The effect of incongruity on quality of health information systems : Bama, Nigeria PHC case study

Generally, organisations mobilise information from varying sources on which policies, plans, objectives and organisational management are predicated. indeed, everyone within organisation needs information to perform tasks, it is thus indispensable and its use so pervasive that a methodical approach for collection and processing is imperative. In health care organisations, involved with people and life, this is even of greater significance, in many instances allowable margin of error is narrow and can be devastating.Accurate and reliable information in clinical care for example cannot be compromised.On the other hand, adequate assessment of health services quality,effectiveness and efficiency depends on quality of information generated by the system, that is, accurate, relevant, timely, understandable and complete information. To achieve this, appropriate system design and operation is essential. Adoption of primary health care (PHC), in many developing countries in response to the Global 2000, necessitated establishment of chanisms for monitoring and evaluating effectiveness of services and programmes.Accordingly, in 1986 PHC was adopted in Nigeria, concomitantly, system monitoring and evaluation or the PHC Management Information System was effexted.The information system was envisaged to ameliorate the lack of reliable health information that has persisted since nception of modern health services in Nigeria. Findings in this and other studies indicate that existing health information systems have failed to provide accurate and reliable information, systems of data generation and processing are ineffective.The aim of this was to identify and understand factors that have contributed to the seemingly intractable and insalubrious information problem within the Nigerian health care system. It would be a herculean task for a lone researcher to undertake study of the entire health system, within resource and time limitations, data collection was therefore narrowed to the PHC level. Quality of the PHC management information system was assessed, with Bama Local Government as a case study. Focus was on understanding the information system's structure from a broad perspective to include, policies, objectives,established procedures; physical, material and human resources, in terms of their quality and quantity.Data collection was carried out using both qualitative and quantitative techniques. The structure, process and outcome models provided a framework for in-depth data collection, through observation, interview, review of records and administration of questionnaire, as well as for organisation and analysis of research data. The PHC MIS was followed through, from the village, health facility, local government, state and national levels.Study results suggest general ineffectiveness due to pervasive incongruity in the information system. In the first instance design of the MIS did not reflect information needs of community health workers and the community in general,who to the most part limited appreciation of the MIS structure, objectives to be achieved. Local and regional information need was not delineated, data collected had little relevance to local information needs, resource for systems operation was abysmal, skilled personnel and training provided severely inadequate.Consequently, data collection and processing was hampered, information produced often inaccurate, untimely, immense, irrelevant and unreliable. Data collected were neither analysed nor utilised. The information system was short of being integrated since 60% of functional units within the PHC department as well as related health organisations in the community ran parallel information systems.Research data point to serious incongruity in the organisation and management of the information system. Incongruity that resulted from factors within the organisation as well derived from events within the wider social environment, which however culminated in an effective and dysfunctional information system.Chapters one to three of the thesis deal with conceptual issues related to management information systems, organisational design and quality respectively. In chapter four methodological issues surrounding data collection were discussed. Empirical data and analysis are presented are presented in chapters five to seven. In chapter eight, an attempt was made to develop a model of organisational incongruity, applied to explicate research findings.Chapter nine focuses on measures toward establishment of an effective PHC information system in Nigeria, contributions of this study and suggestions for future research

Adolescents and Utilization of Family Planning Services in Rural Community of Nigeria

Adolescence is a critical stage in human development characterized by peer pressure, confusion, exuberance and experimentation particularly with sex, drugs and alcohol.  Hence, adolescent reproductive health is critical due to the gregarious sexual activities, which predispose young people to sexually transmitted diseases, unwanted pregnancies, unsafe abortion, and death. Adolescents in Nigeria constitute about a fifth of the national population, 12% have first childbirth before 15 years, most become parents before 20 years, and suffer from sexually transmitted infections (Federal Ministry of Health, 2003).  Objectives of the study were to determine family planning services available, and pattern of utilization among adolescents in a rural community of Akwa Ibom State, Nigeria; identify factors influencing utilization of services; and determine knowledge, and attitude of adolescents to family planning services. Four hundred (400) randomly selected adolescents completed a structured questionnaire, 277(69.75%) said family planning services were available. Sources of services were chemists 125(31.25%), pharmacy 74(18.50%) and hospital/health centre 184(46.00%); and  reasons  for  using a place were low cost 26%,  privacy  23.5%, proximity 22.75%, and 19.75% attitude of provider. Sources of information on family planning include radio 33.25%, health facility 24.75%, school 19%, peers 12.75%, church 8.5% and parents 6.5%. Interestingly, 58.25% said family planning was for both sexes, 67.5%, it was not for married people alone, and 91.5% said their religion was not against family planning.  Most, 68% were sexually active, 55.25% were not worried about unplanned pregnancy after unprotected sex, and 44.8% were not worried about HIV and sexually transmitted diseases, only 34.5% were using condom, yet 76.50% acknowledged condom could protect a woman from unwanted pregnancy, and 27% did not use any method.  Conclusion, family planning services were available but not well-utilized and rather worrisome most adolescents were not worried about unplanned pregnancy and consequences of unprotected sex. Keywords: Adolescent sexuality; family planning utilization among adolescents, rural adolescents and family planning.

Malaria in Under Five Children and Help Seeking Behavior of Mothers in Calabar, Nigeria

Malaria is a serious public health problem worldwide, yet preventable and treatable. However, in 2010 the disease killed an estimated 660, 000 people largely children under five years in sub-Saharan Africa; the Republic of Congo and Nigeria account for more than 40% of estimated global malaria deaths (WHO, 2013).  Federal Ministry of Health (FMOH) reports Nigeria accounts for one quarter of all malaria cases in Africa, one of the world’s highest rates of all cause -mortality for children under five, and about one in six children die before their fifth birthday (FMOH, 2012).  In Cross River State  under five mortality of 176 per 1000 births and infant mortality of 120 per 1000 births, placing Cross River among those with the highest child deaths in the country( State Ministry of Health, 2010), and  malaria prevalence of 19.8% (National Population Commission, 2009). Hence, the malaria control targets include 100% children under five years and pregnant women to use mosquito nets by 2015 (Community Health Department, 2013). Objective of the study was to determine help seeking behavior of mothers with children less than five years, and factors that influenced behavior. We randomly selected six primary health facilities out of 41, and administered a structured questionnaire to four hundred (400) women who brought their sick children to outpatient department of selected health facilities, and gave oral informed consent.  State Ministry of Health gave ethical clearance for access to community and health facilities. Most, 370 (93%) respondents completed the questionnaire, 37% were married, 50% had primary education, 26% secondary, and 10% tertiary,  42% were homemakers, 31% 19 -23 years, and 54% of children were within one year.   Many respondents 46% brought babies to health facility due to fever, and 32.4% said child had fever for over a week, yet 39.0% gave fever as symptom of malaria and 39.4% mosquito bite. Most 96% had heard of malaria largely from electronic media 40.5% and parents 32.4%.  However, despite knowledge about malaria, 35% gave tepid sponging, 31% herbal enema, 27% gave baby left over drugs; 40% said treatment  at home lasted 4 to 6 days and 12% more than a week. Home intervention led to child’s illness worsening 40%, and improved 38%. Respondents delayed taking children to hospital because they had no time 35.1%, husband was not at home 30%, had no money 22.7%, had no transport 6.2% and customary to first treat at home 6.0%. Furthermore, 52.4% said hospital was too far from residence and 14.0% no hospital in locality, 64.5% said father was responsible for child’s treatment. Cost of care 47.5%, transportation 32.7%, waiting time 10.0% and lack of time 9.2% were major factors affecting help seeking. This study shows that significant relationship exists between mother’s health seeking behavior and outcome of child’s illness. Further, suggests as global and national efforts continue, the role of fathers in reducing morbidity and mortality among infants requires considerable attention, particularly in patriarchal traditional societies, where mothers depend on decisions of husbands to seek help for the child. Key words: Malaria, Children and Malaria, Help Seeking Behavior of Mothers

Health Security in Africa and Quality of Health Services

National security and development are inextricable and depend largely on health security that strengthens general health of citizens and productive capacity.  Health security reflects quality of governance and commitment of policy makers, and health managers to quality of services.  Improving the seemingly intractable poor health situation and fostering health security in Africa require attention to the quality of services at every level. This paper examines health situation in Africa, the concept of quality in health care and efforts toward advancing quality of health services since primary health care.  It then provides strategies for establishing national health care quality program in order to advance health security in Africa. Keywords: Quality in Health, Health Security in Africa, National Policy on Quality Health Care, National Health Quality Program

Emergency Contraceptive Use among Female Undergraduate Students at the University of Calabar, Calabar, Nigeria

About 42 million abortions take place annually worldwide with almost 20 million of them unsafe and responsible for 70,000 maternal deaths. Young undergraduate women are especially vulnerable with risky sexual behaviours which lead to unwanted pregnancies, abortions and sexually transmitted infections including HIV/AIDS. Cross River State of which Calabar is the capital, has one of the highest HIV prevalence (7.1%) in Nigeria. The purpose of this study was to determine the knowledge and practice of emergency contraception by female undergraduate students of the University of Calabar. A cross sectional descriptive survey design was used to study 400 full time fourth year female undergraduate students randomly selected from 30 departments at University of Calabar. A semi-structured self-administered questionnaire was used for data collection. Data were analysed using statistical packages for the social sciences version 16.0. The research protocol was approved by the Ethical Review Committee of the Cross River State Ministry of Health. Most of the respondents (69.9%) knew what emergency contraceptive pills (ECPs) were used for, but specific knowledge on timing (51.7%) and dosage (39.1%) were lower. With almost 70% sexually active, single, young people, condom use was 59.8% and ECP use was very low (31%). The commonest reasons for ECP non-use were lack of awareness (42%) and fear of side effects (34.2%).  Reproductive health education including ECP awareness and HIV/AIDS prevention should be part of the general studies course. Peer-to-peer health education should be encouraged at the University Medical Center. Keywords: Emergency contraception, abortions, reproductive health, peer-to-peer communication, client-centere

The effect of incongruity on quality of health information systems : Bama, Nigeria PHC case study

Generally, organisations mobilise information from varying sources on which policies, plans, objectives and organisational management are predicated. indeed, everyone within organisation needs information to perform tasks, it is thus indispensable and its use so pervasive that a methodical approach for collection and processing is imperative. In health care organisations, involved with people and life, this is even of greater significance, in many instances allowable margin of error is narrow and can be devastating.Accurate and reliable information in clinical care for example cannot be compromised.On the other hand, adequate assessment of health services quality,effectiveness and efficiency depends on quality of information generated by the system, that is, accurate, relevant, timely, understandable and complete information. To achieve this, appropriate system design and operation is essential. Adoption of primary health care (PHC), in many developing countries in response to the Global 2000, necessitated establishment of chanisms for monitoring and evaluating effectiveness of services and programmes.Accordingly, in 1986 PHC was adopted in Nigeria, concomitantly, system monitoring and evaluation or the PHC Management Information System was effexted.The information system was envisaged to ameliorate the lack of reliable health information that has persisted since nception of modern health services in Nigeria. Findings in this and other studies indicate that existing health information systems have failed to provide accurate and reliable information, systems of data generation and processing are ineffective.The aim of this was to identify and understand factors that have contributed to the seemingly intractable and insalubrious information problem within the Nigerian health care system. It would be a herculean task for a lone researcher to undertake study of the entire health system, within resource and time limitations, data collection was therefore narrowed to the PHC level. Quality of the PHC management information system was assessed, with Bama Local Government as a case study. Focus was on understanding the information system's structure from a broad perspective to include, policies, objectives,established procedures; physical, material and human resources, in terms of their quality and quantity.Data collection was carried out using both qualitative and quantitative techniques. The structure, process and outcome models provided a framework for in-depth data collection, through observation, interview, review of records and administration of questionnaire, as well as for organisation and analysis of research data. The PHC MIS was followed through, from the village, health facility, local government, state and national levels.Study results suggest general ineffectiveness due to pervasive incongruity in the information system. In the first instance design of the MIS did not reflect information needs of community health workers and the community in general,who to the most part limited appreciation of the MIS structure, objectives to be achieved. Local and regional information need was not delineated, data collected had little relevance to local information needs, resource for systems operation was abysmal, skilled personnel and training provided severely inadequate.Consequently, data collection and processing was hampered, information produced often inaccurate, untimely, immense, irrelevant and unreliable. Data collected were neither analysed nor utilised. The information system was short of being integrated since 60% of functional units within the PHC department as well as related health organisations in the community ran parallel information systems.Research data point to serious incongruity in the organisation and management of the information system. Incongruity that resulted from factors within the organisation as well derived from events within the wider social environment, which however culminated in an effective and dysfunctional information system.Chapters one to three of the thesis deal with conceptual issues related to management information systems, organisational design and quality respectively. In chapter four methodological issues surrounding data collection were discussed. Empirical data and analysis are presented are presented in chapters five to seven. In chapter eight, an attempt was made to develop a model of organisational incongruity, applied to explicate research findings.Chapter nine focuses on measures toward establishment of an effective PHC information system in Nigeria, contributions of this study and suggestions for future research