Enugu State District Health System : Knowledge, Attitude and Practice of Phc Workers, and the Effect of Dfid (Paths) Support on PHC Service Utilization

Abstract

INTRODUCTION: In the past decades, the decentralization and strengthening of district health systems have been common strategies for structurally changing health services in low income countries especially in Africa. The World Health Organization recommends the District Health System (DHS), (which is a self contained segment of the national health system) as a good means of achieving the aims for which the primary health care approach to health service delivery was set up. Health outcomes are unacceptably poor in most of the developing countries, including Nigeria; hence the need to reform. In 1988 when t he National Health Policy was launched, Nigeria adopted the district health system as a means of ensuring self reliant healt h care delivery to the entire population. In Enugu state, the need to reform arose as a resul t of the negative health indices in the state and Nigeria generally. Partnership for Transforming Health Systems (PATHS), which was a United Kingdom Department for International Development (DFID) funded programme, supported t he DHS from planning stage in 2004, until the PATHS programme wound up in June, 2008. This research project is aimed at investigating the Enugu state District Health System knowledge, attitude and practice of the Primary Health Centre workers; and the effect of the PATHS support in respect of the health facilities utilization. LITERATURE REVIEW: The general principle for developing DHS include; equity, accessibility, emphasis on promotion and prevention, intersectoral action, community involvement, decentralization, integration of health programmes, and co-ordination of separate health activities. Donor support has been shown to improve health facility utilization, while this has not been the case in few cases MATERIALS AND METHODS: The 77 primary health care facilities that were supported by PATHS through drug and equipment supply, constituted the study population. An equal number of the primary healt h care facilities that were not supplied with drugs and equipment were selected as control facilities. Structured questionnaire was used to carry out a cross-sectional study designed to assess the knowledge, attitude and practice of the Officers in-Charge (OICs) of the primary health care facilities in t he state, and their Assistants, on the district health system in Enugu state while retrospective cohort study was used to extract secondary data from t he ministry of health. Data analysis was done using SPSS. . RESULTS: The result s revealed that the supported facilities were already doing better than the control facilities, prior to the support . The support however resulted in improved health facility utilization, especially in terms of outpatient attendance. The OICs of the primary health facilities and their Assistants had good knowledge and attitude towards OHS, but their reported practices were inconsistent with observed practices. DISCUSSION: This research project successfully looked at the general and specific objectives for which it was embarked upon. The findings were essentially in keeping with similar findings In Nigeria and elsewhere. There were however some other findings that require further research work. CONCLUSION: District Health System in this study provided the best chance of implementing the primary health care system, and donor support significantly contributed to improved health facility utilization in the supported facilities. RECOMMENDATIONS: These include choosing poorly performing facilities for support in future, focusing on personnel issues, and research on the impediment s to effective implementation of District Health System in Enugu state.