SPATIAL PATTERN AND UTILISATION OF PRIMARY HEALTH CARE FACILITIES IN EDO STATE, NIGERIA

Abstract

The spatial distribution of Primary Health-Care (PHC) facilities in Nigeria does not meet the World Health Organisation (WHO) distance threshold bench mark. This has consequently affected accessibility and utilisation of PHC in the country. The literature on the spatial pattern of PHC, and on distance threshold, in particular, has received scant attention in Nigeria. This study was carried out to investigate the spatial pattern of PHC facilities and the effect of distance on their accessibility and utilisation in Edo State, Nigeria.

Gravity Model, Central Place Theory (CPT) and Health Belief Model (HBM) provided the conceptual framework. Using a two-stage stratified sampling technique, ten Local Government Areas (LGAs) were randomly selected. Twenty settlements stratified into ten rural and urban settlements were randomly selected from the ten LGAs. Housing units along identified routes within each of the selected settlements were listed. Fifteen rural and twenty-five urban household heads comprising 400 household heads were randomly sampled at defined intervals and interviewed. Ten higher cadre PHC personnel (one per LGA) were also interviewed. Primary data on PHC awareness, utilisation, cultural inhibitions, marital status, equipment and PHC funding were collected. Secondary data on disease profile, PHC utilisation and health personnel profile were also collected from PHC centres in 18 LGAs. Quadrant Count Analysis (QCA), Pearson correlation and regression analysis were used in testing the stated hypotheses. Qualitative data were content analysed.

The QCA with Variance/Mean Ratio (VMR) of 5.0 indicated clustered spatial pattern of PHC facilities. PHC facilities were more concentrated in LGAs with large sizes of rural settlements such as Akoko-Edo, Etsako East and Owan East than in Uhunmwonde, Ovia South-West and North-East with smaller sizes. There was significant positive correlation between sizes of rural population and number of PHC facilities per LGA (r = 0.71, p<0.05). Respondents’ access to PHC facilities varied from 35.7% to 78.2% across the communities within a distance band of four kilometres. Access to PHC across the LGAs decreased differentially with increasing distance from facilities in different communities (r = -0.81 to -0.99, p<0.05). Distance accounted for 22% to 67% of the variations in access to PHC facilities. PHC awareness and marital status positively influenced PHC utilisation (R2 = 31.0%, p<0.05). Socio-cultural inhibition on women/dependants in seeking household heads consent delayed timely PHC utilisation (R2 = 17.3%, p<0.05). Preference for, and utilisation of indigenous medicine insignificantly hindered PHC utilisation (R2 = 6.2%, p>0.05). There was low level utilisation of immunisation vaccines: hepatitis-B1 (13.0%), polio (39.0%) and tuberculosis-BCG (47.7%). Low level PHC utilisation was attributed by PHC officials to poor funding (77.8%), inadequate health personnel and equipment to work with (55.5% each).

Edo State has not met the World Health Organisation distance threshold bench mark for Primary Health-Care spatial distribution. To improve Primary Health-Care accessibility in Edo State, there is need to define different distance thresholds for different Local Government Areas as the uniform four kilometres set by government is unrealistic due to differential effects of distance on utilisation.

Keywords: Primary healthcare, Indigenous medicine, Healthcare utilisation, Distance threshold. Word count: 489