Modern HealthCare Facilities – Factors Influencing The Utilization

Modern HealthCare Facilities – Factors Influencing The Utilization

Modern HealthCare Facilities – Factors Influencing The Utilization

Health is the state of physical, mental and social well being. It involves more than just the absence of disease. A true healthy person not only feels good physically but also has a realistic outlook on life and gets along well with other people. Good health enables people to enjoy life and have the opportunity to achieve the goals they have set for themselves.

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To achieve and maintain good health people must have basic knowledge about the human body and how it functions. Only then can they determine what will or what will not help or hurt their health. Therefore learning about health should be a part of every person’s education, current knowledge about health together with good living habits can help almost everyone to maintain good health and improve the quality of life.

Society as a whole benefits from people good health just as individuals do. For this reasons various government and voluntary agencies strive to preserve and improve people health condition.

In this respect therefore, health is of strategic importance to a nation and its people because a healthy nation is a wealthy nation, since good health implies high productivity, low morbidity (ill health) and low mortality (death) rater. Hence the world health organisation (WHO) recommendation to the nations of the world to strive 2010”. Ransome Kuti (1986) has pointed out, however, that health for all in that year, does not mean that healthcare services would be totally free for all citizens in terms of cost, nor does it mean that everybody would be taken care of by specialist, teaching or general hospital, it simply means that in terms of accessibility, healthcare services would be available to each individual to utilize.

Byrant (1972) asserted that every apparent medical success must be measured against the need of all. Every effort, every cluster of resources must be divided by the total number of people. In insistence on using this denominator’ that is all the people, according to him, has profound social, political, ethical and educational implications. For examples of resources are too scared to serve all, the question of who should served arises. An effective healthcare system must meet the needs that the people see as immediate and urgent. At the same time, the health services and facilities must get to the communities and homes and influence patterns of life, the construction of dwellings, the protection of water, the delivery of babies, the feeding of children and the size of families. Whatever considerations, the obvious fact is that the increasing cost of medical care is posing a serious threat to the individual, family, state and the nation as a whole.

The concept of health, keeps before governments and the public the understanding that health is not something that can be achieved exclusively by the traditional health services, it is profoundly influenced by conditions of life. The provision of healthcare facilities varies from country to country. In America for instance, there are voluntary hospitals and other establishments owned by philanthropic organisations. There are also private establishment run on a commercial basis, and municipal, state and federal establishment for those unable to afford other forms of care.

In Nigeria, government has on various occasions adopted different healthcare plans, most of which did not achieve their intended objectives for a number of reasons. The first of such health plans was Harken Waller 10 years plan. This was 3-action programme with basic strategies being

a. Provision of portable water in sufficient quantities for every one.

b. Progressive promotion of environmental hygiene and

c. Expansion of hospitals, maternities, child welfare and dispensary services. This followed by the 1st National Development Plan of 1962 – 1968, which was since mainly at: -.

1. Improving the health situation in the country

2. Priority was given to the training of medical manpower and construction of medical centre e.g. maternities, dispensaries and hospitals.

The second National Development Plan was meant to be an improvement on the 1st National Plan after the post civil war economy and wide spread of malnutrition.

In 1975, a 3rd National Development Plan was set up and was regarded as the National Basis Health Services scheme (NBHSS), which was designed with the assistance of the WHO. Based on primary Healthcare. This was designed to:

a. To increase the coverage of medical services

b. To ensure community mobilization and participation in providing health services,

c. The use of simple and relevant medical technology appropriate to each community.

d. For preventive measures.

This was a more positive step to provision of basic healthcare facilities to the people, although problems were also encountered which gave rise to 4th National Development Plan in 1981. This was designed as an integrated primary healthcare system. In 1986, therefore the Federal Ministry of Health adopted a strategy from implementing THE HEALTH FOR ALL BY THE YEAR 2010 in which Nigeria is divided into 4 zones and each zone by a zonal coordinator.

In spite of all those plans and acceptance of the concept of healthcare, there is continued in-balance in the distribution and utilization by healthcare facilities especially among rural folk. Based on this therefore, this study is aimed at finding out the causes of non-utilization of modern healthcare facilities among Akpulu community. The study also focuses on the correlation between the people’s level of education and knowledge towards the understanding of healthcare.

Most members of Akpulu community are ignorant of environmental sanitation cultural belief, family planning, malnutrition and mostly, the traditional medicine men dominated the rural communities and these exercise create influence on the communities. The poor situation had with an alarming high rate of mortality. It is these problems that accused the researcher interest in finding out factors responsible for non-utilization of available healthcare facilities.


The utilization of public health facilities is a serious problem among rural areas especially Akpulu community where the present study was carried out. Despite improvement in medical and healthcare services all over the world, problem of healthcare still persists in the area. This is because medical and healthcare faculties are more concentrated in the towns, making these facilities inaccessible in terms of distance to the rural populace and even the urban dwellers that live in slum areas. In rural community, where the majority of our people live and work, health facilities are rare, poverty is rife and scientific thought and action are unknown. As a result of little or no medical facilities, there is high incidence of mortality among infant and elderly people in the rural areas like Akpulu, hence the study.


This study is however the survey of those factors responsible for non-utilization of modern healthcare facilities in Akpulu.


1. Does Akpulu people go to hospital when they are sick?

2. Does cultural belief have any effect on Akpulu people’s healthcare?

3. Does the people of Akpulu receive the kind of healthcare treatment that is suitable for them?

4. Does Akpulu people treat themselves quickly as soon as they fall sick?


The broad objective of this is to find out the factors influencing the utilization of modern healthcare facilities in Akpulu community. On the basis of the general aim, the following specific objectives have been formulated.

a. To determine the available modern health facilities in Akpulu area.

b. To determine the categories of the people that seek the use of these facilities,

c. To determine the extent to which the available modern health facilities are put into use.


This study is necessary because it is an effort to find out what health facilities are available in Akpulu Community and how adequate they are when compared with the standard set by the government. It is hoped that the information from this research may help the authorities of this area in the future plans for provision of health facilities. It is therefore hoped that the result of this study may lead to more emphasis on preventive rather than curative aspect of medicine by the provision of more basic health facilities in the community and also members of the society as a whole. Besides better health necessarily results in accelerated population growth and improvement in health would promote learning, reduce absenteeism, improve stamina and increase energy output. Therefore better health especially among adults would contribute to improving the economic status of the poor, the low life expectancy in communities is due largely to very high death rate among children and this due to health conditions.

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For better understanding of this work, certain concepts, which appear vague in terms of their usage, were operationally defined.

1. Utilization: Utilization is the use of something especially for a practical purpose. For the purpose of this study utilization refers to the people’s participation in modern health area programmes and attitudes there to.

2. Modern Healthcare Facilities: This refers to the facilities and attitudes relating to orthodox medicine.


The study area is Akpulu Community in Ideato North Local Government in Imo State, which consist of five villages namely Okwu, Isieke, Umuisim, Ubaha and Okpoko.

I will like to write on the following.

1. Location: Akpulu is a community in Ideato North Local Government Area in Imo State. It is located at the northwestern frontier of Imo State and maintains good boundary relationship with its neighbouring communities. It lies between Aguata Local Government Area in Anambra State and Ideato Local Government Area of Imo State.

2. Economy: Akpulu is well known for her economic activities right from time. Their economic life is based mainly on agriculture and trading. Both sexes take part in farming and trading. They grow such crops as yam, melons, Cocoyam, maize. These they sell in order to get money in return.

3. Politics: The political organisation of Akpulu is very similar to that found in any other Igbo community.

Political administration in Akpulu is mainly based on village assembly comprising all adults male, there after is Diokpara (council of elders) then followed by Age grade Umuada. The compound elders make laws or the “Amala and Ozo” titleholders act as the appeal court.

4. Religion: Akpulu Community is a traditional community. They believed so much in traditional religion and they worshipped their gods until the white men brought in Christianity. In Akpulu today, more then half of the community are Christians.




Much of the literature reviewed here centre on the situation as it applies to population outside Nigeria.

However, there is also information on the situation, as it exists in Nigeria and some other African Countries.

Before modern medicine was introduced into Nigeria, traditional medicine was in existence. There is evidence to show that traditional medicine with its component health measure, still exist in Nigeria alongside with modern healthcare system. Laoye, (1975) described the existence of traditional midwives in nearly all the Nigeria villages and even in highly urbanized areas of the country even though some modern facilities also existed. This pattern of health care delivery system is not peculiar in Nigeria alone, as it has been described in other African countries. In addition, to the co-existence of the two types of health services, traditional health care services predominantly exist in rural areas. MacLean (1971) reported of local people in East Africa and South Africa who employed traditional treatments to a large extent as determined in a cancer survey.

According to Benyoussef (1977) in his analysis carried out in the government of Nabent, Tunisia by the Tunisian ministry of public health and the world Health organisation (WHO) to ascertain which factors discriminate high and low level of utilization of health services. A total of 678 (446 Urban and 232 rural) households, comprising 3,808 individuals were interviewed. The result revealed that those who made existence use of the health services were generally more literate than those who did not and that social-cultural and economic differences existed between the two categories. On the basis of this study Benyoussef suggested that the utilization of health facilities may be an indicator of modernization and hence that improvement in health services as well as the process of change in the society. He further asserted that the effects of socio-economic status as a factor influencing choice and in utilization of health facilities are more pronounced in developing counties because of the greater relative differences influence and also because of the scarcity of health services.

World Bank Health Sector Policy (1976) noted that in Yemen Arab Republic shortages and mal-distribution of some categories of health personnel characterised Middle Eastern Countries. Nursing, laboratory and technician staffs are generally in short supply. Cultural and religious traditions require that only females attend no men, yet all countries in the region have a critical shortage of female personnel. As a result, emphasis was laid on training traditional midwives to ensure access to service for women and children. In Yemen Arab Republic fore example 47% of physicians and 20% of nurses are expatriates.

WHO Annual Statistics (1973: 76) reviewed that, a fairly wide spread system of private medical facilities compensates to some degree for public sector mal-distribution. Health centre and clinics or sub-centre in rural area are often understaffed and so do not adequately serve their catchments areas. However, underutilization of public health facilities is a serious problem throughout rural sectors, due to poor staff and management as well as competition with highly complex system of traditional medicine.

World Bank Health Sector Policy (1980) noted that rural areas face major problems of health personnel due to greater opportunities abroad for specialization and economic advancement.

However, the distribution of physicians remains a problem for most rural communities. For instance, in Indonesia, about 60% of physicians are concentrated in urban areas. In Thailand there are three times as many physicians in Bangkok as in the remainder of the country. In Korea there are eight times as mush physician times available per capital in Seoul as in the rural provinces.

Macstravic (1978) was of the opinion that the factors that possible affected demand for contact with the health service system can be classified under two major headings namely: those that affect future demands; initial factors are: socio-economic status, physical, cultural and geographical factors while new factors according to him include cost for alternative type of care; institutional ties, knowledge and cost to the physician in time and effort. He asserted that economic factors, though important are not the sole determinants of utilization of healthcare facilities and services.

Galli (1978) observed that within African cultures, the central figure responsible for the well being of the people is the witch doctor, which continues to hold a secure place in the socio-cultures. Many people still have infinite faith in his healing powers and services.

In a study to determine factors that influence the choice of medical services among residents of Nsukka, Nwana (1986) identified socio-economic status and nearness or accessibility as factors associated with utilization of health services. The sample consisted of 189 residents of the of the Nsukka Campus health services has been identified by some experts as an important factor in hospital utilization. New and Ogunmekan (1977) identified geographical accessibility as factors especially in developing countries where transportation services are lacking or deficient and there are great distances between urban areas. In some areas, the people or inhabitants may have to walk for days to reach the hospital, which is sited within an urban area. Such people will not be motivated to visit such modern health services in future and will tend to patronize such sources as may be available within their community.

However, Hamburg and Russell (1986) noted that when considering the impact of ways of life on health, we must recognize the importance of influences determined by personal behaviour. The are significant in developing countries, not only in relation to mental illness and basic needs such as nutrition, sanitation and family planning but also for control of new hazard acquired from the developed world-alcohol, smoking.

Robert Soeters and Selestine Nzala (1994) on their emphasis in primary health care maintain that health facilities were often unobtainable for vehicles used by the health services. The lack of resources in both communities and the health institution became the main obstacle to success in the primary health care programme. And the main reasons for this are as follows: Motivation is low because of poor salaries and working conditions, good performance is neither encourage or rewarded, poor performance is not discouraged, Government garages, transport units and other bodies are not permitted to make their services available to outside organization or community.

The health of human beings covers many dimensions- physical, mental, social and spiritual. The promotion of health of individuals and whole communities must therefore take into account all these components based on the available human and technological resources.


Abdul- Azizm and Hedia Belhadi (1994) in their own view emphases that serious organizational problems beset family planning and maternal and child care. This is because shortages of qualified personnel exist at both the center and the periphery planning and target setting are defective and there is a failure to control resources adequately in the interest of the safe motherhood strategy. More so, there are considerable shortages in the supervision and monitoring of services delivery, particularly in the rural areas. In general, supervisors are too few in number, too far away and saddled with heavy responsibilities and they often exhibit non- supportive styles that do lead themselves to motivation.

In addition, the financial resources allocated to maternal health and family planning is grossly inadequate. Drugs, equipment and other commodities are in short supply and their distribution is hampered by factors ranging from time consuming, administrative procedures to highly centralize, inefficient storage and inventory systems.

World Health forum (1994) observed that, the resources available for health are limited, those that exist are seldom fully utilized and are often wasted or misused. These resources include both economic factors, preventive and therapeutic elements, latent and ability information, knowledge and the community. All resources should be taken into account and used in better if not new ways, skills and authority often lacked and in many societies, there is a common view that the health sector is merely a receiver of resources rather than a rational and creator of them.

Eastman (1947) maintained that the failure of poor women to seek modern medical care reflects ignorant, cultural attitude among the impoverished about medical care in general. Non-utilization or minimal utilization of public and quasi-public health facilities is considered to be the result of residents not being aware of the value of preventive medicine, since most aspects of their lives are run on an emergency basis, taking care of a condition only when severe pain is experienced.

Education is another factor, which appears to influence patterns of care in the rural community. Ross (1962) in his analysis of National Health Survey data, found that in general, highly educated persons made a much higher percentage of their physician visits for preventive care than did those with less education and that there were marked differences in the total number of physician visit, children receive according to the educational level of the family head.

However, traditional medicine also has an influence on utilization of modern health care facilities.

Charles Boelen (1993) in his analysis estimated that some 80% of the world’s inhabitants rely chiefly on traditional medicine for their primary health care needs and it can safely be assumed that a major part of traditional therapy involves the use of plant extracts of the active principle.

Based on the above assertion Olayiwola Akerele (1993) noted that Government, ministries and department of health should take the lead in formulating policies and actions to promote the training and the use of healers in primary care. They should ensure that traditional practitioners are incorporated as fully and effectively as possible into health services that meet the needs of the communities. An atmosphere of understanding, trust and respect should be created between modern health workers, traditional healers and the communities they serve. This according to him, should require a mechanism whereby activities such as informal meetings, seminars and workshops are planned and key people representing the modern and traditional sectors come together to express their views establish common goals and develop ways of using traditional healers in primary care teams.

Benyoussef (1977) and New (1977) observed that health care delivery system could be categorized into two major types. They are the modern healthcare delivery system, which includes the alternate system of healing. The traditional health care system can be aquatic to folk medicine. It is characterized by the use of herbs and it shrouded in magical methods. It is more abundant in the rural areas. The alternative systems of healthcare delivery consist of prayer/healing houses acupuncture and homeopathic medicine. The prayers/healing houses combine the use of prayers and incantations. The modern health care delivery system consists of such health care services that rendered by the hospitals, clinics, maternities, health centres, dispensaries and laboratory units etc. they are predominantly located in the urban areas. The problem with these major systems of healthcare delivery has been that interaction of all them as each system tends to be antagonistic of the other. Although the responsibility for ones health rests with the individual, no one is totally self-sufficient in dealing with all the necessary requirements to safeguard, maintain and promote health. Consequently, one has to patronize to utilize one or all the available systems in ones locality. Djukanovic V. and Mach E. P. (1975) Has observed that, less than 15% of the rural population and other underprivileged groups have access to health services. More serious still, these people are both exposed and prone to disease. A hostile environment, poverty, ignorance of the causes of disease and of protective measure lack of health services or inability to seek and use them all may combine to produce this sorry situation. More so interest should been taken in improving basic health coverage, the mobilization of resources, the utilization of services, understanding of health problems and health services, the quality of health care and the satisfaction of consumers and providers with the care given.

Finally, from the researchers own point of view, the non-utilization of modern health care facilities among the rural folks are as a result of social and environmental factors. Community lack human materials and financial resources to meet its health needs. There is an absolute shortage and the situation is often complicated by faulty utilization or distribution of the health resources that exist. The shortage of financial resources affects the larger needier, rural population more than the city dwellers. Non-utilization of health care facilities could also be reflected such factors as the attitudes of health personnel, disregard of traditional system and personnel insufficient awareness of the need for community knowledge and involvement, social inaccessibility and poor transport. It is also true however, that people are often not inform about available health services or are not clearly aware of the types of health measure offered or the reasons for them. Even people lack confidence in the local health institution preferring when ill to go to urban hospitals or traditional practitioners and this led to under utilization of health units.


In explaining the theoretical orientation, some of the sociological theories like functionalist perspective and conflict perspective will be applied.


Generally, functionalists look at any thing in the society from the perspective of those functions, which it performs for the survival of the society at large. From the point of view of health care and factors influencing the proper utilization, functionalist believe that some level of health is very essential for both the individual and society, to function effectively. If human society must function effectively, there must exist a reasonable number of productive members who will carry on the vital tasks necessary for the survival of the society.

The functionalist sees the society as the body organs, and the malfunctioning of one part affects the whole system. In this case, the community will not witness proper utilization of its modern health care facilities if the whole community is not working in one mind. Health institution therefore emerged to help society provide for the proper utilization of the modern Heath care.

In a situation where large number of the people suffer from diseases especially of the acute infections types as is common in third world societies, and such are unable to carry out their normal life activities, this will certainly affect general productivity of the people and survival of the society as a whole. High degree of morbidity affects the individual’s vitality, ability to work and play. Hence, every society evolves a medical institution to address the health problems and help the society to ensure a high level of health.


The conflict perspective sees the health care facilities from a radical viewpoint. The conflict perspective believes that in human societies like ours, is a magnitude of inequality in modern health care facilities. Some people have greater access to health care services and other resources that contribute to good health while some others live in conditions that are in sharp contrast to this. This is therefore a product of social conflict, which is endemic in society.

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The conflict viewpoint challenges this postulation of the functionalist. They see health care as something that is desired by every body in society, but not every body is able to have it. No one actually prefers to be ill. What happens is that some people have better health than others because they have access to those resources that keep them in good health and to recover quickly if they fall sick.

In Nigeria today, health just like many other important resources are unequally distributed among the population. People in the rural area when compared with their counterparts in the urban settings do not have access to adequate health care facilities. Even when we compare the ruralities among themselves, we would se that some are more rural than others. Some rural communities do not only lack health care facilities but also lack access to basic social amenities such as roads. This makes it very difficult for such people to have easy access to such health facilities in other communities where they exist. There have been cases where patients die on the way to hospital due to delays resulting from absence of memorable roads. Aside from the absence of heath care facilities in rural areas, most rural dwellers live in abject poverty and as such cannot afford what it takes to maintain the modern health care facilities. This has serious consequences on their ability to stay healthy and to recover quickly when sick.

Some of the problems militating against the proper utilization of modern health care to all are:

(1) Widespread poverty, which makes it very difficult for many people not to have good health.

(2) In many rural health centers it is a common knowledge that qualified health personnel are often lacking. Most hospitals do not have resident doctors, even where one is posted to such hospital, they prefer to operate from outside the community, where there is electricity and pipe-borne water. These are among the factors militating against proper utilization of modern health care facilities. Also, most of these rural communities are so infrastructural and economically underdeveloped that they cannot attract qualified private medical doctors from urban areas.

The inequality in health between the poor and rich and otherwise urban and rural is made worse by the glaring contrast in the conditions of their living. Most poor people live in the rural areas, and those who live in the urban areas, live in squatter settlements most often characterized by absence of tap water, electricity, poor housing and sanity conditions and so on.



This chapter identifies the scope of the study, the target population, the sample size and sample technique, as well as the instrument used for data collection.


This study was carried out within the premises of Akpulu community, mainly to investigate the influential factors responsible for non-utilization of modern health care facilities.


The population of this study consisted of five villages in Akpulu community in Imo state.

The five (5) selected villages are: Okwu, Umuisim, Ubaha, Isieke and Okpoko with the total population of 91, 489 based on the 1991 population census in Nigeria. They are categorized as follows; Okwu 13,000, Umunisim 15,500, Ubaha 13000, Isieke 10000, Okpoko came last with the total population of 8,803 which the final total came to 59, 803.



Having collected and analysed the data in chapter four of this research, it becomes very necessary to summarize the findings.

Based on the questionnaires distributed and collected among the Akpulu community in Ideato North Local Government Area, the following findings and observations were made.

(1) The research work revealed to us that majority of Akpulu people has the knowledge that there are hospitals in heir community and will quickly rush themselves or their relatives to the hospital whenever they fall sick.

(2) The far distance of where the hospital are located is another factor influencing the proper utilization of modern health care facilities, because is not everyone in the community that will or can afford the transport fare to where the hospital is being located or trek the far distance.

(3) The findings also revealed that despite the availability of hospital, large number of the Akpulu people will prefer to receive treatment in chemist shop believed not to be serious, far cheaper services, cost and because of unavailability of medical doctors. These views are influenced by educational level. People with tertiary education would prefer chemist shop, uneducated nurses mainly when doctors are not readily available, those with primary or secondary would prefer not well trained personnel for illness believed not to be very serious, while those with formal education prayer chemist shop/ uneducated medical nurses because their services are always cheaper. These results agree with the widely reported finding of Johns E. B. Webster and W. E. Sultan (1970) “Quacks are no respecter of persons. It reaches the rich and the poor, the Gullide and the supposedly wise, as will as all age groups including college students.

(4) He people of Akpulu according to my findings does not care whether the health care is modern health care or orthodox instead they prefer the one that is cheaper and this has greatly influence the proper utilization modern health care because the populace does not patronize it.

(5) In my findings it was revealed that majority of Akpulu people does not go to hospital once they fall sick, but will only go after they must have tried other means and failed to get the desired result.

(6) Another factor affecting the proper utilization of modern health care from my findings is the attitude of the doctors to the patients. The respondents complained that the doctors and hospital management does not give quick attention or responses to the patients and this atimes results to more serious thing or even death.

(7) Finally, the government intervention to the healthcare was seen as a remedy to the factors influencing the utilization of modern health care.


By way of conclusion, and reflecting on all that has been gathered in this research, the factors influencing the utilization of modern health care facilities has been vehemently tackled. Nevertheless, more effort need to be put in place as this factors defiled various solutions in the past. It remains perennial to the detriment of humanities since lives are often lost.

From the data collected, one notes that the lack of resources in both the communities and the health institution are the main obstacle to success in the primary healthcare programme. The main reasons for this is that motivation is low because of poor salaries and wages, inadequate transport facilities, low level of health education, poor economic condition, healthcare attitude and beliefs equally affect the willingness of people to take action with respect to health issues. Other factors such as cost of hospital services, socio-cultural issues as well as age and sex are equally influence a great deal peoples level of utilization of modern healthcare facilities.


Based on my findings, the following recommendations are made:

(1) The Government should endeavour to build more hospitals so that it will be within the reach of everybody living in the community. If the hospitals are many, believe that they will not be complaining of the far distance instead they will rush themselves or their relations to hospital whenever they fall sick.

(2) Organizing of seminars or workshops, that with be educative to the people and thus letting them knows the dangers of not going to hospital when sick as most of them prefer visiting the chemist shop and as well as prayer houses.

(3) The hospital management should try to be giving quick fast services to patients as this has resulted to several deaths in the past and even now.

(4) Finally, the cost of medical services should be moderate so that everybody can afford it because the Akpulu people most often did not go to hospital just because they believe the prices is always every exorbitant.

Modern HealthCare Facilities – Factors Influencing The Utilization

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