CHAPTER ONE

INTRODUCTION

1.1 Background Of Study

In poor and middle-income nations like Nigeria, children and women account for three-quarters of the population. They are also the most vulnerable and environmentally conscious. As a result, children bear a disproportionate amount of the global disease burden. 1 Although significant progress was made in the previous decade in terms of reducing childhood health indicators, several countries suffered stasis or even reversals during the 1990s. 1 Low usage of high-quality health services is one of the explanations offered. Another explanation is that, in these emerging countries, the concept of quality has received less attention, owing to economic collapse, political instability, and emigration of health professionals, among other issues. Many international organizations, including the United Nations Children's Fund (UNICEF), the World Health Organization (WHO), and the Rockefeller Foundation, have expressed interest in developing programs to address these extremely low health indicators. Integrated techniques (Primary Health Care, Integrated Management of Childhood Illnesses), selective parallel programs (Child Survival Strategies), and development programs have all been used to build these intervention programs. These international bodies' most recent pledges were made during the Millennium Summit in September 2000, which resulted in the Millennium Declaration and, later, the Millennium Development Goals (MDGs). This topic was also addressed at the UN General Assembly's Special Session on Children in May 2002, with the outcome document "A World Fit for Children." These two compacts work together to develop a strategy – a Millennium agenda – for safeguarding childhood in the early years of the twenty-first century.

Representatives from 189 countries, including 147 heads of state and government, assembled at the United Nations for the Millennium Summit in the year 2000. The Millennium Development Goals were accepted as a set of objectives (MDGs). The lives of people all across the world will be transformed if these goals are met by the deadline of 2015. The MDGs are made up of eight goals, 18 targets, and 48 indicators, three of which are directly related to health (goals, targets, and indicators). The fourth Millennium Development Goal focuses on reducing child mortality. The major goal of MDG 4 is to cut under-five mortality rates (U5MR) in half between 1990 and 2015. Under-five mortality rates (U5MR), infant mortality rates (IMR), and the proportion of one-year-old infants inoculated against measles are the indicators numbers 13,14, and 15.The U5MR and IMR indices include immunization against common childhood diseases, maternal nutrition and health awareness, and the availability of maternal and child health services within a five-kilometer or 30-minute walk. These youngsters are the foundation of the nation's human resource development, and it is only ideal that society provide a supporting and enabling atmosphere for them to achieve their intrinsic talents to their full potential. This study evaluates the quality of child health care provided by primary health care facilities in the LGA as a means of assessing progress toward MDG 4.

1.2 Statement Of Problem

High rates of mortality among children under the age of five and infants continue to exist. These needless deaths suggest a substantial failure of essential services in the country, particularly primary health care. As a result, coverage and use of these therapies are both poor. Nigeria's health scenario makes it a critical sector in achieving MDG 4 globally. Achieving MDG 4 necessitates addressing issues such as low immunization coverage, insufficient provision of clean and potable water, and a lack of infrastructure in rural regions, such as good roads and transit. Other issues to address include the lack of basic obstetric and neonatal care in most health institutions, mothers' low levels of education, and the unwholesome sale of outdated medications in rural areas and urban slums. It is also required to increase government political will, as the health budget still accounts for around 5% of the national budget.

The effectiveness and efficiency with which available resources were used to generate an effective and efficient outcome are reflected in the quality of care. However, in most poor nations, there has been little research on assessing the quality of primary health care. When it comes to the quality of children's health services, the figure drops even more. Formal systems to measure the quality of care in Nigeria's health system have yet to be developed. The majority of PHC program evaluations have focused on coverage. Only a small amount of time is spent evaluating the quality of service given. An evaluation of the health service's quality will reveal its value and is undoubtedly a step in determining its effectiveness and, ultimately, the achievement of the MDG-4.

1.3 Objective Of Study

The following are primary objectives of this study:

1. To determine the availability of child health services in PHC facilities in Nnewi North LGA, Anambra state.

2. To examine the health resources (human, material, and financial) available for the provision of child health services in PHC facilities in Nnewi North LGA, Anambra state.

3. To examine if quality supervision is carried out on child health services in PHC facilities

1.4 Research Question

The following research question guides this study:

1.     Are there adequate availability of child health services in PHC facilities in Nnewi North LGA, Anambra state?

2.     Is there adequate provision of health resources (human, material, and financial) for the provision of child health services in PHC facilities in Nnewi North LGA, Anambra state?

3.     Is quality supervision carried out on child health services in PHC facilities?

1.5 Significance Of Study

This study will be of significance to the government as it ensures that services rendered at PHC are up to standard and to implement policies that would enhance their service quality and readiness should be channeled. The government should also reevaluate the state of services delivered in rural healthcare facilities with a view to reequipping them with necessary drugs and medical equipment. This study will further add to the existing literature on this study domain and as well serve as a reference material for scholars, researchers, and students who may want to carry out further research on this topic or related area in the future.

1.6 Scope Of Study

This study focuses on assessing the quality of child health services in the public primary health care facilities in Nigeria. The study will also delve into determining  the availability of child health services in PHC facilities in Nnewi North LGA, Anambra state, examining the health resources (human, material, and financial) available for the provision of child health services in PHC facilities in Nnewi North LGA, Anambra state. And if quality supervision is carried out on child health services in PHC facilities.  The study therefore is delimited to Edoji Community Health Centre (age grade)  and  Okpuno-otolo health centre Nnewi.

1.7 Limitation Of Study

Finance, inadequate materials and time constraint were the challenges the researchers encountered during the course of the study.

1.8 Definition Of Terms

Child Health Services: Child Health Service is defined as the medical services that are provided by the medical health professionals to the children having disease or infection. These services are funded by different health organizations.

Public Health Care Facilities: Public health system across nations is a conglomeration of all organized activities that prevent disease, prolong life and promote health and efficiency of its people.

CHAPTER TWO

REVIEW OF LITERATURE

2.0 INTRODUCTION

Our focus in this chapter is to critically examine relevant literature that would assist in explaining the research problem and furthermore recognize the efforts of scholars who had previously contributed immensely to similar research. The chapter intends to deepen the understanding of the study and close the perceived gaps.

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