Patient satisfaction with public primary health care service delivery in Khomas region, Windhoek district Namibia
Sherif, Hesham E.L
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Primary Health Care (PHC) services in Namibia are based on the principles of equity,availability, accessibility, affordability of services, and community participation and empowerment. According to the Namibian Constitution and the National Health Policy,all Namibians should have equal access to public health services at no cost to the patient.The government places a high premium on the involvement of communities in PHC through communication, consultation and respectful interaction between health workers and patients and communities in the interests of quality service delivery. Services provided at PHC facilities include immunisations, antenatal care, post-natal care, family planning, health education, tuberculosis and malaria treatment, outreach services, antiretroviral treatment (ART), and the Prevention of Mother to Child Transmission(PMTCT) programme. Numerous complaints have been received from patients relating to patients' admissions at clinics, long waiting hours, over-crowded facilities, poor communication between patients and nurses, and non-availability of some medications and medical officers at some of the PHC facilities.This study investigated patient satisfaction and the reasons for reported poor nursepatient relations at PHC facilities in Khomas region in Namibia. The objectives of the study were to describe patient’s perceptions concerning quality of service delivery at PHC clinics, to explore factors related to the clinic environment that might influence perceived quality of care and to describe the nature of nurse-patient relations. Methodology A descriptive, qualitative study was conducted among randomly selected patients (15) and registered nurses (5) at five purposively selected PHC clinics in Khomas region, in the Windhoek district. Five sisters-in-charge from the designated facilities were interviewed as key informants.Data was collected through key informant interviews and focused interviews with nurses and patients, respectively. Data on the participants’ experiences and perceptions of using the health services, as well as factors influencing nurse-patient relations and patient satisfaction was collected. Interview data was recorded on audiotape and transcribed verbatim. Data from key informants was captured in field notes. Thematic analysis of transcribed data was conducted.Results Low patient satisfaction with services was confirmed as a key problem facing four out of the five health facilities visited in Khomas region. Patient dissatisfaction was mostly related to the long waiting times, which in turn, was caused by increased patient numbers as a result of the escalating HIV/AIDS and tuberculosis (TB) epidemics, ART roll out and increased immigration to Windhoek. Other factors attributed to low patient satisfaction were poor communication between health providers and patients, nonavailability of family planning and immunisation services, and frequent stock-outs of some prescribed medicines.ConclusionsThe findings of this study support the need to rethink nurse-patient relations for greater patient satisfaction and quality of service delivery in the public Primary Health Care facilities in Khomas region. Greater care should be taken to inform patients about service days and the staffing limitations at health facilities, and to educate and empower patients for self-care. Communication strategies should target negative perceptions about service delivery at PHC clinics in the communities. In-service training in areas like case management, different PHC disciplines and communication skills are needed to improve the competency of nurses. In addition, motivation of nurses needs to be addressed through recognition and appreciation from management in order to avoid frustrations and negative attitudes towards patients. Motivation of nurses can be improved by paying attention to their work environment and the physical structure of health facilities.