Clients Centeredness of the Governmental Primary Health Care Services: Gaza Governorates
Huda Haidar Anan
هدى حيدر عنان
Universally, Primary Health Care (PHC) services are considered the vertebral column of health care systems. Ideally, it is assumed that PHC services should be responsive to people's needs and expectations. Client-centered PHC services could meet the goal of being responsive through designing and providing health care services that suit clients and guarantee appropriate accessibility, involvement in the caring processes and the delivery of quality health care services. A quantitative analytic cross-sectional study was conducted in order to assess the extent to which the governmental PHC services are client-centered. The instruments used in this study were exit interviews for 300 randomly selected clients who received health care services from the 10 randomly selected PHC clinics in the Gaza Governorates (GG), with a response rate of 91%. Another questionnaire was used to capture general information about the investigated PHC clinics. The researcher collected the data by herself with the help of two welltrained data collectors. Validity and reliability measures such as standardisation of data collection and data quality check and re-entry were assured. Reliability consistency test was very high (Cronbach’s Alpha 0.9). Clients' perceptions were good regarding physical, financial, technical and information accessibility. Accessibility to essential medications was good but there were gaps in the dispensing, labelling procedures and the constant availability of drugs. Most of the clients were satisfied with the delivery of health care services such as; waiting time, time spent with health care providers, communication, respect and quality of basic amenities. Clients have low chances to select the health care provider or to provide consent before undergoing medical procedures. Clients were not adequately involved where most of the clients did not participate in activities aiming to improve health care services. Three out of the ten (30%) investigated PHC clinics reported having community committees with regular meetings. Clients’ participation in deciding their treatment plans were perceived as weak. Also, most of the clients did not participate in activities related to evaluating the health care services they receive from the PHC clinics. The most important factor that reflects good quality of health care services from clients perspectives was the availability of drugs (67.3%), being respected by the health care providers (46.5%) followed by being cured (34.6 %). Respondents from level two and level three clinics, southern governorates clinics and clinics that had community committees, elicited higher scores than their counterparts from other clinics with statistically significant differences (P <0.05) between these groups. Similarly, respondents with higher education level reported higher scores than their counterparts with statistically significant differences between these groups (P<0.05). The study recommends adopting new policies that enhance the client centeredness of the heath care services through increasing the awareness about basic clients’ health rights, increasing clients’ involvement in the planning, implementation and evaluation of health services. Also, improving communication and interaction between the clinics teams and the local communities is essential including establishing community committees.