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This work investigated Community Involvement in Health Care (CIH) programmes in Umunze, Orumba South Local Government Area of Anambra State. The study specifically verified the extent of involvement of the community in preventive, promotive and curative components of health programme; reasons behind the extent of community involvement in health programmes, community agencies behind community involvement in health programmes;  gender and age differences in community involvement in health programmes; community agencies behind community involvement  in health programmes; and relative involvement of the various villages in Umunze in health programmes.  The population for study comprised  twenty-two health workers and 37409 adult members of the population in Umunze.

A cross-sectional survey design was employed in the study. A sample of 300 adults (comprising 150 males and 150 females) was used in the study. Data were collected using structured questionnaire and key informants interview. The mean (x), standard deviation, t-test and analysis of variance (ANOVA) were used for data analysis. Results showed that the community involvement in the various components of health programmes varied: The community was involved in preventive health to a great extend; promotive health to a little extent; and curative health programme to a very great extent. The results also revealed, among others, that several reasons were behind community involvement in health programmes such as availability of qualified health personnel, awareness of health needs, presence of female caregiver. The hypotheses tested at.05 level of significance showed that there was significant difference in the extent of community involvement in health programmes according to gender, age and villages. Females were more involved than males in preventive and curative health programmes. The age brackets 18 – 25  and 46 – 55 were more involved than others in curative health. Among the villages, Ugwuano and Amuda villages led in the various health programmes. The need for the use of local and modern media to promote greater community involvement in promotive health; and greater empowerment of women and certain age groups for greater participation in matters concerning health programmes, were recommended.  

CHAPTER ONE Introduction

  Background to the Study 

 Good health is basic to human welfare and a fundamental objective of social and economic development (Ukwu, 1993). It is not by accident therefore that three of the eight Millennium Development Goals (MDGs) adopted by world leaders in September 2000 are on health. These are to reduce child mortality (MDG-4); improve maternal health (MDG-5) and combat HIV/AIDS, malaria and other diseases (MDG6). Nigeria is signatory to this pledge targeted for achievement before 2015. While government and donor agencies are stepping up efforts to strengthen health systems in order to meet the target, community involvement appears to be the only way to reach the grassroots. (Abiodun & Kolade, 2006).

  In most parts of Africa, the concept of community development and local involvement is a cultural phenomenon. Self-help efforts through which several social amenities were provided by local communities are not new in this part of the world. Since no local, state or even federal government can meet all the health demands of its people, especially in the light of contemporary complex health issues, local involvement in health care programmes has become indispensable and is intensified in recent years in Nigeria. 

Annett (2006) defined community involvement in health as a deliberate strategy which systematically promotes community participation and supports and strengthens it in order to provide better health care for the majority of people. It involves both a commitment to promote better health with people and not merely for them, and a strategy radically different from the more conventional approaches to health development.  Community involvement in health is conceptually one of partnership between government and local communities in the three key areas of planning, implementation and utilization of health programmes. 

Health projects like the building of clinics, maternities, dispensaries, cottage hospitals, National Programme on Immunization (NPI) and so on, have tended to become focal points across the nooks and crannies of the Nigerian society since the 1980s (Ewhrudijapor & Ojie, 2005) . Indigenous participation as an approach in most developing economies has been able to penetrate the health sector as it is seen as a method of accelerating the reduction of ill health in the society. This is against the backdrop of contemporary public health issues like reproductive health, HIV/AIDS, tuberculosis, female genital mutilation and other harmful traditional practices. 

 Aregbeyen (2006) observed that there was a deliberate attempt to draw a comprehensive national health policy dealing with such health issues as manpower development and the provision of comprehensive health care service based on the health services scheme, disease control, and efficient utilization of health resources, medical research, health planning and management. However, the mentioned factors below seem to account for the seemingly futile efforts of governments in Nigeria over the years to improve health care delivery under several health projects (NHPS, 1988):

The coverage  were inadequate, no more than 35% of the Nigerian population had access to health care services; rural  communities and urban poor were not well served the orientations of the services were inappropriate with a disproportionately high investment on curative services to the detriment of preventive ones. The involvement of the communities were often negligible at critical points in the decision making process; and the management of the funds often showed major weaknesses resulting in defective basic infrastructures and logistic supports.

It is therefore apparent that government alone neither can shoulder the responsibilities of communities  health problems nor can the effort of government mean much in the absence of community involvement. Population is a question of people, healthy people, not of numbers. It is the indigenous participatory efforts in health issues that determine the extent of success of government health programmes. Udoye (1989) stated that community involvement in development programmes and strategies have become a handy framework for the provision of the basic needs of rural Nigeria communities.

 In  Anambra State cooperative effort is a way of life, a philosophy embraced by the government and the people alike.  What is perhaps new is that for the first time a direct and conscious effort is being made to harness this abundant resource (Adeyeye, 1987). There are two principles emerging from the idea of community participation. These are the principle of individual and corporate survival and the principle of societal felt need.  According to Udoye (1992) these two have been the propelling force behind organizing and mobilizing the people in the pursuit of selfdevelopment.

 Apart from initiating certain programmes of self-help like building of health centres, the community must be involved in the context of embracing the health programmes of government especially in the light of the prevailing health problems. Erinosho and Oke (1994) stated that chronic diseases and disability cannot be understood or treated solely as medical phenomena; but should be in the context of the total environment. According to them, there is general agreement among health providers that macro environmental variables of the people are as necessary and sufficient as physical conditions. The communities need to know the implications of some health hazards and certain behaviours on their well being. There is therefore symbiotic relationship between the government and the communities in the achievement of the health programmes. Hence, the idea of primary health care (PHC) emerged in the 1960s, in recognitions of the shortcomings of the health systems inherited by developing countries, like Nigeria after independence (1d 21, insights 2008). The Alma Ata conference of 1978 placed emphasis on preventive, rural peripheral and appropriate services, integration and local communities. According to Okoye (1989) the success of this programme requires the promotion of maximum community and individual self-reliance and participation in the planning, organization and control of primary health care, making fullest use of local, national and other available resources. Health programme is a deliberately planned activity by government aimed at eradicating or controlling specific identified diseases (Mbah, 2000). Health progrmmes are aimed at achieving public or community health and by so doing promote socio – economic activities and well-being of the society. There are three components of any health programme – preventive, promotive and curative health programmes. 

 The preventive health programme seeks to prevent the occurrence of diseases. The programme tries to identify the habits of man that encourage the occurrence of diseases with a view to educating the masses on ways to avoid the habit or eliminating it. The promotive component of health programme is closely related to preventive health programmes since the main purpose of promotive health programme is to encourage people to lead healthy life style. However, promotive health programme could also be used to provide basic health education to communities, as well as provide information to communities on certain health concerns.   Curative component of heath programme on the other hand aims at curing some specific diseases in order to curtail its prevalence for a health society. 

 Against this background, Moronkola and Okanlawon (2003) concluded that the community is the common target of all the health programmes or activities whether, it is called public, community or primary health care. The main goal is the attainment of a level of health that will permit all the citizens of a particular community to live a socially and economically productive life. Hence health pregrammes are usually all inclusive bringing in all the three components in order to achieve wider success. 

 Community involvement in health was first used explicitly as the term to describe a basic principle of health care and promotion in community in 1985 at an inter-regional meeting on the subject of community involvement in health (WHO 1985).   Community involvement in health (CIH)  programme is a deliberate strategy which systematically promotes community participation and supports in order to provide better health care for the majority of people (Kahssay & Oakley, 2006 ) CIH is not a health programme in itself, but an essential principle of health development. 

 CIH is essentially a process whereby people, both individually and in groups, exercise their right to play an active and direct role in the development of appropriate health services, in ensuring the conditions for sustained better health and in supporting the empowerment of communities for health development.  CIH actively promotes people’s involvement and encourages them to take an interest in and to contribute to and to take some responsibility for the provision of services to promote health. 

 Rifkin (1990) identified three components of community involvement in health care programmes – planning, implementation and utilization.  CIH actively promotes people’s involvement in the critical areas of planning for, implementing and utilization of health programmes . It implies a partnership among individuals, groups, organizations and health professionals, in which all sides examine the basic of health issues and agree upon approaches to tackle them. At each stage of planning, implementation and utilization, all actors come together to discuss issues and feasible solutions and to agree upon a course of action.

 Planning is the process of determining the major objective of a programme and the strategy that will govern the acquisition, use and disposal of services to achieve those objectives (Ransome – Kuti; 1990). In the context of health, Jones (1992) described planning as: 

…. defining the extent and characteristics of community health problems   and identifying unmet needs; assessing available and potential resources establishing priority goals by matching need and resources and considering alternative action to active programme goals and their consequences; formulating the necessary administrative action to achieve programme goals ; relating results to goals by continuing evaluative studies (p. 74).

The Successful implementation of a health programme is hinged on community involvement and support, the notion is that people are likely to support programme which they are a party in planning. The Pan American Health Organization (PAHO) reported on an experiment to promote community involvement in health (PAHO, 1994). The experiments have five main elements: identification and discussion of the key health problems within a particular community, agreement upon a proposal of action; ongoing negotiation when decisions are needed; implementation of agreed plan of action; and evaluation of the action with the involvement of all concerned. 

In the present study, all the three dimensions of health programme i.e. planning, implementation and utilization of health programmes will be considered at the three levels of prevention, promotion and cure.  This will provide a comprehensive study of the nature and pattern of health involvement in the locality.

CIH is not a new concept in Nigeria. Since the Alma – Ata adoption of primary Health care in 1978, community has remained the focal point of health service delivery (Mbah, 2000). In fact all the components of PHC are targeted at the community, for the achievement of the goal of health for all.

      Moronkola and Okanlawon (2003) argued that the focus of community health work is the promotion and maintenance of health  of the  host communities. According to them, it is essential that community health workers take note that the  success of any health care initiative depends on community participation.  The following should be noted: involve community to effectively assess community needs and resources, be able to assess the health of the community, identify the characteristic, resource and needs of the community; Work with community members on those issues that arise, addressing individual and environmental variables related to health issues; and facilitate meaningful participation of community members at all stages in the assessment, planning, delivery and evaluation of health services.

Ewhrudjakpor and Ojie (2005) observed that community utilization of health programme facilities can be influenced by quite a number of variables such as location, namely distance of facilities, cost at which health care is provided to the public, socio-economic factors in addition to the way in which illness is perceived or evaluated. 

Abiodun and Kolade (2006) observed that females utilize health facilities more than males on account of their care and their children’s care.  It therefore follows that community involvement in health programme is skewed in favour of women. This is however understandable as Joint Learning Initiative (2004) stated, in a health crisis, by culture or tradition, it is women who ease pain and suffering, offer physical care and nurturing and provide comfort and support.

The observations in the foregoing may not be different from what is obtained in Umunze which is the focus of this study. Umunze is one of the 16 autonomous communities in Orumba South and also the Headquarters of Orumba – South Local Government Area, Anambra state.  Umunze has projected population figure of 37,490 people as at 2006 (LEEDS Document, Orumba – South L.G.A (2006).  The Umunze community has one functional comprehensive health centre, three health posts, one cottage hospital (now elevated to general hospital), two mission hospitals and seven private hospitals. Umunze community is therefore a fertile ground for this kind of study. 

The Primary Health Care (PHC) programme is a visible health programme in Umunze community. Although it has been recognized that community involvement is a prerequisite for the success of the PHC programme, it is doubtful whether the community is actively involved in the three components of planning, implementation and utilization of health care programmes in the area. Indeed, one of the pillars of Primary Health Care is community participation, the active involvement of people and the mobilization of societal forces for health development (Dhillon & Philip, 1994). Following from this, the present study seeks to find out the extent of community involvement in the health care programmes in Umunze (a local community).

Statement of the problem  

A collective approach to the fight against diseases has been observed by many authors and researchers (Okoye, 1989; Dhillion & Philip, 1994). Since the Alma Ata Declaration in 1978, the issue of community involvement in health care programmes has been given greater impetus. It has been shown th

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