Willingness of WHO staff to work in health emergencies in the African Region: opportunity for phased deployment of staff and ensure continuity of health services

A human resource base that ensures appropriate deployment of staff to emergencies, addressing different shock events in emergencies, without disrupting continuity of service is germane to a successful response. Consequently, the WHO Health Emergencies programme in the African Region, in collaboration with Africa Centre for Disease Control (ACDC) launched the African Volunteer Health Corps (AVoHC) and Strengthening and Utilization of Response Group for Emergencies (SURGE), an initiative aimed at ensuring a pool of timely responders. We explored the willingness of WHO staff to work in emergencies. A call for expression of interest to be part of the Elite Emergency Experts (Triple E) was published on 5th July 2022 via email and was open for 5 weeks. The responses were analyzed using simple descriptive statistics and presented with graphic illustrations. A total of 1253 WHO staff, from all the six WHO regions, cutting across all cadre, applied to the call. The applicants had various trainings and experiences in emergency and have responded to mostly disease outbreaks. Two-third of the applicants were males. This paper did not explore reasons for the willingness to work in emergencies. However, contrary to fears expressed in literature that health workers would not want to work in emergencies with potential for infections, the applicants have worked mostly in infectious emergencies. Literature identified some themes on factors that could impact on willingness of health workers to work in emergencies. These include concerns for the safety of the responders and impact of partners, child and elderly care, as well as other family obligations, which emergency planners must consider in planning emergency response.

Disability inclusion in malaria services in western Tanzania: A rapid barrier analysis

Background: Persons with disabilities generally face greater challenges in accessing healthcare and interventions compared with the general population. Malaria is one of the diseases that can seriously affect individuals with disabilities, as it requires early diagnosis and prompt treatment. Objective: This study explores the extent to which locally available malaria services and interventions are inclusive of persons with disabilities and identifies associated access barriers. Method: A qualitative case study focusing on social, cultural and health system factors associated with the inclusion of persons with disabilities in malaria services was conducted in Kigoma Region, western Tanzania. Thematic analysis of emerging themes identified barriers affecting access to locally available malaria services and interventions. Results: Inclusion of persons with disabilities in planning, implementation and reporting of health issues in different malaria programmes was reported to be limited. Persons with disabilities were unable to access malaria services because of different barriers such as the distance of the service provision sites, communication and information issues and a lack of financial resources. Conclusion: Persons with disabilities are widely excluded from malaria care provision across the entire health services paradigm, impacting access and utilisation to this vulnerable population. Barriers to malaria service access among persons with disabilities were physical, attitudinal, financial and informational. Contribution: The findings of this study identify that malaria intervention stakeholders need to take a holistic approach and fully involve individuals with disabilities at all levels and scope of malaria service planning and provision.

Facteurs de demande de services de santé préventifs en contexte épidémique (Dengue et COVID 19), Côte d'Ivoire, 2020 / NA

Introduction : L'une des missions de l'Institut National d'Hygiène est de prévenir et contrôler les maladies transmissibles et autres urgences de santé publique à travers ses services compétents. En situation de crises sanitaires comme une épidémie, les besoins augmentent et alors les bénéficiaires sont exemptés de paiement pour toute intervention préventive de masse. Le paiement rentre en vigueur lorsque la demande est exprimée dans une perspective individuelle. L'objectif de l'étude était d'analyser les facteurs de la demande des prestations du service de lutte anti-vectorielle (LAV) en période épidémique de Dengue et de COVID-19. Méthodes : Une étude transversale a été réalisée de janvier 2018 à décembre 2020 dans une antenne communale, celle d'Abobo. La collecte des données a été effectuée à travers une revue documentaire et l'administration d'un questionnaire auprès du gestionnaire et des techniciens du centre. L'analyse des données a été réalisée avec le tableur Excel. Résultats : La recette cumulée du service LAV pour ces trois dernières années s'élèvait à 57 708 100 F CFA (≈ 88 103 €) avec une accentuation de l'ordre de 65,6% en 2020, année de pandémie à Covid-19. Les ménages ont été pour les trois années, les principaux demandeurs du service LAV. Leurs recettes cumulées s'élevaient à 22 663 120 FCFA (≈ 34 600 €). Les facteurs de la demande pour le service LAV étaient le lieu de résidence, le niveau d'instruction, le niveau de revenu et la source d'information. Conclusion: La pandémie à COVID 19 a favorisé une augmentation plus importante des recettes. Les gestionnaires du centre devront ajuster les objectifs de recettes en tenant compte des facteurs de la demande en service de soins préventifs.

Introduction: The National Institute of Hygiene's mission is to prevent communicable diseases andother public health emergencies. During health crises, beneficiaries are exempt from payment. The study's objective was to analyze the factors that influence the demand for vector control services during Dengue and COVID-19 epidemics. Methods: This was a cross-sectional study from January 2018 to december 2020 at the Abobo public health unit. Data collection was done through a literature review and the administration of a questionnaire. Data analysis was performed using Excel software. Results: The cumulative revenue of the LAV service for the last three years amounted to 57,708,100 F CFA (≈ 88,103 €). Households were the principal applicants for the LAV service for the three years. Their cumulative revenue amounted to 22,663,120 FCFA (≈ 34 600 €). Factors influencing demand for the LAV service were residence, level of education, income level, and source of information. Conclusion: Center managers will need to adjust revenue targets by considering demand factors for preventive care services.

The impact of public health interventions in a developing nation: an overview

Introduction: Around 80% of factors that determine population health sit outside the control of health services. It is essential we influence these factors in addition to those within the remit of health services in order to improve and protect the health of population in a developing country. Public health functions encompass working across the domains that constitute population health systems with various partners. The objective of this article is to give an overview of public health interventions that can improve the health of the population of a developing nation. Method: A descriptive study, based on a review of the literature of key public health frameworks and interventions that are likely to have significant impacts on population health. Some selected public health interventions and case studies are highlighted to illustrate the importance of priority areas in developing countries. Results: Various public health frameworks recognise the importance of wider determinants of health (socio-economic factors), effective healthcare, healthy behaviours, working with communities as critical to securing population health. Another framework adopts a life-course model of intervention starting from public health interventions during preconception period and childhood, adolescence, working life and older age. For many developing countries, the author identified some examples of priority areas for interventions such as stopping and preventing wars; improving child health, including free school meals; achieving universal healthcare through integrated primary health care; addressing commercial determinants of health; embracing new technologies; and measuring and monitoring population health. Conclusion: In order to improve the health of a population in a developing country, attention needs to go beyond health services to influence the wider determinants of health, health behaviours and adopting the World Health Organisation's roadmap on essential public health functions.

Impact of COVID-19 public health responses on income, food security and health services among key and vulnerable women in South Africa

Globally, COVID-19 has impacted lives and livelihoods. Women living with HIV and/or at high risk of acquiring HIV are socially and economically vulnerable. Less is known of the impact of COVID-19 public health responses on women from key and vulnerable populations. The purpose of this cross-sectional survey conducted in four South African provinces with a high burden of HIV and COVID-19 from September to November 2021 was to advance understanding of the socio-economic and health care access impact of COVID-19 on women living with HIV or at high risk of acquiring HIV. A total of 2 812 women >15 years old completed the survey. Approximately 31% reported a decrease in income since the start of the pandemic, and 43% an increase in food insecurity. Among those accessing health services, 37% and 36% reported that COVID-19 had impacted their access to HIV and family planning services respectively. Economic and service disruptions were enhanced by living in informal housing, urbanisation and being in the Western Cape. Food insecurity was increased by being a migrant, having fewer people contributing to the household, having children and experience of gender-based violence. Family planning service disruptions were greater for sex workers and having fewer people contributing to the household. These differentiated impacts on income, food security, access to HIV and family planning services were mediated by age, housing, social cohesion, employment and household income, highlighting the need for improved structural and systemic interventions to reduce the vulnerability of women living with HIV or at high risk of acquiring HIV.

Urban-rural differences in health service-related factors associated with male involvement in family planning services in Abia State, Southeastern Nigeria

Objective: To identify and compare the health service-related factors associated with male involvement in family planning services among the rural and urban areas in Abia State, Nigeria. Design: A community-based cross-sectional study. Setting: Twelve communities (six urban and six rural) in Abia State, Nigeria Participants: Five hundred and eighty-eight (588) men aged 15-59 years and resident in the study area 6 months before the study were recruited. Main outcome measure: Male involvement in family planning services Results: The mean ages of the respondents were 41.8±8.0 years and 43.1±8.0 years in the urban and rural areas, respectively. Active male involvement in family planning services was significantly higher in urban areas (62.6%, 95%CI: 56.8%-68.1%) compared to the rural areas (47.6%, 95%CI: 41.5%-53.2%. p<0.001). The predictors of male involvement included gender preference of healthcare workers (aOR=1.75, 95%CI:1.01-3.03) and attitude of the healthcare workers (aOR=2.07, 95%CI:1.17-3.67) among the urban participants, compared to occupational status of the respondents (aOR=2.50, 95% CI: 1.16-5.56) and the availability of male-friendly clinics (aOR=2.27, 95%CI:1.25-4.15) among the rural participants. Conclusion: Health service-related factors associated with male involvement varied between the urban and rural settings. Stakeholders should target addressing health service-related factors by types of settlement while designing family planning programs targeting men

HIV-prevention measures on a university campus in South Africa ­ perceptions, practices and needs of undergraduate medical students

Background: Young adults such as university students are considered to be a key population for HIV-prevention efforts. This study aimed to determine the perceptions, practices and needs of undergraduate medical students regarding HIV-prevention measures available on campus. Methods: The research design was descriptive cross-sectional. Data were collected using an anonymous, self-administered questionnaire distributed to all 745 undergraduate medical students in the School of Clinical Medicine, University of the Free State, South Africa, of whom 470 responded (63.1%). Results: Almost half (45.5%) of all respondents across the five academic years had received information about available HIV-prevention measures on campus. Most reported that information had been received during lectures (59.7%) and only 24.2% from the local health clinic on campus. The findings also revealed that 14.2% of students had used at least one prevention measure in the past, while the majority of students (70.2%) used abstinence as an HIV-prevention measure. A large percentage of all the students (47.6%) had been tested for HIV before the start of the study. Two-thirds (67%) of students indicated that the current HIV-prevention services on campus were not sufficient. Conclusion: Medical students received HIV-prevention information as part of their curriculum but this was deemed not to be sufficient. This study suggests that tertiary education institutions should evaluate the effectiveness of strategies currently in place for the distribution and awareness of HIV-prevention measures and sexual health issues affecting students, using a student-centred approach

The effects of coronavirus disease 2019 pandemic on the South African health system: A call to maintain essential health services

South Africa had its first coronavirus disease 2019 (COVID-19) case on 06 March 2020 in an individual who travelled overseas. Since then, cases have constantly increased and the pandemic has taken a toll on the health system. This requires extra mobilisation of resources to curb the disease and overcome financial loses whilst providing social protection to the poor. Assessing the effects of COVID-19 on South African health system is critical to identify challenges and act timely to strike a balance between managing the emergency and maintaining essential health services. We applied the World Health Organization (WHO) health systems framework to assess the effects of COVID-19 on South African health system, and proposed solutions to address the gaps, with a focus on human immunodeficiency virus (HIV) and expanded programme on immunisation (EPI) programmes. The emergence of COVID-19 pandemic has direct impact on the health system, negatively affecting its functionality, as depletion of resources to curb the emergency is eminent. Diversion of health workforce, suspension of services, reduced health-seeking behaviour, unavailability of supplies, deterioration in data monitoring and funding crunches are some of the noted challenges. In such emergencies, the ability to deliver essential services is dependent on baseline capacity of health system. Our approach advocates for close collaboration between essential services and COVID-19 teams to identify priorities, restructure essential services to accommodate physical distancing, promote task shifting at primary level, optimise the use of mobile/web-based technologies for service delivery/training/monitoring and involve private sector and non-health departments to increase management capacity. Strategic responses thus planned can assist in mitigating the adverse effects of the pandemic whilst preventing morbidity and mortality from preventable diseases in the population

Primary healthcare implementation in practice: evidence from primary healthcare managers in Ghana

Background: Primary healthcare (PHC) is a core part of healthcare in developing countries. However, the implementation of PHC since its inception in developing countries has been lethargic, inconsistent and marred by controversies. Aim: This study investigates some of the controversies surrounding PHC implementation. It also examines how PHC is being implemented in Ghana as well as how the approaches adopted by PHC implementers influence PHC outcomes in developing countries. Setting: This study is set in Ghana and involves national, regional and district managers of PHC. Methods: A qualitative case study was used to gather information from 19 frontline PHC managers through semi-structured interviews. Interviews were recorded and transcribed. They were then qualitatively analysed using the thematic framework analyses approach. Results: Findings uncover a lack of clear meaning of what PHC is and how it should be approached amongst key implementers. It also shows discrepancies between official policy documents and directives, and actual PHC practices. Findings also show a gradual shift from Alma Ata's comprehensive PHC towards a more selective and intervention-specific PHC. Whilst donor and external stakeholders' influence are the key determinants of PHC policy implementation, their support for vertical and other medicine-based interventions have gradually medicalised PHC. Conclusion: There is a need to pay more attention to understanding and addressing the gaps in PHC implementation and its inconsistencies. Furthermore, the role and control of donors and external development partners in PHC policy formulation and implementation, and their concomitant effects on community participation and empowerment, must be critically examined

Reasons for non-compliance with quality standards at primary healthcare clinics in Ekurhuleni, South Africa

Background: The South African Minister of Health stated that compliance with quality standards in health services is non-negotiable as it is fundamental in improving South Africa's current poor health outcomes, restoring patient and staff confidence in the public healthcare system, achieving widespread sustainable development and providing basic quality healthcare in South Africa. Non-compliance with quality standards, as evidenced by increased quality-related queries from the community, prompted the researcher to explore and describe the reasons for such at primary healthcare clinics in Ekurhuleni. Aim: This study sought to explore and describe the reasons for non-compliance with quality standards at the primary healthcare in Ekurhuleni in order to propose recommendations to facilitate compliance with quality standards. Setting: The study was conducted at primary healthcare clinics in Ekurhuleni, one of the metropolitan districts, situated in an area east of the Gauteng province. Methods: A qualitative, exploratory, descriptive and contextual research design was used for this study. Participants were purposefully selected from the population and consisted of individuals who willingly consented to participate. Twelve semi-structured individual interviews were conducted. Results: The study findings revealed challenges with management practices, for example, non-involvement in decision-making, lack of support and poor internal communication practices. In addition, challenges with human, material and financial resources were stated as reasons for non-compliance with quality standards. Conclusion: Recommendations to facilitate compliance with quality standards were described, which included implementation of effective management practices and allocation of adequate healthcare resources required to facilitate such compliance

Clients and service providers' assessment of Public and Non-Governmental Youth-Friendly Health Services in Lagos Nigeria: a mixed method approach

Background: The World Health Organization prescribed that Youth-Friendly health services must be accessible, acceptable, equitable, efficient, effective, comprehensive and appropriate to meet the health needs of young people. Objective: To compare the clients' and service providers' assessment of services offered at the public and Non-Governmental Organization (NGO) Youth Friendly facilities (YFF) in Lagos Nigeria. Methods: A mixed method approach was used. Structured questionnaires were administered on youths (294 from public and 273 from NGO YFF) from ten (5 public and 5 NGO) YFF. Ten key informant interviews with service providers were also conducted between March 1st and December 31st 2014. SPSS version 22 was used to analyze quantitative data while thematic analysis of interviews with service providers was done. Results: Youths who utilized the public YFF had 60% chance (AOR 1.6, 95%CI 1.3 ­ 2.5, p= 0.005) of experiencing longer waiting times, 80% chance (AOR 1.8, 95%CI 1.2 ­ 2.8, p=0.004) of being counseled in a separate room and over two-fold chance (AOR 2.3, 95%CI 1.7 ­ 3.3, p <0.001) of having free services. Sexual and reproductive health was the major complaint area of the youths while funding was the major challenge of service providers at both the public and NGO YFF. Conclusion: To address the needs of the youths, there is a need to provide more funds and provide necessary logistics required by YFF

Development of a Sesotho health literacy test in a South African context

Background: Research shows that poor health literacy (HL) can be a threat to health and health care. Health literacy is under-researched and poorly understood in developing countries, including South Africa, because of the absence of language and context-specific HL tests. Aim: The researchers aimed to develop an appropriate HL test for use among South African public health service users with Sesotho as their first language. Setting: The test was developed in the Free State Province of South Africa, for use among Sesotho speakers. Methods: Mixed methods were employed to develop the Sesotho Health Literacy Test (SHLT). The process of developing the test was carried out in distinctive methodological steps. Results: The stepwise process set out by identifying abstracts (n = 206) referring to HL tests. Sourcing of HL tests followed a tapered process resulting in the use of 17 HL tests. Elements within a conceptual framework guided HL test item selection (n = 47). Two Delphi sessions assisted in reaching consensus regarding final HL test items (n = 40). The readability testing of the SHLT tested 4.19 on the Coleman­Liau Index score. A context-suitable and comprehensive SHLT ensued from this work. Conclusion: The SHLT assessment instrument development creates a platform for HL testing among Sesotho first language speakers in South Africa. The context-sensitive methodology is entrenched in a theoretical framework, distributing HL test items between identified competencies and related skill dimensions and domains. The methodology can be applied to the development of HL tests for other languages and population groups in developing countries

Institutional tuberculosis infection control in a rural sub-district in South Africa: A quality improvement study

Background: Tuberculosis (TB) is a major global health challenge, and South Africa is one of the high-burden countries. A national TB infection control (TBIC) guideline has stipulated three areas of infection control at health facilities: work practice and administrative control, environmental control, and personal protection for health workers. Aim: The aim of this study was to identify the gaps and address the challenges in institutional TBIC. Setting: The district hospital and a primary health care clinic within the Mossel Bay sub-district in the Western Cape. Methods: According to the national TBIC draft guideline, a quality improvement cycle was used to evaluate and improve TBIC. Each facility had an existing infection and prevention control and occupational health and safety team, which were used as the audit teams. Results: A baseline assessment was followed by a set of interventions, which did not show a significant improvement in TBIC. The difference between the pre- and post-intervention TB screening rate was not statistically significant. An assessment of time interval between 101 patients presenting with TB symptoms and diagnosed with TB was 4 days at baseline and post-intervention. Most of the anticipated improvements were dependent on the health workers' adherence to the local TBIC policies, which emerged as an unexpected finding. Conclusion: We found good managerial commitment reflected by the presence of various policies, guidelines, specific personnel and committees to deal with infection control in general. This study has created awareness about TBIC among staff and pointed out the complexity of health workers' behaviour towards adhering to policies

Coping with the supply-side effects of free maternal healthcare policies in seven sub-saharan african countries: a systematic review

Free maternal healthcare policies (FMHP) result in enormous supply-side effects on care delivery in sub-Saharan Africa (SSA). This review synthesises the mechanisms adopted by supply-side actors to cope with the effects of FMHP and the results of coping mechanisms on policy objectives in seven SSA countries. We searched bibliographic databases for articles published in English for research that reported supply-side effects of FMHP, coping mechanisms, and effects of various coping mechanisms on attainment of reform objectives. Out of 215 studies identified, nine qualified for inclusion. Selected studies were exploratory in design and based on either mixed or qualitative methods. While local health system authorities and health facilities coping mechanisms that were intended to enhance implementation, facility managers and staff engaged in self-interest adaptation decisions and behaviours. Lack of explicit policy commitment to enhancing organisational and managerial capacity of local health authorities contribute to sustaining negative supply-side effects and adverse coping mechanisms. Without due consideration to governance and health system strengthening, FMHP are prone to perverse outcomes that undermine intended benefits. Context-specific empirical studies are needed to further conceptualise the supply-side effect ­ coping mechanism ­ consequential effect nexus of the policy

Factors affecting patient safety: a qualitative content analysis

Background: Patient safety is one of the main components of good-quality health services. The main objective of this study is to explore the most effective factors relating to patient safety in Iran. Methods: This qualitative study was done using content analysis. Data were collected using semi-structured interviews. Through purposive sampling, 14 participants were selected by experts who were familiar with the patient safety friendly hospital program. Interviews were recorded and then analyzed by framework analysis using MAXQDA software. Results: Of 2,474 initial codes, 10 main themes and 53 sub-themes were identified, including importance of human resources; organization and management; interactions and teamwork; medication; equipment and physical environment; patient-related factors; patient safety and quality improvement; the importance of documentation; assessment and monitoring; medical errors; barriers and challenges. Conclusion: Factors affecting patient safety can be divided into two groups: facilitators and barriers. Hospitals can improve the implementation of patient safety standards, reduce the adverse events and enhance patient safety by strengthening facilitating factors, such as providing human resources, adequate medical equipment and facilities, increasing employee participation in quality improvement programs, improving staff training, communicating with patients and their families, and addressing the existing challenges and barriers

Equality analysis of main health indicators among children under 5 years in Uganda

BACKGROUND: Inequality in the access to health services is a major cause of health problemsamong children under five old. The aim of this analysis is to measure the inequality among children under-5 years in relation to main health indicators in Uganda. METHOD: Main child health indicators data in Uganda were obtained from WHO inequity data set for the years 1995, 2000, 2001 and 2011. Indicators such as under-5 years mortality rate, underweight prevalence and full vaccination converge and child with infection access to health facilities were included in th analysis. For simple indicators, inequality difference was calculated, and relative concentration index for complex order indicators was used. Four different inequality dimensions were used to work as stratifies for these indicators. RESULTS: Inequality regarding child health indicators was observed in different dimensions. It was clear that inequality among people living in rural areas were more than urban areas. Femaleshad high inequality than males. Poor and uneducated people are more likely to have inequality than rich and educated people. CONCLUSION: Great effort should be made to decrease inequality among children less than five years through access to health services for all groups in different areas

Provider-related predictors of utilization of university health services in Nigeria

BACKGROUND: The utilization of health services is an important policy concern in most developing countries. Many staff and students do not utilize the health services within the university system despite the availability of good quality services. This study investigated the provider-related factors related to utilization of university health service by staff and students in a privately owneduniversity in Nigeria. METHODS: The perception of the quality of a university health service was investigated among a cross-section of 600 university staff and students who were selected by a stratified random sampling scheme. A self-administered questionnaire-based study was conducted. The structure, process and output predictors of utilization of the university health facility were assessed. Data analysis was carried out using Stata I/C 15.0. RESULTS: The average age of the participants was 22.93±7.58 years. About two-thirds of them did not have opinion about the mortality and morbidity rates at the university health center. Significant proportions of the participants reported good perceptions about the structure and process quality of service indicators. Utilization of the university health center was predicted by some structure and process indicators namely; the availability/experience of staff (AOR 2.44; CI 1.67-3.58), the organization of healthcare (AOR 1.64; CI 1.11-2.41), the continuity of treatment (AOR 1.74; CI 1.12-2.70) and the waiting time (AOR 0.41; CI 0.28-0.61). CONCLUSION: The utilization of university health services was predicted by availability/experience of staff, the organization of healthcare, the waiting time and the continuity of care. The structure-process-outcome approach discriminates between the students and staff who utilize the university health center and those who donot. It also suggests a complex interplay of factors in the prediction of choice of a health facility

Households' satisfaction with the healthcare services rendered by a ward-based outreach team in Tshwane district, Pretoria, South Africa

Introduction: Households' satisfaction is an important and commonly used indicator for measuring quality in health care. Anamelioration of primary health care services at the level of households, by utilising community health workers, has led to a good healthcare system in many countries, such as Brazil. In South Africa, little is known about the satisfaction of households (HH) regarding the healthcare services they receive from ward-based outreach teams (WBOTs). A study was undertaken to determine this phenomenon. Methods: The study used a cross-sectional study design. Tshwane district had established 39 ward-based outreach teams at the time of the study and households were conveniently selected. Hence the study population was estimated to be 3 600. Using 99% confidence level and 5% confidence interval, the sample size was 660, and oversampled to 765 since all households present during the data collection were willing to be included in the survey. Data collected was captured on Microsoft Excel and analysed using SAS, version 9.2. Results: Interviews were held with members of the families, who were willing to participate. Participants' ages ranged from 18 to 110, mean age 53.1years (SD = 19.7). The study participants included more females (74.0%), and 45.2% were single. The majority (89.8%) were unemployed. Overall satisfaction was seen in 692 participants (90.7%). Outcome of satisfaction according to sex (91.9%), age (90.7%) and employment (90.8%) was not statistically significant with p-value < 0.05.Conclusions: The findings of households' satisfaction regarding the healthcare services rendered by the ward-based outreach team in Tshwane district, Pretoria, South Africa showed a high level of satisfaction from the households. This high level of satisfaction was referred to as excellent and was not associated with sex, age or employment status. A recommendation is made to all stakeholders that the ward-based outreach team programme cover all municipal wards in the country in order to raise the level of households' satisfaction with the healthcare system

Community perception of quality of health care received and client satisfaction in Lagos, Nigeria

Background: Quality of health care and client satisfaction are key elements in improving the performance of health systems. A community-based assessment was conducted to determine the level of client satisfaction and the perception of the quality of services received by citizens of Lagos State.Methods: A descriptive cross-sectional study using both quantitative and qualitative methods, was conducted in four local government areas of Lagos State. Respondents were selected by multi-stage sampling technique. The survey instruments included an interviewer-administered, pre-tested questionnaire and a 10-itemed focus group discussion guide.Results: Two thousand respondents with a mean age of 37.6±10.21 years were recruited. Almost all respondents (98%) rated the health facilities to be clean, 96% felt they received effective treatment from their providers. Six out of ten respondents rated the waiting time to be short and 60% felt that most drugs were available. Eight-five percent opined that the quality of care received was good and 95% were satisfied with the services received. There was a significant correlation between quality of care and client satisfaction (ρ=0.145, p=0.001). Short waiting time was predictive of client satisfaction (OR=13.9, 95%CI, 5.68-33.33, p<0.001) and confidence in health care providers was predictive of both client satisfaction (OR=3.489, 95%CI, 1.554-7.835, p<0.001) and perception of good service quality (OR=2.234, 95%CI, 1.509-3.308, p<0.001)