A comparative analysis of client satisfaction among people receiving HIV/AIDS care from public and private health facilities in Kabale District

Abstract

Introduction: In Uganda in 2008, about 121,218 people were on ART, which was 40% of all persons eligible for it at the time. Despite increasing availability and accessibility to HIV/AIDS care services in Uganda, there are limited data on the effect of this scale-up on the quality of care and cost-effectiveness.

General objective: To determine whether client satisfaction with quality of HIV/AIDS care services differed between public and private health facilities in Kabale district, South Western Uganda.

Methods: A cross-sectional study using quantitative methods and an adapted SERVQUAL tool was conducted and 216 client exit interviews were done. 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: Generally, clients were not satisfied with services, as shown by the average gap score of -0.06. There was no statistically significant difference in client satisfaction between the public and private health facilities (p=0.5000), though clients at the private facility scored higher (-0.03 compared to -0.09) thus better perceived quality. Tangibles was the worst rated dimension (-0.16) and responsiveness the best (0.00). The item ‘employees give personal attention’ had the highest score (0.04) while the biggest gap was ‘up-to-date equipment’ (-0.54). The odds of women respondents being satisfied were over two and a half times higher than that of men and this was statistically significant (Adjusted OR 2.56, 95% CI 1.33,4.95 and p=0.005).

Conclusion: HIV/AIDS care services at both facilities had gaps in quality as perceived by their clients, especially in the areas of physical facilities and equipment and ability of service providers to perform the service dependably and accurately. Managers and staff in both need to improve on these services and on overall quality of care.