Experience and perspectives of quality of health care in Nigerian rural community: An exploratory study

Abstract

Significant percentage of health care services for rural Nigerians is being provided in rural health facilities by rurally based doctors, nurses, midwifes and other categories of health professionals. These services include general medical and obstetric care as well elective and urgent surgeries. As a result of these, there is likelihood of a decrease in the need for rural people to travel to major centres to seek health care service except for referral purposes. Medical education and health service management policy appear to support the location of tertiary and secondary health facilities in urban areas to the detriment of rural community health care. Hence there is an assumption, without much evidence, that the quality of care in rural hospitals' is lower than that provided in larger urban hospitals. Also there is dearth of literature on the aspects of heath care to be measured to indicate quality. This article reports an exploration of multiple perspectives on what constitutes quality of care in rural community medical practice. This is a multiple perspective analytical study. Data were obtained from a series of 134 individual patient cases involving internal medicine, obstetric and surgical procedures in small to large rural hospitals. Interviews were conducted with several participants in each case and these include doctors; nurses; midwives; patients; and family members of the patients. The interviews also explored the perspectives of individuals in each group on the broader question of what constitutes quality of care in a general sense. Their comments were subjected to qualitative analysis using SPSS software package. The different groups produced different views on what might determine the quality of health care in rural community hospitals. The health professionals tended to focus on technical aspects of care, although the doctors and nurses had some different emphases, while the patients and their families were more concerned with access, interpersonal communication, convenience and cost. These factors appeared to be consistent with previous literature from general healthcare settings. Some indicators were suggested for measuring the quality of rural health care. The contribution of this study to knowledge is in area of improvement of understanding of the differing views held by rural health professionals, patients and patients' families in thinking about the quality of care provided in rural community health facilities. Consideration of the quality of procedural rural medical care should include the needs and expectations of those living and working in a smaller, more familiar environment. This has implications for health planners, and suggests that there is a continuing need for rural health professionals to be trained to provide procedural medical services in rural hospitals, and for rural hospitals to be maintained at a standard necessary to support quality service provision.Keywords: Nigeria; quality of health care; experiences; perspectives; rural community Nigerian Medical Practitioner Vol. 50 (2) 2006: pp 48-53