TABLE OF CONTENTS
Title
page i
Certification iii
Dedication iv
Acknowledgement v
Table
of content vii
List
pf plates x
List
of figure xi
List
of table xii
Abstract xiii
CHAPTER ONE
1.1 Introduction 1
1.2 Statement of
the problem 3
1.3 Aims and
objectives 5
1.4 Objective of
the study 6
1.5 Hypothesis 8
1.6 Study area 9
CHAPTER TWO
2.1
Introduction 17
2.2 Literature
review 18
2.3 Theoretical
framework 25
CHAPTER THREE
3.1 Type and
sources of data 30
3.1a Primary
Sources of data 30
3.1b Secondary
Source of data 30
3.2 Method of
collection 31
3.3 Method of
analysis 31
3.4 Method of
presentation 32
3.5 Limitation of
study 32
CHAPTER FOUR
4.1 Data analysis 34
4.2 Hypothesis one 34
4.3 Hypothesis two 37
4.4 Level of
satisfaction with the condition
of
health care facilities 39
CHAPTER FIVE
5.1 Summary 66
5.2 Recommendation 68
5.3 Conclusion 70
References 74
Questionnaire 77
LIST OF PLATES
Plate 4.1 Shows Patron at Eguare Pry Health care,
Irrua
Plate 4.2 Shows Patron at Zuma
memorial Hospital Irrua
Plate 4.3 Shows Patron at Irrua specialist
Hospital Irrua
Plate 4.4 Shows Patron at Eguare
Primary Health care Ewu
Plate 4.5 Show Primary health
care Eko-Ewu
Plate 4.6 Shows Eguare Primary
health care Opoji
Plate 4.7 Shows Primary health
care Ugbegun
LIST OF FIGURES
Fig
1.1 Map of Edo State showing the area of study
Fig
1.2 Map of Esan Central showing the case study
Fig 4.1 Rating of services rendered at
the health care centre
Fig 4.2 Number of health care found in
each clan
Fig 4.3 Types of health care found in
Esan Central
Fig 4.4 Size of health care facilities
Esan Central
Fig 4.5 Level of accessibility
LIST
OF TABLE
Table 1.1 The distributed and
retrieved questionnaire
Table 3.1 Types of health care
facilities
Table 4.1 Distance travelled
Table 4.2 Distance travel of
observed & expected frequency
Table 4.3 The relationship
between population of clan and patronage
Table 4.4 The relationship
between population and observed frequency of the observed & expected
Table 4.5 Rating of service
rendered at the health care facilities centre
Table 4.6 Number of health care
found in each clans
Table 4.7 Type of health care
facility
Table 4.8 Size of health care
facility
Table 4.9 Level of accessibility
Table 4.10 Level of equipness
Table 4.11 Means of
transportation
Table 4.12 Social attitude
Table 4.13 Cost of treatment
Table 4.14 Other factors
affecting patronage.
ABSTRACT
This
is a research essay work on the patronage pattern of health care facilities, it
talks about the location of some these health centres, how the inhabitants of
areas patronize the hospitals. An attempt was also made to know the factors
responsible for the variation in patronage of the health centres.
In
Esan Central Local Government area, which is this case study, an insight field
work was made to known the location of these centres whether, it is centrally
or not centrally located. Factors behind such location, their distribution,
types of health care centres whether private or public in their respective
locations. Also discussed in this essay were the various sources for data,
methods and problems encountered in gathering this data. After the research,
the researcher then comes out with these findings which are distance, high
population and level of health sensitization. As a factors influencing the
patronage Based on finding, some recommendations where made.
CHAPTER ONE
1.1
INTRODUCTION
A
healthy nation is a wealthy nation. The rural population exhibits a greater of
number of infrastructural problems that tend to be more adverse. This is
obviously associated with the poor health facilities, quality and quantity of
infrastructural facilities, services in the rural areas and is undoubtedly
associated with individual low income and healthy care problems. Poor
infrastructural provision of a good health care facilities leads to high
mobility rate. Most of there members of the society are also denied basic
amenity such as good health care facilities. However, any single measure is not
enough to reveal the complete state of poor conditions of these health
facilities. There is no gain saying the fact that infrastructure is vital in a
community. The health of the inhabitants of any nation is fundamental to the
present and future development of that country.
From
the above facts, most developing countries have devotes a substantial amount of
totality concerned towards the expansion of health care facilities. This is
usually a planned expansion designed to obtain the maximum return from a
limited investment, this planned process.
The
real output of this is an emphasis on projection expansion for example, the
total number of health facilities, the number of doctors and auxiliary medical
personal’s and ration. But within the most efficient aggregate pattern of
health provision, there exist the possibility for considerable variation in
spatial pattern of expansion and patronage pattern within any nation, for
example over 70% of health care facilities in most developing countries like Nigeria
is concentrated in the urban centres where less than 20% of the total
population live ONOKERHOYE (1978).
1.2
STATEMENT
OF RESEARCH PROBLEM
In
spite of the federal government and all the states and local government council
laudable plans of solving the problem of health care facilities in the country
at any particular time, the few available health care facilities are within the
reach of not even only those urban area in all parts of the country.
There
came up a number of problems, one of such problems is the distance people are
willing to travel in order to be able to utilize these facilities available at
different types of health centres, the patronage pattern of this health
centres. Available research showed that users may not be prepared to go beyond
their limit to attend a particular health centres for example in 1974, it was
noticed that in some parts of the former western states of Nigeria, the critical
distance limit for a dispensary is between 5km and 8km for hospital it goes
beyond 32km Adejuyigbe (1974).
In
view of the situation described in the proceeding paragraph, their necessity to
ensure that the different types of health centre should be established in a
country in future are located in such a way as to achieve maximum utilization
by the population.
In
Irrua the headquarters of Esan Central local government area, there is
considerable variation in patronage pattern of health centre one would see
along this research. This patronage pattern of health care facilities in other
words. Known as distance and if distance was the only factor affecting
attendance at the institution, the suggestion in the foregoing paragraph would
be easily implemented through simple mathematical calculations.
But
attendance of health centre is also greatly affected by social attitude. A
person may choose to walk along distance to attend a relation health centre
rather than attending the one closer to him/her.
The
implication of this is that, if health care facilities are to be properly
utilized their location ought to take account of such social attitude, that is
should located to coincide with movement zone of the people they are expected
to serve.
The
spatial distribution of this health care facilities affects their patronage
patter, it is assumed that the main reason for the provision of certain service
by the public authorities in an local government area to be make sure that no
person should be deprived of the access to such facilities become of the
geographical location or lack of finance.
The
spatial aspect of medical care facilities must receive adequate attention in
health planning of Esan Central local government area.
1.3
AIM
AND OBJECTIVES
a. To
examining the distribution of the already existing health care facilities in
relation to the population in different parts of the entire Esan Central local
government areas.
b. To
identify the spatial and social constraints affecting the patronage of health
care facilities in the areas.
c. To suggest a distribution of health care
units which will take into account the existing movement pattern and the
critical distance people are prepared to travel to enjoy these facilities.
1.4
AIMS
AND OBJECTIVES OF STUDY
Would
be easily implemented through simple mathematical calculations.
But attendance or patronage pattern of
health care centre is also greatly affected by social attitude. A person may
choose to walk a long distance to attend a relation health care centre rather
than attending the one closer to him/her.
The implication of this is that, if
health care facilities are to be properly utilized, their location ought to
take account of such social attitude, that is should located to coincide with
movement zone of the people they are expected to serve.
The spatial distribution of this health
care facilities affects their patronage pattern, it is assumed that the main
reason for provision of certain service by the public authorities in an local
government area to make sure that no person should be deprived of the access to
such facilities because of the geographical location or lack of finance. The
spatial aspect of medical care facilities must receive adequate attention in
health planning of Irrua the headquarter of Esan Central Local government area.
The
aims around which the essay centred on are:
a. To
examine the distribution of the already existing health care delivery
facilities in relation to the population in different parts of the areas.
b. To
identify the spatial and social constraints affecting the patronage of health
care facilities in the areas.
c. To suggest a distribution of health care
units which will take into account the existing movement pattern and the
critical distance people are prepared to travel to enjoy these facilities
1.5 HYPOTHESES
The hypotheses are as follows:
Ho: That patronage pattern of health
care facilities does not decrease with distance.
Hi: That patronage pattern of health
care facilities decreases with distance.
Ho: That
there is no relationship between the population of a clan, harmlet community and
the number of patients patronized health care facility centre.
Hi: That
there is relationship between the population of a clan harmlet community and
the number of patients patronized the health care facility centres.
1.6 STUDY AREA
Esan central Local Government Area is
located in Edo State. It was curved out from the former
Okpebholo local government in the defunct Bendel
State of Nigeria. Esan central local
government area is located within latitude 8035E and 8030N
and longitude 8021E and 8035E (2006
census). The area has estimated area coverage of about 33.2kmsq.
Esan Central local government area is
one of the 5 senatorial district in Edo
State. Esan central local
government area has a common boundary with Etsako West and South by Esan West
local government. It is also bounded in the east by two local government which
are Esan North East and Igueben local government.
Esan central local government with
headquarters of Irrua is located in East plateau under lain by the lignite
group of rocks consisting of clay, fine grained sand and carbonaceous shaky
clay. Most part of the relief in this region have an elevation of between 356
and 400 metre above sea level. There is no significant river in the areas
though the Ugbalo water scheme was constructed. But there are number of streams
following radically to river Osse in Agbede. Esan as a case study is endowed with
a lake popularly called Agua-lake.
The terrain is relatively plain, this
probably contributed to the number of large settlements like Esan Central (the
administrative headquarters) Ewu, Opoji and Ugbegun amongst others.
The local government has a total number
of four settlements. These are Ewu, Opoji, Ugbegun and Irrua. Esan central
local government belong to the region which experience the humid tropical
climate characterized with wet and dry season. The dry season which last
between November and March usually coincide with the period of low sun while
the wet season lasts between April and October which also coincide with the
period of high sun.
The common vegetation of these area is
the most deciduous forest which is very rich in timber resources.
According to Adejuwon (1971) in western Nigeria,
evidence of savannah patchers abound in this vegetation belt. This could be the
direct effects of traditional methods of farming which are the rotational type
and the bush fallow system of excessive cultivation of land. When abandoned, it
is normally covered by grasses and subsequently gives rise to a new type of
vegetation known as the derived savannah.
The cover formed by the vegetation is
more open than in the rainforest region, characterized with tropical hardwood, like
timber, Iroko, Obeche, Agber Walnut Mahogany while industrial and food crops find
in this area include the following: palm fruits, rubber maize, yam cassava,
cocoyam, plantain and other varieties of local fruits.
This
forest product, are the basis of raw materials for the industries in the area
(traditional industries).
An agriculture and industries product is
a major source of living of the people. Apart from the flour mill at Ewu and
pure water company, variety of small and medium scale industries abound in the
study area. Unlike the urban centre, there are predominantly agro-based
industries such as rice and cassava processing mills.
The spatial distribution of roads in the
study area is poor, coupled with a low density of road work for instance; Esan
central has about five major roads linking the major settlements. These roads
are Benin-Auchi road which is a federal road, cut across two major settlements,
in Esan central that is Irrua and Ewu. The other roads are the Irrua Atuagbo
road which cut across settlement like Eidenu, Ibore, Ugbalo, and Ujabhole.
Others are Usugbenu Igueben road via Ugbegun and Irrua-Opoji road.
Some of these roads are tarred which
makes it motorable all through the year. Among those that are not motorable all
the year round is the Usugbenu Ugbegun road which is presently under
construction under the Government of Aliyu Adam Oshiomole. This inaccessibility
is especially for the transportation of agricultural products produced in these
areas, thereby reducing the level of interaction. Some of these roads are too
bad because the old age are prone to erosion attack which makes it to be easily
washed away.
Considering the size of the entire
region understudy, Esan central (i.e. Irrua) is the only urban area compared to
others, this can be attributed to its function as an administrative centre and
the presence of such social amenities like electricity, telephone, post office,
court, hospitals, police station and a particular single bank. As a result of
the facilities present in this area, movement of both intra and inter regional
activities are attached to this area of study.
From the above description of the area
of study, it could be seen that both the physical and human factor including
political, social attributes, not centrally locating of any health care
facility in Esan Central local government area are likely to affect the
patronage pattern of health care facilities.
CHAPTER TWO
LITERATURE
REVIEW AND THEORETICAL FRAMEWORK
2.1
INTRODUCTION
The
health care facilities in Nigeria
occupied a considerable and important position in line of rural infrastructure
facilities provision by the first national development plan, the aims of the
health care industry in Nigeria
is as follows.
i. Expansion
of hospitals services commensurable with the ability of the economy to sustain
than and this include amongst stipulated rules given by the united nation (UN)
“Health for all by the year 2000 AD”
ii. The
improvement of accessibility to all health care services centres.
iii. The cost of medicals treatment given to
patients and the maximization of effective medical health service to all
citizens, based on the above blue print provide by the Federal and State
Government of Nigeria, placed emphasis on the provision of hospitals and
primary health care in walking distance.
Attitude
of some health workers are placed among other things affecting the patronage pattern
of health care facilities applicably in Esan Central L.G.A health care centres.
2.2
LITERATURE
REVIEW
In
the developed, developing and under developed nation of the world the role of
health care facilities cannot be undermined based on the fact that various
scholars have generated a growing body literature in the location, distribution
and patronage of health care facilities. It is on this ground that the national
health policy is worthy of definition.
According
to the 56th world health Assembly of 1993, National Health policy
was defined as an expression of goals, for improving the health situation, the
priorities among this goals, and the main direction for attaining them” are
matter of priority is national health care system. That is to bring health care
delivery services nearer to the populace wherever they may be by the year,
2000.
World
health organisation on the other hand to defined as “any combination of
information and education activities leading to situation where the people went
to be healthy, how to obtain good health individually and collectively to
maintain health and seek help when necessary”. Therefore, the importance of
health education in rural area like Esan Central local government will enhance
the awareness of the inhabitants and aid them in achieving the health
programmes designed for such purpose.
One
of such contribution is the one made by geographers and regional planners about
distance as a major determinant of the intensity of relationship between
different set of phenomena distributed in space. As a general principle, it has
been stated that the greater the distance between two points, the lower is the
probability that those points will be functionally related Revenstein (1989).
This principle can also be apply health
service in Esan central local government as the further the health service from
the home of patients, the lesser the patronage people will give to such health
centre. In this case, distance affects patronage pattern. According to Okafor
(1984) S.I Omofonmwan and M.A. Kadiri (2006), the major barrier reducing
patronage pattern of health care facility are distance, between client and the
provider and the time at the health centre. In this, Adejuyigbe (1974) opined
that the critical distances which a patients are ready to travel for services
rendered are primary health service is 5km and 8km but for the hospital the
distance goes beyond 32km. Due to the frustration received by patient from
government hospitals, there has been an urgent needs, by patients to patronize
private hospitals or health care services which has mitigated the burden of
both the state and federal government, it has also helped the government to
improve and intensity preventing medical services to both urban and rural
populace.
The problem of health care facilities
location in Nigeria that is where and how medical facilities are located and
patronage received by such centres in very important in this literature. The
work of Mumphery and Wolperx (1973) on the location of medical facilities,
centred on the minimum distance a patient has to travel to receive treatment,
based on the attractiveness of the hospital site. Smith (1977) emphasized the
effect of distance upon a patient ability to stay out of hospital once discharged.
Similarly, S.I. Omofonmwan and M.A.
Kadiri (2006) opines that the factors influencing the location of
socio-economic facilities like health care facility are distance, proprietor’s
interest, community of interest, quality of services and accessibility.
Furthermore, Onokerhoraye (1976)
revealed also that social economic factor effects the geographical distribution
of medical care within the major urban centres in Nigeria. A traditional city such as
Benin and Ibadan, it is found out that similar socio-economic
factor contributed to the concentration of most health facilities in the newly
built up residential areas. When most of the middle and upper income household
are living.
While
the indigenous residential neighbourhood, characterized by poor housing quality
and low income facilities attract few people to its medical facilities. Much has
also been said to the quality and quantity of care given and the attitude of
physicians and paramedical personnel’s to ward patients.
Bloom
(1963) emphasized the importance of the attitude of physicians and paramedical
personnel’s toward patient will make service attractive to them. And this will
affect the patronage pattern.
One
noticeable problem in our hospitals today is that, some patients are usually
attend to on the basis of whom they are or their position in the society and
this connection with the medical personnel and not first come first serve.
The patronage received from patient to
any health care centre is dependent on the number of factors such as attitude
of the health worker, patients distance from the health care centre and the
amount change for treatment which varies him one health centre to another
health and populace journal volume II (1995).
With
person interview held with some respondent officials of health workers in
regard to be research problem, in (1999) it was agreed to that patronage
pattern of health care centres varies from one hospital or health care centres
to another, and this health centres are uneven distributed in the study area.
It
is therefore, of importance to state here that having review the literature,
one thing become paramount that is distance as a major barrier or factor that
is affecting the patronage needs to be properly taken into consideration when
planned on the way to establish their social amenities.
It is the above fact that Adejuyigbe
(1977) opined that the various health care delivery unit to be established in
the country in the future should be located in such a way to achieve optimal
utilization by the population.
2.3
THEORETICAL
FRAMEWORK
Nigeria
is today confronted with numerous health problems. Some of these relate to the
survival existence and spread of severed diseases within our environments,
while some relate to the perceptions and behaviours of our people regarding
various levels of their environments and their sanitation standards. It is
against this background there is an ever growing demand for medical services in
Nigeria.
To
have a functionally and efficient health care facility, there should be a
theoretical prove to it location. The first among the theories that I employed
in course of this research work is gravity model.
These
idea is drawn from Isaac Newton’s law of universal gravitation 1687, and it has
been used by E.G. Ravenstein 1985 do analyze patronage. And the law states
that, two bodies in the universe attract each other in proportion to the
product of the masses and inversely as the square of their distance.
In
gravity model, mass is equated with population size and these suggest two
relationships.
i. That
as the population of one or two town increase. So does the patronage pattern
between them.
ii. The
further the distance between the towns, the less, the patronage pattern of
health care facility.
Applying
gravity model to patronage pattern of health care facility shows that
interaction has a regularity which can be analyzed. In other words, the
interaction between two places is dependent on the population of the area and
the distance between them. However, this interaction result if there is complementarity’s,
transferability and lack of intervening opportunity.
2.3.1 The
second model that is be employed in this research work is the central place by
Christaller (1933). According to this theory, service centres exist to fill
basic human desire needs and services. Since all people desire goods and services
which they cannot produce e.g. Medical health facility, it is imperative to
find where such goods and services can therefore be exchanged. The centred
place theory emphasis two basic concepts which sustain the viability of the
facilities such as health care centres; there is the upper and lower range
concept.
The
lower range concept which Christeller called the threshold population is the
minimum of population that justifies the allocation of scarce financial and
personnel resources to the establishment of the health centre. Below that
level, the health centre will quote below accepted efficiency. The threshold
population for an health centre ascertained by relating to the overall
population to be located (ONOKERHORAYE 1976).
The
second basic concept of central place theory is the range concept term e.g.
“The range of goods”. This is the distance which the people are willing to
travel to reach the service (market range of service activity) it is the outer
limit of the market area for the service activity beyond which people will trek
for another centre (Gladson 1978).
2.3.2 The
last model is that fit into this work is the distance decay concept by Efi
(1946). This concept involves the tendency towards decreasing intensity or
human activity as distance from a given point increase. It is a common
knowledge that longer distance generally imposes heavier cost (in terms of
energy, time or money) than shorter distance do. Therefore distance
minimization in a natural tendency of every rational individual in the process
of meeting his needs across space, for example people independent to make use
of facilities in a place tend to live as close as possible to the facilities
work place, market, school. Hence, population are more concentrated in towns
where there facilities and institutions are mainly found conclusively as
distance from the town centre on health centre. Increase the density of
population patronizing the health centre decrease, very little or no more of
the centre oriented activities are found.
CHAPTER THREE
3.1 TYPES AND SOURCES OF DATA
The
data used for this research work were gotten from the following source personal
communication with the respondents, questionnaire distribution to get information,
some data were also collected from already compiled document of establishment
such as the department of health in Esan Central local government.
3.1a Primary
sources of data are raw data or first hand data that has not be used by any
researcher. They are personal communication with respondents the distribution
of questionnaires and ground troth. Primary data are important than the
secondary data.
3.1b Secondary
sources of data relate to the already existing information that have undergone
processing.
Secondary
data could be stereotype in nature. They are already used data that are gotten
from the following sources e.g. population, police, tax office, Hospital
records, textbook ministry record, the Internet, Revenue record Newspapers,
map, and Aerial photography.
3.2
METHOD
OF DATA COLLECTION
Esan
central local government is a town with so many villages for I to have a
justified data pertaining to my research work I decided to use the following
methods of data collection e.g. Distribution of questionnaire at the different
villages and clans personal observation and communication with the respondents.
3.3
METHOD
OF ANALYSIS
I
employed inferential statistic and descriptive statistic in my mode of
analysis. The hypothesis earlier stated was tested with chi-square to know
whether to accept or reject it. Apart from chi-square statistical table was
also used. The hypothesis earlier stated which and distance travelled and
population of a clans. Life is full of choices. The propensity of patrons to
any of the health care facilities centre in Esan Central local Government is the
bases of this research work.
The
two hypotheses earlier stated which are the distance travelled and population of
clans. Premised on these, the data collected in each of the clans is going to be
analyzed and tested to know how factual or not a distance as a determining
factor of patronage to health facilities in Esan Central local Government.
3.4
METHOD
OF PRESENTATION
Is
good to present a work in a form that is to give a factual description of the
tended resulted at one sight. Hence the following statistical methods will be
used e.g. Histogram, Bar Chart, Pie charts and linear graph.
3.5
LIMITATION
OF STUDY
Life
undulates. Esan Central Local Government is more of the linear and scattered
settlement. Base on these undisputable facts, the problem of transition from
one village to another as then in lack of good roads network and vehicles cost
me some impresumed delay and stress.
Not
only these limitations I encountered. As a matter of fact, most of the rural
dwellers are illiterate. These hamper free flow of communication in my process
of administering questionnaires.
Because
some of them are still timid and unsocialized they refused to give me their
audience.
CHAPTER FOUR
4.1
DATA
ANLYSIS
Life
is full of choices. The propensity of patronage to any health care facilities
centres in Esan Central local government in the basis of this research work.
In
this chapter the collected data will be analyzed so as to enable the research
to test the hypothesis earlier stated to determine its acceptance or rejection.
TABLE 4.1 DISTANCES
TRAVELLED
|
Distance
in km
|
Observed
frequency
|
|
0-1km
|
56
|
|
1-2km
|
39
|
|
2km-3km
|
34
|
|
3km-Above
|
25
|
Source:
Fieldwork 2012
4.2
HYPOTHESIS
ONE
Ho: This
states that, the patronage pattern of health care facilities in Esan Central
local Government area does not decrease with distant
Hi: This
states that, the patronage pattern of health care facilities in Esan Central
decrease with distance
Table
4.2 Distance travelled
|
Distance in
km
|
Observed
frequency
|
Expected
frequency
|
|
0-1km
|
50
|
37
|
|
1-2km
|
39
|
37
|
|
2-3km
|
34
|
37
|
|
3km-Above
|
25
|
37
|
|
Total
|
148
|
37
|
Source:
Fieldwork, 2012
Chi-square
formula: (O-E)2
E
= (50-37)2
+ (39-37)2 + (34-37)2 + (25-37)2
37 37 37 37
= 169 + 4 +
9 + 144
37 37
37 37
=
4.57 + 0.11 + 0.24 + 3.89
=
8.81 calculated value
The
degree of freedom is (n-1)
4-1
= 3
With
reference to the (X2) table 0.05 table of significance and degree of
freedom of 3, the table Chi-square’s value is 7.81. Hence the compound (X2)
value of 8.81 is higher than the, table X2 value 7-81, the
researcher, rejecting the null hypothesis and accept the alternative hypothesis
which states that the patronage pattern of health care facilities in Esan
central local government decrease with distance. This means that people prefer
to patronize any health care facilities centre that is much closer to them.
It is an indisputable facts that most of
the inhabitants in clans e.g. Ewu, Opoji, Usugbenu and Ugbegun and low income
earner which invariable affect the propensity at which they attend far away
health centres. Bad road-network and unsound vehicle had also contributed to
the patronage of far. There are occasions whereby there is sound car to move
patient to a far instance health centres became of well equipped due but bad
road network then act as impediment factor thereby gendering the death of the
patient on the way.
The
factor had resulted to a pregnant woman given birth on the way to patronize a
more specialize health care centre at Esan Central local government.
Furthermore, the rate of disseminations of
information about the model health care facilities from the information source
which is Esan central to all the appropriates claims in Esan Central is a
square movement. Premised an the distanced apartments.
4.3
HYPOTHESIS
TWO
Ho: This
states that there is no relationship between population of a clan and the
number of patient patronizing the health facilities.
Hi: This
states that, there is relationship between population of a clan and the number
of patient patronizing the health facilities.
TABLE 4.3 The
Relationship between population of clan and patronage
|
Reprises
|
Observed
|
Expected
|
% of
response
|
|
Yes
|
91
|
74
|
61
|
|
No
|
58
|
74
|
39
|
|
Total
|
148
|
|
100
|
Source:
Fieldwork 2012
Chi-Square
formula X2 = (O-E)2
E
= (91-74)2
+ (58-74)2
74 74
= 289 + 256
74 74
=
3.91 + 3.46
=
7.37 computed value
The
degree of freedom = (2-1) = 1
The table value at 0.05 significance
level is 2.84. Since the computed value of 7.37 is greater than the table value
of 2.84, we reject Ho and accept Hi. We therefore conclude that there is
relationship between the population of clan and the number of patient
patronized health care facilities.
The above hypothesis results attest that,
the table below and figure are correct of each clan.
TABLE 4.4 RELATIONSHIP
POPULATION AND PATRONS
|
Clan
|
Population
of Esan central in 2006 census
|
Percentage
|
Against to the backdrop of population
census equipment 2006, villages in Esan central specific population was unable
to be ascertain.
But the gross total of Esan Central
population is 105, 340 both Male and Female.
TABLE
4.5 Rating of service rendered at the
Health care facilities centre.
|
Responses
|
Frequency
|
Percentage %
|
|
Very
efficient
|
9
|
6.08
|
|
Efficient
|
14
|
9.46
|
|
Fair
efficient
|
40
|
27.03
|
|
Not
efficient
|
85
|
57.43
|
|
Total
|
148
|
100
|
Source:
Fieldwork, 2012
In
table 4.5, show that, out of 148 people interview about the rating of service
rendered at all clan of Esan Central local Government only response with 6.08% justified that is very
efficient which is not encouraging. For efficient 14 respondent with 9.46%. 40
respondents with 27.03% response that the service rendered at Esan Central
health care are fairly efficient.
While above 85 respondent attested rated
the services to be a not efficient. It is far below average, the rating of service
rendered at all the health care centre at.
Table 4.6 Number
of Health care Found in clans
|
Variables
|
Response
|
Percentage
|
|
1-2
|
95
|
64.19
|
|
3-4
|
42
|
28.38
|
|
5 and above
|
11
|
7.43
|
|
Total
|
148
|
100
|
Source:
Fieldwork 2012.
In
table 4.6 it is obvious that, some claims has more health care facilities than
another. 95 out of the total respondents with 64.19% affirmed that they have 1
to 2 health care facilities in the clans. 28.38% (42) respondent asserted that,
in the clans they have up to 3-4 health care facilities.
While
11 (7.43%) respondent, attest to the fact that, 5 and above health care
facilities are found in the area. Majority of the respondent at response to 3-4
and 5 and above number of health care in each clans hail from Esan central
where all the major public facilities are found and people care centre here.
  |
4.7
Types
of Health care Facilities found in Esan Central level Government
|
Items sample
|
Responses
|
Percentage
|
|
Dispensary
|
3
|
2.0
|
|
Maternity
|
5
|
3.4
|
|
Primary
health care
|
79
|
53.4
|
|
Hospital
|
30
|
20.3
|
|
Clinic
|
28
|
18.9
|
|
Other
specific
|
3
|
2.0
|
|
Total
|
148
|
100%
|
Source:
Fieldwork, 2012
Table
4.7 above shows the overall breakdown of the types of health care found in each
clans and response. Dispensary had 3 respondent with 2.0% which means that
there are few of it’s kind in the whole of Esan central.
Maternity is second to dispensary, it
had just five respondents with 3.4% literally, and dispensary and maternity are
wind out for model primary health care in all clans. 79 (53.4%) respondents
asserted that the types of health care found in are model primary health care.
This is an elusive fact, that the Government of the present days are no making
a spiritual effort to provide all the clans with average population with model primary
health care not dispensary or maternity.
Hospital had 30 (20.3%) respondent
hospital means a health care centre that is equipped with model facilities.
These type of health care can mainly be
found in Esan Central because of there commercialized, socio-economic endowment
and accessibilities.
28 (18.9%) respondent affirmed that, the
type of health care facilities found in the area is clinic. While 3 (2.0%)
respondent reacted to others. And these could be native doctor home and
herbalist home. They are found at Esan Central
4.8 LEVEL OF SATISFACTION WITH THE CONDITION OF HEALTH CARE FACILITIES IN ESAN CENTRAL
|
Items sample
|
Responses
|
Percentage
|
|
A room
|
21
|
14.19
|
|
2 bedroom
flat
|
39
|
26.35
|
|
3 bedroom
flat
|
35
|
23.65
|
|
Other
specify
|
53
|
35.81
|
|
Total
|
148
|
100
|
Source:
Fieldwork 2012
Table
4.8 shows the sizes of different health care centres in Esan. 21 respondents
asserted that is a bedroom. And the type of health care is a close door type
which is basically melts for consultancy. 39 (29.35%) out of the total sample respondent
asserted that, it 2 bedroom flat. This is actually a fact of all the or nearly
all the private health care centre. 3 bedroom. And major of the health care are
privately owned. There is a great problem of inconvenience and privacy.
53 (35.81%) alert the researcher that
they are in form of hall or wards. From personal observation all the privately
owned health cares are a room, 2 bedroom and 3 bedroom flat unless Zuma Memorial
Hospital but all the
public owned ones are in form of hall or ward to see smaller level bails. This
kind of health care centre lack privacy.
Table 4.9 Accessibility
|
Variables
|
Response
|
Percentage
|
|
Yes
|
59
|
39.86
|
|
No
|
39
|
60.14
|
|
Total
|
148
|
100
|
Source:
Fieldwork 2012
It
was able from the questionnaire if health care facilities are accessible to all
the dweller in Esan Central at large. Table 4.9 shows the responses of the afferent
sample population. 30 (40.14%) asserted that yes is accessible. Accessibility
lies to do with cost a transportation and services rendered at the services
centre and the time spent in travelling, waiting on queue and finally be
attended to while 89 (39.86%) respondent said it is not accessible. Judging by
the total number of respondent for both Yes or No of accessibility to health
care centre in Esan central it is obvious that all the health centre are not
accessible.
From the researcher observations of the
private and public health care centre accessibilities, he discovered the
private health care centre is accessible to public.
Table 4.10 Equipment level
|
Variables
|
Responses
|
Percentage
|
|
Yes
|
35
|
23.65
|
|
No
|
113
|
76.35
|
|
Total
|
148
|
100
|
Source:
fieldwork 2012.
The
above table 4.10 vividly shows the response to the equipment level of the
entire health care centre.
35
(23.65%) respondence said yes, meaning the level of equipment of health care
centre in Esan Central is very low. It is below average, so it needs
enhancement. While 113 (76.35%) of the total sample population relied no
meaning the level of equipment in all the health care centre is still very at
the low edge. There had result to the death of some dwellers in some of the
clans. The standard health centres are found in Esan Central Local Government.
But accessibility to it cumbersome promise transportation, cost of treatment
and awareness of the model drug and facilities.
TABLE 4.11 FACTOR AFFECTING PATRONAGES
Means
Transportation
|
Means
|
Responses
|
Percentage
|
|
Trecking
|
73
|
49.3
|
|
Private
transport
|
41
|
27.7
|
|
Public
transport
|
34
|
23.9
|
|
Total
|
148
|
100%
|
Source:
Fieldwork 2012.
It
impossible to locate health care centre at the door steps of all the patrons in
the clans. But when it is established in an area that is accessible to all the
maximum patronage is sure.
Table
4.11 shows the different means patrons uses to health care centre.
49.3%
of the sample population treck to health care centre base on close and lack of
transportation fare. Most of the dwellers in all the clans in Esan Central are farmers
and Petti retailers’ retailer.
Public
transport of the sample population is 27.7%, those that have no personal
vehicle but financially buoyant can bored the commercial transport to health
care centre of their choice.
While
private transport account for 23% respondents. This means that 34 responses
travelled in the personnel vehicles to health care centre which is related to
the total population in Esan Central.
These
means of transportation to health care centre is one of the key factor limited
some follows from going to the more equipped centre in Esan Central.
TABLE 4.12 SOCIAL ATTITUDES
|
Variation
|
Responses
|
Percentage
|
|
Yes
|
71
|
47.97
|
|
No
|
77
|
52.03
|
|
Total
|
148
|
100%
|
Source:
Field 2012.
Table
412 above shows the social attitude of response to the patronage of different
health care centre. 47.97% said no to social attitude as a determining factor that
could galvanized then to patronize health care centre. So the consequence of
high patronage is on the level of equipment accessibilities, and type of
ailment.
While
52.03% of the total sample population said they prefer to treck or travel along
distance to attend any health care centre that is owned by the relation for
these could afford them more privacy and personal social discussion
opportunities.
TABLE 4.13 COST OF
TREATMENT
|
Variation
|
Responses
|
Percentage
|
|
Yes
|
87
|
58.78
|
|
No
|
61
|
41.22
|
|
Total
|
148
|
100%
|
Source:
Fieldwork 2012.
With
regard to cost of treatment as showed in table 4.13 in above 87 (58.88%)
respondents responded that the cost of treatment in the health care centre is exorbitant.
It is a fact become most of the dweller
are former, so the most equitable health care centre are unaffordable to them
61 (41.22%). Respondent said No. These categories of respondent chose not to go
beyond take paracetamol to about ailment. And most of the believe in the use on
roots and herbs.
TABLE 4.14 OTHER
FACTOR
|
Factors in
the patronage
|
Frequency
|
%
|
|
Proximity to
health care
|
25
|
16.89
|
|
Religion
|
22
|
14.86
|
|
Efficient
medical facilities
|
39
|
26.35
|
|
Only
available centre
|
32
|
21.62
|
|
Others
|
30
|
20.27
|
|
Total
|
148
|
100%
|
Source
Fieldwork, 2012.
Table
4.14 shows other factors that are capable of determining the rate at which
people patronize health care.
16.81%
of total sample population affirmed that proximity to health care centre is one
of other factors that attendance of health care centres in Esan Central. Some
people have actually chosen to patronize health care centre closer to them,
than the far distance one.
15.86%
of the respondent attributes other factors affecting patronage pattern of
health to religion believe, unlike the Christ Chose church vehemently believed
on having faith in God for healing when you are sick. Their members neither
patronize orthodox nor traditional home. Also the Muslim women are not allowed
to patronize all the health care but only a restricted or some designated ones
in their laws or husband.
Efficient medical facilities accounted
for 39 (26.35%) of the total sample respondent. The assertion of these
respondents is that the basic factor that propel than to a particular health
care centre premised on efficient medical facilities which are competent of
using to diagnose ailment and circumvent it.
Only
available centre had 32 (21.62%) respondent
Meaning
that because of the availability of one health care in Esan Central where so
many health care centres both private and public are available so they chose to
afford the available ones. Other accounts for 30 (20.27%) respondent. The
respondent said all the above effect patronage pattern of health care but some
person who are not well informed or educated about the current health care
facility will sees it as a valueless stuff and prefer the use of roots and
herbs to the orthodox.
CHAPTER FIVE
5.1
SUMMARY
The
foregoing chapter of this research work is nothing but premised on insight
research to patronage pattern of health care facilities in Esan Central Local
Government Area.
The
first chapter gave a preamble of the research problem, followed by the Aims and
Objectives, Hypothesis, study area, research method, and data analysis.
The
second chapter is all about literature review around which the work is centred
upon. Followed by theoretical framework, that is the opinion of some persons
about the subject matter. This took the research to chapter three, was
dedicated to the analysis of all the data and information collected on the
field for example distance, travel level of accessibilities, cost of treatment
as that determining patronage pattern.
Having
given a summary of the work, the following were the finding of the research
after a critical examination of the patronage pattern of health care centres in
Esan Central Local Government Area.
It
was discovered that the health care centre in Esan Central Local Government is
unevenly distributed. Clans Irrua Ewu, Opoji and Ugbegun.
The
distance of health care centre to that of the patrons was a great militating
factor that determines the propensity of patronage pattern of health care
centre in Esan Central local Government Area.
Furthermore,
population of a clans determine more as well on the patronage pattern of health
care centre in Esan Central, clans like Ewu had a small patronage figure,
consequence on it total population density likewise some other clans.
Accessibilities
is another unregulated factor. So many dwellers of these clans are facing this
problem. Cost of medical, social attitude and equipment of the health centre
are further factor? Finally, inspite of much awareness created through
seminars, postal and mobile campaign irrespective to the benefit of health
care, most of the inhabitants still resort to traditional means while some
others premises their healing on God.
5.2
RECOMMENDATIONS
To
circumvent the inherent problems associated with the insight research of the
subject matter, the following are the suggestion of the researcher and his
recommendations. If considered, the planner shall of the health care shall
definitely have impact.
The
federal government should endeavour through the state and local government make
provision of at least one equitable health care facilities in each clan and
their should be a maintenance culture by both the government and the users of
such centres.
In
location of health care facilities hence forth, optimal location should be
considered. That is an efficient location of the health care facilities can
serve all, irrespective of the distance separating them. But one thing remains
clear, socio-economic, geographic and political factor could shift the site for
the facilities from the said optimal location. Base on these optimality is
highly achieved.
The
far away clans which are very distance from the centre of health care should
not be totally left out, when dispatching medical care facilities at the local
government. Spirited effort should be make through the use of mobile clinics to
reach such distances clan to ensure effective and healthy existence for it’s
populace.
Nevertheless,
the government should try to revive the few established centre that are almost
going out of faction.
Employ
more specialist personnel and lower the cost of treatment.
Lastly,
if the government alone cannot provide all the necessary health facilities,
alternatively is by encouraging a well bake physician and nurses and other
related medical field guru to established their private health care centre with
a stipulated minimum standard of accommodation, equipments and workers.
5.3
CONCLUSION
It
is generally realized that the most pressing problems with the health care
delivery system in Esan Central are many and varies. There are many others the
researcher has emphases in the summary of findings, these problem form the
basis for which the researcher undertake the view of finding solution to the
various problems.
The
most crucial of this problem was the distance affecting patronage pattern,
shortage of personnel’s trecking as the major means of transport, the
concentration of few health care centre at Eguare lack of health care seminar,
high cost of treatment, inaccessibility all bedevil the patronage pattern of
health care centre in Esan Central. However, the recommendation of the research
will systematically take care of those militating problems of patronage pattern
of health care centre in Esan Central local government.
Although
the federal, state and local authorities have ambitions plan to solve the
health care problem, it is centre that to provide adequate solution it will
take a long time to achieve. The most reliable short time solution to the
problem of health care centre in Esan Central is to locate health care centre
in area that is accessible to all not only those in special clan also those in
far away in rural areas in all parts of Esan Central local government.
In
view of the situation described in the proceeding paragraph there is necessity
to insure that the various health care centre to be established in the future
are located in such a way to achieve optimal utilization by the population. If
distance were the only factor affecting patronage pattern of health care centre
the suggestions in the foregoing paragraphs could be easily implemented through
mathematical computation as it had been in the analysis but patronage pattern
of health care centre is also to be affected by population, social attitude,
type of ailment and level of awareness. Based on the proceeding paragraph, that
is where this final conclusion is been drawn from. The fact that the researcher
has undertaken the research, problems were identified and below recommendation
are suggested. This is to ensure that health care is located to be accessible
to all most especially the rural dwellers. If the below recommendations are
considered in the planning of health care facilities, there is no doubt that
Esan Central, Edo State and the country at large will see this problem as a
thing of the past.
REFERENCES
Adejuyigbe O. (1973) “Basic health
care facilities location in Nigeria.
Adejuyigbe O. (1973) “Location of
Social Service in West Africa the case of
medical facilities man and society, vol. 1.
Adeleye G. (1981) A Handbook of
Geography teaching
Akinbode, A. (1996) Research
Methodology
Bechi, L.C. (1981) “Location of Models
for system of private and public facilities based on concept of accessibility
and access opportunity Environmental and Planning vol. 13.
Boom, 1963 “Attitude of Physicians and
Paramedical Personnel toward Patients
Doctors Report (1985) Health and
Populace Journal vol. 11
Etheh M. (2005) Patronage pattern of
health care facilities in Esan Central L.G.A of Edo State.
Rilwani, M.L. (2005) Statistics for
Environmental and Social Sciences.
Mumphery, A.J. and Wolpex, J. (1973)
Equity consideration and concession in the sitting of public facilities.
Economic Geography vol. 49, vol. 1.
Okafor, S.I. (1984) “Sphere of
influence of Regional
Hospital” Nigeria Journal
of Economic and Social Studies vol. 22 No. 1
Omolade, A. (1977) the location of
rural Basic Health facilities Area of South West Nigeria.
Omonfonmwan, S.I. (2006) Quantitative
Techniques in Geography and Regional Planning.
Omonfonmwan, S.I. and Kadiri, M.A.
(2006) Urban socio-Economic facilities location problems.
Onokerhoye A.G (1978) Analysis of
spatial Distribution of post primary schools in Kwara
State proceeding the location of
social services in Nigeria,
NISER, Ibadan.
Onokherhoye, A.G (1976) a suggested
framework for the provision of health facilities in Nigeria, social science and medical
journal vol. 10
Smith, D.M. (1977) Human Geography A
welfare Approach
World Health Organization Alamamata
1978 primary Health care report of the international conference of primary
Health care, Alamamata U.S.S.R, Geneva
(Health for all series No. 1.
APPENDIX A:
DEPARTMENT OF GEOGRAPHY AND REGIONAL
PLANNING
FACULTY
OF SOCIAAL SCIENCES
AMBROSE ALLI
UNIVERSITY, EKPOMA
Topic:
Patronage Pattern of Health care
facilities in Esan Central L.G.A
Note:
The research is basically for an academic exercise aimed at collections of
information on the patronage pattern of health care facilities in Esan Central
Local Government Area.
Hence
any information given will be used for such and treated with a full confidence.
Tick
the correct options.
PART A
PERSONAL INFORMATION
1. Age:
(a) Under 20 years ( ) (b) between
21-30yrs ( ) (c) 31-40yrs ( ) (d) 41-50yrs ( ) (e) 50yrs and above ( )
2. Sex
(a) Male ( ) (b) Female ( )
3. Occupation----------------------------------------------
4. Marital status (a) Single ( ) (b) Married ( ) (c) Divorce ( ) (e) Widow (
) (e) Widower ( )
5. If married how many children do you
have------------
6. Do
you have any dependent relation staying with you (a) Yes ( ) (b) No (
)
7. Educational
Background
a. Primary School Education ( )
b. Secondary school Education ( )
c. Tertiary education ( )
d. Other
qualification specify-------------------------------
8. Income per annum (a) Below N40,000 (
) (b) 40,500-50,000 ( ) (c)
50,500-60,000 ( ) (d) 60,500-70000
( ) (e) Above 80,000
PART
B
GENERAL
INFORMATION
9. Owners
of the health centre (a) Government ( )
(b) Private ( ) (c) Company ( )
10. The distance
in between your residence to the health centre (a) less than 1km ( ) (b) 1-2km (
) (c) 2-3km ( ) (d) 3km and above
( )
11. How would you rate the services rendered are
the health care centres (a) Very efficient (
) (b) Efficient ( ) (c) Fairly efficient ( ) (d) Not efficient ( )
12. How many Health Centre are found in your
village (a) 1-2 ( ) (b) 3-4 ( ) (c) above (
)
13. The types of health care facilities in your
place? (a) Dispensary ( ) (b) Maternity
( ) (c) Health Centre ( ) (d) Hospital ( ) (e) Clinic ( )
14. Which of them do you attend? (a) Government
( ) (b) Private ( ) c) Other (
)
15. Why do you attend Health care
centre-------------------------------------------------------------------------------
PACT
C:
16. What is the
size of the Health Centre (a) room ( )
(b) 2 rooms ( ) (c) 3 rooms ( ) (d) other specify------------
17. Can everybody
attend these health centres? (a) Yes
( ) (b) No ( )
18. Are you
satisfied with the kind of services rendered by the Hospital? (a) Yes ( )
(b) No ( )
19. If the
response to 18 is not, how can it been
improved?-----------------------------------------------
20. Is the health care centre well equipped with
modern facilities? (a) Yes ( ) (b) No (
)
21. If your answer
to above 20 is suggest the kinds of equipment needed to equipped the health
care centre in your area-----------------------------------------
22. What are the
means of transportation? (a) Trecking
( ) (b) Private transport ( ) (c) Public transport ( ) (d) if there is away other means
specify----------------
23. Are the
patients prepared to treck a long distance to reach the health care facility
due to social attitude (a) Yes ( ) (b) No (
)
24. Is the cost of
treatment to high for the patients to afford (a) Yes ( )
(b) No ( )
25. Is there any
relationship between population of a town, clan and the number of patients
patronizing the health care facility centre (a) Yes ( )
(b) No ( )
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