Client-centredness of government primary health-care services in the Gaza Strip, occupied Palestinian territory: a cross-sectional study

Abstract

BackgroundClient-centred services respond to clients' needs and involve them in the provision of health-care services to achieve improved health outcomes. We aimed to assess the extent to which governmental primary health-care services in the Gaza Strip are client-centred, from the clients' perspectives. MethodsFive themes representative of clients' centredness were identified: accessibility, delivery of health-care services, involvement, clients, and clinics characteristics variables (included the clinic level (levels 2–4) according to the Palestinian Ministry Of Health's classification of clinics according to the number of staff, type of services provided, and other factors; location in the Gaza Strip [north, Gaza, middle area, Khanyounis, Rafah]; availability of a community committee which holds meetings once per year between the community and the clinic staff). Every theme has subthemes and related items. A self-administered questionnaire was developed by the author, and reviewed by ten experts. The study questionnaire showed high internal consistency (α=0·9). Through exit interviews, randomly selected clients completed the study questionnaire between Oct 1, 2010, and Dec 30, 2010. We used SPSS (version 13). The questions had its scores that were compared and analysed (eg, if one question has three answers: yes [score of 2], intermediate [score of 1], or no [score of 0]). FindingsWe invited 300 clients to participate (response rate 91%). Clients' perspectives were positive regarding most of the accessibility subthemes except the accessibility to drugs; 35% (88 of 252) of clients reported shortages of drugs at the clinics. For the service delivery theme, the subthemes of waiting time (71·2% [195 of 274]), contact time (70·9% [188 of 264]), and quality of basic amenities were perceived positively by the clients (80·17%; in which 100% was the best score). Only 35% (70 of 273) of clients reported involvement in planning their own treatment plans. About 67% (181 of 269) of clients reported that the availability of drugs was the main factor to show the perceived quality of care of a health facility, followed by respect from the health provider personnel (46%, 125 clients). Further analysis was done to compare the overall scores of selected subthemes that illustrate the clients-centredness' of services (ie, choice, respect, communication, and involvement in planning) between clinics' characteristic variables. Significant differences in scores were reported between level 4 and level 2 or 3 clinics (choice, p=0·015, communication, p=0·002, involvement in planning, p=0·029), and clinics that did frequent meetings with community members and clinics that not (respect, communication, and involvement in planning p=0·01). InterpretationIncreased involvement of beneficiaries in the delivery of health care promotes clients' centredness. Promotion of interactions between health-care providers and clients, increasing confidentiality and privacy, and ensuring the availability of essential drugs all positively affect clients' perspectives about health services. A limitation of our study is that it did not include the clients who did not present to the identified clinics, who might have different perspectives than the included clients FundingNone.