FIRST CHAPTER

FIRST CHAPTER

Study Background Information

Known worldwide as the cornerstone of efficient, fair, and sustainable health systems, primary healthcare
(PHC) PHC has been crucial to reaching "Health for All" (World Health Organisation, 2008) since the Alma-
Ata Declaration of 1978. Well-functioning PHC systems all around help to greatly lower morbidity, mortality,
and population health results. The success of these services, however, still depends on the function and
performance of the buildings housing them (Ilesanmi, 2010; Hinde, 2012).

Buildings meant for healthcare should not only fulfil their functional goals but also assist the comfort, safety,
and satisfaction of staff members as well as patients (Ilesanmi, 2010; Jiboye, 2012). Studies have shown that the
efficiency of healthcare delivery and the user experience are greatly affected by design quality, environmental
factors including ventilation, lighting, spatial layout, and accessibility (Abbas & Ghazali, 2010; Department of
Health, 2014). Well-designed hospital settings, for example, help to lower hospital-acquired infections, increase
staff productivity, and speedier patient recovery (Ulrich et al., 2008).

Poor building performance is mostly caused by designers and facility managers' lack of knowledge of users'
changing needs (Natasha & Abdul Hadi, 2008). Building Performance Evaluation (BPE) or Post-Occupancy
Evaluation (POE) offers a vital feedback tool by means of users' experiences and satisfaction to guide next
improvements (Ibem et al., 2013; Said, 2012). Regular evaluation guarantees that facilities, especially in
healthcare, provide therapeutic environments actively support healing (Abbas & Ghazali, 2010; Dandajeh,
2011).

Tackling important health issues like high maternal and child death rates depends on the PHC system in Nigeria
(Asuzu, 2004). Though thousands of PHC facilities have been set up around the country (Federal Ministry of
Health, 2011), Nigeria still battles poor health outcomes owing in part to infrastructure deficiencies and
maintenance failures.

Potiskum, in Yobe State, exemplifies these difficulties. Being a commercial centre and one of the most
populated cities in the northeast, Potiskum has seen fast population growth, internal displacement caused by
conflict, and rising need for health services (Adebayo, Adeniran, & Aliyu, 2015; Okeke, Iwu, & Chukwu,
2019). Sadly, many PHC structures in Potiskum lack infrastructure including insufficient spatial planning, bad
ventilation, inconsistent water and power supply, and run-down sanitation facilities, all of which harm service
delivery and user satisfaction (Adebayo et al., 2015).

Furthermore, by displacing communities, stressing current resources, and redirecting funds intended for
infrastructural growth towards emergency responses, the Boko Haram insurgency has aggravated healthcare
infrastructure even more (Okeke et al., 2019). Many PHC buildings in Potiskum are therefore physically unfit to
meet present healthcare needs, so compromising their use and the welfare of users.

Though building performance is essential for healthcare results, empirical research evaluating the functional
performance and user satisfaction of PHC buildings in Potiskum is surprisingly lacking. Most current
assessments either national-level generalisations or focus on secondary and tertiary healthcare institutions. This
study thus intends to close the gap by methodically assessing the functional performance and user satisfaction of
primary healthcare facilities in Potiskum, Yobe State, using Building Performance Evaluation frameworks to
offer evidence-based recommendations for future enhancements.

Problem Statement of the Study

User satisfaction and health outcomes are greatly influenced by the physical features of healthcare facilities.
Research has indicated that the design, function, and spatial quality of buildings have a direct impact on how
people view and engage with medical services (Ibem, Opoko, Adeboye, & Amole, 2013; Jiboye, 2012).
Traditional hospital and primary care designs in Nigeria frequently neglect user needs, so contributing to
problems like overcrowding, poor ventilation, insufficient lighting, and lack of privacy. Particularly in poorly
maintained or ageing health facilities, these shortcomings have been linked to higher stress, anxiety, discomfort,
and in some cases, hospital-acquired infections (HAIs) (Atata, Ibrahim, Akanbi II, Olurinola, & Sani, 2006;
Dandajeh, 2011).
Although several studies have looked at healthcare infrastructure and building performance at tertiary or general
hospital levels, especially in rural and semi-urban areas like Potiskum, Yobe State, the assessment of Primary
Healthcare (PHC) buildings still shows a clear gap. Still, for more than 70% of Nigerians, PHCs are the nearest
point of treatment and meant to handle more than 90% of the nation's health issues (Abdulraheem, Olapipo, &
Amodu., 2012). One wonders whether these structures are satisfactory to their users and functionally efficient.
And to what degree do they promote safe, comfortable, and efficient service delivery?

Located in northeastern Nigeria, Potiskum has seen fast population growth and infrastructural pressure
exacerbated by insecurity and limited government investment in health infrastructure. Though a significant
commercial centre in Yobe State, many of its PHC facilities still run under unacceptable standards with little
space, worn building finishes and inadequate access to vital utilities including water and power (Dandajeh,
2011). These circumstances not only lower the morale and output of healthcare professionals but also drive
patient patronage away and undermine confidence in public health institutions.

It is urgent to evaluate the functional performance of PHC buildings and the degree of user satisfaction for both
patients and health workers in Potiskum. Policy choices on infrastructure development and healthcare quality
improvement stay uneducated without such statistics. This study therefore aims to close the gap by assessing the
physical environment of PHC buildings in Potiskum and applying post-occupancy evaluation ideas to find how
well these structures support the provision of primary healthcare services and fulfil user expectations.

1.3 Study Aims and Objectives

This study intends to evaluate the functional performance and user satisfaction of Primary Healthcare (PHC)
buildings in Potiskum, Yobe State, so enabling the identification of design and operational flaws and the
presentation of evidence-based recommendations that improve user experience and facilitate efficient healthcare
delivery. The study outlines the following particular goals to reach the stated goal:

To assess the functional performance of chosen Potiskum PHC buildings.

To gauge the degree of user satisfaction among patients and healthcare workers with the physical environment
and infrastructure state of PHC buildings.

To investigate the connection between user satisfaction and the functional performance of PHC buildings.

To find particular design-related and operational flaws in PHC facilities that could affect user experience or
service delivery.

To offer reasonable, context-sensitive ideas for enhancing the design, upkeep, and general performance of PHC
structures in Potiskum.

1.4 Research Hypotheses

Consistent with the third goal, the research speculates the following:

Null Hypothesis (H₀): In Potiskum, Yobe State, the functional performance of PHC buildings has no
statistically significant relationship with user satisfaction.

Alternative Hypothesis (H₁): In Potiskum, Yobe State, user satisfaction and the functional performance of PHC
buildings are statistically significant.

1.5 Research Enquiries

The following study questions have been designed to help this study:

In terms of spatial layout, ventilation, lighting, thermal comfort, safety, accessibility, and maintenance, how
functionally effective are the chosen PHC buildings in Potiskum?

How satisfied are users—patients and healthcare staff members—with the physical environment of PHC
buildings in Potiskum?
Does user satisfaction in Potiskum correlate statistically significantly with the functional performance of PHC
buildings?

What particular design and operational flaws are present in the PHC buildings that could impair user experience
or delivery of healthcare services?

What context-appropriate design or maintenance suggestions could be made to enhance the functional
performance and user satisfaction of Potiskum's PHC buildings?

Study Relevance

This work is academically and practically important. Practically speaking, it offers important knowledge on the
state and usability of PHC buildings in Potiskum, a town that has struggled with major infrastructural and
security issues. The study provides evidence-based suggestions that can help local and state governments,
architects, and facility managers plan future enhancements by means of identifying particular functional and
user-experience flaws.

Academically, the study adds to the expanding body of literature on post-occupancy evaluation (POE) and
building performance in healthcare infrastructure, particularly in low-resource and conflict-affected areas such
as northeastern Nigeria. Focussing on primary healthcare building facilities often ignored in infrastructure
assessments, it tackles a noted research gap since these facilities are vital to over two-thirds of Nigerians. The
results will also help future research aiming to investigate the connections between patient outcomes, user
satisfaction, and healthcare architecture in comparable settings.

1.7 Study Scope and Restrictions

1.7.1 Study Coverage

The functional performance and user satisfaction of Primary Healthcare (PHC) buildings in Potiskum, Yobe
State is analysed in this paper. Adopting a Post-Occupancy Evaluation (POE) method to evaluate both the
physical conditions and user experiences of the buildings, it is limited to chosen, actively operational PHC
facilities within the local government area. Key functional criteria including spatial layout, lighting, ventilation,
thermal comfort, accessibility, safety, and maintenance are the emphasis of the study. The study generates
context-specific insights that can guide future design, renovation, and policy interventions by means of a mixed-
methods approach comprising physical audits, structured questionnaires and checklists, so assessing satisfaction
from both healthcare personnel and patients.

1.7.2 Study Shortcomings

Geographically limited to PHC buildings in Potiskum LGA, this study's results might not represent the situation
in other areas of Yobe State or Nigeria with different socio-economic, climatic, or security conditions.
Academic deadlines define the study's timeline, which could restrict data collecting to a single season and so
influence observations connected to climate-sensitive variables such thermal comfort. User satisfaction surveys
offer useful information but also reflect personal bias and perception, which might not always correspond with
the actual condition of the performance of the building. Notwithstanding these limitations, the research intends
to provide significant suggestions that accurately represent the state of PHC infrastructure in Potiskum.