| dc.description.abstract | There is continued concern about unequal access to quality health care, which
includes public, private and faith based health care services. In assessing the
utilisation of health services, the indicators often assessed include people's
health status (morbidity and mortality) accessibility to basic health services,
utilization of health services and expenditures on health. A number of factors
affect whether or not a person seeks health care services. Studies have
identified several factors that account for patient delay in seeking care and
health service delay that translate in inaccessibility to health care (Phillip, D. et.
al 1999). Factors that characterise the response of the health care services
include: quality of care provided, cost of services, waiting time.
The study was carried out in ten health facilities in Nyeri district. The objective
was to determine how patient characteristics, quality and access factors of
health care service influence utilization of health care facilities. The study results
indicate that a person values quality health care and thus utilizes the facilities
where quality care is provided such as the hospitals. Education promotes value
and attitudes that provide incentive to use health care services.
The extent of present health status is a determinant of use for health services.
The fee paid for health services was significant at 5% confidence level. Results
show that many patients (83.8%) lived 1-20 km from the health facility; hence
distance from respondent home to facility of choice is not a deterrent to seeking
health care. The reason leading to this health-seeking pattern is attributed to the
poor quality of health care provided in nearby rural facilities, which translate into
inaccessibility. The poor quality in rural health facilities is related to lack of
quality enhancements such as presence of theatre facilities, diagnostic facilities
and the staffing levels. However, many clients (42.3%) walked to the facilities
and the overload on the district and referral facilities can be reduced by
improving the quality of health care at the primary health care level. From the
results, 16.5% of the respondents' wishes doctors were made available in the
health facilities. Respondents consider the provider consultation when judging
quality of care.
Clients' demographic and social/economic characteristics are proxies for the
health status of patients and are key determinants of health services utilization.
Access to services and their perception by clients influences health service
utilization. User fee and waiting time are major determinants of health care
demand and they were significant at 5%. The study has illustrated the critical
role of clients' perception about service quality on visits to health facilities. The
attitude of health facility personnel towards patients is a determinant of service
utilization and is significant at 5% level. Based on the data from the health
records office in Nyeri District, the rate of utilization of health services in the
government facilities is high, compared with the utilization rate in the private
and the mission facilities. This may be due to proximity of government health
facilities. User fees are a deterrent to health service utilization by the poor. To
further encourage utilization of existing health facilities qualification of the
personnel deployed in all facilities needs improvement. Patients' perception of
adequacy of drugs and diagnosis at the health facilities affect health services
utilization. The presence of a doctor in a health facility significantly increases
demand for health services. | en |
