Gietaneh Wodaje, Alle Atsede, Alene Muluneh, Agazhe Assemie Moges, Simieneh Muluye Molla, Birhanu Molla Yigzaw
Health economics and health services management unit, department of public health, College of health sciences, Debre Markos University, P.BOX:269, Debre Markos, Ethiopia.
Reproductive health unit, department of public health, College of health sciences, Debre Markos University, P.BOX:269, Debre Markos, Ethiopia.
Health Policy Open. 2022 Apr 7;3:100068. doi: 10.1016/j.hpopen.2022.100068. eCollection 2022 Dec.
In Ethiopia; even though utilization of health care services has been improved after the introduction of user fee exemption, little is known about the quality of the services. There are fragmented studies on the output dimension of quality of health care services particularly on clients' satisfaction. Therefore this study aims to assess overall quality (in terms of clients' satisfaction) and its disparity among users of selected exempted health care services provided in Ethiopia.
The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline was used to undertake this study. Both published and unpublished articles conducted in Ethiopia on the quality of health care services in terms of clients' satisfaction dimensions were searched. A total of 750 articles were retrieved through international databases (Scopus, MEDLINE/PubMed, Science Direct, Google Scholar and Cochrane Library) and national digital library repositories (Addis Ababa University's digital library repository); 703 of which were excluded while only 47 articles were included in the -analysis. The search for articles was conducted during the period 03 December 2019 to 28 January 2020. For methodological qualities of the included articles assessment, a modified version of the Newcastle-Ottawa Scale adapted for cross-sectional studies was used. R version 3.6.1 and stata version 14 soft wares were used for analysis. A random-effects model was used to calculate pooled estimates. The I2 tests were used to assess the heterogeneity of the studies.
The pooled overall prevalence of included 47 studies revealed that clients' satisfaction among users of selected exempted health care services in Ethiopia was 70% (95% CI: 64, 74%). In subgroup analysis; the lowest prevalence of clients' satisfaction was observed among users of obstetrics maternal health care services with the prevalence of 65.04% (95% CI: 57.50, 72.58).
This study found that more than one-third of respondents; was not satisfied with exempted health care services. There is slight difference in satisfaction of clients across type of exempted health care services and regions. Policy and decision makers in Ethiopia shall design strategies to optimize quality of health care services besides exemption of its costs.it is also strongly recommend that a special emphasis shall be given to obstetric health care services provision. Moreover, concerned stakeholders' (ministry of health, etc.) should strengthen compassionate respectful care provision in public health facilities; beside to removing user fees.
在埃塞俄比亚，尽管实行免费用户费后医疗服务利用率有所提高，但对服务质量却知之甚少。关于医疗服务质量的产出维度，特别是客户满意度，有一些零散的研究。因此，本研究旨在评估埃塞俄比亚提供的选定免费医疗服务使用者的总体质量（以客户满意度衡量）及其差异。
本研究采用系统评价和Meta分析的首选报告项目（PRISMA）指南。搜索了埃塞俄比亚发表和未发表的关于客户满意度维度的医疗服务质量的文章。通过国际数据库（Scopus、MEDLINE/PubMed、Science Direct、Google Scholar和Cochrane图书馆）和国家数字图书馆存储库（亚的斯亚贝巴大学数字图书馆存储库）共检索到750篇文章；其中703篇被排除，只有47篇文章纳入分析。文章检索时间为2019年12月3日至2020年1月28日。对于纳入文章的方法学质量评估，使用了适用于横断面研究的纽卡斯尔-渥太华量表的修改版。使用R 3.6.1版和Stata 14版软件进行分析。采用随机效应模型计算合并估计值。I2检验用于评估研究的异质性。
纳入的47项研究的合并总体患病率显示，埃塞俄比亚选定的免费医疗服务使用者的客户满意度为70%（95%CI：64，74%）。在亚组分析中，产科孕产妇保健服务使用者的客户满意度患病率最低，为65.04%（95%CI：57.50，72.58）。
本研究发现，超过三分之一的受访者对免费医疗服务不满意。不同类型的免费医疗服务和地区的客户满意度存在细微差异。埃塞俄比亚的政策制定者和决策者除了免除医疗服务费用外，还应设计优化医疗服务质量的策略。还强烈建议特别重视产科保健服务的提供。此外，相关利益攸关方（卫生部等）应在公共卫生设施中加强富有同情心和尊重的护理服务；除了取消用户费。
