EVALUATION OF CHILD HEALTH CARE SERVICES IN HEALTH FACILITIES IN NSUKKA URBAN OF ENUGU STATE

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Table of Contents
Title Page
Approval Page
Certification
Dedication
Acknowledgement
Table of Contents
List of Tables
Abstract

CHAPTER ONE – – – – – – – – – 1
Background to the Study – – – – – – – – 1
Statement of the Problem – – – – – – – – 8
Purpose of the Study – – – – – – – – – 9
Research Questions – – – – – – – – – 10
Hypotheses – – – – – – – – – – 10
Significance of the Study – – – – – – – – 10
Scope of the Study – – – – – – – – – 12

CHAPTER TWO: Review of Related Literature – – – – 13
Conceptual Framework
Theoretical Framework
Objectives and Importance of Child Health Care – – – – – 28
Factors Affecting the Provision of Child Health Care Services – – – 30
Studies on Child Health Care Services – – – – – – 32
Summary of Literature – – – – – – – – 38

CHAPTER THREE: Methods – – – – – – – 39
Research Design – – – – – – – – – 39
Population for the Study – – – – – – – – 39
Sample and Sampling Technique – – – – – – – 40
Instrument for Data Collection – – – – – – – 40
Validity of instrument – – – – – – – – 40
Reliability of instrument – – – – – – – 40
Method of Data Collection – – – – – – – – 41
Method of Data Analysis – – – – – – – – 41

CHAPTER FOUR: Results and Discussion
Results
Summary of Major Findings

Discussion of Findings
Efficiency of Immunization Services Provided Health Facilities for Children
Reliability of Growth Monitoring and Screening Tests
Provided in Health Facilities for Children
Effectiveness of the Curative Services Provided in Health Facilities for Children
Reliability of the Emergency Services Avaialable in Health Facilities for Children
Usefulness of Nutritional Service Available in Health Facilities for Children
Consistency of Health Education Services Available
Competency of Staff who Provide Care for Children on Health Facilities.
Problems that Affects the Provision of Child Health Care in Health Facilities
Administrative Strategies for Improvement in Child Health Care in Health Facilities
Difference in the Quality of Services Competency of Staff and administrative Problems of Public and Private Health Facilities.

CHAPTER FIVE: Summary, Conclusion and Recommendations – – 65
Summary – – – – – – – – – – 65
Conclusion – – – – – – – – – – 68
Implications of the Study
Recommendations – – – – – – – – – 69
Suggestion for Further Study – – – – – – – – 69
References
Appendixes
Appendix I: Letter of Introduction
Appendix II: Questionnaire
Appendix III: List of Health Facilities Studied.
List of Health Facilities Studied
1. University of Nigeria, Medical Centre
2. Comprehensive Health Centre Obukpa
3. Nsukka Health Centre
4. General Hospital, Nsukka
5. Bishop Shonahan Hospital
6. Good Shephard Hospital
7. Nsukka Medical Clinic
8. All Saints Medical Clinic
9. St. Antaony’s Hosptial
10. St. Michael Cottage Hosptial
11. Holy Child Clinic and Maternity
12. Unity Medical Clinic
13. Chukwuemeka Hospital and Maternity
14. Arinze Memorial Hospital
15. Akulue Memorial Hospital
16. Chidubem Hospital
17. Zenith Hospital

List of Tables

1. Efficiency of Immunization Services in Health Facilities in Nsukka Urban
2. Mean Ratings of the Reliability of Growth Monitoring and Screening Tests Provided in Health Facilities for Children
3. Effectiveness of the Curative Health Care Services in Health Facilities for the Specified Health Conditions
4. Mean Ratings of Responses for the Reliability of Child Care Emergency Services in the Specified Situations
5. Mean Ratings of the Responses About the Usefulness of Nutritional Services Provided in Health Facilities for Children According to the Specified Conditions
6. Consistency of the Expected Health Education Services Provided in Health Facilities for Children
7. Competency of Staff who Provide Care for Children in Health Facilities for Specified Situations
8. Administrative Problems that Affect Provisions for Child Health Care in Health Facilities
9. Administrative Strategies Used for Improvement in Child Health Care in Health Facilities
10. Summary of t-test Analysis of Services Provided in Public and Private Health Facilities
11. Summary of t-test Analysis of Competency of Staff who Provide Care for Children in Public and Private Health Facilities
12. Summary of t-Test Analysis of Problems Encountered in Public Hospitals and Problems Encountered in Private Hospitals

Abstract

Evaluation of child health care services in health facilities in Nsukka Urban is the main focus of this work. To achieve the purpose of this work, 430 mothers and 156 health care providers were used to collect quantitative data for the establishment of the baseline data. The instrument for data collection was the evaluation of child health care questionnaire comprised of two questionnaires, which helped to gain responses from mothers and health care providers respectively. The data collected was analyzed using arithmetic mean and percentages for the research questions and t-test statistics for the hypotheses. The findings of the study showed that the components of child health care services proved supportive in the improvement of children’s health status in Nsukka urban and staff were reasonably commended as competent in their effort ensure quality care for children in health facilities. The findings of the study also showed that the investigated administrative problems and strategies for improvement in child health care services were considerable and should constitute part of the established standard protect providers in their practice in order to avoid obstacles and uphold high quality care for children.

CHAPTER ONE
Introduction
Background to the Study

Child health was once part of adult medicine, but emerged in the 19th and early 20th century as a medical specialty because of the gradual awareness that the health problems of children are different from those of grown ups and that response to illness and medication depends upon the age of the child (Hetch & Shiel, 2006). Children are the promise and future of every nation and the core of development which made World Health Organization-WHO (2004) observe that investing in children’s health and development means investing in future of a nation. Children are vulnerable group whose needs and rights must be protected including the right to health and development. Paediatricts (2004) also reported that advances in prenatal intensive care have been associated with improved survival of high risk neonates, but have not resulted in decreased morbidity in children. This helped to bring about child health care services.
Child health care services according to Turmen (2006) are provisions made to improve optimal growth and development in infancy and childhood through disease prevention, good nutrition and health supervision. Hetch and Shiel (2006) defined child health care as services which focus on the well-being of children from conception and is concerned with all aspects of children’s growth and development and with the unique opportunities that each child has to achieve his or her full potential as a healthy adult. According to Onuzulike (2005), child care services are total care and services rendered to children 0 – 5 years in order to maintain their healthy living. Therefore, child health care services are efficient strategies provided by health workers in order to promote health and prevent diseases, disabilities and death in children through simple cost effective measures. Hetch and Shiel (2006) observed that a healthy child’s development actually begins from the parents, and once the baby is delivered other matters such as breastfeeding, newborn screening tests, sleeping safety, health care appointments for check ups and immunizations are considered. As services are provisions made for the public to use as much as they need in order to benefit from them, the purpose of child health care in health facilities is to promote the health of children, provide support in maintaining and improving children’s health through counseling, medical examination, treatment and immunization.
Child health is a critical issue of concern to everyone, and at the level of the family, the community, the nation and the international community. This is because successful societies safeguard their future by continually striving to improve the well being of their children. They understand that healthy, well developed educated and respected progeny ensures that past achievements serve as the foundation for continuing progress (Turmen, 2006). In order to improve health outcomes of children there should be more effective organization of preventive services and more coordination between practices. Intervention to achieve an effect on children and to overcome specific barriers in the process of care delivery needs to be adopted so that preventive services could be effectively delivered.
Therefore, Changes in the organization of the delivery system that concerns children will lead to improvement in preventive health outcomes for them (Margolis et al., 2005). International communities and individual countries are repeatedly committed to improving child health. WHO (2004) however stated that this commitment needs to be translated into stronger action if the silent tragedy of preventable death, illness, disability and impaired psychosocial development among children are to be avoided, and if children’s quality of life is to be improved.
Improving child health development relies, to a great extent, on understanding the causes of child morbidity and mortality with programmes and policies aimed at improving the health of children. Moy (1998) reported that twelve million children under five years of age in developing countries die every year before their fifth birthday and seventy per cent of these deaths are due to five common preventable and easily treated childhood diseases namely: acute respiratory infections, diarrhea, measles, malaria, and malnutrition or the combination of all five which also account for three quarter of all childhood morbidity. Schor (2004) observed that historically, the field of paediatrics has been concerned with promoting children’s health and development as with treating children’s diseases, and the trend in children’s health status showed that their physical health is better than it has ever been. This is as result of scientific progress which has led to substantial reduction in many of the acute morbidities of the early 20th century and increasing survival from acute illness and premature births.
Various interventions for the prevention and management of childhood illnesses have been established to be provided through health services. According to Moy (1998), Expanded Programme on Immunization (EPI) was founded by WHO in 1977, the control of Diarrhoeal Diseases Programme (CDD) was established in 1980, and in 1985 the control of Acute Respiratory Infection Programme (ARI) was added to these vertical strategies. With WHO technical support and UNICEF (United Nations Children’s Fund) sponsorship, these three programmes have been put in place and health workers are trained through workshops to recognize key signs of illnesses and to implement correct treatment and follow-up actions. Also, a strategy known as integrated management of childhood illnesses (IMCI) was formulated by WHO and UNICEF in 1996 as an additional and principal strategy to improve child health, which concentrates on their overall health status by integrating all intervention for prevention, treatment and health promotion (Healthy Children Goal, 2002).

However, the potential policy option for reducing the burden of children’s diseases would be to utilize the public and private sector health resources in a coordinated fashion with options for health sector reform to achieve its goal of providing quality health care to members of the population (Thind, 2004). Evaluation of child health care services is one of the strategies that can be used to provide for this reform, to encourage improvement in the quality of care provided for children.
Trochim (2006) defined evaluation as the systematic acquisition and assessment of information to provide useful feedback about some object. Evaluation as it concerns child health care in hospitals can be defined as the assessment of the features or attributes of hospital provisions for children’s care in order to determine their influence on children’s health, and the extent to which they are meeting the objectives of child health care. The goal of evaluation is to provide useful feedback to clients, groups, administrators, staff and other relevant constituencies and to influence decision making or policy formulation. It strengthens or improves the object being evaluated by examining the delivery of the programme, the quality of its implementation, the organizational context, personnel, procedures and inputs.

Evaluation helps to emphasize the importance of evaluation participants, especially the client or users of a programme and stake holders. Agency for Health Care Research and quality – AHRQ (2007) observed that potential audiences for quality measurement report for child health care services are the providers and the consumers. This is because providers are more familiar with their methods and problems they encounter in care delivery. Also parents are useful observers of the pattern of services provided for their children. In this case, several parental and health care providers’ perception measures, as well as several measures of the delivery of preventive care may be used to assess the quality of the health plan or programme for children in hospitals and health centres in Nsukka Urban. WHO (2004) observed that the main providers of health care and their role in child health includes the two main categories of government and public sector players. Thind (2004) added that the quality of the public facilities and quality of the private facilities were variables based on drug availability and ORS (Oral rehydration solution). This is because provisions for child health care in government hospitals may differ from provisions for child health care in private hospitals in both coverage and quality.
However, AHRQ (2007) emphasized that regular measurement of quality is an important programme management tool because it;

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