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Knowledge of Mother to Child Transmission of HIV Infection

Introduction:

Despite many efforts, the knowledge of pregnant women on mother-to-child transmission of HIV is low. By receiving information on HIV from health care providers while pregnant women attend antenatal care, they are more likely to be knowledgeable on MTCT of HIV. Strengthening women education and by reaching previously inaccessible parts of the community, integration of HIV, prevention of MTCT, and ANC service, is highly recommended. Moreover, strengthening discussion of MTCT with community health practitioners, especially those who execute the Primary Health Care Services is important. Primary Health Care workers will find more interest in their work if they continue learning after qualifying and continue developing their skills. Continued learning may be achieved through refresher course, in-service training course and internet education study.

The HIV and AIDS pandemic is one of the most serious health crises in the world. an estimated 78 million people have become infected with HIV and 35 million people have died from AIDS-related illnesses since the start of the epidemic and end in 2015. In 2015 only, there were 36.7 million [34.0 million–39.8 million] people living with HIV, while at the end of 2015, 1.1 million people died from AIDS-related causes worldwide, compared to 2 million in 2005. It is assuming that passing HIV microbe from infected mother-to-child is 15% to 45%. Therefore when there is PMTCT interventions, it can reduce this risk to below 5%.

Before the introduction and implementation of PMTCT, Mother—to—child transmission (MTCT) of HIV is a major public health challenge, and maternal knowledge on HIV transmission during pregnancy and its prevention is important in reducing childhood HIV acquisition. It is up to one point six million children who are newly infected with HIV and which have been prevented since 1995 due to the establishment of PMTCT services. Of these, 1.3 million are estimated to have been averted in the five years, between 2010 and 2015.

Despite the difference significant progress in PMTC, in 2015 23% of pregnant women living with HIV did not have access to ARVs and 150,000 children (400 children a day) became infected with HIV.

Definition:

Mother-To-Child-Transmission (MTCT) is the transmission of HIV virus from an infected woman to her unborn child during pregnancy, delivery and breastfeeding. Vertical transmission of HIV occurs when an infected mother’s blood mixes with that of the baby during vaginal delivery (Kourtis et al., 2006; Adogu et al., 2013). 25-35% of breastfed infants born to infected women will be infected.

Abiodun et al., (2007) reiterated that there are cases of Mother-To-Child–Transmission of HIV/ AIDS despite the effort in implementing PMTCT. Mothers are still lacking knowledge about MTCT especially transmission through breastfeeding. Only 10% of 100 pregnant women had knowledge regarding mother to child transmission of HIV/AIDS, 13% of pregnant women knew that breastfeeding while suffering from HIV/AIDS may put the baby at risk of contracting the virus (Maputle, 2008)

Risk of transmission without interventions

Without intervention (ARV prophylaxis or treatment) up to 40% of infants born to mothers infected with HIV can become HIV-infected.

Among the 40 (out of 100) that become infected, 5 to 10 are infected during pregnancy, 15 during labour and delivery, and 5 to 15 during breastfeeding.

Risk factors for transmission:

A great deal is known about specific factors that may put a woman at higher risk of transmitting HIV to her baby. These factors might be related to mother, infant, or the type of virus. These risk factors could be present during pregnancy, labour and delivery, and breastfeeding.

  • The most important risk factor for MTCT is the amount of HIV virus in the mother’s blood, known as the viral load. The risk of transmission to the baby is greatest when the maternal viral load is high, which is often the case with recent HIV infection or advanced HIV and AIDS.
  • Mixed feeding is also an important risk factor. Artificial feeding increases the risk of intestinal illness and a weakened intestine associated with (contaminated) breast milk increases the chances of HIV crossing the intestinal barrier.

The intrapartum risk of MTCT is multi factorial involving viral, maternal, placental and foetal factors as well as the delivery process.

  1. Viral factors:
  • Viral load. The higher the viraemia the higher the risk of transmission
  • Presence of resistance to antiretroviral drugs.
  • Transmission rates are higher with HIV 1 than HIV 2 infection.
  1. Maternal factors: The following maternal factors positively influence MTCT.
  • Maternal immune deficiency.
  • Symptomatic disease in the mother
  • Poor nutritional status of the mother.
  • Presence of sexually transmitted infections and other genital ulcers during labour.
  1. Placental factors: disruption from any cause increases the chance of feto-maternal transfusion thereby increasing the risk of HIV infection.
  • Intra partum Haemorrhage
  • Chorioamnionitis
  1. Obstetric factors:
  • Vaginal delivery
  • Invasive obstetric procedures during labour like External Cephalic Version, foetal scalp electrodes and foetal blood sampling.
  • Instrumental deliveries like vacuum extraction or forceps.
  • Prolonged duration of rupture of foetal membranes (4 hours and above).
  • Prolonged labour
  • Episiotomy and lacerations.
  • First born of multiple pregnancies.
  1. Foetal factors:
  • Prematurity (Preterm birth)
  • Foetal genetic characteristics

Prevention of Mother-to-Child Transmission of HIV

One of the goals of the June 2001 Declaration of Commitment of the United Nations General Assembly Special Session on HIV and AIDS (UNGASS) is to reduce the proportion of infants infected with HIV by 20% by 2005 and 50% by 2010. In the 2003 AIDS Policy, the Nigerian national goal for PMTCT is to reduce the transmission of the HIV through MTCT by 50% by the year 2010 and to increase access to quality HIV counselling and testing services by 50% by the same year. To achieve this goal, a comprehensive four pronged strategy to prevent HIV infection among infants and young children has been developed, which promotes implementation in an integrated manner within the health care delivery system. These strategies are:

  • Primary prevention of HIV infection in women of reproductive age group and their partners.
  • Prevention of unintended pregnancies among HIV positive women.
  • Prevention of HIV transmission from HIV infected mothers to their children.
  • Care and support for HIV infected mothers, their infants and family members.

Strategy 1: Primary prevention of HIV infection in women of reproductive age group and their partners

The best way to prevent HIV infection in children through mother-to-child transmission, including transmission through breastmilk, is to prevent HIV infection of parents-to-be. About 70% of the global HIV burden is borne by sub-Saharan Africa, where the main mode of HIV transmission is heterosexual contact.

The following factors are known to increase the risk of HIV infection in women:

  • Multiple sex partners
  • Immaturity of the genital tract
  • Vaginal ectopy
  • Sexually transmitted infections (STIs)
  • Poor nutritional status

Other factors contributing to women’s vulnerability to HIV include:

  • Poverty
  • Lack of information
  • Abuse
  • Violence
  • Sexual relationships with men who have multiple sex partners

Primary prevention strategies include the following components:

  1. Safer and responsible sexual behaviour and practices

These include:

  • Delaying the onset of sexual activity until marriage
  • Practicing abstinence
  • Reducing the number of sexual partners
  • Using condoms

This approach has come to be known as the “ABC” approach:

A = Abstinence – Refrain from having sexual intercourse

B = Be faithful – Be faithful to one partner

C = Condom use – Use condoms correctly and consistently

Recent reports of increasing new HIV infections transmitted from husbands to wives indicate a continued need to educate people about safer sex practices and other behaviour changes. For example, being faithful to one partner not infected with HIV is a risk reduction behaviour that has been proven to be significant in slowing the spread of HIV infection.

Behaviour change communication (BCC) efforts aim to change the behaviours that place individuals at risk for becoming HIV-infected or spreading HIV infection. BCC recognises that behaviour change is not simply a matter of increased knowledge; many factors, including family, church, and community influence change. BCC attempts to create household, community, and health facility environments in which individuals can modify their behaviour to decrease risk.

Especially among young women, the successful implementation of “ABC” outlined above may require support from organised programmes. Healthcare workers can help women address these challenges through education and community linkages.

Condoms can help prevent HIV transmission when used correctly and consistently, especially in high-risk settings. Programmes that promote condom use for HIV prevention should also focus on condom use for PMTCT.

  1. Provision of early diagnosis and treatment of STIs

The early diagnosis and treatment of STIs can reduce the incidence of HIV in the general population by about 40%. STI treatment services present an opportunity to provide information on HIV infection, MTCT, and referral for testing and counselling.

  1. Making HIV testing and counselling widely available

HIV testing and counselling services need to be made available to all women of childbearing age because PMTCT interventions depend on a woman knowing her HIV status.

  1. Provision of suitable counselling for women who are HIV-negative

Counselling provides an opportunity for a woman who is HIV-negative to better understand how to protect herself and her infant from HIV infection. It can also serve as powerful motivation to adopt safer sex practices, encourage partner testing, and discuss family planning.

Strategy 2: Prevention of unintended pregnancies among HIV-positive women

It is every woman’s fundamental right to decide for herself, without coercion, whether or not to have children. The responsibility of the government and health services is to provide HIV-positive women and their partners with comprehensive information and education about the risks associated with childbearing. This should be part of routine information about HIV and AIDS, to ensure that HIV-positive women and their partners have real choices of action, and to respect and support the decisions they reach. This means:

  • Providing good quality, user-friendly, and easily accessible family planning services so that HIV-positive women can avoid pregnancy if they choose
  • Promoting condom use, either alone or combined with a more effective method of contraception (dual method) for dual protection from HIV and other STIs and from unplanned pregnancy as an effective strategy to prevent HIV infection in all sexually active women
  • Integrating dual protection messages into family planning counselling services
  • Offering contraception to replace the birth-spacing effect of breastfeeding in women who choose replacement feeding because of their HIV infection

In many countries in sub-Saharan Africa, bearing healthy children provides social status and access to family resources. These accesses are denied to women whose HIV-infected children fail-to-thrive and die. To that extent, interventions to reduce HIV transmission from mother-to-child can help a woman consolidate her social position, despite her HIV infection.

Strategy 3: Prevention of HIV transmission from women infected with HIV to their infants

Specific interventions to reduce HIV transmission from an infected woman to her child include:

  • HIV testing and counselling
  • Antiretroviral prophylaxis and treatment
  • Safer delivery practices
  • Infant-feeding counselling for safer infant-feeding practices

When an ARV drug is given to mother and infant to prevent MTCT, it is referred to as ARV prophylaxis.

How do these interventions work?

  • Identify women infected with HIV.
  • Reduce maternal viral load.
  • Curtail infant exposure to the virus during labour and delivery.
  • Curtail infant exposure to the virus through safer feeding options.

In industrialised countries where women infected with HIV receive triple drug ARV therapy and do not breastfeed—and where elective caesarean sections are safe, feasible, accessible and commonly performed—the rate of MTCT has been reduced to about 2%.

ARV prophylaxis can reduce MTCT by 40–70%. The impact is greater (closer to 70%) when women do not breastfeed, because current ARV prophylactic regimens only prevent HIV transmission during late pregnancy and labour and delivery.

Testing and counselling of pregnant women

In Nigeria, the high fertility rate, the premium placed on children as objects of parental hope for future survival, and the acceptance of antenatal care, enhance the cultural endorsement of testing and counseling for PMTCT of HIV in antenatal settings. The aim of testing and counselling is to help the woman take necessary action to ensure that she does not become infected with HIV. However, if she is already infected, the aim is to help her protect her own health, the health of the unborn child, of her sex partner and of her family.

ARV prophylaxis to mother-child pair

ARV prophylaxis given to a pregnant woman who is HIV-infected does not confer long-term benefits to the woman herself. Pregnant women with advanced HIV infection require combination ARV treatment to reduce the risk of AIDS-related illnesses. As treatment becomes more available, there should be integration between prophylaxis and treatment services.

Several potent regimens, either as monotherapy or combination therapy are currently in use as ARV prophylaxis. These regimens are discussed in detail in module 4.

Modification of obstetric practices

(i) Modification of routine obstetric practices for all women:

Recognition of HIV infection in pregnant women is the key to the prevention of childhood HIV infection. Issues of access to and affordability of antenatal care are crucial and must be addressed if interventions are to make any significant impact. All doctors, midwives and community healthcare workers who attend to pregnant women should be trained in HIV and PMTCT testing and counselling to effectively include HIV antibody testing among the routine booking investigations. Rapid test kits should always be available for free HIV testing. In resource-constrained settings, the introduction of any fee, no matter how small, will prevent many willing patients from determining their HIV status. Syndromic management of STIs in the antenatal setting should be strengthened. Iron and folic acid supplementation, tetanus and malaria prophylaxis should be given to all pregnant women irrespective of their HIV status.

(ii) Specific modification of obstetric care for HIV positive women:

All HIV-positive women should be given optimal health care to ensure a safe delivery. An HIV-positive woman identified in pregnancy should have a full physical examination with focus on HIV-related symptoms and illnesses and signs of opportunistic infections especially tuberculosis (TB).

In addition, apart from the routine laboratory investigations conducted on all pregnant women, other investigations for HIV-positive women should include FBC, CD4 count LFT’s, Renal function test, Lipid profile and Viral load. Details of management considerations for HIV-positive women are addressed in module 4.

Invasive procedures such as chorionic villus sampling, amniocentesis and cordocentesis should be avoided. External cephalic version should be avoided as it may also increase the risk of HIV transmission to the foetus.

Where CS is performed (either elective or emergency) in HIV-positive women, they should receive prophylactic antibiotics. If CS is performed after prolonged labour or prolonged ROM, longer courses of antibiotics should be considered.

Modification of infant feeding practices and support for mother’s choice

Breastfeeding is an important route of HIV transmission from mother-to-child. HIV-positive mothers should be counselled about this risk and where possible should try to avoid or limit breastfeeding. For HIV-negative mothers or mothers with unknown HIV status, exclusive breastfeeding remains the best infant-feeding choice.

In the context of PMTCT of HIV, the challenge is to strengthen and support mothers and partners to make breast milk substitutes acceptable, feasible, affordable, sustainable and safe (AFASS). Much as it is important to respect and support HIV-positive mothers in their decisions regarding infant feeding, they should be well-informed about the various feeding options available to prevent their infants from becoming infected through breastfeeding. (See Module 5)

Strategy 4: Provision of treatment, care, and support to women infected with HIV, their infants, and their families

Programmes for the prevention of HIV in infants and young children will identify large numbers of women infected with HIV who will need special attention. Medical care and social support are important for women living with HIV and AIDS to address concerns about both their own health and the health and future of their children and families.

If a woman is assured that she will receive adequate treatment and care for herself, her children, and her partner, she is more likely to accept HIV testing and counselling and, if HIV-positive, interventions to reduce MTCT.

It is important to develop and reinforce linkages with programmes for treatment, care, and support services to promote long-term care of women who are HIV-infected and their families.

HIV-related treatment, care, and support services for women

Services for women include the following:

  • Prevention and treatment of opportunistic infections
  • ARV treatment
  • Treatment of symptoms
  • Nutritional support
  • Reproductive health care, including family planning, cervical screening, and counselling
  • Psychosocial and community support
  • Palliative care

Care and support of the infant and child who are HIV-exposed

Infants and children who are HIV-exposed require regular follow-up care, especially during the first 2 years of life, including immunisations, HIV testing, and ongoing monitoring of feeding, growth, and development

Children whose mothers are infected with HIV are at higher risk than other children for illness and malnutrition for many reasons:

  • They may be infected with HIV and become ill, even when adequate health care and nutrition are provided.
  • Those who receive replacement feeding lack the protective benefits of breastfeeding against diarrhoeal diseases, respiratory infections, and other complications.
  • If the mother is ill, she may have difficulty caring for the children adequately.
  • Families may be economically vulnerable due to AIDS-related illnesses and deaths among adult relatives.

Health Workers

Knowledge Attitudes and Practice of Health Workers:

Internationally, studies evaluating attitudes of health care providers toward HIV/AIDS patients have suggested that current negative attitudes of health care workers toward people with HIV—compounded by fear of infection in the workplace, perceptions of risk, and lack of understanding of HIV—perpetuate the prevalence and manifestation of stigma toward this population (Chen et al., 2004; Juan et al., 2004; Quach et al., 2005; Reis et al., 2005). For example, a study examining discriminatory attitudes and practices by health care workers in Nigeria found that providers inadequately trained in HIV/AIDS care and ethics were more likely to agree that it was acceptable to refuse treatment to infected patients and were more likely to have done so (Reis et al., 2005).

HIV/AIDS-related stigma has been recognized as one of the largest challenges to improving HIV/AIDS care around the world. Studies suggest that provider stigma may be affecting the quality of care and patient decisions to seek health care services. (Juan et al., 2004) One study shows that discriminatory behavior and stigma toward them do exist and may be attributable to poor HIV/AIDS-related knowledge and high perceived risk of infection (Quach et al., 2005)

Stigma has been defined as “… a real or perceived negative response to a person or persons by individuals, community or society…[that] is characterized by rejection, denial, discrediting, disregarding, underrating and social distance” (Reis et al., 2005)

HIV-related stigma and discrimination defined as: a process of devaluation that significantly discredits an individual either living with or associated with HIV/AIDS (The Joint United Nations Programme on HIV/AIDS, 2011). Delivery for HIV positive women were refused by 62% of the doctors and 80% of the patients were referred to other institutions. People living with HIV were experienced that 88% of the doctors refused to conduct surgery and 85% of doctors were also accepted about rejection of surgery. Only 3% of doctors accepted that they had performed surgeries/Invasive procedure for HIV patients. We recommend that seminars, workshops should be organized on a continuous basis for health care workers on universal precautions, stigma and discrimination reduction. The institution should also make available materials needed to protect workers against the risk of acquiring pathogenic infection in the course of providing health services to their patients. (Jeevitha et al., 2013)

Pregnant Woman

Benefits of Prevention of Mother to Child Transmission of HIV:

In some parts of sub-Saharan Africa without any interventions most children that acquired HIV through MTCT die within the first two years of life. The increasing number of AIDS-related deaths in under- fives in Nigeria may reverse the gains made in child survival. The cost of care and support for HIV infected children places heavy financial burden on families, communities and the health care system.

PMTCT of HIV benefits the mother, infant, family, community and the health system.

Benefits to the Mother

  • Identifies HIV positive mothers for targeted interventions to reduce risk of

transmission of infection to their babies and to access care and support services

  • Promotes positive behaviour change
  • Reduces HIV risk behaviour
  • Increases use of dual protection methods of family planning and STI prevention
  • Helps to plan for the future
  • Promotes Infant feeding support system
  • Promotes access to early preventive and medical care
  • Helps personal and financial decision making

Benefits to the Infant

  • Decreases numbers of HIV infected infants
  • Promotes early diagnosis and intervention for the HIV exposed infants
  • Improves child health and survival

Benefits to the Family

  • Promotes communication between couples and testing of both partners
  • Provides opportunity for testing other family members
  • Contributes to reduction of stigma and discrimination
  • Helps to plan for the future
  • Provides infant feeding support system

Benefits to the community

  • Promotes the understanding and acceptance of the HIV and AIDS epidemic and those living with HIV and AIDS
  • Promotes uptake of risk reduction practices leading to reduction in the incidence of HIV
  • Promotes acceptance and uptake of HIV testing and counselling
  • Contributes to reduction of stigma and discrimination
  • Helps to plan for the future
  • Provides infant feeding support system

Benefits to the health system

  • Decreases the disease burden on the health system
  • Gives an opportunity to strengthen the health system.

Mother and Child

Conclusion:

The healthcare providers had deficient knowledge and practice of PMTCT and still had gaps in certain areas. In Primary Health Care setting, most of the health care providers could not correctly answer the four pillars of PMTCT. And they are poorly informed on practical issues in the prevention of MTCT of HIV. They are therefore handicapped to play an effective role in this important aspect of prevention of mother to child transmission of HIV. Their attitude was fairly appropriate. There is need for improved knowledge through structured educational intervention. Resources needed for practice should always be made available and the environment should be much more conducive for practice. Most of these healthcare providers willingness to update their knowledge and improve their knowledge and improve their attitude and practice of PMTCT.

References:

Bajunirwe F, Muzoora M (2005). Barriers to the implementation of programs for the prevention of mother-to-child transmission of HIV: A cross-sectional survey in rural and urban Uganda. BioMed Central Health Services Research 2(10). Accessed from http://www.aidsrestherapy.com/content/2/1/10 on 30/11/2011.

Brunner Suddarth (2008): Textbook of Medical-Surgical Nursing; Eleventh Edition.

Chen WT, Han M, and Holzemer WL (2004): Nurses’ knowledge, attitudes, and practice related to HIV transmission in northeastern China. AIDS Patients Care and STDs 18 (7):417– 422.

Cambridge University Press (2005): Advance learner. Dictionary 2nd edition. Mobile Systems Version 2.11. Visit: www.mobi.system.com

De Cock KM, Fowler MG, Mercier E, de Vincenzi I, Saba J, Hoff E (2000). Prevention of mother-to-child HIV transmission in resource-poor countries: translating research into policy and practice. Journal of American Medical Association. 283(9):1175-82.

Druce N, Nolan A(2007). Seizing the big missed opportunity: linking HIV and maternity care services in sub-Saharan Africa. Reproductive Health Matters.15 (30):201-203.

Doherty TM, McCoy D, Donohue S (2005). Health system constraints to optimal coverage of the prevention of mother-to-child HIV transmission programme in South Africa: lessons from the implementation of the national pilot programme. Africa. Health Science. 5 (3): 213- 218.

Psychosocial Support for Tb and multi-Drugs Resistance Tuberculosis Patients

Psychosocial support for TB, DR-TB Patients

  • Describe psychosocial support for the patient
  • Identify type of support available to DR-TB patients
  • Describe how to avoid stigma and discrimination

What is Psychosocial Support?

  • Psychosocial support means the way we take care of one another. It is about building a relationship of respect and acceptance where the dignity of people is strengthened.
    • Psycho: meaning psychological or to do with the mind, thoughts, feelings and emotions.
    • Social: about relationships and connections with people and the society we live in.
    • Support: ways of caring for a person and assisting them in difficult circumstances.
  • Psychosocial support addresses the ongoing psychological and social problems of individual patients, their partners, families and caregivers.

Rationale for Providing Psychosocial Support

  • Chronic disease condition
  • In Hospital based treatment, staying away from home or family for a long time
  • Loss of job or business
  • Stigma and discrimination
  • Daily intake of medicines with side effects for prolonged period
  • Co-morbidities

Stigma and Discrimination: Implications for DR-TB Response

  • What is Stigma?
  • Stigma is a powerful and shame and disapproval social label that radically and negatively affects the way individuals  view themselves or the way others view the individual
  • To stigmatise is to label someone, to see them as inferior because of an attribute that they have
  • Stigma is rooted in both fear and ignorance.
  • What is Discrimination?
    • The practice of treating one person or group of people less fairly or less well than other people or group because of prejudice about race, ethnicity, age, religion, or gender.
    • Persons infected and affected by TB, DR-TB may face discrimination as a result of their health condition

Types of Stigma

  • Self Stigma
    • self-hatred, shame, blame people
    • feel they are being judged by others so they isolate themselves
    • Clients who practice “self-stigma” isolate themselves from their families and communities
  • External Stigma: The judgemental words used on TB, DR-TB patients and also the negative attitudes shown them by the society, community or immediate families
  • Felt Stigma

Perceptions or feelings towards client

Causes of Stigma

  • The main causes of stigma include:
    • Insufficient knowledge, disbeliefs and fears about
      1. How TB is transmitted
      2. Fears about death and disease
      3. Intolerance
      4. Cultural/religious beliefs
      5. Terminologies – Mind your language !

Types of Psychosocial Support

  • Food
  • Shelter
  • Clothes
  • Security
  • Relationships
  • Referrals

Ways of Offering Psychosocial Support

  • Show respect and care for the patient
  • Help them to deal with difficult feelings, and cope with ’bad’ experiences.
  • Assess what mental health and supportive services are available at both the governmental and non-governmental level in order to refer patients when the need arises
  • the needs of individual patients and affected family members can be provided from the group in the community level community level
  • Establish linkages with relevant organizations for psychosocial support and services for your clients/patients
  • Any case beyond your knowledge, refer to someone with more specialized qualifications, e.g. a registered counselor, a social worker or psychologist.
  • Try to see, hear, think and feel what the unique needs of a patient at particular time might be such as:
  • Showing respect to the patient
  • Listening to a patient tell his/her story
  • Noticing the strengths of a patient
  • Providing encouragement
  • Letting a patient be honest about their feelings without judgment
  • Telling a patient stories that help them understand their situation more
  • Helping a patient join a sports group, social group, support groups or any hobby group
  • Joining in cultural activities like singing, dancing, attending Mosque or church, etc.

Qualities of a good Provider of Psychosocial Support

  • Friendly and approachable
  • Non-judgmental
  • Works for the best interests of a patient, family or community
  • Warm disposition
  • Show respect for individuals, families and communities and their beliefs.
  • Aware of the limitations of our knowledge and training
  • Work in the best interests of an individual, family or community
  • Respect the autonomy of people we work with.
  • Accepts the patient the way she/he is

DEVELOPMENTS IN LOCAL GOVERNMENT ADMINISTRATION IN NIGERIA

INTRODUCTION:-

The term local Government is an integral part of the social Sciences with a number of not- too unrelated definitions or meanings. This suggests that there is little divergence in the opinions of writers, local government executives and even the people in the academics as to the definition

The United Nations office for public Administration sees local Government “as a political sub –division of a nation (in a federal system) or state which is constituted by law and has substantial influence or control over affairs. These areas include powers to impose and collect taxes and rates. In most, the governing body of a local government is either elected or selected.

“Local government is infra- Sovereign geographic unit contained within a sovereign nation or quasi – sovereign entity.

In essence Local Government must possess the following characteristics, amongst others,

(a)   A Defined area with a specified Population.

(b)   An institutional framework for legislative, Executive or

administrative purpose.

(c)    A separate legal entity.

(d)    Sub – division of a sovereign nation or quasi – nation.

(e)    It can impose taxes and rates and can incur expenses.

(f)    It comprises of elected members and or selected members for its

smooth administration.

PURPOSE OF LOCAL GOVERNMENT

There may be some variations in the purpose for which local governments were set up in different countries Socialist, Communist, Theocratic, Autarky, dictatorial, et cetra, but the primary purpose of local government in a democratic government include the following among others.

  • To decongest government at the centre thereby freeing national leaders from

unnecessary details and avoidable involvement in local affairs

  • To ensure ease in coordination thereby facilitating and expediting action at the local level,
  • It is also designed to increase people’s understanding and support for social and

economic development activities at the grass roots level

  • To make programmes at local level foster social and economic betterment of the

inhabitants of local settlements and villages for a desired change in their living standards

  • Expose grassroots people to the art of self-government, which will prepare them for

leadership role at the local, state or national level.

  • To strengthen local and national unity.

Background Issues/Proposition

  1. There are two sets of opposing views or proposition concerning Local Government. The first segment justifies the existence of Local Government as being essential to a democratic administration or government. The argument here is centred on the fact that local government allows purely local issues/ politics to be administered by people concerned thereby providing civic education and political altitudes that enhances probity and accountability. In addition, local government discovers and promotes NATIVE INTELLIGENCE. Native intelligence is an essential ingredient in electoral victories the world over
  1. The other opinion concerning local government is centred around the argument that local government SUBVERTS, rather than PROMOTES democracy. According to this group

“THERE IS NOTHING LIKE LOCAL AFFAIRS WHICH IS OF ANY SIGNIFICANCE. In other words, emphasis should be placed on more global issues.

  1. Decentralisation is the foundation upon which Local Government is built. Decentralisation is defined as “the transfer of legal and political authority, to make and implement decisions, on public issues, to a body by the central authority or government.
  1. The aims and objectives of decentralization are to make government responsive to immediate local needs thereby reducing the workload and time at the headquarters. This in turn, produces tested and well – trained individuals at the local or grassroots level.

TYPES OF DECENTRALISATION

There are basically four (4) types of Decentralisation in local administrative practices and they include:

  • Deconcentration
  • Delegation
  • Devolution, and
  • Privatisation

The first three systems are commonly found in capitalists and non-capitalists countries alike, but privatization seems to be in the extreme as it involves total transfer of responsibility for the provision of certain community services from the public sector or voluntary agencies.

Deconcentration

This administrative practice involves Handing over some amount administrative responsibility and authority to lower level offices or officers within the government, Ministries, Parastatal, and Agencies. It involves shedding of workloads and official duties to staff or officers outside the national or state headquarters.

Delegation

This process entails transfer of managerial responsibility for specifically defined functions to establishment/organizations that are outside the regular bureaucratic structure but are being controlled indirectly by the central authority or central government. Under this system, the ultimate responsibility / accountability rest with the central authority, a kind of agencies relationship is created allowing the agent or delegate to exercise some degree of authority at the local level. The key issue here is that the transfer of specific duties/functions must be to a body that is TECHNICALLY and ADMINISTRATIVELY capable of carrying out the stead assignments.

Devolution

This entails creation or strengthening (financially or legally,) of sub-division of the central government the activities, which are substantially outside the direct control of the central government. However, this allows the central authority to frequently exercise indirect supervision and control over such sub-division or units. Devolution implies divestment of functions by the central government and creation of new units of governance outside the control of central authority.

Peculiar Characteristics

According to Rondineli, et al (1984), the characteristics include

(a) Autonomy and independence to the units

(b) Clearly and legally recognized geographical boundaries

(c)  Corporate status, power to raise funds and expend such funds

(d) The sub- division is regarded as an institution on its own

(e) Reciprocity, mutual respect and benefits in all dealings.

Privatisation

Under this arrangement certain duties of government are transferred to voluntary organization or private profit maximizing firms, Here some goods, services or amenities hither to provide government is shifted to private enterprises for efficiency and effectiveness.

FUNCTIONS OF LOCAL GOVERNMENT

The 21 member Nigerian Local Government review committee (The Dasuki committee’s) recommendation which was endorsed by the Political Bureau and approved by the federal Government charged the LGS with the following functions:

(a)  Basic Environment Sanitation and preventive health.

(b)  Construction and Maintenance of maternity centres, dispensaries,

leprosy clinics and health centres

(c)   Construction and maintenance of Road and Drainages

Excluding State and federal Government roads.

(d)   Maintenance of inland water-ways

(e)  Rural water supply schemes

(f)  Community development projects

(g)  Agricultural and Veterinary extension service

(h)  Construction and maintenance of primary parks

(i)  Town and lay- out planning

(j)  Markets, motor parks, Gardens and Public Park

(k) Maintenance of law and Order

(l)  Afforestation

(m) Maintenance of Mortuaries and Morgues

Sources of Revenue

One of the reasons for poor performance of local government in the past was inadequate revenues base. Traditionally, sources of local government revenues can be categorized internal or independent as well as external sources.

 Internal sources include:

(a)  Local rates and community taxes.

(b)  Rents on market stalls, rates on motor parks.

(c)  Fees from bicycle licenses, radio, television, etc

(d) Tenement rates payable on building annually by landlords

(e)  Pool tax

(f)   Development levies, court fines, and fees (customary courts)

(g)  Invested surplus funds and other commercial undertakings.

External Sources Include:-

(a) Monthly statutory allocation from the federation account/VAT.

(b) Percentage state IGR meant for Local Governments.

(c) Occasional grants from NGO’S and international bodies.

Local Government Under Military Regimes

  1. During the first republic, local governments were grossly mis – used by the politicians, they were used to intimidate, harass and destroy political opponents.
  2. After the January 1966 coup, the military government re-organized the judicial system and removed criminal jurisdiction from customary courts.
  3. Military governors of west and Eastern state dissolved the elected council offices and replaced them with sole Administrators who were carrier officers in the civil and public service.
  4. While Politicians in the west and East were treated with disdain, the politicians in the North found their ways in to the local government councils.
  5. The Local government reform of 1976 represented a landmark in the history of local government administration in Nigeria.
  6. The reform was designed to confer autonomy over local affairs on local representative to decentralize powers, bring efficiency, accountability and probity into the system.
  7. The reform constitution allowed local government to pertake in the sharing of revenue from the federation account.
  8. Unlike the practices in the past, the role of traditional rulers was defined as being PURELY ADVISORY.
  9. Despite all constitution provision, local government system in Nigeria between 1979and 1983 were not democratic all governors dissolved the elected local government councils and replaced them with nominated management committee who were mainly politicians.
  10. Proliferation of local government was the order of the during 1979and 1983 without due regards to constitutional provisions thereby making state government to default in their financial obligations to these local councils. The military reversed this in 1984.
  11. The Babangida administration introduced number of progressive innovations in to the local government system: One of such innovation was that local government were allowed to receive their monthly financial allocation directly from the federation account. Secondly the regime abolished the ministries of local government and created and/ or re-invigorated the local government service commissions.
  12. Responsibility for managing primary Education was transferred to the local Governments.
  13. Presidential system of government was introduced into the system – the executive and the legislative arms.
  14. Financial inadequacies have always been identified as the bane of local government system prompting people to call for a revenue allocation system that would reduce federal government’s “lion share” favour of other tiers of government.

Concluding Comments:

A study of local government is universally justified on two main grounds: in the first instance, it is believed (rightly too) that modern government began at that level, secondly, it is seen as the modern vehicle for accelerated economic, social and political development. Some nations operate on purely local government arrangement. E .g. Switzerland.

The system has increased the pace of development in Nigeria since the colonial times and it is still assisting in the overall development of the nation except certain lapses that have been identified such as the inability of the system to account for all funds allocated to them from their various revenue sources.

The sanda ndayako committee (now shehu Musa committee) is carrying out a new reform and restricting of the system. No one knows exactly what the federal government intends to achieve through this channel. However, we sincerely hope that the system will not be worse than the present arrangement after the exercise.

Thank you

BUILDING AN EFFECTIVE WORKPLACE RELATIONSHIP WITH YOUR BOSSES

Tips to manage up for an Effective Boss Relationship

Prologue

At one point or another in your career, you will report to a manager, the person you fondly- or not- call boss. The relationships that you immediate boss, and other company employees, are critical for your work success and career progress. Whether you like it or not, you’re in charge of your relationship with your boss.  Your boss has information that you need to succeed in your workplace

How To Develop An Effective Relationship With Your Boss

  1. The first  step is to develop a positive relationship with your boss
  • Relationships are based on trust.
  • Keep timeline commitments.
  • Never blind side your manager with surprises that you could have predicted or prevented.
  • Keep him/her informed about your projects and interactions with the rest of the organization.
  • Tell the boss when you’ve made an error or one of your reporting staff has made a mistake
  • Cover-ups don’t contribute to an effective relationship. Lies or efforts to mislead always result in further stress for you as you worry about getting “caught” or somehow slipping up in the consistency of your story.
  • Communicate daily or weekly to build the relationship.
  • Get to know your manager as a person – he/she one, after all. She/he shares the human experience, just as you do, with all of its joys and sorrows.
  1. Know that success at work, it is not all from you; but put your boss’s needs at the center of your universe.
  • Identify your boss’s areas of weakness or greatest challenges and ask what you can do to help.
  • Recognize the anxiety state of your boss; how can your contribution mitigate these concerns?
  • Understand your boss’s goals and priorities.
  • Place emphasis in your work to match his/her priorities
  • Think in terms of the overall success of your department and company, not just about you more narrow world at work.

 

  1. Look for and focus on the “Best” parts of your boss;
  • just about every boss both good points and bad.
  • When you’re negative about your boss, the tendency is to focus on his worst traits and failings.
  • This is neither positive for your work happiness nor your prospects for success in your organization.
  • Instead, compliment your boss on something he does well.
  • Provide positive recognition for contributions to your success.
  • Make your boss feel valued. Isn’t this what you want from him for you?

 

  • Instead of trying to change your boss, focus instead, on trying to understand your boss’s work style
  • Your boss is unlikely to change; she/he can choose to change, but the person who shows up to work every day has taken years and years of effort on her part to create.
  • And, who your boss is has worked for him/her in the past and reinforced his/her actions and beliefs
  • Learning how to read your boss’s moods and reactions is also a helpful approach to communicate more effectively with him.
  • There are times when you don’t want to introduce new ideas; if he preoccupied with making this month’s numbers, your idea for a six month improvement may not be timely.
  • Problems at home or a relative in failing health affect each of your workplace behaviours and openness to an improvement discussion
  • Additionally, if your boss regularly reacts in the same way to similar ideas, explore what she/he fundamentally likes or dislikes about your proposals.
  1. Learn from your boss.
  • Although some days it may not feel like it, your boss has much to teach you.
  • Appreciate that she/he was promoted because your organization found aspect of her work, actions, and/or management style worthwhile.
  • Promotions are usually the result of effective work and successful contributions. Be as a questionnaire in order to learn and listen more than you speak to develop an effective relationship with your boss.
  1. Ask your boss for feedback.
  • Let the boss play the role of coach and mentor.
  • Remember that your boss can’t read your mind.
  • Enable him/her to offer you recognition your excellent performance.
  • Make sure he knows what you have accomplished.
  • Create a space in your conversation for him to praise and thank you
  1. Value your boss’s time.
  • Try to schedule, at least, a weekly meeting during which you are prepared with a list of what you need and your questions
  • This allows him/her to accomplish work without regular interruption
  1. Tie your work, your requests and your project direction to your boss’s and the company’s overarching goals
  • Try to see the large picture ,while making proposals to your boss,
  • Your suggestion may not be adopted: resources, time, goals, and vision There may be are many reasons.
  • Maintain strict confidentiality
  1. At times you may disagree with your boss and occasionally experience an emotional reaction in relationship.
  • Don’t hold grudges.
  • Don’t make threats about leaving
  • Disagreement is fine; discord is Get over it.
  • You need to cooperate with the fact that your boss has more authority and power than you do
  • You are unlikely to always get your way.

By using this information, you can build a powerfully effective good relationship with your boss. Good Relationship has several characteristics like trust, mutual respect mindfulness welcoming diversity and open communication.

THE NEED TO TEACH COMMUNICATION IN PUBLIC HEALTH

Introduction:

I believe that the most essential skill of the Primary Health Care workers is the ability to communicate well. This is because bringing health to people depends to a major extent on community participation. Primary Health Care programmes only function when community and families actively participate in changing some aspect of the environment and habit of life. This active participation is depending on the Primary Health Care workers being effective in communicating health-promoting messages to the community.

One of the features of Primary Health Care that makes it different from the medical care model is the emphasis on communication. Many of the components of Primary Health Care simply cannot take place unless the health care workers are effective communicators. For instance of situations where communication is necessary include all aspects of health education, encouraging community participation, developing intersectoral cooperation and sharing knowledge about health so that individual people can take more responsibility for looking after themselves. The emphasis on these areas is comparatively new; however medical care has always been more successful where there has been effective communication between the patient and the doctor or nurse. Therefore, communication skills are essential skills in providing health care.

What are the communication skills

The ability to convey information to another effectively and efficiently. Public Health practitioners with good verbal, non verbal and written communication skills help facilitate the sharing of information between people within a geographical community for its benefit.

Communication skills are essential. Most Community Health Practitioners would probably agree with this conclusion ˵Communication is a good issue˵. But what, exactly, are communication skills?

I can start off by saying that they are the skills used when one informs, persuades, explains, tells, listens makes clear, demonstrates etc. So, for example, right from training period, one must teach Primary Health Care workers how to ῝explain῞ as part of their communication skills. But what exactly is involved in ῝explaining῞? Meaningful communication must include two important elements: the audience and the goal. It should clearly define both within the context of your communication.  Different audiences require different approaches in order to get them to the desired goals that are the reason.

The purpose of the communication is to get the audience to the desired goal, where the goal can mean to inform, persuade, explain, or to get the audience to take action. To bring your audience to the desired goal,  that communication is a successful one.

Analysis Communication Skills

It would be impossible to teach the skills of public health care without knowing what those skills were.

In the same way, communication skills cannot be taught unless you first analyze what communication skills are needed. This analysis can be started by thinking about when the public health practitioner needs to communicate. For instant, it might be when the public health practitioner:

  • Explains to the community why nursing mothers should be immunized their baby;
  • Persuade individual, family and community to use a pit latrine;
  • Ask a community meeting to choose their Tuberculosis community volunteer;
  • Finds out why community members do not want to use Primary Health Care Centres;
  • Discusses with an agricultural adviser how nutrition can be improved in a community;
  • Explains to a patient what anaemia is and how it can be prevented;
  • Writes to request that the health centre roof is repaired.

The next stage of the analysis is to separate the facts or information from the skills of communication. For example, think about the situation when a public health practitioner explains to mother that her baby needs to be immunized. There will be some facts- what the word immunization means, what the mother will have to do, the benefits of immunization, etc. But there are also the skills involved in explaining—use of appropriate words which the mother will understand, arranging the facts in a logical order, asking the mother questions to find out whether she understands, etc. these are the skills which need to be taught.

 

Functonal Communication And Health Care Delivery Services

Each time one person is talking to another person or to an audience, it is believed that communication is talking place. The newscasters on the radio or television are believed to be communicating to the listeners and viewers respectively. In the health care delivery system, communication prevails among the patient, the doctor, and the nurse, and other medical/paramedical personnel. There can be no effective and efficient health delivery system without functional communication among the key actors in the system, the doctor, the nurse, the Community Health Practitioners, the patient etc. Communication therefore is an essential ingredient for effective and result-oriented performance in health care delivery. When a patient cannot communicate well with either the doctor or the nurse, he/she may likely contribute to inefficiency in the system. Secondly, a Community Health Extension Worker or Community Health Practitioners who cannot communicate effectively to the community being served on health extension services, he/she may likely complicate healthcare services delivery in that community. Thirdly, any Doctor who cannot communicate very well to either the nurse or the patient is a problem to the system. Simply put, without functional communication in healthcare delivery, there can be no positive interaction between the healthcare providers and the benefiting community/individual.

DEFINITION:

Communication has been defined in various ways

(i)  It is a way to share information and ideas with other people

(ii) It is the transmission of information with the purpose of influencing the audience.

(iii) It is a bridge between generating knowledge and utilizing knowledge

(iv) It involves the transfer of a message from a source to a receiver with a view of effect a charge in or a reaction from the receiver.

Effective communication can be defined as that message which, when well delivered by the source or sender.

Efficient communication can be defined as that message which, when well delivered very well understood and utilized by the receiver.

A functional communication therefore is an effective and efficient communication.
Components of Communication

  1. Source: The source is the originator, the sender, the initiator of the message.

A good source /sender must exhibit:

  • Credibility: having the technical expertise and being trustworthy. The nurse can only effect the doctor’s directives when he/she is aware the doctor has adequate knowledge of the subject matter.
  • Empathy: having the ability to empathies with the receive.
  1. Message: The message is the knowledge the communicator or source wishes the

receiver to act upon.    A good message must.

  • Have relative advantage
  • Be compatible, i.e consistent with what is prevalent
  • Be simple, not complex
  • Be triable
  • Be observable to produce better result
  • Be of minimal risk
  • Be Understood.
  1. Channel: The Channel is the medium through which the message is conveyed from the sender to the receiver (e. g Doctor’s Prescription, patient’s folder, verbal channel, routine preventive health care delivery mammals, etc
  2. Receiver: The receiver is the audience, the benefiting individual/community, the action- taker. The receiver, on receiving the message, decodes it and translates it to his/her own terms and then accepts and acts on it.

Types of Communication

There are two type of communication

  1. One way communication:- There is a one way communication in the church or mosque where the preacher has no time to check the understanding and acceptance of his message by the audience. The one way communication is faster and simpler. It often does not lead to change in behavior/action.
  2. Two way communication: – A communication is two way, when the sender checks to ensure that the receiver understands accepts his message and will act on it. It involves both the sender and the receiver equally in the exchange of ideas. It requires the communicator working hard. It requires the communicator to exhibit the ability to listen:
  • Before the communication, to ensure that the receiver is in a responsive frame of mind.
  • During the communication, to ensure that the discussion is useful
  • After the communication, to ensure that there is no misunderstanding or confusion about the message by the receiver.

STAGES OF COMMUNICATION (FOR SENDER)

The sender or communicator of a message must ensure the functionality of his/her message by ensuring the following seven stages:-

(i) Determine objective or desired result of communication.

(ii)            Translate objectives into a message

(iii) Gain attention of intended receiver

(iv) Send the message

(v)  Secure understanding and acceptance of message

(vi) Stimulate action on message

(vii) Ensure action takes place, (follow up)

BARRIERS TO FUNCTIONAL COMMUNICATION

  1. Noise: During the time message is transmitted, can hinder the understanding of

             the message by receiver. Noise can be manifested in;

  • Physical appearance –look, cloths, posture, etc
  • Language used
  • Voice deformity (cracked, sharp, stammering)
  • Bad writing/pen, inaudibility, etc
  1. Lack of understanding, (by receiver or between sender and receiver)
  2. Interpretation personalized interpretation
  3. Fear, (by receiver at action time)
  4. impatience
  5. Assumption
  6. Interest

Facts and Inferences and Functional Communication

Managers in the health delivery system must test information before acting on it otherwise; it will be difficult for them to maintain accuracy in the communication chain. When a message is transmitted along a chain of receiver, there is a risk that the message may become distorted by successive transmission. The more links there are in the chain, the greater the likelihood of distortion or breakdown in the communication process. It is therefore imperative that managers must differentiate between facts and inferences.

FACTS:

  • can be observed
  • Can be stated (as facts), by observer
  • do not beyond what has been observed.

INFERENCES

  • Are guesses
  • Are assumptions
  • Are personal options/agenda opinions
  • Are extension of facts, based on assumptions.

When the receiver uses inferences instead of relying on facts, there is DISTORTION in communication and the communication is no more functional.

CAUSES OF DISTORTION IN COMMUNICATION

  • Desire to simplify
  • Desire to make message more meaningful
  • Desire to make message less disturbing or more pleasant
  • Various interpretation of message
  • Failure to distinguish between facts and inferences

Conclusion

Although the responsibility for communication rests primarily with the sender and the receiver work hard to experience satisfaction or pain and learn change. The rewards of a functional communication are neither the appearance of the process, nor the satisfaction of issuing instructions or giving advice. The reward is the achievement of results.