ASSESSMENT OF USERS’ PERCEIVED QUALITY OF CHILD HEALTH SERVICES IN PHC FACILITIES IN OSUN STATE: DEVELOPMENT AND APPLICATION OF A NEW TOOL

Abstract

Introduction: Quality of child health care is an important determinant of child health services utilization ultimately influencing child health outcomes. It is a multidimensional concept that can be seen from the technical and the users’/caregivers’ perspectives. This study developed and applied a tool for the assessment of users’ perceived quality of child health care services in PHC facilities.
Methodology: The study was cross sectional survey carried out in 3 phases using mixed methods (quantitative and qualitative methods). In the first phase, a qualitative survey using focus group discussion sessions was carried out to elucidate community perspectives on issues about quality of child health services in PHC facilities in selected communities in Osogbo LGA, a predominantly urban LGA, and Ife North LGA, a predominantly rural LGA in Osun State. Analysis of the findings yielded thirty-nine items on users’ perception of quality of child health care. In the second phase, the quality related items derived from the FGD were reviewed by thirty-three experts in Public Health and related fields as a means of ensuring validity using the Modified Delphi Method. Analysis of the findings in this phase produced items for the new users’ perceived quality of child health care (PQCHC) tool. In the third phase, the new tool and a pre-existing tool were administered to 619 caregivers of under-five children attending the child health services at selected PHC facilities in Osogbo LGA and Ife North LGA in Osun State.
Results: The availability of drugs and other health related consumables was perceived by the community as the most important determinant of the quality of child health care services in PHC facilities. Some participants in this study had the perception that some of the drugs offered to the patients in the free health care were substandard and associated free health with substandard health care service. There were mixed opinions about friendliness and openness of health workers at the PHC facilities. Non availability of drugs and other medical supplies, insufficiency of chairs for patients/caregivers, distance of health facility to home, poor road access, inadequacy of water supply and uncleanness of the environment of the health facility were reported as reasons for low quality child health care in the PHC facilities among users of the facilities. Health workers being always available and spending adequate time with the children, and the children recovering from their illnesses when treated at the health facility
xiii
were the areas in which the PHC facilities were perceived to have high quality of the child health services.
There was high correlation between the newly developed tool and the pre–existing tool (R=0.7, p<0.001). However the pre-existing tool classified a higher proportion of the respondents as having ‘high perception’ of quality of care (88.7%) compared with the new tool (69.0%), implying that the new tool is more conservative than the pre-existing tool in the assessment of perception of quality of child health care. Caregivers in the urban setting were less likely to have a high perception of quality of child health care compared to those from the rural settings (OR=0.580, p=0.017). Also the caregivers younger than 20 years old (OR=0.286, p=0.009) and the caregivers with tertiary education (OR=0.478, p=0.014) were more likely to have a low perception of quality of child health services in PHC facilities.
Conclusions and recommendation: A mixed methodology was used to develop a 21-item tool for assessment of users’ perceived quality of child health care services in PHC facilities. Majority of respondents had a high perception of quality of child health care in the PHC facilities assessed. Reasons for high perception of quality in the PHC facilities were availability of health workers, spending adequate time in treating the children, and the children recovering from their illnesses when treated at the health facility. Non availability of drugs and the physical infrastructure were the most important reasons for perceived low quality of child health care services at PHC facilities. The urban residence, high level of education and young age of caregiver were significantly associated with their perception of quality of child health care services in PHC facilities. The quantity and quality of drugs made available in PHC facilities need to be improved in order not to lose the confidence of the users. Also efforts should be in place to improve the quality of the PHC facilities in terms of cleanliness, chairs for patients/caregivers, good road access and adequate functional toilet

ASSESSMENT OF USERS’ PERCEIVED QUALITY OF CHILD HEALTH SERVICES IN PHC FACILITIES IN OSUN STATE: DEVELOPMENT AND APPLICATION OF A NEW TOOL