CHAPTER ONE

INTRODUCTION

1. BACKGROUDN  OF THE STUDY

Sound health is a fundamental requirement for living a socially and economically productive life. Poor health inflicts great hardships on households, including debilitation, substantial monetary expenditures, loss of labour and sometimes death. The health status of adults affects their ability to work, and thus underpins the welfare of the household, including the children’s development (Asenso-Okyere et al., 2011). Poor health affects agricultural production. Treatable conditions often go untreated because of lack of access to healthcare.

The World Health Organization (WHO, 2019) declares a high number of maternal deaths in some parts of the world, which reflects inequities in access to health services and highlights the gap between rich and poor. Nearly 100% of global maternal deaths occur in developing countries, with more than half of these deaths occurring in sub-Saharan Africa and almost one-third happening in South Asia. More than half of maternal deaths occur in fragile and humanitarian settings (WHO, 2019; World Bank Group, 2014). Nigeria, one of the developing countries, accounts for nearly 20% of all global maternal deaths (WHO, 2019). Records indicate that between 2000 and 2015, the maternal mortality rate in Nigeria has reduced from 1,170 deaths to 814 deaths per 100,000 live births, representing (30.4%) decrease (Adamu Hauwa Suleiman, 2011; WHO, 2018).

The need for health care varies in space and so the organization of provision necessarily has a spatial component. Neither population totals nor population characteristics such as age, sex, income, occupation, fertility et cetera are uniform in space. In a like manner, the physical environment varies in characteristics from place to place and this invariably has implications for the pattern of demand for health care facilities. The spatial dimension is also important in utilization behavior since accessibility is a major determinant of the use of health care facilities (Onokerhoraye, 1997).

For maternal health, women’s decision-making ability regarding the use of health services often discussed using the concept of autonomy. In Nigeria, the choice to deliver outside modern healthcare infrastructure settings could be motivated by varying factors such as economic, social, physical, cultural, or institutional. Outside the contemporary healthcare infrastructures setting, women are assisted by an attendant who may be unskilled. This attendant could be a traditional birth attendant (TBA), village midwife, member of the family, or neighbor. According to the Nigeria Demographic and Health Survey 2008, between 2003 and 2008, only 46% of women living in rural areas received antenatal care from a skilled provider: skilled provider assisted doctors, nurses/midwives, auxiliary nurses/midwives, 28% of births, and 25% of deliveries took place in modern healthcare facilities. Expectant mothers who cannot access these services, due to perceived challenges like cost, distance, and trust, are left to use “alternatives” such as Traditional Birth Attendance (TBA) services (Beauchamp & Childress, 2001).

In developing countries, the under-utilization of the health services in public sector has been a universal phenomenon (Zwi, 2001). The state of the Nigerian health system is dysfunctional and grossly under-funded with a per capita expenditure of US$ 9.44 (World Bank, 2010). As a result, Nigeria still has one of the worst health indices in the world and sadly accounts for 10 percent of the world’s maternal deaths. The National health management information system is weak, without an integrated system for disease surveillance, prevention and management. Research also indicates that there are high rates of absenteeism (about 40%) among medical doctors, especially in rural areas (Hamid et al., 2005). The high level of mortality, and morbidity which accounts for 157 deaths per 1000 live births (NDHS, 2008), nonattainment of international goals for health and survival, and the inequalities in access to health facilities are the challenges of rural populace.

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. In Nigeria, there has been a growing recognition of the challenge of rural people’s health issues and the need for it to be addressed (Hamid et al., 2005). There is a huge shortage of qualified practitioners in the rural areas. Accessing health care in rural areas is confounded by problems such as insufficient health infrastructure, the presence of chronic diseases and disabilities, socioeconomic and physical barriers (Ricketts, 2009).

1. STATEMENT OF THE PROBLEM

In most rural areas in Nigeria it is difficult and in most cases impossible to attain the minimum threshold population to provide secondary health care facilities. In such areas it is basically unrealistic to plan the provision of a tertiary health care facility which will achieve the required efficiency in terms of the utilization of scarce resources. The market on the day when it is their turn to hold the market. In this case the traders and sellers move from one market place to another so that they can sustain their continued stay in business by attracting customers periodically. If every settlement attempts to hold its market daily, the threshold population which will ensure a daily availability of customers to sustain the tracers to make sales will not be attained and so the markets will die a natural death of nonsurvival (Onokerhoraye, 1970).

Despite various national and international initiatives to improve maternal health, more than half a million women from developing countries die each year as a result of complications related to pregnancy and childbirth (Ronsmans & Graham, 2006; WHO, 2005, 2019). While virtually all developed countries have made appreciable progress in curbing the menace of maternal mortality, the terrible rates in Nigeria and other sub-Saharan African countries remain worrisome (F. Fagbeminiyi Fasina & Oni, 2017; WHO, 2019). Besides, between 2000 and 2017, Southern Asia has achieved the greatest overall reduction in maternal mortality ratio with a decline of nearly 60%, from maternal mortality ratio of 384 down to 157 (WHO, 2019).

1.3 AIMS AND OBJECTIVES OF THE STUDY

This study is aimed at assessing the level of utilization of Healthcare among women of childbearing age in Billiri community, Gombe State.

Specifically, the study seeks to:

1. Assess the level of awareness of the services provided by Healthcare centers.
2. Assess the level of utilization of the Healthcare centers available in the community.
3. Determine the various problems and challenges associated with the use of the Healthcare centers in the community.

1. RESEARCH QUESTIONS

The following research questions will be addressed in the study:

1. What is the level of awareness of the services provided by Healthcare centers?
2. What is the level of utilization of the Healthcare centers available in the community?
3. What are the various problems and challenges associated with the use of the Healthcare centers in the community?

1. STATEMENT OF THE HYPOTHESIS

H0 there is no significant relationship between healthcare utilization among women of child bearing age

H1 there is significant relationship between healthcare utilization among women of child bearing age

1. SIGNIFICANCE OF THE STUDY

The study is on assessing the level of healthcare utilization among women of childbearing age is very significant in Nigeria and speicifically Billiri community of Gombe State where majority of women lack the access and utilization of healthcare during pregnancy period, as a result end up dying.

The findings of the study will reveal the level of awareness and utilization of women of childbearing age; it will also reveal the some of the problems and challenges associated with the healthcare centres.

Ultimately, the findings of the study will be useful to the policy makers and the ministry of health to make urgent pragmatic measures in ensuring healthcare centres are up to the standard of utilization to the women of childbearing age in Nigeria and specifically Billiri community of Gombe state.

1. SCOPE OF THE STUDY

This study focuses mainly on assessing the level of utilization of healthcare among women of childbearing age, specifically; the interest of the study will be restricted to only women of childbearing age in Billiri community of Gombe state due to time and finance constraints. Thus, the investigation of the study will be conducted within and focus on the level of awareness of the services provided by Healthcare centers; the level of utilization of the Healthcare centers available in the community; the various problems and challenges associated with the use of the Healthcare centers in the community.

1. LIMITATION OF THE STUDY

TIME CONSTRAINTS: One the challenges experienced by the researcher is the issue of time; the research will simultaneously engage in departmental activities like seminars and attendance to lectures. But the researcher was able to meet up with the deadline for the submission of the project.

FINANCIAL CONSTRAINTS: Every research work needs funding; however lack of adequate funds might affect the speed of the researcher in getting materials for completion of the project.

1.9 DEFINITION OF TERMS

Maternal care

Maternal care covers all aspects of the mother's caretaking activity from her child's birth until it reaches the age of twelve to fifteen months, or, in the view of some authors, such as John Bowlby, the age of three years.

Utilization

The action of making practical and effective use of something.

Healthcare

Healthcare is the maintenance or improvement of health via the prevention, diagnosis, treatment, recovery, or cure of disease, illness.

Rural communities

A rural area is an open swath of land that has few homes or other buildings, and not very many people. A rural areas population density is very low. Many people live in a city, or urban area. ... Hamlets, villages, towns, and other small settlements are in or surrounded by rural areas.