Quality of Reproductive Health Service at Primary Health Care Level with Special Reference to Client's Satisfaction in Nepal

Abstract

Background: Nepal has experienced significant development in health services in the last decade which is justified by the increased numbers of health service provides. But the important and missing link is that those services centers are almost located in the district headquarters of limited districts. People living in rural parts are sill beyond the access of basic health facilities. Primary Health Care centers, by principle, have to provide services in rural areas. However, poor physical facilities, insufficient and poor staffing and unavailability of medicines people are not benefited from those service centers; meanwhile they are also compelled to visit district hospitals and/or other private health service centers carrying economic burden. This trend has pushed a large number of populations into vicious circle of poverty. The study is an attempt to explore whether clients are satisfied with the services provided by PHCs and also identify the obstacles for providing regular and quality health services. In addition, the present study has explored additional expectations of clients on reproductive health services from the PHCs. Methods: The study was conducted in the Kathmandu valley, two Tarai districts namely Chitwan and Kanchanpur and one hill district Kavre. A total of 6 districts and 16 PHCs are covered in this study. The present study has covered 231 married women of reproductive age (15-49) from six districts who received reproductive health services from PHCs. DBase IV and SPSS software were used to computerize the data. Before transferring to the SPSS software for analysis, dBase IV software was used to eliminate all inconsistencies. Frequency, percentage and cross tables were generated as needed and support the objectives of study. Results: A few respondents (1.7%) filed complained that PHCs were not open all office days (6 days a week) but exceeding to proportion complaining by some 7 folds gave an extremely positive response that PHCs used to provide services all-round the weeks. There were also complains on irregularity of services providers at PHCs. about 80 percent respondents reported to have ever used any modern method of contraceptives. Proportion of women using Injectables (Depo-Provera) was the highest, which shows the popularity of the specific method for birth spacing. Of those who received family planning services from PHCs, about one-fifth had complains that they were not counseled before adopting contraceptive method. Injectables (Depo-Provera) tops among the temporary female contraceptives in the popularity, pills and condom follow injectables. More than four-fifths of clients had positive response on regularity of the family planning services at PHCs. Side effects of contraceptive were experienced by more than two-fifths of respondents. STIs symptoms were experienced by a few respondents. Those experiencing STIs, more than three-fifths visited PHCs. Respondent reporting to receive ANC services is remarkably higher compared to national average. Coverage of PNC services compared to ANC was noticed to be poor. More than half of the respondents were interested to file suggestions for improvement of the physical facilities and services provided by PHCs. More than 7 in 10 respondents wanted improvement in services. Conclusions: Despite some drawbacks in the service delivery systems, physical facilities and quality of services, the findings of this study are positive certifications for the government and service providers. If paid attention to the reported dissatisfactions of clients, the services can be made more effective, comprehensive and acceptable. Keywords: client's satisfaction; primary health care; primary health center; reproductive health services; quality.