CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND

The World Health Organization (WHO) is greatly concerned with the provision of quality health care for everyone irrespective of varying levels of living. This implies whether the person is in the advanced or poor countries, rural or urban, poor or rich; good health should be guaranteed by the governments of all countries1. Health as defined by WHO is a state of complete physical, mental, and social well-being and not merely the absence of diseases or infirmity.2 The determinants of health of an individual at any particular time include: the social and economic environment, the physical environment, and the person’s individual characteristics and behaviours3. Illness or diseases is a very common thing that can come at anytime to an individual, when this occur the in-born survival instinct in man will want to fight back at all cost to become well again. Methods engaged to maintain and restore healthy status is described by Health seeking behaviors. Health or care seeking behaviour has been defined as any action undertaken by individuals who perceive themselves to have a health problem or to be ill for the purpose of finding appropriate treatment.7 Health services utilization simply means the willingness of the would-be or potential patients to make use of the most of the services offered at a medical establishment.4The health care utilisation of a population is dependent on their health seeking behaviour which has many determinants: physical, political, socioeconomic and socio-cultural.5

Researchers have long been interested in what facilitates the use of health services, and what influences people to behave differently in relation to their health. Most theoretical models view health care-seeking behavior as a result of rational individual choice.6 Although many of these factors are similar across populations, exactly how they interact and influence the actions of people is often unique to a population in the context of the environment they live in.7

Across the globe, no country can boast of a perfect health system that caters for the need of the whole populace. According to Anderson and Newman, studies on the Analyses of the determinants of medical care utilization in USA are receiving increasing attention because of the emergence of a number of related societal values and perceptions including:

(1)   A growing consensus that all people have a right to medical care regardless of their ability to pay for this care.

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(2)   The general belief that certain disadvantaged population groups such as the “poor,” blacks, Spanish-speaking Americans, American Indians, and inner city and rural residents, are not receiving medical care which is comparable in terms of quality and quantity that is available to the rest of the population.

(3)   High expectations concerning the extent to which medical care can contribute to the general health level of the population.

(4)  Public consternation over “the crisis in medical care” stimulated by rapidly rising prices and growing dissatisfaction about the availability of services.8

These reasons are not far from the situation in the African continent, Nigeria in this context. Many low-income countries, Nigeria inclusive, have not been able to meet the basic

healthcare needs of their people, especially those in the rural areas.9With a population estimate of more than 170 million, Nigeria is the most populous country in Africa and ranks the 7th in the world. The percentage of the populace residing in the rural area is about 70% . It has an annual population growth rate of 2.83% and the male female ratio is 50.9:49.1.10Nigeria’s overall health system performance was ranked 187th position among the 191 Member States of the World Health Organization in 2000.11 Health status indicators are worse than the average for sub-Saharan Africa. For example, 2013 estimates put life expectancy in Nigeria at 55 years.12 It is assumed that improvement in health leads to improvement in life expectancy, which is a robust indicator of human development13. Improvements in key health indicators have been slow and today Nigeria ranks among the countries with the highest child and maternal mortality: infant mortality rate of 74 deaths per 1,000 live births, the Under-five mortality rate is 117 per 1,000 live births, and the maternal mortality ratio is estimated at 560 per 100,000 live births.14 This is one of the highest in the world.

Nigerian health system includes orthodox, alternative and traditional systems of health care delivery. The Government recognises and regulates these three systems. The health care system in Nigeria accommodates both private and public health care providers. In the public sector health care providers are under the three tiers of government; federal (tertiary hospitals and some hospitals in federal institutions like universities), state (state specialist and general hospitals) and local government areas (primary health care centres and health posts). In the private sector, they are broadly categorized into those that provide primary care (general practitioners), those that provide secondary care and those that provide both primary and specialist care. There are also several non-governmental organizations and donor- owned and operated facilities. 15 Various Nigerian governments have made great

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efforts toward the provision of healthcare facilities to its populace. Notable among these efforts were the expansion of medical education, improvement of public health care systems, provision of primary health care (PHC) in many rural areas.16

According to the Federal Ministry of Health (2008), the total shares of public ownership in 2004 on health facilities were 14,607 while the private sector accounted for 9,029 in Nigeria. Public and private health care facilities are sparsely provided in many rural areas within the country.1 Moreover, clinics in rural areas often lack adequate equipment or trained health personnel, and require payment before providing services.18 With over 70% of inhabitants in Nigeria residing in rural communities, the overall health indices can only improve if sufficient health facilities/projects are attracted to such areas.

Good health is a need for all and the choice of a particular healthcare system respond to the laws of demand and supply, the demand for health care is a derived demand. Health care is not demanded for itself but for the advantages that can be derived from being healthy.16 This choice has been shown to be limited by factors such as availability, accessibility, affordability of services of the health facilities, cultural beliefs, the situation per time (i.e. urgency of care needed) and whether the kinds of services provided meet the need of the user.17,18