Establishing A Sustainable Ward Health System In Nigeria: Are Key Implementers Well Informed?

Abstract

In response to World Health Organisation recommendation that " community mobilization would greatly be assisted if the boundaries of the health district are the same as the electoral ward which elects a councilor to the LGA " , the Federal Government of Nigeria re-vitalized the National Primary Health Care Development Agency (NPHCDA) and introduced the Ward Health Service (WHS) system in the Year 2000. This study identified one of the major reasons why the WHS was still not well established. Objective: The objective was to determine and document gaps in the knowledge of the key implementors on WHS. Methodology: A self-administered multiple choice questionnaire was administered to a total of 955 participants including 200 Primary Health Care Coordinators and 200 Zonal Technical Officers (ZTOs) of the NPHCDA in the 6 health zones of the country, 255 final year medical students of the College of Medicine, University of Lagos and 300 Community Development Committee/Association members. Five years after, the same instrument was administered to139 Primary Health Care providers of Lagos State. Result: The medical students were the most informed, 76.5% scoring above the cut-off mark of 50% but only 9.8% above 70%. Of the Medical/Community Health Officers, ZTOs (75.5%) were better informed than the PHC Coordinators (72.3%). Community leaders were the least informed; none of them having adequate knowledge about the WHS and therefore all scoring below the cut-off mark. Conclusion: Inadequate stakeholder mobilization remains a major problem of Nigeria's primary health care system. For effectiveness and sustainability, rigorous effort directed to this is urgently needed.