CHAPTER ONE

INTRODUCTION

Background of the Study

According to the National Primary Health Care Development Agency (2013), Standing Orders are set of specific guidelines arranged by symptoms which defined how clients with different conditions should be cared for

Evolution of health care system in Nigeria is predated to pre-colonial era when provision of healthg care was centered on the traditional healers. In those days, midwives used to be equivalent to traditional birth attendant. There were also traditional bone setters. However, some of the socio-cultural practices in those days were injurious to the health of human being for example. Female Genital Cutting, use of bamboo stick to cut umbilical cord and use of potash after delivery among many others (Adebayo, 2009).

As at the first indigenous populations contact with Europeans, whose primary motive was commerce which was later dominated with slave trade. As trade intensified, the scourge of locally endemic disease was noticed, such as malaria, yellow fever and diarrhea which led to introduction of limited form of medical care facility. Medical care services were based and available only on board of the slave ship for only the white staff. Therefore, there was increased morbidity and mortality among the slaves that were kept in transit.

The end of slave trade in the late 18th century saw the influx of missionaries in  Nigeria who established various hospitals among which was sacred heart hospital, Baptist Mission Hospital to mention but a few. The missionaries also trained some nurses and paramedical personnel to provide the Health care services for the indigenous populations. They also sponsored most of the first generation professional doctors to study medicine in Europe (Johnson, 2011).

The first formal planned provision of medical services was by the British Army Medical Corps to its colonies and protectorate in Nigeria. With the introduction of the colonial government during the colonial era, government offered free medical services to their colonial service officers. This was later extended to civil servant and eventually to local people who were closer to the government station (Adebayo, 2009)

In 1946, a formalized health plan was introduced through a Harken Walker 10 years development plan (1946-1956). But it was the colonial masters oriented, hence no impact on general population. Post independently, Nigeria began an attempt to provide health care service for its masses. The first National Development Plan (1960-1968) was introduced and gave priority to the training of medical manpower and building of hospitals. in l970-1974, another five years development plan was formulated, but this could not achieve much as a result of prevailing civil war and poverty in the country.

As a result of these, there were low coverage of health care and the few available doctors and nurses were in the urban centres, leaving the rural community where most citizens reside to be cared for by the traditional healers and quacks. About  80%  of the population were without any modern health care services, as only doctors were allowed to treat simple, common diseases such as malaria and diarrhea. The morbidity and mortality indexes were very high and some of the worse in the world.

With the introduction of Basic Health Service Scheme (BHSS) in 1977, the need arose for the development of new cadre of health workers who will deliver health services in the rural areas and urban centres where majority of the population lived and worked. Four cadres of the polyvalent health workers were identified and trained and these have remained up till now, the core primary health care workers in Nigeria primary health care system. These are:-

i.                   Community Health officers

ii.                 Community Health Supervisors

iii.              Community Health Assistants

iv.              Community Health Aides

The Community Health Supervisors cadre was later phased out while the assistant and aids cadres were renamed as the community health Extension Workers (CHEWS) Senior and Junior respectively.

The training of community Health Workers has been centered on the development of relevant skills to improve health care delivery which include provision of evidence based on preventive and curative care with the use of standing orders.

During the training the community Health Workers were taught how to use standing Orders  and use of uniform which are specifically designed to cover the following:-

1.     History taking

2.     Diagnostic procedures

3.     Treatment and referral of common diseases

4.     Other health conditions that are prevalent in the community

The Standing Orders are drawn by a panel of physicians. The strategy was to ensure quality of care and also provide legal backing for the community health practitioners (Obionu, 2007). Community Health Practitioners are to treat and manage clients conditions strictly with the use of Standing Orders and proper use of uniform as demanded by law and the following code of professional practice:-

a)     A Community Health Practitioners must use his/her standing orders, uniform and other medical equipments in arriving at any diagnosis and management of his/her patient (Rule 6 sub-section iii-code of professional conduct, Ethic and Etiquette for Community Health Practitioners, 2011).

b)    Community Health Practitioners shall use professional skill, the standing orders and uniform as a guide to manage the clients (Code 7 sub-section ii).

c)     A Community Health Practitioners must use his/her Standing Orders, Uniform and other diagnostic and management equipment in arriving at any diagnosis and management of his/ her patient. Where he/she fails and the patient suffers as a result, he/she may be sued for negligence (Rule 14, sub-section iii).

d)    Any Community Health Practitioner who made a wrong assessment of the patient without using standing orders and uniform  (Rule 15 sub section vi), will be punished in consonance with section 23,  subsection 2a-e of the community Health Practice  Act (Decree 61 of 1992).

The main aim of Standing Orders is to ensure quality in health care delivery. According to Umar, (2012), opined that quality in health care delivery is the discharge of integrated primary health care services correctly at the right time and to the satisfaction of the client under uniforms.

Standing orders also ensure uniformity of care and provide legal backing of the practitioners who use them. In conclusion, Nigeria health system has passed through many phases from colonial to indigenous, but despite these, still faced with many challenges. Therefore, community health practitioners who are the front liners and as a first point of call by masses for health care services, must be able to provide quality health care through effective use of standing orders and uniforms. This will help Nigeria to attain millennium development goals and achieve health for all.

Within Sub-Saharan Africa countries like Ghana, Zambia, Leshoto, Uganda, Niger Republic, Togo among others are practicing the use uniform for example Army, Policemen, Nurses, Doctors, community health practitioners to mention but a few.

The professional attributes in this research work include:

1.     Attitude of community health practitioners towards patients/clients services.

2.     Attitude of community health practitioners on immunization.  

3.     Attitude of community health practitioners towards their employer.

4.     Attitude of community health practitioners towards use of uniform.

5.     Attitude of community health practitioners towards use of standing orders. 

In view of the above, the researcher is relying on the use of standing orders and the use of uniform respectively. 

Statement of the Problem

Strict compliance to the use of standing orders and uniform is a major challenge to the effective delivery of quality health care service at the primary health care level. This fact was established by the Acting Registrar of the community Health Practitioners Registration Board of Nigeria, while delivering a speech at the launch of 2010 edition of Standing Orders in Abuja. He said “Any community health practitioners found to be practicing without procuring a copy of Standing orders and uniform will be prosecuted more especially  that the documents has been made more user friendly (Vanguard Newspaper online, 2010).

Nigerian Maternal Mortality rate which range from 8-15 per thousand of live birth according to the world Health Organization are alarming meeting the Millennium Development Goals 4,5 and which are:

MDGS 4: Rule child mortality

MDGS 5: Improve maternal health

MDGS 6: Combact HIV/AIDS, malaria and other disease are also major challenge to Nigeria health sector.

Therefore, low level of compliance with the use of Standing orders and uniform will lead to ineffective and substandard care given, thus contributing to poor health care service in term of quality and quantity. This may constitute an obstacle to the effort of Nigerian government to achieve health for all and attainment of vision 2020. Poor compliance to the standing orders and uniform will also make evaluation of care difficult and render the principle of uniformity of care unachievable. The current state of maternal and child mortality rate is alarming. If urgent steps are not taken, the situation will grow worse. This study is an attempt to determine the utilization of professional attributes among Community Health Practitioners in Yorro Local Government Area of Taraba State.

Purpose of the Study

The purpose of the Study is to determine the utilization of professional attributes among Community Health Practitioners in Yorro Local Government Area of Taraba State. Specifically, the study seeks to:

1.      Identity areas of difficulties associated with the contents of the standing orders.

2.      Determine problems associated with the contents of the uniforms.

3.      Examine the obstacles encountered by community health workers during the use of standing orders.

Significance of the Study

It is expected that the findings of this study will be of benefit to the community health practitioners, the community Health practitioners Registration Board of Nigeria and the National Primary Health Care Development Agency (NPHCDA).

Through this study, the attitudinal problems of community health practitioners in relation to the use of uniform and standing orders will be highlighted and addressed. For the members of the community, the study will help in providing standard treatment to them by using essential drugs in the standing orders which are affordable and effective. This will improve their health status at affordable rate.

The finding of the study will compel health workers to marry their standard standing orders and uniform to use them in their daily practice in all primary health care setting thereby improving the health of our people thereby prolonging their lives.

The findings will also serve as an information bank for subsequent researchers carrying out studies on similar topics.

Research Questions

The following research questions were formulated to guide the study.

1.     What are the areas of difficulties associated with the contents of the standing Orders in Yorro Local Government Area of Taraba State?

2.     What are the problems associated with references to use of uniform during treatment in Yorro Local Government Area of Taraba State?

3.     What are the obstacles encountered during the usage of standing orders in Yorro Local Government Area of Taraba State?

Scope of the Study

This study is centred on the utilization of professional attributes among Community Health Practitioners in Yorro Local Government Area of Taraba State.

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