Abstract
Formalized task shifting structures have been used to rapidly scale up antiretroviral service delivery to underserved populations in several countries, and may be a promising mechanism for accomplishing universal health coverage. However, studies evaluating the quality of service delivery through task shifting have largely ignored the patient perspective, focusing on health outcomes and acceptability to health care providers and regulatory bodies, despite studies worldwide that have shown the significance of patient satisfaction as an indicator of quality. This study aimed to measure patient satisfaction with task shifting of antiretroviral services in hospitals and health centres in four regions of Ethiopia. This cross-sectional study used data collected from a time–motion study of patient services paired with 665 patient exit interviews in a stratified random sample of antiretroviral therapy clinics in 21 hospitals and 40 health centres in 2012. Data were analyzed using f-tests across provider types, and multivariate logistic regression to identify determinants of patient satisfaction. Most (528 of 665) patients were satisfied or somewhat satisfied with the services received, but patients who received services from nurses and health officers were significantly more likely to report satisfaction than those who received services from doctors [odds ratio (OR) 0.26, P < 0.01]. Investments in the health facility were associated with higher satisfaction (OR 1.07, P < 0.01), while costs to patients of over 120 birr were associated with lower satisfaction (OR 0.14, P < 0.05). This study showed high levels of patient satisfaction with task shifting in Ethiopia. The evidence generated by this study complements previous biomedical and health care provider/regulatory acceptability studies to support the inclusion of task shifting as a mechanism for scaling-up health services to achieve universal health coverage, particularly for underserved areas facing severe health worker shortages.
Highlights
In December 2012, the United Nations unanimously adopted a resolution which recognized the responsibility of governments to accelerate the transition towards providing universal coverage of affordable and quality health care services (United Nations General Assembly 2012)
Four regions of Ethiopia were selected for inclusion based on variables we considered relevant for a representative sample, such as density of doctors, antiretroviral therapy (ART) patient load and population density
This is consistent with another study of ART services in Ethiopia that found that patients generally accepted nurse and health officer services for non-severe cases in 2009 (Assefa et al 2012)
Summary
In December 2012, the United Nations unanimously adopted a resolution which recognized the responsibility of governments to accelerate the transition towards providing universal coverage of affordable and quality health care services (United Nations General Assembly 2012). Task shifting’s success in rapidly scaling up ART services may make it a promising mechanism for accomplishing UHC. Countries adopting task shifting as a formal policy were able to scale-up ART rapidly. Ethiopia adopted task shifting as an element of decentralization and ART services increased from three facilities in 2004 to 743 in 2010 (Ethiopia National AIDS Resource Center 2012). Task shifting improves availability of health services, the quality of services delivered and its relation with patient satisfaction must be considered before recommending its use for UHC
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