Ds Ogaji

Systematic review of patients' views on the quality of primary health care in sub-Saharan Africa.

This is the first systematic review of patient views on the quality of primary health care services in sub-Saharan Africa using studies identified from MEDLINE, CINAHL Plus, EMBASE and PsycINFO. In total, 20 studies (3 qualitative, 3 mixed method and 14 quantitative) were included. Meta-analysis was done using quantitative findings from facility- and community-based studies of patient evaluation of primary health care. There was low use of validated measures, and the most common scales assessed were humanness (70%) and access (70%). While 66% (standard deviation = 21%) of respondents gave favourable feedback, there were discrepancies between surveys in community and facility contexts. Findings suggest that patient views could vary with subject recruitment site. We recommend improvement in the methods used to examine patient views on quality of primary health care.

Setting agenda for quality improvement in a public hospital in Nigeria using the consumers' judgement

Background: The paradigm shift in the locus of control in many health systems brought about by consumerism, makes it imperative for consumers of health services to be involved in setting agenda for quality improvement.. This study sought to identify service quality gaps in a public hospital using the clients’ judgement. Methodology: Sixty-eight consenting clients attending the State House Hospital, Yenagoa, were administered an adapted version of the SERVQUAL instrument to rate their expectation before and perception after the encounter with the practice. Negative gap scores indicated that the actual service (the perceived score) was less than what was expected (the expectation score) and thus requires some form of quality improvement. Criteria having high expectation scores from the clients were also of importance to the administrators of the facility. Result: Majority of the raters were married (71.2%) and female (55.9%). Significant gaps were elicited in clients’ desire for up-to-date equipment for patient care (-1.15); desire to be able to trust staff (-1.06) and feel safe with hospital’s employees (-1.11). All 5 dimensions showed some degree of inadequacies but none crossed the pre-set critical line. Majority of the clients showed general satisfaction with the performance of the hospital (88.4%), a likelihood of return (76.3%) and recommending to others (81.0%) Conclusion: The identification of symptoms of dysfunction in this organization through this instrument provided a starting point for the examination of underlying problems that inhibit the provision of quality service.

Findings and Predictors of Patient-Reported Experience of Primary Health Care in Nigeria

Objective: The study reports findings and patients’ characteristics that predict their experiences of primary health care (PHC) in Nigeria. Methods: A cross-sectional survey of 1680 patients attending 24 primary health centers in 6 states from the 6 geopolitical subdivisions in Nigeria. The patient evaluation scale was used for exit survey of patients’ experiences with PHC. Categorical findings and mean ratings on experiences of PHC were analyzed using both descriptive and inferential statistics. Results: The mean response rate was 98%, and most respondents were female (73%) and married (72%). A higher proportion of patients gave positive feedback on their relationships with staff (84%) than they did available space in the waiting area (60%). Higher self-rated health status and nonpayment for care at the point of receipt were consistent predictors of positive patient experiences from the multilevel analysis. Conclusion: Study reported findings and drivers of patient experiences with PHC. Aspects of PHC showing less positive patient experiences and some patients’ factors associated with these are amenable to change and can form the focus of quality improvement actions.