Fostering Collaboration and Sense of Belongingness between Community Health Stakeholders and PHC Workers to Promote Health Extension Delivery in Yobe State, Nigeria

Fostering Collaboration and Sense of Belongingness between Community Health Stakeholders and PHC Workers to Promote Health Extension Delivery in Yobe State, Nigeria

Shugaba Saminu, & Alhaji Salele Mohammed

Department of Education, Yobe state University, Damaturu, Nigeria

DOI: https://dx.doi.org/10.47772/IJRISS.2025.903SEDU0164

Received: 14 March 2025; Accepted: 19 March 2025; Published: 19 April 2025

ABSTRACT

The study examined fostering Collaboration and Sense of Belongingness between Community Health Stakeholders and PHC Workers to promote Health Extension Delivery in Yobe State, Nigeria. The objectives of the study were To; examine how are the forms of collaborative responsibilities between health extension workers and community health stakeholders during health service project delivery, determine the extent of fostering sense of belongingness between health extension workers and community health stakeholders during health service project delivery, examine implication of sense of belonging between health extension workers and community health stakeholders on promoting health service project delivery, examine differences in the opinion of community health stakeholders about sense of belonging and collaboration on promoting health services project delivery in PHCCs Yobe State. The study adopted descriptive survey research design. The total population of the study was (360) comprised of 157 health extension workers and 203 community health stakeholders. The sample size of 108 was drawn population of 157 health extension workers and 132 from population of community health stakeholders for the study. The two set instruments for data collection used in the study were; Collaboration and Sense of belonging for Community Health Stakeholder Respondents Questionnaire (CSCHSRQ) and Collaboration and Sense of belonging for Primary Healthcare Worker Respondents Questionnaire (CSPHCWQ). The instruments were validated through content and face validity by six experts. The reliability of 0.870 for the research instrument was established through the use of test and re-test method. Descriptive Statistics of mean and standard deviation and simple frequency count percentages counts using (Statistical Package for Social Science) SPSS were used to determine the differences between independent and dependent variables. The findings, under forms of collaborative responsibilities indicated positive outcomes among four domains, the findings in sense of belongingness between community health stakeholders and PHC workers indicated positive outcomes among four domains, the findings on implication of sense of belongingness between community health stakeholders and PHC workers revealed low outcomes among four domains and lastly the findings revealed differences on opinion among community health stakeholders in three domains The findings, under forms of collaborative responsibilities indicated positive outcomes among four domains. It is recommended based on findings that Yobe state management of PHC should pay special attention to raise more internal and external forces for collective community awareness campaign to foster collaboration and sense of belongingness among community members to promote health extension service delivery.

Key words: Fostering Collaboration, Sense of Belongingness, Community Health Stakeholders, PHC Workers and Health Extension Delivery.

INTRODUCTION

The health extension workers of Primary health care (PHC) remained the prime promoters and movers for healthcare service programmes in the rural areas, after Alma-Ata declaration in 1978. Since then the promotion and work of health extension workers in health extension service delivery became critically indispensable and recognized by public and private organizations of PHC around the world and Nigeria in particular. The National Agency of Primary Health Care is responsible for coordination all health development programmes and projects and regulation of the activities of PHCs in Nigeria. The State Primary Health Care Management Board (SPHCMB) in Yobe State, is therefore responsible for coordinating all health development programmes and projects at primary healthcare level through its various units across the Yobe State. One of the units of SPHCMB in Yobe State is Health Education and Promotion Unit responsible for health extension services delivery.

The delivery of health extension services under SPHCMB involved sense of belonging and collaboration of responsibilities between health extension workers and community health stakeholders in health Extension Service programme. The collaborative responsibilities involve; making health care services delivery available to their clientele through the use of education process, the provision of timely information, the linking of communities with sources health center resources and service providers, improving communication between healthcare providers and communities, providing culturally appropriate health education/information on topics related, chronic communicable disease prevention among others.

However, the others collaboration of responsibilities in delivery of health extension services includes; physical activity and nutritional counseling Providing informal counseling, health screenings, and referrals for MNCH, ensuring a regular supply and use of essential drugs at affordable costs Reducing social isolation among patient populations, informing health service providers about health needs of community stakeholders Facilitating healthcare service and community health services, to promote the advancement of health-related products, services, research, and programmes, and control healthcare service costs, create connections between vulnerable populations and healthcare providers, ensure cultural competence among healthcare providers serving vulnerable populations.

The sense of belonging in the delivery of health extension services involves attachment, interpersonal and intra-relationships, sense of joint ownership. It is very notable that in any community health extension services delivery, the essence of fostering sense of belonging is therefore to build trust, interpersonal, relationships, teamwork, team spirit and understanding between community health stakeholders and health extension service workers to increase an inclusive environment that promotes a sense of joint ownership for effective health services delivery and contribute to better health outcomes when strategically applied to shared goals.

In several times, many social science scholars in their studies have explained that the interaction of people would connect mutual relationship and inspires sense of belongingness and can lead to change in behaviors, beliefs, and attitudes. According to Kendra, C. MS (2023) individuals are inspired to belong to interacting groups as a result of many reasons, thus the reasons may include cultural interests, Religious beliefs, Shared goals and Socioeconomic status.

One of the critical management goals of SPHCMB in Yobe state is to promote unity, attachment, cohesion teamwork, team spirit and good relationship within their personnel and as well as outside communities to bring conducive atmosphere to work together so that they can rely on each other and by implication can lead to promotion of health extension service delivery and help to maximize and achieve a common goal (Ministry of Health Yobe State{MoHYS}2014)

It is on this ground the health extension services workers under the SPHCMB have been collaborating to work alongside with the community stakeholders to promote health extension services delivery and by implication fostering sense of belonging with health communities. However, there was no documentary evidence indicating how fostering sense of belonging and collaboration of responsibilities promote health extension services delivery. It is on this background this study examined Fostering collaboration and sense of belongingness between PHC workers and Community health stakeholder to promote health extension service delivery in Yobe state.

Objectives of the study

1. To examine how are the forms of collaborative responsibilities between health extension workers and community health stakeholders during health service project delivery in PHCC Yobe state.
2. To determine the extent of fostering sense of belongingness between health extension workers and community health stakeholders during health service project delivery in PHCC Yobe state.
3. To examine implication of sense of belonging between health extension workers and community health stakeholders on promoting health service project delivery in PHCC Yobe state.
4. To examine differences in the opinion of community health stakeholders about sense of belonging and collaboration on promoting health service project delivery in PHCC Yobe state.

Research Questions

1. How are the forms of collaborative responsibilities between health extension workers and community health stakeholders during health service project delivery in PHCC Yobe State?
2. To what extent fostering sense of belongingness between health extension workers and community health stakeholders during health service project delivery in PHCC Yobe State?
3. What are implication of sense of belonging between health extension workers and community health stakeholders on promoting health service project delivery in PHCC Yobe State?
4. What is the difference in the opinion of community health stakeholders on sense of belonging and collaboration on promoting health service project delivery in PHCC Yobe State?

METHODOLOGY

Research Design: The study adopted descriptive survey research design which was used on fostering collaboration and Sense of belongingness between PHC workers and Community health stakeholder to promote health extension service delivery in Yobe state. The closed ended questionnaire was used to search subjective opinion from PHC worker respondents about collaborative responsibilities and sense of belongingness on Health extension service delivery to form empirical evidences from case reporting in field through paper-questioning technique. Similarly, the open ended questionnaire was equally chosen to find out in-depth feeling and perception of Community Health Stakeholder respondents about collaborative responsibilities and sense of belongingness on Health extension services delivery to form subjective evidences through self-reporting technique, and to draw the logical conclusion from the sampled data and measured by descriptive statistic of mean and standard deviation.

Population: The population of the study consists of PHC extension workers and community health stakeholders covering village heads school heads and Community birth attendants who participated in health extension service delivery under SPHCMB Yobe state. According to annual project progress report of SPHCMB (2024) There are 157 PHC health extension workers and 203 community health stakeholders who participated in health extension project delivery under SPHCMB Yobe state. The total population of 360 were constituted for the study.

Sample Size and sampling procedure: The sample size of (108) was drawn from population of 157 (Health extension workers) using Research Advisor Table (2006). The table formula of sample size stated that the population between 150 and 200 requires a sample size of (108).

Similarly, the sample size of (132) was drawn from population of 203 (Community Health Stakeholders) using Research Advisor Table (2006). The table formula of sample size stated that the population between 200 and 250 requires a sample size of (132). The sample size of both was 240.

Sampling procedure: Stratified sampling technique was used to divide the state into (3) three health zones and purposive was used to select two sampled groups (facilities) from each health zone (making 6 sampled groups). The Personnel Participation Survey Method was used to identify the 108 Health extension worker respondents. The selection of sample was done by dividing sample size into 6 sampled groups (facilities). Therefore 18 samples represented each facility for the study.

Similarly, the Participants Registration Survey Method was used to identify the 132 community health stakeholder respondents. The selection of sample was done by dividing sample size into 6 sampled groups (facilities). Therefore 22 samples represented each facility for the study.

Instrument for Data Collection: The researcher developed two set of Instruments for the study which are Collaboration and Sense of belonging for Community Health Stakeholder Respondents Questionnaire (CSCHSRQ) and Collaboration and Sense of belonging for Primary Healthcare Worker Respondents Questionnaire (CSPHCWQ) The CSCHSRQ offered open ended questionnaire technique involving subjective feeling with rating scale to select the responses from the three health zones. Vis-a-vis (CSPHCWQ) closed ended questionnaire method was used for to select options of choice from categorical data with multiple selections.

Validation of the instruments: The validation of the instruments was done through content and face validity. The researcher gave six sets of instruments to six experts in three different departments of three institutions. The reliability of the research instrument was established through the use of test and re-test method. A sample of 20 respondents were selected for the test. The test was conducted twice at an interval of two weeks. The data collected were analyzed using PPMC and the result shows a reliability index of 0.870. It is based on this result that the reliability of the instrument was considered suitable; hence the instruments was administered for the study.

Data Analysis: The data collected were analyzed using descriptive statistics of mean and standard deviation using (Statistical Package for Social Science) SPSS. Collaboration and Sense of belonging for Primary Healthcare Worker Respondents Questionnaire (CSPHCWQ)

Q.1. How are the forms of collaborative responsibilities between health extension workers and community health stakeholders during health service project delivery in PHCC Yobe state?

The research question one was answered, the results in the table (1) were presented using Descriptive statistic of mean and standard deviation with 108 sampled representatives.

Table 1

Item 1 from Table 1 revealed that, adequate communication between healthcare providers and communities. This could be seen from the responses of the respondents where the decision mean is 3.0. Item 2 revealed that, Creating adequate connections between vulnerable populations and healthcare providers. This could be seen from the responses of the respondents where the decision mean is 3.2. Item 3 revealed that, Making effective health care services delivery available to their clientele through the use of education process. This could be seen from the responses of the respondents where the decision mean is 2.9. Item 4 revealed that, ensuring appropriate culturally health education/information on topics related, chronic communicable disease prevention, physical activity and nutritional counseling. This could be seen from the responses of the respondents where the decision mean is 3.1.

Q. 2. To what extent fostering sense of belongingness between health extension workers and community health stakeholders during health service project delivery in PHCC Yobe state?

The research question two was answered, the results in the table (2) were presented using Descriptive statistic of mean and standard deviation with 108 sampled representatives.

Table 2

Item 1 from Table 2 revealed that, Fostering of Unity/attachment between PHC workers and CH stakeholders during project service delivery. This could be seen from the responses of the respondents where the decision mean is 3.0. Item 2 revealed that, Fostering of interpersonal relationship between PHC workers and CH stakeholders during project service delivery. This could be seen from the responses of the respondents where the decision mean is 3.10. Item 3 revealed that Fostering of mutual cohesion and teamwork between PHC workers and CH stakeholders during project service delivery. This could be seen from the responses of the respondents where the decision mean is 2.6. Item 4 revealed that Fostering attachment and understanding between PHC workers and CH stakeholders during project service delivery. This could be seen from the responses of the respondents where the decision mean is 2.10.

Q. 3. What are implication of sense of belonging between health extension workers and community health stakeholders on promoting health service project delivery in PHCC Yobe state?

The research question three was answered, the results in the table (3) were presented using Descriptive statistic of mean and standard deviation with 108 sampled representatives.

Table 3

Item 1 from Table 3 revealed that, Interpersonal relation/teamwork and MNCH services delivery in PHCC. This could be seen from the responses of the respondents where the decision mean is 2.4. Item 2 revealed that, Unity/attachment and nutritional counselling services delivery in PHCC. This could be seen from the responses of the respondents where the decision mean is 2.3. Item 3 revealed that, Cohesion/ teamwork and communicable disease control services delivery in PHCC. This could be seen from the responses of the respondents where the decision mean is 2.2. Item 4 revealed that, Teamwork/understanding and drugs supply services delivery in PHCC. This could be seen from the responses of the respondents where the decision mean is 2.1.

Collaboration and Sense of belonging for Community Health Stakeholder Respondents Checklist Table (CSCHSRCT)

Q. 4. What is the difference in the opinion of community health stakeholders on sense of belonging and collaboration on promoting health service project delivery in PHCC Yobe state?

The research question four was answered, the results in the table (4) were presented using Descriptive statistic of mean and standard deviation with 132 sampled representatives.

Table 4

Item 1 from Table 4 revealed differences in the opinion on collaborative responsibilities among community health stakeholders during health service project delivery in PHCC. This could be seen from the responses of the respondents where the decision mean is 2.1. Item 2 revealed differences in the opinion on sense of belongingness among community health stakeholders during health service project delivery in PHCC. This could be seen from the responses of the respondents where the decision mean is 1.9. Item 3 revealed differences in the opinion on implications of sense of belonging among community health stakeholders on promoting health service project delivery in PHCC. This could be seen from the responses of the respondents where the decision mean is 1.9.

DISCUSSION OF FINDINGS

This study examined collaboration and sense of belongingness between community health stakeholders and PHC workers to promote health extension project delivery in Yobe state. The study discussed the findings of the four research questions. The findings, under forms of collaborative responsibilities indicated positive outcomes among four domains which are; communication between healthcare providers and communities, connections between vulnerable populations and healthcare providers, Making effective health care services delivery available to their clientele through the use of education process and ensuring appropriate culturally health education/information on topics related, chronic communicable disease prevention, physical activity and nutritional counseling.

The study revealed better outcome, hence demonstrating a convincing evidence on positive goodwill, interest and commitment to collaborative responsibilities between community health stakeholders and PHC workers with better health extension service delivery. This is in line with Hugh A., Andrew H., Adam B., and Nicholas M. (2021) on the study Impacts of Collaboration between local Health care and non-Health Care Organizations and Factors shaping how they work: A Systematic Review of Reviews which suggested that there is little convincing evidence that collaboration between local health care and non-health care organizations improves health outcomes.

It is also in consistent with Thomas L. (2022) on the study The Impact of Using Community Health Workers in Collaboration with Nurse Case Managers in Effecting Change in the Quality of Life for Diabetes Patients. The study reported communication and relationships of CHWs are grounded in bonding with their patients and recognizing the importance of social determinants in healthcare and developing a sense of community belonging is vital for the future of the care continuum.

The findings in sense of belongingness between community health stakeholders and PHC workers indicated positive outcomes among four domains; which are Unity/attachment, interpersonal relationship/teamwork, cohesion/teamwork, and Teamwork/understanding between PHC workers and CH stakeholders during project service delivery. The study revealed positive outcome, thus demonstrating a convincing evidence on good will/intention, passion and attitude between community health stakeholders and PHC workers to generate good impact on health extension project delivery. This is in line with Fredrik. (2024) in a book entitled Creating a sense of belonging at work: Strategies to use in your organization, which therefore advanced reasons to foster employee engagement, satisfaction, and productivity.

It creates a positive work environment and relationship where individuals feel valued, included, and motivated to contribute their best. It is also in consistent with Morgan M. F. (2023) Understanding the Impact of Collaborative Learning on Sense of Belonging. reported good collaboration between learners and instructors statistically increased significant sense of belonging from pre- to post-course survey,

The findings on implication of sense of belongingness between community health stakeholders and PHC workers revealed low outcomes among four domains; Interpersonal relation/teamwork, Unity/attachment, Cohesion/teamwork and Teamwork/understanding. The study indicated, there is gap between exiting treatment and outcome, thus demonstrating low relationship on promotion of health extension project delivery. This is in line with Madhosingh H. R. and Seal L. M. (2022) on the study of Fostering a Sense of Belonging in Urban Extension for Internal and External Stakeholders. The study revealed low relationship of Sense of Belonging, and Urban Extension stakeholders. This is not in consistent with Martha E. (2024) in a paper titled Nurturing a sense of belonging at school: What helps pupils feel connected?

He claimed that Research shows pupil’s sense of belonging impacts their academic outcomes including academic achievement, classroom engagement, motivation and attendance positive peer relation and emotional wellbeing also play significant roles. Conversely low academic achievement often coincides with a lack of belonging. He also claimed that evidence increasingly demonstrates that children and young people’s sense of belonging play a decisive role in shaping their social, emotional and mental health outcome and academic performance.

The findings revealed differences on opinion among community health stakeholders in three domains; which are collaborative responsibilities, sense of belonging and implication of sense of belonging on promoting health service project delivery. Hence there is convincing evidence demonstrating divergent opinion among stakeholders leading to outcomes. This could be factors associated with commitment, teamwork team spirit relationship and motivation. This is line with Korpershoek H. Canrinus, E. T. Fokkens-Bruinsma M. & Boer H. (2019) on study of The Relationships between School Belonging and Students’ Motivational, Social-Emotional, Behavioural, and Academic Outcomes in Secondary Education: A Meta-Analytic Review.

The study indicated result across different student groups (grade level, SES). Although the results vary to some extent across measurement instruments and region, generally, the results reveal that school belonging plays an important role in students’ school life. On average, a small positive correlation with academic achievement, and small to moderate positive correlations with motivational outcomes such as mastery goal orientations; with social emotional outcomes such as self-concept and self-efficacy; and with behavioral outcomes such as behavioral, cognitive, and agentic engagement. A small negative correlation is observed with absence and dropout rates.

CONCLUSION       

The findings reported both close and far relationships across the tested domains between Community’s health Stakeholder Respondents and Primary Healthcare Workers in four research questions.

The findings of form of collaborative responsibilities revealed positive outcomes among the study domains suggesting goodwill and commitment to collaborative responsibilities between community health stakeholders and PHC workers with better health extension service delivery.

The findings of fostering sense of belongingness revealed positive outcomes among the study domains demonstrating good will/intention, passion and attitude between community health stakeholders and PHC workers to generate good impact on health extension project delivery.

The findings of implication of sense of belonging revealed low outcomes among the study domains indicating that there is gap between exiting treatment and outcome, thus demonstrating low relationship on promotion of health extension project delivery.

The findings on opinion among community health stakeholders revealed low outcomes among study domains articulating low subjective view, thought and sentiment to collaboration and sense of belongingness to promote health extension project delivery.

RECOMMENDATION

The good outcomes of collaborative responsibilities that is manifested by the respondents is an indicator that community based collaboration with the stakeholders of community and workers of PHC are doing well to promote health extension service delivery. Hence, recommending the need for Yobe state management of PHC to readapt and re-observe the collaboration in other context of political based collaboration for multiple extension supports to promote health extension service delivery.

The good outcomes demonstrated by respondents in sense of belongingness is the indication that the stakeholders of community and workers of PHC demonstrated positive sense of belongingness. It is recommended that Yobe state management of PHC should pay special attention to raise more internal and external forces for collective community awareness campaign to foster collaboration and sense of belongingness among community members to promote health extension service delivery.

The implication of sense of belongingness in respondents revealed low despite the commitment. This indicates deficiency in some domains. It is recommended that Yobe state management of PHC should retest some health service delivery domains within the Unit of Health extension and promotion afterward to discover any deficiencies in these domains as well as the area in which the health extension delivery.

The outcomes of respondent opinions based on study signifies divergent in some domains and low relationship also in some domains among community health stakeholders under study. It is recommended that Yobe state management of PHC, should add more to raise love of unity and team spirit and attachment between community health stakeholders and health extension workers to promote the level of health extension service delivery.

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