Spatial Distribution of Primary Health Centers in Kaduna State, Nigeria: An Assessment
An Assessment of the Spatial Distribution of Primary Health Centers in Giwa, Kudan, and Sabon Gari Local Government Areas of Kaduna State
1. Introduction
Primary health care, as defined by the World Health Organization (WHO), is universally accessible, socially acceptable, and affordable healthcare that encourages individual self-reliance. Wikipedia further elaborates that primary health care is based on practical, scientifically sound, and socially acceptable methods and technology, made universally accessible to individuals and families through their full participation and at a cost the community and country can afford. Health is a fundamental human right, as recognized in the UN Declaration of Human Rights (1948) and Article 12 of the International Covenant of Economic, Social and Cultural Rights. In Nigeria, healthcare provision is structured across three levels: Primary, Secondary, and Tertiary. Primary health care is crucial due to its proximity and accessibility, addressing common health concerns like malaria, child mortality, and tuberculosis. Its successful provision contributes to achieving at least three of the United Nations Millennium Development Goals (MDGs).
The Alma Ata Declaration (1978) established an ideal model for healthcare, emphasizing the importance of equitable distribution and community participation. The WHO outlines five key elements for achieving better health for all: reducing exclusion and social disparities, organizing health services around people’s needs, integrating health into all sectors, pursuing collaborative policy dialogue, and increasing stakeholder participation.
Primary health care is delivered through Primary Health Centers (PHCs), which are the basic structural and functional units of public health services in developing countries. PHCs were established to provide accessible, affordable, and available primary health care, aligning with the Alma Ata Declaration. Equitable distribution of PHCs is crucial for accessibility. In Nigeria, the neglect and misdistribution of the primary health care system can lead to an inadequate healthcare pyramid, as noted by Asuzu (2004).
2. Rationale for the Study
Demand for public services, including healthcare, is often unevenly distributed. This study investigates the spatial distribution of PHCs in Giwa, Kudan, and Sabon Gari local government areas to understand accessibility and inform future planning. The research questions guiding this study are:
- Where are health centers located and how are they distributed in the three local government areas?
- Does the distribution encourage accessibility to the health centers?
- What factors are responsible for the observed distribution?
- How can future siting be rationally done?
The study will utilize data from fieldwork (GPS measurements), statistical records, and maps to analyze the spatial characteristics of PHCs.
3. Aim and Objectives
The aim of this study is to investigate and describe the spatial distribution of Primary Health Centers in Giwa, Kudan, and Sabon Gari local government areas using spatial statistical formulas. This will contribute to the spatial database for the primary health sector in these areas, serving as a reference for administrators and decision-makers. The objectives are:
- Determine the number of Primary Health Centers in each local government area.
- Measure the coordinates of each PHC using GPS to determine their geographic location.
- Geographically position every PHC on a geo-referenced map of the local government.
- Statistically describe the observed spatial distribution pattern.
4. Methodology
This study will employ various analytical and geographical tools, including spatial measures of central tendency and dispersion, spatial random tests, nearest neighbor analysis, quadrat tests, density measurements, remote sensing tools (e.g., Google Earth), and Geographic Information System (GIS) tools (e.g., ArcGIS).
5. Scope of Research
This research focuses specifically on the spatial characteristics of Primary Health Centers and their potential impact on physical accessibility. While acknowledging the influence of social, financial, and functional accessibility, this study is limited to the spatial dimension.
6. The Study Area
The study area encompasses Giwa, Kudan, and Sabon Gari local government areas in Kaduna State, Nigeria. These areas are predominantly rural with diverse populations and varying economic activities. The region is characterized by a Northern Guinea Savannah ecological zone and experiences distinct wet and dry seasons.
Map 1: Kaduna State in the context of Nigeria
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Map 2: The Study Area in the context of Kaduna State
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7. Conceptual Framework and Literature Review
This section provides a comprehensive review of relevant literature on spatial data analysis, the concept of health, health systems, primary health care, the Alma Ata Declaration, components of primary health care, standards in healthcare, primary care versus primary health care, primary health care in Nigeria, and the problems of primary health care in Nigeria. It draws upon various sources, including academic articles, reports, and online resources.
Spatial Data Analysis
Spatial analysis involves studying entities using their topological, geometric, or geographic properties. It aims to extract implicit knowledge, such as spatial relations and patterns, from spatial databases. Spatial statistics deals with spatial data types like points, lines, and areas, and utilizes descriptive spatial statistics that are areal or locational equivalents to non-spatial measures.
The Concept of Health
Health is defined by the WHO as a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. It is a resource for everyday life and a fundamental human right. The spiritual dimension of health is increasingly recognized.
Health System
A health system is a complex network of elements working together to promote, restore, or maintain health. In Nigeria, healthcare is structured across primary, secondary, and tertiary levels, with concurrent management by different levels of government.
Primary Health Care (PHC)
PHC is essential healthcare based on practical, scientifically sound, and socially acceptable methods and technology, made universally accessible to individuals and families through their full participation and at an affordable cost. It is the first point of contact with the national health system and is crucial for achieving health equity.
The Alma Ata Declaration
The Alma Ata Declaration (1978) emphasizes health as a fundamental human right and calls for the attainment of the highest possible level of health for all. It highlights the unacceptable inequalities in health status and the importance of government responsibility and community participation in healthcare.
The Components of Primary Health Care
There are eight essential components of primary health care: immunization, maternal and child care, essential drugs, food and nutrition, education, illness and injury management, water and sanitation, and vector and reservoir control.
Standards in Health Care
Standards in healthcare ensure the highest quality of care possible within available resources. They provide a basis for monitoring, comparison, supervision, and regulation of health services. The Alma-Ata conference specified eight minimum health service areas as standards for PHC.
Primary Care versus Primary Health Care
While often used interchangeably, primary care and primary health care are distinct concepts. Primary care focuses on individual illness management, while primary health care is a broader public health strategy aimed at addressing health inequities and promoting community participation.
Primary Health Care in Nigeria
The Nigerian PHC system evolved from the Basic Health Service Scheme and aims to provide comprehensive healthcare based on primary health care principles. However, challenges remain in achieving equitable distribution and access to PHC services.
Problems of Primary Health Care in Nigeria
Several challenges hinder the effective implementation of PHC in Nigeria, including inadequate funding, lack of materials and equipment, shortage of qualified staff, lack of commitment, inadequate community participation, and political interference.
8. Study Area: Kaduna State & Kaduna
Kaduna State, located in Northern Nigeria, has a diverse population and a predominantly agricultural economy. The state capital, Kaduna, has a rich history and serves as a major commercial center. The study area, comprising Giwa, Kudan, and Sabon Gari LGAs, is located in the northern part of the state and is characterized by a savannah vegetation and distinct wet and dry seasons.
Fig i: Map of Nigeria showing Kaduna State
Fig ii: Map of Kaduna State showing Giwa, Kudan and Sabon Gari LGAs
This study aims to contribute to a better understanding of the spatial distribution of PHCs in Giwa, Kudan, and Sabon Gari LGAs, ultimately informing strategies to improve healthcare accessibility and equity in these regions.