DEVELOPING AN INSTRUMENT TO ASSESS PRIMARY HEALTH CARE PROGRAMME IMPLEMENTATION IN MISSION HOSPITALS IN OYO STATE, NIGERIA

Abstract

This study was based on a checklist of six primary health care (PHC) programme processes that was developed to assess the organisational and administrative support that mission hospitals in Nigeria were giving to PHC implementation. Mission health services are a major provider of health care in developing countries, Nigeria included. Even before the advent of the Alma Ala Declaration in 1978, missions in Nigeria were practicing village based, participatory health care. Now that PHC is the globally accepted strategy for achieving "Health for All." It is necessary to evaluate the degree of PHC programme implementation generally, and in mission health services specifically. This exploratory research utilised case study design, but also involved elements of survey research using a standard instrument. In fact it was the purpose of this pilot study to develop and test such an evaluation instrument, thus the study assumed some characteristics of evaluation research. The instrument was designed by reviewing literature on PHC to discern major PHC programme. Implementation and management processes as well as indicators for successful attainment of these processes. A checklist was developed and pre-tested consisting of (1) Review questions (2) documents to be perused and (3) activities to be observed in order to attest to the attainment of a PHC process indicator. The six programme processes were divided into a total of 30 criterion, and were scored, after evidence of indicators was gathered, on a scale of 0-2 points (not attained, partially attained or fully attained). The data was gathered in five of 14 mission health services within the boundaries of Oyo State, Nigeria, as it stood in early 1991. These facilities represented different levels of PHC organization from a strictly clinic based service to a completely community based programme. The researcher spent a minimum of one week living on site to gather valid information. At this stage of pilot testing the instrument, the intention of reporting the research results was not to make a conclusive comparison of the different types of facilities, but to determine if the indicators were feasible to measure and valid. The ordered ranking of scores attained by the facilities, from no community component (48%), outreach only (57% and 62%), community and clinic based (78%) to only community based (88%), attests to the validity of the instrument. Generally, staff of the facilities were cooperative, and it was easy to find and verify evidence for the chosen indicators. There were only a few occasions where staff appeared reluctant to discuss sensitive matters involving finance. From this pilot testing experience the researcher recommends that the instrument be made available for general use in evaluating mission PHC services either at the self-study level or at zonal or national level through such organisations as CHAN.