Assessment of Voluntary Counseling and Testing (VCT) Service Quality in Terms of Client Satisfaction; a Comparative Study between Public and Private Health Institutions in Addis Ababa, Ethiopia.

Abstract

Background: Although Quality of the service is key principle for effectiveness of the program, very little work has been done to assess the quality of Voluntary Counseling and Testing (VCT) services in most countries including Ethiopian. Objectives: To assess quality of VCT services in terms of client satisfaction in both private and public VCT sites. Methods: cross-sectional comparative health institution based study was employed in public and private VCT sites in Addis Ababa from January 1 to February 30, 2009. By modifying the UNAIDS VCT Quality Evaluation Tools and quality assurance and quality improvement guide developed by Family Health International (FHI), data were collected using interviewer administered questionnaires for both qualitative and quantitative methods. Results: A total of 160 clients, of which 80 from private and 80 from public as well as 20 counselors of which seven from private and 13 from public sites were included in the study. Clients from public sites were more satisfied than private sites with the VCT service they took; 90% versus 76%. Motivation of seeking the service, estimated time spent waiting the test result and waiting to see the counselor, service fee, the presence of comfortable and private counseling room, service given individually, issue of confidentiality, discussion with counselors on different risks and meaning of the test result had significant difference in public and private institutions. Educational status of grade 9-12 in private sites OR=.22(.05-.92), p=.038, time spent on waiting the test result within 30-60 minutes in public sites OR=8.4(1.5-41.9), p=.024, information on HIV/AIDS and Sexual transmitted Infections (STIs) given to protect themselves and others in private sites OR=62.3(17.7-123), p=.025, counselor comfortable on taking sensitive issue in private sites (OR= 54.5(2.3-90.1), p=.014 ) were found to be significantly associated with client satisfaction. All, but one, counselor took training in formal institutions, all counselors from public and only some in private were given fulltime counseling, no regular supportive supervision by governmental officials or partners, all had not taken any refreshment training. Conclusions and recommendations: generally, rate of client satisfaction was low in private VCT sites so that effort should be made to maintain the quality. In addition, regular and supportive supervision by regional health bureau and its partners were minimal so that strong and coordinated supervision in both sites need to be done.