Users’ perceptions of outpatient quality of care in Kilosa District Hospital in Central Tanzania

Juma, Daniel; Manongi, Rachel

doi:10.4314/thrb.v11i4.50176

Cited by 31 publications

(38 citation statements)

References 15 publications

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“…Similar findings have been reported elsewhere in Tanzania and Ethiopia [5,7,17]. The reasons could be due to level of patient's expectations that differed between these two groups and time spent during the process of care.…”

Section: Discussionsupporting

confidence: 86%

“…In Nigeria 84% are satisfied while in Ethiopia 77% are satisfied with the health services rendered at the OPD [3][4][5]. In Tanzania, at Muhimbili National Hospital satisfaction level was found to be high (90%-95%) while in Morogoro (Kilosa District Hospital) satisfaction level was moderate (70%) but at Mwananyamala Referral Hospital, satisfaction level was found to be low (<50%) [6][7][8]. If patient's level of satisfaction on quality of care does not meet their standards, patients may decide to seek treatment somewhere else out of the formal health system that may lead to poor health seeking behaviors resulting in poor initial uptake of services, poor adherence, poor retention of services and at the end this may contribute to high morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

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Patients’ Level of Satisfaction with the Health Care Services Received at Outpatient Departments in Kilimanjaro Region, Tanzania

Ga¹,

Ib²,

Rn³

2017

J Pat Care

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Introduction: Patients' satisfaction is a measure of health system performance and can be used as a foundation of encouraging health care providers to become more responsible to their patients. Satisfaction manifests itself as a distribution, access and utilization of health services. This study aimed to determine patients' level of satisfaction with the health care services received in outpatient department in Kilimanjaro Region. Methods:A cross-sectional study design was conducted at Mawenzi Regional Referral Hospital (MRRH), Same District Hospital (DH) and Huruma Designated District Hospital (DDH) using Donabedian model to determine patients' level of satisfaction with the health care services received at outpatient departments in Kilimanjaro Region. Systematic sampling was used to select 450 patients. Service quality questionnaire was used for data collection. Descriptive statistics was performed. Paired sample t-test, independent sample t-test and one-way ANOVA with Bonferroni posthoc test were used to compare mean gap scores. A p-value of <0.05 was considered statistically significant. Results:The overall patient's level of satisfaction with health service provision at OPD in all three hospitals was 20%. The gap on health services provision in all three hospitals was -37.0 (± 47.0) signifying overall dissatisfaction among patients. No statistically significant difference (p<0.05) on the gap in satisfaction with quality of service provision existed between MRRH and Huruma DDH as well as between MRRH and Same DH. However, a significant gap difference was demonstrated between Huruma DDH and Same DH (p, 0.002) with a smaller gap in satisfaction at Huruma DDH compared to Same DH (-28.0 versus -46.7). The highest level of dissatisfaction in the five service dimensions tested was on empathy (-7.8). Conclusion:Patients attending OPD in all three hospitals demonstrate an overall dissatisfaction with quality of care. Hospital managements should focus on: improvement of patient-provider relationship, availability of equipment and drugs and affordability of hospital bills.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Patients’ Level of Satisfaction with the Health Care Services Received at Outpatient Departments in Kilimanjaro Region, Tanzania

Ga¹,

Ib²,

Rn³

2017

J Pat Care

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“…Previous study in Zambia also found no association of perceived quality of care and use of health professionals for childbirth [17]. A possible explanation is that measurement of perceived quality of health care in low income countries is subject to social desirability bias as respondents tend to give a more favourable response [59]. However, studies in Guinea and India showed high reliability for components of health personnel attitudes for the measure of quality of health care [60-62].…”

Section: Discussionmentioning

confidence: 99%

“…Limitations of this study could include measurement bias regarding perceived quality of care, distance and cost. It is possible that some participants could over-rate the services because they fail to openly criticize the system [59,60]. However, perceptions give the user’s perspectives of health system functioning and provides opportunities for improvement of service provision [56].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with health facility childbirth in districts of Kenya, Tanzania and Zambia: a population based survey

Phiri

Kiserud

Kvåle

et al. 2014

BMC Pregnancy Childbirth

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BackgroundMaternal mortality continues to be a heavy burden in low and middle income countries where half of all deliveries take place in homes without skilled attendance. The study aimed to investigate the underlying and proximate determinants of health facility childbirth in rural and urban areas of three districts in Kenya, Tanzania and Zambia.MethodsA population-based survey was conducted in 2007 as part of the ‘REsponse to ACcountable priority setting for Trust in health systems’ (REACT) project. Stratified random cluster sampling was used and the data included information on place of delivery and factors that might influence health care seeking behaviour. A total of 1800 women who had childbirth in the previous five years were analysed. The distal and proximate conceptual framework for analysing determinants of maternal mortality was modified for studying factors associated with place of delivery. Socioeconomic position was measured by employing a construct of educational attainment and wealth index. All analyses were stratified by district and urban–rural residence.ResultsThere were substantial inter-district differences in proportion of health facility childbirth. Facility childbirth was 15, 70 and 37% in the rural areas of Malindi, Mbarali and Kapiri Mposhi respectively, and 57, 75 and 77% in the urban areas of the districts respectively. However, striking socio-economic inequities were revealed regardless of district. Furthermore, there were indications that repeated exposure to ANC services and HIV related counselling and testing were positively associated with health facility deliveries. Perceived distance was negatively associated with facility childbirth in rural areas of Malindi and urban areas of Kapiri Mposhi.ConclusionStrong socio-economic inequities in the likelihood of facility childbirths were revealed in all the districts added to geographic inequities in two of the three districts. This strongly suggests an urgent need to strengthen services targeting disadvantaged and remote populations. The finding of a positive association between HIV counselling/testing and odds in favor of giving birth at a health facility suggests potential positive effects can be achieved by strengthening integrated approaches in maternal health service delivery.

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“…We estimated the size needed to detect a 17% reduction in waiting time from 114 minutes (SD 66) [24] to 95 minutes, with a k value of 0.25, 80% power and a significance level at of 5% (two tailed test). We did not increase the sample size to account for non-response because response rates of 100% were observed in previous studies in Tanzania [25,26]. The estimated sample size was 10 exit interviews per facility, equivalent to a total of 750 interviews in intervention and control areas respectively.…”

Section: Methodsmentioning

confidence: 99%

Protocol for the evaluation of a pay for performance programme in Pwani region in Tanzania: A controlled before and after study

et al. 2013

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BackgroundThe use of supply-side incentives to increase health service utilisation and enhance service quality is gaining momentum in many low- and middle-income countries. However, there is a paucity of evidence on the impact of such schemes, their cost-effectiveness, and the process of implementation and potential unintended consequences in these settings. A pay for performance (P4P) programme was introduced in Pwani region of Tanzania in 2011.Methods/designAn evaluation of the programme will be carried out to inform a potential national rollout. A controlled before and after study will examine the effect of the P4P programme on quality, coverage, and cost of targeted maternal and newborn healthcare services and selected non-targeted services at facilities in Tanzania. Data will be collected from a survey of 75 facilities, 750 patients exiting consultations, over 75 health workers, and 1,500 households of women who delivered in the previous year, in all seven intervention districts. Data will be collected from the same number of respondents in four control districts. A process evaluation will examine: whether the P4P programme was implemented as planned; stakeholder response to the programme and its acceptability; and implementation bottlenecks and facilitating factors. Three rounds of process data collection will be conducted including a review of available P4P documents, individual interviews and focus group discussions with key informants working at facility and district level in five of the intervention districts, and at the regional and national levels. An economic evaluation will measure the cost-effectiveness of P4P relative to current practice from a societal perspective.DiscussionThis evaluation will contribute robust evidence on the impact and cost-effectiveness of P4P in a low income setting, as well as generate a better understanding of the feasibility of integrating complex intervention packages like P4P within health systems in resource poor settings.

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