|Year : 2014 | Volume
| Issue : 1 | Page : 19-22
Assessment of client satisfaction with the services rendered by female health workers (auxiliary nurse midwife) in sub centers of selected primary health centers, Dakshina Kannada District, Karnataka state, India
Kunnath Chacko Leena1, Berigai Settiappa Shakuntala2
1 Professor, Department of Community Health Nursing, Father Muller College of Nursing, Mangalore, Karnataka, India
2 PhD guide, National consortium for PhD in Nursing, Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India
|Date of Web Publication||15-Mar-2014|
Kunnath Chacko Leena
Department of Community Health Nursing, Father Muller College of Nursing, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
Context: Though, India has made impressive growth in providing primary health care, programs and providers have overwhelming emphasis on the quantitative aspect (targets), neglecting quality of services. Client satisfaction represents a key marker for the quality and needs to be studied repeatedly for smooth functioning of the health care systems. Client is the best judge for accurate assessment and overall improvement of quality health care provision through rectification of system weaknesses. Aims: The aim of the following study is to determine client satisfaction with the services rendered by female health workers. Settings and Design: Descriptive survey approach was used to determine satisfaction of 30 clients, 2 from each sub centers chosen during the immunization program about services received from female health workers. Study was conducted in 15 sub centers of Dakshina Kannada district Karnataka state, India. Materials and Methods: The clients of female health workers were identified. Baseline data of clients were collected using a questionnaire and client satisfaction scale was used to assess satisfaction with the services. Ethical clearance and informed consent were obtained and data was collected. Statistical Analysis Used: Descriptive and inferential statistical tests were employed and data were analyzed using SPSS package 13.0 SPSS Inc., 233 South Wacker Drive, 11 th . Floor, Chicago, IL. Results: The overall mean percentage scores of satisfaction 67.81% shows that the clients were only "moderately satisfied." On further analysis of satisfaction scores based on the three domains of satisfaction under consideration it is found that clients were "satisfied" (71.58%) about reproductive and child health (RCH) services, whereas they were "moderately satisfied" (62.13%) about the interpersonal relationship and services other than RCH (66.15%). Conclusions: The study concludes that quality may be improved by paying more attention to the perspectives of clients, improving competencies and skills of providers and improving the working environment by better management, supplies and motivation of staff.
Keywords: Client satisfaction, female health workers (auxiliary nurse midwife/junior public health nurse), public health nursing services in India, sub center services
|How to cite this article:|
Leena KC, Shakuntala BS. Assessment of client satisfaction with the services rendered by female health workers (auxiliary nurse midwife) in sub centers of selected primary health centers, Dakshina Kannada District, Karnataka state, India. Muller J Med Sci Res 2014;5:19-22
|How to cite this URL:|
Leena KC, Shakuntala BS. Assessment of client satisfaction with the services rendered by female health workers (auxiliary nurse midwife) in sub centers of selected primary health centers, Dakshina Kannada District, Karnataka state, India. Muller J Med Sci Res [serial online] 2014 [cited 2020 May 31];5:19-22. Available from: http://www.mjmsr.net/text.asp?2014/5/1/19/128938
| Introduction|| |
The health sector occupies an enormously important position in ensuring sustainable overall socioeconomic advancement in developing countries.  Improvement in the quality of primary health care services apart from increasing accessibility and affordability has become a matter of grave concern for developing nations.  Excellence in service is a foremost issue for those in need of health care services. However, in resource limited environment with continuously and increasing health care needs, quality is challenging. 
Quality of services provided plays a major role in acceptance of any service. Poor quality of service in terms of technical inputs, processes, interpersonal communications and limited choice leads to unsatisfied clients with resulting underutilization of services.  Shortcomings in the delivery of primary health care services have resulted in lesser utilization rates. 
Real improvement in quality cannot occur if user perception is not involved. Clients perception is significant as it impacts their health seeking behavior' including utilization of services, seeks involvement in issues directly related to them and enables the service provider to meet their expectations better.  It is used by healthcare providers, administrators and policy makers to assess the quality of services make decisions about organizations and provision of health care services. 
Client satisfaction represents a key marker for the quality of health care delivery and needs to be studied repeatedly for smooth functioning of the health care systems. Client is the best judge since he/she accurately assesses and his/her inputs help in the overall improvement of quality health care.  Satisfaction is important for several reasons-firstly, satisfied patients are more likely to maintain consistent relationships with their care provider. They become our ambassadors by spreading positive word of mouth information. Secondly, by identifying the source of dissatisfaction; the primary care administration can address system weakness, thus improving their services. Thirdly, satisfied patients are more likely to develop a deeper and longer lasting relationship with their medical provider leading to improved compliance, continuity of care and ultimately better health outcomes.  Therefore, client satisfaction in general is important both as a quality assurance measure and a marketing tool. 
Poor quality of health care result in loss of customers' lives and time, morale of the staff, trust, respect, recognition in individual and adds to communities apathy toward health services, all of which contribute to lowered effectiveness and efficiency. It is believed that quality may be improved by paying more attention to the perspectives of clients, improving competencies and skills of providers and improving the working environment by better management, supplies and motivation of staff. 
Customer satisfaction, an established outcome indicator of the quality and efficiency is fundamental to the practice of consumer sovereignty. Therefore satisfaction assessment should become an integral part of health care organizations' strategic processes. 
This study was carried out with the intention of determining the satisfaction of clients of female health workers, in all aspects of their work assuming that a woman with an infant would have had sufficient interaction and exposure to the female health workers to grade their level of satisfaction.
| Materials and Methods|| |
A descriptive survey approach was employed to study satisfaction with services rendered by female health workers among 30 women in 15 sub centers of selected primary health centers (PHC) of Dakshina Kannada district, Karnataka state, India. One PHC each were chosen randomly from 2 taluks, namely Puttur and Mangalore. From each of the 15 sub center areas two women each who had at least one under five children were chosen when they visited the PHC for immunization services. Tools for data collection consisted of a baseline proforma of clients and a five point satisfaction rating scale consisting of three domains namely inter personal relationship, reproductive child health (RCH) services and services other than RCH. Validity and reliability of the tool was ascertained. Tool was also pretested. Permission was obtained from district health officer. Ethical clearance was obtained from concerned institution, informed consent was taken from subjects and confidentiality was assured. Interview technique was used to collect baseline information and client satisfaction rating scale was utilized for determining their satisfaction.
| Results|| |
SPSS package 13.0 was used to analyze the data (SPSS Inc., 233 South Wacker Drive, 11th. Floor, Chicago, IL). The overall mean percentage scores of satisfaction 67.81% shows that the clients were only "moderately satisfied." Domain wise analysis of satisfaction scores show only in reproductive health domain the clients were "satisfied" with a mean score of 71.58%. No statistically significant association was found at P < 0.05 between satisfaction of clients of female health workers and their baseline characteristics.
[Table 1] shows the overall satisfaction of clients with services rendered by female health workers among their clients. The satisfaction scores were 128.8 and the mean percentage scores of satisfaction 67.81% Therefore overall satisfaction is considered to be moderate.
|Table 1: Analysis of overall satisfaction with the services rendered by ANMs among their clients (N = 30)|
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[Table 2] shows the clients were "satisfied" (71.58%) about RCH services whereas they were "moderately satisfied" (62.13%) about interpersonal relationship and services other than RCH (66.15%).
|Table 2: Analysis of satisfaction (domain wise) with services of female health workers among their clients (N = 30)|
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Most clients 22 (73%) were of age below 27 years, 16 (43%) were educated less than 10 th standard, 12 (40%) were unemployed, 21 (70%) were Hindus of which 6 (20%) were scheduled caste and 1 (3.3%) were scheduled tribe and 20 (67%) were from families above the poverty line. Mean distance from home to sub center was 1.88 km and home to PHC was 5.84 km. Just above half 17 (57%) considered that female health workers will be of help in emergency health need. Less than half 14 (47%) had a contact number of the female health workers (auxiliary nurse midwife [ANMs]) though the ANMs compulsorily have the departmental SIM in their mobile phones for official purposes including communication with their clients. 27 (90%) had mobile phones and 26 (86.67%) had television at home.
No significant association was found between satisfaction of clients of female health workers and their baseline characteristics.
| Discussion|| |
The overall mean percentage scores of satisfaction 67.81% shows that the clients were only "moderately satisfied" with services provided by female health workers. On further analysis of domains of work it is found only in the area of reproductive health the clients were satisfied with mean score of 71.58%.
This finding supports the information available from existing studies conducted in India on client satisfaction. A cross-sectional study among 409 women with children less than 12 months was conducted in Varanasi district to study utilization and satisfaction with services. Overall 16% were not satisfied, 25% of the ST category were not satisfied, despite of being the major users. Around 14% were not satisfied with the behavior of health workers.  Another cross sectional survey conducted on 195 respondents to identify their level of satisfaction and expectation from PHCs in Varanasi found communication as the most problematic area. They also expected better attention by the staff. 
A study on client satisfaction with services provided by sub centers of 2 PHCs in AP, found 65% respondents reporting ANMs undertaking motivational activities for family planning.  Another cross sectional study to evaluate client satisfaction with primary health care in Davanagere district, Karnataka found 90% of antenatal women satisfied with availability of service, 85% with efficiency to treat, 90% with professional competence and skill and 93% with interpersonal quality respectively. 
No statistically significant association was found between satisfaction of clients of female health workers and their baseline characteristics at P < 0.05.
The study finding throws light upon the wholeness of services provided by the female health worker in the sub center setting. Work at the sub center is more integrated especially when in many sub centers the post of male health worker is vacant. Though the predominant responsibility of female health workers is RCH services, on a regular basis she provides services other than RCH, including responsibilities of male health worker. Satisfaction is a derivative of inclusive services provided to the whole family. This study aims at measuring the satisfaction in totality with services provided by sub centers by the female health workers, which could be used as a measure to improve client satisfaction.
The study recommends conducting further studies with larger sample with better representation from a cross-section of beneficiaries of various services. Efforts could also be made to study reasons for poor satisfaction.
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[Table 1], [Table 2]