European Journal of Social Sciences Studies ISSN: 2501-8590 ISSN-L: 2501-8590 Available on-line at: www.oapub.org/soc Volume 2 │ Issue 2 │ 2017 doi: 10.5281/zenodo.400705 INFLUENCE OF PRIMARY HEALTH CARE DELIVERY SERVICES ON THE HEALTH STATUS OF RURAL DWELLERS IN ABIA STATE, NIGERIA Obinna, Leo. O.1, Onu, S. E.2i Dr. Engr., Snr. Lecturer, Department of Rural Sociology & Extension, 1 Michael Okpara University of Agriculture, Umudike, Abia State, Nigeria Assistant Lecturer, Department of Rural Sociology & Extension, 2 Michael Okpara University of Agriculture, Umudike, Abia State, Nigeria Abstract: The study examined the influence of primary Health Care delivery services on the health status of rural dwellers in Abia State Nigeria. A sample size of 120 respondents selected via multi-stage random sampling technique was used. in selecting .Primary data generated using structured questionnaire and Focus Group Discussion were analyzed using descriptive statistics such as frequency counts, percentages, means, pooled means, and KAP analysis respectively. Result showed a mean age of 25 years, 58.3% were male, and 75% were married. About 61.0% had secondary education, 58.3% were farmers/traders, and earned mean monthly income of N48, 250.00 and had a mean household size of 4 persons respectively. Majority (50.0%) owed water system toilets, and 58.3% sourced their drinking water from boreholes, 75.0% fed 32 meals/day and 83.3% were not registered with NHIS. Result further showed high (X = 3.03) level of awareness on seven out of eight PHC delivery service packages in the study area. There was also high level of utilization on immunization (X= 3.00) and moderate level of utilization on treatment for malaria, prevention/ treatment of communicable diseases, family planning/ HIV and AIDS, maternal / child health care, public health education and environmental health education respectively. The KAP analysis showed the Knowledge, Attitude, and Practice Levels of the respondents towards these PHC activities and interventions influenced their health status positively in the study area. The study concluded that PHC delivery services influenced the health status of the rural dwellers positively. It recommends that the Ministries of Health at the three tier Copyright © The Author(s). All Rights Reserved. © 2015 – 2017 Open Access Publishing Group 87 Obinna, Leo. O., Onu S. E. INFLUENCE OF PRIMARY HEALTH CARE DELIVERY SERVICES ON THE HEALTH STATUS OF RURAL DWELLERS IN ABIA STATE, NIGERIA levels of government should provide the needed support for enhancing and sustaining the PHC as well as encouraging participation among the rural dwellers mostly in the study area. Keywords: primary health care, health status, rural dwellers 1. Introduction Health is a treasure of inestimable value, which has implications for the individuals and national economic activities (Federal Ministry of Health (FMOH) 2007). Good health not only contributes to better life but also is essential for sustained economic and social development of a country. On the other hand, poor health generally imposes cost on the society and individuals in terms of reduced ability to enjoy a good living, or work effectively. It was on the above premise that Effiong and Ebong (2009) asserted that health should not be considered in isolation from other elements of development process, given, the fact that it affects socio economic factors notably income and production. Health is equally, according to Johns et al (1995) a quality resulting from the total functioning of the individual in his environment that empowers him to achieve a personally satisfying and socially useful life. Consequently, therefore, the inseparable relationship between health and economic development and the fact that right to health is the most basic of all human rights and a fundamental objective of social and economic development (WHO, 1999) made Nigeria in 1987 to launch her Primary Health Care Plan, which categorized health care delivery services under three levels, Tertiary, Secondary and Primary levels respectively (FMOH, 2007). The Federal Ministry of Health of Nigeria is responsible for Tertiary Health Care Delivery Services, the State, through the State Ministry of Health and Hospital Management Board is responsible for the Secondary Health Care Delivery Services and the Local Government Area is responsible for Primary Health Care Delivery Services respectively FMOH, . The PHC represents essential health care based on practical scientifically sound and socially acceptable to individuals and families in the community through their full involvement” (FMOH, 1988). This approach to health care emphasizes the cooperation and involvement of the community as contributor and customer in the health care system in Nigeria (Nwafor, 2014). A community health center is a core programme for many communities in Nigeria; it is not only the first point of contact but the only available health practice in the area (Nwafor, 2014). In other words, the principles of PHC allow individuals and groups particularly rural communities active participation in planning, implementing, monitoring European Journal of Social Sciences Studies - Volume 2 │ Issue 2 │ 2017 and evaluating health 88 Obinna, Leo. O., Onu S. E. INFLUENCE OF PRIMARY HEALTH CARE DELIVERY SERVICES ON THE HEALTH STATUS OF RURAL DWELLERS IN ABIA STATE, NIGERIA interventions (FMOH, 2007). Therefore, PHC is at the core of the Nigerian health system and key to providing basic health services to the people with their full participation (Nwafor, 2014). Abia State Strategic Health Development Plan (ASSHDP) (2010 - 2015) reported that there were 501 PHC Centres in the state, employing 2702 health personnel as in 2008. It further, reported that the PHC in Abia State is divided into three main categories namely: Primary Health Care Centres which cover an expected population of between 10,000 and 20,000 persons, Primary Health Clinics which cover an expected population of between 2,000 and 5,000 persons and The Health Posts which cover an expected population of 500 persons respectively. The ASSHDP (2010 – 2015) equally stated that the PHC Centres discharge the following functions among others: prevention and treatment of malaria, prevention and treatment of communicable diseases, immunization, maternal and child health service, family planning & HIV/AIDS, public health education, environmental health and the collection of statistical data on health and health related events. In other words, PHC reflects and evolves from the economic conditions and sociocultural and political characteristics of the country and communities (Nwaafor, 2014). It addresses the main health problems in the communities, providing preventive, curative and rehabilitative service, which includes education concerning prevailing health problems and the methods of preventing and controlling them. PHC also involves, in addition to the health sector all related sectors and aspects of national and community development such as agriculture, education and housing among others (FMOH, 2007). Therefore, the essence of bringing PHC to the Local Government Areas (LGAs) in Abia State is to make the management of the PHC services more effective and closer to the grassroots (Nwafor, 2014). However, studies Effiong and Ebong (2009) and Nwafor (2014) have shown that health needs of many rural dwellers in Abia State were not adequately met. They further, observed that rural and remote communities continued to show poorer health outcomes than residents in urban areas of the State. Nwafor (2014) further observed that rural communities in Abia State still experience difficulties in recruiting and retaining adequately trained medical and health personnel in the workforce of PHC Centres. Similarly, Killen (2005) reported that rural dwellers in Nigeria incur heavy losses due to poor health through expensive health – care fees and menace of fake drugs syndrome. In like manner, Nwafor (2014) observed that there was the problem of insufficient PHC Centres in Abia State. He further highlighted the problem of accessibility to the available ones, due to the spatial inefficiency of their distribution and insufficiency in trained medical personnel. Abia State Health Data Bulletin (2007) reported that between 2008 and 2015 human resources for health was on the decline with high attrition rate of health care workers. That there were 41 doctors employed European Journal of Social Sciences Studies - Volume 2 │ Issue 2 │ 2017 89 Obinna, Leo. O., Onu S. E. INFLUENCE OF PRIMARY HEALTH CARE DELIVERY SERVICES ON THE HEALTH STATUS OF RURAL DWELLERS IN ABIA STATE, NIGERIA under PHC in 2002, 38 in 2004 and 28 in 2008 respectively. The report further added that the same was the case for other cadres of health – care workers in the State. Going by the aforementioned, there is no empirical study to the best knowledge of the researcher that has investigated the influence of PHC delivery services on the health status of rural dwellers in Abia State, Nigeria. 2. Objectives of the Research Therefore, the study was guided by the following specific objectives, to: 1. examine the socio economic characteristics of the rural dwellers in the study area; 2. assess the respondents level of awareness to the activities and interventions of PHC in the study area; 3. assess the respondents level of utilization of PHC delivery services; and 4. ascertain the extent to which the PHC health activities and interventions influence the health status of the respondents in the study area. 2. Methodology 2.1 The Study Area The study was conducted in Abia State which is located in the South East Ecological Zone of Nigeria. It covers a total land area of about 5,243.3 Km2 being about 5.8 % of the total land area of Nigeria (Abia – State Ministry of Health, 2010). Abia State has a population of 2.8 million people and a population growth rate of 3 % per annum (Abia State Health Data Bulletin, 2007). The State lies within Longitude 70 23 E and 80 2 E and Latitude 40 N and 0 N and is in the rainforest belt of Nigeria ‚bia -ADP 2006). The minimum and maximum temperature range is between 200 and 300 Celsius and the rainy season starts from April to October, with an average annual relative humidity of 75% (Abia – ADP, 2006). The State is divided into three Political Senatorial Zones namely: Abia North, Abia Central and Abia South Senatorial Zones respectively. The State is also, made up of 17 Local Government Areas where the PHC Centres are situated (Abia State, Ministry of Health, 2010). About 70 % of Abians are involved in agricultural production which contributes about 27 % to the State GDP (Abia SHDB, 2007). The major crops cultivated in the state include: cassava, yam, cocoyam, maize, melon, vegetables, plantains, cocoa, oil- palm, oranges, rubber, and coconuts among others. While livestock production includes: sheep and goat production, rabbitary, poultry, piggery, snailary, and fisheries (Abia ADP. 2006). A sample size of 120 European Journal of Social Sciences Studies - Volume 2 │ Issue 2 │ 2017 90 Obinna, Leo. O., Onu S. E. INFLUENCE OF PRIMARY HEALTH CARE DELIVERY SERVICES ON THE HEALTH STATUS OF RURAL DWELLERS IN ABIA STATE, NIGERIA respondents (40 from each of the three Senatorial Zones) realized through multi stage random sampling technique was used for the study. Primary data were generated using structured questionnaire and Focus Group Discussion (FGD). Data generated were analyzed using descriptive statistics such as frequency counts, percentages, means, pooled means, and ranks respectively. Objective 2 was realized by requesting all the respondents to indicate the extent of their awareness of PHC activities and interventions in the study area through the use of 4 point Likert type scale of Highly aware, weighted and scored 4pts, Aware, weighted and scored 3pts, Not highly aware, weighted and scored 2 pts and Not aware, weighted and scored 1pt respectively. The significant level of awareness was established through the threshold of 2.5 mean score. ‚ny mean score , was adjudged aware, while any mean score < . was adjudged not aware and level of awareness was established as follows: 1.00 - 2.49 = Low Awareness Level 2.5 - 4.00 = High Awareness Level. Objective 3 was realized by requesting the respondents to indicate their extent of utilizing PHC activities and interventions by using a 3 point Likert type scale of Highly utilized weighted and scored 3 points, Utilized, weighted and scored 2 points and Not utilized weighted and scored 1 point respectively. The significant level of utilization was modeled after Olatunji, et al (2007) and specified as follows: S/No Mean Values Levels 01 1.00 - 1.49 Very Low Utilization Level 02 1.50 - 1.99 Low Utilization Level 03 2.00 - 2.49 High Utilization Level 04 2.50 - 3.00 Very High Utilization Level Source: Olatunji et al (2007) KAP Survey Analysis was adopted for objective 4. Knowledge, Attitude and Practice ( KAP) Survey is problem – solving oriented and operate at a micro level with a focus on determining the knowledge, attitude and practice levels of target audiences vis – a – vis the critical elements of a given technology recommendation (Adhikarya, 1994). It was based on the above premise that a grand mean of KAP survey on PHC activities and interventions provided to the respondents was used as a baseline to determine the influence of these PHC activities and interventions had on the health status of the respondents in the study area. In this study, the Knowledge Level of the respondents was equated to be the same as their Awareness Level therefore; the Table 2 generated for awareness level of the respondents was used for knowledge level as well. Also, the Practice Level was equated to be the same as the Utilization Level therefore results European Journal of Social Sciences Studies - Volume 2 │ Issue 2 │ 2017 91 Obinna, Leo. O., Onu S. E. INFLUENCE OF PRIMARY HEALTH CARE DELIVERY SERVICES ON THE HEALTH STATUS OF RURAL DWELLERS IN ABIA STATE, NIGERIA generated in Table 3 for utilization were as well used in discussing practice level of the respondents in PHC activities in the study area. For the Attitudinal disposition (opinions) of the respondents on PHC activities and interventions, a three point Likert type rating scale of Agreed, weighted and scored 3 points, Undecided, weighted and scored 2 points and Disagreed, weighted and scored 1 point respectively was employed. ‚ threshold of . was established. ‚ny mean score . was adjudged positive attitude, while any mean score < 2.00 was adjudged negative attitude respectively. A grand mean was established through the summation of the pooled mean from the KAP Survey scores and divided by the number of items to get a grand mean score of 2.17 for each activity / intervention of PHC in the study area. Therefore, any grand mean . was adjudged to have influenced the health status of the respondents positively, while on the other hand, grand mean < 2.17 was adjudged not to have significantly influenced the health status of the respondents in the study area respectively. 3. Results and Discussion 3.1 Socio–economic characteristics of the respondents Table 1 shows that the mean age of the respondents was 25 years, and 58.3 % of them were males and 41.7 % were females respectively, among whom 75 % were married and 16.7 % single. Table1 further shows that 88.5 % were literates, with about 61 % having attained at least secondary education with a mean monthly income of ₦48,250.00 and about 58.3 % of them were either farmers or traders with only 16.7 % as public servants and a quarter ( 25 %) were from other professions. Table 1 equally, shows that the mean household size was about 4 persons with a mean of 4 children that were years per household. Table 1 also shows that about 4.2 % of the respondents had no toilets and 45.8 % had pit toilets. About 16.7 % of them had no source of drinking water, (rain/ well water) while 25 % got their drinking water from streams/ rivers and only 58.3 % got theirs from boreholes. Also, about 25 % of the respondents could not afford three square meals par day, with very high proportion (83.3 %) not registered with the National Health Insurance Scheme (NHIS). The implications of the results are that: the respondents earned mean monthly income of ₦48,250.00, which was moderately higher than ₦18,000.00 the National Minimum Wage. This implies that they will be spending a lot on drugs due to health challenges given the high percentage (49 %) that either had no toilet or had pit toilets, coupled with the fact that about 25 % could not afford three square meals a day and a very high proportion (83.3 %) not registered with NHIS, which subsidizes the cost of treatment therefore, one could conclude that their income European Journal of Social Sciences Studies - Volume 2 │ Issue 2 │ 2017 92 Obinna, Leo. O., Onu S. E. INFLUENCE OF PRIMARY HEALTH CARE DELIVERY SERVICES ON THE HEALTH STATUS OF RURAL DWELLERS IN ABIA STATE, NIGERIA will be majorly spent on drugs and medication. The finding collaborates with Killen (2005) who stated that rural dwellers in Nigeria incur heavy losses due to poor health through expensive health care fees coupled with the menace of fake drug syndrome. Table 1: Distribution of the Respondents Personal and Socioeconomic Characteristics S/No 01 02 03 04 05 Variables Frequency Percentage 5 4.17 21 - 31 10 8.33 32 - 42 20 16.67 43 - 53 40 33.33 54 and Above 45 37.50 Male 70 58.33 Female 50 41.67 Single 20 16.67 Married 90 75.00 Separated/ Divorced 06 5.00 Widowed 04 3.33 No formal Education 15 12.50 Primary Education 30 25.00 Secondary Education 55 45.83 Tertiary Education 20 16.67 . 30 25.00 19,000.00 – 29,000.00 40 33.33 30,000.00 – 40,000.00 30 25.00 41,000.00 – 51,000.00 15 12.50 52,000.00 and above 05 4.17 Farming 30 25.00 Trading 40 33.33 Public Servant 20 16.67 Others 30 25.00 20 16.67 5 40 33.33 6 and Above 60 50.00 Age in Years 07 Marital Status Educational Attainment Monthly Income in (₦) ₦48,250.00 Primary Occupation Household Size 3 - 08 25.17years Gender , 06 Mean 3.8 persons Number of Children ≤ 5 yrs 1 - 2 20 16.67 3 - 4 40 33.33 European Journal of Social Sciences Studies - Volume 2 │ Issue 2 │ 2017 3.9 children 93 Obinna, Leo. O., Onu S. E. INFLUENCE OF PRIMARY HEALTH CARE DELIVERY SERVICES ON THE HEALTH STATUS OF RURAL DWELLERS IN ABIA STATE, NIGERIA 5 09 and Above 60 50.00 5 4.17 Pit – toilet 55 45.83 Water – System Toilet 60 50.00 Rain Water and wells 20 16.67 Streams / Rivers 30 25.00 Borehole water 70 58.33 Once 10 8.33 Twice 20 16.67 Thrice 90 75.00 Yes 20 16.67 No 100 83.33 Type of Toilets owed None 10 11 12 Source of Drinking Water Feeding rate No. of Square meal/ day Registration with NHIS Source: Field Survey 2016 3.2 Level of awareness of respondents on the activities and interventions of PHC Table 2 shows that out of eight PHC service delivery packages investigated, the respondents in the study area indicated high level of awareness in seven of them. They include::prevention & treatment of malaria ( = 3.08), prevention & treatment of communicable diseases ( = 3.17), immunization ( = 3.33), maternal / child health care ( = 2.54), family planning ( environment health ( = 3.25), public health education ( = 3.38) and = 3.42) respectively. It is only collection of statistical data on health and health related events that they indicated low level of awareness with = 2.08. The implication of the findings is that it is not surprising that the respondents had high level of awareness on the activities of the PHC due to the fact that many Non – Governmental Organizations and Agencies such as USAID, WHO among others assisted in the awareness creation by donating free malaria drugs, treated mosquito nets, de-wormer drugs among other things, free of charge through the PHC centres in the State (Abia State Health Data Bulletin, 2007). European Journal of Social Sciences Studies - Volume 2 │ Issue 2 │ 2017 94 Obinna, Leo. O., Onu S. E. INFLUENCE OF PRIMARY HEALTH CARE DELIVERY SERVICES ON THE HEALTH STATUS OF RURAL DWELLERS IN ABIA STATE, NIGERIA Table 2: Distribution of the Respondents According to Their Level of Awareness on PHC Health Delivery Services in the Study Area S/NO PHC Health Delivery V/M/A A N/V/M/A N/A Total Mean Remarks 25 80 15 - 370 3.08 High 10 - 380 3.17 High - - 400 3.33 High 40 15 305 2.54 High - - 390 3.25 High - - 405 3.38 High - - 410 3.42 High 40 40 250 2.08 Low Services 01 Treatment/ Prevention of Malaria 02 Treatment/ Prevention of 30 Communicable Diseases 03 80 Immunization 40 80 04 Maternal / Child Health Care 15 Services 05 50 Family Planning 30 90 06 Public Health Education 45 75 07 Environmental Health 50 Education 08 70 Collection of Statistical Data 10 on Health & Health Related 30 Events Grand mean 3.03 Source: Field Survey 2016 N/B V/M/A = Very Much Aware, weighted and scored 4 points, A = Aware, weighted and scored 3 points, N/V/M/A = Not Very Much Aware, weighted and scored 2 points, N/A = Not Aware, weighted and scored 1 point respectively. significant, while . was adjudged < 2.5 was adjudged not significant. Level of Awareness: Mean 1 - 2.49 = Low Level of Awareness and Mean 2.5 - 4.00 = High Level of Awareness 3.3 Assessing the level of utilization of PHC packages among the respondents in the study area Table 3 shows that out of eight PHC delivery services investigated upon in the study area, seven were significantly utilized and only one was not significantly utilized. The significant ones included: immunization ( = 3.00) which had high level of utilization. This collaborates the assertion of Abia State Health Data Bulletin (2007) which reported that Abia State had achieved about 39 % immunization coverage against polio and other child killer diseases in the State. Table 3 equally, shows that the moderately utilized PHC delivery services to include: prevention & treatment of malaria ( = 2.33), European Journal of Social Sciences Studies - Volume 2 │ Issue 2 │ 2017 95 Obinna, Leo. O., Onu S. E. INFLUENCE OF PRIMARY HEALTH CARE DELIVERY SERVICES ON THE HEALTH STATUS OF RURAL DWELLERS IN ABIA STATE, NIGERIA prevention & treatment of communicable diseases ( care ( = 2.33), family planning & HIV/ AIDS ( 2.08), and environmental health ( = 2.50), maternal / child health = 2.33), public health education ( = = 2.75) respectively. The implication is that for the fact that some NGOs/ Agencies such as USAID and WHO and coupled with the assistance of some notable sons and daughters of Abia State in diaspora who donated free medical care such as drugs, mosquito treated nets, de- wormers and free eye treatment among others through the PHC centres located at the different parts of the State and also the fact that WHO introduced exclusive breast feeding awareness creation and family planning / HIV & AIDS testing centres in the state, assisted in a great deal in the moderate utilization increase in the use of PHC delivery services in the State. Table 3 shows non- significant utilization of PHC statistical data collection on health and health related events by the respondents. The implication is that rural dwellers in Abia State do not on their own go to the PHC centres in- order to supply information unless they go there for other reasons, mostly, health - wise and thereby giving information. Table 3: Distribution of Respondents According to their Level Utilization of PHC Delivery Services S/No PHC Delivery Services Highly Utilized Utilized 01 Prevention & treatment of Not Total Mean Remarks utilized 60 40 20 280 2.33 Utilized 70 40 10 300 2.50 Utilized 100 20 - 360 3.00 Utilized 60 40 20 280 2.33 Utilized malaria 02 Prevention & treatment of communicable diseases 03 Immunization 04 Maternal / Child health care 05 Family planning / HIV & AIDS 50 50 20 270 2.25 Utilized 06 Public health education 40 50 30 250 2.08 Utilized 07 Environmental health 70 50 - 310 2.75 Utilized 08 Collection of data on health & - 40 80 160 1.33 Not heath related events utilized Grand Mean 2.32 Source: Field Survey 2016 Decision Rule: ‚ny mean score . was adjudged utilized, while any mean score < 2.00 was adjudged not utilized. Level of Utilization: 1.00 - Utilization Level, 2.00 2.49 = High Utilization Level and 2.5 - 1.49 = Very Low Utilization Level, 1.5 - - 1.99 = Low 3.00 = Very High Utilization Level respectively. European Journal of Social Sciences Studies - Volume 2 │ Issue 2 │ 2017 96 Obinna, Leo. O., Onu S. E. INFLUENCE OF PRIMARY HEALTH CARE DELIVERY SERVICES ON THE HEALTH STATUS OF RURAL DWELLERS IN ABIA STATE, NIGERIA 3.4 Provision of PHC Activities / Interventions in the Study Area Table 4: Distribution of the Respondents According to Their Opinions on PHC Activities/ Interventions Provided in the Study Area S/No PHC Activities / Agreed Undecided Disagreed Total Mean Remarks Interventions 01 Prevention& 60 20 40 260 2.17 treatment of Malaria Positive Attitude ( P/A) 02 Prevention & 40 40 40 240 2.00 P/A treatment of Communicable Diseases 03 Immunization 80 20 20 300 2.50 P/A 04 Maternal/Child 60 40 20 280 2.33 P/A 70 30 20 290 2.42 P/A 40 60 20 260 Health Care Services 05 Family Planning/ HIV/ AIDS 06 Public Health Education 07 P/A 2.17 Environmental 50 60 10 280 2.33 P/A - 80 40 200 1.67 Negative Health Education 08 Collection of Data on Health & health Attitude related events Grand mean 2.20 Source: Field Survey 2016 N/B Decision Rule: . was adjudged Positive ‚ttitude, while < 2.00 was adjudged Negative Attitude. 3.5 Influence of PHC Activities and Interventions on the Health Status of the Respondents in the Study Area Table 5 shows that out of 8 PHC packages that were investigated, seven of them significantly influenced the health status of the respondents in the study area. They included: prevention & treatment of malaria with grand mean = 2.53, prevention & treatment of communicable diseases ( = 2.56), immunization ( = 2.94), maternal / child health care ( = 2.40), family planning/ HIV& AIDS ( = 2.64), public health ( = 2.54) and environmental health ( = 2.83) respectively. The implication of the finding is that the KAP analysis of the respondents has shown that the Knowledge, Attitude, and Practice Levels of the respondents towards the PHC activities and interventions influenced their European Journal of Social Sciences Studies - Volume 2 │ Issue 2 │ 2017 97 Obinna, Leo. O., Onu S. E. INFLUENCE OF PRIMARY HEALTH CARE DELIVERY SERVICES ON THE HEALTH STATUS OF RURAL DWELLERS IN ABIA STATE, NIGERIA health status positively in the study area with ( = 2.17). On the other hand, Table 5, equally shows that collection of statistical data on health and health related events ( = 1.69) did not influence the health status of the respondents in the study area. The implication could be that the policy makers on health did not consider the unique situation (if any) of the study area in the programme development on health matters or that they did not consider the data collected on health/ health related issues from the study area. The finding collaborates with Nwachukwu (2003) who postulated that any programme for the people must start from the felt needs of the people through bottom – top approach instead of the reverse which was always the case in Nigeria. Table 5: Distribution of the Respondents According to the Influence of PHC Activities and Interventions On Their Health Status in the Study Area S/No PHC Activities and Knowledge Attitudinal Practice Pooled Grand Level Disposition Level Mean Mean Remarks Interventions 01 Prevention & 3.08 ( High) 2.17 ( P/A) 2.33 ( M/ Treatment of 7.58 2.53 P) Positive Influence Malaria 02 Prevention & 3.17 ( High) 2.00 ( P/A) 2.50 treatment of 7.67 2.56 (H/P) Positive Influence Communicable diseases 03 Immunization 3.33 ( High) 2.50 ( P/A) 3.00 8.83 2.94 (H/P) 04 Maternal / Child 2.54 ( High) 2.33 ( P / A) 05 Family Planning Public Health 3.25 ( High) 2.42 (P / A) 2.17 (P /A ) 2.08 ( 7.92 2.64 3.42 ( High) 2.33 ( P /A) 2.75 ( 7.63 2.54 8.50 2.83 2.08 ( Low) 1.67 ( N/A) health data & Positive Influence H/P) Collection of Positive Influence M/P) Environmental Positive Influence 2.25 ( 3.38 (High) Health 08 2.40 M/P) Education 07 7.20 P) & HIV/ AIDS 06 Influence 2.33 ( M/ Health care Positive Positive Influence 1.33 5.08 1.69 (L/P) No Influence health related on Health events status Grand Mean 6.50 2.17 Baseline Source: Field Survey 2016. n= 120 Grand . was adjudged to influence the health status of the respondents, while < 2.17 was adjudged not to have had influence on the health status of the respondents. European Journal of Social Sciences Studies - Volume 2 │ Issue 2 │ 2017 98 Obinna, Leo. O., Onu S. E. INFLUENCE OF PRIMARY HEALTH CARE DELIVERY SERVICES ON THE HEALTH STATUS OF RURAL DWELLERS IN ABIA STATE, NIGERIA 4. Conclusion and Recommendation The study provided an empirical evidence of the effect of Primary Health Care delivery services on the health status of the rural dwellers in the study area. The study concluded that Primary Health Care delivery services influenced the health status of the rural dwellers positively. The study therefore recommended that Ministry of Health both at the Federal and State levels should provide the needed support for enhancing and sustaining the programme as well as encouraging participation among the rural dwellers. References 1. Abia – ADP (2006). Root and Tuber Expansion Programme (RTEP), Annual Report 2001 – 2006 pp 1 – 52. 2. Abia State Ministry of Health and FHI 360. 2013. Abia State-wide Rapid Health Facility Assessment, Nigeria: Abia State Ministry of Health and FHI 360 3. Abia State Strategic Health Development Plan (2010 - 2015), Report Abia State Government Ministry of Health, Abia State, Nigeria.pp 1 – 81. 4. ‚dhikarya, R. Strategic extension campaign: A participatory – oriented method of agricultural extension, Rome Italy: FAO/ United Nations 1994. 5. Effiong, E. O. and Ebong, V. O. (2009) Economic Analysis of Health Care Accessibility on Productivity by Rural Farmers in Ikwuano Local Government Area of Abia State, Nigeria. Nigerian Journal of Agriculture, Food and Environment 5( 2 – 4): 20- 25, December, 2009 6. Federal Ministry of Health (FMOH) (2007): Integrated Maternal, Newborn and Child Health Strategy. Federal Republic of Nigeria. 94 (24), 15 May 2007. 7. Federal Ministry of Health (FMOH) (1988): The National Health Policy and Strategy to achieve health for all Nigerians: Federal Ministry of Health, Lagos Nigeria, October. 8. Killen, B. (2005). The Millennium Development Goals for health. International Journal of Public Health. Bulletin of World Health Organization Vol.83 No 10 pp876 9. Marafa, B. K. (2007): Primary Health Care Students Publication Alliance International University, American Journal of Public Health, V 95, No 5, pp 757 May. 10. Nwachukwu, Ike (2003) Agricultural Communication: Principles and Practice Lambhouse Publications, Umuahia 132pp European Journal of Social Sciences Studies - Volume 2 │ Issue 2 │ 2017 99 Obinna, Leo. O., Onu S. E. INFLUENCE OF PRIMARY HEALTH CARE DELIVERY SERVICES ON THE HEALTH STATUS OF RURAL DWELLERS IN ABIA STATE, NIGERIA 11. Nwafor, S. C. (2014) Effect of Primary Health Care Centres on Rural Farmers Health in Abia State, Nigeria. An MSc. Thesis presented to the Department of Rural Sociology and Extension, Michael Okpara University of Agriculture, Umudike, Abia State, Nigeria. 12. World Heath Organizations (WHO) (1978) Primary Health Care: Report of the International Conference on Primary Health Care, Alma-Ata, USSR, 6 – 12 September 1978. European Journal of Social Sciences Studies - Volume 2 │ Issue 2 │ 2017 100 Obinna, Leo. O., Onu S. E. INFLUENCE OF PRIMARY HEALTH CARE DELIVERY SERVICES ON THE HEALTH STATUS OF RURAL DWELLERS IN ABIA STATE, NIGERIA Creative Commons licensing terms Author(s) will retain the copyright of their published articles agreeing that a Creative Commons Attribution 4.0 International License (CC BY 4.0) terms will be applied to their work. Under the terms of this license, no permission is required from the author(s) or publisher for members of the community to copy, distribute, transmit or adapt the article content, providing a proper, prominent and unambiguous attribution to the authors in a manner that makes clear that the materials are being reused under permission of a Creative Commons License. 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