Niger J Paed 2012; 39 (4):179 –184 ORIGINAL Adogu POU Caregivers’ satisfaction and Nnebue CKC supervision of primary health care Ebenebe UE Ezechukwu CC services in Nnewi, Nigeria DOI:http://dx.doi.org/10.4314/njp.v39i4,6 Accepted: 15th May 2012 Abstract Although major gains and analyzed accordingly. Also key were made in the reduction of informant interviews were used to ( ) Adogu POU childhood health indicators in the elicit information facility Nnebue CKC, Ebenebe UE previous decade, stagnations or supervision frequency and Department of Community Medicine reversals were seen in many adequacy. and Primary Health care Ezechukwu CC countries since the 1990s. Despite The mean age of the mainly female Department of Paediatrics presence of primary health centers caregivers was 31.9 ± 9.4 years. Nnamdi Azikiwe University (PHC) in Nigeria, there are still high Majority of the caregivers attended Teaching Hospital Nnewi, levels of morbidity and mortality health facilities closest to them but Anambra State, Nigeria among children because the quality 18.5% of the 65 who do not, said Email: [email protected] of child health services falls short of they did not like the health workers. Tel: +2348037817707 what it could be in the country. Although more than 80% of clients Supportive supervision of PHCs were satisfied with quality of child should also improve the quality of health services received, yet 41.3% child health services. This study of them felt that the number of ser- assessed the level of clients’ vice days were inadequate. None of satisfaction with care received and the health facilities had a work plan, the quality of supervision of child supervision schedule or supervision health services in selected PHC checklist. Increasing the number of facilities of Nnewi, Nigeria. service days and providing supervi- The study design was cross sec- sion schedules and checklists at the tional. Four health facilities were health facilities can improve care- selected by simple random sampling giver satisfaction and hopefully technique from a list of 12 public enhance quality of child health ser- PHC facilities that provide at least vices at the PHCs three of the range of essential child health services. Using interviewer Key words: Caregivers, satisfac- administered questionnaire, data tion, supervision, PHC, Nnewi were collected from 305 caregivers Introduction The objectives 2 of child health services include promotion of health like monitoring growth and Children and women form three-quarters of the development; protection of children from major hazards population in low and middle income countries such as through immunization, chemopropylaxis and dietary Nigeria. They are also the most vulnerable and most supplementation and early diagnosis and treatment of sensitive to their environment. As such, children bear an common childhood diseases where caregivers are undue share of the global burden of diseases. 1 Although encouraged to seek early treatment. Attention to the major gains were made in the reduction of childhood improvement in the quality of health care for children health indicators in the previous decade, observations has been on the increase world over. 3-6. In this vein, are that stagnations or even reversals were seen in many models have been conceptualised taking into account the countries since the 1990s.1 One of the reasons given for various dimensions of quality notably, the Donabedian this is low level of utilization of quality health services. Model. 4,5,7,8. The main model uses a non–categorical It is necessary to ensure that the limited resources approach to quality measurement. This approach puts allocated to health care, inspite of growing demands is into focus both healthy and sick children who access the effectively utilized to meet the health needs of the child health services not only for sick child care, but people. also for growth monitoring and immunization. 5,7,9 180 There are four specific areas of challenge to the conduct quality has been recognised as vital, and clients opinions of child health services and health care quality, particularly their degree of satisfaction are seen as represented by four Ds. These are development, essential to understanding it. 14 The rationale for dependency, different epidemiology and assessing client’s satisfaction is that care assessed to be demographics. 7,9. The development of children is marked of high quality according to the provider–defined criteria by rapid changes that affect their health care needs. As is far from being ideal if the client is dissatisfied with they grow, their health care utilization as well as the it. 16 Clients’ satisfaction is multidimensional, and preventive care they require changes. Children depend information about structure, process and outcome of on their caregivers for access to healthcare. As a result, medical care can be obtained from an assessment of research depends on these caregivers to provide clients’ satisfaction. 17 information regarding their health outcome. The different epidemiology rests on the interactions of Assessment of health service effectiveness is a wider childlren with the health care systems. For the majority concern for assurance of quality of care and serves as a of children, contact with the health care system is basis for recommendation of appropriate intervention focused on prevention and treatment for acute illness towards the improvement of the quality of child health rather than chronikc illness and disability. The services with possible reduction of morbidity and demographics refer to the fact that children are amongst mortality in children. This study assessed the level of the vulnerable groups and thus are more likely to live in clients’ satisfaction with care received, the quality of poverty than any other segment of the population. supervision of child health services, and identified factors influencing the quality of child health services in The National health Policy of Nigeria is aimed at selected PHC facilities of Nnewi North local achieving health for all using PHC as the basis for government area (NNLGA). development. However, despite presence of PHC facilities, and coverage of the population by maternal and child health care services in the country there are still high levels of morbidity and mortality among children In Nigeria, Olumide, Obionu and Mako in an Methodology assessment of the quality of primary healthcare in Nigeria revealed inadequacies of staff and equipment as The study design was cross-sectional and the study well as poor perception of the quality of primary health population comprised of caregivers utilizing child health care by most PHC workers and the clients who use the services in the public PHC facilities in NNLGA. services. 10 However, an assessment of quality of The sample size for study was determined as follows: a maternal and child services in Southeast Nigeria showed pilot study was conducted at the Comprehensive Health that 90% of the respondents rated the services to be at Centre, Neni (Anaocha LGA), a health facility located least good. 11 outside the study area, but which offers a full range of the child health services similar to that of the health Supervision, another aspect of quality care, is the facilities that were selected for the study. Proportion of process of monitoring activities to ensure that the clients considered to be satisfied with the child health desired level of performance (standards) are met. services is: P = 38/50 × 100 = 76%, while the Supervision is expected to improve the functioning of unsatisfied clients is (100-76) = 24%. Using the formula the supervised person or team and consists of a variety for the calculation of sample size in populations greater of functions such as involving the team in planning, than 10,000, 18 n= z 2pq/d, 2 where n = sample size, z = communicating with all concerned, providing on-the-job standard normal deviate at 95% Confidence Interval = training during the course of supervision. 12 A 1.96, p = proportion of clients considered to be satisfied supervisory schedule is needed and this is drawn on the with the child health services, q = the complementary basis of the targetted programme, areas where extra probability of p (1-p) i.e the proportion of clients control is needed and reports of previous visits. The considered not to be satisfied with the child health health workers in the facility to be visited should be services and d = precision level 5% = 0.05. informed of the date of the visit so that they will be n = 1.96 2 x 0.76x 0.24 = 280. available. 13 A supervisory checklist of the things to be (0.05) 2 checked should be prepared before the visit to serve as a reminder of the specific areas that need attention. The calculated minimum sample size required for care givers in the study was 280. The anticipated non- The increased attention to the quality of care has been response rate was 10%, ie response rate of 90%. An accompanied by similar increase in efforts to monitor adjustment of the sample size estimate to cover for non- and assess it. This is because failure to address quality response rate was made by dividing the sample size of care may be more costly than most improvement in calculated with a factor f, i.e n/f 82 , where f is the health care service would be. 14,15. Assessing clients estimated response rate. 17 Therefore anticipating a satisfaction can be a useful way of evaluating certain response rate of 90%, minimum sample size for aspects of quality, and increases in satisfaction may caregivers in the study =280/0.90 = 310. indicate improvement in quality and better prospect for sustainability. In recent years, the subjective side of Only public primary health facilities that must provide 181 three essential child health services viz: growth transcribed verbatim, translated (where necessary) and monitoring, immunization and sick child consultation field notes made.