Factors Associated with Client Satisfaction with Institutional Delivery Care at Public Health Facilities in South Ethiopia

Abstract

Background: Ethiopia has one of the world’s highest maternal death rates. Client satisfaction is a dynamic indicator of quality of delivery care services. However, little is known about the factors that contribute to client satisfaction in this setting. Objective: To assess client satisfaction with institutional delivery in women attending for delivery at public health facilities in South EthiopiaMethods: A quantitative and qualitative cross-sectional study was conducted. Sixteen health facilities (one hospital and 15 health centers) were included in the study: a total of 380 mothers were interviewed when discharged. Consecutive sampling was employed to obtain the required sample size. Trained nurses collected the quantitative data, and the principal investigator collected qualitative data from focus groups. Data were coded, entered, cleaned, and analyzed using binary logistic and multivariable logistic regression analyses to identify predictors of client satisfaction. Qualitative data were analyzed according to themes and triangulated with the quantitative data. Result: Overall, 67.9% of clients were satisfied with delivery care in public health facilities in the study zone. Satisfaction varied from 23.4% in the technical dimension to 76.1% in outcomes of care. Predictors of satisfaction were: the presence of an attendant throughout delivery (AOR=2.18; 95% CIs 1.23-3.85), being informed about the baby following neonatal examination (3.22; 1.85-5.62), being prepared for labor and delivery (3.53 1.81-6.89), and care taken to assure privacy (3.07; 1.70-5.52). Qualitative data revealed a range of client satisfaction from perceiving warm, courteous, and respectful care to expressing grievances about being insulted, embarrassed, and even beaten by care providers.

Conclusion and recommendations: Physical, interpersonal, and technical aspects of care influence client satisfaction with delivery care services. Healthcare providers should address problems related to physical, technical, and intrapersonal aspects of care and develop friendly and courteous relationships with clients and cleaner environments to escalate satisfaction, and hence utilization, of services by clients.

Keywords: Client satisfaction, delivery services, South Ethiopia