Determination of quality of health care offered by clinical officers in Kenya: Patients satisfaction and performance assessment

Abstract

In Kenya Clinical officers (COs) are important health care providers. However, data on the quality of the services they offer is not readily available. This limitation partly compromises efforts that aim at improving the quality of health care. This study aimed at establishing the quality of health care services that are offered by COs in Kenya from both the provider and patients’ perspectives. A descriptive survey approach was adopted in this study. The setting of this study was the consulting rooms of COs in public health facilities across the country. A sample of 18 former districts (now counties) in all the former eight provinces of the country was randomly selected. Lists of all COs working in public health facilities in the selected districts were prepared. A total of 367 COs were randomly selected from the prepared lists. In addition, 2118 adult patient who consulted the selected COs were randomly selected. A Patients Satisfaction Assessment Tool (PSAT) was established using standard scale development procedures. This tool was administered by trained research assistants. The selected COs were also requested to fill a questionnaire on their socio-demographic characteristics and rate their performance in ten general aspects of their practice. The average age of the patients was 31.31 years (SD = 13.64). The patients were mostly females (58%), married (51%) and had secondary level education (38%). Most patients stated that they have middle level income (64%) and the majority lived in urban areas (60%). The PSAT showed good internal consistency with a Cronbach’s alpha (α) of 0.92, and was positively correlated with a widely validated global rating of patients’ satisfaction (Pearsons correlation coefficient, r = 0.24, ρ < 0.01). The patients gave the COs an overall score of 67% on the quality of services they received. The quality aspect of ‘waiting to see the clinical officer’ was given the lowest score at 56%. Regression analysis showed that patients from rural areas tended to rate satisfaction more favourably (β = 0.09, ρ < 0.05) while sicker patients tended to rate it less favourably (β = -0.03, ρ < 0.05). Both correlates however showed minimal effects on patient satisfaction (Eta squared = 0.01). The average age of the COs was 37.60 years (SD = 9.48). Further results showed that the typical clinical officer is male (73%) and married (78%). Over half of the COs (54%) held administrative positions. Most COs hold diploma level education (54%) while few had published (13%) or were members of voluntary organization (35%). A performance index was calculated by summing ratings of the ten general aspects of COs practice. This index showed some promise (α = 0.65). The COs gave themselves an average score of 32.85 (SD = 3.60) on self assessed performance, with a range of 18-40. Most of the COs (33.8 percent) rated their performance at best practice. Noted deficiencies were mainly in generic skills particularly in information technology, management and finance. The number of trainings attended (β = 0.24, ρ < 0.05), having no publications (β = -1.74, ρ < 0.05) and holding no administrative duties (β = -3.26, ρ < 0.05) were statistically associated with self assessed performance. The results suggest that the PSAT is a valid and internally reliable tool for assessing patient satisfaction with their visit to COs. The need to adjust the tool for patients’ characteristics is however not supported by the data. Further, the patients rated the quality of their visit to COs at below complete satisfaction. Elsewhere, the COs rated their performance in general aspects of practice at below best practice. The results can be used by COs to improve the quality of health care. The need to train COs in management, client handling and patient centred accountability is suggested.