Assessing patients’ satisfaction with universal health coverage reforms using servqual model: a case of Matuu Sub County Hospital, Machakos County

Abstract

Kenya’s quest to be among nations worldwide providing Universal Health Coverage (UHC) to their populations took off in earnest in December 2018 with the roll out of a pilot study in four Counties namely Isiolo, Kisumu, Nyeri and Machakos. Quality health care services offered in a health facility as postulated by patient satisfaction is one of the cornerstones of UHC. Some studies have shown that as financial barrier to access of health care is lifted and service coverage increases, service quality often plummets in terms of safety, timeliness, efficiency, effectiveness and patient-centeredness due to overutilization and deficient governance structures among others. Empirical evidence of this in Sub Saharan Africa is however rather thin especially the shift in patient’s expectations and perceptions of service quality in the early phase (first five years) of UHC implementation. This study addressed this gap by evaluating patient’s satisfaction of services offered at a public sub-national level 4 health facility in Kenya three years after UHC roll out. Using a descriptive cross sectional study design, a sample of 311 patients was randomly selected to fill a SERVQUAL questionnaire to record their pre-service expectations and post service consumption perceptions of the services given since UHC commencement. Perception-expectation (P-E) gap scores were then analyzed using Statistical Package for Social Science (SPSS Version 25) to determine the statistical significance of the mean differences between patients’ expectations and perception of the five dimensions surveyed. The study findings showed a statistically significant overall patients’ satisfaction with UHC reforms in Matuu Sub County hospital. Patients were most satisfied with assurance; followed by empathy, reliability, tangibles and finally responsiveness. However, notable areas of dissatisfaction included the long turn-around time, staff’s inability to effectively communicate on when services will be offered and the uncaring attitude of the healthcare workers.