What factors are critical in improving client satisfaction with PMTCT services in Zimbabwe? Findings from a client satisfaction survey
Background: Quality improvement (QI) in health care aims to improve quality of care by modifying service delivery processes to optimize health services and client satisfaction. In Zimbabwe, client satisfaction with PMTCT services is not well-documented. Through support to the Ministry of Health and Child Care (MOHCC), the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) conducted a survey to assess client satisfaction with PMTCT services.
Methods: EGPAF conducted a descriptive cross-sectional survey on client satisfaction with services at 43 rural and urban health facilities across 6 provinces in November 2014. Interviews and focus group discussions were conducted with pregnant and breastfeeding women attending antenatal care (ANC) and postnatal care (PNC) clinics after receiving care. Client satisfaction with PMTCT services was assessed through 2-5 point bipolar Likert scales on care experiences and perceptions such as waiting time and confidentiality during consultation. Availability and functionality of client involvement systems was also assessed. Logistic regression was conducted to determine independent factors associated with client satisfaction. Ethical approval was granted by Medical Research Council of Zimbabwe.
Results: Five hundred and sixty six, (300 ANC and 266, PNC) women were interviewed. Eighty two percent lived within 10km of the health facility. Eighty nine percent of the respondents were satisfied with PMTCT services received on the assessment day. Having had a physical health assessment by a clinician was independently associated with client satisfaction (AOR=2.12, p=0.04). Perceived long waiting periods before receiving services was associated with client dissatisfaction (AOR=0.36, p=0.008). Although not statistically significant, giving out clear instructions to clients was associated with client satisfaction (AOR=2.40, p= 0.07). Systems to gather client views and comments (health center committees, comments books and suggestion boxes) were present; however client awareness of the platforms was low (43%, 5% and 29% respectively).
| Variable | Adjusted Odds Ratio | 95% Confidence Interval | Coefficient | P- value |
| Long client waiting time | 0.37 | 0.17- 0.78 | -1.01 | 0.0087 |
| Being physically examined during consultations | 2.12 | 1.01- 4.46 | 0.75 | 0.047 |
| Being given clear instructions on how to take medication | 2.40 | 0.92- 6.22 | 0.87 | 0.073 |
Conclusions: Client satisfaction with PMTCT services in Zimbabwe is high. Efforts to further improve client satisfaction should target shortening client waiting time and promoting good medical practice that involves physical examination of clients during consultations. This requires more health staff time, which could be accomplished through task shifting. Clients should be continuously engaged by promoting use of available client feedback systems.
B. Mutede1, E. Tachiwenyika1, R. Musarandega1, B. Khabo2, M. Mhangara3, E. Tumbare4
1Elizabeth Glaser Pediatric AIDS Foundation, Technical Department, Harare, Zimbabwe, 2Ministry of Health and Child Care Zimbabwe, AIDS and TB Unit, Harare, Zimbabwe, 3Ministry of Health and Child Care, AIDS and TB Unit, Harare, Zimbabwe, 4Elizabeth Glaser Pediatric AIDS Foundation, AIDS and TB Unit, Harare, Zimbabwe