10th International Science Congress (ISC-2020) will be Postponed to 8th and 9th December 2021 Due to COVID-19.  International E-publication: Publish Projects, Dissertation, Theses, Books, Souvenir, Conference Proceeding with ISBN.  International E-Bulletin: Information/News regarding: Academics and Research

Knowledge, Attitudes and Practices of Enugu State District Health System by Public Primary Health Care Workers

Author Affiliations

  • 1 Department of Community Medicine, Enugu State University College of Medicine, Park Lane, Enugu, NIGERIA
  • 2 Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu, NIGERIA
  • 3 Department of Community Medicine, Enugu State University Teaching Hospital, Park Lane, Enugu, NIGERIA
  • 4 Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu, NIGERIA

Int. Res. J. Medical Sci., Volume 3, Issue (4), Pages 1-10, April,28 (2015)


The District Health System (DHS) provides the best chances of implementing primary health care as laid down in the declaration of Alma-Ata in 1978. In December 2003, Enugu state, Nigeria made a decision that the healthcare system will operate a District Health System with a unitarised healthcare delivery structure based on 17 Local Government Areas (LGAs) and 39 LGA Development Centers. After the adoption of DHS by the state Government, Partnership for Transforming Health Systems (PATHS) effectively commenced providing essential technical support for the development and implementation of the DHS. The objective of this research is to assess the knowledge, attitudes and practices of the district health system being implemented in Enugu state, by primary health care facility workers. Observational study, employing Cross-sectional study technique was the study design. Analysis was done in terms of percentage of health workers with the correct knowledge of district health system; and the right attitudes and practices of the Enugu state district health system. Scores were assigned to the response, and scores above 50% were considered adequate. Overall knowledge level of 72.7% was recorded on the supported health facilities, while 54.5% was recorded in the non-supported facilities. One hundred and forty two (98.7%) respondents from the supported facilities have right attitudes to the Enugu state DHS, while 93.7% have the right attitudes in the non-supported facilities. Over 60% of respondents from both the supported and non-supported facilities had the right practices to most of the provisions of the Enugu state DHS. Some of these provisions are; correct DRF practice, integrated supportive supervision, provision of basic obstetrics services, and existence of facility health committee. However, some provisions such as staff posting, discipline, promotion, recruitment and quality recognition initiative were poorly practiced.


  1. World Health Organization. The Challenge of Implementation: District Health Systems for Primary Healthcare. Geneva, Switzerland. WHO, (1988)
  2. World Health Organization, Every body’s business: Strengthening Systems to improve health outcomes: WHO’S frame work for Action. Geneva, Switzerland. WHO Health Systems and Services, (2007)
  3. Chatora R. and Tumusiime P., Module 1, DHMT training modules: Health Sector Reform and District Health Systems. Congo, Brazzaville, WHO Regional office for Africa, (2004)
  4. Lucas A. O. and Gilles H. M., Short Textbook of Public Health Medicine for the Tropics. International students’ Edition 4th ed. United Kingdom. ARNOLD, (2003)
  5. Seqall M., District Health System in a Neoliberal World: A Review of Five Key Policy Areas, Int. Journal of Health Planning and Management,18 5–26,(2003)
  6. World Health Organization, Health Systems Strengthening in Africa. African Union 2nd Ordinary session of the Conference of African Ministers of health (CAMH2), Gaborone, Botswana, 10-14 October, (2005), www.chr.up.ac.za. undp/regional/ docs/ audeclaration7.
  7. Gorgen H., Kirsch-Woik T. and Schmidt-Ehry B., The District Health System; Experiences and Prospects in Africa. Manual for Public Health Practitioners. Germany, GTZ, (2004)
  8. Tarimo I. E., Towards a Healthy District: Organizing and Managing District Health Systems based on Primary Healthcare, Geneva, Switzerland, WHO, (1991)
  9. Obionu C. N., Primary Healthcare for Developing Countries, 2nd ed. Enugu, Nigeria. Institute for Development Studies, University of Nigeria, Enugu Campus, (2007)
  10. Enugu State Ministry of Health, Enugu state Health Policy, Enugu, Nigeria, Enugu SMoH, (2003)
  11. National Primary Health Care Development Agency, Introduction to Ward Health System: Briefing Package for Sensitization on the Ward Health System, Abuja, Nigeria, NPHCDA, (2006)
  12. National Primary health Care Development Agency and Federal Ministry of Health, Operational Training Manual and Guidelines for the Development of Primary Healthcare in Nigeria, Abuja, Nigeria, NPHCDA/ FMoH, (2004)
  13. Federal Government of Nigeria. Constitution of the Federal Republic of Nigeria, 1999, Abuja, Nigeria., The Federal Government of Nigeria, (1999)
  14. Enugu state government, Enugu State Poverty Reduction Strategy/State Economic Empowerment Strategy, Enugu, Nigeria, Enugu state government, (2003)
  15. Partnership for Transforming Health Systems, Togetherness in Health: The Enugu Experience in Health Sector Reform, 2002-2008, PATHS Enugu Final Programme Report, Abuja, Nigeria. PATHS (DFID), 2008)
  16. Enugu state Ministry of Health, Health Sector Reform: Implementing the District Health System, Enugu, Nigeria, Enugu SMoH/PATHS, (2004)
  17. Enugu State Government. Health Law, 2005. Enugu, Nigeria, Enugu State Government, (2005)
  18. Uzochukwu B.S.C., Onwujekwe E.O., Soludo E, Nkoli E, Uguru N.P., The District Health System in Enugu state, Nigeria: An analysis of Policy development and implementation, Enugu, Nigeria. Consortium for Research on Equitable Health Systems (Health Policy Research Group, College of Medicine, University of Nigeria, Enugu – Campus), (2009)
  19. Pillay Y., McCoy D. and Asia B., The District Health System in South Africa: Progress made and the next steps, Report of a study in South Africa, USAID, (2001)
  20. The Enugu State Government. Enugu State Government Diary, 2009, Enugu, Nigeria, The Enugu State Government, (2009)
  21. National Population Commission, Nigeria, 2008. Data for National Development, www.population.gov.ng/ index.php/state-population, (2008)
  22. Enugu State Ministry of Health, Health Services Directory, Enugu state Ministry of Health, (2008)