The quality of health service provision by Nairobi city council health clinics

Abstract

Health care provision is a challenge facing most developing countries. Financial constraints continue to be a stumbling block at all levels of public health provision. Even with introduction of cost sharing, health provision has still not met the rising demand for the services. Due to this, concern about the quality of health services provided is becoming relevant as increases in health needs become evident. This study was designed to examine the quality of health services delivered at the NCC health centers with regard to health service users. Specifically, the researcher sought to find out the factors influencing user satisfaction and utilization if the health services provided. It was also important for this study to find out how effective the centers were in delivering services. The study was guided by situational approach theory that sees human behavior as determined by situations. This model sees individuals' health seeking behavior as determined by factors real to them. Their definition of a situation is followed by a process of thinking, in which the possible cause of action taken or selected will be based on their relative high value to the individual. Health seeking behavior is sometimes influenced by the relative value placed on certain health facilities depending on the individuals' situation. Another theory utilized was the social systems theory. Health care facilities are parts of social systems that act independently of each other and yet must wholly function together to achieve their goal. The success of NCC health centers solely depends on all other actors in the-interactive relationship to function as a healthcare provider. The researcher focused on health service users visiting the selected NCC health centers at the time of the study. Information in the field was collected by use of structured interviews that were administered to the health service users at the end of the health service delivery (exit interview). Interview guide was also used for the key informants. An observation checklist was used to record physical infrastructure and equipment in use at the centers. The data obtained was analyzed using SPSS and presented through descriptive statistics. The study revealed several factors that influence users in choice of a health facility. Time and distance were seen as important factors in health seeking. Majority of the users were satisfied with using those facilities near to where they lived or worked. Studies indicated that affordability was important in health consumption. The users found to frequent the NCC centers were mostly people from low income groups who were in lowly paying jobs or were not working at all. Reliable treatment was another factor that respondents felt was important in health services. Indeed the findings showed that health users were satisfied with the services offered in these centers. This, as the study found, was directly related to the provision of drugs that had improved within 3 years previous to the study. The respondents reported faster recovery with the treatment given and even indicated that they would use the same facility again incase of an illness episode. However key informants indicated that there is shortage of staff and lack of essential resources despite improvements in drug stock out. The study revealed that health service users were concerned with qualification of health service providers. Indeed, they revealed that the qualification of providers in private health clinics is often suspect and they felt that public health facilities had qualified personnel as they are under government management. Some of the constraints that emerged from the study were under-funding in the centers and lack of utilizing the revenue collected. The key informants felt that provision of services depended highly on availability of funds. At the time of the study, it was revealed that there are no mechanisms to utilize the funds collected during registration of the health users' attendance. The health centres administration staff were still waiting for advice from the management board on the way forward.