Abstract
BackgroundMany simple, affordable and effective disease control measures have had limited impact due to poor access especially by the poorer populations (urban and rural) and inadequate community participation. A proven strategy to address the problem of access to health interventions is the Community Directed Interventions (CDI) approach, which has been used successfully in rural areas. This study was carried out to assess resources for the use of a CDI strategy in delivering health interventions in poorly-served urban communities in Ibadan, Nigeria.MethodsA formative study was carried out in eight urban poor communities in the Ibadan metropolis in the Oyo State. Qualitative methods comprising 12 focus group discussions (FGDs) with community members and 73 key informant interviews (KIIs) with community leaders, programme managers, community-based organisations (CBOs), non-government organisations (NGOs) and other stakeholders at federal, state and local government levels were used to collect data to determine prevalent diseases and healthcare delivery services, as well as to explore the potential resources for a CDI strategy. All interviews were audio recorded. Content analysis was used to analyse the data.ResultsMalaria, upper respiratory tract infection, diarrhoea and measles were found to be prevalent in children, while hypertension and diabetes topped the list of diseases among adults. Healthcare was financed mainly by out-of-pocket expenses. Cost and location were identified as hindrances to utilisation of health facilities; informal cooperatives (esusu) were available to support those who could not pay for care. Immunisation, nutrition, reproductive health, tuberculosis (TB) and leprosy, environmental health, malaria and HIV/AIDs control programmes were the ongoing interventions. Delivery strategies included house-to-house, home-based treatment, health education and campaigns. Community participation in the planning, implementation and monitoring of development projects was reported as common practice. The resources available for these activities and which constitute potential resources for the CDI process include community volunteers, CBOs and NGOs. Others are landlords; professional, women and youth associations; social clubs, religious organisations and the available health facilities.ConclusionThis study’s findings support the feasibility of using the CDI process in delivering health interventions in urban poor communities and show that potential resources for the strategy abound in the communities.
Highlights
Many simple, affordable and effective disease control measures have had limited impact due to poor access especially by the poorer populations and inadequate community participation
The community had nomenclature for some of these diseases which have been published in the literature – and for some diseases such as diabetes, TB, hypertension, fever, typhoid, malaria, asthma, cough and helminthiasis, they used descriptions which fit into medical diagnoses
Community-based interventions using the Community Directed Interventions (CDI) strategy will definitely go a long way to reduce the prevalence of malaria in the country as this study has shown that community-based medicine distributors (CMDs) have a great influence on members of their communities, in terms of mobilising them and encouraging adherence to health interventions
Summary
Affordable and effective disease control measures have had limited impact due to poor access especially by the poorer populations (urban and rural) and inadequate community participation. Neglected populations living in poverty throughout the developing world, such as the urban and the rural poor, are often heavily burdened by communicable and noncommunicable diseases, and are highly marginalised by the health sector due to their limited access to health and social support services [1]. Without improved delivery of health services, the present obstacles – accessibility, affordability and utilisation of the health systems – will perpetuate disparities and likely increase the risk factors, incidence and prevalence of treatable and manageable health conditions as the size of vulnerable and marginalised urban populations grows. Reduction in disease burden would enable these communities and groups to become more economically active and, thereby, further reduce the socio-economic factors contributing to disease occurrence
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