Abstract

The health status of developing countries of the world is miserable and unacceptable. A large segment of the population in developing countries is deprived of access to basic health care. The services delivered by the health care providers are not up to the level of need and perception of the clients (United Nations High Commissioner for Human Rights, 2008). Health, on the other hand, can retain us from going to school or work, from attending to our family responsibilities or from engaging fully in the activities of our community. We are willing to make many sacrifices if only that would guarantee our families and us a longer and healthier life. In Africa and Cameroon in Particular, there is the absence of certain medical facilities which cause patients to travel out of the country for these facilities and also, the “right to health”, like many other human rights, remains poorly implemented in Cameroon (Greve, 2008 as cited in Shu, 2010). During the last decades, there has been more rising cost of medical services and poor nature of these services storm the developing countries, hence the need to assess health services delivery, in public and private hospitals in Cameroon. It is because of this problem that the researcher came up with the idea of assessing patients’ satisfaction of health service delivery in public and private hospitals in Buea municipality: the case of General Hospital, Mount Mary hospital and solidarity hospital and more specifically the study aim at identifying services rendered  at four departments {laboratory department, pharmacy, ward and out-patient {consultation} department} in the targeted private and public hospitals in Buea, also assessing patients satisfaction of the services rendered in these four departments and to investigate the challenges hindering the effective provision of services provided in four departments.  A sample size of 389 patients from these three hospitals was used. A descriptive research design was used to undertake this study to generate patients’ satisfaction of healthcare services over the period. This helped to know the difference between the three different hospitals and how patient assess them. The total population for the study was 13946 patients (6748(48%) patients for Buea regional hospital, 3600 (26) and 3598(26) patients for Solidarity and Mount Mary hospitals respectively). The sample size for this study was calculated using Taro Yamane (Yamane, 1973) formula with a 95% confidence level. This study also makes use of multistage sampling technique including convenient sampling, stratified sampling and simple random sampling. The data collection tools used for this study were both primary and secondary data. Semi-structured questionnaires and interview were used as primary data. Secondary data for this study was gotten from hospital reports, books, journals, magazines, internet libraries, published articles by scholars and websites. Results from findings reveal the different health care services that are provided in public and private hospitals in Buea which include: laboratory services, pharmacy services, ward service and consultation department}. The findings also reveal that patients are more satisfied with consultation services offered at the private hospital than those of public hospitals, the private hospital provides better ward services than public hospitals, public hospitals provide better laboratory services than those of private hospitals, and the public hospital provides much better pharmaceutical services than a private hospital. The findings equally reveal that the Challenges hindering the effective provision of services rendered in Public and private hospitals in Buea include; inadequate technology, inadequate number of nurses, inadequate infrastructure, inadequate security, inadequate diagnosis and lack of specialists. Therefore, the study recommended amongst others that; management of the hospitals should continue to improve healthcare management practice. This is because management practices significantly enhance the quality of healthcare delivery. Also, the management of the hospitals should be innovative and come out with programs and activities that help them to generate internally generated funds to put up facilities to aid in the smooth delivery of health care services. The study also suggested some areas for further research; Health services, Patient assessment, Public Hospital and Private hospital

CHAPTER ONE

INTRODUCTION

1.1 Background Of The Study

Health is a basic human need and a vital human right. It is the obligation of government and health care personnel to deliver health care to all persons in equal measures and to ensure the realization of the health needs of the total population. The health status of developing countries of the world is wretched and unacceptable. Basic healthcare has been deprived from a large section of the people in developing countries. The services provided by the health care providers are not up to the standard of need, perception and standard of the customers (United Nations High Commissioner for Human Rights, 2008).

The right to health is an important part of our human rights and our understanding of a life in self-esteem. The right to the satisfaction of the highest achievable standard of physical and mental health, to give it its complete name, is not new. Globally, it was first articulated in the 1946 Constitution of the World Health Organization (WHO), whose introduction defines health as “a state of complete physical, mental and social well-being and not just the absence of disease or frailty”. The introduction further states that “the satisfaction of the highest achievable standard of health is one of the essential rights of every human being without difference of race, religion, political belief, economic or social condition.”

World Bank and other donor agencies in recent years have been advising developing countries to ensure that limited resources not only have an optimal effect on the population’s health at affordable cost but also that health care services are expected to respond to patients’ preferences directly and demands (De Geydent, 1995; Calnan et al., 1994, 1988; Kwan, 1994, as cited in Ashrafun & Uddin, 2011)

Developing countries has also influenced greatly in recent years by findings in developed countries, which have become increasingly interested in assessing the quality of their health care. Outcomes have received specific emphasis as a measure of quality. Assessing outcomes has value both as an indicator of the effectiveness of different involvements and as part of observing system directed to improving quality of care as well as identifying its drop. Quality assessment studies usually measure one of three types of results: medical results, costs, and client satisfaction. For the last mentioned, clients are asked to assess but their satisfaction with the services delivered not their health status after receiving care (Ashrafun & Uddin, 2011).

According to (Donabedian, 1988), client satisfaction is an essential of the quality of care because it offers information on the provider’s success at meeting those expectations of most importance to the client. Measures of satisfaction are, therefore, relevant tools for research, administration and planning. Patient satisfaction can as well be used to evaluate the method of health care (Carey & Seibert, 1993; Etter et al., 1996; Fitzpatrick, 1991a, b; Guadagnoli & Cleary, 1995; Kane et al.1997; Lasek et al., 1997; Linn et al., 1995; Ross et al., 1995; Williams, 1994, as cited in Ashrafun & Uddin, 2011). As greater satisfaction may be related to superior compliance, improved attendance at return visits and better outcomes (Cleary et al., 1989, as cited in Ashrafun & Uddin, 2011).

Factors linked with satisfaction are thought to consist of the structure, process and outcome of care as well as patient socio-demographic, physical and psychological status, and attitudes and expectations concerning medical care (Cleary & McNeil, 1988; Minnick et al., 1997; Williams, 1994, as cited in Ashrafun & Uddin, 2011). Quality assessment studies mostly measure one of three types of results: medical outcomes, costs, and client satisfaction. For the last mentioned, clients are asked to assess but their satisfaction with the services delivered and not their health status after receiving care (Fisher 1971; Smith, 1989, as cited in Ashrafun & Uddin, 2011). In some studies, intellectual evaluations of service quality attributes (e.g., appointment waiting time was acceptable or too long) are linked with client satisfaction (Newman et al., 1998, as cited in Ashrafun & Uddin, 2011). In others, customer satisfaction is measured directly by asking whether respondents feel satisfied or dissatisfied with individual service quality stuffs (Nathorst-Boos et al., 2001, as cited in Ashrafun & Uddin, 2011). The degree of difference between expectations and perceived performance is defined as client satisfaction (Williams, 1994). In Bangladesh, very limited studies have tried in measuring patient satisfaction with the quality of hospital services.

Health care establishment depends on efficiently combining financial resources, human resources, and supplies, and delivering services in a timely fashion disseminated spatially throughout a country. This requires a “system” that assembles and distributes resources, processes information and acts upon it, and encourages providers’ suitable behavior by individuals, health care workers, and administrators. Good governance is a serious factor in building such a system function. In health care, good governance indicates that health care systems function excellently and with some level of efficiency. Though many governance indicators have been established for countries, governance indicators for specific sectors, such as health, are not readily accessible. Therefore, it is essential to look for substitutes that reflect the quality of health sector governance (Lewis, 2006).

The Cameroon health system consist of both the state sector and a considerable private sector. At a central level, health is the duty of the Ministry of Health. The organisation of the health system was well-defined in 1989 by decree No89/011. Consequently, the Ministry of Public Health is in charge of the design and implementation of the national health policy. It oversees the growth and technical control of services rendered by the public and private health units, manages professional bodies and healthcare organisations, plans the training plan for staff working in the ministry of public health, and manages public health facilities among others. It is organised in three different levels as follows: The Central level which is in charge of the elaboration of ideas, policies and strategies, organization and regulation of the health system through the central services of the Ministry of Public Health with structures like general reference hospitals, central hospitals and university teaching hospital centres, The Middle level is in charge of technical support to health districts through regional delegations of public health, having structures like regional hospitals. The Peripheral level implement health programmes through district health services having structures like health centres, district and sub-divisional hospitals among others (NIS/PETS2, 2010 as cited in Molem et al., 2017). Each level is made up of the public sector, the private sector comprising of profit and non-profit (Denominational and NGOs) healthcare institutions and the traditional sector which is not yet regulated (Molem et al., 2017).

Numerous public health researchers have, over the past years, revealed a lot of interest in measuring the performance of health systems caused by the rising cost of caring for an ever-increasing population of countries, growths in medical innovations and technology (Molem & Beri, 2016 as cited in Molem et al., 2017). The emphasis of economics is to study how to distribute scarce resources throughout an unlimited number of wants and needs. A constant increase in the demand for healthcare resources together with tightening budgets have forced researchers to analyse the provision of healthcare services, understand whether healthcare resources are used efficiently or not and to find out whether good incentives and healthcare systems exist or can be created to ensure efficiency (Marsha et al., 2008 as cited in Molem et al., 2017). It is essential that these resources be put to their best use to translate inputs to outputs so that the healthcare services can be delivered to as many people as technically feasible because the aim of every public health delivery system is to provide the most significant benefit to society from its health interventions; therefore healthcare production has to be optimal (Kirigia et al., 2011; Beri et al., 2016 as cited in Molem et al., 2017). Nevertheless, some researchers put up with that healthcare markets do not stick to the traditional neo-classical optimizing behavior of markets. The provision of healthcare services, therefore, demands market disappointment and non-profit maximizing conduct arising from institutional structures that contrast from private ownership; hence, healthcare service institutions are often suspected of incompetence and compromised productivity.

In most developing countries such as Cameroon with no health insurance policy to cover the cost of healthcare treatment, patients have to cover the cost of their treatment from their pockets. Valuable healthcare treatment is unaffordable to more than half of the population in developing countries. The sensitivity of cost of treatment in developing countries is visible with the more productive segment of the population using the best public and private hospitals, and the weaker section preferring self-care or the public hospitals (Tembon, 1996 as cited in Shu, 2010).

 

1.2 Problem Statement

As human beings, our health and the well-being of those we care about is a matter of daily concern. Irrespective of our age, gender, socio-economic or ethnic background, we consider our health to be our most basic and important asset. Health, on the other hand, can prevent us from schooling or going to work, from attending to our family duties or from partaking fully in the activities of our community. We are ready to make many sacrifices if only that would guarantee our families and us a longer and healthier life. Moreover, when we talk about well-being, health is often what we have in mind (United Nations High Commissioner for Human Rights, 2008). Adequate access and efficiency of Healthcare service within a nation are essential for economic development and the long term sustainability of the nation.  However, access to vital services such as availability and affordability of medicines remains a critical issue. In Africa and Cameroon in Particular, there is the absence of certain medical facilities which cause patients to travel out of the country for these facilities and also, the “right to health”, like many other human right, remains poorly implemented in Cameroon (Greve, 2008 as cited in Shu, 2010). During the last decades, the increasingly rising cost of medical services and poor nature of these services storm the developing countries, hence the need to assess health services delivery, in public and private hospitals in Cameroon.

 

1.3 Objectives of the Study

1.3.1 Main Objectives

The main objective of this study is to assess patients’ satisfaction in health service delivery in public and private hospitals in Cameroon.

1.3.2 Specific Objectives

Specifically, this research sought to:

1. To identify services rendered at four departments {laboratory department, pharmacy, ward and out-patient {consultation} department} in the targeted private and public hospitals in Buea
2. To assess patient’s satisfaction of the services rendered in four departments {laboratory department, pharmacy, ward and out-patient {consultation} department} in the targeted private and public hospitals Buea.
3. To investigate the challenges hindering the effective provision of services rendered in four departments {laboratory department, pharmacy, ward and out-patient {consultation,} department} in the targeted private and public hospitals in Buea.

 

1.4 Research questions

1.4.1 The Main Research Question:

What is the level of patients’ satisfaction of health service delivery in public and private hospitals in Buea?

1.4.2 The Sub-questions of research:

1. What are the services rendered in the laboratory department, pharmacy, ward and out-patient {consultation} department in private and public hospitals in Buea?
2. What is the level of patients’ satisfaction with regards to the services rendered in the laboratory department, pharmacy, ward and out-patient {consultation} department in private and public hospitals in Buea?
3. What are the challenges hindering the adequate provision of services rendered in laboratory department, pharmacy, ward and out-patient {consultation} department in the targeted private and public hospitals in Buea?

 

1.5 Hypothesis of the study

H0: Patients are not satisfied with health care service delivery in public and private hospitals in Buea.

H1: Patients are satisfied with health care service delivery in public and private hospitals in Buea.