1.1 Introduction
The health care is relevant to individuals, national productivity and growth cannot be over–emphasized. This is evidenced by the numerous enquiries into the relationship between health and human welfare in the literature. Evidence of the importance of health in growing the economy of a country have shown that good health raises the level of human capital, promotes the productivity capability of individuals in the country and facilitates the rate of economic growth (Cooray, 2013; Nkpoyen, Bassey, & Uyang, 2014). It enhances labour productivity by limiting incapacitation and un-healthiness among workers as well as reduces absenteeism associated with sick leave.
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitations of the Study and Definition of technical terms.
1.2 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.
Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Patient's Perception and Satisfaction with Health Care Professionals at Primary Care Facilities.
1.3 Statement of Problems
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.
1.4 Aim and Objectives of Study
The aim of the study is to scrutinize the Patient's Perception and Satisfaction with Health Care Professionals at Primary Care Facilities in Nigeria. In achieving this aim, the following specific objectives were laid out as follows:
- 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 study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- 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 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
Hypothesis One
- H0: There is no significant relationship between Patient's Perception and Satisfaction with Health Care Professionals at Primary Care Facilities in Enugu State
- H1: There is a significant relationship between Patient's Perception and Satisfaction with Health Care Professionals at Primary Care Facilities in Enugu State
Hypothesis Two
- H0: The level of client satisfaction with health care professionals in the health facilities is low
- H1: The level of client satisfaction with health care professionals in the health facilities is high
1.7 Significance of Study
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.
1.8 Scope of Study
The study focuses on the Patient's Perception and Satisfaction with Health Care Professionals at Primary Care Facilities in Nigeria using Enugu State Primary Health Care (PHC) Facilities as a case study.
1.9 Limitations of the Study
During the course of this study, many things militated against its completion, some of which are:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Research material: availability of research material is a major setback to the scope of the study.
- Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
1.10 Operational Definition of Terms
Attitude: The way one behaves towards somebody or something that shows how you think or feel.
Knowledge: To have information about something because you have experience or because you have learned it or be told.
Mortality: The number of death in a particular situation or period of time.
Perception: To notice something in a particular way or hold a view about something.
