ABSTRACT
Background.
Children as a vulnerable group bear an undue share of the global burden of disease. Attention to the provision of quality child health services can prevent many diseases that cause severe illness and death in children in developing countries. Child health services form part of the maternal and child health services, one of the components of primary health care. Quality child health services if made available at the primary health care level will produce an effective and efficient outcome; reduce child morbidity and mortality and ultimately the attainment of the MDG – 4. The study was conducted from 15th September to 30th November, 2009 to assess the quality of child health services in
the Public PHC facilities in Nnewi North LGA of Anambra state.

Methodology.
The study was a cross – sectional descriptive study that assessed the quality of child health services and its determinants in the LGA using both qualitative and quantitative methods. Focus group discussion of caregivers and providers of child health services as well as key informant interviews of the facility heads and the LG PHC coordinators were conducted. A checklist adapted from the minimum requirements for a primary health centre developed by the National Primary Health Care Development Agency was used in assessing the health resources
available for child health services in NNLG. A total of 305 caregivers utilizing child services in the public PHC facilities in NNLG selected by stratified sampling with proportionate allocation were interviewed. In addition, some selected health care workers, facility heads and the health facilities providing child health services were included in the study.

Result.
The result from the study showed the quality of child health services as poor. This is as evidenced by inadequacy of basic amenities, inadequate staff distribution. The providers were not motivated due to delayed promotion, insufficient training opportunities. The caregivers corroborated the managers’ views that equipment were sufficient, were not shared by the caregivers and providers of child health
services.

Conclusion.
It was concluded that the quality of child health services in NNLG was poor. There is a need for the LGA authorities to provide minimum equipment package, drugs and supplies as well as make funds available for the delivery of quality child health services. There is also a need for the adoption of quality of care action plan at the LGA to improve the quality of child health service delivery which is a step towards the attainment of the MDG4.

CHAPTER ONE

1.0 INTRODUCTION
Children and women form three-quarters of the population in low and middle income countries such as Nigeria. They are also the most vulnerable and most sensitive to their environment. As such, children bear an undue share of the global burden of diseases. Although major gains were made in the reduction of childhood health indicators in the previous decade, observations are that stagnations or even reversals were seen in many countries since the 1990s.1 One of the reasons given for this is low level of utilization of quality health services. Another reason is that the concept of quality has not received much attention in these developing countries, coupled with economic decline, political
instability, and emigration of health professionals amongst other factors. This has drawn the interest of many international agencies like the United Nations Children’s Fund (UNICEF), World Health Organization (WHO), Rockfellers Foundation, among others to plan programmes for interventions on these alarmingly poor health indices.These intervention programmes have been developed through integrated approaches (Primary Health Care, Integrated Management of Childhood Illnesses), selective parallel programmes (Child Survival Strategies) and development programmes. The latest of such commitments by these international agencies, were made at the Millennium Summit in September 2000, from which the Millennium Declaration, and subsequently, the Millennium Development Goals (MDGs) emerged.
Also at the UN General Assembly’s Special Session on Children in May 2002, this issue resulted in the outcome document ‘A World Fit for Children’. These two compacts complement each other, and taken together, form a strategy – a Millennium agenda – for
protecting childhood in the opening years of the 21st century. In the year 2000, representatives of 189 nations, including 147 heads of state and
government, gathered at the United Nations for a historic Millennium Summit. They adopted a set of goals, the Millennium Development Goals (MDGs). Achieving these goals by the target date of 2015 will transform the lives of the world’s people. The MDGs are made up of 8 goals, 18 targets and 48 indicators out of which 3 goals,  8 targets and 18 indicators, are directly related to health. 2.
The Millennium Development Goal number four, is about the reduction of child mortality.2,3. The main target of MDG 4 is to: reduce under – five mortality rates (U5MR) by two-thirds between 1990 and 2015. The indicators numbers 13,14 and 15 are: under – five mortality rates (U5MR), infant mortality rates (IMR) and the proportion of 1 year old children immunized against measles.2,3. U5MR and IMR
measure such indices as: the level of immunization against common childhood diseases; the nutritional state and health knowledge of mothers; availability of maternal and child health services within five kilometers or 30 minutes walk. 2, 3. 2 These children form the base of the nation’s human resource development and it is only ideal that the society provides the supportive and enabling environment for the optimal
attainment of their innate qualities. Assessment of the quality of these child health services that are offered through Primary Health Care facilties in the LGA is a way of assessing the progress towards the attainment of MDG 4, and is undertaken in this study.

1.1 PROBLEM STATEMENT

High rates of under–five and infant mortalities still persist.These unnecessary mortalities reflect a significant breakdown of basic services, and in particular of primary health care in the country. 4 Coverage and utilization of these interventions are correspondingly low.
The Nigerian health situation makes it a major sector in the global achievement of MDGs

1. 4 Achieving the MDG 4 means tackling such problems as low immunization coverage, inadequate provision of clean and potable water, lack of infrastructures like good roads and transportation in the rural areas. Other problems to tackle include: unavailability of basic obstetric and neonatal care in most health facilities, low education level of mothers, unwholesome sale of expired drugs in the rural areas and urban slums. It is also necessary to increase political will on the part of government, as health budget still remains about 5% of national budget.5
   Quality of care reflects how the available resources have been utilized to produce an effective and efficient outcome. However, very few studies have been done on the assessment of the quality of primary health care in most developing countries. This number further dwindles when the quality of child health services is particularly referred to.

In the Nigerian health system, formal mechanisms to assess quality of care are yet to be developed.2 Evaluation of PHC programmes has focused mainly on coverage. A little attention is paid to assessing the quality of service provided.6 An assessment of the
quality of the health service will indicate the degree of its worth and is no doubt a step towards determining its effectiveness and ultimately the attainment of the MDG-4.

1.2 JUSTIFICATION OF THE STUDY
Globally, the quality of health care services for children can be better than what it is, especially as these children constitute one of the vulnerable groups in the society. In Nigeria high childhood morbidity and mortality from preventable causes remain major
public health problems. How then can we achieve the MDG-4, when the deficiencies in the health system account for these alarmingly poor health statistics?

Assessment of the quality of child health services serves as an appraisal of the degree of worth of these services to meet the identified needs as contained in the Millennium Declaration. It is necessary to ensure that the limited resources allocated to health care, inspite of growing demands is effectively utilized to meet the health needs of the people. Quality assessment is also a managerial process to ensure that standards are maintained with the aim of improving the effectiveness of services. Assessment of health service effectiveness is a wider concern for assurance of quality of care It is also important in this era of health sector reforms so as to serve as a basis for recommendation of appropriate intervention towards the improvement of the quality of child health services with a consequent reduction of morbidity and mortality in children. This will facilitate the attainment of MGD-4 which is to reduce child mortality.The study would also contribute to research in the quality of child health services in Nigeria.

1.3 AIM AND OBJECTIVES
Aim
To assess the quality of child health services and its determinants in the PHC facilities of Nnewi North Local Government (NNLG) Area Anambra state. Specific objectives
1. To determine the availability of child health services in PHC facilities of NNLG Area Anambra state.

1. To examine the health resources (human, material and financial) available for the provision of child health services in PHC facilities of NNLG Area Anambra state.

2. To study the quality of supervision of child health services in the PHC facilities.

3. To assess the level of clients’ satisfaction with care received at these PHC facilities.

4. To identify factors influencing the quality of child health services in NNLG.