Approach to evaluate CHOs activities is based on and composed of training, functioning, productivity, resources including facilities and national objectives. The central concern of this thesis is to study CHOs' activities in clinical settings. The study objectives were: To provide baseline data on CHOs' characteristics relating to their performance and training for future studies; to identify factors which might influence their future performance. The cross sectional study collected data from 364 CHOs in Nigeria. A sample of 54 CHOs obtained from four randomly selected local government areas in each of the 10 randomly selected states were observed in the field between February and March 1983. Some components of "Functional Analysis model" served as the general reference and provided the analytical framework. All training institutions, and Chief Health Officers in State Ministries of Health participated in the study. Three statements of hypotheses stated were tested. A major problem in performance evaluation in health care research has been the lack of appropriate research method with acceptable degree of precision and validity. This study developed and tested instruments from CHOs curriculum. The significant result obtained from an experimental work carried out suggests the validity and reliability of the instruments to evaluate CHOs performance. Descriptive findings provided detailed baseline data not previously available about the institutions since their inception. Bivariate relationships were analyzed with cross-tabulations, and analyses of variance techniques. The following significant influencing factors emerged: Professional background; Years of Experience; Adequacy-of-Training Perception of CHOs, and their Educational Needs were related to performance. Another significant result was that resource constraints were related to problems CHOs were encountering at the clinical settings. Another important finding about CHOs’ productivity indicated that a higher proportion of CHOs' time (46.7%) was spent performing administrative, functions while (32.9%) was spent performing clinical functions. Implications of the findings and recommendations suggest the need for the Federal Governments, and Institutions to re-structure organization, and supportive strategies for CHOs, which will enhance their future performance and improve the health care coverage of communities.