CHAPTER ONE

INTRODUCTION

1.1     Background of Study

Primary Health Care forms the bedrock of the health-care services of a country. It is the quality of health care available to the majority of the population that determines the health status of the country and is the best indicator for the level of social development of the country. The important conditions of Primary Health-Care Services are that they should be: Efficient with regard to cost, techniques and organization; readily accessible to those concerned; Acceptable to the community served; at a reasonable cost. Health-care services should be available in a manner and language that is suitable to the community and population it serves and accommodating of local traditions and customs, and at a price which the population can afford. Patient satisfaction has been linked to increased patient compliance, continuity of care, better clinical outcomes, and greater service utilization and risk management. Patient satisfaction is thus a key marker for the quality of health-care delivery and an important indicator for evaluation and improvement of health-care services. Studies of Patient Satisfaction in health care originated in the USA during the 1950s,the earliest studies attempted to identify patient characteristics such as age, gender, and race to predict patient satisfaction levels (Apostle and Oder 1967;Bertakis et al. 1991). Another group of studies analysed health-care attributes such as nursing care, physician care, etc. to identify attributes that influence overall patient satisfaction (Ware et al. 1975; Ross et al. 1993; Dansky and Brannon 1996; Oswald et al. 1998). DrVeera Prasad in his comparative study of patient satisfaction said that there are five determinants of patient satisfaction.

Reliability: The ability to perform the promised service dependably and accurately.

Responsiveness: The willingness to help the patients and provide prompt service.

Assurance: The knowledge and courtesy of employees and their ability to convey trust and confidence.

Empathy: The provision of caring and individualized attention to patients.

Tangibles: The appearance of physical facilities, equipment, personal, and communication materials.

A study was carried out to identify which attributes of a primary health-care experience access, staff care and physician care, and which aspects of each attribute are most significant in patients’ response to the services they receive. Analysis showed that among the three attributes, physician care was most influential, closely followed by the staff care, with access having least influence.However, it is the combination of all these factors that influence patient satisfaction, and need to be assessed to ensure a positive experience at the health-care facility.

Unfortunately, while several studies have been carried out which have explored the parameters of patient satisfaction in tertiary care centers and large hospitals in India, very little attention has been paid to studies of patient satisfaction at the primary care level, especially GPs running solo clinics, which form the bulk of private primary care services.

Measuring client or patient satisfaction has become an integral part of health facility management strategies across the globe (Smith and Engolbracht, 2001). The success of a health facility depends on client perceptions of health care quality because of the impact it has on client satisfaction based on services provided by health professionals. Satisfaction of clients not only ensures compliance with treatment and instructions about their illness, but also influences utilization of health facilities.

Turhal and others (2002) made a comment that ―in the last 20 years the old way of treating patients in the “disease centred” approach has changed to “patient centred” style. Now patients have more influence toward the care they receive and they are given opportunity to change the way care is delivered to them. Health care in Nigeria has over the years been characterized by poor provider-client relationship which has made clients and some health providers to raise serious concerns. Provision of high quality client-centred care is therefore one of the greatest challenges of the Ministry of Health (MOH). As a result of the concerns raised by clients and health providers, the issue of improving quality of health care attracted serious attention in 1989 during the Regional Directors’ conference. Subsequent to the conference, improving the quality of health care attracted attention of both policy makers and health care professional groups and efforts have been made to identify key issues for improving the quality of health care throughout the country.

1.2     Statement of the problem

Health facilities at all levels of care are required to provide quality health care that meets the expectations of their clients. This is however, not so throughout the country. Provider-client relationship has been very poor resulting in growing concern among clients about the quality of care. The MOH (2007) in its national health policy document identifies complaints from users about the abusive and humiliating treatment by the health providers and shortages of equipment, consumables supplies and some essential drugs as some of the challenges of the health services. The national health policy document reveals that some health facilities are efficient, delivering high quality services and being responsive to the needs of their clients, but many are not.

To monitor and improve the quality of care by health professionals in the health facilities, the Nigerian Health Services recommends client satisfaction surveys by health facilities at least twice in a year.

Even though, some client satisfaction surveys have been conducted, annual reports show that it has not been able to do it twice a year. It is therefore not known how sustainable quality improvement efforts have been throughout the year.The health centres and clinics in the country have not been conducting client satisfaction surveys.The level of quality of care by professionals is therefore not known in these facilities, hence this study on patient perception and satisfaction with healthcare professionals at primary health care facilities.

1.3     Justification

Client satisfaction data is an important tool for quality improvement.This study describes client perception and satisfaction with health care professionals as a means of measuring quality of health care in Enugu. In addition to evaluating client perception and satisfaction with services provided by health professionals, it also elicits which service areas are priorities for improvement. It will also help bridge the gap between clients‘ expectations and the actual service they receive. Seeking clients’ opinions of the current level of service will ensure client focus in service delivery. This is necessary in ensuring high level of quality of service delivery.

This study will also help the health facilities to initiate policies and programs that can lead to improved client-provider relationship which will result in increased utilization and revenue generation. It will also serve as a baseline study, since no such study describing the quality of care across the various levels of care has been done in the area.

1.4     Research Objectives

The general objective of this study is to describe patient perception and satisfaction with healthcare professionals at primary health care facilities in Enugu. The specific objectives are:

To describe and compare the perceived quality of care at the various levels of care in Enugu

To determine the level of client satisfaction with health care professionals in the health facilities

To identify the predictors of perception of quality of care and client satisfaction in the health facilities

1.5     Research Questions

The following research questions guided the study;

What is the perceived quality of care at the various levels of care in Enugu?

What is the level of client satisfaction with health care professionals in the health facilities?

What are the predictors of perception of quality of care and client satisfaction in the health facilities?

1.6     Limitation to Study

The major limitations of the study were

Interviews and FGDs were held on the health facility premises. This might cause clients to have the tendency to give higher ratings for fear of victimization even though they were assured of confidentiality.

Interviewing caretakers of patients less than 15 years of age rather than the patients themselves might not give the true picture since their views may be different from that of the patients themselves.

Only one health centre and one clinic were sampled due to resource constraints.