By Dr Baluku B Joseph
I recently visited Uganda Revenue Authority branch at Ku-bbiri and the health department of Kampala Capital City Authority head offices.
Amazed by the customer care at these public institutions which are often demonised as the worst places to go, I realised how the Government health establishments need a customer care facelift to engender patient satisfaction.
Patient satisfaction determines whether a client seeks medical advice/care and adheres to a prescribed treatment schedule thus affecting treatment outcomes.
Dissatisfied patients will discourage others from seeking healthcare. In 2011 the Uganda Bureau of Statistics estimated that only 44% of women preferred to deliver from a public health facility.
Additionally, the upsurge in utilisation of alternative medicine; herbal medicine, reflexology, witchcraft, and food supplements marketed as cures are probable indicators of patient dissatisfaction with formal health facilities.
abbuye-Sekandi and others found general patient satisfaction of 2.7 on a scale of one to four among patients attending outpatient clinics in Mulago Hospital while another study in Kabale showed overall dissatisfaction of patients receiving HIV care in both private and public health facilities.
Factors that determine patient satisfaction include; tangibles, responsiveness, empathy, reliability and assurance. Public health facilities almost invariably falter on all five.
Tangibles denote presence of modern functional equipment and appearance of staff and premises. A countrywide study of 533 health facilities in Uganda found running water in only 12% of them and 24.7% of them having a functional theatre. Though this was 10 years ago, grounded ambulances and debilitated buildings are still the sight and scenes of health facilities.
Responsiveness is the willingness to help patients. Medical attention at public health units is often obtained in exchange for a bribe despite abolition of user fees in 2001. Jenifer Hunt estimated in 2007 that one needs an average of $ 7.88 to bribe health workers to get care in a public health facility in Uganda.
Empathy includes communication, understanding the patient and individualised attention. There have been media reports of hostile or negligent staff, mistreating patients, and gender discrimination.
Reliability is the ability to perform the promised service dependably and accurately on time. The medicine and health services delivery monitoring unit (MHSDMU) report of 2011 estimated staff absenteeism at 52% with over 80% of facilities in Mukono, Wakiso and Kamuli closed at the time the study team visited. Drug shortages, long waiting hours, understaffing, and absentee staff make public health facilities unreliable.
Assurance includes competence, credibility, knowledge of health workers and their ability to inspire trust and confidence. The MHSDMU report above estimated over 2,000 quack health workers graduating from illegal training schools. The same report noted that some health facilities visited were manned by night watchmen (askaris) and porters while districts; Kole, Buyende, Zombo and Aleptong did not have a single doctor.
I opine that Government health facilities need to shift orientation from patient cure to patient care, from patient flow charts to patient experience. This may necessitate designating personnel or departments to patient relationship management and continuous professional training that addresses customer care.
The writer is a medical officer with Mulago Hospital
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