Perceived quality of health care services in Dar es Salaam municipal hospitals: comparison between clients using user fees and national health insurace fund.

Abstract

A cross sectional study was conducted in Dar es Salaam Municipal hospitals in the month June 2005, with the main objective of comparing perceived quality of health care services, amongst clients using user fees and National Health insurance Fund. A total of 563 exit interviews were conducted, of which, 281 were with clients using user fees and 282 were with NHIF members. Respondents were selected using convenience sampling method. A Structured questionnaire and facility checklists were used to collect data. The study findings show that provider client interaction was perceived to be good, with a higher proportion of NHIF clients (93.6%) compared to clients paying user fees (88.3%) reporting to have spent adequate consultation time with the prescriber (P<0.05), and almost similar proportions of respondents paying user fee and NHIF reporting to have been given adequate explanation about their health problems (i.e. 74.4% and 75.5% respectively) and that they had received adequate instructions on the use of prescribed drugs (i.e. 97.2% Versus 97.3% respectively). The study findings also show that Overall, 28.4% of the clients interviewed reported that were physically examined, with about 30% of clients paying user fees reporting lack of enough privacy. Majority of the clients (81.5%) interviewed were satisfied with physical state of buildings and attitude of health worker (i.e. 85.1 % user fees versus 86% NHIF) at the facilities that they had attended. The respondents were also interviewed on aspect of duration of time spent waiting to get health care. Less than a quarter of clients interviewed perceived waiting time to be short, with significantly higher proportion of clients paying user fees (21.4%) compared to

Vlll NHIF (13.5%) clients perceived waiting time as being short. Drug availability was reported to be a problem in this study, where more than two thirds (71.2%) of the client responded that drugs were not always available at the facilities they attended. The level of satisfaction with the quality of health care services was high (84.4 %) among clients interviewed, with a small proportion (15.6%) being dissatisfied mainly due to long waiting time (72.7%) and lack of drugs (64.8%). In order to improve quality of health services clients suggested that waiting time should be reduced, drugs availability, attitude of health care provider, physical state of facility buildings and cleanliness of surroundings should be improved. The author recommends that clients' opinions be in cooperated in the strategies planned to improve quality of health care services