2. PRA findings: community priorities and institutions.
Men and women are asked in each of the research sites to identify the main institutions in their community, the importance of these institutions to them, and whether they perceive these institutions as belonging to the community. They are then asked to identify the institutions they would like to see in the community. This exercise is done to gain a better understanding of how people view their community, identify their priority problems, and ascertain the overall priority attached to health concerns.
In each LGA access to and storage of potable water is identified as the primary concern followed by the need to raise agricultural production and improve access to markets. This relates closely to the belief that poverty has increased, making it is necessary to improve agricultural yields and increase access to credit and markets. While the lack of adequate health care services and drugs is a concern in the LGAs, they are secondary to broader poverty-related concerns.
Policy makers and public sector health service providers are also interviewed on the priority concerns of individuals in their LGA. The sizable overlap between the matrix ranking of policy makers and that of community groups shows that political authorities are aware of the issues that concern their constituents. Officials caution nonetheless that without financial resources they are unable to address many of their communities' needs.
Box 1 How to Read Institutional Maps The circles and boxes in the map represent the relative importance and accessibility of institutions to the group. The large circle represents the community, and the smaller circles signify key institutions. The importance of an institution is depicted by its size--the larger the box or circle, the more important the institution. Institutions that are placed outside of the larger circle represents the perception that they do not "belong" to the community; and, in the case of the idealized maps, these are institutions that should be located outside of the community. A focus group of women in Zamko community, Langtang drew the two maps below, and explain them as follows: Water. This is a basic necessity but the sources are too distant. Hospital. The hospital is built but not equipped; it should be on the outskirts of the community so that people could not catch infectious diseases. Existing private facilities do not belong to the community, as they could close at any time. Market. It must be easily accessible, grinding machines in the market must be close to its center for ease of access. School. More government schools would be cheaper than private education. Bank. It would provide loans for market women, protect money against theft, and allow them to save. Church. It is located outside the community and controlled by missionaries.
Priority Health Concerns
To ascertain communities' perceived health needs, respondents are also asked to list and rank their main health concerns. STDs and AIDS do not feature significantly in any of the rankings, with the exception of one group of women in Langtang Town (see Table 4). They rank AIDS as their fourth health priority; and they also rank gonorrhea as a problem. In general, women perceive childhood diseases as priorities, and they rank them higher than men do. Among women, the main health concerns are measles, dysentery/diarrhea, and hypertension; men's main health concerns are meningitis, typhoid, and hernia. Malaria is mentioned more by men than by women.
Doctors and nurses identify similar health priorities with some notable exceptions. In each LGA, for example, doctors at private and public hospitals indicate complications arising from abortion as a priority health problem, particularly among girls under age 20. Relatedly, one of the health concerns secondary school girls express is the fear of pregnancy and having abortions.
With respect to two high risk populations, CSWs rank their reproductive health top among their health concerns, and LDTDs give priority to piles, headaches, and backache.
Two types of community-based organizations have evolved in the LGAs: groups established at governmental request, such as the Health and Village Development Committees, and organizations formed around local women's, civic or religious concerns. In most of the communities studied government-sponsored organizations have either not met in a long time or were never established. In the cases of groups that once functioned, such as the Village Development Committees, the lack of sustained support is cited as a reason for their failure. According to a group of women in Laranto, Jos North: The problem with the committees is that after meetings are held with us once or twice the organizers of such meetings don't come again and most of the time they don't supply the women with enough materials to develop their skills, for example in soap making, mat making. As a result, we feel it is a waste of time and everyone has to disperse.
The exception to this pattern is the government-sponsored groups which conduct fortnightly sanitation activities. In some areas participation in sanitation days is the only health activity that involves the entire community. However, government officials generally perceive community participation to be limited to contributions of local labor. According to one LGA official, "Community participation means acceptance of our education to them and taking part which makes our work very easy."
Meanwhile, village-based organizations have developed in all of the communities to address common concerns. Indeed, local leaders and groups are willing to become fully involved--financially, technically and managerially--in developing and implementing strategies to address priorities and problems that they identify. For example, Langtang church leaders organize communal labor groups, or Gaya, for building repair and agricultural work. Community groups also construct market stalls, schools and clinics; dig wells; work on agricultural pests control; and maintain drainage systems. In Jos North, one community buys drugs and provides them at subsidized rates in PHC clinics. Nevertheless, in the absence of sustained support such as credit or technical assistance from outside and within the community, even many of these local initiatives have not been sustained.
Table 4: Ranking of Health Problems Jos North LGA Laranto Apata Men Women Men Women Fever Meningitis Malaria Hypertension Meningitis Gastro-enteritis Tuberculosis Malnutrition Typhoid Typhoid Typhoid Diabetes Tuberculosis Measles Cough Anemia Hypertension Malaria Gastro-enteritis Measles Asthma Tuberculosis Piles Pneumonia Pneumonia Hypertension Hypertension Whooping Cough Epilepsy -- Meningitis Asthma Mangu LGA Kombun Mangu Town Men Women Men Women Typhoid Headache Hypertension/Typhoid Hypertension Ulcer Typhoid Meningitis Appendix Worms Hypertension Diarrhea Diabetes Meningitis Worms Measles Ulcer Bilharzia Measles Worms Diarrhea -- Dysentery Malaria Rheumatism -- Diarrhea -- Fever -- -- -- Measles Langtang LGA Zamko Langtang Men Women Men Women Snakebite Eye Problem Hypertension Meningitis Drug Abuse Diarrhea Typhoid Measles Diarrhea Cold/Chills Appendicitis Diarrhea Hernia Convulsion Hernia AIDS Meningitis Chest Pain Malaria Appendicitis Measles Liver Cirrhosis Dysentery Diabetes Malaria Whooping Cough -- Pneumonia Bilharzia Measles -- Gonorrhea
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|Title Annotation:||Towards STD/AIDS Awareness and Prevention in Plateau State, Nigeria: Findings from a Participatory Rural Appraisal|
|Publication:||Towards STD/AIDS Awareness and Prevention In Plateau State, Nigeria: Findings From A Paricipatory Ru|
|Date:||Apr 1, 1997|
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|Next Article:||3. Community knowledge, behaviors, and practices related to STD/AIDS.|