CHAPTER ONE

INTRODUCTION

1.1 Background To the study

Health is a central to well-being and a prerequisite for successful development. The WHO, the key UNs agency concerned with global health matters defined health as, “A state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity“(WHO, 1947). Developing countries encountered a serious health problem than developed countries especially regarding infectious disease. Every year about 8 million children under the age of five die in developing countries (WHO 2011a). The main source of the death for these children is easily preventable diseases that could be prevented by spending few cents per child. This shows that their real enemy is poverty (M. P.Todaro and S. C. Smith, 2003).Thus, the provision of basic health service is an effective means to achieve goals of poverty reduction. This is because the health level of the population can influence economic progress through affecting the productivity of each worker. For this fact, all countries consider the provision of health service as an important aspect of the socio-economic development of their country.

According to various health status indicators, the Nigerian population health status is very low. Generally, low life expectancy, high infant, child and maternal mortality, low immunization coverage, and low access to proper sanitation characterize Nigeria.Under-5 year mortality and maternal mortality rates are very high; 166 per 1,000 live birth and 850 per 100,000, respectively (WHO 2011b).

Despite major progresses have been made to improve the health status of the population in the last two decades, Nigeria’s population still face a high rate of morbidity and mortality and the health status remains relatively poor. Following changes of government in 1991, the new government of Nigeria introduced the health policy that was the first of its kind in the country and was among a number of political and socio-economic transformation measures that taken place. To achieve the objective of the health sector, the government of Nigeria designed the Health Sector Development Programs (HSDP). This has been a 20-years health development strategy implementing through a series of four consecutive 5-year investment programs (MOH, 2010). The first phase (HSDP I) was initiated in 1996/97. This program had the objectives of increasing access of health care, improving service quality, improving health service management and increasing the participation of private and NGO sectors in health service provision. Moreover, decentralization of the health care delivery system is also considered as a measure to improve health service management and resource mobilization ((MOH, 2010), 2010). 

Despite this effort, there is no significant improvement in health service utilization and health care financing aspects as compared to a significant increase in health facility construction. In addition, the participation of the private and NGO sectors has been below expectations as they are concentrated in urban areas (MOH, 2010).

One way of ensuring the effectiveness and sustainability of the programs and policies in the health sector would be the involvement of households in designing such policies and programs. For instance, identifying the factors that determine households demand for health care services could be of vital role in assisting of rational strategies. The utilization of health care services depends on demand factors such as income, cost of care, education, social norms and traditions, and the quality and appropriateness of the services provided. Therefore, interest should not only on merely provision of physical access, but also should ensure that effective utilization of those services among sick group of the population. (M. Lindelow, 2003). By keeping the above in mind, this study concerned with determining the factors that are associated with the decision of seeking medical treatment and the choice of health service providers.

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