Client satification, primary health care and utilization of services in Sidama district, Southern Ethiopia

Abstract

Client satisfaction, one of the health outcome measurements, is directly related with utilization of services and continuity of care. Moreover, the possible effect of clients’ satisfaction that might bring on improvement of the health status of patients adds on the merit of studying the subject. However, so far few reports on client satisfaction have been made on developing countries. This study presents findings on multi-dimensions of client satisfaction, carried out in Southern Ethiopia. Objectives: As part of the comprehensive assessment, the study evaluates quality of primary care from clients perspective on the following multi-dimension: Informativeness, Humanness, Professional skills, Accessibility, Overall quality of care & health care providers, Structures, Reception, Perceived need for further laboratory investigations & drugs, Expectation met, Need for alternative physician and Recommendation of services. Method: An episode specific, exit, interview method using validated VRQ (Visit Rating Questionnaire) was made for data collection. The responses were scored using Likert scales. Relationships between confounders and main variables were adjusted with logistic multiple regression. Setting and subjects: A representative sample of 329 clients in Sidama district primary care were interviewed to evaluate the health delivery process from their view by filling a questionnaire. Results: Overall, in this study clients regarded 67% of primary care quality as poor and very poor. Infrastructures (equipment and sanitation), overall quality of care and unmet expectations were potential quality problems. These are followed by inter-personal relationships, professional skills and under prescription of drugs and laboratory investigations, as perceived by clients. Over the multi-dimensions examined, level of education and income were the major influencing factors on clients’ satisfaction. Conclusions: In this study, a significant drop in quality of PHC services from clients perspective was seen in the district. Such drop of quality might have been a reason for low utilization and less continuity of care, which were reflected in this study. So, quality improvement process in the district is required to consider meeting clients’ expectation (raising level of satisfaction) as a target. Furthermore, the results in this study depicted the importance of clients to make clear signs of quality problems. So if clients are accepted as integral part of quality of health care, considering clients in evaluation process and planning, too, may be of great help in improving quality.