The State of Public Health Care Service in Ethiopia :Health Service Quality, Accessiblty and Operational Efficiency in the Case of Addis Addis Public Hospitals
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Date
2021-12
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A.A.U
Abstract
The study aimed at analyzing the state of health care service provision in Ethiopia in the case of Addis Ababa‘s Public hospitals. Though empirical evidence on the state of hospitals service provision is important, systematic research results encompassing the core health care service dimensions and views of patients is scant in Ethiopia.The absence of data and research prioritization on hospitals is a self-perpetuating problem and in the absence of substantive data or pressure from external donors, policymakers face few incentives to improve hospital services. Health care reform has frequently been more an act of faith than on the basis of evidence-based policy making; therefore this study provides evidence on the actual health care service provision state of public hospitals in Addis Ababa city. To this end the study considered three specific objectives i.e. Assessing the public hospitals health care service: (1) quality (2) accessibility and (3) operational efficiency. The study has defined these three categories of health care service dimensions and adopted OECD‘s (2006) analytical framework.
To achieve the objectives the study has employed a pragmatic research paradigm with mixed methods research design. To answer the research questions of the study data was collected from both primary and secondary sources. Primary sources include health care service users, and health care service providers. Observation was also made to hospital facilities, service provision sessions and the situation of service users and providers. Secondary data was collected from policy documents, hospital reform implementation reports and related published and unpublished sources. The individual level units of the study were hospital health care service providers (staffs and leaders) and also hospital service users (patients and other service seekers). The institutional level of unit of analysis were the public hospitals selected, and health care reform and policy documents. To these end seven hospitals, 376 hospital health service users and 14 hospital health care service professionals, 2 AACHB officials and 2 FMoH officials were selected and interviewed. Qualitative, descriptive and inferential statistics were used in the data analysis. Thematic analysis was used to organize and interpret qualitative data. Cronbach's alpha, descriptive statistics, from Chi-square test, Mann-Whitney U test, and Kruskal-Wallis test were used for descriptive statistical analysis. A principal component and logistic regression analysis were used for inferential statistical analysis. The overall satisfaction of patients with the effectiveness of the hospitals service provision was (71.28%). The multivariate logistic regression analysis predicts that the availability of thorough treatment and examination of patients (p<0.05, exp=3.147, 95% CI) and good explanation regarding medical tests (p<0.05, exp=6.258, 95%CI) enhances patients satisfaction. With respect to safety only 42 %( 158) respondents indicated satisfaction with the facilities safety procedures. The multivariate logistic regression analysis shows that medical staffs capability not to expose patients to unnecessary risk (p<0.05, exp=4.916, 95% CI) and extent of care exercised by medical personnel to patients during treatemnts (p < 0.002, exp=7.282, 95% CI) affects patients satisfaction. Regarding responsiveness of the service only 118(31%) revealed contentment with responsiveness of service provision. The multivariate logistic regression analysis shows that health care professionals courtesy and respect (p < 0.05, exp=2.682, 95% CI), medical personnel‘s symathy for patients‘ problems (p < 0.05, exp=2.521, 95%CI), and medical personnels‘ individual attention to patients (p < 0.05, exp=7.112, 95% CI) increases patient satisfaction.
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The multivariate logistic regression analysis with the temporal component of accessibility shows that acceptability of waiting time (p<0.05, exp=15.766, 95% CI), and getting medical service on short notice (p<0.05, exp=8.444, 95% CI) positively contributes to patient satisfaction. Similarly with respect to availability sub dimension of access ease of access to medical specialists (p<0.05, exp=8.444, 95% CI) and getting the ordered laboratory tests in the hospitals laboratory (p<0.05, exp=9.06, 95% CI) enhances patient satisfaction.The study also indicated prevalence of catastrophic helath expenditure and 265(70.5%) respondents revealed their worry about having to pay large medical bills. The multivariate logistic regression analysis shows that being never worry about having to pay large medical bills (p < 0.002, exp=5.927, 95% CI) and getting medical care service without financial set back (p<0.05, exp=4.689, 95% CI) enhances patient satisfaction.
The findings vividly indicated the existing state of the public hospitals service provision in Addis Ababa City. From the respondents, 55% indicated that they have an overall good experience with the facilities and services while the rest indicated discomfort. The analysis of the available literature and documents also portrays the operational inefficiency of the public hospitals. The study concludes that improvements in quality, accessibility and operational efficiency of health care service provision significantly enhances the satisfaction of service seekers (patient) and service providers (staffs and leaders). Based on the key findings and conclusion, study presents suggestions for FMoH, AACHB and public hospitals administrators, and the federal government on how to address loopholes that hamper positive improvements in health care service provision in public hospitals in Addis Ababa.
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Keywords
Health care service quality, Responsiveness, Accessibility, Operational