CHAPTER ONE
INTRODUCTION
1.1     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.