DIRECT AND INDIRECT COSTS OF STRUCTURAL OPPRESSION IN PRIMARY HEALTH CARE DELIVERY SYSTEMS

ETHNOGRAPHY OF HEALTH CARE PROVISIONING IN AGADAMA, DELTA STATE, NIGERIA

Abstract

Globally, all oppressed people suffer some inhibitions to their ability to optimally develop and exercise their capacities and express their needs, thoughts, and feelings and one of such inhibitions is limited access to primary health care (PHC). In Africa, particularly in Nigeria, certain structurally oppressive factors limit access to quality healthcare in some water-logged rural communities like Agadama in the Oil-rich Niger-Delta region. In this paper, structural oppression (SO) refers to systemic constraints on groups or individuals and its causes, embedded in unquestioned norms, habits, and symbols, in the assumptions underlying health institutional rules, cultural beliefs, and the collective consequences of following those rules. SO comes with direct and indirect costs on the people, society, and government. Through a qualitative ethnographic approach, this study employed 34 in-depth interviews, 6 key informant interviews and participant observation that lasted for over one year, as well as callbacks to elicit data from a rural farming community. Thematic analysis was employed to analyze data collected based on the study objectives. Findings reveal avoidable child and maternal mortality (deaths); traveling long distances in search of a healthcare center, poor health-seeking behavior due to ignorance and poverty. Patent medicine stores/vendors often serve as an intervening factor but results to over-reliance on patent medicine stores for all healthcare needs ranging from surgery, injections, intramuscular/vein drips, stitching of cuts, etc. These and more show overt and covert structural oppression confronting this agrarian water-logged rural community as a result of environmental realities, geographical location, traditional health beliefs/practices, and failure of the government to provide PHC. This paper, therefore, recommends a review of the grass root health care policy to eliminate inequality in healthcare access.