University of Medical Sciences and Technology Graduate College
M.Sc. in Public and Tropical Health programme
Project TitlePatients satisfaction with primary health care
services in Khartoum state, Sudan, 2013
Student name: Imran Ahmed Abdikadir Batch number and year of
admission: Batch 11, Year of Admission 2012 Student index number:
PHT11-2011-039Telephone number: 0923511161E-mail:
[email protected]
Project Supervisor:Name: Dr. Muna Hassan Mustafa Position:
Telephone number: 0912257378E-mail: [email protected]
Project Number: .......... Date of Submission: ..
2013Table of Contents
NO ContentsPage number
I.Title page......1
II.Table of Contents.....2
III. Lists of Abbreviations.....3
1. Introduction.....4
2. Statement of the problem .......5
3.Objectives.....6
3.1.General Objectives.......6
3.2.Specific Objectives......6
4.Material and Methods..............6
4.1.Study design.........6
4.2.Study area ....6
4.3.Study population .................................6
4.4.Sample size and technique ..............7
4.5.Data collection tools ....7
4.6.Data analysis ...8
4.7.Data presentation .....8
4.8.Ethical considerations......................8
4.9.Time plan (Gantt chart) ...............9
4.10.5. 6.7.8.
Budget .........References....Appendix 1: Consent Form..Appendix
2: Questionnaire..Appendix 3: Questionnaire in Arabic
language...
1011131419
Lists of Abbreviations
1. WHO: World Health Organization2. PHC: Primary Health Care3.
NGOs: Non-governmental organizations4. SPSS: Statistical Package
For Social Sciences5. UMST: University of Medical Sciences and
Technology 6. MOH: Ministry of Health7. UNICEF: United
NationsInternationalChildren's Emergency Fund8. KAP: Knowledge,
Attitudes and Practices9. USSR: Union of Soviet Socialist
Republics10. HIC: Health Insurance Corporation11. PPS: Probability
Proportionate to Size12. SPSS : Statistical Package for Social
Sciences SPSS13. SIRB: SUMASRI Institutional Review Board SIRB
Introduction:Primary health care is defined by the WHOs Alma Ata
declaration (1978) as follows:The essential health care based on
practical, scientifically sound and socially acceptable methods and
technologies made universally accessible to individuals and
families in the communities through their full participation and at
a cost they can afford. (1) The government of Sudan was a signatory
to Alma Atas declaration and committed to providing quality primary
health care services to achieve health for all by the year 2000.
(2)Primary health care centers have an important role in improving
the basic health services and if they fail to provide satisfactory
services to patients, this will lead to adverse patients attitudes
towards health care system at all. (3) Community participation is
one of the key principles on which primary health care is
established others being equitable distribution, inter sectoral
coordination and appropriate technology. (1)In the way of providing
primary health care services the government of Sudan has made
impressive growth in term of the establishment of primary health
care institutions across urban and rural areas hard to reach
sectors. (2) However, shortcomings in the delivery of primary
health care services have resulted in lesser utilization rates and
more dependence on private health care services providers.(4) The
delivery of health services for the poor people in urban and rural
areas remains a challenge in Sudan. (5)Information about community
perception with a thorough understanding of the needs and
expectations of the community about the health care services can
help in better delivery and higher utilization of health services.
(5)Patient satisfaction is generally considered as the extent to
which the patients feel that their needs and expectations are being
met by the services provided. (6)Patient satisfaction is an
important tool to measure the performance of providers, managed
care organizations and health care systems. (7) Also patient
satisfaction is an important aspect of health care quality and can
be used for monitoring of some aspects of quality. (8)The
determinants of patient satisfaction include demographic factors,
socioeconomic status and general health status. Satisfaction is
also influenced by the manner in which health care is delivered,
the type of health care setting and characteristics of medical
provider such as experience, age and gender. Finally continuity of
care is another important determinant of patient satisfaction.
(8)Problem statement: Sudan health system is based on the district
health system approach, which emphasizes the principles of primary
health care (PHC). Nevertheless, the decentralization of the public
sector resulted in more deterioration of the PHC system
particularly in rural and peripheral areas due to lack of financial
resources and managerial capacities. The local health system act
gave the responsibility of management of PHC level to the
localities while, this wasnt accompanied by ensuring availability
of sufficient financing resources to localities to run this
function.This condition is worsened by the focus of government
spending on hospitals leading to an unbalanced health system. For
instance, 36% of the total health expenditure goes to the secondary
and tertiary hospitals. Moreover, over 90% of the government health
expenditure is directed to the secondary and tertiary hospitals.
(9) However, when it comes to crucial issues such as finance,
budget planning and allocation is usually skewed towards curative
and tertiary care. For example, in 2004, about 82% of the total
health expenditure was devoted to curative care in the secondary
and tertiary levels. (4) This problem manifested in terms of the
very low access to PHC in Sudan. One quarter of the population has
no access to health facilities with considerable inter-state, urban
and rural disparity. Many rural areas are underserved by the health
system in terms of functional facilities, in particular health
centres and hospitals, which are found to be clustered in towns and
cities. It should be noted that 33.2% of the population live in
urban areas. Furthermore, the minimum PHC package is provided by
19% of PHC facilities which hamper the adequacy and quality of PHC
services. Therefore, one of the major problems of Sudans health
system delivery is the lack of optimal access to high quality PHC
services. (9) Although some evidence indicates that the perception
of the general public regarding quality of care is more to the side
of institutions. (4)
ObjectivesGeneral objectives: To assess the levels of Patient
satisfaction with the services and to identify factors relating to
the patient satisfaction.Specific objectives:1. To assess the
patient satisfaction with primary health care services in Khartoum
state2. To determine the effect of socio demographic factors of
patient on the level of satisfaction of primary health care
services in Khartoum statesMaterial and Methods Study design:
Cross-sectional descriptive facility-based study design.Study area:
The study will be was carried out in Health Centers in Khartoum
state.Khartoum state is the national capital of the country with an
area of about 28,000 square kilometers and is administratively
divided into 7 Localities: Khartoum, Omdurman, Khartoum North,
Jabal Owlia, Karari, Um Badda, and Eastern Nile. (10)Its health
facilities include 43 hospitals, (11) 195 health centers, (12) 185
NGO centers, 235 dispensaries, 365 primary health care units. (11)
The total population is about Five million citizens; the state
climate is semi-desert due to its geographical position. (10) Most
of the population of Khartoum state is working in the work offices
in governmental and private institutions.Study population: The
study population will consist of as all adult patients (more than
18 years) seeking health care in health centers in Khartoum
state.
Sample size and technique: A sample of 450 patients will be was
calculated selected bythe following equation:n = * pq * deff
n =sample size=the value which corresponds tothe level of
confidence95% andis1.96.p =the proportion ofthe phenomenonunder
studyandwill be taken73%.(The study conducted in the first half of
2010 by Health Insurance Corporation (HIC) showed that 73% of the
insured patients feel that the level of service provided by the
health insurance is very good).q = 1 - pd =the desiredmargin of
errorand will betaking thevalue of5%.deff =designeffectof
clustersampleand will betaking thevalue1.5.This gave a sample size
of 450 patients.The sampling technique that to be used in this
study is Multi Stage Cluster Stratified Systematic technique. The
health centers are classified into 3 levels, each level represent a
stratum: the primary level (PHC), the secondary level (multi
specialists' centers) and the third level (hospitals). The
secondary level (multi specialists' centers) and the third level
(hospitals) will be excluded in this study.The sample will be
distributed over the primary level according to the load of users
at each level. The total number of centers chosen will be 30
centers. The centers were chosen in each stratum by the Probability
Proportionate to Size (PPS) method, and the sample will be
distributed over the localities of Khartoum State. From
eachcenter,15patientswill beselected after receivingthe service.
Patients in each center will be chosen by systematic sampling
technique.
Data collection tools: Interviews based on structured
questionnaire, information will be obtained from the patients on
background information (gender, age, marital status, education,
occupation, religion, and residence), distance of the health center
from house, travel time, means of arrival to the health center,
waiting time for services, Information received, level of
satisfaction with health care services. The interviews were
conducted with patients after the consultation but before
departure.Data analysis:Data will be reviewed, edited and entered
into computer and to be analyzed by software program Statistical
Package for Social Sciences (SPSS) and Excel program.Factor
analysis procedure will be used to group intercorrelated items load
(cluster) onto one factor which then formed a scale (dimension).
The effect of each factor on general satisfaction was tested using
Chi square test with p
