Assessment of client satisfaction with integrated community case management program in Wakiso district, Uganda

Abstract

Introduction and Background Malaria, pneumonia and diarrhea are the leading causes of death in children under five in Uganda. In a bid to improve access to prompt effective treatment of these diseases, Malaria Consortium in partnership with United Nations International Children's Emergency Fund (UNICEF) introduced Integrated Community Case Management (ICCM) in eight central districts of Uganda. There is currently limited information on client satisfaction with this program. The main objective of this study was to assess client satisfaction with the ICCM program in Wakiso district, one of the implementing sites. Methods A cross-sectional study using quantitative methods and a modified SERVQUAL tool was conducted and 454 care givers of children under 5 years were interviewed. Differences in mean scores between expected and perceived services were analyzed using paired t-tests and chi-square tests. A negative score implied that clients were not satisfied with the care they received. Logistic regression models were also used. Results Among 454 respondents, 80% of the care givers of children under five were satisfied with ICCM program. The overall gap (-0.332) between expectations and perceptions was significant, (t=-4.89, p-value 0.0081) meaning that despite the high level of client satisfaction, there still exist a quality gap in services provided under ICCM. Furthermore, there were no significant differences in the expectation and perception scores among the different dimensions except for reliability which had a score of -0.49 (p-value 0.0005). The multivariable logistic regression model showed that primary education (OR 2.8, 95% CI 1.116-6.795) and being a Muslim (OR 2.9, 95% CI 1.403372-6.341) was significantly associated with client satisfaction. Conclusion Overall, 80% of the clients were satisfied with ICCM services despite the overall quality gap in ICCM services and there was no statistical significant difference between perceptions and expectations for all the dimensions except for reliability dimension. The DHO and implementing partners should ensure a systematic approach to gathering, aggregating, analysing and reporting data to map and identify key gaps in treatment coverage.