AN INDEPT ANALYSIS ON THE FACTORS INFLUENCING THE PATRONAGE OF PRIMARY HEALTHCARE AMONG RURAL DWELLERS 

CHAPTER ONE

INTRODUCTION

Background of the study

According to the United Nations in 2009, almost half of the world's population lived in rural regions, with 3.41 billion people residing in rural areas and 3.42 billion people living in urban areas. In Nigeria, 48.04 percent of the population resides in rural regions, according to the Nigeria Rural Population Service (2020). The latest United Nations study highlighted the need to focus efforts on nations and areas with the greatest child mortality rates in order to achieve MDG4: Target 4.a, which aims to reduce the under-five mortality rate by two thirds between 1990 and 2015. These locations were classified as emerging regions and remote areas (United Nations, 2016). In addition, the availability and quality of healthcare services in underserved and rural regions are insufficient. As a result, those who are economically disadvantaged experience the burdensome financial consequences of poor health in two ways: via the expenses associated with obtaining healthcare services and the loss of productive days (Ministry of Health, 2017). In order to achieve a satisfactory level of health among the population and accomplish the Millennium Development Goals (MDGs), it is necessary to substantially enhance access to high-quality healthcare in rural areas. Nevertheless, this has had a devastating impact on several governments, especially those in the developing world. Accessing health care services is essential for maintaining good health and promoting socio-economic and infrastructural progress (Bathia & Rifkin, 2020). The use of health care services is affected by certain factors, such as the presence of healthcare facilities (Cueto, 2014). Availability encompasses several aspects such as proximity, ease of access, knowledge, transportation, language, cultural differences, and personal choice. Other factors include the expense of healthcare services and the level of service delivered by healthcare professionals. The utilization of health care varies significantly between urban and rural communities due to disparities in the availability of essential medical equipment and the presence of trained medical personnel. Urban areas tend to have a higher supply of such resources, while rural communities, where over 60% of the population resides, face a relatively limited supply. Health indices in Nigeria have seen a significant slowdown in overall growth, particularly in terms of maternal mortality ratio, where the country ranks among the highest. Based on the 2018 NDHS, the estimated maternal mortality ratio for the 7-year period prior to the survey is 512 maternal deaths per 100,000 live births (Gillam, 2018). In rural areas, where access to modern health facilities is restricted, the situation is even more concerning. The majority of residents rely on local traditional birth attendants for their healthcare needs. The utilisation of health facilities in rural and urban populations is significantly influenced by the distribution of health facilities and the presence of healthcare workers at these facilities. These recurring gaps have been attributed to factors such as the state of service, inadequate working equipment, insufficient infrastructure, and poor communication service and access road (Gillam, 2018). Rural residents have challenges in accessing healthcare due to the need to drive larger distances and spend more time reaching health centres, which hinders their ability to make repeat visits. The lack of sufficient access to healthcare services has resulted in a decrease in life expectancy among rural residents and urban slum dwellers, as well as an increase in newborn mortality rates (Gillam, 2018). Therefore, the researcher sought to examine the factors influencing the patronage of primary healthcare among rural dwellers in  Ikole-Ekiti

 Statement of the problem

Access to high-quality healthcare is a basic entitlement for all individuals worldwide, and Nigeria is no exception. The objective of primary health care was to provide universal and readily available healthcare services for all individuals. Undoubtedly, this is yet to be accomplished in Nigeria. Primary health care facilities were built in both urban and rural regions in Nigeria to promote equity and provide convenient accessibility. The majority of individuals living in underdeveloped nations, particularly in Africa, possess little knowledge of their national health systems and programmes, resulting in a propensity to underutilize healthcare services. Furthermore, several studies conducted in Nigeria since the establishment of PHC in 1992 have consistently revealed low rates of utilization, which in turn contribute to the poor health condition of the population (Jaro and Ibrahim, 2015; Galadanchi, 2017; Cueto, 2014). Considering that the primary goal of primary health care (PHC) in developing nations is to enhance the health of individuals and communities by promoting health and increasing the use of preventive, curative, and rehabilitative health services, it is important to comprehend the factors that lead to the low patronage of health care facilities, particularly at the primary level. Rural populations continue to have ongoing difficulties in accessing sufficient healthcare services, leading to discrepancies in health outcomes when compared to metropolitan regions. Although attempts have been made to enhance primary healthcare delivery systems, there is still a lack of comprehension of the elements that influence the behaviour of rural residents in seeking and using these services. Hence, the study examine  the factors influencing the patronage of primary healthcare among rural dwellers in  Ikole-Ekiti.

 Objective of the study

The broad objective of the study is to examine the factors influencing the patronage of primary healthcare among rural dwellers in  Ikole-Ekiti. Specifically, the study will;

Ascertain whether affordability of healthcare services influences patronage of  primary healthcare in Ikole-Ekiti.

Examine whether educational level of rural dwellers influence their patronage of primary healthcare in Ikole-Ekiti

Determine whether distance and transportation barriers influence patronage of  primary healthcare in Ikole-Ekiti.

Identify potential strategies aimed to improve the patronage of primary healthcare services among rural dwellers in Ikole-Ekiti.

Research questions

The following questions have been prepared to guide the study

Does affordability of healthcare services influence the patronage of  primary healthcare in Ikole-Ekiti?

Does educational level of rural dwellers influence their patronage of primary healthcare in Ikole-Ekiti?

Does distance and transportation barriers influence patronage of  primary healthcare in Ikole-Ekiti?

What are the potential strategies aimed to improve the patronage of primary healthcare services among rural dwellers in Ikole-Ekiti?

 Significance of the study

The findings of this study will aid the local governments in charge of service delivery at these facilities in focusing their education and community communications on the core aspects that operate as obstacles to health-care utilization. It will also assist service providers at the facility level in developing strategies and action plans to encourage increased use of the services available. These efforts will help to start the process of enhancing access to health care services, which will eventually improve the overall health of everyone in the state.

The findings of the study will further be of benefit to the academic community as it will contribute to the existing literature.

1.6 Scope of the study

The study focuses on the factors influencing the patronage of primary healthcare among rural dwellers in  Ikole-Ekiti. Geographically, residents in Ikole local government area, Ekiti State.

1.7 Limitation of the study

Like in every human endeavour, the researchers encountered slight constraints while carrying out the study. Insufficient funds tend to impede the efficiency of the researcher in sourcing for the relevant materials, literature, or information and in the process of data collection (internet, questionnaire, and interview), which is why the researcher resorted to a moderate choice of sample size. More so, the researcher will simultaneously engage in this study with other academic work. As a result, the amount of time spent on research will be reduced.

1.8 Definition of terms

Patronage Behavior: The actions and decisions made by individuals or communities regarding their utilization of goods or services, particularly in the context of healthcare, encompassing factors such as choice of healthcare provider, frequency of visits, and adherence to treatment plans.

Rural Dwellers: Individuals residing in sparsely populated areas characterized by agricultural or natural landscapes, typically located outside urban centers and cities.

Primary Healthcare Delivery System: The network of healthcare facilities, professionals, and services focused on providing essential and preventive care to individuals and communities, typically serving as the first point of contact within the healthcare system.