Virginia Kanowa, Project Manager for Local Initiatives for Health project, CARE- Malawi, for the assistance provided. The study participants in Chiwamba and Kawale for your cooperation and for setting aside time for the sake of this research.
DISCUSSIO OF RESEARCH FINDINGS, CONCLUSIO T AND RECOMMENDATIO S
Background to the problem
Accessibility of health services for a community as one of the PEe principles has shown a relationship with client satisfaction. Surveys on client satisfaction with community participation and accessibility of services are one of the approaches to assessing PGS services provided (Huber, 2000).
Problem Statement
Patient satisfaction studies are conducted to evaluate health services using outcomes that are sensitive to user values. After implementing the PZC approach to health service delivery in Lilongwe, it is essential to determine111 whether the people receiving these services are satisfied with the provision of health care.
Purpose of the Study
Since there is no evidence of studies conducted on client satisfaction with PHC service delivery in Lilongwe, the researcher saw the importance of conducting such a study focusing on 1\vo aspects of the PHC philosophy, namely accessibility of health services and client involvement in health care delivery.
Research Objectives
Significance of the Study
It is hoped that the results of the study will be used as part of the PGS service evaluation studies in the country.
Operational Definition of Terms
Functional accessibility means that the right kind of care is continuously available to those who need it, when they need it, and that it is delivered by the health team necessary for its proper delivery (WHO, 1978, p.59). The literature reviewed showed that there is little relevant literature on customer satisfaction, social involvement and.
Conceptualisation of Client Satisfaction
The WHO (1994) (cited in King 1999, pg. 85) supports this view by . participation as a) "Structural participation, where the active involvement of the community becomes the ideological basis for the project itself, b) mandatory. The last and ultimate level is empowerment and it means the development of the power of the individuals, groups and communities .
Accessibility to Care
In addition, easy access to health care is associated with persons in the urban area who have means of obtaining income. A study by Paul (2000) revealed that adolescents' access to primary health care facilities was administratively hindered ie.
Aspects Measured In Satisfaction Studies
Intra/J nterpersonal aspects consist of the nurse's expressive functions, the nurses' personality characteristics of appearance, friendliness and trust and interpersonal-social aspects of nursing. Most of the above studies looked at satisfaction from as many angles as possible, but they underemphasized the evaluation of the structural component of.
Factors Affecting Satisfaction
- Socio Demographic Factors
- Patient Expectations
- Physical Environment
- Health, Physical and Psychological Status
- Communication and Information
- Participation and Involvement
- Previous Experience and Knowledge
- Socio Economic Factors
- Other Factors
Perceived empathy and compassion of healthcare professionals towards patients affects satisfaction (Messner & Lewis, 1996). First, they are increasing due to the growing consumer orientation of healthcare.
- Expectancy- Discont1rmation Model
- PHC Concepts
- Donabedian Model for Quality Care
He classifies accompanying phenomena in three tracts, the patient, the nurse and . The environment. The physical environment was measured in the study in terms of accessibility of PI-lC services.
Conclusion
Aspects of client involvement were measured in this tract because it measured the client's expectation in involvement of health service delivery. In this study the organizational environment was assessed in tel111S of policies including opening and closing hours of. This model guided the study and it used the aspects of nursing care characteristics, patient channel and the environmental channel.
It was appropriate for the study as it integrated the variables of community participation or involvement and accessibility of PHC services with patient or client satisfaction.
Research Methodology
The purpose of the evaluation design is to describe how "well a program, practice, procedure or policy is working with the purpose of assessing the success of a program" (Polit & Hungler, 1995 p201). The study therefore evaluated the extent to which community involvement and accessibility of health services were achieved to the satisfaction of the clients. A triangulated approach was used to enable the patient's perceptions to be collected in his or her own understanding, implying more reliable data on client satisfaction.
There are 26 government-owned health centers in Lilongwe, with 4 in the urban and 22 in the rural areas of the district. Chiwamba is a rural health center located on the northern side of the district in the rural area.
Population
Sampling
In this case, the list for systematic sampling for those using the health center came from the daily register of clients visiting the health center on the day of data collection. In this study, the selection was based on the section they visited, in the Health Center. The clients came from the different departments of the Health Center and were representative of all departments, namely: matellal and child health care (with prenatal and postnatal clients).
This method was used because it allowed for representation of all the services provided at the Health Centre. The focus groups were held at the Health Center and consisted of both users and non-users of the Health Centers.
Data Collection and Instrument
- Gender Distribution of Respondents in Kawale and Chiwamba Health CeJ1tres
- Employment Status
- Nature of job
- Tribe
- Time Spent in Travelling to the Clinic
- Means of Transportation
- Waiting Time
- Satisfaction with Waiting Time
- Cultural Accessibility
- Results on Client Satisfaction with Community Involvement
- Explanation of Procedures
- Planning
- Coordination
Most respondents (43) in the entire sample were in the 19-30 age group. In the entire sample, the majority of clients stated that they had an education up to primary school level. In the entire sample, the majority of respondents strongly agree that the Health Center should be open more hours.
In the entire sample, the majority of customers agreed with the statement, namely 20 respondents (28.2%) strongly agreed, i.e. 69% of respondents agreed with the statement. In the entire sample, the majority of respondents agreed with this, namely 35 respondents (49.3%) completely agreed with the statement.
Qualitative Data Analysis
- Data Analysis
- Sample Realisation
- KAWALE HEALTH CENTRE
The users were purposefully drawn from the different departments of the health center which are maternity, family planning, nutrition, under five and the outpatient department. The non-users were conveniently drawn from the catchment population of Chiwamba Health Center and were requested to attend. The focus group sessions were limited to two due to the unavailability of participants, especially those who did not use the Health Center but were within the catchment areas of the Health Centers.
The three themes were: a) Community involvement in the provision of health care, b) Client satisfaction with involvement, and c) Accessibility of health services. Two categories emerged from this theme, namely a) Non-involvement in health care provision and b) Lack of understanding of the importance.
No Involvement in the health care delivery
Lack of understanding on the meaning of Community Involvement in Health care delivery
Theme 2: Client Satisfaction with Involvement in Health care delivery Out of the broader theme of satisfaction with involvement of the participants
The data analyzed revealed that participants were not satisfied with the current form of involvement, namely involvement in healthcare as users. The following quotes illustrated this. 34;We are not satisfied with the non-involvement we mention. then we could have been respected and the government could have also respected the health workers." The biggest problem, as expressed by the clients, was that the health center is far away from where most of the participants live; they have to travel a long distance to get to the health center to come.
Again, they attributed their lack of involvement in health service delivery to the long distance between their homes and the health center. Those who live near the health center will be satisfied, but those who stay will not be satisfied.
Cultural accessibility
Functional Accessibility
Inappropriate Hours of operation
Inadequate Resources
34;They start our attelldillg very late, all close early ill day hellce give us a limited time to be seen and when they close they don't even remember that the)' opened late to give us extra time, \I ' I'm just told to call back tomorrow. The services are there, but I can use them because one is especially the opening and closing hours. 34;The health workers are trying, but they are limited in what they can do for us because of the limited supply of drugs.
Human Resources Problems
CHIWAMBA HEALTB CENTRE
- Theme 1: Community Involvement in Health service delivery
These were a) Community involvement in health service delivery, b) satisfaction with community involvement and c) accessibility of health services (Table 4.5). The issue of involvement in health care services in the f01111 of planning for health services, decision making, implementation of health programs and evaluation of health services was discussed. The three categories that emerged from this theme were a) No involvement in health service delivery b) lack of understanding about the meaning of community involvement in health care delivery and c).
Participants indicated that they were not involved in the planning, decision-making, implementation and evaluation of health programs. They were only involved during outbreaks when asked by the health surveillance assistants to participate in the control and prevention of conditions such as cholera.
Lack of understanding about the meaning of Community involvement in health care delivery
Pe"ceptions of who should be involved in health care delivery Participants felt that for one to be involved in health care delivery, one had to
Theme 2: Satisfaction with community involvement in health care delivery
This topic explored whether participants were satisfied with CULTent's form of involvement, which was only involved as patients using the health service and not involved in the planning, decision-making, implementation and evaluation of health services.
No satisfaction
Theme 3: Accessibility of Health Services
Three categories emerged from the broader theme of accessibility of health services. These were a) geographical accessibility of health services, b) functional accessibility of health services and c) cultural accessibility of health services (Table 4.5).
Geographical Accessibility
Cultural Accessibility
- Sociodemographic Factors .1 Gender
- Functional Accessibility
- Cultural Accessibility
- Community Involvement
- Limitations of the Study
- Implications for Health Services
- Conclusion
- Recommendations
- Recommendations for Nursing Research
- Recommendations for Health Service Managers
- Recommendations for Nursing Education
This study revealed a variation in the educational status of the respondents between the two Health Centers. In Kawale, the majority of respondents (54.3%) lived 0-5 kilometers from the Health Center (Figure 4.5). The majority of clients (75%) (Figure 4.6) either strongly disagreed or disagreed that they were satisfied with the distance between their homes and the Health Center.
This study found that 68% of respondents in Kawal felt that their health needs were met at the Health Center (Table 4.3). All respondents in Kawale (100%) (Table 4.3) were satisfied with the cultural accessibility of healthcare. This study found that 97.2% of respondents in each of the health centers were not involved in the planning of health care services (Table 4.4).
WHO (1978) recommended that communities be involved in every phase of health service delivery from planning to evaluation of health services.
APPE DIX 1: DATA COLLECTION I STRUMENTS
- Mumapephera mpingo wanji?
- Mumakhala mtunda wautali bwanji ndi chipatala?
- Zimakutengerani nthawi yayitali bwanji kuti mukafike ku chipatala?
- Mumayenda bwanji kukafika ku chipatala?
- PERMISSION LETTER FOR KA WALE HEALTH CENTRE
- PERMISSION LETTER FOR CHIWAMBA HEALTH CENTRE
- ETHICAL CLEARA CE LETTER
- CONSENT LETTER
- EDITORS' COMMENT
It is easy for me to get medical care in this health center after 4pm. The health center meets my health needs. The costs of going to this health center are high. I am satisfied with the distance between the Health Center and where I am staying. The Health Center is in a convenient location compared to my house.
The purpose of the study is to find out your perceptions regarding satisfaction regarding participation in health programs and accessibility of this health center. The results will be for academic purposes and can be used for future planning for this health center.
