FACTORS INFLUENCING THE CHOICE OF HEALTH CARE PROVIDING FACILITY AMONG WORKERS IN A LOCAL GOVERNMENT SECRETARIAT IN SOUTH WESTERN NIGERIA

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O.C. Uchendu^1,2 O.S. Ilesanmi³ and A.E. Olumide⁴

1. Department of Preventive Medicine and Primary Care, College of Medicine, University of Ibadan.
2. Department of Community Medicine, University College Hospital, Ibadan.
3. Department of Community Health, Federal Medical Centre, Owo, Ondo State.
4. Department of Community Medicine, Bowen University, Iwo

Abstract

Background: There is increasing interest in the choice of health care providing facility in Nigeria.

Objectives: This study aimed to assess the factors influencing choice and satisfaction with health service providers among local government staff.

Methods: A cross sectional survey of all 312 workers in a Local Government Secretariat in South West Nigeria was done. Chi Square and logistic regression analysis was done.

Results: The mean age was 38.6 ± 7.5 years, 55% were females and 71.7% had tertiary education. The median monthly family income of the respondents was N 28, 000 (N3,000 – N500,000), with 24.4% earning a monthly income of N21, 000 to N30, 000. Many (72.3%) utilized public health facilities attributing the choice to the low cost of services. Respondents who are satisfied with their usual care providing facilities are 12.2 times more likely to have used public facilities than private facilities (95%, CI 3.431 – 43.114). Respondents who described the quality with ease of getting care/short waiting times as being good are 3.9 times more likely to have private facilities as their chosen health care providing facility (95%, CI 1.755 – 8.742). Cost/payment for service is 2.9 times more likely to predict the use of public health facility as the usual health care provider.

Conclusion: Private facilities though costlier do not appear to be providing better services than public facilities. To increase access to health care the cost of services and the waiting time are important factors to address.

Keywords: Service, Quality, Cost, Choice, Satisfaction

Introduction

The health care system in Nigeria has a blend of private and public health care providers. In the public sector health care providers are under the three tiers of government; federal (tertiary hospitals and some hospitals in federal institutions like universities), state (state specialist and general hospitals) and local government areas (primary health care centres and health posts). In the private sector, they are broadly categorized into those that provide primary care (general practitioners), those that provide secondary care and those that provide both primary and specialist care. There are also several non-governmental organizations and donor- owned and operated facilities. Unlike in many developed nations, health care in Nigeria is not universally free. According to the Nigeria Demographic and Health survey 2008, majority of women and men have no health insurance coverage (98 and 97 percent, respectively), which means they pay for health care from their pockets.¹ Health care service consumers are therefore bound to make the choice of where to receive health care based on some factors. Typically, choice of health care providing facility is based on six types of information: quality of service provided, access to providers (both hospitals and physicians), out-of-pocket costs, health provider communication skills, courtesy, and administrative burden. However, patients perceptions of the quality of services provided is a key factor (along with cost effectiveness) in determining the use of the health care facility.²

An interplay of the availability and affordability of drug, geographical accessibility to the facility as well as appropriate opening hours are important contributors to choice of care providing facility.^3-6 Other factors which have been documented to determine choice of facility utilized include: travel time, education, age, sex, level of education of household head, household size and perceived quality of care provided in the facility.^7,8

Determining the factors responsible for patient’s choice of health care providing facility cannot be measured without considering several factors some of which the consumer of healthcare services cannot control. Therefore unlike making choices over tangible things like dresses or cars, accurately measuring how patients feel about their out-patient visit, hospital stay, medical procedure, or total health care experience can be a very difficult challenge.⁹

Several efforts have been made to identify which of service quality, service value and satisfaction has the most influence on choice of a service provider.¹⁰ In the health care system, patient satisfaction has emerged as an important component that determines consumer choice of a product or service.¹¹ However, quality of care as a determinant for choosing healthcare providers is gaining grounds over the past decade.^{8, 10, 12-14}

Several parameters have been used to measure quality of care and include; waiting time, privacy of the medical examination, cleanliness of the health facility, staff treatment and sufficient treatment time. Other parameters include staff-patient relationships; administration and management; patient care, vaccines and drugs; and, infrastructure (i.e. building and equipment situation.¹⁵

Unlike in developed countries, research on factors affecting patient’s choice of health care provider in Nigeria has not been fully explored. It is not very clear what influences the household’s choice of one or the other within a health system with many health care providing facilities. The behaviour of the patient which is made evident by their choice of health care provider may also give an insight into how these health facilities can improve on their service delivery, improve client satisfaction and by extension ensure a healthier population.

This study was conducted to investigate how demographic and socioeconomic factors, quality of care, and expenditure on health care, impact on patient’s choices of public or private facilities as their health care providing facility. It also aimed to provide a better understanding of the role, magnitude and contribution of both the public and the private health care providers and highlight the main factors determining choice of these providers in Ibadan, South West Nigeria.