‘The nurse did not even greet me’: how informed versus non-informed patients evaluate health systems responsiveness in South Africa
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Date
2021-04
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ Global Health
Abstract
Introduction Universal Health Coverage is not only
about access to health services but also about access
to high-quality
care, since poor experiences may deter
patients from accessing care. Evidence shows that quality
of care drives health outcomes, yet little is known about
non-clinical
dimensions of care, and patients’ experience
thereof relative to satisfaction with visits. This paper
investigates the role of non-clinical
dimensions of care in
patient satisfaction.
Methods Our study describes the interactions of
informed and non-informed
patients with primary
healthcare workers at 39 public healthcare facilities
in two metropolitan centres in two South African
provinces. Our analysis included 1357 interactions using
standardised patients (for informed patients) and patients’
exit interviews (for non-informed
patients). The data
were combined for three types of visits: contraception,
hypertension and tuberculosis. We describe how
satisfaction with care was related to patients’ experiences
of non-clinical
dimensions.
Results We show that when real patients (RPs) reported
being satisfied (vs dissatisfied) with a visit, it was
associated with a 30% increase in the probability that a
patient is greeted at the facilities. Likewise, when the RPs
reported being satisfied (vs dissatisfied) with the visit, it
was correlated with a 15% increase in the prospect that
patients are pleased with healthcare workers’ explanations
of health conditions.
Conclusion Informed patients are better equipped to
assess health-systems
responsiveness in healthcare
provision. Insights into responsiveness could guide broader
efforts aimed at targeted education and empowerment of
primary healthcare users to strengthen health systems and
shape expectations for appropriate care and conduct.
Description
Keywords
Healthcare workers, South Africa, Health-systems
Citation
Hompashe DM, Gerdtham U-G, Christian CS, et al. ‘The nurse did not even greet me’: how informed versus non-informed patients evaluate health systems responsiveness in South Africa. BMJ Global Health 2021;6:e004360. doi:10.1136/ bmjgh-2020-004360