ANÁLISIS COMPARATIVOS DE LOS RESULTADOS OBTENIDOS E

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addition of the use of key informant interview and actual visit to executed project sites to determine its maintenance and sustainability.

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Community ownership is people working together voluntarily to achieve their own initiatives using available resources to shape their own destiny with the help of Almighty God.⁴⁴

The role of the community in making choices and decisions with regard to priorities and strategies should be adequately supported by health education.⁴⁵ They should be involved in planning, implementation, utilization, operation and evaluation of programs/projects that would be beneficial to the community. There are three ways in which a community can participate in beneficial programs to prove their commitment and ownership. Firstly they can provide in the form of facilities, manpower, logistic support, and possibly funds. Secondly, they can be actively involved in planning, management, and evaluation. Thirdly, by maximum utilization of the provided facilities.⁶ Also the community can provide managerial control over planned projects by making sure that the objectives decided on are carried out as planned, correcting any deviation from methods planned and by endorsing any deviation from methods planned if they are better than the original plan.⁴⁵ Effective interventions rely on community participation. Effective interventions are achieved when the community supports the identified health needs, priorities, capacity and any barriers to action. However, community participation is not easy to obtain as extensive experience has indicated.⁴⁶ It has become an aphorism that is still awaiting genuine realization in many countries of the world.⁶

Several studies have shown that the task of good governance of the local/rural areas cannot be left to the government alone; rural people themselves must have a stake in their own development and that unless there is full participation of the rural people in the whole process of local/rural development; there will not be any sustainable development. Participation should be coupled with democratization of the rural masses and transfer of power to the grassroots level. Also of note is that development is not really possible if it is not

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participatory. External agents may facilitate this process, but they cannot even with the best of intentions consummate it. In the final analysis, a people develop itself through its own exertions.^47–53 A study carried out by Oviasuyi on model for involvement of local community in development projects and programs of Local Government Authorities in Nigeria⁵⁴ advocated the adoption of his proposed 10-step model to bridge the gap between the Local Government officials and their local communities. The steps include: Identification of local communities and their representatives; inauguration of partnership meeting between local government officials and local communities’ representatives; report the resources of the local government authority to the various local communities; report the proposed utilization of the resources to the local communities; articulation of the basic needs of the people with them; involve the local communities in planning projects/programs that will meet their needs;

involve the local communities in the process of awarding contracts for the execution of projects/programs; involve the local communities in monitoring the execution of projects by contractors; involve local communities in the evaluation of projects at every stage of implementation/execution and compare the executed projects/programs with the articulated basic needs of the people. These steps necessarily should be followed judiciously to enable the local community gain full ownership of programs/projects executed in their domain and thus encourage them to maximally utilize the provided facilities/services.

A study in Kenya assessed the factors that promote community participation in community driven approach⁵⁵ and concluded that benefits (financial and non-material) are key factors that make communities to participate in development. Specifically, factors that promote beneficiary community participation in the community driven development approach included development need, followed by development interest, wanting to belong and project meeting needs. Other factors include community member’s felt need and burden to serve their communities. It was further concluded that financial benefits, previous development

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experience, to serve community, material benefits and peer pressure do not necessarily motivate communities to participate in development in the community driven development approach.

Utilization of provided facilities (for example health services) is influenced by the prevailing economic, educational, geographical, socio cultural, political, legal and religious conditions of the community or society.²⁹ It is also affected by the attitude of health workers, availability of skilled staff in the health facilities, supply of commodities and service delivery. Other important factors that influence utilization are: distance of clients from health facilities, age (maternal age), gender roles and parity.^56-57 It is difficult to identify which determinants are most influential in the decision to utilize health care. The distance patients must travel in order to obtain treatment is especially significant in rural third world settings where the density of western-type health facilities is low, where the majority of patients are likely to make the journey for treatment as pedestrians and where there are viable and usually more accessible alternative sources of medicine.^58–60 In general, factors influencing the utilization of health services may be classified into individual related variables and provider related variables. Common examples of individual related variables include socio-demographics, (i.e. Age, Gender, Marital status, Educational level, and Employment status and Family income); and individual health related factors (i.e health insurance, perceived health status, presence of chronic diseases, and registration with public PHC center). Some commonly mentioned provider-related variables are: accessibility factors (i.e. location of health facility, waiting time in the facility); availability factors (qualified staff, ancillary services, specialist doctors, modern equipment) and quality-related factors (Staff cleanliness and friendliness, internal organization and procedures and reputation of the health facility).⁶¹

In the 2008 NDHS, the perceived problem in accessing health care was assessed. Women were asked whether each of the following factors would be a big problem in seeking medical

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care: getting permission to go for treatment, getting money for treatment, distance to health facility, transport cost, not wanting to go alone, concerns that there may not be a female provider or any health provider, and concern that drugs may not be available. Three-quarters of women reported that they have at least one serious problem in accessing health care. The leading barrier to health care for Nigerian women is getting money for treatment. Fifty-six percent of women said that getting money for treatment was a serious problem in accessing health care. Forty-one percent of women said they were concerned that there would be no drugs available at the health facility. About one in three women reported that transportation, distance to the health facility, and not having a provider to attend to them are big problems.

Twenty-one percent of women were concerned that there would be no female provider to attend to them. Not wanting to go alone (17%) and problems getting permission to go for treatment (14%) were less likely to be reported as a hindrance to seeking health care.²⁴ The relevance of this study to my work is that one of the reasons for establishing the MDG-CGS-LG is to eliminate some of these constraints to accessing health care or educational services through provision of new health centre buildings, new school buildings or renovation of old ones. There was also provision of health facility commodities like drugs, ambulances and medical equipment and school books, benches and chairs free of charge. How best have these provided commodities improved utilization of these public health and education facilities would be assessed in this study.

In another study in Edo North Senatorial Zone of Edo State that assessed the utilization, determinants and perceptions of public primary health care services, it was found out that the utilization of services for treatment of common ailments at PHC facilities ranged from 433 to 947 per year per 10,000 populations for respondents from rural and sub-urban communities respectively. The utilization of selected services was 80%, 70.8% and 37.3% for ANC, delivery and family planning services respectively. There was however no utilization for

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postnatal services. The predictors of the utilization of the basic services included: ethnic groups of the respondents, educational status of respondents, cost per illness episode at the PHC facilities, self-assessment of health of the respondents, clean environment of the PHC facilities, marital status of respondents, average income of respondents and type of community of the respondents. The perception of respondents about the quality of services was 53% and 42% for good and very good quality of services respectively.²⁹ The study design was a comparative cross sectional analytical study. An equal number of respondents (171) from both the sub-urban and rural communities participated. This study was conducted using researcher administered questionnaires; key-informant interview guides for heads of primary health care facilities; and medical officers of health and an observational check list for the health facilities. Household members were selected through a multistage sampling method. Quantitative data were analyzed using SPSS version 17.0. Binary logistic regression was used to identify predictors of utilization of these services. However utilization of the health services were assessed using hospital based records and questionnaires. Individuals who had accessed services for a minimum of 3 times in six months was said to have had an ideal utilization of curative service. This did not put into consideration the possibility of no ill health for the respondents.

2.4 COMMUNITY INVOLVEMENT IN THEMATIC AREAS OF PROJECT