1.1 Background to the Study
Many countries have limited access to primary healthcare for residents (Rutherford et al., 2009; World Health Organization [WHO], 2008b). A combination of factors contributes to this condition, including sociodemographic characteristics of the population, lack of resources, challenges posed by the primary-care model, and government healthcare administrators’ failure to incorporate input from the community regarding healthcare needs (Higgs, Bayne, & Murphy, 2001; Uneke et al., 2009). As a result, many people suffer illnesses unnecessarily, and communities experience high mortality and morbidity rates from preventable causes (Irwin et al., 2006). This unfortunate situation is the case among many African countries (World Bank, 2011).
Compared to other countries, African countries bear a greater burden of disease and death from preventable and terminal causes. In fact, 72% of all deaths in Africa are the result of communicable diseases such as HIV/AIDS, tuberculosis, and malaria; respiratory infections; and complications of pregnancy and childbirth. Deaths due to these conditions total 27% for all other WHO regions combined (WHO, 2006). In addition, the WHO reported that 19 of the 20 countries with highest maternal mortality ratios worldwide are in Africa. Data from a 2009 report from the World Bank (2011) indicated that the prevalence of HIV among people ages 15–49 in sub-Saharan Africa is nearly seven times of that in other areas of the world (5.4% compared to 0.8%, respectively).
Similarly, WHO (2006) reported that Africans account for 60% of global HIV/AIDS cases, 90% of the 300–500 million clinical cases of malaria that occur each year, and 2.4 million new cases of tuberculosis each year. As of 2003, infant mortality rates were reported to be 29% higher than in the 1960s (43% up from 14%; WHO, 2006). Lack of safe drinking water (58% of the population) and access to sanitation systems (36% of the population) contribute to these poor health outcomes (WHO, 2006). However, these poor health conditions also are due in part to the historical and current states of primary healthcare in Africa, and particularly in Nigeria (Asuzu, 2004; National Primary Health Care Development Agency, 2007; TulsiChanrai Foundation, 2007; WHO, 2008b).