Evaluation of ART Service in Private Hospitals in Addis Ababa: A Quality Assessment
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Date
2009-07
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Addis Abeba University
Abstract
BACKGROUND: To scale up the Anti Retroviral Therapy (ART) program the
Government of Ethiopia has recently expanded the service to include private
hospitals. But the quality in ART service provision is hardly known particularly in
such a setting.
OBJECTIVES: The main objective of the study is to assess the quality of ART
service in private hospitals in Addis Ababa with respect to clients’ satisfaction,
change in quality of life and adherence to medications. In doing so it identifies
unexpected problems that should be corrected immediately and it will be a good
prelude for future out come studies.
METHODS: A cross sectional study was conducted which used qualitative and
quantitative approaches to look in to the inputs, process of care and outcome as
indicators of quality of ART service being delivered in private hospitals in Addis
Ababa. A total of 183 ART clients who were selected through cluster sampling from
ART clinics in private hospitals in Addis were assumed for exit interview on client
satisfaction, perceived quality of life and adherence to medications using adapted
questionnaires. Both health care providers and ART clients were approached through
in-depth interview for the above indicators of service quality. Additionally check lists
were used to asses the structural status of ART services in these hospitals.
RESULTS: A total of 183 clients accessed of which 130 of them responded (non
respondent rate of 28.4%) to the questionnaire and from which 78.5% and 67.7% of
them have a level above the mean satisfaction score and above the mean for quality of
life respectively. Most of the clients were highly satisfied by the cleanliness and
comfort of the environment but of the clients who were dissatisfied a significant
number of them were complaining of the high cost they incur for laboratory.
Comparing the various domains for perceived quality of life the role/social
functioning and health distress were lower than the other domains. Adherence rate
was found to be 87% at 95% adherence requirement. Otherwise this study showed a
strong relation ship between the variables client satisfaction and adherence & quality
of life and adherence. A closer look via in-depth interview has revealed supportive
evidences for the above results and a checklist for the minimum package for ART
service provision has shown no major gaps in the inputs.
CONCLUSION: Clients of ART service in private hospitals are significantly
satisfied with the service, have generally witnessed a better quality of life and had
satisfactory adherence record. To improve these measures of quality of care further
the gaps identified should be filled by the health facilities and the major stakeholders
involved. The investigator recognized the variables that contributed for the optimal
level of quality of care at these hospitals and recommended a means to lower
laboratory cost and provide psychosocial support along with others.
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Keywords
ART Service