Assessment of Utilization of Standing Order in the Management of Patients by Community Health Extension Workers in Ekiti State, Nigeria

Abstract

Engagement and training of community health extension workers was the strategy adopted by Nigeria to solve the problem of the dearth of skilled health workers at the primary health care level. This group of health workers were trained to use standing orders in the management of the patient at this level of care. The purpose of this study is to investigate the extent of utilization of standing order among community health extension workers. The research was cross-sectional in nature, and it used a self-applied structured questionnaire. The questionnaire was distributed between March and April 2022. There were 265 respondents with age ranges between 23 and 58 years, and the majority (86.7%) were females. 98.1% possessed a copy of the standing order, and 88.5% and 9.9% kept their standing orders in health facilities and home, respectively. 62.3% used it regularly, 19.6% occasionally, 8.3% sometimes and 9.8% rarely used it. Reasons given for not using standing orders included- waste of time, patients who think I am not competent, and not containing new drugs. Regular utilization of standing order is low, and there is a need to educate the community extension workers on the importance of standing order at the primary health care level. Keywords: Standing order, Standardization, Utilization.

Drug prescription pattern in primary healthcare centers in southwest Nigeria. A cohort analysis of primary health workers prescription records

“…In this study diagnoses were made only in 40% but not in 60% of the cases. The low utilization of standing order by community health extension workers as shown in a study by Adepoju and Afe [26] might be responsible for the low percentage of diagnosis in this study. Also comprehensive health centres generally have higher level and more experienced health workers than the basic health clinics and this is expected to translate to better quality of care including prescription practice as supported by less number of non-diagnosis based prescription at the comprehensive center compared to the basic health clinic.…”

“…Doctors are mostly the prescribers at the secondary and tertiary level while community health extension workers are the major prescribers at the primary health care level. While doctors are trained in the act of making diagnosis before making prescriptions; community health extension workers are trained to use standing order to make 'diagnoses or classification [25]. Making diagnosis before making prescription is expected to enhance accuracy of treatment and prevent treatment of mere symptoms rather than diseases leading to better prescription habit.…”

Multi-criteria decision analysis method for differential diagnosis of tropical febrile diseases

“…The works in Refs. 18 and 19 define a standing order (SO) as a procedure for identification of diseases as well as relevant treatments in the absence of a doctor by an authorized non-physician health worker. In multi-symptom, multi-disease situations, these FHWs lack adequate resources to carry out timely and accurate diagnosis with accomplishment of desired efficiency.…”