its for health science students

1. 1
CHAPTER – ONE
INTRODUCTION
1.1 Background Information
This study will be conducted at Jimma University Medical Center
(JUMC) that is one of the oldest public hospitals in Ethiopia. It was
established in 1937 by Italian invaders for the service of their soldiers.
Geographically, it is located in Jimma city 352km southwest of Addis
Ababa. After the withdrawal of the colonial occupants, it has been
governed under the Ethiopian government by the name of Ras Desta
Damtew Hospital and later Jimma Hospital "during Dergue regime and
currently renamed as Jimma University Medical Center. It is the only
teaching and specialized hospital in the southwestern part of the country,
providing services for approximately 18,000 inpatient, 160,000 outpatient
attendants, 11,000 emergency cases and 4500 deliveries in a year coming
to the hospital from the catchment population of about 15 million people.
Cognizant of the fast growing service and teaching role of the hospital, the
federal government considered construction of a new and level best 860
bedded hospital which’ is currently functional as of teaching specialized
hospital.
1.2 Statement of the problems
Patient satisfaction is a multi-dimensional health care construct affected by
many variables. Health care quality affects patient satisfaction which
influences positive patient behaviors such as loyalty.
Client satisfaction is the level of satisfaction that the clients experience
having used a service. It, therefore, reflects the gap between the expected
service and the experience of the service, from the client/patients point of
view. A study on outpatient performance of teaching hospital in Gondar town
showed 22.0% satisfactions rate (2). Another study in Tigrie zonal hospitals

2. 2
found that the client satisfaction level with the outpatient departments in the
zonal hospitals was 43.6%(3).As the expectations of patients increase
overtime, the quality of the service has to keep on improving to maintain or
increase a level of satisfaction. In developing countries even if services are
available at all, they are often of low quality. As a result many people by pass
the closest public facility to go to more costly private facilities. This indicates
that health care systems in most developing countries suffer from serious
deficiency in financing efficiency, quality and equity.
Satisfaction is related to more partnership building, more social conversation
and courtesy, clear communication and information, respectful treatment,
length of consultation, cleanliness of facilities, drug availability and waiting
time (4, 5).
The factors that influence client satisfaction are those that influence what
clients expect of a service as well as those that influence the experience of the
service.
 Factors that influence what clients expect of service are:
 Past experience – how a previous encounter with hospital was
experienced.
 External influence – such as the media
 Personal needs – although there are common things patients
require feeling satisfied, some patients might have special
needs such as religious, dietary requirement.
 Word of mouth – experiences, especially negative ones, are
easily shared amongst communities. This might influence
the expectation of clients.

3. 3
 Factors that influence how patients experienced the service are:
 Tangibles – the quality of equipment and of the physical
surroundings. Study in 6 regions of Ethiopia showed 76.5-
90% (6).
 Reliability – the ability to accurately perform the service
offered. Study in 6 regions Ethiopia showed 68.64-86.48 %(
6).
 Responsiveness – willingness to assist clients.
 Assurance –ability of the service provider to be
knowledgeable and inspire confidence and trust.
 Empathy – ability to care and display compassion, towards
clients. The study in 6 regions of Ethiopia showed 77.25%-
93.23% level of satisfaction.
 Access – the cost and time for patients to use a service as
well as hospital hours (7).
Having adequate information about these factors in hospital is important
in order to provide recommendation to improve the health service delivery
and result in a better client satisfaction
1.3. Significance of the study
Patients’ satisfaction studies allow service users voice to be heard and affirm
the importance of their experience for improved health care planning.
It is also one way to measure hospital quality; so hospitals use the gathered
information to improve the quality of health care.
After having a look at the nationwide health care delivery system, it is
justifiable to define and assess the local situation. This study is significant in
that it attempted to show the situation of health care delivery at a local level
and can be base line for further studies.

4. 4
CHAPTER TWO
Literature review
Hospitals are important part of any health system. They provide curative
care, transfer acknowledgement, work as referral for patients. To achieve
service excellence, hospital requires continuous efforts to improve quality of
the service delivery system. In the health care industry, hospitals provide the
same types of services, but they do not provide the same quality of service.
Further more consumers today are more aware of alternatives on offer and
rising standards in service which increase their expectations. They are also
becoming increasingly critical of the quality of service they experience (8).
To improve hospital performance, there needs to be partnerships including
communication between patients’ community, the health care professionals
and health service managers. These kinds of partnership assist health service
managers in their effort to improve the performance of health facility.
Patients, the only reason for a hospital’s existence, need services which are
reasonably accessible and readily available at all times. Out patient
department must commence treatment and have test and examination results
made available properly (9).
An essential factor to be considered when analyzing the quality of care of a
health facility is the perspective of the client.
For clients and communities, quality of care is something that meets their
perceived needs. Since a client’s needs often differ their personals satisfaction
ultimately depends on the perception, attitude and expectation of each
individual (10).

5. 5
The study found that health plans with the highest satisfaction scores for the
service aspect of health care also have the highest clinical quality score.
Addressing those service aspects of health care that consumers most readily
appreciate (such as access, provider relationship, availability of information
and opportunity of participation) can influence health care quality outcomes
(11).
The quality of physician-patient relationships and interactions are themselves
important in influencing health outcomes. Clear explanations of procedures
by physicians and decision making participation by patients have been shown
to positively influence clinical outcome. Moreover the attitudes and behaviors
of health professionals are known to have an important influence on patient
care and quality of care (11).
Providing patients with relevant and useful information is linked with
increased patient compliance. A recent study surveyed 74 physicians and a
sample of their patients in order to compare the importance of the
information delivery as an indicator to the quality. Provision of information
was ranked 2nd in importance by patients but 6th by physicians (12).
A recent study in Bangladesh found 40% vacancy rate for doctors posting in
poor areas where people lacked access (13). Another study in the country
found that the most powerful predictor for client satisfaction with health
services was provider behaviors, especially respect and politeness. Further
more reduction in waiting time was more important to clients than
prolongation of consultation time (14).
Another study in Singapore hospital showed that out of the total 300
respondents, 30 (11.9%) rated the service quality very good, 12.2(42.4%)
rated the service quality good, 70(31.0%) rated the service quality fair,

6. 6
18(7.1%) rated the service quality poor and 4(1.6%) rated the service quality
very poor. The important findings in sequence were:
 Doctors should thoroughly explain medical conditions to patients.
 Doctors/ staffs should treat patients with dignity and respect.
 Doctors should possess a wide spectrum of knowledge.
 Doctors/staffs should be friendly and courtesy (15).
In Africa there is general agreement that hospitals especially public sector
hospital perform poorly. Other authors have noted that insufficient staffing
and lack of supplies may impede the efficient delivery of health care to
patients (16, 17). Therefore, in low and middle – income countries a like, if
service are available at all, they are often of low quality. So, many poor people
bypass the closest public facility to go to more costly private facilities or
choose better quality at more distant public facilities (13).
This, therefore, indicates that health care systems in most developing
countries suffer from serious deficiency in financing, efficiency, equity and
quality and are poorly prepared to meet these challenges (15).
An in-depth study of the Iringa, district of Tanzania, poor rural area, showed
that patients bypassed low quality facilities in favor of those offering high
quality consultation and prescription, staffed by more knowledgeable
physicians and better stocked with basic supplies (18).
In Egypt participants in a discussion group complained about the attitude of
the staff at local rural hospital with one respondent summing up the
experience “they have their nose up in the air and neglect us” (13).
Study in Mozambique on satisfaction with the outpatient health care services
showed 55% satisfaction rate and failure to receive prescribed medications
was found to be the most common compliant associated with lower
satisfaction rate (19). Many studies also showed that patients equate

7. 7
availability of drugs with high quality services. A study in Kenya, reported
that drug available in health facility had a positive impact on demand for
services. Another study in Tororo district also conduced that the availability
of drugs in the rural health facilities brought satisfaction not only to the user,
but also to the providers (19). A very recent study in Tanzania found that
most patients were satisfied with the services and care they received (20).
In Ethiopia the backward socio-economic development resulting in one of the
lowest standard of living, poor environment conditions and low level of social
services has been the major causes for a poor health status of the people.
This situation has been aggravated in recent years by the high population
growth and repeated natural disasters and civil wars together with the lack of
adequate infra structures (21, 2).
A study on outpatient performance of a teaching hospital in Gondar town
showed 22.0% satisfaction rate (22).
An other study on satisfaction on out-patients services in Amhara region
showed that long waiting time during registration, visiting of doctors after
registration, laboratory procedures and re-visiting of doctor for evaluation
with laboratory results and obtaining drugs from the hospital’s pharmacy
were associated with dissatisfaction (22).
A study done at selected health facilities in six region of Ethiopia depicted
that the percentage for high mean score satisfaction with health providers
characteristics range from 77.25% to 93.23%, with service characteristics
68.64% to 86.48%; and satisfaction with cleanliness ranged from 76.50% to
90.59% (6).
Another study in Tigrie zonal hospital found that the client’s satisfaction level
with outpatient department in the zonal hospital was 43.6%. Satisfaction was
related highest with courtesy and respect by the health workers with 93.8%
satisfaction rate. Dissatisfaction was rated highest by the respondents with
the lack of drugs and supplies in the hospitals pharmacies with 64.9%
reporting dissatisfaction (3).

8. 8
In a survey undertaken in private clinics in Addis Ababa highest rate of
satisfaction (64-99%) were found in all aspects of medical care except
affordability of service charges (23).
A study in Jimma hospital revealed that on the average it took 9 hours and
13 minutes for a patient to finish the whole around before finally living home,
out of which 49.6% spent waiting for services. The laboratory and x-ray
department accounted for 60.1% of the total time spent (24). Another study in
Jimma hospital showed 57.1% level of satisfaction with without health
services. The most frequently faced problems affecting utilization Leading to
dissatisfaction were long waiting time preceding consultation and difficult to
locate different section easily (25).
Therefore, factors related to quality in relation to clients satisfaction like
waiting time in registration, examination rooms, laboratory procedures and
availability of drugs and supplies in the hospital pharmacy, courtesy of the
health professionals and provision of information by the health professionals
are some of the factors that affect the satisfaction of clients. Having adequate
information about these factors in hospitals is relevant in order to provide
recommendation to improve the health service delivery and result in a better
client satisfaction.
As it can be inferred from the above literatures, almost all of the studies were
done in OPD. This study was also conducted to assess and estimate the
perceived level of clients’ satisfaction with the provision of health services in
OPD of Jimma University Medical Center.

9. 9
CHAPTER-THREE
OBJECTIVES
3.1. GENERAL OBJECTIVE
To assess patient’s satisfaction with health services given at outpatient
of Jimma University Health Center (JUMC).
3.2. SPECIFIC OBJECTIVES
To assess Level of satisfaction of patients with health care.
To identify and describe reasons for patients dissatisfaction.

10. 10
CHAPTER FOUR
METHODOLOGY
4.1. Study Area
Study will be conducted in Jimma university medical Centre (JUMC) from
December 24-January24, 2021 G.C. It is one of the teaching, training and
referral hospital that found in Jimma town, Jimma zone 352 km south west
of Addis Ababa. Currently it is the only teaching and referral hospital in the
south western part of the country, providing services for approximately
16,000 inpatient, 170,000 outpatient attendants, 11,000 emergency cases
and 4700 deliveries in a year coming to the hospital from the catchment
population of about 15 million people. Cognizant of the fast growing service
and teaching role of the hospital, the federal government considered
construction of a new and level- best 627 bedded hospital which’ will be
functional as of August 2017. Under this it gives many service under many
departments like pediatrics ward , medical ward, surgical ward, maternity
ward, obstetrics and gynecology ward, MCH ward, OR, emergency OPD,
delivery room, psychiatric clinic, dental and eye clinics , laboratory service,
ultrasound and other imaging studies.it is delivered by the total of 1660
health professional and 595 are nurses.
4.2. Study period
From January 24 – December 24 2020/2021 G.C
4.3. Study design
A cross sectional descriptive study was used.
4.4. Population
4.4.1 Source population

11. 11
Patients attending the OPD of Jimma university medical Centre (JUMC),Jimma
zone,Ethiopia.
4.4.2. Study population
Patients attending OPD services during the study period.
Exclusion criteria:
. Very seriously ill patients with no attendant
. Children under 15 yrs, with no guardians /attendants
4.4.3. Sample size and sampling technique
4.4.3.1. Sample size
The sample of the total number of clients who receive service from
Jimma university medical Centre (JUMC) OPD was determined by the
following formula based on the assumption of 50% prevalence, expected
margin of error of 0.05 and with 95% confidence level and 10%
contingency for non response.
ni= (Za/2)2 p (1-p) = (1.96)20.5(0.5) =384.16
D2 (0.05)2
nf = n = 384.16 = 242.5+24.25=266.75~267
1+n 1+384.16
N 650
n= number of sample size
Za/2= standard normal value at confidence interval of 95 %( 1.96)
P=Expected proportion (0.5)
1-p=0.5
D= margin of sampling error tolerated =0.05
N=Source population=650, as hospital record.
So 267 clients was interviewed
4.4.3.2. Sampling procedure
Sample size was determined and selection was performed randomly
using systematic sampling technique.
Sampling interval= N = 650 = 2.43~2
nadjusted = 267

12. 12
i.e. every other client was interviewed.
4.5. Study variables
Independent variables
Availability of drugs and supplies
Age Doctors/patient relation ship
Sex Hospital service
Marital status Completeness of information given
Occupational status to the patients about their illness
Payment status
Educational status
Address
Dependent variable
Level of client satisfaction/out come
4.6. Data collection process
Structured questionnaire was developed for the purpose of data collection
after reviewing relevant literatures. The questionnaire was designed to obtain
information on sociodemographic characteristics of respondents. A 5- scale
attitude measurement was utilized to assess patient’s level of satisfaction
towards the health services. Also in some part of the study two sided scale
attitude measuring structure was used which was reported as <yes, or No”.
Data collectors were trained. After training, the questionnaire was been
pretested to ensure the quality and validity of data. Regular supervision, spot
checking and reviewing the completed questionnaire was carried out by the
principal investigator daily to maintain data quality.

13. 13
4.7. Data processing and analyzing
The principal investigator performed data entry and cleaning 10% of the
questionnaire was also cross checked with the already entered data to
maintain its validity. Frequency distribution and Percentage test was used for
data summarization and analyzing.
4.8. Ethical Consideration
An official letter from the Jimma University, college of public health and
medical sciences was obtained to the hospital and verbal consent from the
medical director was obtained too. Informed consent was also obtained from
the clients after explaining the purpose of the study to them. Confidentiality
of every respondents secretes was guaranteed.
4. 9. Data quality assurance
Data quality was ensured through training of data collectors, close
supervision and immediate feedback, reviewing each of completed
questionnaires daily. Data consistency and completeness was checked
throughout the data collection, data entry and analysis.
4. 10. Limitations of the study
-The study doesn't describe the cause& effect relationship.
4. 11. OPERATIONAL DEFINITIONS
Accessibility= The distance between the clients place of residence and the
location of health care services including transportation resources, travel time
and the cost.

14. 14
Attitude= the way to which health service consumers are thinking or
behaving towards health service facilities.
Availability=the relationship between resources of existing services to the
volume of clients.
Consultation time=the time spent discussing health matter with ones
physician.
Satisfaction =attaining ones need or desire.
Very satisfactory=above ones expectation.
Satisfactory=just ones expectation.
Dissatisfactory=below ones expectation.
Very dissatisfactory=fail to meet ones expectation usually leading to
disappointment.
Quality= user based quality is defined as” fitness for use” which means the
consumer’s perception of quality.

15. 15
CHAPTER- FIVE
RESULT
A total of 267 outpatient service consumers who had attended the outpatient
of Jimma University Medical Center (JUMC) were interviewed.
Out of the interviewed clients, 63% (169) were male whereas the rest, 36%
(98) were female.
Concerning marital status, 67.8% (181) were married, 213% (59) were single,
7.5% (20) were widowed & 3.4% (9) were divorced.
With regard to religion, majority, 65.2% (174) were Muslims whereas 23.2%
(62) were orthodox, 10.9% (29) were other (Protestant) & 0.7% (2) were
Wakefata who were governmental employees who come from other zones.
Majority of clients, 67% (180) were Oromo by ethnicity, while the rest 18%
(50) were Amhara and 13% (37) South Nation Nationalities and Peoples.
Of the total clients, 74.9% (200) were from rural area while 25.1% (67) were
from two towns of the woreda.
Most, 33% ((88) were farmer by occupation while the rest were governmental
employee, merchant, student &other each constituting 12.7% (34), 12.7%
(34),12% (32) & 29.6% (79) respectively.
With aspect of income, 44.2% (118) had monthly income of less than 500 Eth.
Birr while only 2.2% (6) had greater than or equal to 2500 Eth. Birr.

16. 16
Table 1 The distribution of socio-demographic characteristics of out patient
service consumer in Jimma University Medical centre, Jimma, Ethiopia, 2020/21.
Demographic characteristics No %
Age(in yrs) 15-19 15 5.6
20-24 44 16.5
25-29 49 18.4
30-34 44 16.5
35-39 27 10.1
40-44 22 8.2
45-49 15 5.6
50-54 17 6.4
55-59 11 4.1
60+ 23 8.6
Total 267 100
Sex Male 169 64.0
Female 98 36.0
Total 267 100
Marital status
Married 181 67.8
Single 59 21.3
Widowed 20 7.5
Divorced 9 3.4
Total 267 100
Religion Muslim 174 65.2
Orthodox 62 23.2
Protestant 29 10.9
Wakefata 2 0.7
Total 267 100
Ethnicity Oromo 180 67
Amhara 50 18
SNNP 37 13
Other 0 0.0
Total 267 100
Address Urban 67 25.1
Rural 200 74.9
Total 267 100
Educational status
Cannot read&
write
46 17.2
Only read &write 50 18.7
Primary school 70 26.2

17. 17
High school 65 24.4
College/university 36 13.5
Total 267 100
Occupation
Farmer
88
12.7
Merchant 34 33.0
Government
Employee
34 12.7
student 32 12.0
Other 79 29.6
Total 267 100
Monthly in come
(In Eth. Birr)
<500 118 44.2
500-1000 81 30.3
1001-1499 29 10.9
1500-1999 16 6.0
2000-2499 17 6.4
2500+ 6 2.2
Total 267 100

18. 18
Most of clients, 73% (195) didn’t visit other places prior to present to this
hospital while the rest, 27% (72) had. Of those who had visited other site,
52.8% (38) visited governmental health institution, 34.7% (25) private clinic,
12.5% (9) traditional healers. About 67.8% (181) of clients were new visitors
to the hospital while the rest, 32.2% (86) had atleast one previous visit to this
hospital. From those who had previous visit, 60.5% (52) were unsatisfied in
previous visit. Of which 36% (31) were dissatisfied with overall services,
22.1% (19) with physician courtesy & respect, 19.8% (17) with effectiveness of
previous treatment.
Table 2: status of the client, frequency of visit, satisfaction level in previous visit as
well as reason for current visit in Jimma University Medical centre, Jimma, Ethiopia

19. 19
characteristics
No %
status of client Patient 206 77.1
client for FP,
immunization
17 6.4
Attendant 44 16.5
Total 267 100
Frequency of visit New 181 67.8
Repeat 86 32.2
Total 267 100
satisfactionlevel in previous visit Yes 52 60.5
No 34 39.5
Total 86 100
Reason for previous visit
satisfaction/dissatisfaction
overall services 31 36.0
physician behavior 19 22.1
effectiveness of
treatment
17 19.8
time spent 8 9.3
availability of
medications/supplies
8 9.3
Total 86 100
reason for current visit Sick 206 77.1
check up 16 6.0
FP 17 6.4
other 28 10.5
Total 267 100

20. 20
More than half of clients, 77.1% (206) were patients who come seeking
medical help for their illness. Most of them, 37.9% (78) come between 1
&7days of the onset of their illness, 28.6% (59) after 4 weeks of onset of their
illness. Others were attendant &clients for family planning, each constituting
16.5% (44) &6.4% (17) respectively.
Almost all of the clients, 86.1% (230) paid for the services while 13.9% (37)
got service for free.
Majority of clients, 85.8% (229) were self /family referred, 8.2% (22) by
governmental health institution & 6 %( 16) by private clinic
Table 3: Duration of Illness, payment status, visiting other site and source of
Jimma University Medical centre, Jimma, Ethiopia, 2020/21.
Characteristics No %
duration of illness <24hrs 14 6.8
1-7days 78 37.9
1-4wks 55 26.7
>4 wks 59 28.6
Total 206 100
payment status Free 37 13.9
Paying 230 86.1
Total 267 100
visiting other place Yes 72 27.0
No 195 73.0
Total 267 100
place of visit
Traditional healer 9 12.5
private clinic 25 34.7
Government health
institution
38 52.8
Other place 0 0.0
Total 72 100

21. 21
Source of referral
Self/family 229 85.8
Private clinic 16 6.0
Gov’t health
institution
22 8.2
Other 0 0
Total 267 100
Regarding time spent to obtain complete services, 67.4%(180) took less than
6 hrs, 27%(72) with in 6-12 hrs, 4.1%(11) within 13-24hrs while 1.5%(4)
took more than 1 day. Most of them 30.7 %( 82) spent most time for waiting
for examiner physician whereas 25.1 %( 67) for Laboratory services and 24.7
%( 66) waiting for registration. Majority of clients 44.9 %( 120) reported that it
took them longtime for the reason of many people waiting for services while
31.5 %( 84) complains unavailability of person in charge. of all clients, 66.63
%( 177) were satisfied with time spent while 33.7 %( 90) were unsatisfied.
Table 4: Total time spent, satisfaction with time spent, most spent place &
reason for long time spent by outpatient service consumers to obtain health
service in Jimma University Medical centre, Jimma, Ethiopia, 2020/21.
Characteristics
No %
Total time spent to
obtain complete services
<6hrs 180 67.4
6-12hrs 72 27.0
13-24hrs 11 4.1
>1day 4 1.5
Total 267 100
Satisfaction with time
spent
Yes 177 66.3
No 90 33.7
Total 267 100
Place where most time Waiting to obtain card 66 24.7

22. 22
spent Waiting for examiner 82 30.7
Waiting for consultation
time
23 8.6
Waiting for x-ray 9 3.4
Waiting for Laboratory
services
67 25.1
Waiting for pharmacy
services
20 7.5
Total 267 100
Reason for long time
spent
Many people waiting
for services
120 44.9
Person in charge not
available
84 31.5
Other 63 23.6
Total 267 100
Concerning health personnel's, 68.9%(184) were satisfied with the courtesy&
respect of examiner, 17.2%(46) were very satisfied,13.5%(36)were unsatisfied
&0.4%(1) was very dissatisfied. 41.6% (111) agreed that the examiner could
understand their problem, 36.7 %( 98) strongly agreed while 14.9 %( 40)
disagreed. Regarding completeness of information given by examiner, 39%
(104) were neutral&3.7 %( 10) were dissatisfied.

23. 23
Table 5: patients' Level of satisfaction with courtesy& respect of examiner, reason
for satisfaction/dissatisfaction, their overall judgment whether examiner understand
their problem &completeness of information given in Jimma University Medical
centre, Jimma, Ethiopia, 2020/21.
Characteristics No %
Courtesy & respect very satisfactory 46 17.2
Satisfactory 184 68.9
un satisfactory 36 13.5
very dissatisfactory 1 0.4
Total 267 100
Reason for
satisfaction/dissatisfaction
Respect &polite 176 65.9
Not respect &polite 18 6.7
give enough information 41 15.4
Aggressive 14 5.2
order expensive
laboratory
3 1.1
Other 15 5.7
Total 267 100
Examiner could
Understand problem
very strongly agree 17 6.4
strongly agree 98 5.2
Agree 111 41.6
Disagree 40 149
strongly disagree 1 0.4
Total 267 100
completeness of
information
very dissatisfactory 82 30.7
Satisfactory 104 39.0
Neutral 71 26.6
Dissatisfactory 10 3.7
very dissatisfactory 0 0
Total 267 100

24. 24
Majority of clients 82% (219) got prescribed drugs from the hospital pharmacy
while the rest 18% (48) didn’t. For the reason of unavailability 70.8% (34), too
expensive 25% (12). Out of the total clients, 52.4% (140) were satisfied with
availability medications/supplies, 292% (78) neutral, 18.4 %( 49) were
dissatisfied.
Table 6: patients’ level of satisfaction with availability of prescribed
medications in Jimma University Medical centre, Jimma, Ethiopia, 2020/21.
characteristics No %
Did you get prescribed
medications
Yes 219 82
No 48 18
Total 267 100
Reason for the lack of
medications
Too expensive 12 25
not availability 34 70.8
Other 2 4.2
Total 48 100
Satisfaction with
availability of
medication
very satisfactory 22 8.2
satisfactory 118 44.2
Neutral 78 29.2
Dissatisfactory 49 18.4
very
dissatisfactory
0 0.0
Total 267 100

25. 25
Generally out of all clients, 35.2% (99) reported as there were satisfied with
over all services given at out patient of this hospital while 28.8 %( 77) were
neutral, 19.5% (52) were very satisfied &16.5 %( 44) were dissatisfied.
Table 7: patients level of satisfaction with overall services given at outpatient
of Jimma University Medical centre, Jimma, Ethiopia, 2020/21.
satisfaction level No %
very satisfactory 52 19.5
Satisfactory 94 35.2
Neutral 77 28.8
Dissatisfactory 44 16.5
very dissatisfactory 0 0
Total 267 100

26. 26
CHAPTER SIX
DISCUSSION
This study has revealed that the overall satisfaction level of clients with
services rendered at outpatient of Jimma University Medical Center (JUMC)
54.7%. In analysis of this study, the very satisfied and very dissatisfied
clients were categorized to the satisfied and dissatisfied groups respectively
because the numbers of respondents in very satisfied and dissatisfied were
small. This finding is more or less consistent with the two studies done at
Jimma hospital which showed 57.1% and 59.3 %( 25). The slight proportion
of difference could be described by the difference in the set up where Jimma
hospital is specialized hospital which is better stocked with basic supplies
and staffed by more qualified health professionals where as Jimma University
Medical Center (JUMC) hospital is a specialized hospital which has better
infrastructures relatively. This finding is more comparable with other abroad
studies done in Mozambique on satisfaction with outpatient health care
services which consisting of 55% of satisfaction rate (19). It is low compared
to the study done in private clinics in Addis Ababa which was with highest
rate of satisfaction (64-99%) in all aspects of medical care except of
affordability of service charges(23).This is simply explained as private clinic is
more equipped and gives services on time for competition than governmental
health facilities.
The highest satisfaction level rate is related with the courtesy and respect
of the examiner which is followed by satisfaction with completeness of
information given by health provider each constituting 86.1% and 69.7%
respectively. Means that their good behavior and approach with patient could
improve satisfaction of the patient.This is comparable with the study done at
selected health facilities in six regions of Ethiopia (6).
This finding is also found to be slightly consistent with study done in Tigrie
zonal hospital which showed 93.8% satisfaction rate with courtesy and
respect of health workers even if there is slight variation (3).

27. 27
This study has also indicated that majority of service consumers (76%)
were satisfied with courtesy and respect of examiner and most believed that
the examiner could understand their problems. The association was found to
be statistically highly significant .
According to this study it was found to be statistically highly
significant association between satisfaction level with behaviors of health
providers and satisfaction level with over all services.
According to this finding, the average time taken to obtain complete
service was 6 hours and 15 minutes. Out of interviewed clients, 67.4% took
less than 6 hours, 27% stayed 6-12 hours and 4.1% stayed 13-24 hrs.
It was found that the highest rated dissatisfaction by the respondents was
with total time spent to Obtain complete services before finally leaving home
(33.7%), out of which 30.7% was spent waiting for examination after
registration. Waiting for laboratory services and to obtain card accounted
25.1% & 24.7% respectively. The study showed out of interviewed clients,
44.9% complained many people waiting for services as a source for long time
spent to obtain complete services whereas 31.5% complained that person in
charge was not available and 23.6% for other reason.
This finding is very low when compared with the study done in JUSH
which showed 49.6% was spent waiting for services and average time was 9
hrs and 13 minutes (24). This can be explained in one way as JUSH is a
referral hospital gives services for millions of patients from different regions
as well as it may has laboratories whose results take long time i.e. it has
sophisticated laboratories. This hospital has chemistry laboratories and
ultrasonography. The other possible explanation can be implementation of
the new BPR in this hospital .In other round inappropriate report by clients
for fear of disclosure of information can be considered.
As the patients/clients satisfied with the total time spent to obtain complete
services also satisfied with the overall service, the association is found to be
statistically highly significant.

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It was also indicated that one who stayed long time to obtain services is not
satisfied with time. This shows that there is an association which is
statistically significant.
Majority of clients, 82% got prescribed drugs from the hospital pharmacy
while the rest, 18% did not partially or as a whole. Out of those failed to
receive prescribed medications, 70.8% complained that for reason of
unavailability, 25% for expensive cost. Almost half of clients, 52.4% were
satisfied with availability of medications and supplies while 18.4% were
dissatisfied for the above reasons. This finding is greatly different from the
study done in Tigre zonal hospital that showed 64.9% rated dissatisfaction
with lack of prescribed drugs from hospital pharmacy which was highest
dissatisfactory factors (3). This fact can be explained by considering time of
study’ where these can be explained by considering time of study where there
was a new BPR policy in between two studies which had great change on
hospital’s management. It can also be interpreted as this hospital treats only
uncomplicated illness which needs only inexpensive medications while
complicated diseases are referred as compared to zonal hospital which has
more investigatory equipment for complicated disease.
This study showed that clients those satisfied with availability of
medications and supplies were also reported that they were satisfied with the
overall services given at this hospital. The association was found to be highly
significant .This finding was found to be highly consistent with abroad study
done in Kenya which identified that drug availability in health facility had a
positive impact on demand for services (19).
According to this study, about 86.1% of clients paid for the services while
13.9% got service for free. This is much exaggerated as compared with one
study done in JUSH that showed 51.3% obtained health services for free. Out
of those got service free majority are those come for anti TB and ART as well
as family planning clients (26). This variation is explained as JUSH is a

29. 29
teaching hospital which gives services freely for patients as they are
participated in academic purpose.
Pertaining to frequency of visit, 67.8% of clients were new visitors to the
hospital while the rest, 32.2% had at least one previous visit to this hospital.
From those who had previous visit, 60.5% were unsatisfied in previous visit.
There is strongly high statistically association between previous visit
satisfaction level and the satisfaction with over all services. Accordingly
previous experience can affect the satisfaction level of clients.
According to this study, there is no association between monthly income of
clients and overall services satisfaction level of clients.
There is also no association between sex of clients and the overall service
satisfaction.

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CHAPTER SEVEN
CONCULUSION AND RECOMMENDATION
7.1. Conclusion
Based on the finding of this descriptive cross-sectional study, the following
conclusions can be drawn:
 Many clients were found to be dissatisfied with services of this hospital:
long waiting time to be examined, unavailability of some medications
and supplies and the expensive cost of some drugs. The examiners are
sometimes not understand their problem in their work area, impolite
health professionals approach.
 Dissatisfaction in previous affects the current overall services
satisfaction.
 There is weak and uncoordinated referral system between Lower and
higher health facilities.
 Older ages are more satisfied with services than younger.

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7.2. RECOMMENDATION
 Jimma University Medical Center (JUMC) should increase human
powers to make waiting time short in all aspects.
 This hospital should balance the drugs and supplies with the needs.
 Ethical problems should be corrected by health professional of Jimma
University Medical Center (JUMC).
 Jimma Zone health office should expand low level of health facilities &
strength those which already exist to improve referral system between
lower health facilities & higher ones.

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ANNEXES
ANNEX -1: REFERENCES
1. Donabadian A. The quality of care, how can it be assessed? J.Am Med
Associ1988:260 174317748.
2. Health and health related indications G.Ambaye D, Asnakech M.
Amare D. Levels of out patient satisfaction at selected health facilities
in sex regions of Ethiopia, Ethio J. Health Dev 2008, 22(1) 42-48.
4. Kincey JA, Bradshow PW, Ley P- patient satisfaction and report
Acceptance
of advice in general practice, JR coll Gen pract 1975: 25 558- 566.
5. Bekere R. Development of a questionnaire to assess patients’ satisfaction
With consultants in general practice Brit-gen pract 1990:40:487-490
6. Mitike G. Mekonen A, Osman M, satisfaction an outpatient services in
Hospitals of Amhara region Ethiopia Med: 2002 40:387-395.
7. Mathew S.and Beth E, Guide to assessing client satisfaction January
2001, health system times. Durban, South Africa.
8. Puay chang Lim, Nelosn K.H. Tang A study of patients’ expectation of
health care quality Assurance. 2000: 290-299
9. James A. William, Hospital management in the tropics and sub tropics
1990.
10. Margaret Brauley, the client perspective, what is the quality health care
service, 2000.
11 Surgit s. Wadhwa, customer satisfaction and health care delivery
system, the internet journal of Nuclear M. 2002 vol1 number 1.
12 Rock well schuls Alton C .Johnson, Management of hospital and health
service, 1990.
13. World development report, making service work for the poor people,
2004.
14. Jorge M. A: Herga P and Ahmed A: Client satisfaction and quality of
Healthcare in rural Bangladesh, Bulletin of the WO 79 (2001), 6.

33. 33
15) Peter A. Berman, A decade of health sector reform in developing
countries, 2000.
16. World health organization report Geneva, 2000.
17. WHO report, Measuring hospital performance to improve the quality
Of care in Europe A need for clarifying the concepts and defining the
Main dimensions. Report on a WHO work shop, Barcelona, Spain, 10-
11 Jan -2008.
18. Claire Batchelor David owenes, Martin Read and Michael Bloor, patient
satisfaction studies, methodologies, management and consumer
evaluation. An international journal of health care quality assurance, Vol
7, No7, 1994s 22-30.
19. Nerman D. Gloyd s. Nyafez M. Machro F. satisfaction with outpatient
health care service in Manica provinces, Mozambique Health
policy and planning 1998, 174-180.
20. E. PY- Muhandduwal, M, T, Lesha boril I M, Muwangu N. member
M.J. Ezekiel 1. Patient satisfaction at Muhimbili nation hospital in
Dareslaam, Tanzania Vol.5 no 2 August 2008.
21. Health sector strategy MOH, 2002 2003.
22. M. Dagnous D. zakus. Community perception on OPD performance
Of a teaching hospital in Gondar town, Ethiopia Ethio Med J. 1997: 35:
153-160.
23. Girmay Adane, Assessment of client’s satisfaction with outpatient
services in Tigrie zonal Hospital. A thesis submitted to the school of
Graduate student’s AA university July 2006 AA.
24. Afework S. HaileMiriam D. Demeke B. Assessment of quality of service in
private clinics in AA. Ethiop med 2003, 41: 267-278.
25. Adamu A. Chali J. Fetene B. Patient waiting and
service time outpatient department of JUSH. Ethio J. Health science
1998: 8(1) 15-23.

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26. Yonis Berhane: Satisfaction and attitude of outpatient service consumers
towards health service given at JUSH; Feb.2003; published research vol 2;
239.
ANNEX 2: QUESTIONNIRE
A data collection format for a cross sectional study on satisfaction of out
patient service consumers towards the health service given at OPD of
Gendebert hospital
Greetings:
Hello, how are you?
My name is ________________________________.I am now going to conduct a
survey. I would like to interview you few Questions about the health service
provision of this hospital. The objective of the study is to assess and estimate
the perceived level of clients’ satisfaction with health service rendered at
Gindebert District hospital, which will be important to improve the health
service delivery of the hospital. Your cooperation and willingness for the
interview is very helpful in identifying the problem related to the issue. Your
name will not be written in the form and I assure you that all information
that you give will be kept strictly confidential. Your participation is voluntary
and is not obliged to answer any question you do not wish to answer. If you
are not still comfortable with the interview, please feel free to stop it any time
you like. Do I have your permission to continue?
PART I: Socio demographic characteristics
1. Age: __ 6. Address
2. Sex A. Urban
A. male B. Rural

35. 35
B. Female 7. Educational status
3. marital status A. cannot read and write
B. only read and write
A. Married C. primary school
B. Single D. high school
C. Divorced E. college /university
4. Religion
A. Orthodox 8. Occupation:
B. Muslim A. Government employee
C. protestant B. Farmer
D. Other C. Merchant
5. Ethnicity: D. Student
A. Oromo E. Other (specify) _______
B. Amhara 9. Monthly in come in Ethiopia Birr:
C. Tigre
D. Other______
PART II: patient/clients satisfaction with the health service provided
1. Status of the individual
A. patient
B. client for FP, Immunization
C. Mother/ Others who a company the patient
2. Visit to health institution (frequency of visit)
D. New
E. Repeat
3. If repeat visit, were you satisfied in previous visit with the services given?
A. yes
B. No
4. What is the reason for answer of question 3?
_________________________________________
_________________________________________

36. 36
5. Reason for the current visit?
F. Sick
G. Check up
H. FP
I. Other(immunization, in injection)
6. Sick, duration of illness
A. In hours
B. In days
C. In weeks
D. In month
7. Health service fee (payment status):
A. Free B, paying
8. Have you visit other places before coming here?
A. Yes B. No
9 If yes, where?
A. Traditional healers
B. private clinic
C. Governmental health institution
D. other (specify) __________________
10. Who referred you?
A. self /family
B. private clinic
C. Governmental health institution
D. Other (Specify)_________________
11. Total time spent to obtain services:
A. __________Minutes
B. __________hour(s)
C._________ day(s)

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12. Are you satisfied with the time spent to obtain services? A. yes B. No
13. Where did you spent most of the total time?
A. Waiting to obtain carol
B. waiting for examination
C. waiting for consolation time
D. waiting for Laboratory service
E. waiting for x-ray service
F. waiting for pharmacy service
14 what is the reason to make you wait long?
A. Many people waiting for the service
B. person in charge not available
C.Other (specify) _________________
15. During your stay in examination room in communicating with the
examiner, how was your experience?(Courtesy &respect)
A. Very satisfactory
B. satisfactory
C. unsatisfactory
D. very satisfactory
16. What was the reason for the answer given to question (15)
____________________________________________________
_____________________________________________________
17. Do you think the examiner could understand your problem?
A. Very strongly agree D. Disagree
B. Strongly agree E strongly disagree
C. Agree
18. How are you satisfied with the completeness of the Information given to
you about your problems by the health provider?
A. Very satisfactory D. Dissatisfactory

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B. satisfactory E. very dissatisfactory
C. Neutral
PART III: Availability of the prescribed medication and treatment
1. Did you all the prescribed medication?
A. Yes B. No
2. If no. what was the reason?
A. Too expensive
B. Not available
C. Other (Specify) _____________
3. How are you satisfied with the availability of drugs and supplies?
A. very satisfied D. Dissatisfied
B. satisfied E. Very Dissatisfied
C. neutral
PART IV: overall satisfaction level
1. How are you satisfied with the overall services given at this hospital?
A. Very satisfactory
B. Satisfactory
C. Neutral
D. Dissatisfactory
E. Very dissatisfactory