NIGERIAN SCHOOL HEALTH JOURNAL

GUIDELINES FOR NIGERIAN SCHOOL HEALTH JOURNAL (NSHA) AUTHORS

In order for manuscript to be accepted for publication

in Nigerian School Health Journal, the following guidelines

must be followed.

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5. Materials submitted to Nigerian School Health

Journal for consideration should not be submitted to

another publication simultaneously. Manuscripts

1

accepted for publication are copyrighted by NSHA and

becomes the property of the Association.

6. Tables and figures should be on separate sheet and

numbered consecutively, using Arabic numerals.

7. The writing style of the journal is the APA, that

is, the American Psychological Association format.

8. Titles of Journals should not be abbreviated.

9. Articles, which do not conform to the above

specification, will be returned to the authors.

Authors are liable to the content of articles

published by NSHA.

10. Manuscripts on any aspect of School Health Education

in particular and health in general are welcomed.

All types of articles are suitable: practical,

theoretical, technical, philosophical, research

report, how-to-do it’s controversial, inspirational,

etc. Readership includes both public, school

readership include both public, school, college or

university people, professional in health related

fields.

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11. Send your manuscripts to:

The Editor-In-Chief,Professor C.O. Udoh,Department of Human Kinetics and Health EducationUniversity of Ibadan

ORThe Journal Secretary,Dr. O.A. MoronkolaDepartment of Human Kinetics and Health EducationUniversity of Ibadan

3

NIGERIAN SCHOOL HEALTH JOURNAL

Editorial Board

Prof. C.O. Udoh – Editor-in-Chief – University of

Ibadan

Prof. James A. Ajala – Member – University of Ibadan

Prof. J.D. Adeniyi – Member – University of Ibadan

Prof. Fajewonyomi – Obafemi Awolowo University, Ile-Ife

Dr. S.D. Nwajei – Member – Delta State, Asaba

D.A.K. Fabiyi – Member – Obafemi Awolowo University,

Ile-Ife

Dr. (Mrs.) B.A. Oladimeji – Member – Obafemi Awolowo

University, Ile-Ife

Dr Danladi Musa – Member – Bayero University, Kano

Dr. O.A. Moronkola – Member/Journal Secretary –

University of Ibadan

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- MAIN FOCUS OF THIS EDITION -

ISSUES IN HEALTH EDUCATION

Nigerian School Health Association (NSHA)

Contents

Page

Editorial ……………………………………..……………………………………………..

ARTICLES

1. Umaru Musa & M.A. Suleiman, Physical and Health

EducationDepartment Ahmadu Bello University, Zaria –

Healthful School Environment: The Need of Nigerian

Schools.

2. Amunega Stephen Bankole, University of Ilorin –

Complexity and Simplicity in Teaching of Health

Education

3. Akinbile, P.O. and Oladumoye, A.O. Adeyemi College of

Education, Ondo-Systematic approach to health

instruction

4. Moronkola, O.A. & Olukanni, M.Y. University of Ibadan –

Parental Educational, Social-Economic Status and Nature

5

of Family Set-Up As Determinants of Prevalence of Child

Labour in Bodija Market, Ibadan.

5. Grace Inyang Masha, Federal College of Education Kano-

Sexual Education in Nigeria: Issues on Parent Child

Communication.

6. Sanusi, A.A. & Igbanugo V.C. University of Ibadan –

Adequacy of School Health Services Communities in

Maiduguri.

7. Bolarinwa, R.O. Osun State College of Education Ilesa-

Diagnosis of Health Problems in Osogbo Steel Rolling

Company: Application ‘PRECEDE’ MODEL.

8. Odewumi, G.I., University of Ibadan – Health Benefits

of Participation in Aquatic Activities.

9. Onifade, O.A. & Oyerinde, O.O. University of Ilorin –

University Students Perception of Engagement Types on

Marriage Success in Nigerian Societies.

10. Adegbenro, C.A. Obafemi Awolowo University Ile-Ife

– Health Education and Primary Health Care

11. Ogundele, B.O. & Bolajoko, O.A., University of

Ibadan – Health Workers’ opinion about the impact of

6

safe motherhood initiative training programme on the

prevalence of material mortality.

12. Tejumola, T.O. Ogun State University, Ago-Iwoye

Effects of Traditional Birth Attendants Services on the

Safe Delivery of Pregnant Women in Akute Ifo Local

Government Area of Ogun State

13. Okanlawon, F.A. University of Ibadan Community

Based Care of HIV/AIDS Clients; Implication for

Community Health Nursing

14. Gaya, M.W.U. & Bwala, D.W., University of

Maiduguri – Impact of Regular Exercise Programme on

Risk Factors of Cardiovascular Diseases: An Overview

15. Edegbai, Ben Federal College of Education,

Abeokuta – Influence of Health Information and

Education (HIE) on Lactation Among Mothers Attending

Post-Natal Clinic of Family Health Care Centre,

Abeokuta.

16. Umar Hassan, Shehu Shagari College of Education,

Sokoto – Strengthening The Utilization of Primary

7

Health Care Services Through Increased Health Education

Activities.

17. Lawal, M.B. & Haastrup, E.A., Adeniran Ogunsanya

College of Education, Otto-Ijanikin – Pre-Service

Teachers Profile on The Knowledge Of And Attitude

Towards Adolescent Reproductive Health Issues.

18. V.C. University of Ibadan’s Welcome Address During

NSHA 2000 Conference

19. Oyo State Commissioner of Health Address During

NSHA 2000 Conference

20. NSHA General Secretary Welcome Address During NSHA

2000 Conference

21. Ogwu, T.N., Ahmadu Bellow University, Zaria –

Perception of Students and Teachers on Teaching of

Sexuality Education in Zaria Educational Zone.

22. Achalu, E.O. & Bassey, F.S. University of Uyo –

Wrk and Socio Economic Status as Aetiological Factors

Incidence of Hypertension

23. Adeleke, A.O., Ojo, A.A., Osayande, O.O., Irinoye

Lola & Mukoro-Obafemi Awolowo Univeristy, Ile-Ife –

8

Knowledge and attitude towards Pre-Marriage Genetic

Screening Among Undergraduates in a Nigeria University.

24. Uwakwe, C.B.U, Moronkola, O.A. & Ogundiran,

Adeniyi – University of Ibadan – Awareness, Prevalence

of Sexually Transmitted Diseases and Health Care

Seeking Behaviour of Adolescents Attending STDs Clinics

in Urban Nigeria.

25. Okanlawon, F.A., University of Ibadan – AIDS

Epidemics in Nigeria: A great challenge

26. Oyerinde, O.O. – University of Ilorin – The

Impacts of Family Structure Parental Practices and

Family Size on Children’s Academic Performances.

27. Kalesanwo, O.O. Ogun State University Ago-Iwoye –

The Impact of Health Education Package on Safe Delivery

of Pregnancy Mothers in Ijebu-Ode.

28. Omonu J.B., Kogi State College of Education Ankpa

– Preparing Bachelor Degree Health Teachers to Meet

National Development

9

29. Ajibike, Y.B., Oyo State Ministry of Education,

Ibadan – Effects of 12 Weeks Exercise Therapy on

Hypertensive Men

30. Yayo, A.A., Umar Dikko & M. Kabir – Bio Ecological

Studies of Kadawa Project, Kano: Implications for

Appropriate Environmental Health Education Programme.

31. Shehu Raheem Adaramaja, University of Ilorin –

Implementation of Primary Health Care (PHC) Through

Community Based Health Education Programme in Ilorin

Metropolis

32. Adeyemo, F.O., University of Ibadan – Review of

Adolescents Attitude Towards Sexual Practice

33. Odesanmi, M.A., Osun State College of Education –

Promoting Healthful Living Lifestyles Among Competing

Athletes in the New Millennium

34. Oke, Kayode, Ogun State University Ago Iwoye – The

Challenges and Prospects of Basic Health Services in

Nigeria

10

35. Ademola Onifade, Dean, Faculty of Education, Lagos

State University – Contributions of Physical Education

to Attainment of Healthful Living

36. Nwajei, S.D. Delta State University – Health

Education in the New Millennium: Pedagogical

Considerations

EDITORIAL TO

VOLUME 13 NUMBER 1 & 2, 2001

The editorial board wishes to thank all NSHA members

and authors for their emotional attachment towards the

sustainability of our prestigious journal. As usual, Journal

production is expensive in Nigeria and we still look forward

to financial support from government and founders to enable

us to publish good health and education - related articles.

The Main focus of this volume is on Issues in Health

Education. We commend it to all policy makers, researchers,

teachers, libraries, students, etc.

The Editors.

11

IMPLEMENTATION OF PRIMARY HEALTH CARE (PHC) THROUGH

COMMUNITY - BASED HEALTH EDUCATION PROGRAMME IN ILORIN

METROPOLIS

BY

SHEHU RAHEEM ADARAMAJADepartment of Physical and Health Education,

University of Ilorin, Ilorin, Nigeria.

Abstract

This paper looks at the implementation of primary health care (PHC) throughcommunity - based health education programme in Ilorin metropolis. Thepopulation of the study consists of primary health care workers and theinhabitants of Ilorin East, West and South LGAs that make up Ilorin metropolis. Atotal of 240 subjects were selected for the study through a multistage-clustersampling technique. The instrument used for the study was questionnaire,validated and tested for reliability through a test re-test method. The coefficientfor the reliability was 0.82r. Analysis of data revealed, among others, thatcommunity based health education programme is a significant factor in theimplementation of PHC services. The paper suggested that the people of Ilorinmetropolis should be adequately informed of the concepts, needs, problems andprospects of PHC programme so that they can perceive the programme positivelyand participate actively in its implementation.

12

Introduction

In 1987, Nigeria adopted a comprehensive national

health policy which accepted Primary Health Care (PHC) as

the foundation of this policy and the principal method of

ensuring the provision of health for all her citizens by the

year 2000 and beyond (Bravema and Tarimo,1994). The

National Health Policy (1988) adopted the Alma‘s definition

and declaration of primary health care as:

Essential health care based onpractical, scientifically sound andsocially acceptable methods andtechnology made universally accessibleto individuals and families in thecommunity and through their fullparticipation and at a cost that thecommunity and country can afford tomaintain at every stage of theirdevelopment in the spirit of self-reliance and self-determination(National Health Policy, 1988:2:3).

The idea of primary health care scheme is to ensure

that both rural and urban dwellers not only have access to

meaningful health care but also that they participate

actively in the implementation of every facet of the

prorgamme. The idea of equal access and affordable health

care for all the people could only be brought about by the

13

education of the public about how they could effectively

carry out their own health care. For primary health care

programme to succeed in this country, Nigerians must be

educated about primary health care concepts. This involved a

number of educational issues which are essentially dependent

on systematic health education. Udoh, Fawole, Ajala, Okafor

and Nwana (1987) defined health education as a process with

intellectual, psychological and social dimensions relating

to activities which increase the abilities of people to make

informed decisions affecting their personal, family and

community well being. According to them, health education is

an integral part of the school curriculumat all levels, and

an integral component of community based health programme.

Mass health education and mobilization of individuals and

the community to create health awareness is an important

tool in the realization of health for all by the year 2000

and beyond. Adegoroye (1984) stated that health education

should run through, and be built into all sectors of the

community. There should be family health education, school

health education and community health education.

14

Community - based health education programme is an

essential tool in the implementation of primary health care

programme towards the attainment of health for all by the

year 2000 and beyond. Health education should be carried

out both at the group and individual levels in the homes,

clinics, market squares, places of worship and other social

gatherings. In the past, health workers were found of

underrating the level of intelligence and problem - solving

skills of health services consumers (community members).

They were often labelled as ignorant, unhygienic or

illiterate. Hence, health services providers saw little or

no need to involve the consumers in the process of providing

services (Folawiyo, 1990). For example, in the past, if a

dispensary was to be built in a village, the government

would only acquire land and start to build the dispensary,

without consulting the villagers. This wrong approach has

led to non-utilization or under-utilization of many

government health centres or hospitals. But today, with the

introduction of community health education programme in the

primary health care delivery system, the orientation has

15

changed tremendously. Henry (1993) asserted that in

reciprocity, the community now sees the primary health care

programme as our programme instead of government’s

programme.

Ransome-Kuti (1987) in his broadcast to the nation on

the launching of Primary Health Care as Health Minister and

as contained in Shodeinde (1982), described Primary Health

Care (PHC) as community-based health programme. This means

that it is organized from the grassroot upward, with the

active participation of the people who will identify their

health needs and participate in planning, implementing and

evaluating the services. In planning the services, they will

ensure that it is designed to tackle those health problems

that take the greatest toll of their lives. They will also

ensure that the cost of delivering the services can be

afforded, bearing in mind all the resources available in the

community to run and maintain the services. WHO (1978)

reported that health can not be imposed on the community nor

is it something that can be provided for the people. What

can be provided is healthcare. It is the people who decide

16

whether to utilize the services or not. The challenge of

health has to be attained and not imposed.

With the experience of child survival/family planning

programme in Ilorin metropolis and Nigeria in general, the

essence of PHC has shown that individuals and communities

need to be informed, educated, motivated and involved

formally or informally in health programmes so that they can

be convinced that the programme is convenient, efficacious,

affordable and as good as, if not better, than that which

they already had. The community can bring energy, time and

even financial resources to develop health-related

programmes/activities when they see that their own interests

are being served (WHO, 1984).

The implementation of PHC in Ilorin metropolis (Ilorin

East, Ilorin South and Ilorin West LGAs) has shown that only

the components of the programme that involved community

participation were effectively implemented in the area i.e,

immunization, health education, essential drugs, and

maternal and child health care, including family planning

programme. All other components like mental health, AIDS

17

control programme, water supply scheme and basic sanitation

services were not properly implemented in the area.

Statement of the Problem

The problem of the study was to assess the

implementation of PHC through a community-based health

education programme in Ilorin metropolis. The study examined

why some of the programme’s components were properly

implemented and why some were not. The study also

investigated and evaluated the degree of success of the

programme and made some recommendations on how to improve on

the programme.

Hypotheses

The following hypotheses were tested in this study.

1. There will be no significant differences in the

pattern of health education provided about

prevailing health problems towards the

implementation of PHC services in the three (3)

L.G.A s. of Ilorin metropolis.

18

2. There will be no significant differences in the way

the people of Ilorin metropolis perceive PHC

delivery system.

3. Community-based health education programme is not a

significant factor in the implementation of PHC

services in Ilorin metropolis.

Rationale for the Study

The study examined the implementation of primary health

care programme as a community-based health programme. It

also examined the acceptability of the programme among the

people of Ilorin metropolis. The result of the study would

reveal the areas that need greater improvement and

reinforcement. It will also provide information to the

people of Ilorin metropolis on how to improve their health.

Finally the outcome of this study will contribute to public

awareness of the nature, needs, priorities and patronage of

the primary health care system.

Methodology

The research design adopted for this study was a

descriptive survey method. The population for the study

19

consisted of the participants (Beneficiaries) in PHC

programmes in the three (3) Local Government Areas (Ilorin

East, South and West LGAs) that make up the Ilorin

metropolis. In addition, medical officers and PHC co-

ordinators in the LGAs were also included in the study.

The investigator used a multistage-cluster sampling

technique in the selection of samples for the study. The

procedure involved the repetition of two basic steps:

Listing and sampling. The list of primary sampling units

(PHC centres) was compiled and stratified for sampling. Then

a sample of those units was made. In all, a total of two

hundred and forty (240) samples were selected.

Questionnaire method was used for the study. The

respondents were requested to indicate their opinion on a 4-

point Likert scale ranging from Strongly Agree, Agree,

Strongly Disagree and Disagree.

The instrument was face validated and the reliability

of the instrument was established through a test-re-test

method. The scores from the first administration were

20

correlated with the second administration using Pearson

Product Moment Correlation co-efficient which yielded 0.82.

The questionnaire forms were administered to the

respondents by the researcher and his assistants. The

hypotheses formulated were tested using t-test to determine

the significant differences between the mean scores of

respondents from the three (3) LGAs on the implementation of

PHC services through a community-based health education

programme.

Results

The results of the data analysis were presented as

follows. All the hypotheses were tested at 0.05 alpha level

of significance.

Hypothesis 1: There will be no significant differences in

the pattern of health education provided about prevailing

health problems towards the implementation of PHC services

in the three (3) LGAs of Ilorin metropolis.

Table 1: Means, Standard Deviation and t-value of

Respondents on the pattern of Health Education

Provided about Prevailing Health

21

problems towards the Implementation

of PHC Services in Ilorin Metropolis

L.G.A

Noofcases

Means StandardDeviatio

n

Degreeof

Freedom

Calculated T-value

Table

Value

Remark

Ilor

in

East

80 6.54 0.43

237 *1.36 1.96

Signifi

cant at

0.05

Alpha

Level

Ilor

in

Sout

h

80 6.03 0.4

Ilor

in

West

80 6.4 0.42

Table 1 shows the responses of the respondents on the

patterns of health education provided to the people about

prevailing health problems towards the implementation of PHC

services in Ilorin metropolis. The calculated t-value of

1.36 as against the table value of 1.96 with a degree of

freedom of 237 was obtained. Since the calculated value was

22

less than the table value, the null hypothesis (Ho) was

accepted at 0.05 alpha level. This implies that there was

no difference in the pattern of health education provided to

the people of Ilorin East, South and West LGAs in the

implementation of PHC services in the area.

23

Hypothesis II: There will be no significant differences in

the way the people of the three (3) LGAs of Ilorin

metropolis perceive PHC delivery system.

L.G.A

Noofcases

Means StandardDeviatio

n

Degreeof

Freedom

Calculated T-value

Table

Value

Remark

Ilor

in

East

80 15.38 1.08 237

??

1.96 Signifi

cant at

0.05

Alpha

Level

Ilor

in

Sout

h

80 12.51 0.07

Ilor

in

West

80 16.02 1.26

*P <0.05

Table 2 shows the perception of PHC delivery system by

the people of Ilorin metropolis. The calculated t-value of

4.73 as against the table value of 1.96 with a degree of

freedom of 237 was obtained. Since the calculated value is

greater than the table value, the null hypothesis (Ho) was

24

rejected at 0.05 alpha level. This means that there was a

significant difference in the way the people of the three

(3) LGAs perceived PHC delivery system. Residents of Ilorin

East and West LGAs were well informed of the activities of

PHC, hence they perceived the programme positively. Their

counterparts in Ilorin South LGA saw the programme on the

negative side. This may be attributed to the fact that

Ilorin South is a new LGA in the metropolis, the health

information unit of the LGA is not yet equipped and staffed

to carry out the necessary enlightenment campaign in the

area.

Hypothesis III: Community Based Health Education Programme

is not a significant factor in the implementation of PHC

services in Ilorin Metropolis.

Table 3: Means, Standard Deviation and t-value of

Respondents on Whether Community Based Health

Education Programme is no a Significant

Factor in the Implementation of PHC

services in Ilorin Metropolis

L.G.A

Noofcases

Means StandardDeviatio

n

Degreeof

Freedom

Calculated T-value

Table

Value

Remark

25

Ilor

in

East

80 22.02 0.9

237 2.32 1.96

Signifi

cant at

0.05

Alpha

Level

Ilor

in

Sout

h

80 23.43 0.9

Ilor

in

West

80 22.65 0.9

Table 3 shows the responses of the respondents on

whether community-based health education programme is or is

not a significant factor in the implementation of PHC

services in Ilorin metropolis. The calculated t-value of

2.32 as against the table value of 1.96 with a degree of

freedom of 237 was obtained. Since the calculated value is

greater than the table value, the null hypothesis (Ho) was

rejected at 0.05 alpha level. This implies that community-

based health education programme is a significant factor in

the implementation of PHC services in Ilorin metropolis.

26

Discussion of Findings

The finding that no significant difference existed in

the pattern of health education provided to the people on

the prevailing health problems towards the implementation of

PHC delivery system is consistent with the fact that Ilorin

is the capital city of Kwara State: people of the area are

bound to benefit from the health education programme of the

Federal State and Local Government Areas; and non-

governmental organizations like WHO, UNICEF and UNESCO are

various attempts to reduce health problems in the area to

the bearest minimum. Ebomoyi, (1986) was of the view that

effective implementation of health information programme of

PHC services is dependent on adequate staffing, facilities

and enabling conditions for the health workers. The finding

shows that health education, is given to the inhabitants on

individual and group basis in the homes, clinics, markets,

places of worship and other gatherings. Health education on

the prevailing health problems in the (3) local government

areas, is given to the recipients by health personnel,

27

parents, teachers, community leaders and members or non-

governmental organizations.

The finding that a significant difference existed in

the respondents perception of PHC delivery system by the

people of Ilorin metropolis is predictable because the

implementation, management and socio-economic status of

respondents in the area were slightly different. The people

of Ilorin East and West LGAs were well informed of the

activities of PHC. This is because the two LGAs were fairly

in the heart of the city, while their counterparts in Ilorin

South LGA were not well informed. The reason for this is

that Ilorin South is located in Fufu village, a suburb of

Ilorin metropolis where the majority of the inhabitants are

illiterate and know nothing about PHC delivery system.

Ilorin South, being a new LGA, the health information unit

of the State Ministry of Health (SMOH) has been trying to

assist the LGA in the organisation of workshops, seminars

and lectures to educate the inhabitants of Ilorin South LGA

on the efficacy and effectiveness of PHC services.

28

Ransome-Kuti (1987) described primary health care in

his broadcast to the nation as Health Minister and as

contained in Shodeinde in (1982) in page 13 as a community

- based health programme which lays credence to the

findings of this study that community-based health education

programme which is a significant factor towards the

effective implementation of PHC services in Ilorin

metropolis in particular and Nigeria in general. Caliendo

(1989) reported that community participation is the

essential prerequisite of PHC programme. Such involvement

can only be inspired through a properly conducted

educational effort (Health Education Programme). In line

with the National Health Policy (1989) which stated that,

The government of the federation shalldrive appropriate mechanisms forinvolving the community in the planningand implementation of health services.The policy further stated that thetraditional system and communityorganization shall be fully utilized inreaching the people.

The three (3) LGAs in the metropolis have decided to bring

health services to the grass root by involving community

29

leaders and members at all the four operational levels of

PHC in the LGAs viz: the village level, the health facility

level, the district level and the LGA level. They were

allowed to serve as members of health development

committees.

Recommendations

Based on the findings of this study, the following

recommendations were made:

1. The people of Ilorin metropolis (Ilorin East, South

and West LGAs) should be adequately informed of the

concepts, needs, problems and prospects of PHC

programme so that they can perceive the programme

positively and participate actively in its

implementation.

2. Government should provide more funds, procure health

facilities, recruit qualified health personnel,

create enabling conditions and provide the personnel

with good incentives in order to achieve effective

implementation of PHC programmes in the rural areas.

30

3. Members of the community should be made to

participate in the implementation of all sectors of

PHC service as members, programme co-ordinators,

initiators and supervisors. They should be well

oriented through seminars, lectures, workshops and

symposia.

31

References

Adegoroye, A. (1984). Community health care, London, MacmillanPublishers.

Bravema, P.A. & Tarimo., E. (1994). Screening in Primary HealthCare: Setting Priorities with Limited Resources. Publications of theWorld Health Organisation.

Caliendo, P.V. (1989). Expanded programme on Immunization.The continuing role of the European Region. World HealthOrganization Chronide. 39 (3) pg. 92.

Ebomoyi, E. (1986). Towards an Ideal curriculum for primaryhealth care Education. Nigerian Journal of Curriculum Studies. 4(1) pg. 140.

Federal Ministry of Health (1988): National Health Policy, Federal

Republic of Nigeria 2:3.

Federal Ministry of Health (1989): National Health Policy, FederalRepublic of Nigeria 1:1.

Folawiyo, A.F.A (1990). Promoting effective health for allthe year 2000: Myths and Realities. Journal of NigerianAssociation for Physical, Health Education and Recreation. Specialedition, 7 (2) September 71-78.

Henry, A.A. (1993). A to Z of Community Health and social medicine inmedical and Nursing practice with reference to Nigeria. Published3Am Communications, Dugbe, Ibadan.

Shodeinde, A.O. (1992). Primary Health Care in Nigeria: Our children cannot Live. 1st Published 1992 by Emancipation Consultantsand Publishers Ltd. Lagos. Printed by ICIC (Directory)Publishers Ltd.

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